Human papillomavirus and World Health Organization type III nasopharyngeal carcinoma: Multicenter study from an endemic area in Southern China

BACKGROUND The current study was conducted to study the incidence of human papillomavirus (HPV)‐associated nasopharyngeal carcinoma (NPC) in Southern China and the corresponding treatment outcome. METHODS A retrospective chart review with a level of evidence of 4 was performed. RESULTS Between 2000 and 2015, a total of 1328 patients with NPC were treated in 3 study institutes in Hong Kong and Foshan City in Guangdong Province, China. All tumors were undifferentiated, nonkeratinizing carcinoma, of which 91.9% were positive for the Epstein‐Barr virus (EBV+) and 7.7% were positive for HPV/p16 (HPV+). Although coinfection with both viruses occurred only in 8 patients (0.6%), 94 patients had tumors that were EBV negative (EBV‐) and HPV+. All patients were treated with intensity‐modulated radiotherapy alone for American Joint Committee on Cancer stage I and II disease, and concurrent chemoradiotherapy for stage III and IV disease. With a median follow‐up of 72.8 months, the authors found that the local recurrence rate was significantly lower for patients with tumors that were EBV‐/HPV+ compared with patients with tumors that were EBV+/HPV‐ (6.4% vs 13.8%; P = .03). Similar trends were observed for the 5‐year disease‐free survival rate (89.8% vs 70.8%; P =.03) and 5‐year overall survival rate (86% vs 72%; P =.03). CONCLUSIONS In regions that are endemic for NPC, the prevalence of EBV and HPV coinfection in patients with NPC is extremely low. Conversely, patients with EBV‐/HPV+ NPC demonstrate significantly better local tumor control and survival after radiotherapy. Cancer 2018;124:530‐6. © 2017 American Cancer Society. In regions that are endemic for nasopharyngeal carcinoma, the prevalence of coinfection with Epstein‐Barr virus and human papillomavirus in patients with the disease is extremely low. Conversely, patients with Epstein‐Barr virus‐negative/human papillomavirus‐positive nasopharyngeal tumors demonstrate significantly better local tumor control and survival after receipt of radiotherapy.