HPV-related oropharyngeal cancer prevalence in a middle eastern population using E6/E7 PCR

Abstract

Background: Given the paucity of data and widely variable rates that have been reported, the main objective of this study was to examine the prevalence of HPV-positivity in oropharyngeal squamous cell carcinoma (OPSCC) in Middle Eastern patients presenting to one of the region's largest tertiary care centers using polymerase chain reaction (PCR) amplification of the HPV E6/E7 oncogenes, a highly sensitive and specific method of detection.

Methods: Medical charts and archived pathological specimens were obtained for patients diagnosed with biopsy proven oropharyngeal cancer who presented to the American University of Beirut Medical Center between 1972 and 2017. DNA was extracted from paraffin-embedded specimens and tested for 30 high-risk and low-risk papilloma viruses using the PCR-based EUROarray HPV kit (EuroImmun).

Results: A total of 57 patients with oropharyngeal cancer were initially identified; only 34 met inclusion/exclusion criteria and were included in the present study. Most patients were males (73.5%) from Lebanon (79.4%). The most common primary tumor site was in the base of tongue (50%), followed by the tonsil (41.2%). The majority of patients (85.3%) tested positive for HPV DNA.

Conclusion: The prevalence of HPV-positivity amongst Middle Eastern OPSCC patients, specifically those from Lebanon, may be far greater than previously thought. The Lebanese population and other neighboring Middle Eastern countries may require a more vigilant approach towards HPV detection and awareness. On an international level, further research is required to better elucidate non-classical mechanisms of HPV exposure and transmission.

Keywords: Head and neck squamous cell carcinoma; Human papilloma virus; Lebanon; Middle East; Oropharyngeal cancer.

Fig. 1

Visual summary of subtypes of HPV detected by polymerase chain reaction (n = 29). Dark color represents positivity. The most common subtype was HPV-16 (26/29, 89.7%). The remaining patients (3/29, 10.3%) tested positive for either HPV-18, HPV-39, or HPV-52 alone. Among the HPV-16 positive patients, one patient tested positive for HPV-52, and another was positive for HPV-59