Feasibility of p16 surrogate biomarker as adjunct diagnosis of oral and oropharyngeal malignancy in a resource-constrained country

Background: Cases of Human papillomavirus (HPV)-associated oral and oropharyngeal cancer are increasing. Proper diagnostic tools are required to detect HPV among patients, especially in areas where high technology is lacking. Aims: To provide mapping of HPV prevalence in Southeast Asia and to determine the effectivity of p16 as a surrogate biomarker for HPV infection in oral and oropharyngeal cancer. Methods: Medical records of 56 patients diagnosed with oral and oropharyngeal squamous cell carcinomas (SCC) were reviewed. HPV PCR DNA and p16 immunohistochemistry (IHC) examination were performed to detect HPV positivity. Results: HPV PCR prevalence in oropharyngeal SCC is 42.9% and 28.6% in oral SCC. P16 IHC has 67% sensitivity and 75% specificity in detecting HPV in oropharyngeal cancer, and 33% and 72% in oral cancer. Conclusion: We conclude that p16 IHC with a 5% cut-off can be used as a surrogate biomarker for oropharyngeal SCC, but not oral SCC, in areas where resources are restricted. However, further diagnostic tools may be needed.