Human papillomavirus (HPV) as a risk factor in oropharyngeal squamous cell carcinoma (OPSCC) is well established. However, accumulating data implies that the OPSCC concept is too broad and unspecific with regard to HPV prevalence and clinical importance. To further study the role of HPV in OPSCC by sub-site, a systematic review and meta-analysis of literature published 2013-2016 was performed.
A systematic review was performed using PubMed (January 2013–November 2016). Eligible studies included all studies that reported HPV data in both lymphoepithelial associated (i.e. tonsillar and base of tongue cancer; TSCC and BOTSCC respectively) and non-lymphoepithelial (i.e. walls of oropharynx, soft palate and uvula; “other” OPSCC) OPSCC. Pooled data by HPV detection method were analysed by calculating odds ratios, using a fixed effects model.
Of the 1266 articles identified, 64 studies met the inclusion criteria, with 58 unique patient cohorts. HPV was more commonly found in TSCC and BOTSCC than in “other” OPSCC sub-sites. Total HPV prevalence in TSCC/BOTSCC was 56% (59% for TSCC only) as compared to 19% “other” OPSCC. Significant association of HPV to TSCC/BOTSCC vs. “other” OPSCC were observed no matter HPV detection method used, but statistical homogeneity was only observed when studies using algorithm based HPV detection were pooled.
HPV prevalence differs markedly between OPSCC sub-sites and while the role of HPV in TSCC/BOTSCC is strong, the role in “other” OPSCC is more uncertain and needs further evaluation before tailored treatment in this patient group.