Dados do Resumo

Título

Factors associated with HPV infection in Oropharyngeal Cancer

Introdução

Main risk factors associated to oropharyngeal squamous cell carcinoma (OPSCC) are tobacco, alcohol consumption, and human papillomavirus (HPV) infection.

Objetivo

To analyze the differences in the profile and risk factors associated in patients with OPSCC regarding the HPV infection in cohort Brazilian population; Identify the prevalence of HPV+ OPSCC by sex and second primary tumors (SPTs) by HPV infection.

Métodos

Retrospective Brazilian cohort with OPSCC patients between 2000-2022. Sociodemographic, clinical and lifestyle information were collected. Cases were staged according to the 8th edition AJCC. Descriptive analysis was conducted and described with absolute/relative frequency. The odds ratio (95%CI) was calculated stratified by HPV infection; multiple regression analysis performed for statistically significant variables. The prevalence of HPV infection was stratified by sex and the second primary tumor by HPV infection. The project was approved by the Human Research Ethics Committee, under approval number nº 2462/17.

Resultados

Of the 448 patients with OPSCC, 292 (65.2%) were HPV+ and 156 (34.8%) were HPV-. Among the HPV+ cases, 79.5% were male, HPV- cases 84.6% were male. The prevalence of HPV was 65.2%, 51.8% for men and 13.4% for women. HPV+ had >11 years of education in 38.7% of cases. The most common topographies were base of the tongue and tonsils for both. HPV+ OPSCC, the tonsils accounted 47.9% of them. Most HPV+ OPSCC cases were staged CS II/III (37.2%/33.0%), while HPV- CS IV (52.9%). HPV+ cases were 46.4% T3/T4, HPV- 60.1%. HPV+ cases were 82.0% cN+, while 61.9% HPV-. In HPV+ OPSCC, cM occurred in 8.0%, compared to 10.6% for HPV-. HPV+ patients were nonsmokers (46.2%), alcohol-drinkers (45.2%), and non-drinkers (44.1%). In regression, soft palate subsite was 84% less likely to have HPV+ tumor compared to the tonsils. Patients with advanced staging have 86%-99% lower chance of having HPV+ OPSCC. Lymph node metastasis is 9.5 times more likely to occur in HPV+ than in HPV-. Non-drinkers are 87% less likely to have HPV+ OPSCC. The prevalence of SPTs in HPV+ cases was 13.8%, in HPV- cases was 29.1%. These tumors occurred more in the respiratory tract, skin, prostate.

Conclusões

The profile of OPSCC Brazilian patients was associated with smoking/alcohol consumption, HPV infection. Individuals HPV+ showed less exposure to the risk factors tobacco/alcohol, demonstrating virus infection plays important role in the development of OPSCC. STPs are more prevalent in HPV- OPSCC, suggesting that the field of cancerization in HPV+ may be restricted and locally limited to the primary site. Although HPV+ OPSCC are more likely to present lymph node metastasis, have a lower chance of being staged at EC IV stage. This result may reflect the changes made in the 8th edition of AJCC and supports the trend for HPV+ OPSCC patients to undergo more conservative treatments. The higher prevalence of OPSCC HPV+ in men shows that is necessary public health measures as HPV vaccination to reduce the virus infection and consequently reduction of cases of OPSCC HPV related in this population. In general, this study demonstrates that OPSCC HPV+ and HPV- have different biological behaviors, this way the p16 immunohistochemistry test should be recommend for planning and better treatments outcomes.

Financiador do resumo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) providing financial support.

Palavras Chave

Oropharyngeal neoplasms; HPV; Smoking