What is the evidence for the role of human papillomavirus (HPV) in the etiology of oropharyngeal cancers, methods of viral detection and the resulting clinical implications?
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September 2010Background: The incidence of head and neck squamous cell carcinoma (HNSCC) has remained stable over the last 15 years, while the incidence of oropharyngeal squamous cell carcinoma (OPSCC), linked both epidemiologically and molecularly to HPV infection, has risen. Fortunately, impressive amounts of clinical and molecular data have been generated in the head and neck cancer literature.
Study design: Contemporary review of literature and conference proceedings
Setting: Department of Otolaryngology-Head and Neck Surgery and Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Mo.
Synopsis: A growing library of evidence details elaborate mechanisms on the molecular level by which HPV may contribute to cellular transformation in squamous mucosal cells. In their review, the authors found that HPV-associated squamous cell carcinomas represent a disease entity distinct from carcinogen-associated squamous cell carcinomas. HPV oncoproteins lead to mucosal cell transformation through well-defined mechanisms, and there are different methods of detecting HPV, each with varying levels of sensitivity and specificity.
Studies demonstrated improved outcomes in HPV-associated carcinoma of the oropharynx only. The cell cycle regulatory protein p16 was shown to be up-regulated by biologically active HPV, serving as a biomarker of improved response to therapy.
Bottom line: Epidemiologic and molecular data document the recognition of a unique subset of HPV-associated OPSCC different from traditional carcinogen-induced HNSCC on the levels of risk factors, tumor development, response to therapy and prognosis. Additionally, the evidence shows that the majority of patients with HPV-associated OPSCC have an improved survival.
Citation: Allen CT, Lewis JS, El-Mofty SK, et al. Human papillomavirus and oropharynx cancer: biology, detection and clinical implications. Laryngoscope. 2010;120(9):1756-1772.
—Reviewed by Sue Pondrom