The association of human papillomavirus infection in indian cohort of head-and-neck squamous cell cancer patients and its impact on treatment outcome

Context: Head and Neck Squamous Cell Carcinomas (HNSCCs) patients with HPV-infected tumors have more favorable prognosis, however data is very sparse in Indian literature. Aim: Our study aims to detect p16 (a surrogate for tumor HPV DNA) in HNSCC and its effect on the survival of the patients. Settings and Design: Observational (prospective study). Materials and Methods: This study was conducted amongst 50 cases of HNSCC. All tissue samples for biopsy were subjected to Immunohistochemistry to study p16 expression, a surrogate marker for HPV. The patients were treated by Radiotherapy or concurrent chemo-radiotherapy depending on performance status and stage of disease. Evaluation was done at 3, 6, 12, 18, and 24 months after treatment. Survival analysis was used to check the outcome of Radiotherapy using Kaplan Meyer survival curves and cox proportional hazards model. Results: Majority of patients had Stage III disease (33 patients – 66%). 16 (32%) patients were HPV positive and 34(64%) were negative. Out of the 16 HPV positive cases, majority, 15 (93.75%) cases were associated with oropharyngeal carcinoma. 2 year DFS for HPV positive was 84% compared to 58% in HPV negative patients (P = 0.089) and 2 year overall survival for HPV positive patients was 83% compared to 52% for HPV negative patients (P = 0.03). Conclusions: Our study concluded that 32% of the HNSCC patients were positive for HPV. Patients who were HPV positive had better disease free survival and overall survival.