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Liu Z, Wang H, Xu Y, Wei H, Zhang Y, Dong H. Oropharyngeal cancer and human papillomavirus: a visualization based on bibliometric analysis and topic modeling. Front Microbiol 2024; 15:1387679. [PMID: 38919494 PMCID: PMC11197978 DOI: 10.3389/fmicb.2024.1387679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/30/2024] [Indexed: 06/27/2024] Open
Abstract
Objectives The incidence of oropharyngeal cancer (OPC) is increasing. This study used bibliometric analysis and topic modeling to explore the research trends and advancements in this disease over the past 10 years, providing valuable insights to guide future investigations. Methods 7,355 English articles from 2013 to 2022 were retrieved from the Web of Science Core Collection for bibliometric analysis. Topic modeling was applied to 1,681 articles from high-impact journals, followed by an assessment of topic significance ranking (TSR). Medical Subject Headings (MeSH) terms were extracted using R and Python, followed by an analysis of the terms associated with each topic and on an annual basis. Additionally, genes were extracted and the number of genes appearing each year and the newly emerged genes were counted. Results The bibliometric analysis suggested that the United States and several European countries hold pivotal positions in research. Current research is focused on refining treatments, staging and stratification. Topic modeling revealed 12 topics, emphasizing human papillomavirus (HPV) and side effect reduction. MeSH analysis revealed a growing emphasis on prognosis and quality of life. No new MeSH terms emerged after 2018, suggesting that the existing terms have covered most of the core concepts within the field of oropharyngeal cancers. Gene analysis identified TP53 and EGFR as the most extensively studied genes, with no novel genes discovered after 2019. However, CD69 and CXCL9 emerged as new genes of interest in 2019, reflecting recent research trends and directions. Conclusion HPV-positive oropharyngeal cancer research, particularly treatment de-escalation, has gained significant attention. However, there are still challenges in diagnosis and treatment that need to be addressed. In the future, more research will focus on this issue, indicating that this field still holds potential as a research hotspot.
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Affiliation(s)
- Zhu Liu
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Haixu Wang
- Department of Abdominal Osteomalacia Radiotherapy, Cancer hospital of China Medical University/Liaoning Cancer hospital and Institute, Shenyang, China
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang, China
| | - Yang Xu
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Hongming Wei
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Yuchong Zhang
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang, China
| | - Huilei Dong
- Department of Head and Neck Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
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2
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Lin ME, Castellanos CX, Acevedo JR, Yu JC, Kokot NC. Cost-Effectiveness Analysis of PET-CT Surveillance After Treatment of Human Papillomavirus-Positive Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2024; 170:122-131. [PMID: 37622527 DOI: 10.1002/ohn.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness of surveillance imaging with PET/CT scan among patients with human papillomavirus-positive oropharyngeal squamous cell carcinoma. STUDY DESIGN Cost-effectiveness analysis. SETTING Oncologic care centers in the United States with head and neck oncologic surgeons and physicians. METHODS We compared the cost-effectiveness of 2 posttreatment surveillance strategies: clinical surveillance with the addition of PET/CT scan versus clinical surveillance alone in human papillomavirus-positive oropharyngeal squamous cell carcinoma patients. We constructed a Markov decision model which was analyzed from a third-party payer's perspective using 1-year Markov cycles and a 30-year time horizon. Values for transition probabilities, costs, health care utilities, and their studied ranges were derived from the literature. RESULTS The incremental cost-effectiveness ratio for PET/CT with clinical surveillance versus clinical surveillance alone was $89,850 per quality-adjusted life year gained. Flexible fiberoptic scope exams during clinical surveillance would have to be over 51% sensitive or PET/CT scan cost would have to exceed $1678 for clinical surveillance alone to be more cost-effective. The willingness-to-pay threshold at which imaging surveillance was equally cost-effective to clinical surveillance was approximately $80,000/QALY. CONCLUSION Despite lower recurrence rates of human papillomavirus-positive oropharyngeal cancer, a single PET/CT scan within 6 months after primary treatment remains a cost-effective tool for routine surveillance when its cost does not exceed $1678. The cost-effectiveness of this strategy is also dependent on the clinical surveillance sensitivity (flexible fiberoptic pharyngoscopy), and willingness-to-pay thresholds which vary by country.
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Affiliation(s)
- Matthew E Lin
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Carlos X Castellanos
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Joseph R Acevedo
- Department of Otolaryngology-Head & Neck Surgery, Kaiser Permanente Medical Center, Panorama City, California, USA
| | - Jeffrey C Yu
- School of Pharmacy, University of Southern California, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Niels C Kokot
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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3
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Chang YS, Nair JR, McDougall CC, Qiu W, Banerjee R, Joshi M, Lysack JT. Risk Stratification for Oropharyngeal Squamous Cell Carcinoma Using Texture Analysis on CT - A Step Beyond HPV Status. Can Assoc Radiol J 2023; 74:657-666. [PMID: 36856197 DOI: 10.1177/08465371231157592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Background and Purpose: Human papillomavirus-associated oropharyngeal squamous cell carcinoma (OPSCC) is increasingly prevalent. Despite the overall more favorable outcome, the observed heterogeneous treatment response within this patient group highlights the need for additional means to prognosticate and guide clinical decision-making. Promising prediction models using radiomics from primary OPSCC have been derived. However, no model/s using metastatic lymphadenopathy exist to allow prognostication in those instances when the primary tumor is not seen. The aim of our study was to evaluate whether radiomics using metastatic lymphadenopathy allows for the development of a useful risk assessment model comparable to the primary tumor and whether additional knowledge of the HPV status further improves its prognostic efficacy. Materials and Methods: 80 consecutive patients diagnosed with stage III-IV OPSCC between February 2009 and October 2015, known human papillomavirus status, and pre-treatment CT images were retrospectively identified. Manual segmentation of primary tumor and metastatic lymphadenopathy was performed and the extracted texture features were used to develop multivariate assessment models to prognosticate treatment response. Results: Texture analysis of either the primary or metastatic lymphadenopathy from pre-treatment enhanced CT images can be used to develop models for the stratification of treatment outcomes in OPSCC patients. AUCs range from .78 to .85 for the various OPSCC groups tested, indicating high predictive capability of the models. Conclusions: This preliminary study can form the basis multi-centre trial that may help optimize treatment and improve quality of life in patients with OPSCC in the era of personalized medicine.
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Affiliation(s)
- Yuh-Shin Chang
- Division of Neuroradiology, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Jaykumar Raghavan Nair
- Division of Neuroradiology, University of Calgary, Calgary, AB, Canada
- Department of Radiology, QEII Health Science Centre, Halifax Infirmary Hospital, Dalhousie University, Halifax, NS, Canada
| | - Connor C McDougall
- Department of Mechanical Engineering, University of Calgary, Calgary, AB, Canada
| | - Wu Qiu
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Robyn Banerjee
- Division of Radiation Oncology, University of Calgary, Calgary, AB, Canada
| | - Manish Joshi
- Division of Neuroradiology, University of Calgary, Calgary, AB, Canada
| | - John T Lysack
- Division of Neuroradiology, University of Calgary, Calgary, AB, Canada
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4
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Kang JJ, Yu Y, Chen L, Zakeri K, Gelblum DY, McBride SM, Riaz N, Tsai CJ, Kriplani A, Hung T, Fetten JV, Dunn LA, Ho A, Boyle JO, Ganly IS, Singh B, Sherman EJ, Pfister DG, Wong RJ, Lee NY. Consensuses, controversies, and future directions in treatment deintensification for human papillomavirus-associated oropharyngeal cancer. CA Cancer J Clin 2023; 73:164-197. [PMID: 36305841 PMCID: PMC9992119 DOI: 10.3322/caac.21758] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 01/19/2023] Open
Abstract
The most common cancer caused by human papillomavirus (HPV) infection in the United States is oropharyngeal cancer (OPC), and its incidence has been rising since the turn of the century. Because of substantial long-term morbidities with chemoradiation and the favorable prognosis of HPV-positive OPC, identifying the optimal deintensification strategy for this group has been a keystone of academic head-and-neck surgery, radiation oncology, and medical oncology for over the past decade. However, the first generation of randomized chemotherapy deintensification trials failed to change the standard of care, triggering concern over the feasibility of de-escalation. National database studies estimate that up to one third of patients receive nonstandard de-escalated treatments, which have subspecialty-specific nuances. A synthesis of the multidisciplinary deintensification data and current treatment standards is important for the oncology community to reinforce best practices and ensure optimal patient outcomes. In this review, the authors present a summary and comparison of prospective HPV-positive OPC de-escalation trials. Chemotherapy attenuation compromises outcomes without reducing toxicity. Limited data comparing transoral robotic surgery (TORS) with radiation raise concern over toxicity and outcomes with TORS. There are promising data to support de-escalating adjuvant therapy after TORS, but consensus on treatment indications is needed. Encouraging radiation deintensification strategies have been reported (upfront dose reduction and induction chemotherapy-based patient selection), but level I evidence is years away. Ultimately, stage and HPV status may be insufficient to guide de-escalation. The future of deintensification may lie in incorporating intratreatment response assessments to harness the powers of personalized medicine and integrate real-time surveillance.
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Affiliation(s)
- Jung Julie Kang
- Yale University School of Medicine, Department of Therapeutic Radiology
| | - Yao Yu
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - Linda Chen
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - Kaveh Zakeri
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | | | | | - Nadeem Riaz
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - C. Jillian Tsai
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Tony Hung
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - James V. Fetten
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Lara A. Dunn
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Alan Ho
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Jay O. Boyle
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Ian S. Ganly
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Bhuvanesh Singh
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Eric J. Sherman
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | | | - Richard J. Wong
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Nancy Y. Lee
- Memorial Sloan Kettering Cancer Center, Department of Medicine
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5
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An interpretable machine learning prognostic system for risk stratification in oropharyngeal cancer. Int J Med Inform 2022; 168:104896. [DOI: 10.1016/j.ijmedinf.2022.104896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
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6
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DeVoti JA, Israr M, Lam F, Papayannakos C, Frank DK, Kamdar DP, Pereira LM, Abramson A, Steinberg BM, Bonagura VR. Oropharyngeal tumor cells induce COX-2 expression in peripheral blood monocytes by secretion of IL-1α. Front Immunol 2022; 13:1011772. [DOI: 10.3389/fimmu.2022.1011772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Oropharyngeal squamous cell cancer (OPC) accounts for 3% of all cancers and greater than 1.5% of all cancer deaths in the United States, with marked treatment-associated morbidity in survivors. More than 80% of OPC is caused by HPV16. Tumors induced by HPV have been linked to impaired immune functions, with most studies focused on the local tumor microenvironment. Fewer studies have characterized the effects of these tumors on systemic responses in OPC, especially innate responses that drive subsequent adaptive responses, potentially creating feed-back loops favorable to the tumor. Here we report that elevated plasma levels of PGE2 are expressed in half of patients with OPC secondary to overexpression of COX-2 by peripheral blood monocytes, and this expression is driven by IL-1α secreted by the tumors. Monocytes from patients are much more sensitive to the stimulation than monocytes from controls, suggesting the possibility of enhanced immune-modulating feed-back loops. Furthermore, control monocytes pre-exposed to PGE2 overexpress COX-2 in response to IL-1α, simulating responses made by monocytes from some OPC patients. Disrupting the PGE2/IL-1α feed-back loop can have potential impact on targeted medical therapies.
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7
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Bteich YT, Hosri JE, Wehbi JA, Daou LR. Current landscape of clinical trials for HPV-positive head and neck squamous cell carcinoma (HNSCC). Ecancermedicalscience 2022; 16:1447. [PMID: 36405940 PMCID: PMC9666285 DOI: 10.3332/ecancer.2022.1447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Indexed: 09/01/2023] Open
Abstract
This study aims to determine the current state of clinical trials regarding HPV-positive head and neck squamous cell carcinoma (HNSCC). Clinical trials were filtered to fit the study's aim using Clinicaltrials.gov: trials concerning HNSCC specifically those related to HPV done between January 2005 and December 2020 were extracted and information regarding location, duration, phases, patient recruitment, trial status, results, primary outcome, type of intervention and publication status were collected and analysed. As a result, 123 trials were included. North American countries (USA and Canada) conducted more than two-thirds of the trials (72.4%) compared to European countries and the rest of the world. Trials in phase II constituted more than half of those included in this study (53.7%). From the 123 trials included in this study, only 30 had their NCT identification number linked to publications, but less than half (46.7%) of the publications stemmed from trials with results. Drug combination was the most widely studied treatment modality. Despite falling in the middle of the spectrum with respect to the number of trials when compared to other diseases, our research highlights the need for even more trials tackling multiple aspects of HPV-positive HNSCC.
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Affiliation(s)
- Yara T Bteich
- Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
- Co-first authors
| | - Jad E Hosri
- Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
- Co-first authors
| | - Jad A Wehbi
- Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| | - Lea R Daou
- Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
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8
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Froehlich MH, Shih MC, Shehee L, Kompelli AR, Aylward A, Nguyen SA, Kaczmar JM, Nathan CA, Day T, Neskey DM. Systematic review of neuroendocrine carcinomas of the oropharynx. Head Neck 2022; 44:1725-1736. [PMID: 35437851 DOI: 10.1002/hed.27055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/15/2022] [Accepted: 03/28/2022] [Indexed: 11/05/2022] Open
Abstract
Data describing features and management of oropharyngeal neuroendocrine carcinomas (NEC) remain sparse. A systematic review was performed. Patients were stratified by treatment modality and examined for disease progression and survival outcomes. Ninety-four patients from 50 publications were included. Average age at diagnosis was 59.7 years (range 14-83). 73.4% were male. Most studies did not document HPV status. Forty patients (85.1%) were p16 positive, and 34 (85.0%) were HPV-ISH positive. Overall survival was 75.4% at 1 year, and 40.0% at 2 years. Of patients with locoregional disease, 33.8% developed distant metastasis. 12.5% of patients developed locoregional recurrence. Patients who developed distant metastases had worse overall survival (p = 0.0004). No significant difference was found between treatment modalities. Human papilloma virus may be associated with oropharyngeal NEC. Current treatments provide locoregional control, but distant metastases are common and confer low overall survival.
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Affiliation(s)
- Michael H Froehlich
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael C Shih
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lindsey Shehee
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anvesh R Kompelli
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Alana Aylward
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John M Kaczmar
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cherie Ann Nathan
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Terry Day
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David M Neskey
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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9
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Lu XJD, Jackson E, Chew J, Nguyen S, Wu J, Poh CF, Prisman E. Combined chemoradiotherapy showed improved outcome with early-stage HPV-positive oropharyngeal cancers. BMC Cancer 2022; 22:513. [PMID: 35525912 PMCID: PMC9077931 DOI: 10.1186/s12885-022-09515-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/24/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The revised 8th Edition American Joint Committee on Cancer (AJCC) Head and Neck Staging Manual distinguishes HPV-mediated from non-HPV-mediated oropharyngeal cancer (OpSCC). The objective was to analyze OpSCC treatment modalities and outcomes. METHODS A retrospective study of OpSCC patients treated with radiotherapy or chemoradiotherapy between January 1st, 2000, and December 31st, 2008, as identified from the BC Cancer Registry. All patients received treatment at cancer clinics and had at least 5 years follow-up post-treatment. A total of 1259 OpSCC patients were identified. After initial chart reviews, 288 patients were excluded from further analysis and the majority (n = 198) was due to not receiving curative treatment. Based on the availability of formalin-fixed, paraffin-embedded (FFPE) tissue, patients were divided into two cohorts: Study Cohort (FFPE available, n = 244) and General Cohort (FFPE unavailable, n = 727). The Study Cohort was restaged according to AJCC 8th Edition based on p16 immunohistochemistry status. Kaplan-Meier analysis was used to estimate the 5-year overall survival (OS), disease-specific survival (DSS), and locoregional recurrence-free survival (LFS). RESULTS Among 971 patients, OpSCC age-adjusted incidence rate was observed to have increased from 2.1 to 3.5 per 100,000 between 2000 and 2008. The General Cohort was relatively older than the Study Cohort (60.1 ± 10.5 vs. 57.3 ± 9.4), but both cohorts were predominantly males (78.3% vs. 76.2%). Amongst the Study Cohort, 77.5% were p16-positive, of whom 98.4% were down staged in the 8th Edition. These early-stage patients showed OS improvement for those treated with chemoradiation, compared to radiation alone (85.8% vs. 73.1%, p = 0.05). CONCLUSIONS OpSCC incidence is increasing in BC. The addition of chemotherapy to radiotherapy may portend a benefit in OS even for early-stage p16-positive OpSCC. Additional research is necessary to assess the safety of treatment de-escalation even among early-stage disease.
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Affiliation(s)
- X J David Lu
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Emmanuel Jackson
- Division of Neuroradiology, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jason Chew
- Division of Neuroradiology, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Sally Nguyen
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jonn Wu
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Center, Vancouver, British Columbia, Canada
| | - Catherine F Poh
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.
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10
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Petrelli F, Luciani A, Ghidini A, Cherri S, Gamba P, Maddalo M, Bossi P, Zaniboni A. Treatment de-escalation for HPV+ oropharyngeal cancer: A systematic review and meta-analysis. Head Neck 2022; 44:1255-1266. [PMID: 35238114 DOI: 10.1002/hed.27019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022] Open
Abstract
Human Papillomavirus (HPV) related oropharyngeal carcinoma (OPC) carries a better prognosis compared with HPV-counterparts, thereby pushing the adoption of de-intensification treatment approaches as new strategies to preserve superior oncologic outcomes while minimizing toxicity. We evaluated the effect of treatment de-intensification in terms of overall survival (OS), progression-free survival (PFS), locoregional and distant control (LRC and DM) by selecting prospective or retrospective studies, providing outcome data with reduced intensification versus standard curative treatment in HPV+ OPC patients, with a systematic analysis till September 2020. The primary outcome of interest was OS. Secondary endpoints were PFS, LRC, and DM expressed as HR. A total of 55 studies (from 1393 screened references) were employed for quantitative synthesis for 38 929 patients. Among n = 48 studies with data available, de-intensified treatments reduced OS in HPV+ OPCs (HR = 1.33, 95% CI 1.17-1.52; p < 0.01). In de-escalated treatments, PFS was also decreased (HR = 2.11, 95% CI 1.65-2.69; p < 0.01). Compared with standard treatments, reduced intensity approaches were associated with reduced locoregional and distant disease control (HR = 2.51, 95% CI 1.75-3.59; p < 0.01; and HR = 1.9, 95% CI 1.25-2.9; p < 0.01). Chemoradiation improved survival in a definitive curative setting compared with radiotherapy alone (HR = 1.42, 95% CI 1.16-1.75; p < 0.01). When adjuvant treatments were compared, standard and de-escalation strategies provided similar OS. In conclusion, in patients with HPV+ OPC, de-escalation treatments should not be widely and agnostically adopted in clinical practice, as therein lies a concrete risk of offering a sub-optimal treatment to patients.
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Affiliation(s)
| | | | | | - Sara Cherri
- Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Paolo Gamba
- Otolaryngology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Marta Maddalo
- Department of Radiation Oncology, University of Brescia and Spedali Civili, Brescia, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, Public Health, University of Brescia, Brescia, Italy
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11
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Differential Incidence of Tongue Base Cancer in Male and Female HPV16-Transgenic Mice: Role of Female Sex Hormone Receptors. Pathogens 2021; 10:pathogens10101224. [PMID: 34684173 PMCID: PMC8539196 DOI: 10.3390/pathogens10101224] [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: 07/29/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
A growing proportion of oropharyngeal squamous cell carcinomas (OPSCC) are associated with infection by high-risk human papillomavirus (HPV). For reasons that remain largely unknown, HPV+OPSCC is significantly more common in men than in women. This study aims to determine the incidence of OPSCC in male and female HPV16-transgenic mice and to explore the role of female sex hormone receptors in the sexual predisposition for HPV+ OPSCC. The tongues of 30-weeks-old HPV16-transgenic male (n = 80) and female (n = 90) and matched wild-type male (n = 10) and female (n = 10) FVB/n mice were screened histologically for intraepithelial and invasive lesions in 2017 at the Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Portugal. Expression of estrogen receptors alpha (ERα) and beta (ERβ), progesterone receptors (PR) and matrix metalloproteinase 2 (MMP2) was studied immunohistochemically. Collagen remodeling was studied using picrosirius red. Female mice showed robust ERα and ERβ expression in intraepithelial and invasive lesions, which was accompanied by strong MMP2 expression and marked collagen remodeling. Male mice showed minimal ERα, ERβ and MMP2 expression and unaltered collagen patterns. These results confirm the association of HPV16 with tongue base cancer in both sexes. The higher cancer incidence in female versus male mice contrasts with data from OPSCC patients and is associated with enhanced ER expression via MMP2 upregulation.
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12
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Nauta IH, Klausch T, van de Ven PM, Hoebers FJP, Licitra L, Poli T, Scheckenbach K, Brakenhoff RH, Berkhof J, René Leemans C. The important role of cisplatin in the treatment of HPV-positive oropharyngeal cancer assessed by real-world data analysis. Oral Oncol 2021; 121:105454. [PMID: 34311328 DOI: 10.1016/j.oraloncology.2021.105454] [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: 04/17/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The prognostic advantage of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) resulted in the initiation of treatment de-intensification studies. Two randomized controlled trials (RCTs) reported inferior survival of HPV-positive OPSCC treated with radiotherapy plus cetuximab compared to standard of care radiotherapy plus cisplatin. In this study we investigated whether the important role of cisplatin in the treatment of HPV-positive OPSCCs would also emerge from causal inference analyses of real-world data. MATERIAL AND METHODS A retrospective cohort of 263 advanced-stage OPSCC-patients from 5 European clinics was studied, treated with radiotherapy (RT) alone or cisplatin-based chemoradiotherapy (CRT) based on standard clinical indications. Causal inference was applied to adjust for treatment assignment, thereby simulating a randomized setting. Average treatment effect of concurrent cisplatin on overall survival (OS) probability was estimated using Bayesian Additive Regression Trees (BART) and Bayesian logistic regression. RESULTS Significantly better survival probabilities were found for HPV-positive OPSCC treated with CRT compared to RT alone (3-year OS probability 0.961 versus 0.798, p = 0.008). CONCLUSION This study using causal inference of retrospective patient data confirms the important role of cisplatin in the treatment of HPV-positive OPSCC. Causal inference analyses of real-world data complements the evidence from the published RCTs.
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Affiliation(s)
- Irene H Nauta
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology / Head and Neck Surgery, Cancer Center Amsterdam, the Netherlands
| | - Thomas Klausch
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Frank J P Hoebers
- Dept. of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Lisa Licitra
- Head and Neck Cancer Medical Oncology Dept., Fondazione IRCCS Istituto Nazionale Tumori Milano and University of Milan, Italy
| | - Tito Poli
- Maxillofacial Surgery Unit, University of Parma - University Hospital of Parma, Parma, Italy
| | - Kathrin Scheckenbach
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ruud H Brakenhoff
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology / Head and Neck Surgery, Cancer Center Amsterdam, the Netherlands.
| | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - C René Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology / Head and Neck Surgery, Cancer Center Amsterdam, the Netherlands
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13
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Waltonen JD, Thomas SG, Russell GB, Sullivan CA. Oropharyngeal Carcinoma Treated with Surgery Alone: Outcomes and Predictors of Failure. Ann Otol Rhinol Laryngol 2021; 131:281-288. [PMID: 34056954 DOI: 10.1177/00034894211021287] [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: 11/16/2022]
Abstract
OBJECTIVE To analyze the oncologic outcomes and risk factors for recurrence in patients who underwent surgery for oropharyngeal squamous cell carcinoma (OPSCC), and in whom adjuvant therapy was not recommended or was declined. METHODS Retrospective cohort study of patients with OPSCC who were treated with transoral surgery only at a tertiary care academic medical center from April 2010 to March 2019. RESULTS Seventy-four patients met inclusion criteria. In 16, adjuvant therapy was recommended but declined. There were 8 recurrences, of which 6 had been given recommendations for adjuvant therapy. Of the 8 recurrences, 2 died, 2 are alive with disease, and 4 were successfully salvaged. Five patients died of unrelated causes. Lymphovascular invasion (LVI, P = .016) had a significant impact on recurrence, while other pathologic features of the primary tumor such as size, location, human papillomavirus (HPV) status, and margin status did not. Margins were classified as "positive" in 4 patients, "close" in 54, and "negative" in 16. There were 3 local recurrences (4.1%), each of whom had declined adjuvant therapy. Lymph node features such as N-stage (P = .0004), number of positive nodes (P = .0005), and presence of extra-nodal extension (ENE, P = .0042) had a statistically significant impact on relapse. Smoking history and surgical approach showed no significant impact on recurrence. CONCLUSION Patients who undergo surgery for HPV-positive OPSCC with negative margins, no PNI, no LVI, and ≤1 positive lymph node without ENE have low risk for recurrence. These patients can likely be safely treated with surgery alone. Patients with these risk factors who decline adjuvant therapy are at risk for recurrence, and should be monitored.
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Affiliation(s)
- Joshua D Waltonen
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sydney G Thomas
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gregory B Russell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christopher A Sullivan
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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14
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Thakar A, Panda S, Kakkar A, Singh V, Singh CA, Sharma A, Bhasker S, Krishnamurthy P, Sharma SC. A matched pair analysis of oncological outcomes in human papillomavirus-negative oropharyngeal squamous cell carcinoma: Transoral surgery versus radiotherapy or concurrent chemoradiation. Head Neck 2021; 43:2896-2906. [PMID: 34050557 DOI: 10.1002/hed.26771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/19/2021] [Accepted: 05/20/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND With the termination of RTOG 1221, there remains a lacuna regarding the optimal treatment for human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC). METHODS Matched pair analysis with propensity score matching (PSM) between Arm I (transoral surgery [TOS] + risk-stratified adjuvant treatment) and Arm II (nonsurgical treatment - radiation/chemoradiation) in HPV(-) OPSCC. RESULTS Unmatched comparison of Arm I (n = 57) and Arm II (n = 89) indicated significantly better overall survival (OS) and disease-free survival (DFS) for Arm I. PSM by matched pairs (n = 48, 24 each arm) indicated 5-year OS at 80% and 72.1%, respectively, for Arm I and II (p > 0.05) and corresponding DFS at 65.3% and 33.4% (p > 0.05). Subgroup analysis did not demonstrate statistical difference in outcomes in stage II and III, but stage IV tumors had significantly better outcomes in Arm I than Arm II (4-year OS: 100% vs. 21%, p = 0.04; DFS: 75% vs. 14.3%, p = 0.04). CONCLUSIONS TOS +/- adjuvant was found to have oncological outcomes at par with nonsurgical modalities in stage I-III OPSCC, whereas a distinct survival advantage was noted in case of stage IV tumors.
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Affiliation(s)
- Alok Thakar
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Panda
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom Amit Singh
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
| | - Padmavathi Krishnamurthy
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh C Sharma
- Department of Otorhinolaryngology - Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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15
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Schrank TP, Lenze N, Landess LP, Hoyle A, Parker J, Lal A, Sheth S, Chera BS, Patel SN, Hackman TG, Major MB, Issaeva N, Yarbrough WG. Genomic heterogeneity and copy number variant burden are associated with poor recurrence-free survival and 11q loss in human papillomavirus-positive squamous cell carcinoma of the oropharynx. Cancer 2021; 127:2788-2800. [PMID: 33819343 DOI: 10.1002/cncr.33504] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Human papillomavirus-positive (HPV+) squamous cell carcinoma of the oropharynx (OPSCC) is the most prevalent HPV-associated malignancy in the United States. Favorable treatment outcomes have led to increased interest in treatment de-escalation to reduce treatment morbidity as well as the development of prognostic markers to identify appropriately low-risk patients. Intratumoral genomic heterogeneity and copy number alteration burden have been demonstrated to be predictive of poor outcomes in many other cancers; therefore, we sought to determine whether intratumor heterogeneity and genomic instability are associated with poor outcomes in HPV+ OPSCC. METHODS Tumor heterogeneity estimates were made based on targeted exome sequencing of 45 patients with HPV+ OPSCC tumors. Analysis of an additional cohort of HPV+ OPSCC tumors lacking matched normal sequencing allowed copy number analysis of 99 patient tumors. RESULTS High intratumorally genomic heterogeneity and high numbers of copy number alterations were strongly associated with worse recurrence-free survival. Tumors with higher heterogeneity and frequent copy number alterations were associated with loss of distal 11q, which encodes key genes related to double-strand break repair, including ATM and MRE11A. CONCLUSIONS Both intratumor genomic heterogeneity and high-burden copy number alterations are strongly associated with poor recurrence-free survival in patients with HPV+ OPSCC. The drivers of genomic instability and heterogeneity in these tumors remains to be elucidated. However, 11q loss and defective DNA double-strand break repair have been associated with genomic instability in other solid tumors. Copy number alteration burden and intratumoral heterogeneity represent promising avenues for risk stratification of patients with HPV+OPSCC.
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Affiliation(s)
- Travis P Schrank
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nicholas Lenze
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lee P Landess
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alan Hoyle
- Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joel Parker
- Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Asim Lal
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Siddharth Sheth
- Division of Hematology and Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bhishamjit S Chera
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Samip N Patel
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Trevor G Hackman
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - M Ben Major
- Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Cell Biology and Physiology, Washington University in St. Louis, St. Louis, Missouri.,Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri.,Department of Otolaryngology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Natalia Issaeva
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pathology and Lab Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wendell G Yarbrough
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pathology and Lab Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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16
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Iorio GC, Arcadipane F, Martini S, Ricardi U, Franco P. Decreasing treatment burden in HPV-related OPSCC: A systematic review of clinical trials. Crit Rev Oncol Hematol 2021; 160:103243. [PMID: 33516806 DOI: 10.1016/j.critrevonc.2021.103243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/16/2020] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Favorable outcomes are observed after treatment with standard chemoradiotherapy (CRT) for Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) patients. The consistent growing interest on treatment-related toxicity burden, potentially jeopardizing survivors' quality of life, led clinicians to investigate possible de-escalation strategies. MATERIALS AND METHODS A comprehensive systematic literature search of clinical trials was performed through the EMBASE database to provide an overview of the de-escalation strategies spectrum. Additionally, hand searching and clinicaltrials.gov were also used. RESULTS Herein, we report and discuss different approaches to de-escalation of therapy, with respect to both local and systemic strategies. CONCLUSIONS Several promising de-escalation experiences have been published. However, while further evidence is awaited, no changes in the management nor deviation from the standard of care should be made outside of clinical trials.
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Affiliation(s)
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Stefania Martini
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
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17
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Jacobs D, Torabi SJ, Park HS, Rahmati R, Young MR, Mehra S, Judson BL. Revisiting the Radiation Therapy Oncology Group 1221 Hypothesis: Treatment for Stage III/IV HPV-Negative Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2020; 164:1240-1248. [PMID: 33198564 DOI: 10.1177/0194599820969613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE In 2014, the Radiation Therapy Oncology Group 1221 trial was initiated to analyze whether surgery with risk-based radiation therapy or chemoradiation therapy was superior to chemoradiation therapy alone in patients with clinically staged T1-2N1-2bM0 HPV-negative oropharyngeal squamous cell carcinoma. However, the study was prematurely terminated. Given the lack of a randomized controlled trial, we retrospectively approached the same question using large national cancer databases. STUDY DESIGN Retrospective cohort study. SETTING The National Cancer Database and Surveillance, Epidemiology, and End Results (SEER) program from 2010 to 2016. METHODS We identified 3004 patients in the National Cancer Database and 670 patients in the SEER database. Statistical techniques included Kaplan-Meier survival analysis, binary and multinomial logistic regressions, Cox proportional hazard regressions, and inverse propensity score weighting. RESULTS On weighted multivariable Cox regression, patients recommended to receive frontline surgery had improved overall survival as compared with those recommended to receive chemoradiation therapy alone (hazard ratio [HR], 0.77; 95% CI, 0.68-0.86). On post hoc multivariable analysis based on therapy actually received, frontline surgery with adjuvant chemoradiation therapy was associated with improved overall survival (HR, 0.59; 95% CI, 0.50-0.71) as compared with chemoradiation therapy without surgery. Analysis of the SEER cohort revealed improved overall survival (HR, 0.69; 95% CI, 0.54-0.87) and head and neck cancer-specific survival (HR, 0.59; 95% CI, 0.41-0.84) in patients recommended to receive frontline surgery over chemoradiation therapy alone. CONCLUSION Our findings support the use of surgery with risk-based addition of adjuvant therapy in patients with cT1-2N1-2bM0 HPV-negative oropharyngeal cancer.
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Affiliation(s)
- Daniel Jacobs
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sina J Torabi
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rahmatullah Rahmati
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Melissa R Young
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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18
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Mariz BALA, Kowalski LP, William WN, de Castro G, Chaves ALF, Santos M, de Oliveira TB, Araújo ALD, Normando AGC, Ribeiro ACP, Brandão TB, Vargas PA, Lopes MA, Santos-Silva AR. Global prevalence of human papillomavirus-driven oropharyngeal squamous cell carcinoma following the ASCO guidelines: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 156:103116. [PMID: 33115701 DOI: 10.1016/j.critrevonc.2020.103116] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/24/2020] [Accepted: 09/25/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES to provide accurate information about the global prevalence of human papillomavirus (HPV) in oropharyngeal squamous cell carcinomas (OPSCC). MATERIAL AND METHODS a systematic review was performed using three main electronic databases. Studies were independently assessed by two reviewers based on established eligibility criteria, to identify the prevalence of HPV-driven OPSCC following criteria defined by the American Society of Clinical Oncology. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Statistical software MedCalc was used to perform meta-analyses. RESULTS from 2215 records found, 15 were included, reporting data from 6009 patients (time period range: 1980-2016), distributed in 11 countries. Eleven studies were considered as presenting low risk, and four as moderate risk of bias. Using proportion meta-analysis, pooled prevalence of HPV-driven OPSCC was 44.8 % (95 %CI: 36.4-53.5 %; i2 = 97.6 %), with the highest rates in New Zealand (74.5 %; 95 %CI: 60.9-85.3 %), and the lowest in Brazil (11.1 %; 95 %CI: 4.5-21.5 %). HPV prevalence was similar between males (45.7 %; 95 %CI: 36.5-55.0 %; i2 = 96.4 %) and females (42.2 %; 95 %CI: 34.3-50.5 %; i2 = 85.4 %). Mean/median age ranged from 59.1-67.1 years in the HPV-negative group, and from 55.7-63.5 years in the HPV-positive group. There was an overall discordance between testing by p16 (49.4 %; 95 %CI, 38.2-60.5 %; i2 = 96.2 %) and p16+ISH/PCR (44.7 %; 95 %CI, 33.5-56.2 %; i2 = 96.4 %). CONCLUSION Overall pooled prevalence of HPV-driven OPSCC was approximately 45 %, with similar distribution among males and females. Double p16/HPV-DNA/RNA testing may be considered to increase specificity and prognostic accuracy.
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Affiliation(s)
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, AC Camargo Cancer Center and Department of Head and Neck Surgery, University of Sao Paulo Medical School, São Paulo, Brazil
| | | | - Gilberto de Castro
- Department of Clinical Oncology, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil
| | | | - Marcos Santos
- UNESCO Chair of Bioethics, Brasília University, Brasília, DF, Brazil
| | | | - Anna Luiza Damaceno Araújo
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | | | - Ana Carolina Prado Ribeiro
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil; Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil
| | - Thaís Bianca Brandão
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil; Oral Medicine Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
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19
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Moore EJ, Van Abel KM, Routman DM, Lohse CM, Price KAR, Neben-Wittich M, Chintakuntlawar AV, Price DL, Kasperbauer JL, Garcia JJ, Hinni ML, Patel SH, Janus JR, Foote RL, Ma DJ. Human papillomavirus oropharynx carcinoma: Aggressive de-escalation of adjuvant therapy. Head Neck 2020; 43:229-237. [PMID: 32969095 DOI: 10.1002/hed.26477] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/24/2020] [Accepted: 09/09/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Aggressive dose de-escalated adjuvant radiation therapy (RT) in patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC). METHODS Patients with HPV(+)OPSCC on a phase II clinical trial of primary surgery and neck dissection followed by dose de-escalated RT (N = 79) were compared with a cohort of patients who received standard adjuvant therapy (N = 115). Local recurrence-free, regional recurrence-free, distant metastases-free survival, and progression-free survival (PFS) were assessed. RESULTS Of 194 patients, 23 experienced progression at a median of 1.1 years following surgery (interquartile range [IQR] 0.7-2.0; range 0.3-5.4); 10 patients in the de-escalated cohort and 13 patients in the standard cohort. The 3-year PFS rate for the de-escalated cohort was 87%, and in the standard cohort was 90% (hazard ratio [HR] 1.18, 95% confidence interval (CI) [0.50-2.75]). CONCLUSION Patients with HPV(+)OPSCC who undergo surgical resection and neck dissection and meet criteria for adjuvant therapy can undergo aggressive dose de-escalation of RT without increasing risk of progression locally, regionally or at distant sites.
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Affiliation(s)
- Eric J Moore
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Daniel L Price
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Michael L Hinni
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Scottsdale, Arizona, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jeffrey R Janus
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dan J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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20
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Berger MH, Yasaka TM, Haidar YM, Kuan EC, Tjoa T. Insurance Status as a Predictor of Treatment in Human Papillomavirus Positive Oropharyngeal Cancer. Laryngoscope 2020; 131:776-781. [PMID: 32790156 DOI: 10.1002/lary.28984] [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: 05/04/2020] [Accepted: 07/10/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The link between human papillomavirus (HPV) and oropharyngeal cancer (OPC) is well known. Locally advanced, HPV-positive OPC (HPV OPC) can be treated with either chemoradiation or primary surgery with or without adjuvant therapy. Head and neck cancer patients with government insurance or uninsured have been shown to have worse prognosis than similar patients with private insurance. In this study, we aimed to determine if insurance status would predict treatment modality in patients with HPV OPC. STUDY DESIGN A retrospective analysis using the National Cancer Database (NCDB). METHODS The National Cancer Database was used to identify patients with HPV OPC who underwent primary surgery or primary chemoradiation from 2010-2015. Insurance status was categorized as government, private, or no insurance. The relationship between insurance status and treatment was investigated using Chi square and multivariate regression models. Kaplan-Meier analyses were performed comparing overall survival (OS) by insurance status. RESULTS There were 10,606 patients were included. There was a statistically significant correlation between insurance status and primary treatment modality for HPV OPC (P < .001). Patients with government insurance were 19.3% less likely to undergo surgery and uninsured patients were 36.9% less likely to undergo primary surgery when compared to those with private insurance (P < .001), even after correcting for TNM stage in multivariate analysis. There was an improved 5-year OS for patients with private insurance (86.6%) versus both government insurance (68.4%) and no insurance (69.9%) (P < .001). CONCLUSIONS Patients with private insurance are more likely to undergo primary surgery in HPV OPC and have improved overall survival. LEVEL OF EVIDENCE 4 Laryngoscope, 131:776-781, 2021.
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Affiliation(s)
- Michael H Berger
- Department of Head and Neck Surgery, University of California Irvine, Irvine, California, U.S.A
| | - Tyler M Yasaka
- Department of Head and Neck Surgery, University of California Irvine, Irvine, California, U.S.A
| | - Yarah M Haidar
- Department of Head and Neck Surgery, University of California Irvine, Irvine, California, U.S.A
| | - Edward C Kuan
- Department of Head and Neck Surgery, University of California Irvine, Irvine, California, U.S.A
| | - Tjoson Tjoa
- Department of Head and Neck Surgery, University of California Irvine, Irvine, California, U.S.A
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21
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Hatten KM, Amin J, Isaiah A. Machine Learning Prediction of Extracapsular Extension in Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2020; 163:992-999. [PMID: 32600154 DOI: 10.1177/0194599820935446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether machine learning (ML) can predict the presence of extracapsular extension (ECE) prior to treatment, using common oncologic variables, in patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN Retrospective database review. SETTING National Cancer Database study. METHODS All patients with HPV-associated OPSCC treated surgically between January 1, 2010, and December 31, 2015, were selected from the National Cancer Database. Patients were excluded if surgical pathology reports did not include information regarding primary tumor stage, number of metastatic regional lymph nodes, size of largest metastatic regional lymph node, and tumor grade. The data were split into a random distribution of 80% for training and 20% for testing with ML methods. RESULTS A total of 3753 adults with surgically treated HPV-associated OPSCC met criteria for inclusion in the study. Approximately 38% of these patients treated with surgical management demonstrated ECE. ML models demonstrated modest accuracy in predicting ECE, with the areas under the receiver operating characteristic curves ranging from 0.58 to 0.68. The conditional inference tree model (0.66) predicted the metastatic lymph node number to be the most important predictor of ECE. CONCLUSION Despite a large cohort and the use of ML algorithms, the power of clinical and oncologic variables to predict ECE in HPV-associated OPSCC remains limited.
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Affiliation(s)
- Kyle M Hatten
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Julian Amin
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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22
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Mestre VF, Medeiros-Fonseca B, Estêvão D, Casaca F, Silva S, Félix A, Silva F, Colaço B, Seixas F, Bastos MM, Lopes C, Medeiros R, Oliveira PA, Gil da Costa RM. HPV16 is sufficient to induce squamous cell carcinoma specifically in the tongue base in transgenic mice. J Pathol 2020; 251:4-11. [PMID: 31994197 DOI: 10.1002/path.5387] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/30/2019] [Accepted: 01/18/2020] [Indexed: 01/26/2023]
Abstract
Head and neck squamous cell carcinomas (HNSCCs) associated with human papillomavirus (HPV) occur specifically in the tonsils and the tongue base, but the reasons for this specificity remain unknown. We studied the distribution of oral and pharyngeal lesions in HPV16-transgenic mice where the expression of all the HPV16 early genes is targeted to keratinising squamous epithelia by the cytokeratin 14 (Krt14) gene promoter. At 30 weeks of age, 100% of mice developed low- and high-grade intraepithelial dysplasia at multiple sites. Twenty per cent of animals developed invasive cancers that remarkably were restricted to the tongue base, in association with the circumvallate papilla. The lesions maintained expression of CK14 (KRT14) and the HPV16 E6 and E7 oncogenes, and displayed deregulated cell proliferation and up-regulation of p16INK4A . Malignant lesions were poorly differentiated and destroyed the tongue musculature. We hypothesised that the tongue base area might contain a transformation zone similar to those observed in the cervix and anus, explaining why HPV-positive cancers target that area specifically. Immunohistochemistry for two transformation zone markers, CK7 (KRT7) and p63 (TP63), revealed a squamocolumnar junction in the terminal duct of von Ebner's gland, composed of CK7+ luminal cells and p63+ basal cells. Dysplastic and invasive lesions retained diffuse p63 expression but only scattered positivity for CK7. Site-specific HPV-induced carcinogenesis in the tongue base may be explained by the presence of a transformation zone in the circumvallate papilla. This mouse model reproduces key morphological and molecular features of HPV-positive HNSCC, providing a unique in vivo tool for basic and translational research. © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Verónica F Mestre
- CITAB, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | | | - Diogo Estêvão
- Grupo de Oncologia Molecular e Patologia Viral, CI-IPOP, IPO-Porto, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Fátima Casaca
- Botelho Moniz Análises Clínicas (BMAC), Porto, Portugal
| | - Sandra Silva
- Botelho Moniz Análises Clínicas (BMAC), Porto, Portugal
| | - Ana Félix
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal.,Serviço de Anatomia Patológica, IPO-Lisboa, Lisbon, Portugal
| | - Fernanda Silva
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Bruno Colaço
- CITAB, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal.,Departamento de Zootecnia, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | - Fernanda Seixas
- Departamento de Ciências Veterinárias, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal.,CECAV, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | | | - Carlos Lopes
- Botelho Moniz Análises Clínicas (BMAC), Porto, Portugal.,Grupo de Patologia Experimental, Ci-IPOP, IPO-Porto, Porto, Portugal.,Departamento de Patologia e Imunologia Molecular, ICBAS, Universidade do Porto, Porto, Portugal
| | - Rui Medeiros
- Grupo de Oncologia Molecular e Patologia Viral, CI-IPOP, IPO-Porto, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Serviço de Virologia, IPO- Porto, Porto, Portugal.,Liga Portuguesa Contra o Cancro - Núcleo Regional do Norte, Porto, Portugal.,CEBIMED, Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal
| | - Paula A Oliveira
- CITAB, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal.,Departamento de Ciências Veterinárias, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | - Rui M Gil da Costa
- CITAB, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal.,Grupo de Oncologia Molecular e Patologia Viral, CI-IPOP, IPO-Porto, Porto, Portugal.,LEPABE, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal.,PPGSAD, Universidade Federal do Maranhão (UFMA), São Luís, Brazil
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23
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Gal TJ, O'Brien KJ, Chen Q, Huang B. Clinical vs Microscopic Extranodal Extension and Survival in Oropharyngeal Carcinoma in the Human Papillomavirus Era. Otolaryngol Head Neck Surg 2020; 162:693-701. [PMID: 32151208 DOI: 10.1177/0194599820910431] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Extranodal extension (ENE) is known to be associated with poor outcomes in head and neck squamous cell carcinoma. The objective of this study is to examine the impact of extent of ENE on survival in oropharyngeal carcinoma in the human papillomavirus (HPV) era. STUDY DESIGN Retrospective database review. SETTING Review of the National Cancer Database. SUBJECTS AND METHODS The National Cancer Database was used to examine surgically treated head and neck squamous cell carcinoma of the tonsil and base of tongue from 2010 to 2015. Nodes available for pathologic examination were classified as ENE negative (-), ENE clinically (+), or ENE (+) on pathology only. The primary outcome was overall survival. Cox regression modeling was used to examine the effect of ENE on survival while controlling for patient demographics, HPV status, stage, adjuvant radiation, and chemotherapy. RESULTS Of the 66,106 patients identified, 16,845 were treated with surgery ± adjuvant therapy, 8780 of whom were known HPV+. Overall 5-year survival for this group was 86%. Documented ENE was associated with over a 60% decrease in survival for clinical (hazard ratio [HR], 1.63) and pathologic (HR, 1.62) ENE compared to negative ENE, after adjustment for stage, adjuvant radiation ± chemotherapy, HPV, and other variables. No significant differences were found between clinical and pathologic ENE (HR, 1.001). CONCLUSION While both surgically resected clinical and pathologic ENE are associated with decreased survival, no significant differences are observed between the two. The impact of these observations on potential de-escalation therapeutic strategies requires further study.
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Affiliation(s)
- Thomas J Gal
- Department of Otolaryngology, University of Kentucky, Lexington, Kentucky, USA
| | | | - Quan Chen
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
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24
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[Comparison of T cell response in the tumor milieu of patients with HPV + and HPV - head and neck cancer]. HNO 2020; 68:80-86. [PMID: 31915881 DOI: 10.1007/s00106-019-00804-0] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND The incidence of HPV-associated squamous cell carcinoma of the head and neck region (HNSCC) has increased dramatically in recent years. Despite a similar localization (oropharyngeal squamous cell epithelia) to smoking- and alcohol-associated cancers, HPV-associated carcinomas are considered to represent a distinct entity. Reasons for the different therapeutic responses of the two tumor entities are not yet fully understood. METHODS AND OBJECTIVE This review investigates the importance of tumor-infiltrating lymphocytes in HPV+ and HPV- HNSCC by means of articles and publications concerning the tumor micromilieu, effects on prognosis, and patients' therapeutic responses. RESULTS HNSCC patients with a positive HPV status and increased frequencies of CD8+ T cells (CD, cluster of differentiation) demonstrated an improved therapeutic response and improved outcomes. Decreased expression of the EGF (epidermal growth factor) receptor correlates with increased TH1 cytokine secretion by CD4+ T cells, which, in their role as T helper cells, can activate macrophages, dendritic cells, and cytotoxic T cells, amongst others. Regulatory T cells (Treg) execute an immune-suppressive effect in the tumor micromilieu through different metabolic and signaling pathways (IL[interleukin]‑4, IL-10, TGF‑β ["transforming growth factor‑β"]). CONCLUSION The importance of the adaptive immune response for treatment response and patients' prognosis has been supported by different investigations. Understanding the immunological processes in the tumor environment plays an important role for the development of new treatment approaches.
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25
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Affiliation(s)
- Laura Q M Chow
- From the Division of Medical Oncology, Department of Medicine, University of Washington, Thoracic, Head, and Neck Malignancies, Seattle Cancer Care Alliance, and Fred Hutchinson Cancer Research Center - all in Seattle
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26
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Lehtinen M, Apter D, Eriksson T, Harjula K, Hokkanen M, Lehtinen T, Natunen K, Damaso S, Soila M, Bi D, Struyf F. Effectiveness of the AS04-adjuvanted HPV-16/18 vaccine in reducing oropharyngeal HPV infections in young females-Results from a community-randomized trial. Int J Cancer 2019; 147:170-174. [PMID: 31736068 PMCID: PMC7318585 DOI: 10.1002/ijc.32791] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/08/2019] [Accepted: 10/29/2019] [Indexed: 01/03/2023]
Abstract
We studied effectiveness of the AS04-adjuvanted HPV-16/18 (AS04-HPV-16/18) vaccine against human papillomavirus (HPV) oropharyngeal infections associated with the increase of head/neck cancers in western countries. All 38,631 resident adolescents from 1994 to 1995 birth cohorts of 33 Finnish communities were invited in this community-randomized trial (NCT00534638). During 2008-2009, 11,275 girls and 6,129 boys were enrolled in three arms of 11 communities each. In Arm A, 90% of vaccinated girls/boys, and in Arm B, 90% of vaccinated girls received AS04-HPV-16/18 vaccine. Other Arm A/B and all Arm C vaccinated participants received control vaccine. All Arm A participants and Arm B female participants were blinded to vaccine allocation. Oropharyngeal samples were analyzed from 4,871 18.5-year-old females who attended follow-up visit 3-6 years postvaccination. HPV DNA prevalence was determined by SPF-10 LiPA and Multiplex type-specific PCR. Total vaccine effectiveness (VE) was defined as relative reduction of oropharyngeal HPV prevalence in pooled Arms A/B HPV-vaccinated females vs. all Arm C females. VE against oropharyngeal HPV-16/18, HPV-31/45 and HPV-31/33/45 infections were 82.4% (95% confidence intervals [CI]: 47.3-94.1), 75.3% (95%CI: 12.7-93.0) and 69.9% (95% CI: 29.6-87.1), respectively. In conclusion, the AS04-HPV-16/18 vaccine showed effectiveness against vaccine and nonvaccine HPV-types oropharyngeal infections in adolescent females up to 6 years postvaccination.
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Affiliation(s)
- Matti Lehtinen
- Department of Infections and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Tiina Eriksson
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Katja Harjula
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Mari Hokkanen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Tuomas Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Kari Natunen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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27
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Han M, Stanford‐Moore GB, Larson AR, Schoppy DW, Cognetti DM, Joshi AS, Houlton JJ, Ryan WR. Predictors of Mortality in HPV‐Associated Oropharynx Carcinoma Treated With Surgery Alone. Laryngoscope 2019; 130:E423-E435. [DOI: 10.1002/lary.28344] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/13/2019] [Accepted: 09/16/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Mary Han
- Department of Otolaryngology, Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
- School of MedicineUniversity of California‐San Francisco San Francisco California
| | - Gaelen B. Stanford‐Moore
- Department of Otolaryngology, Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
| | - Andrew R. Larson
- Department of Otolaryngology, Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
| | - David W. Schoppy
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
| | - David M. Cognetti
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology–Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania
| | - Arjun S. Joshi
- Division of Head and Neck Oncologic Surgery, Department of SurgeryGeorge Washington University Washington DC
| | - Jeffery J. Houlton
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology–Head and Neck SurgeryUniversity of Washington Seattle Washington U.S.A
| | - William R. Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
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28
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Zhang H, Xie M, Levin M, Archibald SD, Jackson BS, Young JEM, Gupta MK. Survival outcomes of marijuana users in p16 positive oropharynx cancer patients. J Otolaryngol Head Neck Surg 2019; 48:43. [PMID: 31477184 PMCID: PMC6720071 DOI: 10.1186/s40463-019-0365-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/20/2019] [Indexed: 12/28/2022] Open
Abstract
Background Oropharynx squamous cell carcinoma (OPSCC) has become the predominant subsite for head and neck mucosal cancers (HNC) due to the rise of human papillomavirus (HPV) related disease. Previous studies have suggested an association between marijuana use and HPV-related OPSCC. Despite this, no study has examined the potential relationship between marijuana use and survival in this subset of patients. Objective To examine the survival outcomes of HPV-related OPSCC patients in marijuana users. Methods Patients who were marijuana users were identified from a prospectively collected database of HNC patients from January 2011 to 2015. A physical review of clinic records was undertaken to extract relevant patient, tumor, treatment, follow-up, as well as survival data. Patients greater than 17 years of age with pathologically proven p16 positive OPSCC were included. They were then case-matched in a 1-to-1 basis to patients who were non-marijuana users based on age, gender, and cTNM staging. Results Forty-Seven patients met inclusion criteria within each group. Univariate logistic regression analysis showed that age, gender, and cT-Stage were predictive of disease recurrence within both groups (p < 0.05). However, cN-stage, treatment modality, tumor subsite, tobacco use, and tobacco dose were not (p > 0.05). There was no statistically significant difference between marijuana and non-marijuana user groups in 5-year (p = 0.400) overall survival, disease-specific (p = 0.993), disease-free (p = 0.404), and metastasis-free survival (p = 0.384). Conclusions No survival difference is found between HPV-related OPSCC marijuana users and non-users. This finding has implications for both de-escalation regimes and the use of cannabis as a therapeutic agent.
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Affiliation(s)
- Han Zhang
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael Xie
- Michael DeGroote Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marc Levin
- Michael DeGroote Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stuart D Archibald
- Michael DeGroote Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - B Stanley Jackson
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - J E M Young
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael K Gupta
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada.
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29
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Torabi SJ, Cheraghlou S, Kasle DA, Savoca EL, Judson BL. Nonsquamous cell laryngeal cancers: Incidence, demographics, care patterns, and effect of surgery. Laryngoscope 2019; 129:2496-2505. [DOI: 10.1002/lary.27785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Sina J. Torabi
- Department of Surgery, Section of OtolaryngologyYale University School of Medicine New Haven Connecticut U.S.A
| | - Shayan Cheraghlou
- Department of Surgery, Section of OtolaryngologyYale University School of Medicine New Haven Connecticut U.S.A
| | - David A. Kasle
- Department of Surgery, Section of OtolaryngologyYale University School of Medicine New Haven Connecticut U.S.A
| | - Emily L. Savoca
- Department of Surgery, Section of OtolaryngologyYale University School of Medicine New Haven Connecticut U.S.A
| | - Benjamin L. Judson
- Department of Surgery, Section of OtolaryngologyYale University School of Medicine New Haven Connecticut U.S.A
- Yale Cancer Center New Haven Connecticut U.S.A
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30
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Nassiri AM, Campbell BR, Mannion K, Sinard RJ, Netterville JL, Rohde SL. Survival Outcomes in T4aN0M0 Mandibular Gingival Squamous Cell Carcinoma Treated with Surgery Alone. Otolaryngol Head Neck Surg 2019; 160:870-875. [DOI: 10.1177/0194599818821892] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives To measure disease-free, disease-specific, and overall survival among patients with T4aN0M0 mandibular gingival squamous cell carcinoma who were treated with surgery alone. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods A retrospective chart review was performed of all adult patients treated surgically with an oral cavity composite resection between January 2005 and March 2017. Among other data, patient preoperative characteristics were recorded (eg, age, sex, smoking history, alcohol use, and clinical stage); operative notes were reviewed to determine tumor subsite involvement, reconstruction method, and intraoperative surgical complications; and pathology reports were evaluated for various pathologic findings. Survival outcomes were determined with Kaplan-Meier analysis. Results The mean follow-up was 18.5 months (range, 0.1-100). The 1- and 5-year disease-free survival rates were 90.5% and 84.5%, respectively, while the 1- and 5-year disease-specific survival rates were 87.8% and 81.9%. The 1- and 5-year overall survival rates were 86.4% and 80.6%. Conclusions Patients with T4aN0M0 squamous cell carcinoma of the mandibular gingiva treated with surgery alone have a 5-year overall survival of 80.6%. Treatment with surgery alone obviates morbidities associated with adjuvant therapy while upholding survival outcomes.
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Affiliation(s)
- Ashley M. Nassiri
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin R. Campbell
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kyle Mannion
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J. Sinard
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James L. Netterville
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah L. Rohde
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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31
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Li H, Torabi SJ, Park HS, Yarbrough WG, Mehra S, Choi R, Judson BL. Clinical value of transoral robotic surgery: Nationwide results from the first 5 years of adoption. Laryngoscope 2018; 129:1844-1855. [DOI: 10.1002/lary.27740] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Hong Li
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Sina J. Torabi
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Henry S. Park
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
- Department of Therapeutic Radiology; Yale School of Medicine; New Haven Connecticut U.S.A
| | - Wendell G. Yarbrough
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
| | - Saral Mehra
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
| | - Rachel Choi
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Benjamin L. Judson
- Yale University School of Medicine; New Haven Connecticut U.S.A
- Department of Surgery, Section of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
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32
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Cramer JD, Ferris RL, Kim S, Duvvuri U. Primary surgery for human papillomavirus-associated oropharyngeal cancer: Survival outcomes with or without adjuvant treatment. Oral Oncol 2018; 87:170-176. [PMID: 30527235 DOI: 10.1016/j.oraloncology.2018.10.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is a unique form of head and neck cancer with improved prognosis. We assessed survival for stage I patients with low- or intermediate-risk pathologic features with surgery alone compared with surgery with adjuvant radiation (RT) or chemoradiation (CRT). MATERIALS AND METHODS We identified patients with stage I HPV+ OPSCC (after restaging with 8th edition staging system) treated with surgery alone, adjuvant RT or CRT in the National Cancer Data Base from 2010 to 2013. We compared survival for low-risk patients (≤1 metastatic lymph nodes with no adverse features) and intermediate-risk patients (2-4 metastatic lymph nodes, microscopic extranodal extension (ENE) or lymphovascular invasion). RESULTS We examined 1677 patients with median follow-up of 43.9 months. In the intermediate-risk group, 4-year overall survival was 94.0% with surgery alone, 91.5% with adjuvant RT and 92.0% with adjuvant CRT (p = 0.72). There were similar rates of overall survival in the low-risk group. In multivariable models accounting for clinicopathologic differences the dose of adjuvant RT was not associated with mortality. On Cox proportional hazard modeling, adjuvant RT (HR 0.94; CI 0.43-2.08) or CRT (HR 0.96; CI 0.45-2.11) did not significantly improved survival compared with surgery alone in the intermediate-risk group (reference). Similar results were seen in the low-risk group. The composite number of pathologic risk features significantly improved risk stratification. CONCLUSION We provide observational evidence that adjuvant RT or CRT does not provide a survival benefit for stage I HPV+ OPSCC with low- or intermediate-risk pathologic features.
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Affiliation(s)
- John D Cramer
- Department of Otolaryngology - Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, United States.
| | - Robert L Ferris
- Department of Otolaryngology - Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Seungwon Kim
- Department of Otolaryngology - Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Umamaheswar Duvvuri
- Department of Otolaryngology - Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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33
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Cheraghlou S, Schettino A, Zogg CK, Judson BL. Changing prognosis of oral cancer: An analysis of survival and treatment between 1973 and 2014. Laryngoscope 2018; 128:2762-2769. [PMID: 30194691 DOI: 10.1002/lary.27315] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/14/2018] [Accepted: 05/07/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS Oral cavity cancer is the most commonly occurring malignancy of the head and neck. There are limited data suggesting a change in prognosis of oral cavity cancers. We aimed to evaluate temporal trends in demographics, treatment, and prognosis of oral cavity cancer diagnosed between 1973 and 2014 inclusive. STUDY DESIGN Retrospective database analysis. METHODS A retrospective study of 16,030 adult patients diagnosed with oral cavity cancer between 1973 and 2014 inclusive and treated surgically in the Surveillance, Epidemiology, and End Results (SEER) 9 registry was conducted. A supplemental analysis was conducted using data from the National Cancer Database. Multivariate Cox survival regressions and univariate Kaplan-Meier analyses were conducted. RESULTS The prognosis of both early- and late-stage disease has significantly improved between 1973 and 2014. Among patients with early-stage disease, 3-year survival increased from 78.0% (standard error [SE] = 1.3) for those diagnosed from 1973 to 1980 to 92.2% (SE = 1.1) for those diagnosed from 2011 to 2014. Among patients with late-stage disease, 3-year survival ranged from 51.9% (SE = 1.5) for those diagnosed from 1973 to 1980 to 70.3% (SE = 1.9) for those diagnosed from 2011 to 2014. For patients with late-stage disease, this improved prognosis occurred in tandem with increasing usage of chemoradiotherapy as adjuvant therapy. There has also been increasing utilization of neck dissection for early- and late-stage disease, along with higher nodal yields from performed dissections. CONCLUSIONS The prognosis of oral cavity cancer has improved significantly from the early 1970s to recent years. In late-stage oral cancer, this change has been associated with an increased use of adjuvant therapy and adjuvant chemoradiotherapy in particular. LEVEL OF EVIDENCE 4 Laryngoscope, 128:2762-2769, 2018.
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Affiliation(s)
- Shayan Cheraghlou
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Amy Schettino
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Cheryl K Zogg
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut, U.S.A
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Philouze P, Céruse P, Thariat J. [Surgery or radiotherapy for oropharyngeal HPV-positive tumours?]. Cancer Radiother 2018; 22:481-486. [PMID: 30145091 DOI: 10.1016/j.canrad.2018.07.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
Oropharyngeal carcinomas related to the human papilloma virus (HPV; usually HPV16) exhibit biological differences in terms of carcinogenesis and are of relatively better prognosis (in the absence of tobacco consumption) compared to tobacco-related cancers. The therapeutic strategies between these two forms of cancers of the upper aerodigestive tract related to different risk factors are however identical, except therapeutic trial. In the absence of a sufficient level of evidence to define a specific strategy for induced HPV carcinomas, the analysis of the recent literature nonetheless allows us to suggest ways to guide the clinician in his therapeutic choice. Given the relative good prognosis HPV+ oropharyngeal cancers, an important goal is to avoid if possible a multimodal treatment that increases the sequelae and could degrade the quality of life. For the early stages I/II, it may be desirable to propose minimally invasive surgery if radiotherapy is avoidable or an exclusive conformal radiation therapy by intensity modulation in the opposite case. For the advanced stages III/IV, the recommendations are similar to those of cancers not related to HPV. Current trials should provide answers on the relevance of therapeutic deflation (absence of chemotherapy in the event of capsular rupture, dose reduction or irradiation volumes, etc.).
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Affiliation(s)
- P Philouze
- Département de cancérologie cervicofaciale, Groupement hospitalier Nord, hospices civils de Lyon, 103, grande-rue de la Croix-Rousse, 69004 Lyon, France; Université Lyon 1, 69000 Lyon, France
| | - P Céruse
- Département de cancérologie cervicofaciale, Groupement hospitalier Nord, hospices civils de Lyon, 103, grande-rue de la Croix-Rousse, 69004 Lyon, France; Université Lyon 1, 69000 Lyon, France
| | - J Thariat
- Département de radiothérapie/archade, Normandie, centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France; Université UniCaen, 14000 Caen, France
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Cheraghlou S, Schettino A, Zogg CK, Otremba MD, Bhatia A, Park HS, Osborn HA, Mehra S, Yarbrough WG, Judson BL. Adjuvant Chemotherapy Is Associated With Improved Survival for Late-Stage Salivary Squamous Cell Carcinoma. Laryngoscope 2018; 129:883-889. [PMID: 30151947 DOI: 10.1002/lary.27444] [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: 03/30/2018] [Revised: 05/25/2018] [Accepted: 06/22/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Salivary squamous cell carcinomas (SCCs) represent a unique disease entity because many are thought to represent metastases from primary cutaneous malignancies. Nevertheless, they represent a significant proportion of parotid gland cancers and have a notably poor prognosis. Recently, there has been controversy regarding the utility of adjuvant chemotherapy in the treatment of these malignancies, with most studies concluding that there is no survival benefit. We aim to determine the outcomes associated with the use of adjuvant radiotherapy and chemoradiotherapy in the treatment of early- and late-stage salivary SCC. METHODS A retrospective study of 2,285 of surgically resected adult salivary SCC diagnosed from 2004 to 2014 in the National Cancer Database was conducted. Patients were divided into early- (I/II) and late-stage (III/IV) groups. Demographic, facility, tumor, and survival variables were included in the analyses. Multivariate Cox survival regressions, propensity-score matched analyses, and univariate Kaplan-Meier analyses were conducted. RESULTS The use of adjuvant chemoradiotherapy for late-stage patients was associated with improved survival compared to the use of adjuvant radiotherapy alone (hazard ratio [HR] 0.774, P = 0.026). Five-year survival for late-stage patients treated with surgery alone, surgery with adjuvant radiotherapy, and surgery with adjuvant chemoradiotherapy was 31.1% (standard error [SE]: 2.5), 45.6% (SE: 2.2), and 58.9% (SE: 3.4). Use of adjuvant therapy (either chemoradiotherapy or radiotherapy alone) was associated with improved survival for early-stage patients (HR 0.746, P = 0.037). CONCLUSION The addition of chemotherapy to the adjuvant therapy of late-stage patients with salivary SCC may result in improved long-term survival. Expanded use of adjuvant therapy for early-stage disease may also improve patient outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 129:883-889, 2019.
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Affiliation(s)
- Shayan Cheraghlou
- Division of Otolaryngology, Department of Surgery, New Haven, Connecticut, U.S.A
| | - Amy Schettino
- Division of Otolaryngology, Department of Surgery, New Haven, Connecticut, U.S.A
| | - Cheryl K Zogg
- Division of Otolaryngology, Department of Surgery, New Haven, Connecticut, U.S.A
| | - Michael D Otremba
- Division of Otolaryngology, Department of Surgery, New Haven, Connecticut, U.S.A
| | - Aarti Bhatia
- Department of Medicine, New Haven, Connecticut, U.S.A.,Yale Cancer Center, New Haven, Connecticut, U.S.A
| | - Henry S Park
- Department of Therapeutic Radiology, New Haven, Connecticut, U.S.A.,Yale Cancer Center, New Haven, Connecticut, U.S.A
| | - Heather A Osborn
- Division of Otolaryngology, Department of Surgery, New Haven, Connecticut, U.S.A.,Yale Cancer Center, New Haven, Connecticut, U.S.A
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, New Haven, Connecticut, U.S.A.,Yale Cancer Center, New Haven, Connecticut, U.S.A
| | - Wendell G Yarbrough
- Division of Otolaryngology, Department of Surgery, New Haven, Connecticut, U.S.A.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut, U.S.A.,Yale Cancer Center, New Haven, Connecticut, U.S.A
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, New Haven, Connecticut, U.S.A.,Yale Cancer Center, New Haven, Connecticut, U.S.A
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Cheraghlou S, Torabi SJ, Husain ZA, Otremba MD, Osborn HA, Mehra S, Yarbrough WG, Burtness BA, Judson BL. HPV status in unknown primary head and neck cancer: Prognosis and treatment outcomes. Laryngoscope 2018; 129:684-691. [DOI: 10.1002/lary.27475] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Shayan Cheraghlou
- Division of Otolaryngology, Department of Surgery; New Haven Connecticut U.S.A
| | - Sina J. Torabi
- Division of Otolaryngology, Department of Surgery; New Haven Connecticut U.S.A
| | - Zain A. Husain
- Department of Therapeutic Radiology; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
| | - Michael D. Otremba
- Division of Otolaryngology, Department of Surgery; New Haven Connecticut U.S.A
| | - Heather A. Osborn
- Division of Otolaryngology, Department of Surgery; New Haven Connecticut U.S.A
- Department of Medicine; Yale School of Medicine; New Haven Connecticut U.S.A
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
| | - Wendell G. Yarbrough
- Division of Otolaryngology, Department of Surgery; New Haven Connecticut U.S.A
- Department of Pathology; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
| | - Barbara A. Burtness
- Department of Medicine; Yale School of Medicine; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
| | - Benjamin L. Judson
- Division of Otolaryngology, Department of Surgery; New Haven Connecticut U.S.A
- Yale Cancer Center; New Haven Connecticut U.S.A
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Cheraghlou S, Yu PK, Otremba MD, Mehra S, Yarbrough WG, Judson BL. Extracapsular extension is not a significant prognostic indicator in non-squamous cancers of the major salivary glands. CANCERS OF THE HEAD & NECK 2018; 3:5. [PMID: 31093358 PMCID: PMC6460801 DOI: 10.1186/s41199-018-0032-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/29/2018] [Indexed: 01/03/2023]
Abstract
Background Extracapsular extension (ECE) is a well-established prognostic feature in squamous cell cancers of the head and neck. Although some extrapolate data from mucosal head and neck cancer to include ECE as a high-risk feature in salivary gland cancers, data is lacking about ECE’s prognostic value for these malignancies. We investigate whether ECE is a significant prognostic indicator in pathologic node-positive cancers of the major salivary glands. Methods A retrospective study of adult salivary gland cancer cases diagnosed from 2004 to 2013 in the NCDB was conducted. Demographic, tumor, treatment, and survival variables were included in the study. Univariate Kaplan-Meier analyses, as well as multivariate Cox survival regressions were performed. Results Positive ECE status was associated with significantly worse survival in salivary SCC (HR 1.687; p = 0.002) but not non-squamous salivary cancers (HR 1.000; p = 0.998) on multivariate analysis. While post-operative radiotherapy was not associated with improved survival for patients without high-risk adverse features (high grade or positive surgical margins), its use was associated with better survival for ECE-positive salivary SCC patients without one of these additional adverse features (HR 0.064; p = 0.010). Conclusions Although ECE is a significant prognostic indicator in salivary SCC, its prognostic significance for non-squamous salivary cancers may be limited. Radiotherapy may improve survival in cases with at least one high-risk adverse feature: high grade; positive surgical margins; and for salivary SCC specifically, positive ECE status.
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Affiliation(s)
- Shayan Cheraghlou
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA
| | - Phoebe K Yu
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA
| | - Michael D Otremba
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA.,2Yale Cancer Center, New Haven, CT USA
| | - Saral Mehra
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA.,2Yale Cancer Center, New Haven, CT USA
| | - Wendell G Yarbrough
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA.,2Yale Cancer Center, New Haven, CT USA.,3Department of Pathology, Yale School of Medicine, New Haven, CT USA
| | - Benjamin L Judson
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA.,2Yale Cancer Center, New Haven, CT USA
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