Basic and patient-oriented research
Prevalence and Significance of Human Papillomavirus in Oral Tongue Cancer: The Mayo Clinic Experience

https://doi.org/10.1016/j.joms.2008.04.009Get rights and content

Purpose

Cigarette smoking and alcohol use have markedly decreased in the past 40 years. However, there has been an increasing trend in the incidence of tongue cancer, particularly in young patients without traditional risk factors. This study sought to examine the prevalence and significance of human papillomavirus (HPV) infection and its clinical significance in patients with oral tongue cancer.

Patients and Methods

Fresh-frozen tissues from 51 patients with oral tongue cancer, treated with primary surgery from January 2004 to December 2006, were included in the study. The presence of HPV infection in tumor specimens was analyzed by polymerase chain reaction with HPV L1 consensus primers (GP 5+/GP 6+) and HPV-16-specific E6 primer pairs. Demographic and clinical data were collected to analyze patient outcomes.

Results

The overall frequency of HPV in oral tongue cancer in our study was 1.96% (1/51). Young patients below the age of 45 years accounted for 15.7% (8/51) of the total number of patients. Eighty-seven percent of the younger age group, including a single patient with an HPV-16-positive tumor, were alive and free from disease during the follow-up period. The overall survival of the study group was 81.4%.

Conclusions

Our data suggest that the incidence of HPV in oral tongue cancer is low and is unlikely to play a significant role in the etiology, pathogenesis, and clinical outcomes of oral tongue cancer. In addition, HPV is unlikely to constitute a significant factor in the rising trend of oral tongue cancer in the young population.

Section snippets

Patients

Fifty-one patients with histologically confirmed oral squamous-cell carcinomas of the tongue, who underwent primary surgical treatment at the Mayo Clinic from January 2004 to December 2006, were included in this study. Age, gender, race, TNM stage, histologic grade, treatment information, and follow-up outcome data were abstracted from the clinical records. The classification of TNM stage was performed according to the American Joint Committee on Cancer (AJCC-Sixth Edition, 2002), and

Results

A sample of 51 patients, diagnosed with squamous-cell carcinoma (SCC) of the oral tongue at the Mayo Clinic from January 2004 to December 2006, was included. Out of 51 samples, there were 50 HPV-negative samples, and only a single HPV-positive (HPV-16) tumor (Figure 1, Figure 2). This single HPV-positive patient was below 45 years of age.

All patients were managed by primary surgery with additional postoperative adjuvant therapy, based on several patient and tumor factors. Patients with high

Discussion

The mechanism of HPV carcinogenesis has been delineated in cervical cancer, where approximately 99% of cervical tumors are associated with HPV-16/18 as the primary etiology.11 The integration of HPV into a human chromosome leads to the loss of E2 and E1 genes in the 8-kb HPV genome, which are important regulators of E6 and E7 protein production.31, 32, 33 The E6 and E7 genes are oncoproteins produced by HPV, and are responsible for the ubiquination and proteosomic degradation of p53 and Rb,

Acknowledgment

We are grateful to Odey Ukpo for technical assistance.

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