Population-Based Analysis of Trends in Incidence and Survival of Human Papilloma Virus-Related Oropharyngeal Cancer in a Low-Burden Region of Southern Europe

Abstract

Introduction: Human papilloma virus (HPV)-related oropharyngeal carcinoma (OPC) can be considered a new subtype of cancer with different clinical characteristics and prognosis than that related to tobacco. Its incidence is increasing worldwide. Its epidemiology has been widely studied in areas such as North America and Northern Europe, but less is known in Southern Europe. Methods: We analyzed the epidemiology of OPC using the database from Girona’s population-based Cancer Registry, in the North-East of Spain, from 1994 to 2018. To analyze differences between neoplasms related to human papillomavirus or not, we determined the immunohistochemical expression of p16 in cases within four time periods: 1997–1999, 2003–2005, 2009–2011, and 2016–2018. Results: Oropharyngeal cancer incidence increased significantly from 2001 to 2018 with an Annual Percentage of Change (APC) of 4.1. OPC p16-positive cases increased with an APC of 11.1. In the most recent period, 2016–2018, 38.5% of OPC cases were p16-positive. European age-standardized incidence rate was 4.18 cases/100.000 inhabitants-year for OPC cancer and 1.58 for those p16-positive. Five-year observed survival was 66.3% for p16-positive OPC and 37.7% for p16-negative. Conclusions: Although with lower burden than in other regions, p16-positive oropharyngeal cancer is increasing in our area and has a better prognosis than p16-negative OPC.

Rising Trend in the Prevalence of HPV-Driven Oropharyngeal Squamous Cell Carcinoma during 2000–2022 in Northeastern Italy: Implication for Using p16INK4a as a Surrogate Marker for HPV-Driven Carcinogenesis

“…Nonetheless, the overall increase in the incidence of oropharyngeal tumors observed in the last decades in our country [27,28] suggests that there is a real increase in the incidence of HPV-driven lesions. These results are consistent with recent trends observed in other European geographical areas including the Netherlands, France, Denmark, Sweden, and Southern Europe [2,[29][30][31][32][33][34][35], with the growing prevalence of oral HPV infection due to changes in sexual habits likely being responsible for the observed epidemiological trends in oropharyngeal cancer [36].…”

“…However, the punctual prevalence can vary considerably according to the population and geographic area [32][33][34][35][37][38][39]. A different exposure to risk factors of oral HPV infection [40], as well as a different genetic susceptibility to persistent oral HPV infection [41], might partly explain these different figures.…”