HPV associated oropharyngeal cancer in eastern China over the last 7 years: is the incidence in chinese truly exceptionally low?

BACKGROUND: The prevalence of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (OPSCC) in China was reported to be remarkably low. Clinicians often prioritize HPV-unrelated OPSCC cases without fully recognizing the clinical and public health significance of HPV-related ones. We conducted a 7-year retrospective study on OPSCCs in China’s highly developed eastern region, aiming to elucidate the clinical and demographic characteristics. METHODS: The presence of HPV infection was determined using p16-immunohistochemistry in pretreatment samples obtained from all patients diagnosed with OPSCC at Eye & ENT Hospital of Fudan University between 2017 and 2023. A Total of 388 OPSCCs comprised 313 males and 75 females were analyzed. RESULTS: p16-positivity rate was 62.6%. The proportion of p16-positive patients increased steadily from 45.5% (2017) to 69.5% (2023). Females exhibited significantly higher p16 positivity rates compared to negativity (84% vs. 16%, p < 0.001), surpassing the proportion in males (84% vs. 57.5%, p < 0.001). Patients with p16-positive were younger, and males had a higher mean age (p < 0.05). The incidence rates peaked at an earlier age for p16-positive OPSCC, while there was a wider range of ages among p16-negative patients. The proportion of smokers (51% vs. 77.2%) and drinkers (41.2% vs. 68.3%) was significantly lower in p16-positive OPSCCs (p < 0.001), merely 3.2% of female patients engaged in smoking or drinking behaviors. Although the number of p16-positive cases was higher in urban areas, there was a notable rise in p16-positivity rate observed in rural areas between 2019 (16.7%) and 2023 (57.1%). p16-positive tumors were more commonly found in tonsil than negative ones (80.7% vs. 56.6%, p < 0.001). The proportion of p16-positive cases in tonsils significantly increased from 2017 to 2023, while the proportion among non-tonsil OPSCCs remained constant. In a multivariate analysis, age, drinking, tumor sublocation, residential location of the patient, and N stage had a significant impact in HPV positivity. CONCLUSIONS: A large proportion of OPSCC was related to p16-positivity, which could be the possible cause. Our study reveals significant demographic and clinical variations based on p16 status, along with a noticeable upward trend in HPV-induced tumor prevalence, emphasizing the importance of vaccination programs in eastern China.