Impact of HPV status on oropharyngeal cancer detection via gastrointestinal endoscopy: a retrospective study

Background Gastrointestinal endoscopy (GIE) performed by gastroenterologists is essential for the early detection of pharyngeal cancer. Human papillomavirus (HPV) is a significant cause of oropharyngeal squamous cell carcinoma (OPSCC). However, the prevalence of HPV-related OPSCC detected by GIE remains unclear. Aim This study aims to evaluate the differences in detection rates, patient characteristics, and treatment approaches between HPV-positive and HPV-negative OPSCCs, with a focus on the role of GIE in early diagnosis. MethodsWe retrospectively analyzed 207 OPSCCs from 2018 to 2022, where HPV infection was diagnosed by p16 immunohistochemistry. We compared detection modalities and evaluated the proportion of lesions detected by GIE in both p16-positive and p16-negative cases. Results Out of the 207 patients, 92 (44.4%) were p16-positive. p16-positive cases had significantly lower rates of alcohol use, smoking, and history of esophageal or head/neck squamous cell carcinoma (all p < 0.001). Only 4.3% of p16-positive cases were detected by GIE, compared to 44.3% of p16-negative cases (p < 0.001). In addition, p16-positive patients were often diagnosed at advanced stages and underwent transoral resection less frequently (2.2% vs. 31.3%, p < 0.001). In cT1 cases, GIE and laryngoscopy revealed that p16-positive lesions were typically protruding and white to normal-colored, while p16-negative lesions were predominantly flat and erythematous. Conclusions HPV-related OPSCC cases are rarely detected by GIE, and few cases are treated with minimally invasive transoral resection. These findings highlight the need for enhanced detection strategies for HPV-positive OPSCC.