Joint effect of human papillomavirus exposure, smoking and alcohol on risk of oral squamous cell carcinoma

Background: Smoking, alcohol consumption, and human papillomavirus (HPV) infection are known risk factors for oral squamous cell carcinoma (OSCC) including SCC of oropharynx (SCCOP) and SCC of oral cavity (SCCOC). Researchers have examined each of these risk factors independently, but few have observed the potential risk of their interaction. This study investigated the interactions among these risk factors and risk of OSCC. Methods: Totally 377 patients with newly diagnosed SCCOP and SCCOC and 433 frequency-matched cancer-free controls by age and sex were included. Multivariable logistic regression was performed to calculate ORs and 95% CIs. Results: We found that overall OSCC risk was independently associated with smoking (adjusted OR(aOR), 1.4; 95%CI, 1.0–2.0), alcohol consumption (aOR, 1.6; 95%CI, 1.1–2.2), and HPV16 seropositivity (aOR, 3.3; 95%CI, 2.2–4.9), respectively. Additionally, we found that HPV16 seropositivity increased the risk of overall OSCC in ever-smokers (aOR, 6.8; 95%CI, 3.4–13.4) and ever-drinkers (aOR, 4.8; 95%CI, 2.9–8.0), while HPV16-seronegative ever-smokers and ever-drinkers had less than a twofold increase in risk of overall OSCC (aORs, 1.2; 95%CI, 0.8–1.7 and 1.8; 95%CI, 1.2–2.7, respectively). Furthermore, the increased risk was particularly high for SCCOP in HPV16-seropositive ever-smokers (aOR, 13.0; 95%CI, 6.0–27.7) and in HPV16-seropositive ever-drinkers (aOR, 10.8; 95%CI, 5.8–20.1), while the similar increased risk was not found in SCCOC. Conclusion: These results suggest a strong combined effect of HPV16 exposure, smoking, and alcohol on overall OSCC, which may indicate a strong interaction between HPV16 infection and smoking and alcohol consumption, particularly for SCCOP.