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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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Evolving Profile of HPV-Driven Oropharyngeal Squamous Cell Carcinoma in a National Cancer Institute in Italy: A 10-Year Retrospective Study. Microorganisms 2020; 8:microorganisms8101498. [PMID: 33003378 PMCID: PMC7599861 DOI: 10.3390/microorganisms8101498] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 11/17/2022] Open
Abstract
Globally, 30% of oropharyngeal carcinomas (OPSCC) are caused by Human Papillomavirus (HPV). Recently, increasing incidence trends for HPV-driven OPSCC have been reported in many countries and changes in the typical HPV-positive OPSCC patient have been recorded, with an increase in the median age and diagnoses in women. We investigated the characteristics of the OPSCC patients attending an Italian Cancer Institute from 2010 to 2019 and assessed possible changes overtime of demographic, behavioral, and clinico-pathologic variables of HPV-driven OPSCC. Overall, 339 OPSCCs were evaluated. HPV-DNA and p16 positivity were 48.7% and 55.2%, respectively, with an HPV-driven fraction (i.e., HPV-DNA+/p16+) of 48.3%. We observed a significant increase overtime in the rate of HPV-associated cases (53.7% in 2015–2019 vs. 40.3% in 2010–2014, p = 0.019). The rate of HPV-driven cases was significantly higher among women, never smokers, patients with T1–T2 tumors, and with nodal involvement. A trend was also observed toward an increase in HPV-driven OPSCCs among patients >61 years, women, former smokers, and patients with no nodal involvement in 2015–2019. Our findings consolidate the observation that HPV-associated OPSCCs are also increasing in Italy. Moreover, they suggest that the profile of the HPV-driven OPSCC patient might be changing.
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Augustin JG, Lepine C, Morini A, Brunet A, Veyer D, Brochard C, Mirghani H, Péré H, Badoual C. HPV Detection in Head and Neck Squamous Cell Carcinomas: What Is the Issue? Front Oncol 2020; 10:1751. [PMID: 33042820 PMCID: PMC7523032 DOI: 10.3389/fonc.2020.01751] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Besides classic tobacco and alcohol risk factors, human papillomavirus (HPV) plays a role in the development of a subset of head and neck squamous cell carcinomas (HNSCCs), and notably oropharynx squamous cell carcinomas (OPSCCs). HPV-induced OPSCCs have a different biological behavior and a better prognosis compared to non-HPV-induced OPSCCs and the eighth-edition TNM classification now separates these two entities. Therefore, determining the HPV status of patients with OPSCC is now essential for treatment, prognosis, and development of clinical trials. In this review, after reminding essential steps of HPV implication in the cell cycle, we describe the existing tools that are currently feasible in routine practice according to facilities available in health structures, with their benefits and drawbacks: HPV PCR, E6/E7 mRNA RT-PCR, E6/E7 mRNA in situ hybridization, HPV DNA in situ hybridization, and P16 immunochemistry. Besides these traditional HPV detection tools, novel diagnostic approaches are being evaluated for HPV-induced OPSCC “ultrastaging.” E6 humoral response and ddPCR-detecting HPVct DNA are two techniques performed on blood and are therefore non-invasive. Baseline E6 humoral levels could have a prognostic value, and HPVct DNA could be helpful for HPV OPSCC recurrence monitoring. At last, next-generation sequencing (NGS)-based “capture HPV” is a technique feasible on biopsies and circulating DNA material. It helps characterize HPV integration status and sites, and it could define prognostic subgroups in HPV-induced OPSCC. These novel precision detection tools could be further integrated in the care of patients with HPV-induced OPSCC.
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Affiliation(s)
| | - Charles Lepine
- Department of Pathology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France.,INSERM U970, Université de Paris, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France
| | - Aurelien Morini
- Department of Pathology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - Anais Brunet
- Department of Pathology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - David Veyer
- Department of Virology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - Camille Brochard
- Department of Pathology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - Haitham Mirghani
- Department of Head and Neck Surgery, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - Hélène Péré
- INSERM U970, Université de Paris, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France.,Department of Virology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - Cécile Badoual
- Department of Pathology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France.,INSERM U970, Université de Paris, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France
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von Witzleben A, Wang C, Laban S, Savelyeva N, Ottensmeier CH. HNSCC: Tumour Antigens and Their Targeting by Immunotherapy. Cells 2020; 9:E2103. [PMID: 32942747 PMCID: PMC7564543 DOI: 10.3390/cells9092103] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/09/2020] [Accepted: 09/13/2020] [Indexed: 12/12/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCC) are a heterogeneous group of malignant tumours typically caused by alcohol and tobacco consumption, although an increasing number of HNSCC arise due to persistent infection with high-risk human papilloma virus (HPV). The treatment of HNSCC remains challenging, and the first-line setting is focused on surgery and chemoradiotherapy. A substantial proportion of HNSCC patients die from their disease, especially those with recurrent and metastatic disease. Among factors linked with good outcome, immune cell infiltration appears to have a major role. HPV-driven HNSCC are often T-cell rich, reflecting the presence of HPV antigens that are immunogenic. Tumour-associated antigens that are shared between patients or that are unique to an individual person may also induce varying degrees of immune response; studying these is important for the understanding of the interaction between the host immune system and the cancer. The resulting knowledge is critical for the design of better immunotherapies. Key questions are: Which antigens lead to an adaptive immune response in the tumour? Which of these are exploitable for immunotherapy? Here, we review the current thinking regarding tumour antigens in HNSCC and what has been learned from early phase clinical trials.
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Affiliation(s)
- Adrian von Witzleben
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (A.v.W.); (N.S.)
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Ulm, 89081 Ulm, Germany;
| | - Chuan Wang
- Head and Neck Center, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 7ZX, UK;
| | - Simon Laban
- Department of Otorhinolaryngology, Head & Neck Surgery, University of Ulm, 89081 Ulm, Germany;
| | - Natalia Savelyeva
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (A.v.W.); (N.S.)
| | - Christian H. Ottensmeier
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (A.v.W.); (N.S.)
- Head and Neck Center, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 7ZX, UK;
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Bahig H, Lambert L, Filion E, Soulières D, Guertin L, Ayad T, Christopoulos A, Bissada E, Alizadeh M, Bélair M, Nguyen-Tan PF. Phase II study of de-intensified intensity-modulated radiotherapy and concurrent carboplatin/5-fluorouracil in lateralized p16-associated oropharyngeal carcinoma. Head Neck 2020; 42:3479-3489. [PMID: 32866313 DOI: 10.1002/hed.26401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/16/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess cancer control and patient-reported outcomes (PROs) after de-intensified intensity-modulated radiotherapy (IMRT) in lateralized p16-associated oropharyngeal cancer (p16-OPC). METHODS Lateralized p16-OPC treated with radiotherapy and concurrent Carboplatin/5-fluorouracil between 2011 and 2014 were enrolled. De-intensified IMRT consisted in elective neck dose of 43.2 Gy/24 fractions and omission of contralateral retropharyngeal/level IV nodes. PROs were assessed using the EORTC QLC-C30 and QLQ-HN35 scales. RESULTS Twenty-nine patients were included. Median follow-up was 44 months. As per AJCC 7th Ed, 7%, 83% and 10% of patients had stage III, IVa and IVb. 5-year locoregional control and overall survival rates were 100% and 100%, respectively. Rates of acute were 52% and 35%, respectively. At 2 years post-treatment, 50% and 14% of patients had grade 1 xerostomia and dysgueusia, respectively. Most PROs scores returned to baseline within 8 months post-treatment. CONCLUSION De-intensified IMRT was associated with excellent cancer outcomes, and rapid recovery of PROs in lateralized p16-OPC.
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Affiliation(s)
- Houda Bahig
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Louise Lambert
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Edith Filion
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Denis Soulières
- Medical Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Louis Guertin
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Tareck Ayad
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Apostolos Christopoulos
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Eric Bissada
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Moein Alizadeh
- Radiation Oncology Department, Centre Intégré de Cancérologie de la Cité de la Santé à Laval, Montreal, Québec, Canada
| | - Manon Bélair
- Radiology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Phuc Felix Nguyen-Tan
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
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Girardi FM, Wagner VP, Martins MD, Abentroth AL, Hauth LA. Prevalence of p16 expression in oropharyngeal squamous cell carcinoma in southern Brazil. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:681-691. [PMID: 32981865 DOI: 10.1016/j.oooo.2020.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/16/2020] [Accepted: 08/16/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Our aim was to evaluate the prevalence of human papillomavirus (HPV)-positive tumors in a cohort of patients with oropharyngeal squamous cell carcinoma (OPSCC) at a single center in southern Brazil and determine the short-term prognostic factors in this sample. STUDY DESIGN Ninety-one consecutive patients with newly diagnosed primary OPSCC between January 2017 and December 2019 were retrospectively included. Demographic, clinical, pathologic, and survival data were collected. HPV status was determined by using p16 immunohistochemistry. RESULTS The overall prevalence of HPV-positive (HPV+) OPSCC was 20.9%. Patients with HPV+ tumors presented a nodal metastasis as the first clinical sign (P = .02); reported less alcohol (P < .001) and tobacco use (P < .001); exhibited lower tumor stages (P < .001) and higher microscopic grades (P = .01); and had higher chances of having resectable tumors (P = .008). p16-negative status (P = .01); unresectable/inoperable tumors (P < .001); presence of nodal metastasis (P = .005); and higher American Joint Committee on Cancer (AJCC) stage (P = .002) were significantly associated with worse disease-specific survival. CONCLUSIONS The prevalence of HPV+ OPSCC in southern Brazil is relatively low, and p16-positive status was associated with Better prognosis. Higher AJCC stage, nodal metastasis, and unresectability/inoperability were associated with the highest hazard ratios for death resulting from OPSCC.
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Affiliation(s)
| | - Vivian P Wagner
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Manoela Domingues Martins
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil; Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Oral Medicine, Porto Alegre Clinics Hospital (HCPA/UFRGS), Porto Alegre, RS, Brazil
| | | | - Luiz Alberto Hauth
- Integrated Oncology Center of Ana Nery Hospital, Santa Cruz do Sul, RS, Brazil
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Abdelhakam DA, Huenerberg KA, Nassar A. Utility of p16 and HPV testing in oropharyngeal squamous cell carcinoma: An institutional review. Diagn Cytopathol 2020; 49:54-59. [PMID: 32845095 DOI: 10.1002/dc.24593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/07/2020] [Indexed: 12/30/2022]
Abstract
In the US, 60% to 80% of oropharyngeal squamous cell carcinomas (OPSCCs) are associated with human papillomavirus (HPV). However, until recently, no consensus existed about when and how to test for HPV in patients with head and neck cancers. We aimed to evaluate the use of p16 and HPV testing at our institution because p16 immunohistochemistry is reportedly a reliable surrogate marker for HPV detection in OPSCCs. METHODS We identified all cases at our institution of primary or metastatic squamous cell carcinoma (SCC) of the head and neck with a concurrent p16 immunostain analysis from January 1, 2013, through August 31, 2018. Patient demographic data, tumor characteristics, p16 result, and any HPV result (in situ hybridization and E6 and E7 RNA test) were captured. RESULTS We identified 104 patients. Most primary tumors (53/57 [93.0%]) and metastases (40/47 [85.1%]) were positive for p16. Thirty-seven cases (35.6%) had reflex high-risk HPV (HR HPV) testing performed. Of the 35 p16-positive cases, 6 had discrepant HR HPV results (p16+ /HPV- ). We identified 47 p16 immunostains that were performed on lymph nodes with primary tumors of unknown origin. Most were cytology cases (34/47 [72.3%]), and most were p16 positive (40/47 [85.1%]). Neither tumor differentiation nor tumor keratinization was predictive of p16 positivity. Tumors with basaloid differentiation were universally p16 positive. CONCLUSION p16 immunohistochemistry accurately identifies HPV-positive OPSCC. Cytology specimens have an important role in characterizing SCC of unknown origin. HR HPV testing is not routinely required, and results may be discrepant with p16 findings.
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Affiliation(s)
- Dina A Abdelhakam
- Department of Clinical Pathology, Ain shams University, Cairo, Egypt.,Department of Cancer Biology, Mayo Clinic, Jacksonville, Florida, USA
| | - Katherine A Huenerberg
- Department of Pathology, George Washington University, Washington, District of Columbia, USA
| | - Aziza Nassar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
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Zhou AL, Wang X, Yu W, Yang L, Wei F, Sun Q, Wang Y, Kou F, Dong R, Ren X, Zhang X. Expression level of PD-L1 is involved in ALDH1A1-mediated poor prognosis in patients with head and neck squamous cell carcinoma. Pathol Res Pract 2020; 216:153093. [PMID: 32825960 DOI: 10.1016/j.prp.2020.153093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/15/2020] [Accepted: 06/26/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the expression levels of ALDH1A1, PDL1, and PDL2 in head and neck squamous cell carcinoma (HNSCC) patients, and explore their clinical relevance in prognosis of patients with HNSCC. METHODS Immunohistochemistry of ALDH1A1 and PD-L1/PD-L2 in 85 primary HNSCC patients was carried out. The expression level of PD-L2 was assessed with the modified Moratin's immune response scoring (IRS) system. tumor proportion score (TPS) was defined as the percentage of viable tumor cells showing partial or complete membrane staining at any intensity. The chi-square test and Fisher's exact test were used to analyze the associations between ALDH1A1 expression and clinicopathological features. The Spearman's correlation was applied to analyze the correlation of ALDH1A1 expression with PD-L1/PD-L2 expression. RESULTS kaplan-Meier analysis showed that the expression levels of ALDH1A1 and PD-L1/PD-L2 were inversely associated with recurrence-free survival (RFS; P = 0.001, 0.014, and 0.023, respectively). Moreover, expression levels of ALDH1A1 and PD-L1 were correlated with poor overall survival (OS; P = 0.002 and 0.039, respectively). Furthermore, multivariate logistics regression analyses demonstrated that expression level of ALDH1A1 was independently associated with shorter RFS (P = 0.013) and poorer OS (P = 0.014) in HNSCC patients, and the expression level of PD-L2 was only negatively associated with RFS (P = 0.041), rather than PD-L1. Spearman's correlation analysis unveiled that expression levels of PD-L1 and PD-L2 were positively correlated with ALDH1A1 expression in HNSCC patients (P = 0.000 and 0.015, respectively). Especially, the patients with expression levels of ALDH1A1 and PD-L1 had the worst prognosis. CONCLUSIONS Our results indicated that ALDH1A1 is an independent prognostic factor in patients with HNSCC, and the expression level of PDL-1 may be involved in ALDH1A1-mediated poor prognosis in patients with HNSCC.
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Affiliation(s)
- Authors Li Zhou
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; National Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Immunology and Biotherapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China
| | - Xuezhou Wang
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; National Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Immunology and Biotherapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Affiliated Hospital of Anhui West Health Vocational College, Mozitan Road, Yuan, Luan, Anhui, 237000, China
| | - Wenwen Yu
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; National Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Immunology and Biotherapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China
| | - Lili Yang
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; National Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Immunology and Biotherapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China
| | - Feng Wei
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; National Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Immunology and Biotherapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China
| | - Qian Sun
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; National Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Immunology and Biotherapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China
| | - Yang Wang
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; National Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Immunology and Biotherapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China
| | - Fan Kou
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; National Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Immunology and Biotherapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China
| | - Ruifeng Dong
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; National Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Immunology and Biotherapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China
| | - Xiubao Ren
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; National Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Immunology and Biotherapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China.
| | - Xinwei Zhang
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; National Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Tianjin's Clinical Research Center for Cancer, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China; Key Laboratory of Cancer Immunology and Biotherapy, Huanhuxi Road, Tiyuanbei, Hexi, Tianjin, 300060, China.
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Prognostic impact of additional HPV diagnostics in 102 patients with p16-stratified advanced oropharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2020; 278:1983-2000. [PMID: 32814982 PMCID: PMC8131341 DOI: 10.1007/s00405-020-06262-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/30/2020] [Indexed: 11/13/2022]
Abstract
Purpose p16 overexpression was considered as surrogate marker to identify human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCCs). Methods 102 patients with advanced stage OPSCCs treated primarily by transoral lasermicrosurgery were included. Prognostic associations of p16- and HPV-status were analyzed separately and combined. Results In contrast to p16, the HPV-status resulted in no significant survival discrepancies (5-year overall survival (OS) HPV-positive 64.9%, HPV-negative 78.7%). Combining both markers, p16-positive (p16-positive/HPV-positive, p16-positive/HPV-negative) and p16-negative/HPV-negative groups demonstrated comparable high survival (OS 78.1% vs. 85.6% vs. 73.6%). Lowest survival was observed for patients with p16-negative/HPV-positive OPSCCs (OS 40.8%). Never smoking patients with p16-positive OPSCCs demonstrated the highest survival, whereas within former/current smokers with p16-positive and p16-negative disease it was comparable low (OS 90.0% vs. 63.0% vs. 57.4%). Conclusions p16- and HPV-status should not be considered as equivalent markers for a better prognosis. Furthermore, they should not generally predominate patient associated factors like smoking. Electronic supplementary material The online version of this article (10.1007/s00405-020-06262-7) contains supplementary material, which is available to authorized users.
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Aydin AM, Chahoud J, Adashek JJ, Azizi M, Magliocco A, Ross JS, Necchi A, Spiess PE. Understanding genomics and the immune environment of penile cancer to improve therapy. Nat Rev Urol 2020; 17:555-570. [DOI: 10.1038/s41585-020-0359-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 02/07/2023]
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Hsieh JCH, Wang HM, Wu MH, Chang KP, Chang PH, Liao CT, Liau CT. Review of emerging biomarkers in head and neck squamous cell carcinoma in the era of immunotherapy and targeted therapy. Head Neck 2020; 41 Suppl 1:19-45. [PMID: 31573749 DOI: 10.1002/hed.25932] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Biomarkers in head and neck squamous cell carcinoma (HNSCC) emerge rapidly in recent years, especially for new targeted therapies and immunotherapies. METHODS Recent, relevant peer-reviewed evidence were critically reviewed and summarized. RESULTS This review article briefly introduces essential biomarker concepts, including purposes and classifications (predictive, prognostic, and diagnostic markers), and the phases of biomarker development. We summarize current biomarkers in order of clinical utility; p16 and human papillomavirus status remain the most important and validated biomarkers in HNSCC. The rationale for biomarker study design continues to evolve with technological advances, especially whole-exome or whole-genomic sequencing. Noninvasive body fluid and liquid biopsy biomarkers appear to hold strong potential for development as tools for early cancer detection, cancer diagnosis, monitoring of disease recurrence, and outcome prediction. In light of discrepancies among different technologies, standardized approaches are needed. CONCLUSION Biomarkers from cancer tissue or blood in HNSCC could direct new anticancer therapies.
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Affiliation(s)
- Jason Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Min-Hsien Wu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan.,Department of Chemical Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Pei-Hung Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan and Chang Gung University, Taoyuan, Taiwan.,Cancer Center, Chang Gung Memorial Hospital, Keelung, and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chi-Ting Liau
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University, Taoyuan, Taiwan
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Yu X, Wang Z, Zeng T. Essential gene expression pattern of head and neck squamous cell carcinoma revealed by tumor-specific expression rule based on single-cell RNA sequencing. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165791. [PMID: 32234410 DOI: 10.1016/j.bbadis.2020.165791] [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] [Received: 01/05/2020] [Revised: 03/14/2020] [Accepted: 03/25/2020] [Indexed: 01/05/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) has been widely reported and considered as one of the most threatening diseases to human health. Derived from complicated tissue subtypes, HNSCC has diverse symptoms and pathogenesis. They make the identification of the core carcinogenic factors of such diseases at the multi-cell level difficult. With the development of single-cell sequencing technologies, the effects of non-malignant cells on traditional bulk sequencing data can be eliminated directly. On the basis of fresh single-cell RNA-seq data, we set up a computational filtering strategy for tumor cell identification in an expression rule manner. This strategy can reveal the accurate expression distinction between tumor cells and adjacent tumor microenvironment, which are all supported by literature reports. Validated by several independent datasets, these rule genes can further group HNSCC patients with significant difference on survival risks. Thus, the establishment of our computational approach may not only provide an efficient tool to identify malignant cells in the tumor ecosystem but also deepen our understanding of tumor heterogeneity and tumorigenesis.
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Affiliation(s)
- Xiangtian Yu
- Clinical Research Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Zhenjia Wang
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, United States
| | - Tao Zeng
- Key Laboratory of Systems Biology, Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, Shanghai 200031, China; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai 201210, China.
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Vu TT, Soong L, Hung T, Fiorillo L, Joseph K. Cutaneous HPV16 and p16 Positive Basaloid Squamous Cell Carcinoma with Brain Metastasis: A Case Report. SAGE Open Med Case Rep 2020; 8:2050313X20935260. [PMID: 32637111 PMCID: PMC7318809 DOI: 10.1177/2050313x20935260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Basaloid squamous cell carcinoma is an infiltrative and aggressive variant of squamous cell carcinoma with basaloid features. Primary skin-derived basaloid squamous cell carcinoma is rare. Basaloid squamous cell carcinoma is commonly observed in the oropharyngeal and anogenital regions and is associated with high-risk human papillomavirus. We report a case of primary basaloid squamous cell carcinoma overlying the right scapula with metastasis to the regional lymph nodes and brain despite surgical resection and adjuvant chemoradiation. Histopathologic investigations of high-risk cutaneous squamous cell carcinoma do not routinely involve human papillomavirus testing. In contrast, oncogenic human papillomavirus and p16 are screened in head and neck squamous cell carcinoma for prognostication. Since the patient presented with an aggressive variant of squamous cell carcinoma and distal metastasis despite standard therapies, human papillomavirus testing was performed. P16, a surrogate marker for human papillomavirus infection and specifically HPV16 was identified in the tumor. This is a unique report of HPV16 in primary cutaneous basaloid squamous cell carcinoma with distal brain metastasis.
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Affiliation(s)
- Trang T Vu
- Department of Dermatology, University of Alberta, Edmonton, AB, Canada
| | - Laura Soong
- Department of Dermatology, University of Alberta, Edmonton, AB, Canada
| | - Tawny Hung
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Loretta Fiorillo
- Department of Dermatology, University of Alberta, Edmonton, AB, Canada
| | - Kurian Joseph
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, AB, Canada
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Dickinson A, Saraswat M, Syrjänen S, Tohmola T, Silén R, Randén-Brady R, Carpén T, Hagström J, Haglund C, Mattila P, Mäkitie A, Joenväärä S, Silén S. Comparing serum protein levels can aid in differentiating HPV-negative and -positive oropharyngeal squamous cell carcinoma patients. PLoS One 2020; 15:e0233974. [PMID: 32542012 PMCID: PMC7295232 DOI: 10.1371/journal.pone.0233974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The surrogate immunohistochemical marker, p16INK4a, is used in clinical practice to determine the high-risk human papillomavirus (HPV) status of oropharyngeal squamous cell carcinomas (OPSCC). With a specificity of 83%, this will misclassify some patients compared with direct HPV testing. Patients who are p16INK4a-positive but HPV DNA-negative, or RNA-negative, may be unsuitable for treatment de-escalation aimed at reducing treatment-related side effects. We aimed to identify cost-effective serum markers to improve decision making for patients at risk of misclassification by p16INK4a alone. METHODS Serum proteins from pre-treatment samples of 36 patients with OPSCC were identified and quantified using label-free mass spectrometry-based proteomics. HPV-status was determined using p16INK4a/HPV DNA and E6/E7 mRNA. Serum protein expressions were compared between groups of patients according to HPV status, using the unpaired t-test with a Benjamini-Hochberg correction. ROC curves (AUC) were calculated with SPSS (v25). RESULTS Of 174 serum proteins identified, complement component C7 (C7), apolipoprotein F (ApoF) and galectin-3-Binding Protein (LGALS3BP) significantly differed between HPV-positive and -negative tumors (AUC ranging from 0.84-0.87). ApoF levels were more than twice as high in the E6/E7 mRNA HPV-positive group than HPV-negative. CONCLUSIONS Serum C7, ApoF and LGALS3BP levels discriminate between HPV-positive and HPV-negative OPSCC. Further studies are needed to validate these host immunity-related proteins as markers for HPV-associated OPSCC.
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Affiliation(s)
- Amy Dickinson
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Mayank Saraswat
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
- HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Stina Syrjänen
- Department of Oral Pathology and Oral Radiology, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Tiialotta Tohmola
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Robert Silén
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Reija Randén-Brady
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Carpén
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Department of Oral Pathology and Oral Radiology, University of Turku, Turku, Finland
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Surgery, University of Helsinki and Helsinki, University Hospital Helsinki, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki, University Hospital Helsinki, Helsinki, Finland
- Research Programs Unit, Translational Cancer Medicine, University of Helsinki, Helsinki, Finland
| | - Petri Mattila
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Sakari Joenväärä
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
- HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Suvi Silén
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
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Pitak-Arnnop P, Witohendro LK, Meningaud JP, Subbalekha K, Iamaroon A, Sirintawat N, Klaisiri A, Neff A. Which characteristics can be expected from p16+-squamous cell carcinomas of the posterior oral cavity and oropharynx? – Distinctive results from Central Germany. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:213-218. [DOI: 10.1016/j.jormas.2019.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/02/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
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Pan H, Edwards SW, Ives C, Covert H, Harville EW, Lichtveld MY, Wickliffe JK, Hamilton CM. An Assessment of Environmental Health Measures in the Deepwater Horizon Research Consortia. CURRENT OPINION IN TOXICOLOGY 2020; 16:75-82. [PMID: 32457927 DOI: 10.1016/j.cotox.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research consortia play a key role in our understanding of how environmental exposures influence health and wellbeing, especially in the case of catastrophic events such as the Deepwater Horizon oil spill. A common challenge that prevents the optimal use of these data is the difficulty of harmonizing data regarding the environmental exposures and health effects across the studies within and among consortia. A review of the measures used by members of the Deepwater Horizon Research Consortia highlights the challenges associated with balancing timely implementation of a study to support disaster relief with optimizing the long-term value of the data. The inclusion of common, standard measures at the study design phase and a priori discussions regarding harmonization of study-specific measures among consortia members are key to overcoming this challenge. As more resources become available to support the use of standard measures, researchers now have the tools needed to rapidly coordinate their studies without compromising research focus or timely completion of the original study goals.
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Affiliation(s)
- Huaqin Pan
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709
| | - Stephen W Edwards
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709
| | - Cataia Ives
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709
| | - Hannah Covert
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112
| | - Emily W Harville
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112
| | - Maureen Y Lichtveld
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112
| | - Jeffrey K Wickliffe
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112
| | - Carol M Hamilton
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709
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Lechien JR, Descamps G, Seminerio I, Furgiuele S, Dequanter D, Mouawad F, Badoual C, Journe F, Saussez S. HPV Involvement in the Tumor Microenvironment and Immune Treatment in Head and Neck Squamous Cell Carcinomas. Cancers (Basel) 2020; 12:cancers12051060. [PMID: 32344813 PMCID: PMC7281394 DOI: 10.3390/cancers12051060] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/13/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCC) are one of the most prevalent cancers worldwide. Active human papillomavirus (HPV) infection has been identified as an important additional risk factor and seems to be associated with a better prognosis in non-drinker and non-smoker young patients with oropharyngeal SCC. The better response of the immune system against the HPV-induced HNSCC is suspected as a potential explanation for the better prognosis of young patients. To further assess this hypothesis, our review aims to shed light the current knowledge about the impact of HPV infection on the immune response in the context of HNSCC, focusing on the innate immune system, particularly highlighting the role of macrophages, Langerhans and myeloid cells, and on the adaptative immune system, pointing out the involvement of T regulatory, T CD8 and T CD4 lymphocytes. In addition, we also review the preventive (HPV vaccines) and therapeutic (checkpoint inhibitors) strategies against HPV-related HNSCC, stressing the use of anti-CTLA4, PD-L1, PD-L2 antibodies alone and in combination with other agents able to modulate immune responses.
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Affiliation(s)
- Jérôme R. Lechien
- Department of Otolaryngology and Head and Neck Surgery, CHU Saint-Pierre, 1000 Brussels, Belgium; (J.R.L.); (D.D.)
- Department of Otolaryngology and Head and Neck Surgery, CHU of Lille, University Lille 2, 59000 Lille, France;
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 8, B7000 Mons, Belgium; (G.D.); (I.S.); (S.F.); (F.J.)
| | - Géraldine Descamps
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 8, B7000 Mons, Belgium; (G.D.); (I.S.); (S.F.); (F.J.)
| | - Imelda Seminerio
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 8, B7000 Mons, Belgium; (G.D.); (I.S.); (S.F.); (F.J.)
| | - Sonia Furgiuele
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 8, B7000 Mons, Belgium; (G.D.); (I.S.); (S.F.); (F.J.)
| | - Didier Dequanter
- Department of Otolaryngology and Head and Neck Surgery, CHU Saint-Pierre, 1000 Brussels, Belgium; (J.R.L.); (D.D.)
| | - Francois Mouawad
- Department of Otolaryngology and Head and Neck Surgery, CHU of Lille, University Lille 2, 59000 Lille, France;
| | - Cécile Badoual
- Department of anatomo-pathology, G Pompidou European Hospital, AP-HP, University of Paris, 75015 Paris, France;
| | - Fabrice Journe
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 8, B7000 Mons, Belgium; (G.D.); (I.S.); (S.F.); (F.J.)
- Laboratory of Oncology and Experimental Surgery, Institute Jules Bordet, Free University of Brussels, Rue Heger-Bordet, 1, B1000 Brussels, Belgium
| | - Sven Saussez
- Department of Otolaryngology and Head and Neck Surgery, CHU Saint-Pierre, 1000 Brussels, Belgium; (J.R.L.); (D.D.)
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Avenue du Champ de Mars, 8, B7000 Mons, Belgium; (G.D.); (I.S.); (S.F.); (F.J.)
- Correspondence: ; Tel.: +32-65-37-35-84
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Perri F, Longo F, Caponigro F, Sandomenico F, Guida A, Della Vittoria Scarpati G, Ottaiano A, Muto P, Ionna F. Management of HPV-Related Squamous Cell Carcinoma of the Head and Neck: Pitfalls and Caveat. Cancers (Basel) 2020; 12:cancers12040975. [PMID: 32326465 PMCID: PMC7226389 DOI: 10.3390/cancers12040975] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 12/31/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCCs) are a very heterogeneous group of malignancies arising from the upper aerodigestive tract. They show different clinical behaviors depending on their origin site and genetics. Several data support the existence of at least two genetically different types of HNSCC, one virus-related and the other alcohol and/or tobacco and oral trauma-related, which show both clinical and biological opposite features. In fact, human papillomavirus (HPV)-related HNSCCs, which are mainly located in the oropharynx, are characterized by better prognosis and response to therapies when compared to HPV-negative HNSCCs. Interestingly, virus-related HNSCC has shown a better response to conservative (nonsurgical) treatments and immunotherapy, opening questions about the possibility to perform a pretherapy assessment which could totally guide the treatment strategy. In this review, we summarize molecular differences and similarities between HPV-positive and HPV-negative HNSCC, highlighting their impact on clinical behavior and on therapeutic strategies.
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Affiliation(s)
- Francesco Perri
- Head and Neck Medical Oncology Unit, Istituto Nazionale Tumori, IRCCS G. Pascale, 80131 Naples, Italy;
- Correspondence: ; Tel.: +39-081-590-3362
| | - Francesco Longo
- Division of Surgical Oncology Maxillo-Facial Unit, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (F.L.); (A.G.); (F.I.)
| | - Francesco Caponigro
- Head and Neck Medical Oncology Unit, Istituto Nazionale Tumori, IRCCS G. Pascale, 80131 Naples, Italy;
| | - Fabio Sandomenico
- Unit, Istituto Nazionale Tumori—IRCCS—G. Pascale, 80131 Naples, Italy;
| | - Agostino Guida
- Division of Surgical Oncology Maxillo-Facial Unit, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (F.L.); (A.G.); (F.I.)
| | | | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Department of Abdominal Oncology, INT IRCCS Fondazione G. Pascale, 80131 Naples, Italy;
| | - Paolo Muto
- Radiation Oncology Unit, Istituto Nazionale Tumori—IRCCS—G. Pascale, 80131 Naples, Italy;
| | - Franco Ionna
- Division of Surgical Oncology Maxillo-Facial Unit, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy; (F.L.); (A.G.); (F.I.)
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Greaney-Davies FST, Risk JM, Robinson M, Liloglou T, Shaw RJ, Schache AG. Essential characterisation of human papillomavirus positive head and neck cancer cell lines. Oral Oncol 2020; 103:104613. [PMID: 32120342 DOI: 10.1016/j.oraloncology.2020.104613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/14/2020] [Accepted: 02/22/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The incidence of human papillomavirus (HPV)-positive head and neck cancer, particularly oropharyngeal, has been increasing rapidly. Understanding of this disease, and modelling of suitable therapeutics, requires sustainable cell cultures, yet they remain limited in number and of variable origin. A comprehensive understanding of these resources is therefore of great importance. MATERIALS AND METHODS Viral gene expression assays and pathological testing methods were used in the six currently available HPV-positive cell lines derived from head and neck (H&N) subsites, two HPV-negative H&N and two cervical carcinoma cell lines. A 2D migration assay monitored cell movement, speed and pattern of migration. RESULTS All six H&N and two cervical cell lines were confirmed HPV-positive by gold standard testing, yet variability between tests was apparent. Although migration was not significantly different between cell lines, each demonstrated unique migration patterns. CONCLUSION Patient-derived cancer cells, arising as a consequence of natural oncogenic processes rather than in vitro manipulation, are essential for understanding cancer biology. We have characterised the available HPV-positive H&N cell lines and provided clear evidence of a persisting viral oncogenic driver in each, as such supporting their ongoing use as a model of HPV-positive H&N cancer. Importantly, we also highlight a need for caution to be exercised when translating future in vitro findings associated with these lines particularly in the context of oropharyngeal cancer given irregularities in tumour provenance (origin site and clinicopathological features).
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Affiliation(s)
- Frances S T Greaney-Davies
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool L7 8TX, UK
| | - Janet M Risk
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool L7 8TX, UK.
| | - Max Robinson
- Department of Cellular Pathology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne NE7 7DN, UK
| | - Triantafilos Liloglou
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool L7 8TX, UK
| | - Richard J Shaw
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool L7 8TX, UK; Head & Neck Unit Aintree University Hospital, Longmoor Lane, Liverpool L9 7AL, UK
| | - Andrew G Schache
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool L7 8TX, UK; Head & Neck Unit Aintree University Hospital, Longmoor Lane, Liverpool L9 7AL, UK
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Molecular Diagnostics in Human Papillomavirus-Related Head and Neck Squamous Cell Carcinoma. Cells 2020; 9:cells9020500. [PMID: 32098320 PMCID: PMC7072739 DOI: 10.3390/cells9020500] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023] Open
Abstract
The incidence of human papillomavirus (HPV)-related head and neck squamous cell carcinoma continues to increase. Accurate diagnosis of the HPV status of a tumor is vital, as HPV+ versus HPV- tumors represent two unique biological and clinical entities with different treatment strategies. High-risk HPV subtypes encode oncoproteins E6 and E7 that disrupt cellular senescence and ultimately drive tumorigenesis. Current methods for detection of HPV take advantage of this established oncogenic pathway and detect HPV at various biological stages. This review article provides an overview of the existing technologies employed for the detection of HPV and their current or potential future role in management and prognostication.
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71
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In Regard to Billfalk-Kelly et al. Int J Radiat Oncol Biol Phys 2020; 106:449-450. [PMID: 31928643 DOI: 10.1016/j.ijrobp.2019.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 11/21/2022]
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72
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In Reply to Duprez et al. Int J Radiat Oncol Biol Phys 2020; 106:450-451. [DOI: 10.1016/j.ijrobp.2019.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/24/2022]
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Maroun CA, Al Feghali K, Traboulsi H, Dabbous H, Abbas F, Dunya G, Ziade G, Mahfouz R, Youssef B, Tamim H, Geara F, Khalifeh I, Moukarbel RV. HPV-related oropharyngeal cancer prevalence in a middle eastern population using E6/E7 PCR. Infect Agent Cancer 2020; 15:1. [PMID: 31921331 PMCID: PMC6945694 DOI: 10.1186/s13027-019-0268-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/31/2019] [Indexed: 12/20/2022] Open
Abstract
Background Given the paucity of data and widely variable rates that have been reported, the main objective of this study was to examine the prevalence of HPV-positivity in oropharyngeal squamous cell carcinoma (OPSCC) in Middle Eastern patients presenting to one of the region's largest tertiary care centers using polymerase chain reaction (PCR) amplification of the HPV E6/E7 oncogenes, a highly sensitive and specific method of detection. Methods Medical charts and archived pathological specimens were obtained for patients diagnosed with biopsy proven oropharyngeal cancer who presented to the American University of Beirut Medical Center between 1972 and 2017. DNA was extracted from paraffin-embedded specimens and tested for 30 high-risk and low-risk papilloma viruses using the PCR-based EUROarray HPV kit (EuroImmun). Results A total of 57 patients with oropharyngeal cancer were initially identified; only 34 met inclusion/exclusion criteria and were included in the present study. Most patients were males (73.5%) from Lebanon (79.4%). The most common primary tumor site was in the base of tongue (50%), followed by the tonsil (41.2%). The majority of patients (85.3%) tested positive for HPV DNA. Conclusion The prevalence of HPV-positivity amongst Middle Eastern OPSCC patients, specifically those from Lebanon, may be far greater than previously thought. The Lebanese population and other neighboring Middle Eastern countries may require a more vigilant approach towards HPV detection and awareness. On an international level, further research is required to better elucidate non-classical mechanisms of HPV exposure and transmission.
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Affiliation(s)
- Christopher A Maroun
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Karine Al Feghali
- 2Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Henri Traboulsi
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Helene Dabbous
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Fatmeh Abbas
- 3Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, 2nd Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Gabriel Dunya
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Georges Ziade
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Rami Mahfouz
- 3Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, 2nd Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Bassem Youssef
- 2Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- 4Biostatistics Unit, Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Fady Geara
- 2Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim Khalifeh
- 3Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, 2nd Floor, Hamra, Beirut, 1107 2020 Lebanon
| | - Roger V Moukarbel
- 1Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, 6th Floor, Hamra, Beirut, 1107 2020 Lebanon
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Human papillomavirus-associated squamous cell carcinoma of the larynx or hypopharynx: Clinical outcomes and implications for laryngeal preservation. Oral Oncol 2019; 98:20-27. [PMID: 31536842 DOI: 10.1016/j.oraloncology.2019.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/02/2019] [Accepted: 09/09/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Human papillomavirus (HPV) can be detected in approximately 25% of squamous cell carcinomas (SCC) of the larynx and hypopharynx. Though HPV is associated with improved survival and disease control in patients with oropharyngeal SCC, the role of HPV as a marker of favorable treatment outcomes in laryngeal and hypopharyngeal cancer is unclear. MATERIALS AND METHODS Patients treated for laryngeal or hypopharyngeal SCC were reviewed. HPV status detected by p16 and/or HPV DNA PCR were abstracted from the medical record. A subset of samples (stage III-IV treated with primary radiotherapy) was retrospectively tested for p16 and HPV DNA. Overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were determined and compared between HPV-positive (p16+, PCR+ or both) and HPV-negative (p16- or PCR-) patients. RESULTS In total, 279 patients were identified, 94 of which were tested for HPV. Eighty-two (87%) were negative and 12 (13%) were positive for HPV. At 3 years, there were no significant differences in OS (72% v. 83%), DFS (60% v. 71%) and LRC (80% v. 89%). Performance status, smoking history and stage predicted for OS, while performance status and stage predicted for DFS. Analysis of patients treated with primary radiotherapy revealed non-significantly higher rates of laryngeal preservation at 3 years (75% v. 100%). CONCLUSION HPV was detected in 13% of tested laryngeal/hypopharyngeal cancers. HPV does not appear to significantly impact survival or disease control in patients with SCC of the larynx or hypopharynx. Non-significant improvements in laryngeal preservation were observed in HPV-positive patients.
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75
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Prevalence of Human Papillomavirus (HPV) Infection and the Association with Survival in Saudi Patients with Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2019; 11:cancers11060820. [PMID: 31200489 PMCID: PMC6627701 DOI: 10.3390/cancers11060820] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 12/11/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) shows wide disparities, association with human papillomavirus (HPV) infection, and prognosis. We aimed at determining HPV prevalence, and its prognostic association with overall survival (OS) in Saudi HNSCC patients. The study included 285 oropharyngeal and oral-cavity HNSCC patients. HPV was detected using HPV Linear-Array and RealLine HPV-HCR. In addition, p16INK4a (p16) protein overexpression was evaluated in 50 representative cases. Oropharyngeal cancers were infrequent (10%) compared to oral-cavity cancers (90%) with no gender differences. Overall, HPV-DNA was positive in 10 HNSCC cases (3.5%), mostly oropharyngeal (21%). However, p16 expression was positive in 21 cases of the 50 studied (42%) and showed significantly higher OS (p = 0.02). Kaplan–Meier univariate analysis showed significant associations between patients’ OS and age (p < 0.001), smoking (p = 0.02), and tumor stage (p < 0.001). A Cox proportional hazard multivariate analysis confirmed the significant associations with age, tumor stage, and also treatment (p < 0.01). In conclusion, HPV-DNA prevalence was significantly lower in our HNSCC patients than worldwide 32–36% estimates (p ≤ 0.001). Although infrequent, oropharyngeal cancer increased over years and showed 21% HPV-DNA positivity, which is close to the worldwide 36–46% estimates (p = 0.16). Besides age, smoking, tumor stage, and treatment, HPV/p16 status was an important determinant of patients’ survival. The HPV and/or p16 positivity patients had a better OS than HPV/p16 double-negative patients (p = 0.05). Thus, HPV/p16 status helps improve prognosis by distinguishing between the more favorable p16/HPV positive and the less favorable double-negative tumors.
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Rasmussen JH, Grønhøj C, Håkansson K, Friborg J, Andersen E, Lelkaitis G, Klussmann JP, Wittekindt C, Wagner S, Vogelius IR, von Buchwald C. Risk profiling based on p16 and HPV DNA more accurately predicts location of disease relapse in patients with oropharyngeal squamous cell carcinoma. Ann Oncol 2019; 30:629-636. [PMID: 30657857 DOI: 10.1093/annonc/mdz010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the era of precision medicine and HPV-related oropharyngeal squamous cell carcinoma (OPSCC), it is relevant to assess the risk of not only survival, but also the risk of local, regional, or distant treatment failure. The UICC 8th edition uses the surrogate marker p16 to stratify for HPV association but discordance between p16 status and HPV association has been shown. The purpose of this study was to develop a prognostic model to predict the risk of local, regional, and distant metastases and non-cancer-related death for patients with OPSCC, test the prognostic relevance of adding HPV DNA and p16 status, and validate the findings in an independent external dataset. PATIENTS AND METHODS Consecutive patients diagnosed with OPSCC and treated with curative radiotherapy with or without cisplatin in eastern Denmark from 2000 to 2014 were included. Characteristics included age, gender, TNM stage, smoking habits, performance status, and HPV status assessed with p16 and HPV DNA. The information was used to develop a prognostic model for first site of failure with four competing events: recurrence in T-, N-, and M-site, and death with no evidence of disease. RESULTS Overall 1243 patients were eligible for the analysis. A prognostic model with the four events was developed and externally validated in an independent dataset with a heterogeneously treated patient population from another institution. The individual prognostication from the competing risk analysis is displayed in a user friendly online tool (https://rasmussen.shinyapps.io/OPSCCmodelHPV_p16/). Replacing p16 status with the combined variable HPV/p16 status influenced the HR and patients with HPV-/p16+ had significantly higher HR of M-site recurrence than HPV+/p16+ with a HR = 2.56; CI [1.30; 5.02]; P = 0.006 (P = 0.013 in the validation cohort). CONCLUSION Patients with HPV-/p16+ have significantly higher risk of M-site recurrence and could potentially be relevant candidates for clinical trials testing systemic treatments in combination with conventional treatments.
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Affiliation(s)
- J H Rasmussen
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology.
| | - C Grønhøj
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology
| | - K Håkansson
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - J Friborg
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - E Andersen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Copenhagen
| | - G Lelkaitis
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne
| | - C Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - S Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - I R Vogelius
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - C von Buchwald
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology
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Craig SG, Anderson LA, Schache AG, Moran M, Graham L, Currie K, Rooney K, Robinson M, Upile NS, Brooker R, Mesri M, Bingham V, McQuaid S, Jones T, McCance DJ, Salto-Tellez M, McDade SS, James JA. Recommendations for determining HPV status in patients with oropharyngeal cancers under TNM8 guidelines: a two-tier approach. Br J Cancer 2019; 120:827-833. [PMID: 30890775 PMCID: PMC6474272 DOI: 10.1038/s41416-019-0414-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND TNM8 staging for oropharyngeal squamous cell carcinomas (OPSCC) surrogates p16 immunohistochemistry for HPV testing. Patients with p16+ OPSCC may lack HPV aetiology. Here, we evaluate the suitability of TNM8 staging for guiding prognosis in such patients. METHODS HPV status was ascertained using p16 immunohistochemistry and high-risk HPV RNA and DNA in situ hybridisation. Survival by stage in a cohort of OPSCC patients was evaluated using TNM7/TNM8 staging. Survival of p16+/HPV- patients was compared to p16 status. RESULTS TNM8 staging was found to improve on TNM7 (log rank p = 0·0190 for TNM8 compared with p = 0·0530 for TNM7) in p16+ patients. Patients who tested p16+ but were HPV- (n = 20) had significantly reduced five-year survival (33%) compared to p16+ patients (77%) but not p16- patients (35%). Cancer stage was reduced in 95% of p16+/HPV- patients despite having a mortality rate twice (HR 2.66 [95% CI: 1.37-5.15]) that of p16+/HPV+ patients under new TNM8 staging criteria. CONCLUSION Given the significantly poorer survival of p16+/HPV- OPSCCs, these data provide compelling evidence for use of an HPV-specific test for staging classification. This has particular relevance in light of potential treatment de-escalation that could expose these patients to inappropriately reduced treatment intensity as treatment algorithms evolve.
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Affiliation(s)
- Stephanie G Craig
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Lesley A Anderson
- Northern Ireland Cancer Registry, Belfast, Northern Ireland, UK
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Andrew G Schache
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, England, UK
| | | | - Laura Graham
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Keith Currie
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Keith Rooney
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, England, UK
| | - Navdeep S Upile
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, England, UK
| | - Rachel Brooker
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, England, UK
| | - Mina Mesri
- Aintree University Hospital NHS Foundation Trust, Liverpool, England, UK
| | - Victoria Bingham
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Stephen McQuaid
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Terry Jones
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, England, UK
| | - Dennis J McCance
- Department of Pathology, University of New Mexico Medical School, Albuquerque, NM, 87131, USA
| | - Manuel Salto-Tellez
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Simon S McDade
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Jacqueline A James
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK.
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
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Božinović K, Sabol I, Dediol E, Milutin Gašperov N, Manojlović S, Vojtechova Z, Tachezy R, Grce M. Genome-wide miRNA profiling reinforces the importance of miR-9 in human papillomavirus associated oral and oropharyngeal head and neck cancer. Sci Rep 2019; 9:2306. [PMID: 30783190 PMCID: PMC6381209 DOI: 10.1038/s41598-019-38797-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/10/2019] [Indexed: 12/18/2022] Open
Abstract
Head and neck cancer is the sixth most common malignancy worldwide, predominantly developing from squamous cell epithelia (HNSCC). The main HNSCC risk factors are tobacco, excessive alcohol use, and the presence of human papillomavirus (HPV). HPV positive (+) cancers are etiologically different from other HNSCC and often show better prognosis. The current knowledge regarding HNSCC miRNA profiles is still incomplete especially in the context of HPV+ cancer. Thus, we analyzed 61 freshly collected primary oral (OSCC) and oropharyngeal (OPSCC) SCC samples. HPV DNA and RNA was found in 21% cases. The Illumina whole-genome small-RNA profiling by next-generation sequencing was done on 22 samples and revealed 7 specific miRNAs to HPV+ OSCC, 77 to HPV+ OPSCC, and additional 3 shared with both; 51 miRNAs were specific to HPV− OPSCC, 62 to HPV− OSCC, and 31 shared with both. The results for 9 miRNAs (miR-9, -21, -29a, -100, -106b, -143 and -145) were assessed by reverse transcription-quantitative polymerase chain reaction on the whole study population. The data was additionally confirmed by reanalyzing publicly available miRNA sequencing Cancer Genome Atlas consortium (TCGA) HNSCC data. Cell signaling pathway analysis revealed differences between HPV+ and HPV− HNSCC. Our findings compared with literature data revealed extensive heterogeneity of miRNA deregulation with only several miRNAs consistently affected, and miR-9 being the most likely HPV related miRNA.
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Affiliation(s)
- Ksenija Božinović
- Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Ivan Sabol
- Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia.
| | - Emil Dediol
- Clinical hospital Dubrava, Department of Maxillofacial Surgery, Zagreb, Croatia
| | | | - Spomenka Manojlović
- Clinical hospital Dubrava, Department of Maxillofacial Surgery, Zagreb, Croatia
| | - Zuzana Vojtechova
- Department of Genetics and Microbiology, Faculty of Science, Charles University, BIOCEV, Vestec, Czech Republic
| | - Ruth Tachezy
- Department of Genetics and Microbiology, Faculty of Science, Charles University, BIOCEV, Vestec, Czech Republic
| | - Magdalena Grce
- Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia.
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HPV-driven oropharyngeal squamous cell cancer in Croatia - Demography and survival. PLoS One 2019; 14:e0211577. [PMID: 30707715 PMCID: PMC6358070 DOI: 10.1371/journal.pone.0211577] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy worldwide. Main HNSCC risk factors are tobacco, alcohol, and high-risk human papillomavirus (HPV). HPV+ oropharyngeal squamous cell cancer (OPSCC) usually have different etiology, increasing incidence and often show an improved survival when compared to HPV-negative cases. The objective of the current study was to retrospectively examine the influence of HPV on the survival of OPSCC patients in a non-Western population setting. Materials and methods We determined the presence of HPV DNA and/or RNA in 99 formalin-fixed paraffin embedded (FFPE) tissue samples of OPSCC patients treated between 2002 and 2015. Patients were compared based on laboratory, demographic, clinical, life style characteristics and survival. Results HPV RNA was found in 29.3% cases. However, groups based on HPV data (either RNA, DNA or retrospectively collected p16 staining) did not show significant differences. Overall, 5-year survival was 30% with minimal influence of the HPV positivity. Conclusions The HPV influence on survival of OPSCC patients is not identical between populations probably due to other factors overshadowing the HPV effect. This should be taken into account when treatment or policy decisions are made in each particular setting.
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80
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Radiotherapy alone as a possible de-intensified treatment for human papillomavirus-related locally advanced oropharyngeal squamous cell carcinoma. Int J Clin Oncol 2019; 24:640-648. [DOI: 10.1007/s10147-019-01394-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/12/2019] [Indexed: 01/04/2023]
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81
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Pan C, Issaeva N, Yarbrough WG. HPV-driven oropharyngeal cancer: current knowledge of molecular biology and mechanisms of carcinogenesis. CANCERS OF THE HEAD & NECK 2018; 3:12. [PMID: 31093365 PMCID: PMC6460765 DOI: 10.1186/s41199-018-0039-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/09/2018] [Indexed: 12/21/2022]
Abstract
Understanding of oropharyngeal squamous cell carcinoma has significantly progressed over the last decades, and the concept that this disease can be subdivided into two distinct entities based on human papilloma virus (HPV) status has gained acceptance. To combat the constantly growing epidemic of HPV+ oropharyngeal cancer, further investigation and characterization the unique features of the disease, along with the development and implementation of new, targeted therapies, is crucial. In this review, we summarize the etiology, pathogenesis, diagnosis, treatment, and molecular characteristics of HPV-associated oropharyngeal squamous cell carcinoma.
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Affiliation(s)
- Cassie Pan
- 1Department of Surgery, Division of Otolaryngology, Yale University, New Haven, CT USA
| | - Natalia Issaeva
- 2Department of Otolaryngology/Head and Neck Surgery; Lineberger Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7070, Chapel Hill, NC 27599 USA
| | - Wendell G Yarbrough
- 2Department of Otolaryngology/Head and Neck Surgery; Lineberger Cancer Center, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7070, Chapel Hill, NC 27599 USA
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82
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Lop J, García J, López M, Taberna M, Mena M, Alemany L, Quer M, León X. Competing mortality in oropharyngeal carcinoma according to human papillomavirus status. Head Neck 2018; 41:1328-1334. [PMID: 30549389 DOI: 10.1002/hed.25559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/24/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The objective of the present study is to assess differences in the competing causes of death in patients with oropharyngeal carcinoma (OPC) as a function of the human papillomavirus (HPV) status. METHODS We studied retrospectively 423 patients with OPC with known HPV status. Among the patients included in the study, 53 (12.5%) were HPV-positive. We analyzed overall survival and competing causes of mortality according to the HPV status of the patients. RESULTS Patients with HPV-negative tumors had lower OPC cancer-specific survival (P = .0001), second primary neoplasm survival (P = .0001), and noncancer-related causes survival (P = .13) than patients with HPV-positive tumors. This resulted in significant differences in overall survival depending on HPV status (P = .0001). CONCLUSION Conclusion: HPV-positive OPC has a better overall survival than HPV-negative OPC. Patients with HPV-positive tumors presented a significant lower OPC cancer-specific and second primary neoplasm mortality and a marginally nonsignificant lower noncancer mortality as compared to HPV-negative tumors.
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Affiliation(s)
- Joan Lop
- Otorhinolaryngology Department, Hospital Parc Taulí, Universitat Autònonoma de Barcelona, Sabadell, Spain
| | - Jacinto García
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montserrat López
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miren Taberna
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomédica de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomédica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomédica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Miquel Quer
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier León
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
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83
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Broccolo F, Ciccarese G, Rossi A, Anselmi L, Drago F, Toniolo A. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) in keratinizing versus non- keratinizing squamous cell carcinoma of the oropharynx. Infect Agent Cancer 2018; 13:32. [PMID: 30455727 PMCID: PMC6230228 DOI: 10.1186/s13027-018-0205-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022] Open
Abstract
Background Oral and oropharyngeal squamous cell carcinomas (OSCC and OPSCC) represent the majority of head and neck squamous cell carcinomas (HNSCC). Human papillomavirus (HPV) is an important etiologic factor together with Epstein-Barr virus (EBV). Little is known on the prevalence of major herpesviruses [EBV, cytomegalovirus (CMV) and HHV-6, − 7 and − 8] in HNSCCs. Methods Fifty-one formalin-fixed paraffin-embedded (FFPE) tissue samples taken at surgery (40 oropharyngeal, 11 oral) were analyzed for 40 HPV genotypes (20 high-risk types), EBV, CMV, HHV-6, − 7 and − 8 by quantitative PCR. Expression of the HPV-induced p16INK4A protein was also investigated by immunohistochemistry (IHC). Results In SCC, the prevalence of EBV was significantly higher compared to that of HPV (EBV 51% vs. HPV 19.5%; P = 0.005). HPV infection was found in 25% of OPSCC and in none of the OSCC; conversely, higher prevalence of EBV was found in OSCC (72.7%). HPV and EBV co-infection was detected only in 4 (10%) OPSCC. CMV was detected in only two cases, whereas HHV-6, − 7 and − 8 resulted negative. The prevalence of HPV but no EBV was associated with the non-keratinizing SCC type (NKSCC) compared to the keratinizing SCC type (KSCC)(HPV-DNA P < 0.005; EBV = 0.054). Conclusions Single HPV or EBV positivity was higher in OSCC than in OPSCC. Other potentially oncogenic herpesvirus types were minimally or not represented.
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Affiliation(s)
- Francesco Broccolo
- 1Department of Medicine and Surgery (School of Medicine), University of Milano-Bicocca, Monza, Italy.,5Laboratory of Medical Microbiology, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Giulia Ciccarese
- 2DISSAL Department of Dermatology, IRCCS A.O.U. San Martino-IST, Genoa, Italy
| | - Agostino Rossi
- 3Laboratory of Medical Microbiology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Luca Anselmi
- Department of Pathology, ASL 3 Genovese, Genoa, Sampierdarena Italy
| | - Francesco Drago
- 2DISSAL Department of Dermatology, IRCCS A.O.U. San Martino-IST, Genoa, Italy
| | - Antonio Toniolo
- 3Laboratory of Medical Microbiology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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84
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pN status predicts outcomes in surgically treated pT1-pT2 patients of various disease stages with squamous cell carcinoma of the head and neck: a 17-year retrospective single center cohort study. Eur Arch Otorhinolaryngol 2018; 275:2787-2795. [PMID: 30159726 DOI: 10.1007/s00405-018-5108-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/24/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The optimal treatment for a substantial proportion of patients with pT1-pT2 squamous cell carcinomas of the head and neck (SCCHN) remains to be refined. The extent of surgery, role and potential benefit of adjuvant treatment are to be balanced against therapy-induced side effects. We compared the outcomes of surgery with or without adjuvant radiotherapy (RT) or chemotherapy (CRT) and investigated the prognostic value of established clinicopathological parameters. METHODS Data were retrospectively collected for 227 patients who were treated by surgery alone (n = 31), RT (n = 87) and CRT (n = 109) in a single center. RESULTS Patients with stage I/II disease who had received adjuvant RT showed a better disease-free survival (DFS) (P = 0.04) than those who had received adjuvant CRT treatment. Conversely, patients with stage III/IV disease who had received CRT showed a better overall survival (OS) (P = 0.003) and DFS (P = 0.03) than those who had received surgery alone or adjuvant RT without chemotherapy. Survival analysis demonstrated that patients with pN0 to pN1 had better OS (P = 0.02), disease-specific survival (DSS) (P = 0.003), DFS (P = 0.02) and metastases free survival (MFS) (P = 0.002) compared to patients with pN2 to pN3. Multivariate analysis showed that the pN status was an independent factor for OS (P = 0.03), DSS (P = 0.04), relapse-free survival (P = 0.03), DFS (P = 0.03). CONCLUSION The pN status is the most important prognostic factor for pT1 to pT2 SCCHN. Adjuvant CRT was associated with significantly better survival outcomes in patients with pN1 and pN2-3 or more advanced stage, while adjuvant RT showed significantly better outcomes in patients with pN0.
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85
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Rollo F, Dona’ MG, Pellini R, Pichi B, Marandino F, Covello R, Benevolo M. Cytology and direct human papillomavirus testing on fine needle aspirates from cervical lymph node metastases of patients with oropharyngeal squamous cell carcinoma or occult primary. Cytopathology 2018; 29:449-454. [DOI: 10.1111/cyt.12581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 01/03/2023]
Affiliation(s)
- F. Rollo
- Pathology Department; Regina Elena National Cancer Institute; IRCCS; Rome Italy
| | - M. G. Dona’
- San Gallicano Dermatologic Institute; Sexually Transmitted Infection (STI) Unit; IRCCS; Rome Italy
| | - R. Pellini
- Otolaryngology Head Neck Surgery Department; Regina Elena National Cancer Institute; IRCCS; Rome Italy
| | - B. Pichi
- Otolaryngology Head Neck Surgery Department; Regina Elena National Cancer Institute; IRCCS; Rome Italy
| | - F. Marandino
- Pathology Department; Regina Elena National Cancer Institute; IRCCS; Rome Italy
| | - R. Covello
- Pathology Department; Regina Elena National Cancer Institute; IRCCS; Rome Italy
| | - M. Benevolo
- Pathology Department; Regina Elena National Cancer Institute; IRCCS; Rome Italy
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86
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Grønhøj C, Jensen DH, Dehlendorff C, Marklund L, Wagner S, Mehanna H, Munck-Wikland E, Ramqvist T, Näsman A, Wittekindt C, Würdemann N, Sharma SJ, Gattenlöhner S, Kiss K, Andersen E, Spruce R, Batis N, Robinson M, Harrington K, Winter S, Jones TM, Klussmann JP, Dalianis T, Friborg J, von Buchwald C. Development and external validation of nomograms in oropharyngeal cancer patients with known HPV-DNA status: a European Multicentre Study (OroGrams). Br J Cancer 2018; 118:1672-1681. [PMID: 29795309 PMCID: PMC6008433 DOI: 10.1038/s41416-018-0107-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/02/2018] [Accepted: 04/12/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The proxy marker for human papillomavirus (HPV), p16, is included in the new AJCC 8th/UICC 8th staging system, but due to incongruence between p16 status and HPV infection, single biomarker evaluation could lead to misallocation of patients. We established nomograms for overall survival (OS) and progression-free survival (PFS) in patients with oropharyngeal squamous cell carcinoma (OPSCC) and known HPV-DNA and p16 status, and validated the models in cohorts from high- and low-prevalent HPV countries. METHODS Consecutive OPSCC patients treated in Denmark, 2000-2014 formed the development cohort. The validation cohorts were from Sweden, Germany, and the United Kingdom. We developed nomograms by applying a backward-selection procedure for selection of variables, and assessed model performance. RESULTS In the development cohort, 1313 patients, and in the validation cohorts, 344 German, 503 Swedish and 463 British patients were included. For the OS nomogram, age, gender, combined HPV-DNA and p16 status, smoking, T-, N-, and M-status and UICC-8 staging were selected, and for the PFS nomogram the same variables except UICC-8 staging. The nomograms performed well in discrimination and calibration. CONCLUSIONS Our nomograms are reliable prognostic methods in patients with OPSCC. Combining HPV DNA and p16 is essential for correct prognostication. The nomograms are available at www.orograms.org .
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Affiliation(s)
- Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - David H Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Linda Marklund
- Department of Clinical Science and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Hisham Mehanna
- Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Eva Munck-Wikland
- Department of Clinical Science and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Clinical Science and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Nora Würdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Shachi Jenny Sharma
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | | | - Katalin Kiss
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Elo Andersen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rachel Spruce
- Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Nikos Batis
- Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle, UK
| | - Kevin Harrington
- The Institute of Cancer Research/The Royal Marsden NIHR Biomedical Research Centre, London, UK
| | - Stuart Winter
- Department of Otorhinolaryngology, Head and Neck Surgery, Nuffield Department of Medicine, Oxford, UK
| | - Terence M Jones
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jeppe Friborg
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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87
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Gopinath D, Kunnath Menon R. The significance of an algorithm for human papillomavirus detection in head and neck squamous cell carcinoma. J Oral Pathol Med 2018; 47:540. [PMID: 29499094 DOI: 10.1111/jop.12702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Divya Gopinath
- Faculty of Dentistry; Prince Philip Dental Hospital; University of Hong Kong; Hong Kong SAR China
| | - Rohit Kunnath Menon
- Faculty of Dentistry; Prince Philip Dental Hospital; University of Hong Kong; Hong Kong SAR China
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