Human Papillomavirus-associated oropharyngeal cancer: an observational study of diagnosis, prevalence and prognosis in a UK population

Abstract

BackgroundThe incidence of Human Papillomavirus (HPV) associated oropharyngeal cancer (OPC) is increasing. HPV-associated OPC appear to have better prognosis than HPV-negative OPC. The aim of this study was to robustly determine the prevalence of HPV-positive OPC in an unselected UK population and correlate HPV positivity with clinical outcome.MethodsHPV testing by GP5+/6+ PCR, In Situ Hybridisation (ISH) and p16 immunohistochemistry (IHC) was performed on 138 OPCs diagnosed in South Wales (UK) between 2001–06. Kaplan-Meier analysis was used to correlate HPV status with clinical outcome.ResultsUsing a composite definition of HPV positivity (HPV DNA and p16 overexpression), HPV was detected in 46/83 (55%) samples where DNA quality was assured. Five year overall survival was 75.4% (95% CI: 65.2 to 85.5) in HPV-positives vs 25.3% (95% CI: 14.2 to 36.4) in HPV negatives, corresponding to a 78% reduction in death rate (HR 0.22, p < 0.001). HPV-positives had less locoregional recurrence but second HPV-positive Head and Neck primaries occurred. Poor quality DNA in fixed pathological specimens reduced both HPV prevalence estimates and the prognostic utility of DNA-based HPV testing methods. As a single marker, p16 was least affected by sample quality and correlated well with prognosis, although was not sufficient on its own for accurate HPV prevalence reporting.ConclusionsThis study highlights the significant burden of OPC associated with HPV infection. HPV positive cases are clinically distinct from other OPC, and are associated with significantly better clinical outcomes. A composite definition of HPV positivity should be used for accurate prevalence reporting and up-front DNA quality assessment is recommended for any DNA-based HPV detection strategy.

HPV-Related Oropharynx Cancer in the United Kingdom: An Evolution in the Understanding of Disease Etiology

“…Previous small, single centre studies from the UK reported HPV prevalence rates in OPSCC of 37.5% (95% CI:28, 48%), 42.7% (95% CI:36, 50%), and 55% (95% CI:45, 66%). [12][13][14] The current study is consistent with these, but is based on a much larger sample with broader geographical representation, including centres in all four countries of the UK. We observed a consistent proportion of HPV-positive OPSCC over time from 2002 to 2011, against a background of increasing incidence.…”

“…[7][8][9][10][11] In the UK, the proportion of OPSCC attributable to HPV has been assessed in several single-centre studies, however each was small, applied diverse methodology and had restricted geographical coverage. [12][13][14] The current pan-UK study aimed to assess the proportion of OPSCC attributable to HPV infection in a large contemporary sample (2002-2011 inclusive) using robust, standardised methods. There is a pressing need for these data to facilitate health economic analyses and to inform evidence-based policy-making with regard to prophylactic male HPV vaccination, as has recently been implemented in Australia.…”

Genotipificación, niveles de expresión y estado físico del virus del papiloma humano en pacientes colombianos con cáncer de células escamosas en la cavidad oral

“…Con respecto a la edad, aunque no se encontraron diferencias estadísticamente significativas y la mayoría de los pacientes era mayor de 50 años, se encontró una tendencia a registrar una mayor prevalencia de la infección con HPV en las personas entre los 31 y los 40 años de edad, lo cual también corrobora otros estudios en los que, generalmente, los casos positivos para HPV se presentan más entre las personas más jóvenes (6,10,28).…”

“…La incidencia del cáncer de células escamosas en la cavidad oral inducido por HPV aumenta cada año, con tasas de prevalencia que fluctúan entre 36 y 80 %, dependiendo de la ubicación geográfica y la región anatómica (9)(10)(11)(12). En Colombia solo se ha publicado el estudio sobre cáncer de cabeza y cuello asociado a HPV llevado a cabo por Quintero, et al, en el cual se registró una prevalencia de HPV de 18,9 % (13).…”

Bone Marrow Failure in HPV-Associated Oropharyngeal Squamous Cell Carcinoma

“…In Europe, there were approximately 250,000 cases and 63,500 deaths in 2012 [4]. A 2013 study designed to determine the prevalence of HPV-positive oropharyngeal cancer in an unselected UK population detected HPV in 55% of patients [5].…”