Rising incidence of HPV positive oropharyngeal cancer in Taiwan between 1999 and 2014 where betel nut chewing is common

Abstract

Background The incidence of human papillomavirus (HPV) positive oropharyngeal cancer (OPC) is rising but HPV negative OPC is decreasing in Western countries. In Taiwan, the incidence of HPV negative OPC is common but the incidence of HPV positive OPC remains unknown. The objective of this study is to estimate the incidence trend and the survival of HPV positive OPC in Taiwan. Methods Between 1999 and 2014, primary tumor tissues from 425 incident OPCs were obtained from 5 medical centers in Taiwan. 408 OPCs were evaluated by the EasyChip HPV genotyping (King-Car, I-Lan, Taiwan) and 369 OPCs by p16 staining. The clinical data were retrospectively obtained from the medical records. Results In our study, 29% of OPCs were HPV positive. The percentage of HPV positive OPC was stable from 1999 to 2014 (25% (1999–2002), 30% (2003–2006), 30% (2007–2010), 29% (2011–2014)). The estimated crude incidence rate of HPV positive OPC increased significantly from 0.62 (1999–2002), 1.06 (2003–2006), 1.52 (2007–2010) to 1.74 (2011–2014) per 100,000 person-year. The sensitivity and specificity of p16 staining for positive HPV infection were 92% and 91%, respectively. The 5-year overall survival rates for patients with HPV positive OPC and with HPV negative OPC were 67.8% and 49.0%, respectively (HR = 0.52 (0.35–0.76), p = 0.0005). Patients with HPV positive OPC but no betel nut/cigarette exposure had the best overall survival (5-year: 88.2%, p < 0.0001). Patients with HPV negative OPC and betel nut/cigarette exposure had the worst overall survival (5-year: 46.6%, p < 0.0001). Patients with HPV positive OPC but also with betel nut/cigarette exposure had poorer 5-year overall survival (48.3%, p < 0.01). Conclusion The incidence of HPV positive OPC is increasing along with HPV negative OPC, which leads to stably low percentage of HPV positive OPC in Taiwan. HPV positive OPC may become an important head and neck cancer when the incidence of HPV negative OPC declines in the near future. P16 is a useful surrogate marker for HPV infection in OPC and a good prognostic indicator for treatment outcome of OPC. Patients with HPV positive OPC but no betel nut/cigarette exposure has an excellent prognosis. Betel nut/cigarette exposure significantly worsens the prognosis of HPV positive OPC.

Treatment outcomes of primary surgery versus chemoradiotherapy for T4 oropharyngeal cancers

“…Although the HPV status was not available in the current study, we believe that most of our patients were HPV-negative given the relatively low rate of HPV infection in patients with OPSCC in Taiwan. [19–21] Thus, our results are consistent with those presented in the aforementioned study.…”

Incidence trends of oral cavity, oropharyngeal, hypopharyngeal and laryngeal cancers among males in Taiwan, 1980–2019: a population-based cancer registry study

“…Focused on male patients, HPV positive OPC has steadily increased from 1.11 to 3.18 per 100,000 person-year for 1999–2002 to 2011–2014. In the same study, HPV subtype varied among 119 HPV positive oropharyngeal cancer with distributions for HPV16, HPV58, HPV35, and HPV33 measuring 70, 12, 3, and 2%, respectively [ 26 ].…”

Mendelian randomization eradicates the causal relationship between educational attainment, household income, and oropharyngeal cancer

“…This study also highlighted that the risk of oropharyngeal cancer is increasing in females, those aged 15 to 49 years, and people from low/middle-income countries. It should be noted that East Asians are likely to be exposed to betel nuts and tobacco, which would deteriorate the prognosis of HPV-positive oropharyngeal cancer (51). Using additional databases could have resulted in the identification of additional publications and a more precise identification of trends (4).…”