title: HPV status and second primary tumours in oropharyngeal squamous cell carcinoma.
abstract: BACKGROUND
  The incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCCs) is rising in developed nations. Studies have shown that these virally mediated tumours are epidemiologically, clinically, and biologically different than other head and neck squamous cell carcinomas and traditional concepts of field cancerization may not apply to HPV-related oropharyngeal cancer.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the rate of second primary tumors and the diagnostic yield of field cancerization work up in the upper aerodigestive tract in patients with HPV-related and HPV-unrelated oropharyngeal squamous cell carcinoma.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary cancer care centers in Alberta.
  
  
  METHODS
  Retrospective review of 406 patients diagnosed with OPSCC in Alberta between 2005 and 2009. HPV-status of tumours was determined by tissue microarray using immunohistochemistry staining for p16.
  
  
  METHODS
  
  
  
  METHODS
  incidence of upper aerodigestive tract second primary tumours in p16-positive versus p16-negative OPSCC.
  
  
  RESULTS
  diagnostic yield of traditional field cancerization work-up in p16-positive versus negative patients.
  
  
  RESULTS
  The overall rate of SPTs was 7.4% (30/406). The incidence rate of SPTs was significantly lower in p16-positive patients (0.7 per 100 patient-yrs vs. 8.5 in p16-negative, p < 0.0001). Field cancerization work-up for synchronous lesions in the upper aerodigestive tract, including panendoscopy and whole-body PET-CT, had decreased diagnostic yield in p16-positive patients (2.8% vs. 10.2% in HPV-negative patients, p=0.02).
  
  
  CONCLUSIONS
  Patients with HPV-related OPSCC, who are non-smokers have decreased risk of developing second primary tumours in the upper aerodigestive tract and have low yield on field cancerization work-up. This study provides further evidence that virally mediated OPSCC are distinct and may benefit from alternate diagnostic pathways.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta Hospital, 8440 112 St, Edmonton, AB T6H 2H7, Canada. hadi.seikaly@albertahealthservices.ca.
authors.forename: Caroline C
authors.initials: CC
authors.lastname: Xu
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Biron
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Puttagunta
authors.forename: Hadi
authors.initials: H
authors.lastname: Seikaly
mesh_terms: D000368:Aged; D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000821:virology*; D019941:Cyclin-Dependent Kinase Inhibitor p16; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000378:metabolism; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology / Q000821:virology*; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D046888:Tissue Array Analysis
chemical_list: C000614131:CDKN2A protein, human; D019941:Cyclin-Dependent Kinase Inhibitor p16; D009363:Neoplasm Proteins