Prevalence of Human Papillomavirus in Oropharyngeal Cancer

Abstract

Purpose The global incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been increasing, and it has been proposed that a rising rate of human papillomavirus (HPV) associated cancers is driving the observed changes in OPSCC incidence. We carried out this systematic review to further examine the prevalence of HPV in OPSCC over time worldwide. Methods A systematic literature search was performed to identify all articles through January 31, 2014 that reported on the prevalence of HPV in OPSCC. Articles that met inclusion criteria were divided into four time frames (pre-1995, 1995—1999, 2000—2004, and 2005—present) based on the median year of the study's sample collection period. Employing a weighted analysis of variance (ANOVA) model, we examined the trends of HPV-positivity over time worldwide, in North America, and in Europe. Results Our literature search identified 699 unique articles. 175 underwent review of the entire study and 105 met inclusion criteria. These 105 articles reported on the HPV prevalence in 9541 OPSCC specimens across 23 nations. We demonstrated significant increases in the percentage change of HPV-positive OPSCCs from pre-1995 to present: 20.6% worldwide (p-value for trend: p<0.001), 21.6% in North America (p=0.013) and 21.5% in Europe (p=0.033). Discussion Interestingly, while in Europe there was a steady increase in HPV prevalence across all time frames, reaching nearly 50% most recently, in North America HPV prevalence appears to have plateaued over the past decade at about 65%. These findings may have important implications regarding predictions for the future incidence of OPSCC.

HPV-Related Oropharynx Cancer in the United Kingdom: An Evolution in the Understanding of Disease Etiology

“…This contrasts with previous data, detailing an increased proportion of HPVpositive OPSCC associated with increasing incidence of OPSCC overall. [8] Recent data from North America [10] and Stockholm, [23] however, suggest that plateaus in the proportion of HPV-positive OPSCC and HPV-positive tonsillar squamous cell carcinoma respectively, have been observed from the year 2000 onwards.…”

“…Substantial variation has been reported in the proportion of OPSCC attributable to HPV between countries and time periods. [10,11] This is likely to be a reflection of variations in multiple factors, including sexual behaviour and rates of genital HPV infection, as well as tobacco and alcohol consumption. This highlights that trends in the aetiology of OPSCC must be considered in a population-specific manner.…”

“…[1,4,6] Several North American and European studies have confirmed sharp rises in HPV-induced OPSCC incidence, although the exact proportion of HPV-positive tumours within the total disease burden varies considerably by geographical region. [7][8][9][10][11] In the UK, the proportion of OPSCC attributable to HPV has been assessed in several single-centre studies, however each was small, applied diverse methodology and had restricted geographical coverage. [12][13][14] The current pan-UK study aimed to assess the proportion of OPSCC attributable to HPV infection in a large contemporary sample (2002-2011 inclusive) using robust, standardised methods.…”

Human papillomavirus in oropharyngeal cancer in Canada: analysis of 5 comprehensive cancer centres using multiple imputation

“…5 However, a study in London, Ontario, was restricted to patients with tonsillar cancer for whom a pathology specimen was available; 17 one study in Toronto included only 22 patients with oropharyngeal cancer; 18 other Toronto-based studies either took place before routine HPV testing 12 or focused on recurrent or metastatic disease; 19 and one study in Montréal analyzed patients with locally advanced cancer who were treated with primary chemoradiation and had a minimum 3-year follow-up. 20 A previous study of 1374 Ontario-based patients with oropharyngeal cancer suggested that 66% of cases were HPV-positive by 2010.…”

HPV status is associated with altered PIWI-interacting RNA expression pattern in head and neck cancer

“…However, there have been contradictory reports showing either no or poor associations with outcome. Nevertheless, the growing proportion of HPV-positive cases poses an urgent need for prognostic biomarkers that guide patient management according to HPV status 3,6,8,9 .…”