Age and tumour presentations differ between HPV type 16 positive and other high-risk HPV type-positive oropharyngeal squamous cell carcinomas in a Swedish cohort of 2000-2022

Abstract

The incidence of human papillomavirus positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC) has increased the past decades. Initial reports disclosed that HPV type 16 (HPV16) was predominant and that patients with HPV+ OPSCC were generally younger and had a better prognosis than those with HPV negative (HPV-) OPSCC. However, recent reports suggest that age differences between patients with HPV+ and HPV-OPSCC are less pronounced and that other high-risk HPV types (HR-HPV) are becoming more common. Here, we therefore investigated whether there were age differences between patients with HPV16-positive and other HR-HPV type positive OPSCC. During 2000-2022, in the Stockholm-Gotland-Region, Sweden, 1681 patients with OPSCC tested for the presence of common mucosal HPV types were included. Among these, 1180 cases had a HR-HPV type infection, with 1032 identified as HPV16 and 148 as other HR-HPV types; one with a low-risk HPV type infection; and 500 classified as HPV-. Patients with HPV+ OPSCC were significantly younger than those with HPV- OPSCC (mean 63 vs. 66.5, p <.001). Among patients with HPV+ OPSCC, those diagnosed with HPV16 were significantly younger than those with other HR-HPV types (mean 61.1 vs. 64.5, p< 0.001). These age differences were present irrespective of sex, but patients with HPV16-positive OPSCC were significantly more likely to present with smaller tumours upon diagnosis (p = 0.002). Moreover, notably, statistically significant age differences between HPV16 and other HR-HPV types were mainly observed in the more recent years (2010-2022). To conclude, the increasing influence of HR-HPV types other than HPV16 in OPSCC warrants further investigation.

Keywords: HPV types; age; base of tongue cancer; oropharyngeal cancer; tonsillar cancer.