Prevalence of Human Papillomavirus (HPV) Infection and the Association with Survival in Saudi Patients with Head and Neck Squamous Cell Carcinoma

• Published in: Cancers Vol. 11; no. 6; p. 820
• Main Authors: Alsbeih, Ghazi, Al-Harbi, Najla, Bin Judia, Sara, Al-Qahtani, Wejdan, Khoja, Hatim, El-Sebaie, Medhat, Tulbah, Asma
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 13.06.2019; MDPI
• Subjects: Age; Alcohol; Biomarkers; Deoxyribonucleic acid; DNA; Epidemiology; Head & neck cancer; head and neck cancer; Health risk assessment; Human papillomavirus; human papillomavirus (HPV); Infections; INK4a protein; Multivariate analysis; oral cavity tumors; Oropharyngeal cancer; overall survival; p16 Protein; p16-immunostaining; p16Ink4a biomarker; Prognosis; Protein expression; Proteins; Radiation therapy; Research centers; Sex differences; Smoking; Squamous cell carcinoma; Tumors; Saudi Arabia; Riyadh Saudi Arabia; human papillomavirus (HPV); head and neck cancer; oral cavity tumors; p16Ink4a biomarker; overall survival; oropharyngeal cancer; prognosis; p16-immunostaining; squamous cell carcinoma
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers11060820

Head and neck squamous cell carcinoma (HNSCC) shows wide disparities, association with human papillomavirus (HPV) infection, and prognosis. We aimed at determining HPV prevalence, and its prognostic association with overall survival (OS) in Saudi HNSCC patients. The study included 285 oropharyngeal and oral-cavity HNSCC patients. HPV was detected using HPV Linear-Array and RealLine HPV-HCR. In addition, p16INK4a (p16) protein overexpression was evaluated in 50 representative cases. Oropharyngeal cancers were infrequent (10%) compared to oral-cavity cancers (90%) with no gender differences. Overall, HPV-DNA was positive in 10 HNSCC cases (3.5%), mostly oropharyngeal (21%). However, p16 expression was positive in 21 cases of the 50 studied (42%) and showed significantly higher OS ( = 0.02). Kaplan-Meier univariate analysis showed significant associations between patients' OS and age ( < 0.001), smoking ( = 0.02), and tumor stage ( < 0.001). A Cox proportional hazard multivariate analysis confirmed the significant associations with age, tumor stage, and also treatment ( < 0.01). In conclusion, HPV-DNA prevalence was significantly lower in our HNSCC patients than worldwide 32-36% estimates ( ≤ 0.001). Although infrequent, oropharyngeal cancer increased over years and showed 21% HPV-DNA positivity, which is close to the worldwide 36-46% estimates ( = 0.16). Besides age, smoking, tumor stage, and treatment, HPV/p16 status was an important determinant of patients' survival. The HPV and/or p16 positivity patients had a better OS than HPV/p16 double-negative patients ( = 0.05). Thus, HPV/p16 status helps improve prognosis by distinguishing between the more favorable p16/HPV positive and the less favorable double-negative tumors.