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Keywords:

  • betel-quid;
  • oral squamous cell carcinoma;
  • p16INK4A;
  • prognosis

Abstract

Objectives

In this study, we examined the role of p16INK4A, a surrogate biomarker of HPV-related head and neck cancers with better prognosis, in an endemic area of betel quid (BQ)-related oral squamous cell carcinoma (OSCC).

Methods

p16INK4A immunohistochemistry was examined in 165 OSCCs, statistical analyses were performed to elucidate the correlation between p16INK4A expression and BQ habits/pathologic features, and the prognostic impact of p16INK4A and different parameters were analyzed.

Results

The incidence of p16INK4A expression was similar between BQ chewers and non-chewers. p16INK4A expression was significantly associated with nodal metastasis (P = 0.005). There was a trend suggesting that the loss of p16INK4A expression was more frequent in higher T stages, however, this was found only in patients without lymph node metastasis (P = 0.059). A poorer prognosis and a higher risk of tumor recurrence were found in OSCCs without p16INK4A expression. (The HR for cancer-specific mortality and cancer recurrence was 3.55 and 1.89, respectively.)

Conclusion

Although it has been suggested that BQ chewers had a greater tendency toward tumor recurrence and poor outcome, our data demonstrated that p16INK4A expression is unrelated to BQ habit and that p16INK4A downregulation is a strong predictor for OSCC progression, recurrence and survival in Taiwan. J. Surg. Oncol. 2012; 106:149–154. © 2012 Wiley Periodicals, Inc.