Gypsyamber D’Souza, PhD; William H.Westra, MD; Steven J.

Wang, MD; Annemieke van Zante, MD; Alicia Wentz, MA; Nicole Kluz, MA;
Eleni Rettig, MD; William R. Ryan, MD; Patrick K. Ha, MD; Hyunseok Kang,MD, MPH; Justin Bishop, MD; Harry Quon, MD; Ana P. Kiess,
MD; Jeremy D. Richmon, MD; David W. Eisele, MD; Carole Fakhry, MD, MPH

Presented by :
dr. Belly Sutopo Wijaya
Mentors :
dr. Denny Satria Utama, Sp.T.H.T.K.L.(K), Msi.Med., FICS
dr. Erial Bahar, M.Sc
 INTRODUCTION

• Human papillomavirus (HPV)  ↑ proportion OPSCCs in white men

• The prevalence HPV in HNSCC  unclear in women and non white

 OBJECTIVE

To explore the role of HPV 

women & nonwhites with OPSCC and (non-OP HNSCC)

 METHODS
• Johns Hopkins Hospital Sydney Kimmel

Place Comprehensive Cancer Center

• Helen Diller Family Comprehensive Cancer
Center

Time •1995 - 2012

• Retrospective study
Method • Diagnostic test
INCLUSION CRITERIA EXCLUSION CRITERIA

• HNSCC (OP, oral cavity, • Pathologic sample not

nasopharynx,larynx) available for testing

• Tested HPV-related markers

 PROCEDURE
1345 HNSCC
patients

339 OP, 372 oral cavity,

268 nasopharynx, and 366 larynx cancer

863 eligible
for HPV Included in
testing analysis

p16 IHC
HPV16 DNA ISH
HPV E6/E7 mRNA ISH
 RESULTS

240 OPSCCs
“ 60% p16 (+) 1995 - 2012
56% HPV16 DNA ISH (+)” “ p16 (+) OPSCC ↑
significantly
women (29% to 77%)
men (36% to 72%)”
623 non-OP HNSCCs,
p16(+) and ISH(+) 
10% vs 5%
 DISCUSSION
Jemal A, Simard EP, Dorell C, et al  Population-based data,

Lower incidence & prevalence of HPV-related OPSCC in women

 This study show a significant ↑ in the prevalence of HPV in OPSCC for

women

Schrank TP, Han Y,Weiss H, Resto VA  Incidence HPV-related

OPCCs lower in nonwhites
 In this study there is ↑ HPV related OPSCC in Asian & Hispanic ;
lower in blacks
• Chung CH, Zhang Q, Kong CS, et al  Prior studies shown
prevalence p16 > ISH in non-OPSCC

 Non-OPSCCs p16 had lower sensitivity and poor positive

predictive value for ISH (+)

Sensitivity and specificity of p16 for ISH (+) high among OPSCC cases
 CONCLUSIONS

• From 1995 - 2012, OPSCCs caused by HPV ↑ significantly

• Not restricted to white men  women & nonwhite

• P16 (+)  good surrogate for ISH(+) tumor status in OPSCC,

but NOT a good surrogate for non-OP HNSCC

CRITICAL APPRAISAL
1. Is the background of the study clearly stated?

YES
2. What is the objective of this research?

To explore the role of HPV tumor status among women and nonwhites
with OPSCC and patients with non-OP HNSCC
3. Was there an independent, blind comparison with a
reference (“gold”) standard of diagnosis?

YES
4. Was the diagnostic test evaluated in an appropriate spectrum of
patients (like those in whom it would be used in practice)?

YES
5. Was the reference standard applied regardless of the diagnostic
test result?

YES
6. Was the test (or cluster of tests) validated in a second,
independent group of patients?

YES
7. Is the diagnostic test available, affordable, accurate, and precise
in your setting?

YES
8. Is it unlikely that the disease possibilities or probabilities
have changed since the evidence was gathered?

NO
9. Was the validity of the data can be verified?

YES
10. What kind of association analysis was obtained?

• During 1995 through 2012, the proportion of OPSCCs caused by

HPV has increased significantly

• This increase not restricted to white men but was a consistent

trend for women and men, as well as for white and nonwhite racial

groups

• P16 positivity was a good surrogate for ISH+ tumor status among

OPSCC, but not a good surrogate for non-OP HNSCC

CONCLUSION

Valid Important Applicable

THANK YOU