The importance of HPV testing in oropharyngeal cancer in two US populations

Authors

• M. M. Lawas, University of Michigan, Ann Arbor, MI
• M. Hsieh, LSU Health Sciences Center - New OrleansFollow
• S. Patil, Georgetown University Medical Center, Washington, DC
• E. Mohebbi, Georgetown University Medical Center, Washington, DC
• R. Zhang, Georgetown University Medical Center, Washington, DC
• J. Ahn, Georgetown University Medical Center, Washington, DC
• W. Benjamin, Head and Neck Surgery, Mass Eye and Ear, Boston, MA
• S. B. Chinn, University of Pittsburgh, Pittsburgh, PA
• M. Witek, MedStar Georgetown University Hospital, Washington, DC
• B. Mabvakure, Georgetown University Medical Center, Washington, DC
• A. Duttargi, Georgetown University Medical Center, Washington, DC
• L. M. Cruz, Georgetown University Medical Center, Washington, DC
• B. Garb, University of Michigan Medical School, Ann Arbor, MI
• S. Li, University of Michigan Medical School, Ann Arbor, MI
• N. J. D'Silva, University of Michigan, Ann Arbor, MI
• M. A. Sartor, University of Michigan Medical School, Ann Arbor, MI
• L. S. Rozek, Georgetown University Medical Center, Washington, DC

Document Type

Article

Publication Date

7-2-2026

Publication Title

Neoplasia United States

Abstract

Background: HPV-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) patients have improved survival compared to HPV-negative OPSCC (HPV–) patients (5-year survival rates of ∼80% versus ∼40%). The predictive value of p16 immunohistochemistry (IHC) for HPV+ OPSCC, the most widely used clinical test for HPV status, varies by HPV+ OPSCC prevalence in geographically different populations, but variation within a region is not well described. Methods: We analyzed p16 IHC and survival in two geographically and demographically diverse OPSCC cohorts of African American (AA, n = 177, Louisiana Tumor Registry) and non-Hispanic white (NHW, n = 392, University of Michigan) patients. Results: HPV+ prevalence was 29.3% in AA versus 86.8% in NHW. p16+ OPSCC was associated with significantly better survival in NHW than in AA patients (HR=4.65, 95% CI: 2.88-7.51, Cox p < 0.0001), adjusting for covariates. AA p16– had worse survival than NHW p16– (log-rank p < 0.001). p16 was less predictive of HPV RNA status for AA than NHW patients (positive predictive value = 65.4% vs. 94.9%, p < 0.05). Among HPV RNA+ patients (79 NHW,17 AA), AA had worse survival than NHW (log-rank p < 0.001). Conclusions: Survival disparities exist after accounting for heterogeneous HPV+ tumor rates. The PPV of p16 for HPV RNA–defined OPSCC is substantially lower in AA vs NHW patients. Guidelines for HPV testing in OPSCC should be attentive to factors beyond geography.

PubMed ID

42391786

Volume

79

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Recommended Citation

Lawas, M. M.; Hsieh, M.; Patil, S.; Mohebbi, E.; Zhang, R.; Ahn, J.; Benjamin, W.; Chinn, S. B.; Witek, M.; Mabvakure, B.; Duttargi, A.; Cruz, L. M.; Garb, B.; Li, S.; D'Silva, N. J.; Sartor, M. A.; and Rozek, L. S., "The importance of HPV testing in oropharyngeal cancer in two US populations" (2026). School of Public Health Faculty Publications. 604.
https://digitalscholar.lsuhsc.edu/soph_facpubs/604
10.1016/j.neo.2026.101323