HPV DNA, E6*I-mRNA expression and p16INK4A immunohistochemistry in head and neck cancer - how valid is p16INK4A as surrogate marker?

Cancer Lett. 2012 Oct 1;323(1):88-96. doi: 10.1016/j.canlet.2012.03.033. Epub 2012 Apr 3.


It has been proposed that p16(INK4A) qualifies as a surrogate marker for viral oncogene activity in head and neck cancer (HNSCC). By analyzing 78 HNSCC we sought to validate the accuracy of p16(INK4A) as a reliable marker of active HPV infections in HNSCC. To this end we determined HPV DNA (HPVD) and E6*I mRNA (HPVR) expression status and correlated these results with p16(INK4A) staining. In tonsillar SCC 12/20 were HPVD+ and 12/12 of these showed active HPV infections whereas in non-tonsillar SCC 10/58 were HPVD+ and 5/10 showed active HPV infections. Thus, we prove about 8% of non-tonsillar SCC to be also correlated with HPV-associated carcinogenesis. Strikingly, 3/14 (21.4%) of tonsillar and non-tonsillar HPVD+/HPVR+ cases did not show p16(INK4A) overexpression and these cases would have been missed when applying initial p16(INK4A) staining only. However, in 13 cases negative for HPV, DNA p16(INK4A) was overexpressed. In conclusion, our data confirm tonsillar SCC to be predominantly but not only associated with active HPV infections. Furthermore, our data show that p16(INK4A) overexpression is not evident in a subgroup of HNSCC with active HPV infection. Definitive HPV data should therefore be utilized in diagnostics and treatment modalities of HPV positive and HPV negative HNSCC patients, resulting in a paradigm shift regarding these obviously different tumor entities.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Biomarkers / analysis*
  • Carcinoma, Squamous Cell / metabolism
  • Carcinoma, Squamous Cell / virology*
  • Cyclin-Dependent Kinase Inhibitor p16 / analysis*
  • DNA, Viral / analysis*
  • Female
  • Head and Neck Neoplasms / metabolism
  • Head and Neck Neoplasms / virology*
  • Humans
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Multiplex Polymerase Chain Reaction
  • Oncogene Proteins, Viral / analysis*
  • Papillomavirus Infections / complications
  • Papillomavirus Infections / diagnosis
  • RNA, Messenger / analysis
  • Squamous Cell Carcinoma of Head and Neck
  • Tonsillar Neoplasms / metabolism
  • Tonsillar Neoplasms / virology


  • Biomarkers
  • Cyclin-Dependent Kinase Inhibitor p16
  • DNA, Viral
  • E6 protein, human papillomavirus type 1
  • Oncogene Proteins, Viral
  • RNA, Messenger