Prevalence of HPV in Oral and Oropharyngeal Squamous Cell Carcinoma at a Tertiary Care Centre

Abstract

Background: Oral and oropharyngeal squamous cell carcinoma (OSCC) represents a significant health burden with emerging evidence suggesting dual pathogenic pathways - one driven by traditional risk factors and another by human papillomavirus (HPV) infection. The relationship between HPV infection, vascular endothelial growth factor (VEGF) expression, and tumor characteristics remains incompletely understood, particularly in the Indian population.

Objectives: This study aimed to evaluate VEGF expression patterns in OSCC and their association with HPV E6/E7 oncoproteins, while additionally estimating HPV prevalence through viral oncoprotein detection. The study also examined correlations between VEGF expression and various clinicopathological parameters.

Methods: This hospital-based cross-sectional study examined 80 cases of histologically proven OSCC. Immunohistochemical analysis was performed for VEGF and HPV E6/E7 oncoproteins. VEGF expression was scored using an immunoreactivity scoring system (0-12), while HPV oncoprotein expression was evaluated using combined percentage positivity and intensity scores (0-7). Results were correlated with clinicopathological parameters.

Results: VEGF expression was detected in 85% of OSCC cases, with 30% showing high expression (score 9-12), significantly higher than in adjacent dysplastic tissue (p=0.004). HPV prevalence, as indicated by E6 expression, was 37.5%, with lower rates of E7 expression for HPV16 (26.25%) and HPV18 (20%). A significant correlation emerged between VEGF expression and tumor differentiation (p=0.012), with higher expression in well-differentiated tumors. VEGF expression showed no significant associations with HPV oncoprotein status, age, gender, tumor size, lymph node involvement, or TNM stage.

Conclusions: The high prevalence of VEGF expression in OSCC and its significant correlation with tumor differentiation suggests its potential role as a prognostic marker. The independence of VEGF expression from HPV status, despite considerable HPV prevalence in the study population, indicates that angiogenic mechanisms might operate independently of viral oncogenesis. These findings suggest that anti-VEGF therapy might be beneficial regardless of HPV status, particularly in early-stage disease.