Presence of HPV DNA in convalescent salivary rinses is an adverse prognostic marker in head and neck squamous cell carcinoma

Abstract

Human papillomavirus (HPV) 16 is present in up to 60% of patients with head and neck squamous cell carcinoma (HNSCC) and confers a favorable prognosis in terms of recurrence and mortality. Previous reports demonstrated that HPV-16 DNA can be detected in the initial salivary rinses from these patients. In this study, we assessed the feasibility of post-treatment HPV DNA shed from the oral mucosa as a prognostic marker for persistent/recurrent head and neck cancer. Fresh tumor samples and pre-and post-treatment salivary rinses were collected from 59 patients with HNSCC. HPV-16 E6 and E7 DNA copy number in these samples were quantified by real time PCR. Twenty of 59 patients (33.9%) were HPV-16 positive in their tumors before treatment. Four of 20 HPV tumor positive patients ultimately developed recurrence, and 2 of these 4 patients were HPV-16 positive in surveillance salivary rinses (sensitivity = 50%). Of the 39 (66.1%) HPV-16 negative patients on initial clinical presentation and the 16 HPV-16 positive patients who did not recur, none were HPV-16 positive in salivary rinses after treatment (specificity = 100%). HPV-16 presence in follow-up salivary rinses preceded clinical detection of disease recurrence by an average of 3.5 months. Patients with presence of HPV-16 DNA in surveillance salivary rinses are at significant risk for recurrence. Quantitative measurement of salivary HPV-16 DNA has promise for surveillance and early detection of recurrence.

Prognostic Implication of Persistent Human Papillomavirus Type 16 DNA Detection in Oral Rinses for Human Papillomavirus–Related Oropharyngeal Carcinoma

“…Chuang et al 15 The consistent finding that HPV16 DNA detection in posttreatment oral rinses is predictive of recurrence in our and several previous studies supports its potential utility as a clinical test. Our study has several strengths.…”

“…[10][11][12][13][14] Initial single-center studies suggest that HPV16 DNA detection in posttreatment oral rinses may also be associated with disease recurrence. 11,15 Therefore, in this study we evaluated the prognostic and diagnostic implications of HPV16 DNA detection in serially collected posttreatment oral rinses within a prospective multicenter cohort of patients with HPV-OPC.…”

Human Papillomavirus and Head and Neck Squamous Cell Carcinoma: Recent Evidence and Clinical Implications

“…A recent study nested within a longitudinal cohort study of 59 persons with histologically confirmed HNSCC evaluated salivary rinsing as a possible screening test for recurrence of HPV-positive tumors after treatment. In this cohort, detection of HPV E6 and E7 copy number by RT-PCR from salivary rinses had a specificity of 50% and sensitivity of 100% for detection of oropharyngeal cancer recurrence (Chuang et al, 2008). This study, however, encompassed a small number of persons, and a larger study is warranted to determine the value of salivary rinsing as a screening test for tumor recurrence.…”

The role of high-risk human papillomavirus infection in oral and oropharyngeal squamous cell carcinoma in non-smoking and non-drinking patients: a clinicopathological and molecular study of 46 cases

“…Despite intensive research, larger studies analyzing selective cohorts of non-smoking and non-drinking patients with HNSCCs in detail are lacking. The results of previous studies with these patients included are summarized in Table 3 [19][20][21][22][23][24][25][26][27][28][29][30][31][32]. The number of examined cases is, however, low, not exceeding 20 patients in most studies.…”