Do Human Papilloma Viruses Play Any Role in Oral Squamous Cell Carcinoma in North Indians?

Abstract

Background: Oral squamous cell carcinoma (OSCC) is the most prevalent malignancy among males in India. While tobacco and alcohol are main aetiological factors, human papilloma virus (HPV) presence has surprisingly increased in head and neck Squamous Cell Carcinoma (HNSCC) in the past two decade but its frequency in OSCCS is still uncertain. We aim to explore the frequency of HPV and its major genotypes in North Indian patients and their association with clinicopathological and histopathological features and p16 expression pattern. Materials and Methods: The study group comprised 250 histologically proven cases of OSCC. HPV was detected by real time PCR in tumor biopsy specimens and confirmed by conventional PCR with PGMY09/ PGMY11 primers. Genotyping for high-risk types 16/ 18 was conducted by type specific PCR. p16 expression was assessed by immunohistochemsitry. Results: HPV presence was confirmed in 23/250 (9.2%) OSCC cases, of which 30.4% had HPV 16 infection, 17.4%were positive for HPV 18 and 26.1% had co-infections. HPV presence was significantly associated with male gender (p=0.02) and habit of pan masala chewing (p=0.01). HPV positive cases also had a history of tobacco consumption in 91.3% cases. p16 over expression was observed in 39.1% of HPV positive cases but this was not significantly different from negative cases (p=0.54). Conclusions: The frequency of HPV in OSCC is low in North-India and majority of cases are associated with a tobacco habit. It appears that tobacco shows a confounding effect in HPV positive cases and use of p16 protein as a reliable marker to assess the potential etiological role of HPV in OSCC in our population is not suggested.

p16 and p53 in HPV‐positive versus HPV‐negative oral squamous cell carcinoma: do pathways differ?

“…In our previous study, we have explored the frequency of HPV and its major genotypes in North Indian population with OSCC and their association with clinicopathological and histopathological features and p16 expression pattern. We found contradictory association between HPV and p16 . Since the mucosal surface of oral cavity is exposed to both HPV and chemical carcinogens (tobacco and alcohol) simultaneously, the carcinogenesis of oral cancer might be different and need to be explored.…”

“…Further, identification of high‐risk HPV16 and 18 was done by type‐specific conventional PCR . Methodology in detail was described in our previous study . The diagnostic criteria implemented, defined those cases as HPV positive which were positive by any of two methods.…”

Prevalence of human papillomavirus16 DNA and p16INK4a protein in oral squamous cell carcinoma: A systematic review and meta-analysis

“…Singh et al . [8] reported the prevalence of HPV infection in patients with OSCC involved in the consumption of tobacco and betel leaves. They also revealed that the concordance of HPV-induced OSCC is significantly more in men than in women ( P = 0.02).…”

Human papillomavirus associated head and neck squamous cell carcinoma: Controversies and new concepts

“…Use of p16 protein as a surrogate marker to assess the potential etiological role of HPV in OSCC in our population is not reliable. 58 In our attempt to elicit the differences in the expression pattern of p16 and p53 in HPV-positive and HPV-negative OSCC, if any we observed that risk factors including oral tobacco consumption and alcohol were present in all these ten p16-positive cases. Presence of mutant-type p53 and exposure to tobacco-related risk factors in both HPV-positive and negative cases suggest existence of p53-related carcinogenesis in HPVpositive cases in Indian population.…”