Geographical and anatomical influences on human papillomavirus prevalence diversity in head and neck squamous cell carcinoma in Germany

Quabius,Elgar  Susanne; Haag,Jochen; Kühnel,André; Henry,Hannes; Hoffmann,Anna  Sophie; Görögh,Tibor; Hedderich,Jürgen; Evert,Matthias; Beule,Achim  G.; Maune,Steffen; Knecht,Rainald; Óvári,Attila; Durisin,Martin; Hoppe,Florian; Tribius,Silke; Röcken,Christoph; Ambrosch,Petra; Hoffmann,Markus

doi:10.3892/ijo.2014.2697

Geographical and anatomical influences on human papillomavirus prevalence diversity in head and neck squamous cell carcinoma in Germany

Authors:
- Elgar Susanne Quabius
- Jochen Haag
- André Kühnel
- Hannes Henry
- Anna Sophie Hoffmann
- Tibor Görögh
- Jürgen Hedderich
- Matthias Evert
- Achim G. Beule
- Steffen Maune
- Rainald Knecht
- Attila Óvári
- Martin Durisin
- Florian Hoppe
- Silke Tribius
- Christoph Röcken
- Petra Ambrosch
- Markus Hoffmann
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Affiliations: Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University Kiel, D-24105 Kiel, Germany, Institute for Pathology, Christian-Albrechts-University Kiel, D-24105 Kiel, Germany, Department of Otorhinolaryngology, University of Schleswig-Holstein, Campus Lübeck, D-23538 Lübeck, Germany, Institute for Medical Informatics and Statistics, Christian-Albrechts-University Kiel, D-24105 Kiel, Germany, Institute for Pathology, Ernst-Moritz-Arndt-University of Greifswald, D-17487 Greifswald, Germany, Department of Otorhinolaryngology, Head and Neck Surgery, Ernst-Moritz-Arndt-University of Greifswald, D-17475 Greifswald, Germany, Department of Otorhinolaryngology, Hospitals of the City of Cologne, Cologne, D-51067 Köln, Germany, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Medical Centre Hamburg-Eppendorf, D-20246 Hamburg, Germany, Department of Otorhinolaryngology, Head and Neck Surgery, University of Rostock, D-18057 Rostock, Germany, Department of Otorhinolaryngology, Medical University of Hannover, D-30625 Hannover, Germany, Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum Oldenburg, D-26133 Oldenburg, Germany, Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, D-20246 Hamburg, Germany
Published online on: October 7, 2014 https://doi.org/10.3892/ijo.2014.2697
Pages: 414-422

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Abstract

The increased knowledge regarding HPV-infections in head and neck squamous cell carcinoma (HNSCC) has unexpectedly contributed to several uncertainties related to i) prevalence diversities depending on tumour site and geographical origin of the patients, ii) proportion of HPV-driven tumours among HPV-DNA-positive cases, and iii) identification of patients with HPV-attributed survival benefit. To investigate this heterogeneity, we analysed 307 HNSCC cases (tonsillar, n=135; non-tonsillar, n=172) from eight health care centers mostly from Northern Germany and determined HPV-DNA/mRNA and p16INK4A-status and combined results with the patient outcome. Overall HPV-DNA prevalence rate was 23.5% (72/307); attributed to: 43.7% (59/135) and 7.6% (13/172) tonsillar and non-tonsillar cases, respectively. Among these, 96.6% tonsillar and 38.5% non-tonsillar SCC were HPV-mRNA-positive. Although the study cohort was composed of patients from regions of rather close proximity, prevalence rates showed diversities of up to 40% in HNSCC subsite analysis with the lowest prevalence for tonsillar SCC in metropolitan areas (22.2%) vs. 50.9% in rural areas. Survival analysis identified p16INK4A alone as strongest predictor, followed by HPV-DNA-status alone or in combination with p16INK4A. This survival benefit was shown for tonsillar and non-tonsillar cases. Smoking significantly correlated with HPV-status, however, it does not influence survival when stratified for HPV. In conclusion, the data emphasize the urge for further data on HPV-infection in HNSCC to, e.g. clarify to what extent survival benefits of p16INK4A-positive patients are truly attributed to HPV-infections.

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