Human Papillomavirus Is Rare and Does Not Correlate with p16 INK4A Expression in Non-Small-Cell Lung Cancer in a Jordanian Subpopulation.

Background and Objectives : Human papillomavirus (HPV) was previously investigated in lung cancer with wide inter-geographic discrepancies. p16 INK4a has been used as a surrogate for detecting high-risk HPV (HR-HPV) in some cancer types. This study assessed the evidence of HPV in non-small-cell lung cancer (NSCLC) among Jordanian patients, investigated the expression of p16 INK4a , and evaluated its prognostic value and association with HPV status. Materials and Methods : The archived samples of 100 patients were used. HPV DNA detection was performed by real-time polymerase chain reaction (RT-PCR). p16 INK4a expression was assessed by immunohistochemistry (IHC). The Eighth American Joint Committee on Cancer protocol (AJCC) of head and neck cancer criteria were applied to evaluate p16 INK4a positivity considering a moderate/strong nuclear/cytoplasmic expression intensity with a distribution in ≥75% of cells as positive. Results : HPV DNA was detected in 5% of NSCLC cases. Three positive cases showed HR-HPV subtypes (16, 18, 52), and two cases showed the probable HR-HPV 26 subtype. p16 INK4a expression was positive in 20 (20%) NSCLC cases. None of the HPV-positive tumors were positive for p16 INK4a expression. A statistically significant association was identified between p16 INK4a expression and the pathological stage ( p = 0.029) but not with other variables. No survival impact of p16 INK4a expression was detected in NSCLC cases as a group; however, it showed a statistically significant association with overall survival (OS) in squamous cell carcinoma (SqCC) cases ( p = 0.033). Conclusions : This is the first study to assess HPV and p16 INK4a expression in a Jordanian population. HPV positivity is rare in NSCLC among a Jordanian subpopulation. P16 INK4a reliability as a surrogate marker for HPV infection in lung cancer must be revisited.