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Belfiore MP, Nardone V, D’Onofrio I, Pirozzi M, Sandomenico F, Farese S, De Chiara M, Balbo C, Cappabianca S, Fasano M. Recurrent Versus Metastatic Head and Neck Cancer: An Evolving Landscape and the Role of Immunotherapy. Biomedicines 2024; 12:2080. [PMID: 39335592 PMCID: PMC11428618 DOI: 10.3390/biomedicines12092080] [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: 07/16/2024] [Revised: 09/01/2024] [Accepted: 09/07/2024] [Indexed: 09/30/2024] Open
Abstract
Squamous cell carcinoma of the head and neck (SCCHN) is among the ten most common cancers worldwide, with advanced SCCHN presenting with a 5-year survival of 34% in the case of nodal involvement and 8% in the case of metastatic disease. Disease-free survival at 2 years is 67% for stage II and 33% for stage III tumors, whereas 12-30% of patients undergo distant failures after curative treatment. Previous treatments often hinder the success of salvage surgery and/or reirradiation, while the standard of care for the majority of metastatic SCCHN remains palliative chemo- and immuno-therapy, with few patients eligible for locoregional treatments. The aim of this paper is to review the characteristics of recurrent SCCHN, based on different recurrence sites, and metastatic disease; we will also explore the possibilities not only of salvage surgery and reirradiation but also systemic therapy choices and locoregional treatment for metastatic SCCHN.
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Affiliation(s)
- Maria Paola Belfiore
- Diagnostic of Imaging, Department of Precision Medicine, Campania University ”L.Vanvitelli”, 80131 Naples, Italy; (V.N.); (I.D.); (M.D.C.); (S.C.)
| | - Valerio Nardone
- Diagnostic of Imaging, Department of Precision Medicine, Campania University ”L.Vanvitelli”, 80131 Naples, Italy; (V.N.); (I.D.); (M.D.C.); (S.C.)
| | - Ida D’Onofrio
- Diagnostic of Imaging, Department of Precision Medicine, Campania University ”L.Vanvitelli”, 80131 Naples, Italy; (V.N.); (I.D.); (M.D.C.); (S.C.)
| | - Mario Pirozzi
- SCDU Oncologia, “Maggiore della Carità” University Hospital, 28100 Novara, Italy;
| | - Fabio Sandomenico
- Radiology Unit, Buon Consiglio Fatebenefratelli Hospital, 80123 Naples, Italy;
| | - Stefano Farese
- Medical Oncology, Department of Precision Medicine, Campania University “L.Vanvitelli”, 80131 Naples, Italy; (S.F.); (C.B.); (M.F.)
| | - Marco De Chiara
- Diagnostic of Imaging, Department of Precision Medicine, Campania University ”L.Vanvitelli”, 80131 Naples, Italy; (V.N.); (I.D.); (M.D.C.); (S.C.)
| | - Ciro Balbo
- Medical Oncology, Department of Precision Medicine, Campania University “L.Vanvitelli”, 80131 Naples, Italy; (S.F.); (C.B.); (M.F.)
| | - Salvatore Cappabianca
- Diagnostic of Imaging, Department of Precision Medicine, Campania University ”L.Vanvitelli”, 80131 Naples, Italy; (V.N.); (I.D.); (M.D.C.); (S.C.)
| | - Morena Fasano
- Medical Oncology, Department of Precision Medicine, Campania University “L.Vanvitelli”, 80131 Naples, Italy; (S.F.); (C.B.); (M.F.)
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Abstract
This article reviews the various treatment options, by primary or postoperative external radiotherapy and by brachytherapy for the p16-negative oropharyngeal squamous cell carcinoma. Dose levels, fractionation and association with systemic treatments are presented. The need for neck node dissection post local treatment is discussed, as well as specificities for the management of p16-positive tumours. Guidelines for target volume selection and delineation are thoroughly elaborated. Last, the management by radiotherapy of locoregional recurrences is discussed.
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Johnson DE, Burtness B, Leemans CR, Lui VWY, Bauman JE, Grandis JR. Head and neck squamous cell carcinoma. Nat Rev Dis Primers 2020; 6:92. [PMID: 33243986 PMCID: PMC7944998 DOI: 10.1038/s41572-020-00224-3] [Citation(s) in RCA: 1791] [Impact Index Per Article: 447.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 02/07/2023]
Abstract
Most head and neck cancers are derived from the mucosal epithelium in the oral cavity, pharynx and larynx and are known collectively as head and neck squamous cell carcinoma (HNSCC). Oral cavity and larynx cancers are generally associated with tobacco consumption, alcohol abuse or both, whereas pharynx cancers are increasingly attributed to infection with human papillomavirus (HPV), primarily HPV-16. Thus, HNSCC can be separated into HPV-negative and HPV-positive HNSCC. Despite evidence of histological progression from cellular atypia through various degrees of dysplasia, ultimately leading to invasive HNSCC, most patients are diagnosed with late-stage HNSCC without a clinically evident antecedent pre-malignant lesion. Traditional staging of HNSCC using the tumour-node-metastasis system has been supplemented by the 2017 AJCC/UICC staging system, which incorporates additional information relevant to HPV-positive disease. Treatment is generally multimodal, consisting of surgery followed by chemoradiotherapy (CRT) for oral cavity cancers and primary CRT for pharynx and larynx cancers. The EGFR monoclonal antibody cetuximab is generally used in combination with radiation in HPV-negative HNSCC where comorbidities prevent the use of cytotoxic chemotherapy. The FDA approved the immune checkpoint inhibitors pembrolizumab and nivolumab for treatment of recurrent or metastatic HNSCC and pembrolizumab as primary treatment for unresectable disease. Elucidation of the molecular genetic landscape of HNSCC over the past decade has revealed new opportunities for therapeutic intervention. Ongoing efforts aim to integrate our understanding of HNSCC biology and immunobiology to identify predictive biomarkers that will enable delivery of the most effective, least-toxic therapies.
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Affiliation(s)
- Daniel E. Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Barbara Burtness
- Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - C. René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Vivian Wai Yan Lui
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Julie E. Bauman
- Department of Medicine-Hematology/Oncology, University of Arizona, Tucson, AZ, USA
| | - Jennifer R. Grandis
- Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, CA, USA,
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Non-coding RNAs in drug resistance of head and neck cancers: A review. Biomed Pharmacother 2020; 127:110231. [PMID: 32428836 DOI: 10.1016/j.biopha.2020.110231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 02/06/2023] Open
Abstract
Head and neck cancer (HNC), which includes epithelial malignancies of the upper aerodigestive tract (oral cavity, oropharynx, pharynx, hypopharynx, larynx, and thyroid), are slowly but consistently increasing, while the overall survival rate remains unsatisfactory. Because of the multifunctional anatomical intricacies of the head and neck, disease progression and therapy-related side effects often severely affect the patient's appearance and self-image, as well as their ability to breathe, speak, and swallow. Patients with HNC require a multidisciplinary approach involving surgery, radiation therapy, and chemotherapeutics. Chemotherapy is an important part of the comprehensive treatment of tumors, especially advanced HNC, but drug resistance is the main cause of poor clinical efficacy. The most important determinant of this phenomenon is still largely unknown. Recent studies have shown that non-coding RNAs have a crucial role in HNC drug resistance. In addition, they can serve as biomarkers in the diagnosis, treatment, and prognosis of HNCs. In this review, we summarize the relationship between non-coding RNAs and drug resistance of HNC, and discuss their potential clinical application in overcoming HNC chemoresistance.
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Van Le Q, Quoc Ngo D, Duc Tran T, Xuan Ngo Q. Oral Cancer: The State of the Art of Modern-Day Diagnosis and Treatment. Oral Dis 2020. [DOI: 10.5772/intechopen.91346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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6
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León X, Rodriguez C, Rovira C, García J, López M, Quer M. Analysis of Specific Survival and Local Control Through a Recursive Partitioning Analysis in Patients With Head and Neck Carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Kuhlin B, Kramer B, Nefas V, Rotter N, Aderhold C. Indicators for secondary carcinoma in head and neck cancer patients following curative therapy: A retrospective clinical study. Mol Clin Oncol 2020; 12:403-410. [PMID: 32257195 PMCID: PMC7087480 DOI: 10.3892/mco.2020.2004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 11/21/2019] [Indexed: 12/28/2022] Open
Abstract
Patients with head and neck squamous cell carcinoma (HNSCC) are at risk for local and regional relapse, as well as for occurrence of synchronous or metachronous secondary carcinoma. The aim of this retrospective study was to evaluate the frequency of secondary malignancies amongst HNSCC patients and their association with age, sex and TNM classification, as well as smoking and alcohol abuse. Data from 394 patients with HNSCC who were treated at the Department of Otorhinolaryngology-Head and Neck Surgery of the University Hospital Mannheim between 2011 and 2015 were retrieved and analyzed using t-tests and P≤0.05 was considered statistically significant. Of the 394 patients, 50 (12.7%) developed a secondary carcinoma. In this cohort, >70% of secondary malignancies were diagnosed using clinical inspection or microlaryngoscopy. The majority of secondary malignancies were identified in the oropharynx, with men being more often affected overall. Continued abuse of carcinogenic substances appeared to increase the incidence of secondary carcinoma, whereas the localization of the primary tumor, age, sex or TNM classification were not identified as significant indicators of the occurrence of a secondary carcinoma. The purpose of the present study was to emphasize the importance of intensive follow-up to ensure early detection of secondary malignancies. The aim was to help predict numbers and occurrence within smaller cohorts, and to evaluate the quality of data collected during the establishment of a certified tumor center. To fully evaluate the role of continued exposure to noxious substances and other possible contributing factors, and in order to improve the rate of early diagnosis and establish preventive strategies, multicentered studies with larger cohorts are required.
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Affiliation(s)
- Beatrice Kuhlin
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, D-68167 Mannheim, Germany
| | - Benedikt Kramer
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, D-68167 Mannheim, Germany
| | - Vytis Nefas
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, D-68167 Mannheim, Germany
| | - Nicole Rotter
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, D-68167 Mannheim, Germany
| | - Christoph Aderhold
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Mannheim, D-68167 Mannheim, Germany
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Hu Z, Yang R, Li L, Mao L, Liu S, Qiao S, Ren G, Hu J. Validation of Gene Profiles for Analysis of Regional Lymphatic Metastases in Head and Neck Squamous Cell Carcinoma. Front Mol Biosci 2020; 7:3. [PMID: 32118031 PMCID: PMC7010860 DOI: 10.3389/fmolb.2020.00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/10/2020] [Indexed: 12/24/2022] Open
Abstract
The progress of Head and Neck Squamous Cell Carcinoma (HNSCC) is dependent on both cancer stem cells (CSCs) and immune suppression. This study was designed to evaluate the distribution of CSCs and the characteristic immune suppression status in HNSCC primary tumors and lymph nodes. A total of 303 lymph nodes from 25 patients, as well as tumor and adjacent normal tissue samples, were evaluated by a quantitative PCR assay of the markers of CSCs and the characteristic immune suppression. Expressions of selected genes in The Cancer Genome Atlas (TCGA) datasets were also analyzed. In the primary tumors, we found that expressions of CSCs markers (ALDH1L1, PECAM1, PROM1) were down-regulated, while immune suppression markers FOXP3, CD47, EGFR, SOX2, and TGFB1 were up-regulated significantly when compared to that in adjacent normal tissues. In the lymph nodes, expressions of both CSCs, and immune suppression markers were upregulated significantly compared with that in primary tumors. The mRNA expression of selected CSCs and immune suppression markers exhibited the highest expression in the level II of metastasis, then declined in the level III and remained constant at a reduced value in levels IV and V of metastases. These results reveal a comprehensive understanding of the unique genetic characteristics associated with metastatic loci and potential routes of lymphatic dissemination of HNSCC, which helps to explain why the level II has a high incidence of lymph node metastasis, and why skip metastasis straight to the level IV or level V is rarely found in the clinic.
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Affiliation(s)
- Zhenrong Hu
- School of Stomatology, Weifang Medical University, Weifang, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ranran Yang
- School of Stomatology, Weifang Medical University, Weifang, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Li
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Mao
- School of Stomatology, Weifang Medical University, Weifang, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuli Liu
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatology, Shanghai, China
| | - Shichong Qiao
- Shanghai Key Laboratory of Stomatology, Department of Oral and Maxillo-facial Implantology, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guoxin Ren
- School of Stomatology, Weifang Medical University, Weifang, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatology, Shanghai, China
| | - Jingzhou Hu
- School of Stomatology, Weifang Medical University, Weifang, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.,National Clinical Research Center of Stomatology, Shanghai, China
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9
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Chang WC, Chang CF, Li YH, Yang CY, Su RY, Lin CK, Chen YW. A histopathological evaluation and potential prognostic implications of oral squamous cell carcinoma with adverse features. Oral Oncol 2019; 95:65-73. [PMID: 31345396 DOI: 10.1016/j.oraloncology.2019.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/16/2019] [Accepted: 06/07/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aimed to evaluate the adverse clinicopathologic features of oral squamous cell carcinoma (OSCC), including margin status, depth of invasion, lymphovascular invasion, perineural invasion, and extranodal extension that significantly affect survival outcomes. MATERIALS AND METHODS This retrospective cross-sectional study included 341 patients with OSCC who underwent therapeutic surgical treatment in Taiwan. The Kaplan-Meier method was used to estimate survival outcomes. A multivariable Cox regression model was used to evaluate the associations of various clinicopathologic features with 5-year overall survival (OS) outcomes in patients with pN0 and pN+ tumors. RESULTS Overall, the patients had 5-year OS and progression-free survival rates of 60.0 and 47.9%, respectively. In the pN0 group, the multivariate analysis identified a positive margin (odds ratio [OR] = 16.3, 95% confidence interval [95% CI]: 3.7-72.3; P = 0.001), depth of invasion >5 mm (OR = 2.1, 95% CI: 1.2-3.7; P = 0.012), presence of lymphovascular space invasion (OR = 5.4, 95% CI: 1.3-22.0; P = 0.018), and presence of perineural invasion (OR = 4.3, 95% CI: 1.7-11.1; P = 0.002) as independent and significant prognosticators of OS. In the pN+ group, only the presence of extranodal extension independently predicted OS (OR = 1.7, 95% CI: 1.1-2.7; P = 0.0026). CONCLUSIONS When determining survival prognosis for patients with a pN0 status, we recommended including all adverse features. In contrast, extranodal extension was the most important prognostic factor for patients with a pN+ status.
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Affiliation(s)
- Wei-Chin Chang
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei City, Taiwan, ROC; School of Dentistry, National Defense Medical Center, Taipei City, Taiwan, ROC
| | - Ching-Fen Chang
- Department of Internal Medicine, China Medical University Hospital, Taichung City, Taiwan, ROC
| | - Yu-Hsuan Li
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei City, Taiwan, ROC; School of Dentistry, National Defense Medical Center, Taipei City, Taiwan, ROC
| | - Cheng-Yu Yang
- School of Dentistry, National Defense Medical Center, Taipei City, Taiwan, ROC
| | - Ruei-Yu Su
- Department of Pathology, Division of Clinical Pathology, Tri-Service General Hospital, Taipei City, Taiwan, ROC; Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC; National Defense Medical Center, Taipei City, Taiwan, ROC
| | - Chih-Kung Lin
- Department of Pathology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei City, Taiwan, ROC
| | - Yuan-Wu Chen
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei City, Taiwan, ROC; School of Dentistry, National Defense Medical Center, Taipei City, Taiwan, ROC.
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León X, Rodriguez C, Rovira C, García J, López M, Quer M. Analysis of specific survival and local control through a recursive partitioning analysis in patients with head and neck carcinoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 71:131-139. [PMID: 31060733 DOI: 10.1016/j.otorri.2019.02.004] [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: 01/12/2019] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Recursive partitioning analysis (RPA) is a technique that allows prognostic classification in oncological patients. The aim of the present study is to analyse by means of an RPA a cohort of patients with squamous carcinomas of the head and neck (SCHN). METHODS 5,226 SCHN were retrospectively analysed with an RPA, considering the specific survival and local control of the disease as dependent variables. A cohort of patients was used for the creation of the classification model, and another cohort was used to carry out its internal validation. RESULTS Considering specific survival as a dependent variable we obtained a classification tree with 14 terminal nodes that were grouped into 5 categories, including as partition variables the local and regional extent of the tumour, and the location of the tumour. When considering the local control of the disease as a dependent variable we obtained a classification tree with 10 terminal nodes that were grouped into 4 categories, including as partition variables the local extension and location of the tumour, the type of treatment performed, the age of the patient, and if it was a first tumour or a subsequent neoplasm. The validation study confirmed the prognostic capacity of the models developed with the RPA. One of the advantages of the RPA is that it allows the identification of groups of patients with specific behaviour. CONCLUSION RPA is shown to be an effective technique for the prognostic classification of patients with a SCHN.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Camilo Rodriguez
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Carlota Rovira
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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Pavón MA, Arroyo-Solera I, León X, Téllez-Gabriel M, Virós D, Gallardo A, Céspedes MV, Casanova I, Lopez-Pousa A, Barnadas A, Quer M, Mangues R. The combined use of EFS, GPX2, and SPRR1A expression could distinguish favorable from poor clinical outcome among epithelial-like head and neck carcinoma subtypes. Head Neck 2019; 41:1830-1845. [PMID: 30652380 DOI: 10.1002/hed.25623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We aimed at identifying molecular markers predictive of clinical outcome in patients with head and neck cancer based on the expression profile of cells showing epithelial-like (EL) or mesenchymal-like (ML) phenotypes. MATERIALS AND METHODS We analyzed the association between EL and ML cells and migration, drug resistance, or tumor growth. The differential gene expression profile between cell types was used to build a model to stratify patients according to survival. RESULTS EL cells were sensitive to cisplatin and cetuximab, showed low migration, and generated squamous differentiated tumors in mouse. A differential 93-gene expression signature between ML and EL cells was used to build a three-gene (EFS, GPX2, and SPRR1A) survival model by analyzing the RNA-seq data of the TCGA-HNSC project. Its prognostic value was confirmed in two independent cohorts. CONCLUSION EFS, GPX2, and SPRR1A are prognostic markers able to distinguish clinical outcome among subtypes sharing an EL phenotype.
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Affiliation(s)
- Miguel Angel Pavón
- Infections and Cancer Laboratory/Cancer Epidemiology Research Program. Catalan Institute of Oncology (ICO) and Bellvitge Institute of Biomedical Research (IDIBELL), Barcelona, Spain.,Centro de Investigación Biomédica en Red en Cáncer (CIBER-ONC), Madrid, Spain
| | - Irene Arroyo-Solera
- Oncogenesis and Antitumor Drug Group, lnstitut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Madrid, Spain
| | - Xavier León
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Madrid, Spain.,Department of Otorrinolaryngology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Téllez-Gabriel
- Laboratorio Hematología Oncológica y de Transplantes, Institut Investigacions Biomèdiques (IBB) Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Virós
- Department of Otorrinolaryngology, Hospital Germans Tries y Pujol (Can Ruti), Barcelona, Spain
| | - Alberto Gallardo
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Virtudes Céspedes
- Oncogenesis and Antitumor Drug Group, lnstitut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Madrid, Spain
| | - Isolda Casanova
- Oncogenesis and Antitumor Drug Group, lnstitut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Madrid, Spain
| | - Antonio Lopez-Pousa
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Madrid, Spain.,Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Agustí Barnadas
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Miquel Quer
- Department of Otorrinolaryngology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ramón Mangues
- Oncogenesis and Antitumor Drug Group, lnstitut d'Investigacions Biomèdiques Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomecidicina (CIBER-BBN), Madrid, Spain
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12
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uPA/uPAR and SERPINE1 in head and neck cancer: role in tumor resistance, metastasis, prognosis and therapy. Oncotarget 2018; 7:57351-57366. [PMID: 27385000 PMCID: PMC5302994 DOI: 10.18632/oncotarget.10344] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/13/2016] [Indexed: 12/25/2022] Open
Abstract
There is strong evidence supporting the role of the plasminogen activator system in head and neck squamous cell carcinoma (HNSCC), particularly of its uPA (urokinase plasminogen activator) / uPAR (urokinase plasminogen activator receptor) and SERPINE1 components. Overexpression of uPA/uPAR and SERPINE1 enhances tumor cell migration and invasion and plays a key role in metastasis development, conferring poor prognosis. The apparent paradox of uPA/uPAR and its inhibitor SERPINE1 producing similar effects is solved by the identification of SERPINE1 activated signaling pathways independent of uPA inhibition. Both uPA/uPAR and SERPINE1 are directly linked to the induction of epithelial-to-mesenchymal transition, the acquisition of stem cell properties and resistance to antitumor agents. The aim of this review is to provide insight on the deregulation of these proteins in all these processes. We also summarize their potential value as prognostic biomarkers or potential drug targets in HNSCC patients. Concomitant overexpression of uPA/uPAR and SERPINE1 is associated with a higher risk of metastasis and could be used to identify patients that would benefit from an adjuvant treatment. In the future, the specific inhibitors of uPA/uPAR and SERPINE1, which are still under development, could be used to design new therapeutic strategies in HNSCCs.
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Rueda A, Giralt J, Mañós M, Lozano A, Sistiaga A, García-Miragall E, Cacicedo J, Esteban F, Scola B, Contreras J, Ruiz A, Carral A, Sanchez-Aniceto G, Pastor M, Herranz J, Bernal M, Mesía R. Multidisciplinary management of head and neck cancer: First expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 2). Oral Oncol 2017; 70:65-72. [DOI: 10.1016/j.oraloncology.2017.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/31/2017] [Accepted: 04/08/2017] [Indexed: 10/19/2022]
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Herranz González-Botas J, Varela Vázquez P, Vázquez Barro C. Second Primary Tumours in Head and Neck Cancer. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2016.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Adel M, Liao CT, Lee LY, Hsueh C, Lin CY, Fan KH, Wang HM, Ng SH, Lin CH, Tsao CK, Huang SF, Kang CJ, Fang KH, Wang YC, Chang KP, Fang TJ, Yang LY, Yen TC. Incidence and Outcomes of Patients With Oral Cavity Squamous Cell Carcinoma and Fourth Primary Tumors: A Long-term Follow-up Study in a Betel Quid Chewing Endemic Area. Medicine (Baltimore) 2016; 95:e2950. [PMID: 27015170 PMCID: PMC4998365 DOI: 10.1097/md.0000000000002950] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to explore the incidence and outcomes of patients with oral cavity squamous cell carcinoma (OSCC) and fourth primary tumors (PTs) in a betel-chewing endemic area.We retrospectively examined the records of 1836 OSCC patients who underwent radical tumor resection between 1996 and 2014. The outcome measures included the incidence and number of multiple PTs, the main risk factors, and their associations with overall survival (OS).Of the 1836 patients, 1400 (76.3%) had a single PT, 344 (18.7%) a second PT, 67 (3.6%) a third PT, and 25 (1.4%) a fourth PT. Univariate analyses (log-rank test) identified the following factors as significantly associated with a fourth PT: simultaneous first and second PTs, betel quid chewing, buccal subsite, and pT3-4 status. After allowance for the potential confounding effect of other risk factors, all of these factors retained their independent prognostic significance in stepwise multivariate analyses, the only exception being betel chewing. The incidences of second, third, and fourth PTs at 5 and 10 years were 20.2%/34.6%, 4.0%/8.6%, and 1.0%/2.3%, respectively. The 5 and 10-year OS rates (calculated from the diagnosis of each PTs) for patients with a single, second, third, and fourth PTs were 68%/61%, 43%/37%, 45%/39%%, and 30%/30%, respectively (P < 0.0001). Among patients with a fourth PT, those who underwent radical surgery showed a significantly higher 3-year OS than those who did not (57% vs 13%; P = 0.0442).Fourth PTs are rarely observed in OSCC patients in a betel quid-chewing endemic area. Long-term survival rates of patients treated with radical surgery seems acceptable, being 4-fold higher than their counterparts.
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Affiliation(s)
- Mohamad Adel
- From the Division of Surgical Oncology, Department of Surgery (MA), Al-Azhar University Hospital, Al-Azhar Faculty of Medicine, Cairo, Egypt; Department of Otorhinolaryngology, Head and Neck Surgery (MA, C-TL, S-FH, C-JK, K-HF, YCW, K-PC, T-JF); Head and Neck Oncology Group (C-TL, L-YL, CH, C-YL, K-HF, H-MW, S-HN, C-HL, C-KT, S-FH, C-JK, K-HF, Y-CW, K-PC, T-JF, LYY, T-CY), Chang Gung Memorial Hospital and Chang Gung University; Department of Pathology (L-YL, CH); Department of Radiation Oncology (C-YL, K-HF); Department of Medical Oncology (H-MW); Department of Diagnostic Radiology (S-HN); Department of Plastic and Reconstructive Surgery (C-HL, C-KT); Biostatistics and Informatics Unit, Clinical Trial Center (LYY); and Department of Nuclear Medicine and Molecular Imaging Center (T-CY), Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
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16
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Hedberg ML, Goh G, Chiosea SI, Bauman JE, Freilino ML, Zeng Y, Wang L, Diergaarde BB, Gooding WE, Lui VWY, Herbst RS, Lifton RP, Grandis JR. Genetic landscape of metastatic and recurrent head and neck squamous cell carcinoma. J Clin Invest 2015; 126:169-80. [PMID: 26619122 DOI: 10.1172/jci82066] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 10/22/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Recurrence and/or metastasis occurs in more than half of patients with head and neck squamous cell carcinoma (HNSCC), and these events pose the greatest threats to long-term survival. We set out to identify genetic alterations that underlie recurrent/metastatic HNSCC. METHODS Whole-exome sequencing (WES) was performed on genomic DNA extracted from fresh-frozen whole blood and patient-matched tumor pairs from 13 HNSCC patients with synchronous lymph node metastases and 10 patients with metachronous recurrent tumors. Mutational concordance within and between tumor pairs was used to analyze the spatiotemporal evolution of HNSCC in individual patients and to identify potential therapeutic targets for functional evaluation. RESULTS Approximately 86% and 60% of single somatic nucleotide variants (SSNVs) identified in synchronous nodal metastases and metachronous recurrent tumors, respectively, were transmitted from the primary index tumor. Genes that were mutated in more than one metastatic or recurrent tumor, but not in the respective primary tumors, include C17orf104, inositol 1,4,5-trisphosphate receptor, type 3 (ITPR3), and discoidin domain receptor tyrosine kinase 2 (DDR2). Select DDR2 mutations have been shown to confer enhanced sensitivity to SRC-family kinase (SFK) inhibitors in other malignancies. Similarly, HNSCC cell lines harboring endogenous and engineered DDR2 mutations were more sensitive to the SFK inhibitor dasatinib than those with WT DDR2. CONCLUSION In this WES study of patient-matched tumor pairs in HNSCC, we found synchronous lymph node metastases to be genetically more similar to their paired index primary tumors than metachronous recurrent tumors. This study outlines a compendium of somatic mutations in primary, metastatic, and/or recurrent HNSCC cancers, with potential implications for precision medicine approaches. FUNDING National Cancer Institute, American Cancer Society, Agency for Science, Technology and Research of Singapore, and Gilead Sciences Inc.
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Herranz González-Botas J, Varela Vázquez P, Vázquez Barro C. Second primary tumours in head and neck cancer. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 67:123-9. [PMID: 26386656 DOI: 10.1016/j.otorri.2015.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/02/2015] [Accepted: 04/07/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Head and neck cancer patients have a higher risk of second primary tumours than the general population. The most frequent locations are head and neck, lung and oesophagus, decreasing long-term survival. The aim of this work was to analyse the incidence, location according to index tumour and stage, chronology, patient age, and survival after diagnosis. METHOD Retrospective study on 579 patients with head and neck squamous cell carcinoma, treated with curative intent, with a minimum 24-month follow-up. Early stages (I/II) were 42.4%, and 57.6% were stages III and IV. RESULTS Second primary tumour incidence was 15% (87/579), with 9.2% (8/97) developing a third tumour. The most frequent locations of the second tumours were head and neck, 37.9% (33/87); lung, 36.8% (32/87); oesophagus, 5.7% (5/87); and colon, 5.7% (5/87). Five- and 10-year survival in patients without a second tumour was 65.1% and 52.7% respectively, versus 58.7% and 40.2% in those who developed one. CONCLUSIONS The incidence of second primary tumours increased in the last decade, having a negative effect on survival. Since no specific early diagnosis tool is available, alcohol and tobacco avoidance along with scheduled follow-up are suggested procedures to reduce its incidence.
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Affiliation(s)
| | - Patricia Varela Vázquez
- Servicio de Otorrinolaringología, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - Carlos Vázquez Barro
- Servicio de Otorrinolaringología, Complexo Hospitalario Universitario A Coruña, A Coruña, España
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Abstract
Cancer of the oral cavity is one of the most common malignancies worldwide. Although early diagnosis is relatively easy, presentation with advanced disease is not uncommon. The standard of care is primary surgical resection with or without postoperative adjuvant therapy. Improvements in surgical techniques combined with the routine use of postoperative radiation or chemoradiation therapy have resulted in improved survival. Successful treatment is predicated on multidisciplinary treatment strategies to maximize oncologic control and minimize impact of therapy on form and function. Prevention of oral cancer requires better education about lifestyle-related risk factors, and improved awareness and tools for early diagnosis.
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Affiliation(s)
- Pablo H Montero
- Head and Neck Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Snehal G Patel
- Head and Neck Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Patrucco MS, Aramendi MV. Prognostic impact of second primary tumors in head and neck cancer. Eur Arch Otorhinolaryngol 2015; 273:1871-7. [DOI: 10.1007/s00405-015-3699-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 06/21/2015] [Indexed: 11/25/2022]
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20
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León Vintró X, Sánchez-Santos MT, Mañós Pujol M, Herranz González-Botas JJ, Esteban Ortega F, Nogués Orpí J. Tratamiento quirúrgico de los carcinomas escamosos de cabeza y cuello en España durante el periodo 2006-2011. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 66:98-105. [DOI: 10.1016/j.otorri.2014.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 04/29/2014] [Accepted: 05/10/2014] [Indexed: 02/09/2023]
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21
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Surgical Treatment of Head and Neck Squamous Cell Carcinomas in Spain During the 2006–2011 Period. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2014.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Huang SF, Tung-Chieh Chang J, Liao CT, Kang CJ, Lin CY, Fan KH, Wang HM, Chen IH. The role of elective neck dissection in early stage buccal cancer. Laryngoscope 2014; 125:128-33. [DOI: 10.1002/lary.24840] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 06/04/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Shiang-Fu Huang
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Hung-Ming Wang
- Department of Internal Medicine; Division of Hematology/Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - I-How Chen
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
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Bhattacharjee A, Sen S. Letter to the editor: second, third, and fourth head and neck tumors. A progressive decrease in survival. Head Neck 2014; 36:1376. [PMID: 24975956 DOI: 10.1002/hed.23723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Atanu Bhattacharjee
- Division of Clinical Research and Biostatistics, Malabar Cancer Centre, Thalassery-670103, India
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Kwon M, Roh JL, Song J, Lee SW, Kim SB, Choi SH, Nam SY, Kim SY. Noncancer health events as a leading cause of competing mortality in advanced head and neck cancer. Ann Oncol 2014; 25:1208-14. [PMID: 24669018 DOI: 10.1093/annonc/mdu128] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The survival of patients with head and neck squamous cell carcinoma (HNSCC) can be affected by noncancer health events (NCHE) as well as by index cancer progression and second primary cancer (SPC). This study aimed to investigate the risk factors for NCHE and noncancer mortality (NCM) in patients with advanced-stage HNSCC. PATIENTS AND METHODS This cohort study involved 600 consecutive patients with overall stage III to IV HNSCC who were treated between 2001 and 2010 at our tertiary referral hospital. NCHE was defined as re-admission (i.e. after the primary treatments for the index tumors) due to noncancer-related causes. The incidences of NCHE and NCM and their risk factors were analyzed by using cumulative incidence and cause-specific hazard functions. RESULTS During a median follow-up period of 54 months, 224 (37.3%) and 55 (9.2%) of the 600 patients had NCHE and NCM, respectively. The 5-year index cancer mortality, SPC mortality, and NCM rates were 23.8%, 4.2%, and 8.9%, respectively. Multivariate analyses revealed that body mass index <20 kg/m(2) (P = 0.018), Charlson comorbidity index (CCI) ≥1 (P < 0.001), tumor recurrence (P < 0.001), SPC occurrence (P < 0.001), and initial chemotherapy (P = 0.049) were independent NCHE predictors. Older age (P < 0.001), CCI ≥1 (P = 0.008), tumor recurrence (P < 0.001), and SPC occurrence (P = 0.047) were independent NCM predictors. Patients with respiratory NCHE were at a higher risk of NCM than patients with other NCHE types (P < 0.001). CONCLUSIONS One or more comorbidities, tumor recurrence, and SPC occurrence were independent predictors of both NCHE and NCM. Patients with respiratory NCHE had a particularly high risk of NCM.
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Affiliation(s)
- M Kwon
- Department of Otolaryngology
| | - J-L Roh
- Department of Otolaryngology
| | - J Song
- Department of Clinical Epidemiology and Biostatistics
| | - S-W Lee
- Department of Radiation Oncology
| | - S-B Kim
- Department of Internal Medicine (Oncology), Asan Medical Centre, University of Ulsan College of Medicine, Seoul
| | | | - S Y Nam
- Department of Otolaryngology
| | - S Y Kim
- Department of Otolaryngology Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Republic of Korea
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Montero-Miranda PH, Ganly I. Survivorship--competing mortalities, morbidities, and second malignancies. Otolaryngol Clin North Am 2013; 46:681-710. [PMID: 23910478 DOI: 10.1016/j.otc.2013.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mortality of head and neck cancer has declined in the United States over the past 20 years. This improvement has been linked to use of multimodality treatment of advanced disease. Despite this improvement, disease-specific survival remains low. Patients who survive head and neck cancer are exposed to morbidity and mortality secondary to the same factors as the general population. Factors related to cancer and cancer treatment predispose them to increased risk of mortality. Improvements in head and neck cancer treatment have led to a scenario where an increasing proportion of patients die from causes other than the primary cancer, called competing mortalities.
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Affiliation(s)
- Pablo H Montero-Miranda
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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