Geographic heterogeneity in the prevalence of human papillomavirus in head and neck cancer

Abstract

Human papillomavirus (HPV) causes oropharyngeal squamous cell carcinoma (OPSCC), although strongly divergent results have been reported regarding the prevalence of HPV16 in different countries, whether this represents important differences in etiology remains unclear. Applying rigorous protocols for sample processing, we centrally evaluated 1,420 head and neck tumors (533 oropharynx, 395 oral cavity and 482 larynx) from studies conducted in the US, Europe and Brazil for mucosal HPV DNA and p16 expression to evaluate regional heterogeneity in the proportion of HPV16-associated OPSCC and other head and neck cancer, and to assess covariates associated with the risk of HPV16-positive OPSCC. While majority of OPSCC in the US (60%) were HPV16-positive, this proportion was 31% in Europe and only 4% in Brazil (p < 0.01). Similar differences were observed for other head and neck tumors, ranging from 7% in the US and 5% in Europe, to 0% in South America. The odds of HPV16-positive OPSCC declined with increasing pack years of smoking (OR: 0.75; 95% CI: 0.64-0.87) and drink years of alcohol use (OR: 0.64; 95% CI: 0.54-0.76). These results suggest that while the contribution of HPV16 is substantial for the oropharynx, it remains limited for oral cavity and laryngeal cancers.

Effect of HPV on head and neck cancer patient survival, by region and tumor site: A comparison of 1362 cases across three continents

“…This analysis is based on cases derived from case-control studies of HNSCCs in three distinct regions[15]. Studies included: the Brazilian Head and Neck Genome Project (GENCAPO; Southern Brazil – São Paulo)[16], the Carolina Head and Neck Cancer Study (CHANCE, North Carolina, U.S.A.)[17] and the Alcohol Related Cancers and Genetic Susceptibility in Europe study (ARCAGE).…”

Cancer stage and pack-years, but not p16 or HPV, are relevant for survival in hypopharyngeal and laryngeal squamous cell carcinomas

“…Nevertheless, the prevalence of HPV seems to differ due to geographically different exposure. This phenomenon was analysed by Anantharam et al The authors could show a higher prevalence rate of HPV in the US and a missing prevalence in South America in non-oropharyngeal SCC [13]. …”

High-Risk Human Papillomavirus in Oral Cancer: Clinical Implications

“…The different HPV types are characterized by variations in the DNA sequences of L1 and divided into high-and low-risk types [15]. High-risk types include HPV- 16,18,31,32,33,35,39,45,51,52,56,58,59,66, and 68, and low-risk types are HPV-6, 11, 42, 43, and 44. The high-risk HPV (HR-HPV) types 16 and 18 are the most common etiological agents in 70% of cervical cancers globally.…”

“…The prevalence of HR-HPV in cancers of the oral cavity shows high variability [39]. We have included 50 oral cancer studies reported during 2007-2017, comprising a total of 6,349 samples and individual studies comprising a minimum of 30 oral cancer samples.…”