Introduction: The previously reported prevalence of human papillomavirus (HPV) infection in patients diagnosed with conjunctival squamous neoplasia is highly varied and limited in the Asian population. This study aimed to determine the prevalence of HPV infection in these patients and study the factors associated with disease severity and recurrence. Methods: An observational study was conducted by retrospective data collection from the pathology department database (January 2012 to December 2021) at King Chulalongkorn Memorial Hospital, a tertiary care hospital in Bangkok, Thailand from cases with conjunctival squamous neoplasia, including conjunctival squamous cell carcinoma (SCC), conjunctival SCC in situ (CIS), conjunctival intraepithelial neoplasia (CIN), and conjunctival squamous papilloma. The pathological specimens were sent for p16 immunohistochemical staining. Patients’ demographic data, clinical findings, and disease recurrence were retrieved from the electronic hospital database. Factors related to disease severity and recurrence were analysed using univariate and multivariate analyses. Results: Fifty-eight pathologically proven cases of conjunctival squamous neoplasia, with a mean age at diagnosis of 57 years (standard deviation = 14.7), were classified as SCC (n = 16), CIS (n = 27), CIN (n = 11), and conjunctival squamous papilloma (n = 4). Positive p16 expression was observed in 5 of 58 (8.6%) cases: 3 (18.8%) cases of SCC, 2 (7.4%) cases of CIS, and none of CIN and conjunctival squamous papilloma. Disease recurrence was noted in 6 of the 40 (20%) cases. All recurrent cases tested negative for p16 immunohistochemistry. The patient’s human immunodeficiency virus infection status was available for 10 cases and was 40% positive. None of these patients tested positive for p16. P16 expression and other factors were not significantly associated with SCC. Disease severity was the only factor associated with recurrence in the multivariate analysis (OR 15.34, 95% CI: 1.19–197.52, p = 0.036). Conclusion: This study underscores the relatively low prevalence of HPV in conjunctival squamous neoplasia cases in our setting and highlights the significance of disease severity in predicting recurrence, independent of HPV status as determined by p16 expression.

1.
Lee
GA
,
Hirst
LW
.
Ocular surface squamous neoplasia
.
Surv Ophthalmol
.
1995
;
39
(
6
):
429
50
.
2.
Gichuhi
S
,
Sagoo
MS
,
Weiss
HA
,
Burton
MJ
.
Epidemiology of ocular surface squamous neoplasia in Africa
.
Trop Med Int Health
.
2013
;
18
(
12
):
1424
43
.
3.
Sun
EC
,
Fears
TR
,
Goedert
JJ
.
Epidemiology of squamous cell conjunctival cancer
.
Cancer Epidemiol Biomarkers Prev
.
1997
;
6
(
2
):
73
7
.
4.
Tulvatana
W
,
Bhattarakosol
P
,
Sansopha
L
,
Sipiyarak
W
,
Kowitdamrong
E
,
Paisuntornsug
T
, et al
.
Risk factors for conjunctival squamous cell neoplasia: a matched case-control study
.
Br J Ophthalmol
.
2003
;
87
(
4
):
396
8
.
5.
de Martel
C
,
Plummer
M
,
Vignat
J
,
Franceschi
S
.
Worldwide burden of cancer attributable to HPV by site, country and HPV type
.
Int J Cancer
.
2017
;
141
(
4
):
664
70
.
6.
Ramberg
I
,
Møller-Hansen
M
,
Toft
PB
,
Funding
M
,
Heegaard
S
.
Human papillomavirus infection plays a role in conjunctival squamous cell carcinoma: a systematic review and meta-analysis of observational studies
.
Acta Ophthalmol
.
2021
;
99
(
5
):
478
88
.
7.
Toth
J
,
Karcioglu
ZA
,
Moshfeghi
AA
,
Issa
TM
,
Al-Ma’ani
JR
,
Patel
KV
.
The relationship between human papillomavirus and p53 gene in conjunctival squamous cell carcinoma
.
Cornea
.
2000
;
19
(
2
):
159
62
.
8.
Tornesello
ML
,
Duraturo
ML
,
Waddell
KM
,
Biryahwaho
B
,
Downing
R
,
Balinandi
S
, et al
.
Evaluating the role of human papillomaviruses in conjunctival neoplasia
.
Br J Cancer
.
2006
;
94
(
3
):
446
9
.
9.
de Koning
MN
,
Waddell
K
,
Magyezi
J
,
Purdie
K
,
Proby
C
,
Harwood
C
, et al
.
Genital and cutaneous Human Papillomavirus (HPV) types in relation to conjunctival squamous cell neoplasia: a case-control study in Uganda
.
Infect Agent Cancer
.
2008
;
3
:
12
.
10.
Hanbazazh
M
,
Gyure
KA
.
Ocular human papillomavirus infections
.
Arch Pathol Lab Med
.
2018
;
142
(
6
):
706
10
.
11.
Panwar
A
,
Interval
E
,
Lydiatt
WM
.
Emergence of a novel staging system for oropharyngeal squamous cell carcinoma based on HPV status
.
Oncol
.
2017
;
31
(
12
):
e33
40
.
12.
Jakobsen
KK
,
Carlander
ALF
,
Bendtsen
SK
,
Garset-Zamani
M
,
Lynggaard
CD
,
Grønhøj
C
, et al
.
Diagnostic accuracy of HPV detection in patients with oropharyngeal squamous cell carcinomas: a systematic review and meta-analysis
.
Viruses
.
2021
;
13
(
9
):
1692
.
13.
Ramberg
IMS
.
Human papillomavirus-related neoplasia of the ocular adnexa
.
Acta Ophthalmol
.
2022
;
100
(
Suppl 272
):
3
33
.
14.
Shrestha
T
,
Choi
W
,
Kim
GE
,
Yang
JM
,
Yoon
KC
.
Human papilloma virus identification in ocular surface squamous neoplasia by p16 immunohistochemistry and DNA chip test: a strobe-compliant article
.
Medicine
.
2019
;
98
(
2
):
e13944
.
15.
Carrilho
C
,
Miu
C
,
Kim
Y
,
Karki
S
,
Balmaceda
A
,
Challa
B
, et al
.
p16 expression correlates with invasive ocular surface squamous neoplasms in HIV-infected Mozambicans
.
Ocul Oncol Pathol
.
2020
;
6
(
2
):
123
8
.
16.
Yang
MK
,
Kim
N
,
Choung
H
,
Kim
JE
,
Khwarg
SI
.
Prevalence of human papillomavirus in eyelid carcinoma among Koreans: a clinicopathological study
.
BMC Ophthalmol
.
2023
;
23
(
1
):
390
.
17.
Taylor
A
,
Eade
T
,
Veivers
D
,
Gill
AJ
,
Pang
L
.
Human papillomavirus and oropharyngeal squamous cell carcinoma: a 12-year retrospective review in a New South Wales tertiary referral centre
.
Aust J Oto Laryngol
.
2019
;
2
:
1
.
18.
Ziegert
C
,
Wentzensen
N
,
Vinokurova
S
,
Kisseljov
F
,
Einenkel
J
,
Hoeckel
M
, et al
.
A comprehensive analysis of HPV integration loci in anogenital lesions combining transcript and genome-based amplification techniques
.
Oncogene
.
2003
;
22
(
25
):
3977
84
.
19.
Kim
BH
,
Kim
MK
,
Wee
WR
,
Oh
JY
.
Clinical and pathological characteristics of ocular surface squamous neoplasia in an Asian population
.
Graefes Arch Clin Exp Ophthalmol
.
2013
;
251
(
11
):
2569
73
.
You do not currently have access to this content.