Impact of human papillomavirus status on survival and recurrence in a geographic region with a low prevalence of HPV‐related cancer: A retrospective cohort study

Abstract

Background: Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is associated with better tumor-response rates and survival outcomes. However, in some geographic regions, the impact of HPV infection on prognosis remains unclear. The aim of this study was to describe the patterns of recurrence and survival among patients treated for OPSCC in a geographic region with a reported low prevalence of HPV-related OPSCC. Methods: We retrospectively evaluated 215 patients diagnosed with American Joint Committee on Cancer (AJCC) stages I to IV OPSCC who were treated with upfront surgery or radiation therapy with or without chemotherapy in a tertiary Cancer Center in Brazil. The collected data included demographic information, HPV status, tobacco and alcohol consumption, and pathologic and treatment variables. The patterns of recurrence were recorded according to HPV status. Disease-specific survival and recurrencefree survival were calculated. Results: One hundred twenty-seven (59.1%) patients were diagnosed with HPVpositive OPSCC. According to the AJCC eighth edition, 34 (15.8%), 71 (33%), 47 (21.9%), and 60 (27.9%) patients had stage I, II, III, and IV disease, respectively. Surgery was performed in 109 (50.7%) cases, and upfront chemoradiation regimens were provided in 104 (48.4%, P = .69) patients. Overall, the 5-year cancer-specific survival was 73.5% and 68.1% for patients positive and negative to HPV, respectively. Tobacco status was considered the only independent prognostic factor for survival. Furthermore, HPV status was not associated with differences in recurrence rates (P = .68). While all distant relapses were found to be lung metastases in the HPV-negative group, we observed unusual sites of distant metastases in the HPV-positive group. Conclusions: HPV status was not associated with higher rates of survival among the investigated population. Moreover, smoking status was considered the only independent prognostic factor for survival. Furthermore, patients with HPVpositive tumors were more likely than patients with HPV-negative OPSCC to have unusual distant metastases.

Correlation of p16 immunohistochemistry with clinical and epidemiological features in oropharyngeal squamous-cell carcinoma

“…There was a higher prevalence of patients who never drank in the p16 + group than in the p16 − group (16% vs. 2.7%, P = 0.015). De Cicco et al [ 28 ] and López et al [ 26 ] found similar results. In comparison, Bahl et al [ 29 ] did not find evidence of a correlation between alcohol consumption and HPV positivity (P = 0.18).…”

“…However, specifically in the p16 + group, there was a proportionally larger number of patients with early clinical stages (I and II) compared to the p16 − group (52.6% vs. 13.1%, P < 0.001). De Cicco et al [ 28 ] and Du et al [ 31 ] reported similar results.…”

“…The study by Bahl et al [ 29 ] also identified a higher proportion of patients who had never smoked in the HPV + group (17% vs. 11%), but this was not statistically significant (p = 0.86). Other studies have also found a difference in the prevalence of p16 immunohistochemistry positivity with smoking status [ 24 , 28 ]. In clinical practice, we observed that this difference is explained by the etiology of HPV − cases, most of which are related to drinking and smoking.…”

“…López et al [ 26 ] reported an incidence of 6.6% in Brazil and Anantharaman et al [ 6 ] compared cases from the USA, Europe, and Brazil and found an incidence of only 4.1% of positivity in the population studied in Brazil. Petito et al [ 16 ] studied 82 cases in Brazil and found an incidence of 25.6%, Betiol et al [ 27 ] found 17.7% and de Cicco et al [ 28 ] reported 59.1%. A more recent study in a developing country was that of Bahl et al [ 29 ] who found a 22.8% incidence of HPV in oropharyngeal tumours in India.…”

The emerging risk of oropharyngeal and oral cavity cancer in HPV-related subsites in young people in Brazil

“…In Brazil, studies found a low prevalence of HPV in oropharynx tumors ranging from 4.4% to 8.8% [18][19][20]. Conversely, patients from a private hospital had an HPV positivity rate of 59.1% [21], which demonstrates the HPV heterogeneity in the country. Due to these discrepancies in the prevalence of HPV, it is crucial to monitor these subsites to clarify whether this dramatic shift in incidence trends observed worldwide also affects this population.…”