Abstract
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.
