# Significance of p16 in Site-Specific Human Papillomavirus-Positive and Negative Head and Neck Squamous Cell Carcinoma (HNSCC)

## TL;DR

This study shows that p16 is a reliable biomarker for HPV in head and neck cancers and helps predict patient survival, especially when considering tumor location.

## Contribution

The study highlights p16 as a prognostic factor in HPV+ HNSCC and identifies site-specific variations in p16 expression.

## Key findings

- Most HPV+ HNSCC cases showed p16 overexpression, while few HPV- cases did.
- p16+ and HPV+ tumors were linked to better survival, while p16- and HPV- tumors had worse outcomes.
- p16 expression varied significantly by tumor location, especially in the oropharyngeal area.

## Abstract

Background: Head and neck squamous cell carcinoma (HNSCC) represents a group of cancers characterized by diverse origins and changing epidemiological patterns. The significance of high-risk human papillomavirus (HPV) infection in certain HNSCC cases has gained attention for its impact on the disease's behavior. Our current research focused on exploring the importance of using p16 as an HNSCC biomarker, particularly in the context of HPV infection, assessing its value in prognosis, and examining its variation across different tumor locations.

Materials and methods: A retrospective analysis was carried out on 100 HNSCC patients from a tertiary care center, with particular attention paid to p16 expression, HPV status, clinic-pathological characteristics, and prognosis. HPV was detected using polymerase chain reaction (PCR) techniques, and p16 expression was evaluated by immunohistochemistry. According to the ethical guidelines outlined in the Declaration of Helsinki, multivariate analysis assessed the prognostic value of p16.

Results: Our analysis demonstrated a significant correlation between HPV status and p16 expression in HNSCC cases. A vast majority of 58 (96.7%) HPV-+ cases exhibited p16 overexpression, contrasting sharply with only two (5%) in the HPV-- group. Patients with tumors that were both p16+ and HPV+ exhibited more favorable overall survival rates. In contrast, those with p16- and HPV- tumors experienced the poorest survival outcomes. Notably, having a p16-- status in HPV+ cases emerged as an independent factor for reduced survival. Additionally, the study revealed distinct variations in p16 expression based on tumor location, particularly within the oropharyngeal area.

Conclusion: The study established that p16 is a dependable indication for the existence of HPV in HNSCC and highlights its significant role as a prognostic factor, particularly in cases that are p16-- yet HPV-+. These findings underscore the importance of adopting site-specific treatment approaches in HNSCC management and contribute to a deeper understanding of p16's role in the disease, thereby aiding in more effective risk assessment and treatment planning.