Human Papillomavirus-associated oropharyngeal cancer: an observational study of diagnosis, prevalence and prognosis in a UK population

被引:60
作者
Evans, Mererid [1 ]
Newcombe, Robert [2 ]
Fiander, Alison [3 ]
Powell, James [1 ]
Rolles, Martin [4 ]
Thavaraj, Selvam [5 ]
Robinson, Max [6 ]
Powell, Ned [7 ]
机构
[1] Velindre Canc Ctr, Cardiff CF14 2TL, S Glam, Wales
[2] Cardiff Univ, Sch Med, Dept Primary Care & Publ Hlth, Cardiff CF14 4XN, S Glam, Wales
[3] Cardiff Univ, Sch Med, Dept Obstet & Gynaecol, Cardiff CF14 4XN, S Glam, Wales
[4] Singleton Hosp, Swansea SA2 8QA, W Glam, Wales
[5] Kings Coll London, Inst Dent, Dept Clin & Diagnost Sci, London WC2R 2LS, England
[6] Newcastle Univ, Ctr Oral Hlth Res, Newcastle Upon Tyne NE2 4BW, Tyne & Wear, England
[7] Cardiff Univ, Sch Med, Inst Canc & Genet, HPV Oncol Grp, Cardiff CF14 4XN, S Glam, Wales
关键词
Oropharyngeal; Oropharynx; Cancer; HPV; Papillomavirus; Prognosis; Tonsil; SQUAMOUS-CELL CARCINOMA; RISK HUMAN-PAPILLOMAVIRUS; PHASE-III TRIAL; TONSILLAR CARCINOMA; SURVIVAL; HPV; HEAD; P16(INK4A); SUBSET;
D O I
10.1186/1471-2407-13-220
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: The incidence of Human Papillomavirus (HPV) associated oropharyngeal cancer (OPC) is increasing. HPV-associated OPC appear to have better prognosis than HPV-negative OPC. The aim of this study was to robustly determine the prevalence of HPV-positive OPC in an unselected UK population and correlate HPV positivity with clinical outcome. Methods: HPV testing by GP5+/6+ PCR, In Situ Hybridisation (ISH) and p16 immunohistochemistry (IHC) was performed on 138 OPCs diagnosed in South Wales (UK) between 2001-06. Kaplan-Meier analysis was used to correlate HPV status with clinical outcome. Results: Using a composite definition of HPV positivity (HPV DNA and p16 overexpression), HPV was detected in 46/83 (55%) samples where DNA quality was assured. Five year overall survival was 75.4% (95% CI: 65.2 to 85.5) in HPV-positives vs 25.3% (95% CI: 14.2 to 36.4) in HPV negatives, corresponding to a 78% reduction in death rate (HR 0.22, p < 0.001). HPV-positives had less locoregional recurrence but second HPV-positive Head and Neck primaries occurred. Poor quality DNA in fixed pathological specimens reduced both HPV prevalence estimates and the prognostic utility of DNA-based HPV testing methods. As a single marker, p16 was least affected by sample quality and correlated well with prognosis, although was not sufficient on its own for accurate HPV prevalence reporting. Conclusions: This study highlights the significant burden of OPC associated with HPV infection. HPV positive cases are clinically distinct from other OPC, and are associated with significantly better clinical outcomes. A composite definition of HPV positivity should be used for accurate prevalence reporting and up-front DNA quality assessment is recommended for any DNA-based HPV detection strategy.
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页数:10
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