Infectious Agents and Cancer (Nov 2023)

Findings from a Malaysian multicentre study on oropharyngeal squamous cell carcinoma

  • Hans Prakash Sathasivam,
  • Sangeetha Passu Davan,
  • Szu May Chua,
  • Rahmuna Fazlina Rohaizat,
  • Rohaizam Japar,
  • Zahirrudin Zakaria,
  • Abd Razak Ahmad,
  • Hasmah Hashim,
  • Shashi Gopalan Marimuthu,
  • Yew Toong Liew,
  • Doh Jeing Yong,
  • Pappathy Vairavan,
  • Avatar Singh Mohan Singh,
  • Benjamin Hong Beng Goh,
  • Zulkifli Yusof,
  • Khairul Azlan Shahril Abu Dahari,
  • Ali Haron,
  • Masaany Mansor,
  • Mohd Zambri Ibrahim,
  • Shiraz Qamil Muhammad Abdul Kadar,
  • Mohamad Hazri Hamal,
  • Wan Emelda Wan Mohamad,
  • Malaysian Head & Neck Cancer Research Group

DOI
https://doi.org/10.1186/s13027-023-00557-0
Journal volume & issue
Vol. 18, no. 1
pp. 1 – 10

Abstract

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Abstract Background In addition to the conventional aetiologic agents of oropharyngeal squamous cell carcinoma (OPSCC) such as tobacco usage, alcohol consumption and betel quid usage, it has been established that a proportion of OPSCC are driven by persistent oncogenic human papillomavirus (HPV) infections. Currently, there is a lack of data on the burden of HPV- associated OPSCC in Asian countries including Malaysia. Methods A cross-sectional multicentre study with tissue analysis of Malaysian patients diagnosed with primary OPSCC within a five-year period, from 2015 to 2019 between 01/01/2015 to 31/12/2019 was undertaken. Determination of HPV status was carried out using p16INK4a immunohistochemistry on tissue microarrays constructed from archived formalin-fixed paraffin-embedded tissue. Results From the cases identified, 184 cases had sufficient tissue material for analysis. Overall, median age at diagnosis was 63.0 years (IQR = 15) and 76.1% of patients were males. In our cohort, 35.3% of patients were Indian, 34.2% were Chinese, 21.2% were Malay and 9.2% were from other ethnicities. The estimated prevalence of HPV-associated OPSCC in our cohort was 31.0% (CI 24.4–38.2%). The median age for the HPV-associated OPSCC sub-group of patients was not significantly lower than the median age of patients with HPV-independent OPSCC. More than half of HPV-associated OPSCC was seen in patients of Chinese ethnicity (54.4%). Patients with HPV-associated OPSCC had a much better overall survival than patients with HPV-independent OPSCC (Log rank test; p < 0.001). Patients with HPV-associated OPSCC with no habit-related risk factors such as smoking, were found to have much better overall survival when compared to all other sub-groups. Conclusions The findings from our study suggests that prevalence of HPV-associated OPSCC in Malaysia, though not as high as some developed countries, is however on an upward trend. HPV-associated OPSCC appears to be more frequently encountered in patients of Chinese ethnicity. Conventional risk-factors associated with OPSCC such as smoking, alcohol consumption and betel quid chewing should still be considered when estimating prognosis of patients with HPV-associated OPSCC.

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