Trends in the incidence of oral cavity and oropharyngeal cancers in Spain

Occurrence and Distribution of Cancers with Emphasis Upon Oral Cancers in Registered Oncology Institutes of South India - A Retrospective Study

Background

In the past two decades, the growing economy associated with changes in lifestyle-related behavior is partially responsible for the increasing cancer burden in India. To assess the occurrence and distribution of oral cancer based on the analysis of hospital records from registered oncology institutes of South India over a period of three years.

Materials and Methods

A multicenter, retrospective study was conducted at seven major hospitals in South India to assess the incidence and distribution of cancer among patients over a period of three years (2016-2018). Data were collected on a custom-made validated proforma. Analysis was done using R commander software.

Results

A total of 156090 various types of cancers were reported to the included institutes over a three-year period, an almost similar gender distribution was observed, males (n = 78806, 42.99% per lakh) compared to their female counterparts (n = 77284, 42.16% per lakh). Among males' lung cancer was the most common type with 17709 cases (9.65% per lakh) and among females, breast cancer was the leading cancer type with 22855 total cases (12.46% per lakh). Over a period of three years, a total of 21084 records of malignancies pertaining to oral cavity were identified accounting for 13.51% of cases. Among oral cancers, tongue was the most common site to be involved accounting for 44.22% (2016-2018) cases followed by buccal mucosa (14.69%), least common site to be involved was lip which accounted for 3.49% of the total oral cancer cases.

Conclusion

Breast cancer was the most common cancer followed by lung cancer. Oral cancers occupied second among males and fifth rank in the order of occurrence among females. Tongue was the most common site followed by buccal mucosa. The least common site affected by oral cancer was the lip.

Oral/oropharyngeal "selfies" in gay and bisexual men: a pilot study exploring oropharyngeal screening for HPV-related possible malignancies

Objectives

This study aims to determine the potential uptake and quality of oropharyngeal "selfies" taken by gay/bisexual men as a screening approach for HPV-associated oropharyngeal cancer.

Methods

From 1,699 gay/bisexual men in the US, surveyed about knowledge and attitudes to HPV-associated oropharyngeal cancer, a random sample of 320 men were invited to take an oropharyngeal "selfie" by smartphone and send it to the study website: 113 (35.5%) did so. Images were rated for quality by three healthcare professional raters blinded to each other's rating, with an otolaryngologist as the gold standard. In the second wave, those whose images were rated as unacceptable were sent a short instructional video and asked to send another image. Of the 65 invited, 46 did so. An additional 15.2% sent acceptable images, and a total of 28.3% of the sample was acceptable.

Results

A total of 1,121 men willing to participate in the future study who believed they could take a quality "oral selfie" were potentially eligible for this activity. A random sample of 320 participated: 153 participants started (47.8%) and 113 participants (35.3%) submitted an image. Responders were more likely to be younger, have higher knowledge scores on oropharyngeal HPV-related cancer, and have had HPV vaccination. There was high agreement between the three raters. Images of good/acceptable quality were 22.1%; oropharynx partially occluded images were 29.2%; oropharynx not visible images were 18.6%; images too dark were 21.2%; and images too small were 8.8%. From the second wave of requests with instructional videos, an additional 15.2% sent in quality images, with the remaining issues being partial occlusion of the tonsils by the tongue.

Conclusion

One-third of the invited gay and bisexual men sent oropharyngeal selfie images to the study website and a total of 28.3% were of clinically acceptable quality. Following an instructional video on poorer-quality images, additional quality images were received. One barrier, i.e., partial occlusion of the oropharynx by the tongue remained. Quality oropharyngeal "selfies" are obtainable online.

Differential characteristics of patients with squamous cell carcinoma of the head and neck with no history of tobacco or alcohol use

OBJECTIVE

The present study aims to analyse the differential characteristics of patients with head and neck squamous cell carcinoma (HNSCC) without a history of consumption of toxic substances such as tobacco and alcohol.

MATERIAL AND METHODS

We carried out a retrospective study of 4694 patients with HNSCC located in the oral cavity, oropharynx, hypopharynx or larynx treated in our centre during the period 1985-2019.

RESULT

7.7% of the patients (n = 363) did not report a history of consumption of toxic substances. The group of patients with no toxic history was older, had a higher proportion of women, a higher frequency of cases located in the oral cavity, a higher proportion of cases diagnosed in early stages, and a lower incidence of second neoplasms. The percentage of patients with no history of consumption of toxic substances increased significantly over the study period. The overall survival of patients with no history of consumption of toxic substances was significantly higher than that of patients with toxic substances use. Specific survival for patients with tumours located in the oral cavity without a history of consumption of toxic substances was significantly lower than that of patients with toxic substances use, whereas for patients with oropharyngeal carcinomas the absence of a history of consumption of toxic substances was associated with a better prognosis.

CONCLUSIONS

There were differences in the epidemiological and prognostic characteristics of patients with HNSCC according to the history of consumption of toxic substances such as tobacco and alcohol.

Challenges in the Early Diagnosis of Oral Cancer, Evidence Gaps and Strategies for Improvement: A Scoping Review of Systematic Reviews

Simple Summary

Oral cancer presents a worldwide incidence of 377,713 new cases and 177,757 deaths per year (GLOBOCAN, IARC, WHO). Oral squamous cell carcinoma (OSCC) accounts for approximately 90% of oral malignancies and has a 5-year mortality rate close to 50%. We aim to better understand, based on the evidence, and to discuss in depth, the reasons for the diagnostic delay of oral cancer by reviewing systematic reviews and meta-analyses. We also aim to, identify gaps in evidence, recommend future lines of research that should be implemented, and formulate strategies for improvement.

Abstract

Oral cancer is a growing problem, accounting for 377,713 worldwide new cases per year, and 177,757 deaths annually and representing a 5-year mortality rate close to 50%, which is a considerable mortality that has not decreased substantially in the last 40 years. The main cause of this high mortality is related to the diagnosis of a high percentage of oral cancers in advanced stages (stages III and IV) in which treatment is complex, mutilating or disabling, and ineffective. The essential cause of a cancer diagnosis at a late stage is the delay in diagnosis, therefore, the achievement of the objective of improving the prognosis of oral cancer involves reducing the delay in its diagnosis. The reasons for the delay in the diagnosis of oral cancer are complex and involve several actors and circumstances—patients, health care providers, and health services. In this paper, we present the results of a scoping review of systematic reviews on the diagnostic delay in oral cancer with the aim to better understand, based on the evidence, and discuss in depth, the reasons for this fact, and to identify evidence gaps and formulate strategies for improvement.

Global incidence trends in head and neck cancer for HPV-related and -unrelated subsites: A systematic review of population-based studies

In head and neck cancer (HNC), some subsites are associated with human papillomavirus (HPV) infection, whereas others are unrelated. Although studies have demonstrated the heterogeneity of HPV prevalence worldwide, its impacts on incidence trends in HNC are unknown. This systematic review examined the incidence trends for HPV-related HNC subsites, exploring patterns by geographic region, age group, sex, and race/ethnicity. We searched for publications on PubMed, Embase, and Scopus. Eligible articles included population-based studies that analyzed incidence trends for subsites classified as a proxy for HPV infection in HNC (hereafter referred to as HPV-related subsites). We retrieved 3,948 non-duplicate records, of which 31 were eligible articles, representing 18 countries and spanning almost fifty years. Overall, the incidence of HPV-related HNC subsites rose, while most of the HPV-unrelated subsites declined or remained stable. For HPV-related HNC subsites, incidence trends increased regardless of age group, highlighting a distinct global pattern between sexes. Also, similar peaks in increased risk were observed in recent cohorts from both Australia and the United States. There is a dramatic shift in the global trends of HNCs, characterized by the emerging burden in HNC for HPV-related subsites.

Oral cancer incidence trends in Delhi (1990-2014): An alarming scenario

Background:

Oral cancer ranks in the top three of all cancers in India, which accounts for over 30% of all cancers reported in the country, and oral cancer control is quickly becoming a global health priority. We have conducted an age period analysis of oral cancer incidence trends using the Population-Based Cancer Registry (PBCR) data in Delhi over a 24-year period (1990–2014) to address the trends of one of the leading cancer sites in Delhi.

Materials and Methods:

The data of oral cancer proportion and incidence for the year 1990–2014 were taken from Delhi PBCR which records cancer cases from more than 180 government and 250 private facilities. The data were segregated by sex, age, and anatomical site and were analyzed to calculate age-specific incidence rates and expressed in cases per 100,000 persons/year.

Results:

The highest incidence for both genders was seen in the age group 50–59 years and the lowest incidence for both genders was in youngest age group (<20 years) for all the years from 1990 to 2014. The relative proportion of oral cancer among all types of cancer in Delhi has shown alarming rise from the year 2003 onward.

Concusion:

Increasing relative proportion of oral cancer can be implicated in increased consumption of gutkha chewers in the last decade of the 20^th Century. As access to health-care services and cancer-related awareness is highly variable in India, more in-depth analysis of the incidence of oral cancer in rural regions will be required.

The emerging risk of oropharyngeal and oral cavity cancer in HPV-related subsites in young people in Brazil

Human papillomavirus (HPV) is responsible for the rise in the incidence of cancer in the oropharynx, tonsils, and base of the tongue (i.e., HPV-related subsites). HPV triggered the changes in the epidemiology of oropharyngeal and oral cavity cancer (OPC/OCC) in Asia, Europe, North America, and Oceania. Hence, the incidence of cancer in HPV-related subsites is augmenting, while that in other HPV-unrelated subsites is decreasing. In South America, although the incidence of HPV-positive tumors has gradually increased, there is an atypically low prevalence of HPV in people with OPC/OCC. To clarify whether this dramatic shift in incidence trends also occurred in this population, we estimated the burden of HPV on the incidence trends of OPCs/OCCs in São Paulo city in Brazil. In this population-based study, we categorized OPCs/OCCs by HPV-related and HPV-unrelated subsites. We used Poisson regression to assess the age-standardized incidence rates (ASRs) stratified by sex and age groups, as well as to examine the age-period-cohort effects. There were 15,391 cases of OPCs/OCCs diagnosed in HPV-related (n = 5,898; 38.3%) and HPV-unrelated (n = 9,493; 61.7%) subsites. Overall, the ASRs decreased for most subsites, for both sexes and for all age groups, except for HPV-related OPC/OCC in young males and females, which increased by 3.8% and 8.6% per year, respectively. In the birth-cohort-effect analysis, we identified an increasing risk for HPV-related OPC/OCC in both sexes in recent birth cohorts; however, this risk was sharply decreased in HPV-unrelated subsites. Our data demonstrate an emerging risk for HPV-related OPC/OCC in young people, which supports prophylactic HPV vaccination in this group.

Prognostic significance of E-cadherin and β-catenin expression in HPV-negative oropharyngeal squamous cell carcinomas

BACKGROUND

The purpose of this work was to investigate the prognostic significance of E-cadherin and β-catenin expression in surgically treated human papillomavirus (HPV)-negative patients with oropharyngeal squamous cell carcinoma (SCC).

METHODS

Consecutive patients with oropharyngeal SCC who underwent surgical treatment between 1990 and 2009 were retrospectively collected. Immunohistochemical analysis of E-cadherin and β-catenin expression was performed on tissue microarrays.

RESULTS

E-cadherin and β-catenin expression was evaluable in 232 cases. Low membranous E-cadherin, low membranous β-catenin expression, and nuclear β-catenin expression were associated with a poorer disease-specific and overall survival, although the differences were only significant for β-catenin membranous expression (P = .024 and P = .016, respectively). In multivariate analysis, nodal metastasis and low membranous β-catenin expression were significant independent predictors of reduced disease-specific and overall survival.

CONCLUSION

Low membranous β-catenin expression is a significant independent predictor of both reduced disease-specific and overall survival in patients with HPV-negative oropharyngeal SCC.

Prevalence of HPV Infection in Racial-Ethnic Subgroups of Head and Neck Cancer Patients

The landscape of HPV infection in racial/ethnic subgroups of head and neck cancer (HNC) patients has not been evaluated carefully. In this study, a meta-analysis examined the prevalence of HPV in HNC patients of African ancestry. Additionally, a pooled analysis of subject-level data was also performed to investigate HPV prevalence and patterns of p16 (CDNK2A) expression amongst different racial groups. Eighteen publications (N = 798 Black HNC patients) were examined in the meta-analysis, and the pooled analysis included 29 datasets comprised of 3,129 HNC patients of diverse racial/ethnic background. The meta-analysis revealed that the prevalence of HPV16 was higher among Blacks with oropharyngeal cancer than Blacks with non-oropharyngeal cancer. However, there was great heterogeneity observed among studies (Q test P<0.0001). In the pooled analysis, after adjusting for each study, year of diagnosis, age, gender and smoking status, the prevalence of HPV16/18 in oropharyngeal cancer patients was highest in Whites (61.1%), followed by 58.0% in Blacks and 25.2% in Asians (P<0.0001). There was no statistically significant difference in HPV16/18 prevalence in non-oropharyngeal cancer by race (P=0.682). With regard to the pattern of HPV16/18 status and p16 expression, White patients had the highest proportion of HPV16/18+/p16+ oropharyngeal cancer (52.3%), while Asians and Blacks had significantly lower proportions (23.0% and 22.6%, respectively) [P <0.0001]. Our findings suggest that the pattern of HPV16/18 status and p16 expression in oropharyngeal cancer appears to differ by race and this may contribute to survival disparities.

Oral and oropharyngeal cancer and the role of sexual behaviour: a systematic review

OBJECTIVES

This systematic review identified and evaluated the evidence for the role of sexual behaviours in the development of oropharyngeal cancers (OPCs) and oral cavity cancers (OCCs).

METHODS

Following the PRISMA guidelines, we identified observational and interventional studies reporting associations between several different sexual behaviours and OPC or OCC. Study quality was assessed independently by two reviewers using a validated scoring system.

RESULTS

From 513 papers identified, 21, reporting on 20 studies, fulfilled the inclusion criteria. Two cohort studies were rated as moderate quality. The 18 case-control studies were rated as weak; nine comparing people with OPC or OCC to people without cancer, eight comparing HPV-positive to HPV-negative cancer patients and one comparing OPCs to other head and neck cancers. One study was a pooled analysis of seven of the included studies with some additional information. Twelve sexual behaviours were assessed and 69 associations reported. The studies differed in the comparisons made, the sexual behaviours assessed, and how these were reported and categorized, so no quantitative meta-analyses were appropriate. Most studies combined OPC and OCC. Several significantly increased risks were seen with a high number of lifetime sexual partners (nine studies) and with the practice of oral sex (five studies), although two studies found a significant negative association with OCC and ever performing oral sex. Two cohort studies of men and women in homosexual relationships found increases in oral cancer risk, and a cohort study of men married to women who had a history of cervical cancer also showed an increased risk of oral cancers. Results for other sexual behaviours were limited and inconsistent, and these included the following: younger age at first sexual intercourse, number of lifetime oral sex partners, the practice of oral-anal sex, the number of oral-anal sex partners, and ever performing anal sex. Only one study assessed casual sex, never or rare use of a condom and having a sexual partner with a history of genital warts, finding significant associations in the two former behaviours.

CONCLUSION

The current evidence for sexual behaviours being risk factors for oral and oropharyngeal cancer is limited and inconsistent. Evidence suggests that the number of sexual partners and performing oral sex are associated with a greater risk. Furthermore men whose partners have had cervical cancer may have an increased risk. More studies looking at OPC specifically will be useful to determine whether these behaviours are subsite-selective.

Trends in mouth cancer incidence in Mumbai, India (1995-2009): An age-period-cohort analysis

INTRODUCTION

Despite tobacco control and health promotion efforts, the incidence rates of mouth cancer are increasing across most regions in India. Analysing the influence of age, time period and birth cohort on these secular trends can point towards underlying factors and help identify high-risk populations for improved cancer control programmes.

METHODS

We evaluated secular changes in mouth cancer incidence among men and women aged 25-74 years in Mumbai between 1995 and 2009 by calculating age-specific and age-standardized incidence rates (ASR). We estimated the age-adjusted linear trend for annual percent change (EAPC) using the drift parameter, and conducted an age-period-cohort (APC) analysis to quantify recent time trends and to evaluate the significance of birth cohort and calendar period effects.

RESULTS

Over the 15-year period, age-standardized incidence rates of mouth cancer in men in Mumbai increased by 2.7% annually (95% CI:1.9 to 3.4), p<0.0001) while rates among women decreased (EAPC=-0.01% (95% CI:-0.02 to -0.002), p=0.03). APC analysis revealed significant non-linear positive period and cohort effects in men, with higher effects among younger men (25-49 years). Non-significant increasing trends were observed in younger women (25-49 years).

CONCLUSIONS

APC analyses from the Mumbai cancer registry indicate a significant linear increase of mouth cancer incidence from 1995 to 2009 in men, which was driven by younger men aged 25-49 years, and a non-significant upward trend in similarly aged younger women. Health promotion efforts should more effectively target younger cohorts.

Early oral cancer diagnosis: The Aarhus statement perspective. A systematic review and meta-analysis

BACKGROUND

Mortality is linked to diagnostic intervals in certain cancers. As symptom perception is conditioned by tumor site, a specific study on oral cancer is needed.

METHODS

This study's inclusion criteria were original data, symptomatic primary oral squamous cell carcinoma, and exposure of interest, diagnostic interval, or diagnostic delay. The outcome of interest was survival and disease stage. A meta-analysis was undertaken to investigate the relationship between intervals to diagnosis, TNM classification, and survival in oral cancer.

RESULTS

Regarding referral delay, the results present no heterogeneity and showed a risk increase in mortality of 2.48 (range = 1.39-4.42). The larger the diagnostic delay, the more advanced the stage at diagnosis. High quality studies reveal a higher risk increase than low quality studies (odds ratio [OR] = 2.44; 95% confidence interval [CI] = 1.36-4.36 vs OR = 1.53; 95% CI = 1.26-1.86).

CONCLUSION

A longer time interval from first symptom to referral for diagnosis is a risk factor for advanced stage and mortality of oral cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2182-E2189, 2016.

Oral cancer in Australia 1982-2008: a growing need for opportunistic screening and prevention

BACKGROUND

Globally, a decline in the incidence of oral cancer has been noted, while the mortality rates have remained relatively stable. The aim of this study was to provide an update on the incidence and mortality of oral cancer in Australia on a national and state level.

METHODS

Data regarding new cases and deaths associated with cancer of the lip, oral cavity and oropharynx were obtained from the Australian Institute of Health and Welfare for the period 1982-2008. Crude- and age-standardized incidence and mortality rates were calculated for all of Australia and for each state and territory.

RESULTS

A total of 60 826 cases of lip, oral cavity and oropharyngeal cancer were diagnosed in Australia. Between 1992 and 2008, a decline in the annual percentage change of age-standardized incidence was noted. The lip, followed by the tongue, continue to represent the most common sites of new oral cancer cases. There was no significant change in the rates of mortality for oral cancer over the time period.

CONCLUSIONS

These findings show that the oral cancer mortality rate remains high despite a decline in incidence over the past three decades, highlighting a greater need for dental practitioners to undertake preventive strategies and opportunistic screening for patients.

High-risk HPV types and head and neck cancer

Although HPV16 has been strongly implicated in oropharyngeal carcinogenesis, the role of other high-risk HPV types in the etiology of head and neck cancer remains unclear. To date, few data exist addressing the nature of the association between antibodies to oncogenic proteins of non-HPV16 HPVs in relation to head and neck cancer. We examined the relationship between multiple HPV types (HPV6, 11, 16, 18, 31, 33, 45, 52, 58) and head and neck squamous cell carcinoma (HNSCC) in a large population-based case-control study (1069 cases and 1107 controls). Serological measures for HPV types included antibodies to L1, E6 and/or E7. In a secondary analysis, we excluded HPV16 seropositive subjects to examine independent associations with other high-risk HPVs. All analyses were adjusted for age, race, sex, education, smoking and alcohol consumption. Statistically significant associations were observed for HPV16, 18, 33 and 52 and risk of HNSCC after mutually adjusting for HPV types. Among HPV16 seronegative subjects, elevated risks of HNSCC were observed for HPV18 E6 (OR = 4.19, 95% CI = 1.26-14.0), HPV33 E6 (OR = 7.96, 95% CI = 1.56-40.5) and HPV52 E7 (OR = 3.40, 95% CI = 1.16-9.99). When examined by tumor type, associations with HPV18 and HPV33 remained statistically significant for oropharyngeal cancer, and HPV52 was associated with oral cancer. In addition, magnitude of associations for HNSCC increased markedly with increasing number of seropositive high-risk HPV infections. High-risk HPV types, other than HPV16, are likely to be involved in the etiology of HNSCC.

Time trends in the prevalence of HPV in oropharyngeal squamous cell carcinomas in northern Spain (1990-2009)

Recent studies support an important role for human papillomavirus (HPV) in oropharyngeal squamous cell carcinomas (OPSCC), although the incidence varies widely depending on the geographic location and time period studied. The aim of this study was to determine the proportion of HPV in a large cohort of OPSCC in northern Spain in the years 1990-2009. Clinical records and paraffin embedded tumor specimens of 248 consecutive patients surgically treated for OPSCC (140 tonsillar and 108 base of tongue) between 1990 and 2009 were retrieved. OPSCC cases were histomorphologically evaluated, and protein expression of p16 and p53 was analyzed by immunohistochemistry. Detection of high-risk HPV DNA was performed by GP5+/6+-PCR and in situ hybridization (ISH). Thirty cases (12%) were positive for p16 immunostaining, of which eight (3.2% of the total series) were found positive for HPV type 16 by genotyping of GP5+6+-PCR products. All HPV GP5+/6+-PCR-positive tumors were p53-immunonegative, seven had a basaloid morphology and seven were also positive by HPV ISH. Presence of HPV correlated inversely with tobacco and alcohol consumption (p < 0.001), but not with age of onset of OPSCC. Overall survival was better in the HPV-positive group, although not statistically significant (p = 0.175). OPSCC patients in northern Spain demonstrated a low involvement of HPV, increasing (although not significantly, p = 0.120) from 1.8% in 1990-1999 to 6.1% of cases in 2000-2009.

Selective use of postoperative neck radiotherapy in oral cavity and oropharynx cancer: a prospective clinical study

Background

In cervical postoperative radiotherapy, the target volume is usually the same as the extension of the previous dissection. We evaluated a protocol of selective irradiation according to the risk estimated for each dissected lymph node level.

Methods

Eighty patients with oral/oropharyngeal cancer were included in this prospective clinical study between 2005 and 2008. Patients underwent surgery of the primary tumor and cervical dissection, with identification of positive nodal levels, followed by selective postoperative radiotherapy. Three types of selective nodal clinical target volume (CTV) were defined: CTV0, CTV1, and CTV2, with a subclinical disease risk of <10%, 10-25%, and 25% and a prescribed radiation dose of <35 Gy, 50 Gy, and 66–70 Gy, respectively. The localization of node failure was categorized as field, marginal, or outside the irradiated field.

Results

A consistent pattern of cervical infiltration was observed in 97% of positive dissections. Lymph node failure occurred within a high-risk irradiated area (CTV1-CTV2) in 12 patients, marginal area (CTV1/CTVO) in 1 patient, and non-irradiated low-risk area (CTV0) in 2 patients. The volume of selective lymph node irradiation was below the standard radiation volume in 33 patients (mean of 118.6 cc per patient). This decrease in irradiated volume was associated with greater treatment compliance and reduced secondary toxicity. The three-year actuarial nodal control rate was 80%.

Conclusion

This selective postoperative neck irradiation protocol was associated with a similar failure pattern to that observed after standard neck irradiation and achieved a significant reduction in target volume and secondary toxicity.

Basics of tumor development and importance of human papilloma virus (HPV) for head and neck cancer

Head and Neck Squamous Cell Carcinomas (HNSCC) are the 6(th) most common cancers worldwide. While incidence rates for cancer of the hypopharynx and larynx are decreasing, a significant increase in cancer of the oropharynx (OSCC) is observed. Classical risk factors for HNSCC are smoking and alcohol. It has been shown for 25 to 60% of OSCC to be associated with an infection by oncogenic human papilloma viruses (HPV). The development of "common" cancer of the head and neck is substantially enhanced by an accumulation of genetic changes, which lead to an inactivation of tumor suppressor genes or activation of proto-oncogenes. A more or less uniform sequence of different DNA-damages leads to genetic instability. In this context, an early and frequent event is deletion on the short arm of chromosome 9, which results in inactivation of the p16-gene. In contrast, for HPV-induced carcinogenesis, expression of the viral proteins E6 and E7 is most important, since they lead to inactivation of the cellular tumor-suppressor-proteins p53 and Rb. The natural route of transoral infection is a matter of debate; peroral HPV-infections might be frequent and disappear uneventfully in most cases. Smoking seems to increase the probability for developing an HPV-associated OSCC. The association of HNSCC with HPV can be proven with established methods in clinical diagnostics. In addition to classical prognostic factors, diagnosis of HPV-association may become important for selection of future therapies. Prognostic relevance of HPV probably surmounts many known risk-factors, for example regional metastasis. Until now, no other molecular markers are established in clinical routine. Future therapy concepts may vary for the two subgroups of patients, particularly patients with HPV-associated OSCC may take advantage of less aggressive treatments. Finally, an outlook will be given on possible targeted therapies.

Oropharyngeal Cancer Survival: A Population-Based Study of Patients Diagnosed between 1978 and 2002

Objective. This paper aims at studying oropharyngeal cancer survival from the Population-Based Cancer Registry of Zaragoza, Spain, for the 1978-2002 period. Methods. The survival rates were calculated by the Kaplan-Meier method, and the automated calculation method of the Catalan Institute of Oncology was utilized to obtain the relative survival. Results. The oropharyngeal cancer survival rate was 61.3% in the first year and 33.9% in the fifth year. One-year relative survival was 62.2% (CI 95%: 57.4-67.4), and five-year relative survival was 36.6% (CI 95%: 31.8-42.1). Comparison of survival rates by sex revealed statistically significant differences (P value = 0.017) with better survival in women. There were no differences when comparing the three age groups and the three studied time periods 1978-1986, 1987-1994, and 1995-2002. Conclusions. The data suggests that there were no significant changes in oropharyngeal cancer survival in the province of Zaragoza throughout the years.