Prognostic Value of HPV Infection Assessed by p16 Immunohistochemistry and the Influence of Tobacco Usage in Oropharyngeal Cancers: Real World Scenario

• Published in: Indian journal of otolaryngology, and head, and neck surgery and head, and neck surgery, 2022-12, Vol.74 (Suppl 3), p.5823-5831
• Main Authors: Ghoshal, Sushmita, Dracham, Chinna Babu, Sundaram, Archana, Kumar, Rajesh, Bal, Amanjit, Das, Ashim, Bahl, Amit, Verma, Roshan Kumar, Elangovan, Arun
• Format: Article
• Language: English
• Subjects: Head and Neck Surgery; Human papillomavirus; Medicine; Medicine & Public Health; Original; Original Article; Otorhinolaryngology; Throat cancer; Tobacco
• ISSN: 2231-3796; 0973-7707
• DOI: 10.1007/s12070-021-02427-w

To find if an association could be established between Human Papilloma Virus (HPV) infection and oropharyngeal cancers (OPCs) in a group of patients known to be regular users of tobacco, and to determine the impact of HPV status on clinical outcomes.Case records of 212 patients with AJCC-7 (The American Joint Committee on Cancer 7th edition) stages II–IVB non metastatic squamous cell carcinoma of the oropharynx treated using radical radiotherapy with or without chemotherapy during the years 2015–2018 were retrieved. Formalin-fixed, paraffin-embedded blocks from oropharyngeal biopsies were available for 177 patients and were evaluated for p16 expression by immunohistochemical (IHC) staining. More than 50% nuclear staining with or without cytoplasmic staining was considered HPV+ . The association between tobacco use and HPV, as well as the influence of HPV status on survival outcomes were assessed. p16 expression was found to be positive in 23(13%) patients. Significant association was found between chewable tobacco usage and HPV positivity ( p  = 0.051). The median follow up was 20.5 months (range: 3–80). 5-year Overall Survival was 43.4% and 29.8% ( p  = 0.044) in HPV+ and HPV− patients, respectively. Local control was significantly better in HPV+ patients (38.6% vs. 25.3%, p  = 0.049). There was also a trend towards improved Disease-free Survival in HPV+ patients (31 months vs. 15 months, p  = 0.078). Though less in prevalence among the Indian population, improved outcomes in HPV+ OPC patients and widely available IHC HPV assays signifies the routine implementation of p16 testing in day-to-day clinical practice.