DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20215046

P16 expression and clinicopathological features of oral and oropharyngeal squamous cell carcinoma

Rosemary Raphael, Priya P. V., Anju C. K., Sankar S.

Abstract


Background: There is an epidemiological shift in head and neck squamous cell carcinoma (HNSCC) attributable to HPV infection. HPV positive HNSCC has unique biology, risk factors, clinicopathological characteristics and outcome. There is a large variation in the published prevalence of HPV-related HNSCCs in India ranging from 7 to 78.7%. This study aims to find the P16 expression in the oral cavity and oropharyngeal SCC, thereby prevalence of HPV in our setting and to define the clinicopathological characteristics of HPV positive tumours in our setting.

Methods: 210 specimens of primary Oral squamous cell carcinoma (OSCC) and Oropharyngeal Squamous cell carcinoma (OPSCC) were included. Immunohistochemistry was done using monoclonal mouse p16 antibody. Clinical details of each case were collected. Analysis was done using SPSS software and the association of P16 and clinicopathological variables were calculated using Fishers exact test.

Results: P16 positive expression is observed only in 1/122 (0.82%) of OSCC and 8/88 (9%) of OPSCC. P16 positivity showed significant association with Grade of tumor (p= 0.008) and histological variant of SCC (p=0.00). 77.7% of P16 positive tumours are Grade 2 and 66.6% of Basaloid SCC was P16 positive. There is no significant association between p16 expression and other variables (subsite, age, gender, alcoholism, smoking, betel chewing and stage).

Conclusions: P16 positivity was higher in oropharyngeal than in oral cancer. However, the HPV positivity rates are lower than other parts of India.


Keywords


P16 immunohistochemistry, HPV, Oral Squamous cell carcinoma, Oropharyngeal squamous cell carcinoma

Full Text:

PDF

References


Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol. 2009;45(4–5):309-16.

El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ. WHO Classification of Head and Neck Tumours. International Agency for Research on Cancer. 2017;347.

Murthy V, Swain M, Teni T, Pawar S, Kalkar P, Patil A, et al. Human papillomavirus/p16 positive head and neck cancer in India: Prevalence, clinical impact, and influence of tobacco use. Indian Journal of Cancer. 2016;53(3):387.

List of Classifications – IARC Monographs on the Identification of Carcinogenic Hazards to Humans. Available at: https://monographs.iarc.fr/list-of-classifications. Accessed on 10 October 2021.

de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017;141(4):664-70.

Posner MR, Lorch JH, Goloubeva O, Tan M, Schumaker LM, Sarlis NJ, et al. Survival and human papillomavirus in oropharynx cancer in TAX 324: a subset analysis from an international phase III trial. Ann Oncol. 2011;22(5):1071-7.

Machczyński P, Majchrzak E, Niewinski P, Marchlewska J, Golusiński W. A review of the 8th edition of the AJCC staging system for oropharyngeal cancer according to HPV status. Eur Arch Otorhinolaryngol. 2020;277(9):2407-12.

Mahal BA, Catalano PJ, Haddad RI, Hanna GJ, Kass JI, Schoenfeld JD, et al. Incidence and Demographic Burden of HPV-Associated Oropharyngeal Head and Neck Cancers in the United States. Cancer Epidemiol Biomarkers Prev. 2019;28(10):1660-7.

Bahl A, Kumar P, Dar L, Mohanti BK, Sharma A, Thakar A, et al. Prevalence and trends of human papillomavirus in oropharyngeal cancer in a predominantly north Indian population. Head Neck. 2014;36(4):505-10.

Sannigrahi MK, Singh V, Sharma R, Panda NK, Radotra BD, Khullar M. Detection of active human papilloma virus-16 in head and neck cancers of Asian North Indian patients. Oral Diseases. 2016;22(1):62-8.

Yete S, D’Souza W, Saranath D. High-Risk Human Papillomavirus in Oral Cancer: Clinical Implications. Oncology. 2018;94(3):133-41.

Balaram P, Nalinakumari KR, Abraham E, Balan A, Hareendran NK, Bernard HU, et al. Human papillomaviruses in 91 oral cancers from Indian betel quid chewers--high prevalence and multiplicity of infections. Int J Cancer. 1995;61(4):450-4.

Jitani AK, Raphael V, Mishra J, Shunyu NB, Khonglah Y, Medhi J. Analysis of Human Papilloma Virus 16/18 DNA and its Correlation with p16 Expression in Oral Cavity Squamous Cell Carcinoma in North-Eastern India: A Chromogenic in-situ Hybridization Based Study. J Clin Diagn Res. 2015;9(8):EC04-07.

Singh AK, Kushwaha JK, Anand A, Sonkar AA, Husain N, Srivastava K, et al. Human Papilloma Virus in Oral Cavity Cancer and Relation to Change in Quality of Life Following Treatment—a Pilot Study from Northern India. Indian J Surg Oncol. 2016;7(4):386-91.

D’Costa J, Saranath D, Dedhia P, Sanghvi V, Mehta AR. Detection of HPV-16 genome in human oral cancers and potentially malignant lesions from India. Oral Oncol. 1998;34(5):413-20.

Nagpal JK, Patnaik S, Das BR. Prevalence of high-risk human papilloma virus types and its association with P53 codon 72 polymorphism in tobacco addicted oral squamous cell carcinoma (OSCC) patients of Eastern India. Int J Cancer. 2002;97(5):649-53.

Gheit T, Anantharaman D, Holzinger D, Alemany L, Tous S, Lucas E, et al. Role of mucosal high-risk human papillomavirus types in head and neck cancers in central India. International Journal of Cancer. 2017;141(1):143-51.

Adilbay D, Adilbayev G, Kidirbayeva G, Shipilova V, Sadyk Z, Koyanbekova G, et al. HPV infection and P16 expression in oral and oropharyngeal cancer in Kazakhstan. Infect Agent Cancer. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5767046/. Accessed on 8 June 2021.

Bhosale PG, Pandey M, Desai RS, Patil A, Kane S, Prabhash K, et al. Low prevalence of transcriptionally active human papilloma virus in Indian patients with HNSCC and leukoplakia. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(5):609-618.e7.

Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al., editors. AJCC Cancer Staging Manual [Internet]. 8th ed. Springer International Publishing. 2017. Available at: https://www.springer.com/gp/book/9783319406176. Accessed on 16 November 2021.

Devins KM, Tetzlaff MT, Baloch Z, LiVolsi VA. The evolving landscape of HPV-related neoplasia in the head and neck. Hum Pathol. 2019;94:29-39.

Ralli M, Singh S, Yadav SPS, Sharma N, Verma R, Sen R. Assessment and clinicopathological correlation of p16 expression in head and neck squamous cell carcinoma. J Cancer Res Ther. 2016;12(1):232-7.

Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, et al. Human Papillomavirus and Survival of Patients with Oropharyngeal Cancer. N Engl J Med. 2010;363(1):24-35.

Pickard RKL, Xiao W, Broutian TR, He X, Gillison ML. The prevalence and incidence of oral human papillomavirus infection among young men and women, aged 18-30 years. Sex Transm Dis. 2012;39(7):559-66.

Chaturvedi AK, D’Souza G, Gillison ML, Katki HA. Burden of HPV-positive oropharynx cancers among ever and never smokers in the U.S. population. Oral Oncol. 2016;60:61-7.

Okami K. Clinical features and treatment strategy for HPV-related oropharyngeal cancer. Int J Clin Oncol. 2016;21(5):827-35.