2016 AHNS Annual Meeting

United Kingdom Multicentre Hpv Oropharynx Cancer Cross-sectional Study - An Evolution In The Understanding Of Disease Aetiology

Presentation:	S303
Topic:	Oropharynx
Type:	Oral
Date:	Tuesday, July 19, 2016
Session:	10:30 AM - 12:00 PM Best of Clinical II
Authors:	Andrew G Schache, MD, PhD¹, Ned Powell, PhD², Kate Cuschieri, PhD³, Max Robinson, PhD⁴, Sam Leary, PhD⁵, Hisham Mehanna, MD, PhD⁶, Davy Rapozo⁷, Anna Long⁴, Heather Cubie³, Elizabeth Junor⁸, Hannah Monaghan⁹, Kevin Harrington, PhD¹⁰, Christopher M Nutting, PhD¹⁰, Ulrike Schick¹⁰, Andy S Lau¹, Jon Sheard¹, Catharine M West, PhD¹¹, Ken Oguejiofor¹¹, Steve Thomas, PhD⁵, Andy R Ness, PhD⁵, Miranda Pring⁵, Dennis J McCance, PhD¹², Jacqueline A James, PhD¹³, Michael Moran, MD, PhD¹⁴, Emma V King, PhD¹⁵, Gareth Thomas, PhD¹⁶, Phil Sloan⁴, Richard J Shaw, MD¹, Mererid Evans, MD, PhD¹⁷, Terry M Jones, MD¹ cetirizin pharma gravidgraviditet.site cetirizin loratadin lansoprazol 30 mg dosis lansoprazol sandoz lansoprazol stada 15 mg
Institution(s):	¹University of Liverpool, ²Cardiff University, ³Scottish Human Papillomavirus Reference Laboratory, ⁴Newcastle University, ⁵University of Bristol, ⁶University of Birmingham, ⁷Brazilian National Cancer Institute, ⁸Edinburgh Cancer Research Centre, ⁹Royal Infirmary of Edinburgh, ¹⁰The Royal Marsden Hospital, ¹¹University of Manchester, ¹²University of New Mexico, ¹³Northern Ireland Molecular Pathology Laboratory, ¹⁴University College London Hospital NHS Trust, ¹⁵Poole Hospital NHS Foundation Trust, ¹⁶University of Southampton, ¹⁷Velindre Cancer Centre imipramin cancer imipramin pris imipramin tablete atarax constipation atarax tabletter atarax with alcohol imipramin rezeptfrei imipramin wiki imipramin lek

Background: Substantial increases in the incidence of oropharyngeal squamous cell carcinoma (OPSCC) have been observed throughout the developed world. This observation has frequently been attributed to Human Papillomavirus (HPV). This pan-United Kingdom (UK) multicentre, cross-sectional study aimed to determine the incidence of HPV positive and negative OPSCC within the population.

Methods: OPSCC cases diagnosed between 2002 and 2011 were collated from 11 geographically distributed centres across the UK. An overall target sample-size of 1710 was deemed sufficient to allow comparison of prevalence between years with 7.5% precision. To avoid selection bias, the first 17 cases (11 cases for two smaller centres) diagnosed in each calendar year, with available formalin-fixed paraffin embedded (FFPE) tumour blocks, were included, irrespective of the definitive treatment modality employed.

Of the 1602 archival tumour-tissue blocks returned, 1529 samples met inclusion criteria and were tested for HPV using three commercial tests performed in accredited laboratories (p16 immunohistochemistry, HPV DNA in-situ hybridisation, and multiplex HPV PCR). Valid HPV diagnostic data were obtained for 1474 cases.

UK Incidence data for OPSCC corresponding to the same decade (2002-2011) were obtained from the UK Cancer registries.

The study determined the overall proportion of OPSCC caused by HPV and assessed HPV prevalence by gender, age and anatomical subsite over time. Overall incidence rates for OPSCC in the UK were calculated, and the proportion of OPSCC attributable to HPV estimated.

Results: The overall proportion of OPSCC caused by HPV (2002-2011) was 51.8% (95% CI: 49.3, 54.4).
There was no change in the proportion of HPV-attributable cases over time (unadjusted risk ratio: 1.00 (95% CI: 0.99, 1.02)). This lack of change was irrespective of the HPV diagnostic test employed and the finding remained consistent after adjustment for gender, age at diagnosis, anatomical subsite and study centre (adjusted risk ratio: 1.00 (95% CI: 0.98, 1.03)).

Over the same period however, the incidence of OPSCC in the UK underwent a 2-fold increase (age standardised rate (ASR) 2002: 2.1(95% CI: 1.9, 2.2); 2011: 4.1 (95% CI: 4.0, 4.3)).

Conclusions: Although the absolute numbers of OPSCC diagnosed within the UK between 2002 and 2011 almost doubled, the proportion of HPV-attributable cases remained static within the same period, at approximately 50%.
These results provide the first evidence that the rapidly increasing incidence of OPSCC cannot be solely attributable to the influence of HPV.
The reasons for the parallel increase in HPV-negative disease warrant further investigation so that future appropriate prevention strategies for both HPV-positive and negative disease can be implemented.

AHNS Annual Meeting

July 16-20, 2016
Washington State Convention Center
Seattle, WA

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