BACKGROUND

The aim of this study was to investigate the effect of inconsistent expression of p16 and HPV on the prognosis of patients with Oropharyngeal squamous cell carcinoma (OPSCC) in Chinese/Asian populations.

METHODS

The study included 130 patients. Inclusion criteria were primary OPSCC. The primary outcome was the proportion of cohort patients showing different combinations of p16 and HPV outcomes, as well as overall survival (OS) and progression-free survival (PFS). Patients with relapsed or metastatic disease or palliative care were excluded from the survival analysis. A multivariate analysis model was used to calculate the adjusted hazard ratio for overall survival for different p16 and HPV tests, adjusted for pre-specified confounders.

RESULTS

Among the 130 patients, 25 (19.2%) demonstrated inconsistency between HPV and p16 expressions. The inconsistency in HPV/p16 status was significantly associated with patient age, smoking history, and alcohol consumption, leading to significant differences in tumor site, TNM staging, and differentiation, thereby influencing treatment decisions. There were significant differences in OS (P = 0.04) and PFS (P = 0.011) among the three groups, with the inconsistent group falling between the HPV+/p16 + group and the HPV-/p16- group but closer to the latter. Out of 54 p16-positive patients, only 33 (61.1%) were HPV-positive, indicating a lower predictive value of p16 for HPV positivity in OPSCC than observed in Western populations. Moreover, the study suggested a potential positive correlation between p16 expression intensity and improved patient prognosis.

CONCLUSION

In the China/Asia region, where HPV infection rates are relatively low, the predictive power of p16 for HPV-related OPSCC is low. We recommend additional HPV testing in patients with p16 + OPSCC to improve diagnostic accuracy, thereby enabling the selection of the best de-escalation treatment strategy, increasing treatment response rates, and ultimately improving the overall prognosis in these patients.