Carole Fakhry1, Tim Waterboer2, William H Westra3, Lisa M Rooper4, Melina Windon5, Tanya Troy6, Wayne Koch5, Christine G Gourin5, Noemi Bender2, Siddhartha Yavvari6, Ana P Kiess7, Brett A Miles8, William R Ryan9, Patrick K Ha9, David W Eisele5, Gypsyamber D'Souza10. 1. Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, United States. Electronic address: cfakhry@jhmi.edu. 2. Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Germany. 3. Department of Pathology, Icahn School of Medicine at Mount Sinai, United States. 4. Department of Pathology, Johns Hopkins University School of Medicine, United States. 5. Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, United States. 6. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States. 7. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, United States. 8. Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, United States. 9. Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, United States. 10. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States. Electronic address: gdsouza2@jhu.edu.
Abstract
BACKGROUND: HPV-positive oropharynx squamous cell cancer (HPV-OPC) patients were initially described as younger, however incidence has increased among older age-groups. It is unknown why some patients present at a younger age and others at a later age. METHODS: Multi-institutional prospective study of HPV-OPC cases (n = 163) and matched controls (n = 345) with detailed behavioral survey, and serum tested for HPV antibodies by fluorescent bead-based technology. Age at diagnosis was used to stratify patients into younger (≤50 years), middle-age (51-65), and older (>65). RESULTS: By age, demographic characteristics were largely similar, but HPV biomarkers and sexual acts differed. Younger cases were more likely to be HPV16-positive than older cases (100% vs 77%, p = 0.009). Similarly, younger cases were more likely to be HPV16 E6 or E7 seropositive (100% vs 82%, p = 0.03). Younger cases had a higher number of oral sex partners per year, a marker of sexual intensity (sex-years, p = 0.003), but a similar number of lifetime oral sex partners (measure of cumulative sexual exposure), compared to older cases. While sex-years were higher for younger cases and controls, cases had significantly higher sex-years than matched controls in each age-group (p < 0.001). Younger patients were also more likely to perform oral sex at sexual debut, and were younger at sexual debut (each p < 0.03). CONCLUSIONS: Younger, middle-age and older HPV-OPC have distinct biomarker and behavioral profiles. Younger HPV-OPC cases have higher intensity of sexual exposure than older cases and controls, which may in part explain earlier disease onset. The distribution of HPV16-positive tumors among HPV-OPC differs by age group.
BACKGROUND: HPV-positive oropharynx squamous cell cancer (HPV-OPC) patients were initially described as younger, however incidence has increased among older age-groups. It is unknown why some patients present at a younger age and others at a later age. METHODS: Multi-institutional prospective study of HPV-OPC cases (n = 163) and matched controls (n = 345) with detailed behavioral survey, and serum tested for HPV antibodies by fluorescent bead-based technology. Age at diagnosis was used to stratify patients into younger (≤50 years), middle-age (51-65), and older (>65). RESULTS: By age, demographic characteristics were largely similar, but HPV biomarkers and sexual acts differed. Younger cases were more likely to be HPV16-positive than older cases (100% vs 77%, p = 0.009). Similarly, younger cases were more likely to be HPV16 E6 or E7 seropositive (100% vs 82%, p = 0.03). Younger cases had a higher number of oral sex partners per year, a marker of sexual intensity (sex-years, p = 0.003), but a similar number of lifetime oral sex partners (measure of cumulative sexual exposure), compared to older cases. While sex-years were higher for younger cases and controls, cases had significantly higher sex-years than matched controls in each age-group (p < 0.001). Younger patients were also more likely to perform oral sex at sexual debut, and were younger at sexual debut (each p < 0.03). CONCLUSIONS: Younger, middle-age and older HPV-OPC have distinct biomarker and behavioral profiles. Younger HPV-OPC cases have higher intensity of sexual exposure than older cases and controls, which may in part explain earlier disease onset. The distribution of HPV16-positive tumors among HPV-OPC differs by age group.
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