Authors
M M Lawas, M Hsieh, S Patil, E Mohebbi, R Zhang, J Ahn, W Benjamin, S B Chinn, M Witek, B Mabvakure, A Duttargi, L M Cruz, B Garb, S Li, N J D'Silva, M A Sartor, L S Rozek
Published in
Neoplasia (New York, N.Y.). Volume 79. Pages 101323. Jul 02, 2026. Epub Jul 02, 2026.
Abstract
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.
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.
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).
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.
PMID:
42391786
Bibliographic data and abstract were imported from PubMed on 03 Jul 2026.
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