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Freedman RL, Sibley H, Williams AM, Chang SS. Race, not socioeconomic disparities, correlates with survival in human papillomavirus-negative oropharyngeal cancer: A retrospective study. Am J Otolaryngol 2021; 42:102816. [PMID: 33161259 DOI: 10.1016/j.amjoto.2020.102816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Investigate the impact of black versus white race, socioeconomic status (SES), and comorbidity burden on oropharyngeal cancer (OPC) survival. MATERIALS AND METHODS This study retrospectively analyzed patients diagnosed between 1991 and 2012 at an urban tertiary care center with a high volume of head and neck cancer referrals. Data gathered included demographics, human papilloma virus (HPV) status, follow-up time, comorbidities, smoking history, and overall survival. SES was extrapolated from the 2000 and 2010 censuses. Analysis of variance, chi-square tests, multivariable Cox proportional hazards models, Cox proportional hazards regression, Kaplan Meier curves and the log-rank test were utilized. RESULTS Of 208 charts reviewed, 192 patients met inclusion criteria. Black patients had significantly (p < 0.001) poorer survival at 1, 2, and 5 years than white patients (5-year survival: 32% vs 64%); this discrepancy persisted in only HPV-negative disease (20% vs 50%). In the HPV-negative subgroup, there was no racial difference in treatment modality received, Charlson Comorbidity Index, and proportion receiving inadequate, noncurative or no treatment. Univariate analysis identified significant differences in median household income, education level, and stage at presentation between black and white subgroups. Multivariate analysis identified white race and HPV-positive status as independent predictors of overall survival, but SES and stage at presentation were not. CONCLUSION SES did not explain the greater survival in HPV-negative white versus black patients. This indicates that race is an independent predictor of survival; future studies should examine more accurate indicators of SES and genetic differences in tumors of black and white patients.
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Sheth S, Farquhar DR, Lenze NR, Mazul A, Brennan P, Anantharaman D, Abedi-Ardekani B, Zevallos JP, Hayes DN, Olshan F. Decreased overall survival in black patients with HPV-associated oropharyngeal cancer. Am J Otolaryngol 2021; 42:102780. [PMID: 33152576 PMCID: PMC7988501 DOI: 10.1016/j.amjoto.2020.102780] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Racial disparities for overall survival (OS) in head and neck cancer have been well described. However, the extent to which these disparities exist for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC), and the contribution of demographic, clinical, and socioeconomic status (SES) variables, is unknown. MATERIALS AND METHODS Patients were identified from the Carolina Head and Neck Cancer Epidemiology Study (CHANCE), a population-based study in North Carolina. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for OS in black versus white patients with sequential adjustment sets. RESULTS A total of 157 HPV-associated OPSCC patients were identified. Of these, 93% were white and 7% were black. Black patients with HPV-associated OPSCC were more likely to be younger, have an income <$20,000, live farther away from clinic where biopsy was performed, and have advanced T stage at diagnosis. Black patients had worse OS in the unadjusted analysis (HR 4.9, 95% CI 2.2-11.1, p < 0.0001). The racial disparity in OS slightly decreased when sequentially adjusting for demographic, clinical, and SES variables. However, HR for black race remained statistically elevated in the final adjustment set which controlled for age, sex, stage, smoking, alcohol use, and individual-level household income, insurance, and education level (HR 3.4, 95% CI 1.1-10.1, p = 0.028). CONCLUSION This is the first population-based study that confirms persistence of racial disparities in HPV-associated OPSCC after controlling for demographic, clinical, and individual-level socioeconomic factors.
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Affiliation(s)
- Siddharth Sheth
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Douglas R Farquhar
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Nicholas R Lenze
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Angela Mazul
- Department of Otolaryngology, Washington University in Saint Louis, School of Medicine, St. Louis, MO 63110, USA
| | - Paul Brennan
- International Agency for Research on Cancer, France
| | | | | | - Jose P Zevallos
- Department of Otolaryngology, Washington University in Saint Louis, School of Medicine, St. Louis, MO 63110, USA
| | - D Neil Hayes
- Department of Medicine, Division of Hematology-Oncology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; UTHSC Center for Cancer Research, University of Tennessee, Memphis, TN 38163, USA
| | - F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Dittberner A, Friedl B, Wittig A, Buentzel J, Kaftan H, Boeger D, Mueller AH, Schultze-Mosgau S, Schlattmann P, Ernst T, Guntinas-Lichius O. Gender Disparities in Epidemiology, Treatment, and Outcome for Head and Neck Cancer in Germany: A Population-Based Long-Term Analysis from 1996 to 2016 of the Thuringian Cancer Registry. Cancers (Basel) 2020; 12:cancers12113418. [PMID: 33218009 PMCID: PMC7698743 DOI: 10.3390/cancers12113418] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Head and neck cancer (HNC) comprises a heterogeneous group of cancers. Not much population-based data has been published on gender disparities related to the incidences between different age groups, subsites, tumor stages, and its effect on therapy decisions. All new HNC cases from Thuringia between 1996 and 2016 were analyzed. The incidence of head and neck cancer still was 4-fold higher in men compared to women. Incidence reached a peak for men between 60–64 years, where the incidence increased with older age in women. Male gender, higher tumor stage and subsite (worst: hypopharyngeal cancer) still had a major negative impact on the survival of the patients. Treatment decisions were different between male and female patients, especially in older patients with a tendency to less aggressive therapy. Putting all patients together, there probably was no improvement in survival beyond changes in treatment over the observation period from 1996 to 2016. Abstract This study determined with focus on gender disparity whether incidence based on age, tumor characteristics, patterns of care, and survival have changed in a population-based sample of 8288 German patients with head neck cancer (HNC) registered between 1996 and 2016 in Thuringia, a federal state in Germany. The average incidence was 26.13 ± 2.89 for men and 6.23 ± 1.11 per 100,000 population per year for women. The incidence peak for men was reached with 60–64 years (63.61 ± 9.37). Highest incidence in females was reached at ≥85 years (13.93 ± 5.87). Multimodal concepts increased over time (RR = 1.33, CI = 1.26 to 1.40). Median follow-up time was 29.10 months. Overall survival (OS) rate at 5 years was 48.5%. The multivariable analysis showed that male gender (Hazard ratio [HR] = 1.44; CI = 1.32 to 1.58), tumor subsite (worst hypopharyngeal cancer: HR = 1.32; CI = 1.19 to 1.47), and tumor stage (stage IV: HR = 3.40; CI = 3.01 to 3.85) but not the year of diagnosis (HR = 1.00; CI = 0.99 to 1.01) were independent risk factors for worse OS. Gender has an influence on incidence per age group and tumor subsite, and on treatment decision, especially in advanced stage and elderly HNC patients.
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Affiliation(s)
- Andreas Dittberner
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany; (A.D.); (B.F.)
| | - Benedikt Friedl
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany; (A.D.); (B.F.)
| | - Andrea Wittig
- Department of Radiotherapy and Radiation Oncology, Jena University Hospital, 07747 Jena, Germany;
| | - Jens Buentzel
- Department of Otorhinolaryngology, Südharz Klinikum Nordhausen, 99734 Nordhausen, Germany;
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, 99089 Erfurt, Germany;
| | - Daniel Boeger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, 98527 Suhl, Germany;
| | - Andreas H. Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, 07548 Gera, Germany;
| | - Stefan Schultze-Mosgau
- Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, 07747 Jena, Germany;
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, 07747 Jena, Germany;
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, 07747 Jena, Germany;
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany; (A.D.); (B.F.)
- Correspondence: ; Tel.: +49-3641-9329301; Fax: +49-3641-9329302
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Faden DL, Langenbucher A, Kuhs K, Lewis JS, Mirabello L, Yeager M, Boland JF, Bass S, Steinberg M, Cullen M, Lawrence MS, Ferris RL. HPV+ oropharyngeal squamous cell carcinomas from patients with two tumors display synchrony of viral genomes yet discordant mutational profiles and signatures. Carcinogenesis 2020; 42:14-20. [PMID: 33075810 PMCID: PMC8014522 DOI: 10.1093/carcin/bgaa111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 12/22/2022] Open
Abstract
Human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (HPV + OPSCC) is increasing in prevalence in the USA, as are cases of patients with multiple HPV + OPSCCs (mHPV + OPSCC). mHPV + OPSCCs present a unique opportunity to examine HPV + OPSCC mutation acquisition and evolution. We performed sequencing of the viral genome, somatic exome and somatic transcriptome from 8 patients each with 2 spatially distinct HPV + OPSCCs, and 37 'traditional' HPV + OPSCCs to first address if paired tumors are caused by the same viral isolate and next, if acquired alterations, and the underlying processes driving mutagenesis, are shared within pairs. All tumor pairs contained viral genomes from the same HPV type 16 sublineage and differed by 0-2 clonal single nucleotide polymorphisms (SNPs), suggesting infection with the same viral isolate. Despite this, there was significant discordance in expression profiles, mutational burden and mutational profiles between tumors in a pair, with only two pairs sharing any overlapping mutations (3/3343 variants). Within tumor pairs there was a striking discrepancy of mutational signatures, exemplified by no paired tumors sharing high APOBEC mutational burden. Here, leveraging mHPV + OPSCCs as a model system to study mutation acquisition in virally mediated tumors, in which the germline, environmental exposures, immune surveillance and tissue/organ type were internally controlled, we demonstrate that despite infection by the same viral isolate, paired mHPV + OPSCCs develop drastically different somatic alterations and even more strikingly, appear to be driven by disparate underlying mutational processes. Thus, despite a common starting point, HPV + OPSCCs evolve through variable mutational processes with resultant stochastic mutational profiles.
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Affiliation(s)
- Daniel L Faden
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA,Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Broad Institute of MIT and Harvard, Cambridge, MA, USA,To whom correspondence should be addressed. 243 Charles Street, Boston, MA 02114, USA. Tel: +1 617 807 7882; Fax: +1 587 206 7220;
| | | | - Krystle Kuhs
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James S Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa Mirabello
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Meredith Yeager
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA,Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick, MD, USA
| | - Joseph F Boland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA,Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick, MD, USA
| | - Sara Bass
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA,Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick, MD, USA
| | - Mia Steinberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA,Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick, MD, USA
| | - Michael Cullen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA,Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick, MD, USA
| | - Michael S Lawrence
- Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA,Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA,UPMC Hillman Cancer Center, Pittsburgh, PA, USA
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Alexiev BA, Obeidin F, Johnson DN, Finkelman BS, Prince R, Somani SN, Cheng E, Samant S. Oropharyngeal carcinoma: A single institution study of 338 primaries with special reference to high-risk human papillomavirus-mediated carcinoma with aggressive behavior. Pathol Res Pract 2020; 216:153243. [PMID: 33113454 DOI: 10.1016/j.prp.2020.153243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/31/2022]
Abstract
In a retrospective review, we identified 332 patients with 338 pathologically diagnosed primary oropharyngeal carcinomas (OPC) between January 2013 and March 2020 with known p16/HPV status from a tumor registry at Northwestern Memorial Hospital. The tumors predominantly involved the palatine tonsil (51 %) and the base of the tongue/lingual tonsil (38 %). The most common type of cancer was non-keratinizing squamous cell carcinoma (60 %), and the majority of primaries were p16 positive/HPV-mediated (86 %). A cohort of p16 positive/HPV mediated OPC (27/283, 9.5 %) presented with aggressive clinical behavior, including multiple distant metastases at unusual sites. Tumor size >2 cm and the presence of tumor anaplasia/multinucleation were significantly associated with an increased rate of distant metastases in p16 positive/HPV mediated cases, both in unadjusted and adjusted analyses (all P < 0.05). Of the 332 individuals in the overall cohort, 38 individuals died due to their disease within the observed follow-up time. Among the 283 patients with p16 positive/HPV mediated tumors, survival was estimated at 97 % (95 % CI 95 %, 100 %) at 1 year, 95 % (95 % CI 92 %, 98 %) at 2 years, and 80 % (95 % CI 72 %, 89 %) at 5 years. The presence of tumor anaplasia/multinucleation and distant metastasis were both significantly associated with poorer disease-specific survival in p16 positive/HPV mediated cases (both P < 0.05), with the survival effect of tumor anaplasia/multinucleation likely mediated in part through its association with distant metastasis. For p16 positive/HPV-mediated OPC, age, smoking status, tumor status, and lymph node status were not significantly associated with disease-specific survival in our study.
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Affiliation(s)
- Borislav A Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 251 East Huron St, Feinberg 7-342A, Chicago, IL, 60611, United States.
| | - Farres Obeidin
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 251 East Huron St, Feinberg 7-342A, Chicago, IL, 60611, United States
| | - Daniel N Johnson
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 251 East Huron St, Feinberg 7-342A, Chicago, IL, 60611, United States
| | - Brian S Finkelman
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 251 East Huron St, Feinberg 7-342A, Chicago, IL, 60611, United States
| | - Rebecca Prince
- Department of Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 675 N St Clair St, Galter 15-200, Chicago, IL, 60611, United States
| | - Shaan N Somani
- Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 240 E Erie St, Chicago, IL, 60611, United States
| | - Esther Cheng
- Department of Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 675 N St Clair St, Galter 15-200, Chicago, IL, 60611, United States
| | - Sandeep Samant
- Department of Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 675 N St Clair St, Galter 15-200, Chicago, IL, 60611, United States
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56
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Abdel-Rahman O. Sex-based differences in outcomes of patients with HPV-positive versus HPV-negative oropharyngeal carcinoma: a population-based study. Expert Rev Anticancer Ther 2020; 20:813-818. [PMID: 32787745 DOI: 10.1080/14737140.2020.1810019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Prior studies have suggested that female sex is predictive of poor outcomes among patients with oropharyngeal carcinoma. The current study aims at elucidating whether this observation applies to both HPV-positive and HPV-negative subsets of the disease. METHODS Surveillance, Epidemiology and End Results (SEER) - HPV specialized database was accessed. Cases with oropharyngeal squamous cell carcinoma and known HPV status were reviewed. Multivariable logistic regression analysis was used to evaluate factors predicting HPV positive status. The relationship between sex and overall and cancer-specific survival was further evaluated through multivariable Cox regression analysis. RESULTS Female sex was associated with less probability of HPV positive status (OR: 0.55; 95% CI: 0.50-0.61; P<0.01). Using multivariable Cox regression analysis and among patients with HPV-negative disease, female patients have worse overall survival (HR: 1.24; 95% CI: 1.12-1.39; P<0.01) and cancer-specific survival (HR: 1.27; 95% CI: 1.08-1.50; P<0.01); while among patients with HPV-positive disease, there was no difference between males and females with regards to overall survival (HR: 1.05; 95% CI: 0.91-1.21; P= 0.45) or cancer-specific survival (HR: 1.17; 95% CI: 0.95-1.45; P= 0.12). CONCLUSIONS Among patients with HPV-positive oropharyngeal carcinoma, there is no difference in survival outcomes between women and men; while among patients with HPV-negative oropharyngeal carcinoma, women have worse survival outcomes compared to men.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, Cross Cancer Institute, University of Alberta , Edmonton, Alberta, Canada
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Abstract
PURPOSE OF REVIEW This review attempts to give an update of epidemiological knowledge on head and neck cancers (HNC). RECENT FINDINGS Worldwide, from 1990 to 2017, incidence rates for larynx and nasopharyngeal cancers decreased, whereas they increased for oro/hypopharyngeal cancers and lip/oral cavity cancers. They are still markedly higher among men than women. South Asia has the highest HNC incidence rate, followed by Europe, North America, and Australasia.Tobacco and alcohol remain the major risk factors. Rate of cancers attributable to human papillomavirus (HPV) among HNCs is highly depending on world region and tobacco use prevalence. It increases in high-income countries. In the US population, the number of HPV-attributable oropharyngeal cancers now exceeds the number of cervix cancers. HPV vaccination for boys is recommended in an increasing number of countries. Many occupations are associated with an increased HNC risk. Fruits and vegetables intake have a protective effect against HNC. SUMMARY To decrease HNC incidence, measures to reduce tobacco use and alcohol consumption remain essential. Improvement of HPV vaccination coverage is also a major objective. Reduction of carcinogens at occupation, protection of workers from carcinogen exposures, education for better diet, and easy and affordable access to fruits and vegetables can contribute to incidence decrease.
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Zevallos JP, Kramer JR, Sandulache VC, Massa ST, Hartman CM, Mazul AL, Wahle BM, Gerndt SP, Sturgis EM, Chiao EY. National trends in oropharyngeal cancer incidence and survival within the Veterans Affairs Health Care System. Head Neck 2020; 43:108-115. [PMID: 32918302 DOI: 10.1002/hed.26465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/16/2020] [Accepted: 08/26/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Oropharyngeal squamous cell carcinoma (OPSCC) epidemiology has not been examined previously in the nationwide Veterans Affairs (VA) population. METHODS Joinpoint regression analysis was applied to OPSCC cases identified from VA administrative data from 2000 to 2012. RESULTS We identified 12 125 OPSCC cases (incidence: 12.2 of 100 000 persons). OPSCC incidence declined between 2000 and 2006 (annual percent change [APC] = -4.27, P < .05), then increased between 2006 and 2012 (APC = 7.02, P < .05). Significant incidence increases occurred among white (APC = 7.19, P < .05) and African American (APC = 4.87, P < .05) Veterans and across all age cohorts. The percentage of never-smokers increased from 8% in 2000 to 15.7% in 2012 (P < .001), and 2-year overall survival improved from 31.2% (95% confidence interval (CI) [30-33.4]) to 55.7% (95% CI [54.4-57.1]). CONCLUSIONS OPSCC incidence is increasing across all racial and age cohorts in the VA population. Smoking rates remain high among Veterans with OPSCC and gains in survival lag those reported in the general population.
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Affiliation(s)
- Jose P Zevallos
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,John Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA
| | - Jennifer R Kramer
- VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Vlad C Sandulache
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.,Center for Translational Research on Inflammatory Disease (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Sean T Massa
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,John Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA
| | - Christine M Hartman
- VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Angela L Mazul
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,John Cochran Veterans Affairs Medical Center, St. Louis, Missouri, USA
| | - Benjamin M Wahle
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sophie P Gerndt
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erich M Sturgis
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Elizabeth Y Chiao
- VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Ali A, Lassi ZS, Kapellas K, Jamieson L, Rumbold AR. A systematic review and meta-analysis of the association between periodontitis and oral high-risk human papillomavirus infection. J Public Health (Oxf) 2020; 43:e610-e619. [PMID: 32915228 DOI: 10.1093/pubmed/fdaa156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 07/12/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCCs) is increasing globally. Common oral conditions such as periodontitis may contribute. We undertook a meta-analysis to quantify the association between periodontitis, oral HPV and OPSCCs. METHODS Multiple electronic databases were searched until 12 February 2020. Studies conducted in males and/or females aged ≥ 18 years that examined periodontitis, periodontal procedures, oral HPV infection, and where possible, oral cancers, were eligible. Meta-analyses were conducted and the GRADE approach was used to examine the quality of evidence. RESULTS Of 2709 studies identified, 13 met the eligibility criteria. Five studies could be included in the meta-analyses. There was no significant increase in the odds of high-risk oral HPV infection among individuals with confirmed periodontitis (odds ratio 4.71, 95% confidence interval 0.57-38.97). Individuals with periodontitis had a 3.65 times higher odds of having any type of oral HPV infection compared with those without periodontitis (95% confidence interval 1.67-8.01). The overall body of evidence was rated as low to very-low certainty. CONCLUSION Meta-analysis confirms there is a positive association between periodontitis and oral HPV infection, although the overall quality of this evidence is low. Evidence for an association between periodontitis and high-risk oral HPV infection is inconclusive.
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Affiliation(s)
- Anna Ali
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Zohra S Lassi
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Kostas Kapellas
- Australian Research Centre for Population Oral Health Adelaide Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health Adelaide Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Alice R Rumbold
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005 Australia.,South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
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Stein E, Lenze NR, Yarbrough WG, Hayes DN, Mazul A, Sheth S. Systematic review and meta‐analysis of racial survival disparities among oropharyngeal cancer cases by
HPV
status. Head Neck 2020; 42:2985-3001. [DOI: 10.1002/hed.26328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/02/2020] [Accepted: 05/27/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Eva Stein
- Department of Medicine University of Colorado Denver Colorado USA
| | - Nicholas R. Lenze
- Department of Otolaryngology/Head & Neck Surgery University of North Carolina Chapel Hill North Carolina USA
| | - Wendell G. Yarbrough
- Department of Otolaryngology/Head & Neck Surgery University of North Carolina Chapel Hill North Carolina USA
| | - D. Neil Hayes
- Department of Medicine, Division of Hematology‐Oncology University of Tennessee Health Science Center Memphis Tennessee USA
| | - Angela Mazul
- Division of Head and Neck Surgical Oncology, Department of Otolaryngology Washington University School of Medicine St Louis Missouri USA
- Division of Public Health Sciences, Department of Surgery Washington University School of Medicine St Louis Missouri USA
| | - Siddharth Sheth
- Department of Otolaryngology/Head & Neck Surgery University of North Carolina Chapel Hill North Carolina USA
- Division of Hematology/Oncology, Department of Medicine University of North Carolina Chapel Hill North Carolina USA
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The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020. Cancers (Basel) 2020; 12:cancers12061543. [PMID: 32545409 PMCID: PMC7352543 DOI: 10.3390/cancers12061543] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022] Open
Abstract
Cancers that arise in the head and neck region are comprised of a heterogeneous group of malignancies that include carcinogen- and human papillomavirus (HPV)-driven mucosal squamous cell carcinoma as well as skin cancers such as cutaneous squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma. These malignancies develop in critical areas for eating, talking, and breathing and are associated with substantial morbidity and mortality despite advances in treatment. Understanding of advances in the management of these various cancers is important for all multidisciplinary providers who care for patients across the cancer care continuum. Additionally, the recent Coronavirus Disease 2019 (COVID-19) pandemic has necessitated adaptations to head and neck cancer care to accommodate the mitigation of COVID-19 risk and ensure timely treatment. This review explores advances in diagnostic criteria, prognostic factors, and management for subsites including head and neck squamous cell carcinoma and the various forms of skin cancer (basal cell carcinoma, cutaneous squamous cell carcinoma, Merkel cell carcinoma, and melanoma). Then, this review summarizes emerging developments in immunotherapy, radiation therapy, cancer survivorship, and the delivery of care during the COVID-19 era.
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Ghazawi FM, Lu J, Savin E, Zubarev A, Chauvin P, Sasseville D, Zeitouni A, Litvinov IV. Epidemiology and Patient Distribution of Oral Cavity and Oropharyngeal SCC in Canada. J Cutan Med Surg 2020; 24:340-349. [PMID: 32238063 DOI: 10.1177/1203475420915448] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Oral cavity cancers (OCCs) and oropharyngeal cancers (OPCs) continue to be a major source of morbidity and mortality worldwide requiring the shared effort of numerous specialists. Tobacco and alcohol consumption have long been identified as risk factors for both OCC and OPC. In addition, human papilloma virus (HPV) is gaining its position as the main causal agent for OPC. OBJECTIVE The objective of this study is to analyze the epidemiology of OCC and OPC in Canada. METHODS Data pertaining to the year of diagnosis, the patient's sex, age at the time of diagnosis, province/territory, city and postal code of oral cavity, and oropharyngeal malignancies diagnosed during 1992-2010 were extracted from the Canadian Cancer Registry and Le Registre Québécois du Cancer. RESULTS In total, 21 685 OCC cases and 15 965 OPC cases were identified from 1992 to 2010. Of those, 84.97% were oral cavity squamous cell carcinomas (SCCs), 88.10% were oropharyngeal SCCs, and both had a significant male predominance. While oral cavity SCC incidence stabilized over the study period, oropharyngeal SCC continued to increase. Oral cavity SCC incidence increased with age, while oropharyngeal SCC incidence peaked in the 50- to 59-year age group. Detailed geographic distribution analysis of patients at the provincial/territorial, city, and postal code levels identified several patient clusters. CONCLUSIONS This work highlights important epidemiological differences in trends between oral and oropharyngeal cancers, identifies high-incidence postal codes for each malignancy, and correlates incidence/mortality with known risk factors including alcohol/tobacco use and HPV infections, therefore providing a comprehensive understanding of epidemiology for these cancers in Canada.
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Affiliation(s)
| | - Jessica Lu
- 507266 Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Evgeny Savin
- 5620 Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Andrei Zubarev
- 5620 Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Peter Chauvin
- 507266 Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Denis Sasseville
- 5620 Division of Dermatology, McGill University, Montreal, QC, Canada
| | - Anthony Zeitouni
- 507266 Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Ivan V Litvinov
- 5620 Division of Dermatology, McGill University, Montreal, QC, Canada
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Cerar J, Bryant KB, Shoemaker SE, Battiato L, Wood G. HPV-Positive Oropharyngeal Cancer: The Nurse's Role in Patient Management of Treatment-Related Sequelae. Clin J Oncol Nurs 2020; 24:153-159. [PMID: 32196001 DOI: 10.1188/20.cjon.153-159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients diagnosed with oropharyngeal cancer (OPC) make up about 3% of all new cancer cases in the United States, with increasing numbers of these patients being diagnosed aged younger than 45 years and with human papillomavirus (HPV)-positive disease. Treatment effects may alter patients' physical and mental states during and after treatment. OBJECTIVES This article provides an overview of possible OPC treatment long-term effects to equip oncology nurses with information needed to empower patients with OPC to perform self-care. METHODS The OPC literature was reviewed to identify incidence, survival, risk factors, symptoms, treatment options, and treatment effects. FINDINGS This article provides a foundation for the plan of care for patients with OPC and strategies for patients to contribute to their self-care.
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Faraji F, Aygun N, Coquia SF, Gourin CG, Tan M, Rooper LM, Eisele DW, Fakhry C. Computed tomography performance in predicting extranodal extension in HPV‐positive oropharynx cancer. Laryngoscope 2019; 130:1479-1486. [DOI: 10.1002/lary.28237] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/20/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Farhoud Faraji
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of California San Diego Health San Diego California U.S.A
| | - Nafi Aygun
- The Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins Hospital Baltimore Maryland U.S.A
| | - Stephanie F. Coquia
- The Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins Hospital Baltimore Maryland U.S.A
| | - Christine G. Gourin
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Marietta Tan
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Lisa M. Rooper
- Department of PathologyJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - David W. Eisele
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Carole Fakhry
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Bloomberg‐Kimmel Institute for Cancer Immunotherapy at Johns Hopkins Baltimore Maryland U.S.A
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health Baltimore Maryland U.S.A
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Faraji F, Fung N, Zaidi M, Gourin CC, Eisele DW, Rooper LM, Fakhry C. Tumor-infiltrating lymphocyte quantification stratifies early-stage human papillomavirus oropharynx cancer prognosis. Laryngoscope 2019; 130:930-938. [PMID: 31070246 DOI: 10.1002/lary.28044] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/25/2019] [Accepted: 04/15/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate if a simple method for assessing tumor-infiltrating lymphocytes (TIL) in primary tumor specimens improves the prognostic value of the American Joint Committee on Cancer, 8th Edition (AJCC8) cancer staging system in human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-OPC). STUDY DESIGN Retrospective study. METHODS In this study, TIL density was quantified on hematoxylin and eosin (H&E)-stained specimens from patients presenting to Johns Hopkins Hospital between 2009 and 2017 who underwent primary surgical therapy and had primary tumor specimens available for analysis. The prognostic effect of TIL density was evaluated by Kaplan-Meier method and Cox proportional hazards models considering recurrence-free survival (RFS) as the primary outcome. RESULTS This study included 132 patients. Ninety-five percent were classified by clinical criteria with AJCC8 early-stage disease (stage I: 82%, stage II: 13%). After 84 months of follow-up, 15 recurrences were observed. Among clinically early-stage disease, TILhigh status was associated with improved RFS compared to TILlow (P = .002). Adjusted analysis showed TILhigh status was associated with 79% lower risk of recurrence than TILlow (adjusted hazard ratio [aHR]: 0.210, 95% confidence interval [CI]: 0.061-0.723). In clinical stage I disease, TILhigh status was associated with improved RFS compared to TILlow in both univariate and multivariate analyses (hazard ratio: 0.235, P = .021; aHR: 0.218; 95% CI: 0.058-0.822). TIL density similarly stratified risk in pathologically staged disease. CONCLUSIONS In patients with AJCC8 stage I disease, low TIL density was associated with diminished RFS. Our data suggest that assessing TIL density on H&E-stained primary tumor specimens may enhance the prognostic resolution of the AJCC8 staging criteria for HPV-OPC. LEVEL OF EVIDENCE 4 Laryngoscope, 130:930-938, 2020.
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Affiliation(s)
- Farhoud Faraji
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego Health, San Diego, California
| | - Nicholas Fung
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Munfarid Zaidi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Christine C Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa M Rooper
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.,Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A
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