Clinical profile and pattern of second primary tumors in HPV-positive and HPV-negative oropharyngeal cancer

Sep 22, 2026

Retrospective cohort study evaluates clinical-epidemiological characteristics of patients with oropharyngeal cancer (OPC) who are human papillomavirus positive (HPV+) versus negative (HPV−), and compares how second primary tumors (SPT) emerge. Sociodemographic and clinical data, p16 status, and alcohol and tobacco consumption were extracted. Among 538 OPC cases, HPV+ accounted for 59.8% and HPV− for 40.2%. SPT prevalence was higher in HPV− (21.8%) than HPV+ (13.0%), with HPV-status associated with smoking, drinking, and nodal involvement. SPT patterns differed by HPV group, and the time to SPT diagnosis was shorter for HPV+.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Objectives

Methods

Results

Conclusion

Introduction

[www.scielo.br/rbepid](www.scielo.br/rbepid) Revista Brasileira de Epidemiologia ISSN: 1980-5497 [https://doi.org/10.1590/1980-549720260046](https://doi.org/10.1590/1980-549720260046) ORIGINAL ARTICLE Clinical profile and pattern of second primary tumors in HPV-positive and HPV-negative oropharyngeal cancer Perfil clínico e padrão de segundos tumores primários em câncer de orofaringe HPV-positivo e HPV-negativo Matheus de AbreuI , Dandara Menezes de Araujo OliveiraI , Janaina Naiara GermanoI , Luiz Paulo KowalskiII , Maria Paula CuradoI IA.C. Camargo Cancer Center, International Research Center, Department of Epidemiology and Statistics Nucleus – São Paulo (SP), Brazil. IIA.C. Camargo Cancer Center, Department of Head and Neck Surgery and Otorhinolaryngology Department – São Paulo (SP), Brazil. ABSTRACT | Objectives: To evaluate the clinical-epidemiological profile of patients with oropharyngeal cancer (OPC) positive for human papillomavirus (HPV+) and negative for human papillomavirus (HPV−), and to compare differences in the development of second primary tumors (SPT) . Methods: Retrospective cohort with patients diagnosed with OPC. Sociodemographic/clinical data, p16-status, alcohol/tobacco consumption were extracted. Absolute/relative frequencies, odds ratios (OR), prevalence of HPV and SPT were calculated. Results: Of 538 patients with OPC, 59. 8%(n=322) were HPV+; 40. 2%(n=216) HPV− . The prevalence of SPTs was higher among HPV− (21 . 8%; n=47) than HPV+ (13 . 0%; n=42) . Non-smokers were 4.5 times more likely to have HPV+ OPC (OR 4 . 58; confidence interval — CI 2.48–8. 67), and non-drinkers were 2.06 times more likely (OR=2 . 06; CI 1.15–3. 72) . Nodal involvement was associated with a 2. 77-fold higher likelihood of HPV+ (OR 2 . 77; CI 1.70–4. 56); lymphoepithelial topographies with a 2. 13-fold higher likelihood (OR 2. 13; CI 1.37–3.31) . SPTs occurred most in the skin (17 .3%, n=9) and penis/prostate (15 .4%, n=8) in HPV+, whereas in HPV- in head and neck (36 . 2%, n=22) and respiratory tract (18 . 0%, n=11) . The interval between OPC diagnosis and SPT diagnosis was shorter in the HPV+ (median: 40 months) . Conclusion: SPT pattern in OPC is not equal across HPV-groups. HPV- showed a higher prevalence of SPTs, more often involving the head and neck/respiratory tract, which may reflect the cumulative effect of tobacco/alcohol exposure. In HPV+, the lower SPT prevalence and different tumor distribution may indicate a more limited field cancerization effect. The shorter time to SPT diagnosis in HPV+ suggests that surveillance strategies may need to consider distinct risk profiles according to HPV-status. Keywords: Oropharyngeal neoplasms. Neoplasms, Second Primary. HPV. Alcohol Drinking. Tobacco Smoking. | | --- | | CORRESPONDING AUTHOR: Maria Paula Curado. Rua Tagua, 440, CEP 01508-010, São Paulo (SP), [Brazil. E-mail: mp.curado@accamargo.org.br](Brazil. E-mail: mp.curado@accamargo.org.br) | | CONFLICTS OF INTEREST: The authors declare no conflicts of interest related to this study. | | HOW TO CITE THIS ARTICLE: Abreu M, Oliveira DMA, Germano JN, Kowalski LP, Curado MP. Clinical profile and pattern of second primary tumors in HPV-positive and HPV-negative oropharyngeal câncer. Rev Bras Epidemiol 2026; 29: e260046 . [https://doi.org/10.1590/1980-549720260046](https://doi.org/10.1590/1980-549720260046) | | SCIENTIFIC EDITOR: Maria Fernanda Tourinho Peres | This is an open article distributed under the CC-BY 4.0 license, which allows copying and redistribution of the material in any format and for any purpose as long asthe original authorship and publication credits are maintained. Received on: 04/09/2026 Accepted on: 06/16/2026 HPV, associated factors and second primary tumor in oropharyngeal cancer. Rev Bras Epidemiol. 2026; 29: e260046 1 [www.scielo.br/rbepid](www.scielo.br/rbepid) [https://doi.org/10.1590/1980-549720260046](https://doi.org/10.1590/1980-549720260046) INTRODUCTION

FAQs

What was the primary objective of the study?

To assess the clinical-epidemiological profile of patients with oropharyngeal cancer that are HPV-positive versus HPV-negative, and to compare differences in the development of second primary tumors.

How was the study conducted?

It used a retrospective cohort design, extracting sociodemographic and clinical data, p16 status, and alcohol and tobacco consumption, then calculating frequencies and odds ratios.

Did SPT prevalence differ between HPV groups?

Yes. SPT prevalence was higher among HPV− patients (21.8%) than among HPV+ patients (13.0%), and the pattern of tumor sites also differed.

Sep 22, 2026

Upload by Clementine