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. 2019 Feb;41(2):349-357.
doi: 10.1002/hed.25450. Epub 2018 Dec 14.

Epstein-Barr virus and human papillomaviruses as favorable prognostic factors in nasopharyngeal carcinoma: A nationwide study in Finland

Miia Ruuskanen  1 , Heikki Irjala  1 , Heikki Minn  2 , Tero Vahlberg  3 , Reija Randen-Brady  4 , Jaana Hagström  4   5 , Stina Syrjänen  6   7 , Ilmo Leivo  7
Affiliations

Epstein-Barr virus and human papillomaviruses as favorable prognostic factors in nasopharyngeal carcinoma: A nationwide study in Finland

Miia Ruuskanen et al. Head Neck. 2019 Feb.

Abstract

Background: Nasopharyngeal carcinoma (NPC) is related to Epstein-Barr virus (EBV) in endemic areas; however, the role of viruses in nonendemic countries is unclear. Our nationwide study investigated the prevalence and prognostic significance of EBV and human papillomaviruses (HPVs) in Finnish NPC tumors.

Methods: We analyzed samples from 150 patients diagnosed between 1990 and 2009. Viral status was determined using EBV and HPV RNA in situ hybridizations, and p16 immunohistochemistry. Patient and treatment characteristics were obtained from patient records.

Results: In our white patient cohort, 93 of 150 (62%) patients were EBV-positive and 21/150 (14%) patients were HPV-positive with no coinfections. Thirty-six (24%) tumors were negative for both viruses. The 5-year disease-specific survival for patients with EBV-positive, HPV-positive, and EBV/HPV-negative tumors was 69%, 63%, and 39%, respectively. In multivariable-adjusted analysis, overall survival was better among patients with EBV-positive (P = .005) and HPV-positive (P = .03) tumors compared to patients with EBV/HPV-negative tumors.

Conclusions: In our low-incidence population, EBV and HPV are important prognostic factors for NPC.

Keywords: Epstein-Barr virus; human papillomavirus; nasopharyngeal carcinoma; p16 immunohistochemistry; viral carcinogenesis.

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Figures

Figure 1
Figure 1
Histopathological subtypes of nasopharyngeal carcinoma observed in the study (A‐C). A, Keratinizing squamous cell carcinoma. B, Non‐keratinizing carcinoma, differentiated type. C, Nonkeratinizing carcinoma, undifferentiated type. D, Negative control for HPV DNA in situ hybridization. A‐H, Magnification ×250. EBV, Epstein‐Barr virus; HPV, human papillomavirus; E, Immunohistochemical staining for p16. F, EBV RNA in situ hybridization (EBER). G, HPV E6/E7 mRNA in situ hybridization. H, HPV DNA in situ hybridization
Figure 2
Figure 2
A, Overall survival and (B) disease‐free survival for different viral statuses. EBV, Epstein‐Barr virus; HPV, human papillomavirus
See this image and copyright information in PMC

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