The impact of HPV vaccination on the prevalence of oropharyngeal cancer (OPC) in a hospital‐based population: A cross‐sectional study of patient’s registry

Oropharyngeal cancer and human papillomavirus: a visualization based on bibliometric analysis and topic modeling

Objectives

The incidence of oropharyngeal cancer (OPC) is increasing. This study used bibliometric analysis and topic modeling to explore the research trends and advancements in this disease over the past 10 years, providing valuable insights to guide future investigations.

Methods

7,355 English articles from 2013 to 2022 were retrieved from the Web of Science Core Collection for bibliometric analysis. Topic modeling was applied to 1,681 articles from high-impact journals, followed by an assessment of topic significance ranking (TSR). Medical Subject Headings (MeSH) terms were extracted using R and Python, followed by an analysis of the terms associated with each topic and on an annual basis. Additionally, genes were extracted and the number of genes appearing each year and the newly emerged genes were counted.

Results

The bibliometric analysis suggested that the United States and several European countries hold pivotal positions in research. Current research is focused on refining treatments, staging and stratification. Topic modeling revealed 12 topics, emphasizing human papillomavirus (HPV) and side effect reduction. MeSH analysis revealed a growing emphasis on prognosis and quality of life. No new MeSH terms emerged after 2018, suggesting that the existing terms have covered most of the core concepts within the field of oropharyngeal cancers. Gene analysis identified TP53 and EGFR as the most extensively studied genes, with no novel genes discovered after 2019. However, CD69 and CXCL9 emerged as new genes of interest in 2019, reflecting recent research trends and directions.

Conclusion

HPV-positive oropharyngeal cancer research, particularly treatment de-escalation, has gained significant attention. However, there are still challenges in diagnosis and treatment that need to be addressed. In the future, more research will focus on this issue, indicating that this field still holds potential as a research hotspot.

Human Papilloma Virus Positive Oropharyngeal Squamous Cell Carcinoma and the Immune System: Pathogenesis, Immunotherapy and Future Perspectives

Oropharyngeal squamous cell carcinoma (OPSCC), a subset of head and neck squamous cell carcinoma (HNSCC), involves the palatine tonsils, soft palate, base of tongue, and uvula, with the ability to spread to adjacent subsites. Personalized treatment strategies for Human Papillomavirus-associated squamous cell carcinoma of the oropharynx (HPV+OPSCC) are yet to be established. In this article, we summarise our current understanding of the pathogenesis of HPV+OPSCC, the intrinsic role of the immune system, current ICI clinical trials, and the potential role of small molecule immunotherapy in HPV+OPSCC.

Uneven Expression of 20 Human Papillomavirus Genes Associated with Oropharyngeal Carcinoma

BACKGROUND

Human papillomavirus (HPV) is considered to be responsible for 95% of virus-related cancers in many organs. Oropharyngeal carcinoma (OC) is distinguished by the transformation of the healthy epithelium into precancerous cells.

AIM

The current study sought to examine the uneven gene expression of 20 genes among those scanned by microarray for oropharyngeal cancer patients.

MATERIALS AND METHODS

The GSE56142 dataset was extracted from the Gene Expression Omnibus of the National Center for Biotechnology Information; 24 specimens were evaluated. Gene ontology (GO), the Kyoto Encyclopedia of Genes and Genomes, and the protein-protein interaction (PPI) were used to depict the biological roles of the genes under investigation using types of software.

RESULTS

Six genes out of 20 in patients with invasive OC had a binding correlation with high expression (PDGFRS, COL6A3, COL1A1, COL3A1, COL2A1, and COL4A1), and only two genes with low expression (CRCT1 and KRT78). The expression levels of 20 genes were examined for patients with OC versus head and neck squamous cell carcinoma (HNSCC). The correlation coefficient between highly expressed genes of the OC group was statistically significant at the P<0.05 level.

CONCLUSIONS

High expression levels of specific genes may serve as diagnostic tumor markers, particularly in the early stages of cancer, and testing should be performed in OC and HNSCC patients.

Investigating women's awareness and perceptions on human papillomavirus infection and oropharyngeal cancer in Italy

Introduction

This study explored knowledge, attitudes and behaviors toward human papillomavirus (HPV) infection and oropharyngeal cancer (OPC) among women attending primary care services.

Methods

The cross-sectional study was conducted from September to December 2022 in adult women attending three primary care services in Italy, who were invited to complete a self-administered questionnaire.

Results

Overall, 34.7% of participants know that OPC is HPV-associated; knowledge was higher among women who had personal, familiar or friends' experience of cancer, and who reported to often seek dental care, whereas it was lower in older women. The perception of risk of developing OPC was high for 26.4% of women and was higher in those who had experienced STD, who knew that early sexual debut is a risk factor for OPC, and who considered useful the role of dentists on the provision of information about OPC. Only 22.5% had received HPV vaccination, but 62% intended to receive it in the future. Moreover, 63.2% believe that HPV vaccination is very useful to prevent OPC and only 27% are concerned about health consequences of HPV vaccination.

Conclusion

These findings indicate that women's awareness of the role of HPV infection in the development of OPC is not satisfactory and underline the role that dentists might have in improving their patients' awareness on HPV related OPC.

The effectiveness of HPV vaccination on the incidence of oropharyngeal cancers in men: a review

BACKGROUND

Human Papilloma Virus (HPV) contributes to the development of oropharyngeal cancer (OPC) and is currently the leading cause of OPC in the Western world. There have been limited studies examining the effect of HPV-vaccination on OPC incidence in men. This review aims to interrogate relationship linking HPV-vaccination and OPC in men, to potentially recommend pangender HPV-vaccination, to reduce the incidence of HPV associated OPC.

MAIN BODY

A review was carried out using Ovid Medline, Scopus and Embase databases, on 22nd October 2021 investigating the effect of HPV-vaccination on OPC prevalence in men and including studies with vaccination data pertaining to men in the past 5 years, while excluding those studies without appropriate oral HPV-positivity data and non-systematic reviews. Studies were evaluated as per the PRISMA guidelines and ranked using risk of bias tools including RoB-2, ROBINS-1 and the NIH quality assessment tools. 7 studies were included ranging from original research to systematic review articles. All studies were published in English from 2017 to 2021. Overall, these suggested that HPV-vaccination reduced levels of oral HPV positivity in men. This was thought to be indicative of a reduced risk of development of HPV-associated OPC. A limitation of this study was the inability to conduct meta-analysis due to the heterogeneity of included studies. We noted a significant impact on the reduction of HPV positivity post HPV-vaccination and a potential contribution to reducing the future incidence of OPC.

CONCLUSION

This review makes a strong case for pangender HPV-vaccination in combatting OPC in men.

Health inequities in human papillomavirus prevention, diagnostics and clinical care in the USA: a scoping review

BACKGROUND

Human papillomavirus (HPV) represents the most common STI in the USA. HPV inequities in prevention, diagnostics and clinical care persist. We define inequities as systematic, avoidable and unfair differences in health outcomes.

OBJECTIVES

The objectives of this scoping review are to chart existing data on HPV-related inequities, identify gaps in existing literature and guide future research to reduce these inequities.

METHODS

We completed a scoping review following guidelines from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping reviews extension. We performed a literature search on PubMed and Ovid Embase in July 2022 for articles pertaining to HPV and evaluating populations within the USA. We included English language publications from 2018 to 2022 evaluating at least one health inequity outlined by the National Institutes of Health. General publication characteristics and health inequity data were charted in a masked, duplicate fashion using a pilot-tested Google Form. We analysed frequencies of health inequities and summarised main findings from included studies.

RESULTS

Our final sample included 170 publications. The most common inequities examined were race/ethnicity (140 studies), sex or gender (97 studies), and income (69 studies). Many historically marginalised racial/ethnic groups had lower rates of HPV-related knowledge, vaccination and worse overall outcomes related to HPV. Compared with women, men had lower rates of HPV vaccination and provider recommendation, and higher rates of HPV-infection. Results regarding income were largely conflicting.

CONCLUSION

Findings from our review demonstrate clear gaps in HPV-related inequity research. Vaccine completion, provider recommendation and intersectionality should continue to be evaluated to implement targeted interventions.

Immunisation schedule of the Spanish Association of Paediatrics: 2023 Recommendations

As it does every year, the CAV-AEP publishes the update of its recommendations for the use of vaccines in children, adolescents and pregnant women residing in Spain. The 2 + 1 schedule is maintained in infants (at 2, 4 and 11 months), including preterm infants, with the hexavalent vaccine (DTaP-IPV-Hib-HB) and the pneumococcal 13-valent conjugate vaccine. A booster dose with DTaP-IPV is needed at 6 years for those who received the 2 + 1 series with hexavalent vaccine as infants, in addition to 1 dose of dTap in adolescence. Routine vaccination of pregnant women with a dose of dTap is recommended in each pregnancy, preferably between weeks 27 and 32 of gestation, although can be given from 20 weeks if there is risk of preterm delivery. All infants should receive the rotavirus vaccine (2-3 doses) and the 4CMenB vaccine (2 + 1 series). All children aged 6-59 months should be vaccinated against influenza each year. The MenACWY vaccine should be given routinely at 12 months of age and in adolescence between ages 12 and 18 years. The recommendations for the MMR vaccine (12 months and 3-4 years) and varicella vaccine (15 months and 3-4 years) also remain unchanged, using the MMRV vaccine for the second dose. Recommendations for the use of SARS-CoV-2 vaccines in the paediatric age group will be updated periodically on the CAV-AEP website. The HPV vaccine is indicated in all adolescents, regardless of sex, at age 12 years. Novelties include the recommendation of routine administration of nirsevimab to neonates and infants aged less than 6 months for passive immunization against RSV, and the recommendations regarding the hexavalent vaccine are consolidated in a single section.

Factors Associated with Human Papillomavirus Vaccination and the Intention among Undergraduate Nursing Students: A Cross-Sectional, Correlational Study

PURPOSE

To examine factors associated with overall human papillomavirus (HPV) vaccination status, completion of HPV vaccination, and intention to receive vaccination among nursing students.

DESIGN

A Cross-sectional, correlational study.

METHODS

Data from 86 students were analyzed using logistic and multiple regression.

FINDINGS

Among knowledge, attitudes and beliefs, and recommendation, more positive attitudes and beliefs were the only factors associated with initiation and/or completion of HPV vaccination and the intention to receive HPV vaccination.

CONCLUSIONS

More positive attitudes and beliefs need to be enhanced for HPV vaccination.

CLINICAL EVIDENCE

Changes in attitudes and beliefs can be important targets of interventions to increase HPV vaccination.

Prognostic value of human papillomavirus detection and the eighth edition of the TNM classification staging system in oropharyngeal squamous cell carcinoma: A single-center Polish study

OBJECTIVES

This study aimed to determine human papillomavirus (HPV) status and genotypes, the HPV status-dependent survival, and the applicability of the eighth TNM classification in Polish patients diagnosed with oropharyngeal squamous cell carcinoma (OPSCC).

STUDY DESIGN

All patients with primary OPSCC, diagnosed and treated from 2007 to 2017 at the National Research Institute of Oncology, Warsaw, Poland, who underwent radical radiotherapy were included. The Kaplan-Meier method was deployed to produce 3- and 5-year observed survival (OS) estimates.

RESULTS

A total of 110 OPSCC cases were identified. Double positivity for HPV (IHC p16^INK4a and HPV-DNA) was recorded in 70.9% of cases, with HPV16 being the most prevalent genotype (96.2%). The disease stage was significantly less advanced in the HPV-related group than in the HPV-negative group (P < .001). Three- and 5-year OS in HPV-related carcinoma was 80.7% and 74.0%, respectively; in the HPV-negative group, OS was 52.9% and 48.5%. OS rates were associated with HPV status, tumor stage, and disease stage according to the eighth edition TNM classification.

CONCLUSIONS

The majority of Polish patients with OPSCC are HPV16-positive. In HPV-related OPSCC, survival rates are significantly higher than in HPV-negative OPSCC. The findings support the requirement of HPV testing in Polish patients with OPSCC because HPV-positive status influences tumor prognosis.

HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management

Human papillomavirus (HPV)-positive (HPV⁺) oropharyngeal squamous cell carcinoma (OPSCC) has one of the most rapidly increasing incidences of any cancer in high-income countries. The most recent (8th) edition of the UICC/AJCC staging system separates HPV⁺ OPSCC from its HPV-negative (HPV⁻) counterpart to account for the improved prognosis seen in the former. Indeed, owing to its improved prognosis and greater prevalence in younger individuals, numerous ongoing trials are examining the potential for treatment de-intensification as a means to improve quality of life while maintaining acceptable survival outcomes. In addition, owing to the distinct biology of HPV⁺ OPSCCs, targeted therapies and immunotherapies have become an area of particular interest. Importantly, OPSCC is often detected at an advanced stage owing to a lack of symptoms in the early stages; therefore, a need exists to identify and validate possible diagnostic biomarkers to aid in earlier detection. In this Review, we provide a summary of the epidemiology, molecular biology and clinical management of HPV⁺ OPSCC in an effort to highlight important advances in the field. Ultimately, a need exists for improved understanding of the molecular basis and clinical course of this disease to guide efforts towards early detection and precision care, and to improve patient outcomes.

The incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is increasing rapidly in most developed countries. In this Review, the authors provide an overview of the epidemiology, molecular biology and treatment of HPV-positive OPSCC, including discussions of the role of treatment de-escalation and emerging novel therapies.

The incidence of human papillomavirus-associated oropharyngeal cancer (HPV⁺ OPSCC) is expected to continue to rise over the coming decades until the benefits of gender-neutral prophylactic HPV vaccination begin to become manifest.

The incidence of HPV⁺ OPSCC appears to be highest in high-income countries, although more epidemiological data are needed from low- and middle-income countries, in which HPV vaccination coverage remains low.

The substantially better prognosis of patients with HPV⁺ OPSCC compared to those with HPV^– OPSCC has been recognized in the American Joint Committee on Cancer TNM8 staging guidelines, which recommend stratification by HPV status to improve staging.

The molecular biology and genomic features of HPV⁺ OPSCC are similar to those of other HPV-associated malignancies, with HPV oncogenes (E6 and E7) acting as key drivers of pathogenesis.

Treatment de-intensification is being pursued in clinical trials, although identifying the ~15% of patients with HPV⁺ OPSCC who have recurrent disease, and who therefore require more intensive treatment, remains a key challenge.

An instrument assessing attitudes and beliefs toward human papillomavirus vaccination

OBJECTIVES

The purpose of this study was to test the psychometric properties of a brief attitudes and beliefs toward human papillomavirus (HPV) vaccination instrument in college students.

DESIGN

Cross-sectional, observational study.

SAMPLE

Eighty-six nursing students.

MEASUREMENTS

The Attitudes and Beliefs Toward Human Papillomavirus Vaccination was used to test the reliability (Cronbach's alpha), homogeneity (item-analyses), and validity (factor analysis and correlations).

RESULTS

The reliability of this 8-item instrument was supported by a Cronbach's alpha of .854. Item homogeneity was supported by coefficients for all items > .30. Convergent validity was supported by significant correlations of attitudes and beliefs assessed by this instrument to attitudes, subjective norm, and perceived behavioral control assessed by different instruments (all ps < .001). Construct validity was supported by exploratory and confirmatory factor analyses (all factor loadings ≥ .40). Predictive validity was supported by a significant relationship of attitudes and beliefs to completion of the vaccination (p < .001).

CONCLUSIONS

The Attitudes and Beliefs Toward Human Papillomavirus Vaccination Questionnaire was a reliable and valid instrument. This short instrument can be used to assess and improve attitudes and beliefs toward HPV vaccination, and, in turn, to facilitate the completion of the vaccination.

HPV-induced cancers: preclinical therapeutic advancements

INTRODUCTION

High-risk HPV infections are related to several epithelial cancers. Despite the availability of prophylactic vaccines, HPV infections are still responsible for about 5% of all human malignancies worldwide. While therapeutic vaccines are ongoing clinical trials, genotoxic agents and surgical interventions represent current clinical treatments, with no specific anti-HPV drugs yet available in the clinics.

AREAS COVERED

We offer a comprehensive report of small molecules in preclinical studies proposed as potential anticancer agents against HPV-driven tumors. Given the importance of HPV oncoproteins for cancer maintenance, particularly E6 and E7, we present a classification of both non-targeted and targeted agents, with a further subdivision of the latter into two categories according to their either direct or indirect activity against viral protein functions.

EXPERT OPINION

Prophylactic vaccines can prevent the insurgence of HPV-related cancers, but have no effect against pre-existing infections. Moreover, their high cost, genotype-restricted effect and the growing worldwide distrust for vaccines make the availability of a specific drug an unmet medical need. Different viral early proteins emerge as ideal candidates for drug development. We highlight the most promising strategies and address future challenges in this field to herald the prospect of a specific therapeutic regimen against HPV-related cancers.

[Immunisation schedule of the Pediatric Spanish Association: 2021 recommendations]

The CAV-AEP annually publishes the immunisation schedule considered optimal for all children and adolescent resident in Spain, taking into account the available evidence. The 2+1 schedule is recommended (2, 4, and 11 months) with hexavalent vaccines (DTPa-VPI-Hib-HB) and with 13-valent pneumococcal conjugate.A 6-year booster is recommended, preferably with DTPa (if available), with a dose of polio for those who received 2+1 schemes, as well as vaccination with Tdpa in adolescents and in each pregnancy, preferably between 27 and 32 weeks. Rotavirus vaccine should be systematic for all infants. Meningococcal B vaccine, with a 2+1 schedule, should be included in routine calendar. In addition to the inclusion of the conjugated tetravalent meningococcal vaccine (MenACWY) at 12 years of age with catch up to 18 years, inclusive, the CAV recommends this vaccine to be also included at 12 months of age, replacing MenC. Likewise, it is recommended in those over 6 weeks of age with risk factors or who travel to countries with a high incidence of these serogroups. Two-dose schedules for triple viral (12 months and 3-4 years) and varicella (15 months and 3-4 years) will be used. The second dose could be applied as a tetraviral vaccine. Universal systematic vaccination against HPV is recommended, regardless of gender, preferably at 12 years, and greater effort should be made to improve coverage. The 9 genotype extends coverage for both genders.