【CSCO 2022 Prospect】Progress in the global diagnosis and treatment of HPV-positive oropharyngeal cancer and current situation in China

Oropharyngeal carcinoma (OPC) is one of the common head and neck malignancies, more than 90% of which are squamous cell carcinomas
.
The age of onset is 50~70 years old, more men than women, including tonsils, tongue base, soft palate and posterior pharyngeal wall and other sources
.
The main causes are tobacco and alcohol abuse or high-risk human papillomavirus (HPV) infection
.
The typical imaging manifestations of HPV-related oropharyngeal carcinoma are "small lesion and large metastasis", that is, the primary tumor is small, exophytic and less invasive, and it can be accompanied by obvious lymph node metastasis
at an early stage.

HPV is a double-stranded closed-loop small DNA virus that is epithelial and has more than 15 carcinogenic subtypes (high-risk type), while HPV16
is 90% of HPV-associated head and neck tumors.
Sexual exposure is an important route of
HPV transmission.
Studies have shown that premature first sexual intercourse, excessive number of lifelong sexual partners, and excessive oral sex are all high-risk factors for HPV-related head and neck tumors, and high-risk sexual behavior may increase the risk
of HPV-related head and neck tumors by increasing the HPV transmission load.

The carcinogenic mechanism of HPV is still not fully elucidated
.
It is generally believed that HPV invades basal cells through the damaged mucosa, and completes transcription, replication, and epithelial migration in a relatively immunoisolated environment, resulting in continuous infection
of epithelial cells.
Through the upregulation of oncoproteins E6 and E7 expression, the P53 and RB pathways in HPV-infected epithelial cells are relatively inhibited, while telomerase activity is increased, which in turn leads to uncontrolled cell cycle, inhibition of apoptosis, decreased cell senescence, and finally mediates malignant transformation
of epithelial cells.
In addition, E6 and E7 can also regulate the expression of a series of non-coding RNAs, including miRNA, lncRNA, circRNA, etc.
, and then regulate the expression of downstream target genes, which has an important impact on
cell cycle, growth, adhesion, migration and even immune function.

Over the past 20 years, the incidence of HPV-related oropharyngeal cancer has been increasing, accounting for 70%
of newly diagnosed oropharyngeal cancers.
There are two main types of treatment for HPV-related oropharyngeal cancer: one is the preferred surgical treatment, postoperative adjuvant or non-adjuvant chemoradiotherapy; The second is radical concurrent chemoradiotherapy
.
In recent years, with the development of robotic surgery, surgical applications have become more and more
.
However, for HPV-related oropharyngeal cancer, surgical treatment is preferred or radical chemoradiotherapy, and there is a lack of evidence
for prospective phase III clinical studies.

On November 7, 2022, the 25th National Congress of Clinical Oncology and the 2022 CSCO Annual Conference invited Professor Yi Junlin from the Cancer Hospital of the Chinese Academy of Medical Sciences to introduce the progress of global diagnosis and treatment of HPV-positive oropharyngeal cancer and the current situation in
China.

Resources:

https://mp.
weixin.
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com/s/r1iIQYVIsTUa6LiC3VOVjg

https://mp.
weixin.
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com/s/dQqaX6OujzdJtZKx1U9a0g

https://mp.
weixin.
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com/s/EVGqivwvgoTuX_OHZlyFdA