ENT, Kenyatta National Hospital, ENT Department, Nairobi, Kenya.
ENT, Kenyatta University Teaching, Research and Referral Hospital, Nairobi, Kenya.
JCO Glob Oncol. 2023 Jan;9:e2200259. doi: 10.1200/GO.22.00259.
The proportion of head and neck cancers (HNCs) with human papillomavirus (HPV) positivity in sub-Saharan Africa (SSA) is poorly characterized. Characterizing this has implications in staging, prognosis, resource allocation, and vaccination policies. This study aims to determine the proportion of HPV-associated HNC in SSA.
This systematic review included searches from PubMed, EMBASE, Web of Science, African Index Medicus, Google Scholar, and African Journals Online. All English publications reporting the proportion of HNC specimens from SSA patients who tested positive for HPV and/or p16 were included. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Case Series Studies.
In this systematic review of 31 studies and 3,850 patients, the overall p16 positivity was 13.6% (41 of 1,037 patients tested) with the highest proportion among oropharyngeal cancers (20.3%, 78 of 384 patients) and the overall HPV polymerase chain reaction positivity was 15.3% (542 of 3,548 samples tested) with the highest proportion among nasopharyngeal cancers (16.5%, 23 of 139 patients). Among the 369 HPV strains detected, the most common genotypes were HPV 16 (226 patients, 59.2%) and HPV 18 (78, 20.4%).
HPV was found to be associated with a significant proportion of HNC in SSA. The genotypes reported suggest that the nine-valent vaccine and gender-neutral vaccination policies should be considered. Given that these studies may not accurately capture prevalence nor causation of HPV in HNC subsites, additional research is needed to provide a more thorough epidemiologic understanding of HPV-associated HNC in SSA, including risk factors and clinical outcomes.
在撒哈拉以南非洲（SSA），人乳头瘤病毒（HPV）阳性的头颈部癌症（HNC）比例特征描述较差。这对头颈癌的分期、预后、资源分配和疫苗接种政策都有影响。本研究旨在确定 SSA 中 HPV 相关 HNC 的比例。
本系统综述包括从 PubMed、EMBASE、Web of Science、非洲医学索引、Google Scholar 和 African Journals Online 进行的搜索。所有报告来自 SSA 患者的 HNC 标本中 HPV 阳性和/或 p16 阳性比例的英语出版物均包括在内。使用美国国立卫生研究院病例系列研究质量评估工具评估研究质量。
在对 31 项研究和 3850 例患者的系统综述中，总体 p16 阳性率为 13.6%（1037 例患者中有 41 例检测阳性），其中口咽癌比例最高（20.3%，384 例患者中有 78 例），总体 HPV 聚合酶链反应阳性率为 15.3%（3548 例样本中有 542 例检测阳性），其中鼻咽癌比例最高（16.5%，139 例患者中有 23 例）。在所检测的 369 种 HPV 株中，最常见的基因型是 HPV 16（226 例患者，59.2%）和 HPV 18（78 例，20.4%）。
在 SSA，HPV 与 HNC 有显著相关性。报告的基因型表明，应考虑使用九价疫苗和性别中立的疫苗接种政策。鉴于这些研究可能无法准确捕捉 HNC 亚部位 HPV 的流行率和因果关系，需要进一步研究以提供对 SSA 中 HPV 相关 HNC 的更全面的流行病学理解，包括危险因素和临床结局。
