title: High-risk human papillomavirus in esophageal squamous cell carcinoma.
abstract: BACKGROUND
  Although most cases of esophageal squamous cell carcinoma (ESCC) in western populations have been attributed to high levels of exposure to tobacco and alcohol, infectious agents have been postulated as possible causes, particularly human papillomavirus (HPV).
  
  
  METHODS
  To explore this issue, we analyzed HPV DNA prevalence and HPV types together with lifestyle factors, in relation to tumor stage and survival in a low-incidence population. Archived tumor samples from a nationwide cohort of 222 ESCC patients were tested for the presence of HPV DNA by PCR; positive samples were sequenced to determine HPV type, and p16(INK4a) status was assessed by immunohistochemistry.
  
  
  RESULTS
  Of 222 ESCC patients, 8 tested HPV positive (prevalence, 3.6%; 95% confidence interval, 1.1-6.1%), of which 6 were HPV-16 positive and 2 were HPV-35 positive. Four of the eight HPV-positive tumors overexpressed p16(INK4a). None of 55 normal esophageal tissue samples from healthy participants had any detectable HPV. Although the numbers were low, it seemed that patients with HPV-positive ESCC tumors were younger than those with HPV-negative tumors (mean age, 60.8 versus 65.3 years, P = 0.18) and had higher body mass index (BMI) throughout life (mean current BMI of 25.1 for HPV positive, 22.2 for HPV negative, P = 0.08; mean BMI at 20 years of 25.8 for HPV positive, 22.1 for HPV negative, P = 0.003). We found no difference between patients with HPV-positive and HPV-negative tumors with respect to other lifestyle factors.
  
  
  CONCLUSIONS
  These findings suggest a very low prevalence of HPV DNA in human ESCC.
  
  
  CONCLUSIONS
  HPV is very unlikely to be a common cause of ESCC in Australia.
authors.affiliation: Queensland Institute of Medical Research, 300 Herston Road, Herston, QLD 4029, Australia.
authors.forename: Annika
authors.initials: A
authors.lastname: Antonsson
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Nancarrow
authors.forename: Ian S
authors.initials: IS
authors.lastname: Brown
authors.forename: Adele C
authors.initials: AC
authors.lastname: Green
authors.forename: Paul A
authors.initials: PA
authors.lastname: Drew
authors.forename: David I
authors.initials: DI
authors.lastname: Watson
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Hayward
authors.forename: David C
authors.initials: DC
authors.lastname: Whiteman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001315:Australia / Q000453:epidemiology; D015992:Body Mass Index; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000821:virology*; D016022:Case-Control Studies; D004279:DNA, Viral / Q000032:analysis*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000821:virology*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D027383:Papillomaviridae / Q000145:classification*; D030361:Papillomavirus Infections / Q000150:complications*; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D004279:DNA, Viral