High-risk HPV may increase chances of second malignancy in oral cancer

By Sarah Guy

The proportion of oral squamous cell carcinoma (OSCC) patients infected with the human papillomavirus (HPV) could be around a third, with high-risk versions of the virus accounting for almost three-quarters of those affected, indicate Taiwanese study results.

The findings also show that patients with the high-risk HPV variant HPV-18 were significantly more likely to develop secondary malignancies than their counterparts without this variant.

The small number of participants means the results require confirmation in a larger study, say the researchers. However, the results suggest that "infection with high-risk type HPV-18 plays an important role on the occurrence of second primary tumors in OSCC", they add, in Oral Diseases.

Ann-Joy Cheng (Chang Gung University, Taoyuan, Taiwan) and colleagues investigated the effect of tumor HPV status in 103 surgical patients with early-stage oral cavity cancer who were aged a mean of 49 years.

Participants' tumor tissues were analyzed for presence of 38 types of HPV, and the researchers found that 30.1% of the cohort was positive for at least one type of the infection. Indeed, the most frequent subtypes were HPV 16 and 18, at 51.6% and 22.6%, respectively, both of which are considered to have high carcinogenic risk.

Cheng and co-workers report that 33.3% of tongue and 22.7% of buccal cancers in the cohort were positive for HPV, but that HPV positivity was not significantly associated with patients' gender, tumor subsite, tumor stage, or tumor cell differentiation.

Furthermore, HPV prevalence was not significantly higher among patients who reported a history of cigarette smoking, alcohol drinking, or areca quid chewing (chewing of betel, the leaf of a vine belonging to the piperaceae family) - all known OSCC risk factors - suggesting that HPV infection may combine with other variables in the carcinogenesis of OSCC, write Cheng et al.

A total of 12 patients developed second primary tumors after surgery, including cancers of the soft palate, mouth floor, lower gum, and esophagus, during the median 41-month follow up.

And while HPV infection showed no association with the occurrence of second primary cancers, the occurrence of a secondary cancer was significantly associated with HPV 18 infection. Of the seven patients with HPV-18, three developed a second primary tumor. Moreover, say the researchers, these patients possessed the same HPV subtype in their secondary tumor.

"This result supports the theory of field cancerization that the occurrence of first and second primary tumors may associate with common etiology," the authors remark.

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