Abstract
BackgroundHigh-risk human papillomavirus (HPV) is an oncogenic virus that causes oropharyngeal cancers, and it has a favorable outcome after the treatment. Unlike in oropharyngeal cancer, the prevalence and role of high-risk HPV in the etiology of hypopharyngeal squamous cell carcinoma (HPSCC) is uncertain.ObjectiveThe aim of the present study was to evaluate the effect and prognostic significance of high-risk HPV in patients with HPSCC.MethodsThe study included 64 subjects with HPSCC who underwent radical surgery with or without radiation-based adjuvant therapy. Primary tumor sites were the pyriform sinus in 42 patients, posterior pharyngeal wall in 19 patients, and postcricoid area in 3 patients. High-risk HPV in situ hybridization was performed to detect HPV infection.ResultsThe positive rate of high-risk HPV in situ hybridization was 10.9% (7/64). There was a significant difference in the fraction of positive high-risk HPV among pyriform sinus cancer (16.7%), posterior pharyngeal wall cancer (0%), and postcricoid area cancer (0%) (p = 0.042). The laryngoscopic examination revealed a granulomatous and exophytic appearance in 85.7% (6/7) of patients with high-risk HPV-positive pyriform sinus cancer, but in only 31.4% (11/35) of patients with high-risk HPV-negative pyriform sinus cancer (p = 0.012). Significant correlations were found between positive high-risk HPV and younger age (p = 0.050) and non-smoking status (p = 0.017). HPV-positive patients had a significantly better disease-free survival (p = 0.026) and disease-specific survival (p = 0.047) than HPV-negative patients.ConclusionsHigh-risk HPV infection is significantly related to pyriform sinus cancer in patients with HPSCC.
Highlights
High-risk human papillomavirus (HPV) infection is significantly related to pyriform sinus cancer in patients with hypopharyngeal squamous cell carcinoma (HPSCC)
Hypopharyngeal squamous cell carcinoma (HPSCC) is the most aggressive malignancy of the head and neck region that occurs in the aerodigestive tract; 70–80% of the cases are found at an advanced stage III and IV because of the aggressive features of the tumor, with a high frequency of nodal metastasis and submucosal extension [1]
Around 20% of patients with this disease are not exposed to these risk factors, and only a small proportion of individuals who are exposed to tobacco develop squamous cell carcinoma (SCC) of the head and neck [2]
Summary
Hypopharyngeal squamous cell carcinoma (HPSCC) is the most aggressive malignancy of the head and neck region that occurs in the aerodigestive tract; 70–80% of the cases are found at an advanced stage III and IV because of the aggressive features of the tumor, with a high frequency of nodal metastasis and submucosal extension [1]. Around 20% of patients with this disease are not exposed to these risk factors, and only a small proportion of individuals who are exposed to tobacco develop squamous cell carcinoma (SCC) of the head and neck [2]. In contrast to oropharyngeal SCC, little is known about the significance of HPV in other tumor subsites in the head and neck. It is unclear whether the correlations found in oropharyngeal SCC can be extrapolated to HPSCC. The prevalence and role of high-risk HPV in the etiology of hypopharyngeal squamous cell carcinoma (HPSCC) is uncertain
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