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Histopathologic findings of HPV and p16 positive HNSCC§

Authors

  • Abie H. Mendelsohn MD,

    1. Division of Head and Neck Surgery, Department of Surgery , David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
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  • Chi K. Lai MD,

    1. Department of Pathology and Laboratory Medicine , David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
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  • I Peter Shintaku PhD,

    1. Department of Pathology and Laboratory Medicine , David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
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  • David A. Elashoff PhD,

    1. Department of Biostatistics , David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
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  • Steven M. Dubinett MD,

    1. Division of Pulmonary and Critical Care Medicine , David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
    2. Jonsson Comprehensive Cancer Center , David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
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  • Elliot Abemayor MD, PhD,

    1. Division of Head and Neck Surgery, Department of Surgery , David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
    2. Jonsson Comprehensive Cancer Center , David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
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  • Maie A. St. John MD, PhD

    Corresponding author
    1. Division of Head and Neck Surgery, Department of Surgery , David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
    2. Jonsson Comprehensive Cancer Center , David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A.
    • David Geffen School of Medicine at UCLA, 37-131 CHS, 10833 Le Conte Avenue, Los Angeles, CA 90095
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  • This work has been accepted for oral presentation for The Triological Society Annual Meeting, April 28–29, 2010, Las Vegas, Nevada.

  • The authors have no financial interests to disclose.

  • §

    The authors have no conflicts of interetst to disclose.

Abstract

Objective:

Human papilloma virus (HPV) and p16INKa (p16) positivity in head and neck squamous cell carcinomas (HNSCCs) is currently thought to be an encouraging prognostic indicator. However, the histopathologic changes responsible for this behavior are poorly understood. It is our objective to elucidate these histopathologic characteristics to help define the clinical utility of these markers.

Design:

Retrospective cohort study.

Methods:

71 HNSCC tumors between July 1, 2008 and August 30, 2009 were examined for HPV, p16, and epidermal growth factor receptor (EGFR). Specified pathologic features were examined: perivascular invasion (PVI), perineural invasion (PNI), grade of squamous differentiation, basaloid classification.

Results:

HPV and p16 had no direct impact on perineural or perivascular invasion. However, HPV and p16 were strongly predictive of poorly differentiated tumors, as well as basaloid squamous cell carcinoma (SCCA) (P < .001). Additionally, upon multivariate analysis, HPV(+) and p16(+) tumors had an increased risk of nodal metastasis (HPV: odds ratio [OR] = 23.9 (2.2, 265.1) p = .01; p16: OR = 6.5 (1.4, 31.2) p = .02; PVI: OR = 6.0 (1.6, 22.8) p < .01). The area under the curve (AUC) of receiver operating characteristic (ROC) curves demonstrated improved predictive value for lymph node metastasis above standard H&E histopathologic features (76.7%) for both HPV (83.2%) and p16 (81.3%) individually.

Conclusions:

HPV(+) and p16(+) are highly predictive for poorly differentiated tumors and basaloid SCCA. Additionally, HPV and p16 positivity demonstrate superior predictive value for lymph node metastasis above standard H&E histopathologic features. Although exact recommendations should be tempered by considerations of primary tumor subsite, T-stage, and depth of invasion, head and neck multidisciplinary teams should strongly consider aggressive lymph node treatment for any HPV(+) or p16(+) tumor. Laryngoscope, 2010

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