Abstract
The incidence of human papillomavirus (HPV)-positive oropharyngeal cancer (OPC) is rising in high-income countries, including Australia. Increasing evidence suggests that accurate HPV testing is pivotal for clinical decision making and treatment planning in these patients. Recently, the eighth edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumor–node–metastasis (TNM) staging system for OPC (based on the p16INK4a (p16) status) was proposed and has been implemented. However, the applicability of this new staging system is still far from clear. In our study, n = 127 OPC patients from Queensland, Australia were recruited, and the tumor p16 expression in these patients was examined using immunohistochemical (IHC) analysis. HPV-16 genotyping, viral load, and physical status (episomal versus integrated) in the saliva samples of OPC patients were determined using the qPCR method. A good inter-rater agreement (k = 0.612) was found between tumor p16 expression and oral HPV-16 infection in OPC. Importantly, according to the eighth edition staging system, HPV-16 DNA viral load (>10 copies/50 ng) was significantly associated with the advanced stages of OPC. In concordance with previous studies, a mixed HPV-16 form (partially or fully integrated) was predominately found in OPC patients. Taken together, our data support HPV-16 detection in saliva as a screening biomarker to identify people within the community who are at risk of developing OPC.
Highlights
Oropharyngeal cancer (OPC) usually arises from the tonsillar area, the base of tongue, and the oropharynx, and is one of the most common subtypes of head and neck cancers (HNC), accounting for 97,000 deaths annually worldwide [1,2]
We aimed to investigate the oral human papillomavirus (HPV)-16 prevalence, viral load, and physical status in a cohort of Australian patients with oropharyngeal cancer (OPC) classified based on the seventh and eighth edition of the AJCC/UICC TNM staging system
An elevated HPV-16 viral load (>10 copies/50 ng) was significantly associated with the advanced stages of OPC based on the eighth edition staging system
Summary
Oropharyngeal cancer (OPC) usually arises from the tonsillar area, the base of tongue, and the oropharynx, and is one of the most common subtypes of head and neck cancers (HNC), accounting for 97,000 deaths annually worldwide [1,2]. There has been a significant increase in the incidence of high-risk human papillomavirus (HPV)-associated OPC in high-income countries Cancers 2019, 11, 473 associated with the rising of OPC incidence include a large number of lifetime sexual partners, sexual behavior (e.g., oral sex), poor oral health/hygiene, and being a partner of patients with HPV-related cancers [5,6,7]. The clinical diagnosis of OPC is challenging when compared to other cancer types such as prostate and breast, as the tumors are usually tiny in the early stages of disease, and are located in the regions of the mouth that are not visible and accessible [8,9]. Most of them are either misdiagnosed or only diagnosed at an advanced stage, which leads to complicated treatments
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