Biopsies Confirm HPV18 Infection in Head and Neck Cancer

Pam Harrison

April 16, 2014

CAPE TOWN, South Africa — Archival biopsies from head and neck cancer patients confirm frequent infection with highly oncogenic human papillomavirus (HPV), especially HPV18, new research indicates.

"The incidence of head and neck cancer is increasing in Chile, as it is in the United States and other countries. We should be screening these patients for the presence of HPV," said Sonia Montenegro, PhD, professor of medicine and director of the diagnostic molecular laboratory at Universidad de Concepción in Chile.

"Clinicians treating patients with head and neck squamous cell carcinoma need to know their HPV status because patients with the HPV-related form of the disease have better outcomes than patients without HPV," Dr. Montenegro told Medscape Medical News.

The study was presented here at the 16th International Congress on Infectious Diseases.

Archival Biopsies

Dr. Montenegro and colleagues analyzed archival biopsies taken from 90 patients 34 to 85 years of age who had been treated for head and neck squamous cell carcinoma over a 6-year period. There were about 3 male patients for every 1 female patient in the study population.

The biopsy samples came from patients with and without known risk factors for head and neck squamous cell carcinoma, including drinking and smoking.

All biopsies were histologically determined by a pathologist. Tumor site, stage, and carcinoma type were analyzed for the presence of HPV using highly accurate detection techniques such as real-time and nested PCR. Tumor specimens were also tested for p16 protein expression with immunohistochemistry. There is increasing evidence that p16 overexpression in oropharyngeal head and neck squamous cell carcinoma identifies HPV-induced tumors with a favorable prognosis.

"Instead of finding a lot of HPV16 in our samples, which most people are finding, we found a lot of HPV18, along with other oncogenic HPV types," Dr. Montenegro reported.

HPV was detected most frequently in cancers in the oral cavity, followed by cancers in the oropharynx and cancers in the hypopharynx.

Table. HPV Status According to Cancer Type

Status Oral Cavity, % Oropharyngeal, % Hypopharyngeal, %
p16 overexpression 53 50 47
HPV positive 73 64 59
HPV type      
   HPV16 30 29 30
   HPV18 49 14 70
   HPV35/45 19 50 0


The investigators classified biopsy samples by p16 and HPV status. Approximately 34% of the biopsies were positive for both p16 and HPV, about 17% were negative for both, about 29% were negative for p16 and positive for HPV, and about 16% were positive for p16 and negative for HPV.

They are now analyzing what happened to the different categories of patients, because previous work has suggested that levels of p16 expression in head and neck squamous cell carcinoma tumors can determine prognosis, Dr. Montenegro explained.

The association between high-risk oncogenic HPV types and head and neck squamous cell carcinoma has been well established, said Marc Steben, MD, from the National Institute of Public Health of Quebec in Montreal, who was not involved in the study.

However, in this study, rates of HPV18 were higher than has previously been reported, he told Medscape Medical News.

"HPV typing may help in the counseling of patients, but would not, for now, change treatment course," Dr. Steben added. And he cautioned that HPV typing might trigger "marital turmoil" because issues of HPV transmission through sexual intercourse could be brought to the surface.

Dr. Montenegro and Dr. Steben have disclosed no relevant financial relationships.

16th International Congress on Infectious Diseases (ICID): Abstract 57.017. Presented April 4, 2014.


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