Papillomavirus Research Articles

Clear cell adenocarcinoma of the cervix and its mimickers - A series of 19 cases from a tertiary care referral centre in India.

Clear cell adenocarcinoma (CCAC) of cervix is a rare subtype of endocervical adenocarcinoma that accounts for 4% of all cervical adenocarcinoma with many morphological mimickers. Retrospectively study cases of cervical clear cell adenocarcinoma of the cervix. Clinical profile and pathological features of CCAC of the cervix diagnosed between 2018-2022 were retrospectively analyzed.The database of the Department of Pathology of our institute was systematically searched for patients diagnosed with clear cell adenocarcinoma of the cervix during 2018-2022.A total of 19 patients were studied with the mean age of patients being 53.72 years (range 25 -84 yrs,standard deviation-25.9) and median tumor size being 5.6cm. Lymph node metastasis was identified in 33.3% and distant metastasis were seen in 20% of the cases. Staging could not be done in 4 cases.FIGO staging of the cases included IB1(2 cases), IB2(2 cases), IIB (3 cases),IIIA (1 case)IIIB(4 cases),and IV(3 cases). On histopathological evaluation, heterogeneous architectural pattern comprising of tubulocystic, solid, and papillary patterns were seen in 13 cases (13/19,68.4%). Pure tubulocystic (3/19,15.7%), pure papillary (2/19,10.5%), and pure solid patterns (1/19,5.3%) were also identified. Tumor cells with clear cytoplasm ranged from 5% to 95%. Nuclear atypia was moderate to marked in all the cases (19/19,100%). Mitotic activity varied from 1/10hpf to 20-22/10hpf. By immunohistochemistry, tumor was positive for Napsin A in all the cases,p16INK4a was negative in majority of cases (15/19,78.9%) and ER was negative in 14 cases (14/19,73.7%) .p53 showed wild type staining except for one case . Clear cell adenocarcinoma being a rare subtype of cervical adenocarcinoma, needs to be differentiated from other Human Papilloma Virus(HPV) independent adenocarcinomas (gastric and mesonephric types) and benign entities such as endocervical glandular Arias-Stella reaction. Judicious use of a panel of immunostains is often helpful.

Colposcopically Directed Biopsy Before Ablative Treatment Versus Direct Ablative Treatment in Patients With Cervical Oncogenic HPV.

In the past, the standard of care for women with abnormal cervical cytology has been the performance of colposcopically guided biopsy, followed by conization or large loop excision of the transition zone (LLETZ) where biopsy revealed pre-cancerous or cancerous areas. More straightforward protocols are emerging which advocate performing LLETZ in all women with highly suspicious cytology, suspicious colposcopic impression, or the presence of high-risk oncogenic human papilloma virus (HPV) strains in their cervical swabs. This, theoretically, would reduce the rate of false-negative diagnoses, but at the price of overtreating a significant number of healthy women. We retrospectively analyzed cervical cancer screening protocols in two large cohorts of women with high-risk HPV. The study compared outcomes between patients undergoing a colposcopically directed biopsy before LLETZ (n=683) and those proceeding directly to LLETZ without a biopsy (n=136). The primary focus was to assess whether intervening biopsies would reduce unnecessary ablative procedures without compromising the detection of high-grade lesions. The biopsy group had a high false-negative rate, with several high-grade lesions (CIN3) and a case of invasive cancer initially underdiagnosed. Conversely, the direct-to-LLETZ approach, while ensuring no high-grade lesions were missed, led to overtreatment of lower grade lesions. These findings raise concern about the reliance on biopsy results for treatment decisions. Neither protocol was entirely satisfactory, although the more aggressive one avoided the potentially life-threatening consequence of false-negative results. Further research is mandatory to accurately diagnose all cases requiring aggressive treatment, without subjecting healthy women to ablative treatments they do not need.

The Impact of an Educational Program on the Awareness and Knowledge of Human Papilloma Virus (HPV) Vaccine Among Secondary School Girls in Saudi Arabia.

The objectives were to assess the effectiveness ofthe educational program in enhancing students' understanding of thehuman papillomavirus (HPV) vaccine, correcting misconceptions, and increasing overall awareness. Additionally, the study aimed to identify factors influencing knowledge improvement and willingness to be vaccinated against HPV, including prior knowledge, information sources, session attendance, and school type. In this study, 148 participants were enrolled from secondary schools in Saudi Arabia, and data were collected through pre- and post-educational session assessments, logistic regression analyses, and qualitative investigations. Educational sessions focused on key aspects of the HPV vaccine, including its preventive benefits, administration details, and side effects, tailored to address common misconceptions and enhance understanding among students. The study revealed significant improvements in students' knowledge post-educational sessions, particularly in key areas such as cervical cancer prevention, gender recommendations, vaccine administration, and side effect awareness. Prior knowledge, information sources, session attendance, and school type significantly influenced knowledge enhancement and willingness to be vaccinated against HPV. The qualitative analysis provided additional insights into challenges, perceptions, and misconceptions surrounding HPV vaccination, underlining the significance of targeted education and cultural sensitivity in promoting vaccination uptake. The findings underscored the effectiveness of the educational intervention in enhancing HPV vaccine awareness, dispelling myths, and fostering informed decision-making among Saudi Arabian adolescent populations. The study emphasizes the critical role of tailored educational programs in correcting misconceptions, promoting accurate knowledge, and ultimately increasing vaccination acceptance for improved public health outcomes and disease prevention efforts. Ongoing efforts are essential to sustain and expand educational initiatives to enhance HPV vaccine understanding and adolescent uptake.

A study to assess the effectiveness of structured teaching programme on knowledge regarding human papilloma virus vaccination among adolescent girls in selected colleges at Guntur

A study to assess the effectiveness of structured teaching programme on knowledge regarding human papilloma virus vaccination among adolescent girls in selected colleges at Guntur

High-risk HPV Prevalence Estimates among Older Patients: Implications for Cervical Cancer Screening Programs.

Due to the heterogeneity of existing studies and wide range of human papilloma virus (HPV) prevalence in India, further research into the incidence of HR-HPV and its spectrum of genotypes is essential to develop screening policies. This study aimed to determine the incidence and demographic distribution of HR-HPV among cisgender female patients attending a tertiary care facility in North India. This study was conducted in the Department of Obstetrics and Gynaecology, SGRR Institute of Medical and Health Sciences, Dehradun, India. HPV-DNA test results of 653 female patients were assessed for HR-HPV positivity, genotyping, and age-based differences via Chi-square analysis. Overall prevalence of HR-HPV was 4.90%, HPV-16 was 1.37%, HPV-18 was 0.76%, and HPV non-16,18 was 2.7%. In patients ≤ 50 years, prevalence of HPV-16 was 0.97%, HPV-18 was 0.38%, and HR-HPV non-16,18 was 2.71%. In patients > 50 years, prevalence of HPV-16 was 2.89%, HPV-18 was 2.17%, and HR-HPV non-16,18 was 2.89%. The difference in the prevalence of HPV-16,18 between patients ≤ and > 50 years was found to be highly statistically significant (P = 0.007485). The difference in the prevalence of total HR-HPV between patients ≤ and > 50 years was not found to be statistically significant (P = 0.059905). Our study's finding of higher HR-HPV positivity rates in patients > 50 years emphasizes the need for continued HR-HPV-DNA-based screening of this cohort. With widespread use in post-menopausal patients, HPV screening can serve as an important armamentarium in the fight against cervical cancer.

The relationship between knowledge levels of HPV and health literacy in youth – an example from Türkiye

Introduction and aim. Human papillomavirus (HPV) is a common infection responsible for many cancers. This study was conducted to determine the relationship between the knowledge level of HPV and the health literacy of youth living in Türkiye. Material and methods. The study sample comprised 543 youth aged 18 and 30 living in Türkiye. The data were assessed with a questionnaire, the human papilloma virus knowledge scale (HPV-KS), and the health literacy scale (HLS) and the correlation between them. Results. 50.6% of the youth informed that they are aware of HPV, and 54% of the youth know about the transmission mode of HPV. It was determined that knowing HPV increased 1.839 times by being a woman, 1.949 times by being married, and 14.339 times by knowing STIs. The HPV-KS total score average of the youth was low at 14.26±7.04, and the total score average of HLS was high at 107.91±16.81. A positive and significant correlation was found between HPV-KS total score, all sub-factor scores, HLS total score, and all sub-factors total score (p<0.001). Conclusion. Information studies on HPV should be increased by taking advantage of the generality of health literacy.

Detection of human papilloma virus (HPV) in tonsils of children undergoing tonsillectomy at Muhimbili national hospital

Detection of human papilloma virus (HPV) in tonsils of children undergoing tonsillectomy at Muhimbili national hospital

Knowledge of esophageal cancer and preventive behaviors among nursing students – a cross-sectional study

Introduction and aim. There is a gap in nursing student understanding, knowledge, and preventive behaviors concerning esophageal cancer. This study aimed to investigate knowledge, risk factors, and preventive behaviors among Turkish nursing students. Material and methods. A descriptive cross-sectional survey was performed. The questionnaire was conducted online over a four-month period. A convenience sample of 688 undergraduate nursing students was recruited from health science faculty at three universities in Türkiye. The survey was performed using a self-administered questionnaire. The reliability coefficients of the knowledge test were calculated, yielding Cronbach’s alpha (0.952), KR-20 (0.952), and KR-21 (0.945), respectively. A significance level p<0.05 was accepted. Results. The mean age of the study group was 20±1.86 (min: 17, max: 32). The study group consists of 487 women (70.8%) and 201 men (29.2%). Most of the study population report never using alcohol and smoking (88.4%, 73.1%, respectively), and reported paying attention to oral hygiene (88.5%). Nursing students had a low family history of EC (0.4%), obesity (10.2%), and vitamin deficiency (19.2%) which are risk factors. Knowledge of esophageal cancer risks was low (x̄=14.34±9.53; Min=0; Max=31). Total knowledge scores have higher for students with complaints of EC, vitamin deficiency, and diagnosis of Human Papilloma Virus disease (p<0.05). Conclusion. This study showed that there are significant gaps in the knowledge of nursing students and these need to be addressed through an improved nursing curriculum. In this context, the study can be used as important evidence and a resource in the issues that should be given priority to in the training and research needed to increase the knowledge and awareness of future nurses about esophageal cancer.

Human papilloma virus (HPV)-related information acquisition and seeking behavior among infected women: A single center cross-sectional survey in Shanghai, China.

Lacking of adequate knowledge is an obstacle to effective prevention of cervical cancer, yet factors that affect the information acquisition and seeking behavior as well as the information communication process are not well studied. We assessed information acquisition and seeking behavior, as well as perceived barriers of doctor-patient communication regarding human papilloma virus (HPV)-related information of infected women. Among 437 participants, 405 (93%) expressed demands for HPV-related information, while only a small proportion (100/437, 22.9%) actively sought information and felt obstacles comprehending. Web-based channels were most frequently utilized and medical personnel were the most trusted information source. Patients' satisfaction was significantly correlated with doctor's patience (r = 0.581, p < 0.001) and emotional caring (r = 0.555, p < 0.001). Compared to patients not actively seeking information, those actively seeking information were more likely to be single (p = 0.005), had higher education (p = 0.009) and monthly individual-level income (p = 0.023), and was more likely to undergo regular cervical cancer screening (p = 0.003), and were already or willing to be vaccinated (p = 0.008). The actively seeking information group also achieved higher scores in HPV knowledge test (p = 0.007). Public health interventions targeting HPV-infected women using specifically designed educational materials may influence information seeking behavior, increase HPV literacy and knowledge, which could potentially increase HPV vaccine uptake and cervical cancer screening rate.

Preparation and Evaluation of Cream Containing Betel Leaf Extract for Removal of Cutaneous Warts

Abstract: Warts are common skin growths caused by the human papillomavirus (HPV). They can appear on any part of the body but are most commonly found on the hands, feet, and genitals. Warts are usually harmless but can be unsightly or cause discomfort, especially if they are frequent friction or pressure. There are several types of warts, including common warts, plantar warts (on the soles of the feet), genital warts, and flat warts (often found on the face). Creams are semisolid dosage form containing one or more drugs substances dissolved or dispersed in a suitable base. They are emulsion of either W/O, O/W creams are uses for various purposes. Wart removal cream contains some synthetic substances as well as herbal ingredients like betel steam which is having antiviral activity against the human papilloma virus (HPV). Then calcium carbonate and sodium hydroxide slowly absorbed into the skin causing rupturing of the skin cells that contains the wart virus. To prepare wart removal cream sodium hydroxide and calcium carbonate along with the aqueous extract of betel leaf by maceration with the excipients such as stearic acid, glycerin, methyl paraben, distilled water are used. Finally, the cream is evaluated with various parameters such as physical and chemical properties like pH, viscosity, spreadability, texture. As this cream has clove oil which is used as an analgesic to avoid the irritational pain. The pH of the cream is supposed to be basic and around 12-12.5. During the evaluation the pH of the cream was found out to be 12.1. Cream was easily spreadable and it had a pleasant appearance.

The most common forms of cancer and oncogenic papillomaviruses

Breast, prostate, lung as well as colorectal carcinomas belong to leading positions in the world cancer incidence and mortality rankings. They make up about 40 % of newly diagnosed cancers. Connection of these cancers with oncogenic human papilloma viruses (HPVs) is being examined intensively, however it remains subject for discussion. Basing on case-control meta-analyses data were examined on oncogenic HPV detection in clinical samples of breast, prostate, lung and colorectal carcinomas. Findings on HPV genome activities were summarized. The results available prove to oncogenic HPVs as risk factors of the four enumerated above carcinomas.

Deletion of cyclin dependent kinase inhibitor 2a gene as a marker of oropharyngeal carcinomas non-associated with human papillomavirus and its prognostic value

Patients with human papilloma virus associated oropharyngeal squamous cell carcinoma generally have better treatment outcomes and prognosis compared to those with non-papillomavirus-associated oropharyngeal squamous cell carcinoma. However, prognostic evaluation for non-papillomavirus-associated oropharyngeal squamous cell carcinoma remains a problem that could be solved through the molecular mechanisms of squamous cell carcinoma for the purpose of further development of target therapies. Detection of cyclin dependent kinase inhibitor 2a gene deletion in oropharyngeal squamous cell carcinomas can have clinical significance as it may serve as a prognostic marker and potentially guide treatment decisions. To investigate and analyze cyclin dependent kinase inhibitor 2a gene alterations in oropharyngeal squamous cell carcinoma comparing with clinical data (age of the patient, TNM stage), their histological features and occurrence of papillomavirus infection markers (p16 expression). Formalin-fixed and paraffin-embedded samples after transoral radical surgery of oropharyngeal tumors from 26 male patients with average age 57.35±10.33 years were studied. Histological, immunohistochemical analyses and fluorescent in-situ hybridization were performed to assess histological features, p16 expression, and cyclin dependent kinase inhibitor 2a gene gene abnor­malities respectively. Homozygous deletion of cyclin dependent kinase inhibitor 2a gene was statistically analyzed and compared with p16 expression, age, and occurrence of nodal metastases in investigated patients. Our study demonstrated that the patients with non-papillomavirus-oropharyngeal squamous cell carcinoma with cyclin dependent kinase inhibitor 2a gene homozygous deletion had the highest risk of the nodal metastases development. Our findings suggest that not only detection of the loss of p16 expression, but also the evaluation of homozygous cyclin dependent kinase inhibitor 2a gene deletion might be predictive of worse outcome specifically in oropharyngeal squamous cell carcinomas.

Aluminum oxyhydroxide-Poly(I:C) combination adjuvant with balanced immunostimulatory potentials for prophylactic vaccines

The development of high-purity antigens promotes the urgent need of novel adjuvant with the capability to trigger high levels of immune response. Polyinosinic-polycytidylic (Poly(I:C)) is a synthetic double-stranded RNA (dsRNA) that can engage Toll-like receptor 3 (TLR3) to initiate immune responses. However, the Poly(I:C)-induced toxicity and inefficient delivery prevent its applications. In our study, combination adjuvants are formulated by aluminum oxyhydroxide nanorods (AlOOH NRs) and Poly(I:C), named Al-Poly(I:C), and the covalent interaction between the two components is further demonstrated. Al-Poly(I:C) mediates enhanced humoral and cellular immune responses in three antigen models, i.e., HBsAg virus-like particles (VLPs), human papilloma virus (HPV) VLPs and varicella-zoster virus (VZV) glycoprotein E (gE). Further mechanistic studies demonstrate that the dose and molecular weight (MW) of Poly(I:C) determine the physicochemical properties and adjuvanticity of the Al-Poly(I:C) combination adjuvants. Al-Poly(I:C) with higher Poly(I:C) dose promotes antigen-bearing dendritic cells (DCs) recruitment and B cells proliferation in lymph nodes. Al-Poly(I:C) formulated with higher MW Poly(I:C) induces higher activation of helper T cells, B cells, and CTLs. This study demonstrates that Al-Poly(I:C) potentiates the humoral and cellular responses in vaccine formulations. It offers insights for adjuvant design to meet the formulation requirements in both prophylactic and therapeutic vaccines.

The results of immunotherapy in patients with recurrent and metastatic human papilloma virus positive head and neck squamous cell carcinoma

The results of immunotherapy in patients with recurrent and metastatic human papilloma virus positive head and neck squamous cell carcinoma

Multi-modality imaging parameters that predict rapid tumor regression in head and neck radiotherapy

Background and purposeVolume regression during radiotherapy can indicate patient-specific treatment response. We aimed to identify pre-treatment multimodality imaging (MMI) metrics from positron emission tomography (PET), magnetic resonance imaging (MRI), and computed tomography (CT) that predict rapid tumor regression during radiotherapy in human papilloma virus (HPV) associated oropharyngeal carcinoma. Materials and methodsPre-treatment FDG PET-CT, diffusion-weighted MRI (DW-MRI), and intra-treatment (at 1, 2, and 3 weeks) MRI were acquired in 72 patients undergoing chemoradiation therapy for HPV+ oropharyngeal carcinoma. Nodal gross tumor volumes were delineated on longitudinal images to measure intra-treatment volume changes. Pre-treatment PET standardized uptake value (SUV), CT Hounsfield Unit (HU), and non-gaussian intravoxel incoherent motion DW-MRI metrics were computed and correlated with volume changes. Intercorrelations between MMI metrics were also assessed using network analysis. Validation was carried out on a separate cohort (N = 64) for FDG PET-CT. ResultsSignificant correlations with volume loss were observed for baseline FDG SUVmean (Spearman ρ = 0.46, p < 0.001), CT HUmean (ρ = 0.38, p = 0.001), and DW-MRI diffusion coefficient, Dmean (ρ = -0.39, p < 0.001). Network analysis revealed 41 intercorrelations between MMI and volume loss metrics, but SUVmean remained a statistically significant predictor of volume loss in multivariate linear regression (p = 0.01). Significant correlations were also observed for SUVmean in the validation cohort in both primary (ρ = 0.30, p = 0.02) and nodal (ρ = 0.31, p = 0.02) tumors. ConclusionsMultiple pre-treatment imaging metrics were correlated with rapid nodal gross tumor volume loss during radiotherapy. FDG-PET SUV in particular exhibited significant correlations with volume regression across the two cohorts and in multivariate analysis.

Vaccine-induced strain replacement: theory and real-life implications.

The value of preventive medicine is superior to treatment with vaccinations occupying high priority. Nevertheless, heavy pressure has started to form in regard to strains not included in vaccines contributing to the changing epidemiology of pathogen subtypes leading to 'vaccine-induced strain replacement'. Among other mechanisms, increasing fitness of nonvaccine strains and metabolic shifts in the subtypes have been described. Classical examples include pneumococcal infections and viral diseases, such as the human papilloma virus. Recently, it has been described in SARS-CoV-2, leading to the emergence of new subtypes, such as Omicron and Delta variants. The phenomenon has also been reported in Mycobacterium tuberculosis, Neisseria meningitidis and rotavirus. This study addresses the concepts, examples and implications of this phenomenon.

Effect of metabolic syndrome and its components on the risk and prognosis of cervical cancer: A literature review

Despite the global implementation of preventive strategies against Human Papilloma Virus (HPV) infection, the incidence of invasive cervical cancer rose by nearly 1.3-fold, from 471,000 annual cases in 2000 to 604,000 cases in 2020. With over 340,000 deaths annually, cervical cancer is the fourth leading cause of cancer mortality in women globally.There is a need to understand other factors besides HPV such as metabolic syndrome (MetS) that potentially influence the onset and progression of cervical cancer. In this narrative review, we describe evidence showing that Metabolic syndrome (MetS) increases the risk for cervical cancer and worsens its prognosis. Combined screening for MetS and cervical cancer has potential to significantly reduce morbidity and mortality in women with cervical cancer.

Innovative Design Strategy and Research Progress of Anti Human Papilloma Virus Infection Agents

This review summarized the mechanism of a novel fusion protein (PHPV fusion protein) containing membrane penetrating peptide and oligopeptide-1 (EGF). The new PHPV fusion protein contains two kinds of polypeptides: membrane penetrating peptide and oligopeptide-1, so it has a good function of preventing and treating HPV virus. PHPV fusion protein not only has the multi effect function of membrane penetrating peptide and oligopeptide-1, but also the negative charge (anion) C-terminal of the cross-linked and fused new protein surface interacts with the positive charge (cation) N-terminal on HPV particles. Through the combination of the N-terminal of the positive charge on its surface with the negative charge of the hydrophobic region in the middle and the C-terminal of the recognition region site containing peptidase, the membrane translocation signal is coupled with the NLS of the nuclear localization signal, thus blocking the invasion of human papillomavirus into host cells. Through the interaction of cell membrane, it can penetrate the natural barrier of cell membrane and play a role in destroying the viral membrane shell to inactivate the virus, so as to prevent cervical precancerous lesions and treat HPV infection. PHPV fusion protein can repair damaged cells, enhance the elasticity of loose vaginal mucosa, tighten the inner wall of the vagina, improve the vaginal wetness, and reduce the vaginitis reaction.

High-risk human papilloma virus status & outcomes for penile squamous cell carcinoma: A single institution experience

ObjectivesThere is a paucity of data on North American cohorts of patients with penile squamous cell carcinoma (pSCC). Herein, we aimed to assess the sensitivity of various modalities to identify human papillomavirus (HPV) status, determine the prevalence of high-risk HPV–positivity, and evaluate the prognostic impact of relevant clinicopathologic variables. MethodsPatients with pSCC (n = 121) consecutively treated with partial/total penectomy (2000–2022) at a single institution were included. HPV status (based on immunohistochemistry [IHC], in situ hybridization [ISH], and panviral metagenomic sequencing [PMS]), histologic features, and outcomes were reviewed. Outcome events included death due to disease and progression. ResultsThe majority of patients were white (105/121, 86.8%). Thirty-seven (30.6%) were high-risk HPV–positive, and morphologic evaluation had a sensitivity of 97.3% (95% confidence interval [CI], 86.2–99.5) for predicting high-risk HPV status compared to IHC/ISH/PMS. Disease progression was more common among high-risk HPV–negative compared to high-risk HPV–positive patients (HR 2.74, CI 1.12–8.23, P = 0.03). Moreover, among high-risk HPV–negative patients, those with moderate-poorly differentiated tumors had increased disease-specific mortality (32.6%, CI 17.1–48.1) compared to those with well-differentiated tumors (0%). Among high-risk HPV–positive patients, those with basaloid morphology had lower disease-specific mortality (0% vs 14.4%, CI 0.0–33.1). ConclusionsWe demonstrate high-risk HPV–positivity in approximately one-third of patients with pSCC. Morphologic evaluation alone had a high sensitivity in correctly determining HPV status. Our results suggest that high-risk HPV status and morphologic features (differentiation in high-risk HPV–negative, and basaloid subtype in high-risk HPV–positive pSCC) may have prognostic value.

Clinical Significance of Human Papillomavirus DNA Test and p16 Overexpression in Oropharyngeal Cancer

Background and Objectives Oropharyngeal squamous cell carcinoma (OPSCC) can be caused by human papilloma virus (HPV) infection or other factors like smoking. The 8th Edition of the AJCC Cancer Staging Manual recommends different staging and treatment approaches based on etiology. Despite criticisms of its low specificity, the current guidelines suggest using p16 immunohistochemistry (IHC) as a surrogate marker for the HPV-related OPSCC. This study assessed the reliability of p16 as a surrogate marker by correlating the survival rates of OPSCC patients with the results of p16 IHC and HPV-DNA testing.Subjects and Method A retrospective analysis was performed on patients treated for tonsil squamous cell carcinoma at a tertiary medical institution between 1994 and 2018. All patients underwent p16 immunostaining and HPV-DNA chip tests. Out of 88 patients, 17 were excluded due to insufficient data or secondary primary cancer, leaving 71 patients.Results Among the 71 patients, 51 were p16 positive and 49 were HPV-DNA positive; both tests were associated with extended survival. However, discrepancies were noted in 18 patients: specifically, 11 patients were p16 positive but HPV-DNA negative, displaying a different survival pattern compared to HPV-associated and non-HPV-associated patients.Conclusion Both p16 immunostaining and HPV-DNA testing have their pros and cons. p16 immunostaining is cost-effective but has lower specificity. The study found discrepancies in 18 patients, suggesting that relying solely on p16 immunostaining may have limitations. It would be advisable to complement it with additional tests like the HPV-DNA chip test to predict the disease’s prognosis more accurately.