title: Human papillomavirus/p16 positive head and neck cancer in India: Prevalence, clinical impact, and influence of tobacco use.
abstract: BACKGROUND
  Limited data are available on the prevalence and prognostic significance of human papillomavirus (HPV) in squamous cell carcinoma of head and neck (SCCHN) in the Indian population.
  
  
  OBJECTIVE
  The present study aimed to determine the prevalence of HPV and p16 in an Indian cohort of SCCHN and assess their correlation and influence of tobacco use on patient outcomes.
  
  
  METHODS
  The p16 and HPV status of 170 patients of SCCHN treated with curative chemoradiotherapy was determined using immunohistochemistry and polymerase chain reaction, respectively, and further correlated with their demographic characteristics. In addition, genotyping of HPV-positive samples was performed. Survival outcomes were analyzed and compared for both p16 positive (p16 +ve) and p16 negative (p16 -ve) population. The influence of tobacco use on outcomes was assessed.
  
  
  RESULTS
  p16 expression was observed in 20% (34/170) cases whereas HPV positivity was detected in 39.4% (67/170) of SCCHN patients with HPV16 being the most common (91%) subtype. About 73.5% patients were p16 +ve among the tobacco users in this cohort (83.5%). Interestingly, p16 positivity was significantly associated with nonusers of tobacco (P = 0.02) and younger females (P = 0.06). The p16 +ve and p16 -ve groups did not exhibit a significant difference in the 5-year cause-specific survival (CSS) (79% vs. 72.2%), disease-free survival (DFS) (78.3% vs. 68.3%, P = 0.5), and locoregional control (LRC) (82.2% vs. 71.5%, P = 0.4). However, the outcome analyses in tobacco nonusers revealed a definite large improvement in CSS (P = 0.08) and a trend toward improvement in DFS (P = 0.15) and LRC (P = 0.11) in the p16 +ve versus the p16 -ve groups.
  
  
  CONCLUSIONS
  The low prevalence of p16 positivity (20%) and dual HPV and p16 positivity (38.8%) in the studied Indian cohort indicates the low utility of p16 as a surrogate for HPV in the background of high tobacco burden. The outcomes are largely improved in a small subset of SCCHN cases comprising p16 +ve tobacco nonusers.
authors.affiliation: Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India.
authors.forename: V
authors.initials: V
authors.lastname: Murthy
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: M
authors.initials: M
authors.lastname: Swain
authors.affiliation: Department of Teni Lab, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India.
authors.forename: T
authors.initials: T
authors.lastname: Teni
authors.affiliation: Department of Teni Lab, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India.
authors.forename: S
authors.initials: S
authors.lastname: Pawar
authors.affiliation: Department of Teni Lab, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India.
authors.forename: P
authors.initials: P
authors.lastname: Kalkar
authors.affiliation: Department of Pathology, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India.
authors.forename: A
authors.initials: A
authors.lastname: Patil
authors.affiliation: Department of Teni Lab, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India.
authors.forename: A
authors.initials: A
authors.lastname: Chande
authors.affiliation: Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India.
authors.forename: S
authors.initials: S
authors.lastname: Ghonge
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: S G
authors.initials: SG
authors.lastname: Laskar
authors.affiliation: Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, Maharashtra, India.
authors.forename: T
authors.initials: T
authors.lastname: Gupta
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: A
authors.initials: A
authors.lastname: Budrukkar
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: J
authors.initials: J
authors.lastname: Agrawal
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000821:virology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000821:virology*; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D015995:Prevalence; D000077195:Squamous Cell Carcinoma of Head and Neck; D064424:Tobacco Use / Q000009:adverse effects / Q000453:epidemiology*