Active HPV infection and its influence on survival in head and neck squamous-cell cancer

• Published in: Journal of cancer research and clinical oncology 2020-07, Vol.146 (7), p.1677-1692
• Main Authors: Janecka-Widła, Anna, Mucha-Małecka, Anna, Majchrzyk, Kaja, Halaszka, Krzysztof, Przewoźnik, Marcin, Słonina, Dorota, Biesaga, Beata
• Format: Article
• Language: English
• Subjects: Aged; Alphapapillomavirus - classification; Alphapapillomavirus - physiology; Cancer; Cancer Research; Carcinogenesis; Cell Transformation, Viral; Cyclin-Dependent Kinase Inhibitor p16 - metabolism; Female; Fluorescent Antibody Technique; Genotype; Head & neck cancer; Head and neck carcinoma; Hematology; Human papillomavirus; Humans; Infections; Internal Medicine; Laryngeal cancer; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neoplasm Staging; Oncology; Oral cavity; Original Article – Cancer Research; Original – Cancer Research; Oropharyngeal cancer; Oropharynx; Papillomavirus Infections - complications; Papillomavirus Infections - diagnosis; Papillomavirus Infections - virology; Polymerase Chain Reaction; Prevalence; Proportional Hazards Models; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck - etiology; Squamous Cell Carcinoma of Head and Neck - mortality; Squamous Cell Carcinoma of Head and Neck - pathology; Transcription; Virus Activation
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-020-03218-6

Purpose HPV is involved in the development of some head and neck squamous-cell carcinomas (HNSCC). It was suggested that only transcriptionally active virus can induce carcinogenesis, therefore, the aim of our study was to analyze the frequency of active HPV infection, virus type, and its prognostic role in HNSCC patients. Methods Status of active HPV infection was assessed for 155 HNSCC patients based on p16 expression and HPV DNA presence. Univariate and multivariate analyses with Cox proportional regression model were performed to select independent prognostic factors. Results Active HPV infection was detected in 20.65% of patients. We identified 16.0, 40.9 and 1.7% of HPV positive oral cavity, oropharyngeal, and laryngeal cancer cases, respectively. HPV16 was dominant (81.25%) followed by HPV35 (9.38%) and double infections with HPV16 and 35 (6.25%) or HPV35 and 18 (3.12%). Patients with active HPV infection demonstrated significantly higher survival than HPV negative ones (OS 80.89% vs. 37.08%, p  = 0.000; DFS 93.0% vs. 53.35%, p  = 0.000, respectively). Longer OS and DFS were maintained for infected patients when oropharyngeal and non-oropharyngeal cases were analyzed separately. Interestingly, all patients infected with other than HPV16 types survived 5 years without cancer progression. In the analyzed group of 155 patients the strongest independent favourable prognostic factor for both OS and DFS was HPV presence. Conclusions High prevalence of HPV-driven HNSCC (mostly within oropharynx) was detected, with HPV16 type the most frequent, followed by HPV35 and HPV18. The presence of active HPV infection improved survival of both oropharyngeal and non-oropharyngeal cancer patients and should be taken into account in treatment planning.