Human Papillomavirus-16 Infection in Advanced Oral Cavity Cancer Patients Is Related to an Increased Risk of Distant Metastases and Poor Survival

Abstract

BackgroundHuman papillomavirus (HPV) is an oncogenic virus causing oropharyngeal cancers and resulting in a favorable outcome after the treatment. The role of HPV in oral cavity squamous cell carcinoma (OSCC) remains ambiguous.ObjectiveThis study aimed to examine the effect of HPV infection on disease control among patients with OSCC following radical surgery with radiation-based adjuvant therapy.Patients and MethodWe prospectively followed 173 patients with advanced OSCC (96% were stage III/IV) who had undergone radical surgery and adjuvant therapy between 2004 and 2006. They were followed between surgery and death or up to 60 months. Surgical specimens were examined using a PCR-based HPV blot test. The primary endpoints were the risk of relapse and the time to relapse; the secondary endpoints were disease-free survival, disease-specific survival, and overall survival.ResultsThe prevalence of HPV-positive OSCC was 22%; HPV-16 (9%) and HPV-18 (7%) were the genotypes most commonly encountered. Solitary HPV-16 infection was a poor predictor of 5-year distant metastases (hazard ratio, 3.4; 95% confidence interval, 1.4–8.0; P = 0.005), disease-free survival (P = 0.037), disease-specific survival (P = 0.006), and overall survival (P = 0.010), whereas HPV-18 infection had no impact on 5-year outcomes. The rate of 5-year distant metastases was significantly higher in the HPV-16 or level IV/V metastasis group compared with both the extracapsular spread or tumor depth ≥11-mm group and patients without risk factors (P<0.001).ConclusionsHPV infections in advanced OSCC patients are not uncommon and clinically relevant. Compared with HPV-16-negative advanced OSCC patients, those with a single HPV-16 infection are at higher risk of distant metastases and poor survival despite undergoing radiation-based adjuvant therapy and require a more aggressive adjuvant treatment and a more thorough follow-up.

Human Papilloma Virus in Oral Cavity Cancer and Relation to Change in Quality of Life Following Treatment—a Pilot Study from Northern India

“…In contrast to the clear picture in OPC [7,51,62], where the prognostic relevance of biologically active HPV infection is established, no such clear association has been found in OCSCC. Published literature is divided between the improved likelihood for HPV-positive OCSCC on one hand [63,64] and worst outcome on the other [65][66][67] with no clout on patient survival [10,37,68].…”

Prevalence of Human Papillomavirus Infection in Oral Squamous Cell Carcinoma: a Case-control Study in Wuhan, China

“…Since HPV-16 DNA was first detected in head and neck squamous cell carcinoma (HNSCC) in 1985 (Loning et al, 1985), HPV sequences have been repeatedly detected in a variable proportion of OSCC, from as few as 3.9% to 43.5% (Herrero et al, 2003;Lee et al, 2012;Mondal et al, 2013). It was reported that the incidence of OSCC that potentially HPV-related increased in the USA from 1973-2004 partly due to the changes in sexual behavior, especially in young adults (Chaturvedi et al, 2008;Jemal et al, 2011Jemal et al, ).…”

Effect of p16 positivity in oral cavity and oropharyngeal squamous cell carcinoma

“…[12] In the present study, all patients with local recurrence were in p16-negative group. HPV-positive OC/OP cancers seem to be more sensitive to chemo-radiotherapy than HPV-negative tumors.…”