HPV in oropharyngeal cancer:
the basics to know in clinical practice

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SUMMARY

The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rising in contrast to the decreasing incidence of carcinomas in other subsites of the head and neck, in spite of the reduced prevalence of smoking. Human papilloma virus (HPV) infection, and in particular type 16 (HPV-16), is now recognized as a significant player in the onset of HPV positive OPSCC, with different epidemiological, clinical, anatomical, radiological, behavioural, biological and prognostic characteristics from HPV negative OPSCC. Indeed, the only subsite in the head and neck with a demonstrated aetiological viral link is, at present, the oropharynx. These observations lead to questions regarding management choices for patients based on tumour HPV status with important consequences on treatment, and on the role of vaccines and targeted therapy over the upcoming years.

RIASSUNTO

L'incidenza del carcinoma spinocellulare dell'orofaringe (OPSCC) è in aumento in contrasto con la diminuzione dell'incidenza di carcinomi in altre sedi del distretto cervico-facciale, nonostante la ridotta prevalenza del fumo. L'infezione da Papilloma Virus Umano (HPV), in particolare di tipo 16 (HPV 16), è ora riconosciuto come un importante fattore nell'insorgenza di HPV OPSCC positivo, con diverse caratteristiche radiologiche, epidemiologiche, cliniche, anatomiche, biologiche e prognostiche rispetto all'HPV OPSCC negativo. In effetti l'unica sede del distretto cervico-facciale con un collegamento virale eziologico dimostrato è, attualmente, l'orofaringe. Queste osservazioni portano a domande riguardanti le scelte di gestione per i pazienti in base allo stato del tumore HPV con importanti conseguenze sul trattamento e sul ruolo dei vaccini e terapia mirata per i prossimi anni.

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Most cited references 85

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Human Papillomavirus Types in Head and Neck Squamous Cell Carcinomas Worldwide: A Systematic Review

A. Kreimer (2005)

Mucosal human papillomaviruses (HPV) are the cause of cervical cancer and likely a subset of head and neck squamous cell carcinomas (HNSCC), yet the global prevalence and type distribution of HPV in HNSCC remains unclear. We systematically reviewed published studies of HNSCC biopsies that employed PCR-based methods to detect and genotype HPV to describe the prevalence and type distribution of HPV by anatomic cancer site. Geographic location and study size were investigated as possible sources of variability. In the 5,046 HNSCC cancer specimens from 60 studies, the overall HPV prevalence was 25.9% [95% confidence interval (95% CI), 24.7-27.2]. HPV prevalence was significantly higher in oropharyngeal SCCs (35.6% of 969; 95% CI, 32.6-38.7) than oral SCCs (23.5% of 2,642; 95% CI, 21.9-25.1) or laryngeal SCCs (24.0% of 1,435; 95% CI, 21.8-26.3). HPV16 accounted for a larger majority of HPV-positive oropharyngeal SCCs (86.7%; 95% CI, 82.6-90.1) compared with HPV-positive oral SCCs (68.2%; 95% CI, 64.4-71.9) and laryngeal SCCs (69.2%; 95% CI, 64.0-74.0). Conversely, HPV18 was rare in HPV-positive oropharyngeal SCCs (2.8%; 95% CI, 1.3-5.3) compared with other head and neck sites [34.1% (95% CI, 30.4-38.0) of oral SCCs and 17.0% (95% CI, 13.0-21.6) of laryngeal SCCs]. Aside from HPV16 and HPV18, other oncogenic HPVs were rarely detected in HNSCC. Tumor site-specific HPV prevalence was higher among studies from North America compared with Europe and Asia. The high HPV16 prevalence and the lack of HPV18 in oropharyngeal compared with other HNSCCs may point to specific virus-tissue interactions. Small sample size and publication bias complicate the assessment of the prevalence of HPV in head and neck sites beyond the oropharynx.

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Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States.

Anil Chaturvedi, Eric Engels, William F Anderson … (2008)

To investigate the impact of human papillomavirus (HPV) on the epidemiology of oral squamous cell carcinomas (OSCCs) in the United States, we assessed differences in patient characteristics, incidence, and survival between potentially HPV-related and HPV-unrelated OSCC sites. Data from nine Surveillance, Epidemiology, and End Results program registries (1973 to 2004) were used to classify OSCCs by anatomic site as potentially HPV-related (n = 17,625) or HPV-unrelated (n = 28,144). Joinpoint regression and age-period-cohort models were used to assess incidence trends. Life-table analyses were used to compare 2-year overall survival for HPV-related and HPV-unrelated OSCCs. HPV-related OSCCs were diagnosed at younger ages than HPV-unrelated OSCCs (mean ages at diagnosis, 61.0 and 63.8 years, respectively; P < .001). Incidence increased significantly for HPV-related OSCC from 1973 to 2004 (annual percentage change [APC] = 0.80; P < .001), particularly among white men and at younger ages. By contrast, incidence for HPV-unrelated OSCC was stable through 1982 (APC = 0.82; P = .186) and declined significantly during 1983 to 2004 (APC = -1.85; P < .001). When treated with radiation, improvements in 2-year survival across calendar periods were more pronounced for HPV-related OSCCs (absolute increase in survival from 1973 through 1982 to 1993 through 2004 for localized, regional, and distant stages = 9.9%, 23.1%, and 18.6%, respectively) than HPV-unrelated OSCCs (5.6%, 3.1%, and 9.9%, respectively). During 1993 to 2004, for all stages treated with radiation, patients with HPV-related OSCCs had significantly higher survival rates than those with HPV-unrelated OSCCs. The proportion of OSCCs that are potentially HPV-related increased in the United States from 1973 to 2004, perhaps as a result of changing sexual behaviors. Recent improvements in survival with radiotherapy may be due in part to a shift in the etiology of OSCCs.

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Trends in head and neck cancer incidence in relation to smoking prevalence: an emerging epidemic of human papillomavirus-associated cancers?

Erich M. Sturgis, Paul M. Cinciripini (2007)

The trends in head and neck cancer incidence and smoking prevalence are reviewed, discussing where such trends parallel but also how and why they may not. In the U.S., public health efforts at tobacco control and education have successfully reduced the prevalence of cigarette smoking, resulting in a lower incidence of head and neck cancer. Vigilance at preventing tobacco use and encouraging cessation should continue, and expanded efforts should target particular ethnic and socioeconomic groups. However, an unfortunate stagnation has been observed in oropharyngeal cancer incidence and likely reflects a rising attribution of this disease to oncogenic human papillomavirus, in particular type 16 (HPV-16). For the foreseeable future, this trend in oropharyngeal cancer incidence may continue, but with time the effects of vaccination of the adolescent and young adult female population should result in a lower viral prevalence and hopefully a reduced incidence of oropharyngeal cancer. To hasten the reduction of HPV-16 prevalence in the population, widespread vaccination of adolescent and young adult males should also be considered.

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Author and article information

Journal

Journal ID (nlm-ta): Acta Otorhinolaryngol Ital

Journal ID (iso-abbrev): Acta Otorhinolaryngol Ital

Journal ID (publisher-id): Pacini

Title: Acta Otorhinolaryngologica Italica

Publisher: Pacini Editore SpA

ISSN (Print): 0392-100X

ISSN (Electronic): 1827-675X

Publication date (Print): October 2014

Volume: 34

Issue: 5

Pages: 299-309

Affiliations

[1 ] Division of Otolaryngology Head and Neck Surgery, European Institute of Oncology, Milano, Italy;

[2 ] Department of Otolaryngology, Head and Neck Surgery, Alexandria University, Alexandria, Egypt;

[3 ] Department of Experimental Oncology, IFOM-IEO Campus, European Institute of Oncology, Milano, Italy

Author notes

Address for correspondence: Mohssen Ansarin, Division of Head and Neck Surgery, European Institute of Oncology, via Ripamonti 435, 20077 Milano, Italy. Tel. +39 02 57489490. Fax +39 02 55210169. E-mail: mohssen.ansarin@ 123456ieo.it

Article

Publisher ID: Pacini

PMC ID: 4299160

PubMed ID: 25709145

SO-VID: 8d53c851-1c42-4d17-bb7b-7256eeb4632a

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License, which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/

HPV in oropharyngeal cancer: the basics to know in clinical practice Translated title: HPV nel carcinoma dell'orofaringe: le nozioni base da conoscere nella pratica clinica

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Most cited references 85

Human Papillomavirus Types in Head and Neck Squamous Cell Carcinomas Worldwide: A Systematic Review

Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States.

Trends in head and neck cancer incidence in relation to smoking prevalence: an emerging epidemic of human papillomavirus-associated cancers?

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