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




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BMC Cancer

, 13:220

Translational oncology

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.

KeywordsOropharyngeal Oropharynx Cancer HPV Papillomavirus Prognosis Tonsil AbbreviationsHPVHuman Papillomavirus

OPCOropharyngeal Cancer

ISHIn Situ Hybridisation

IHCImmunohisto chemistry

CRTChemoradiotherapy

RTRadiotherapy

FFPEFormalin Fixed Paraffin Embedded

EIAEnzyme Immunoassay

HRHazard Ratio

OSOverall Survival

PFSProgression Free Survival.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-13-220 contains supplementary material, which is available to authorized users.

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Author: Mererid Evans - Robert Newcombe - Alison Fiander - James Powell - Martin Rolles - Selvam Thavaraj - Max Robinson - Ned Pow

Source: https://link.springer.com/



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