The epidemiological trends and survival of HPV-related oropharyngeal cancer other than tonsils and base of tongue - a systematic review and meta-analysis

Abstract

Importance: Human papillomavirus (HPV) is a well-established cause of oropharyngeal squamous cell carcinoma (OPSCC) located in the tonsils and base of tongue, but the association with other oropharyngeal subsites (otherOPSCC) remains unclear. This study aimed to examine the worldwide prevalence of HPV in otherOPSCC and its impact on survival utilizing the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Methods: The study outcomes and measures were planned at PROSPERO in advance. PubMed was searched from the earliest available record to September 1st, 2023. We included studies reporting otherOPSCC and known HPV-status. Exclusion criteria were (1) studies with ten or less otherOPSCC cases (2) studies with unspecified OPSCC subsite or with unknown primary tumor location (3) review articles, meta-analyses, and case reports (4) studies that focused exclusively on HPV+ or HPV- OPSCC. Two authors independently extracted the data.Risk of bias assessment was done using the ROBINS-E tool. The meta-analysis was conducted utilizing a random-effects model.

Results: A total of 42 studies met the inclusion criteria comprising 20 unique cohorts with a total of 6442 patients (range 11-3776). A meta-analysis showed an overall HPV prevalence of 20% (95% CI 13% 30%). We found no significant differences in the 5-year OS between HPV + otherOPSCC and HPV- otherOPSCC (56% [95% CI 29% 80%] vs 45% [95% CI 41% 49%], p = 0.43).

Conclusion: Our study revealed a low HPV prevalence in otherOPSCC (20%). HPV is not a useful prognostic factor in other OPSCCs than palatine tonsils and base of tongue locations.

Keywords: Head and neck cancer; Human papillomavirus; Meta-analysis; Oropharyngeal squamous cell carcinoma; Outcome; Prevalence; Survival; Systematic review.