1
|
Ozkaya Akagunduz O, Etit D, Yazici G, Veral A, Cetinayak O, Sarioglu S, Guler Tezel G, Duru Birgi S, Yuksel S, Kara G, Mustafayev TZ, Tokat F, Ceylaner Bicakli B, Basak K, Esassolak M, Akman F, Ozyar E. The effect of P53 expression and smoking/alcohol in P16(+) and P16(-) oropharyngeal carcinoma and risk classification: the Turkish Society of Radiation Oncology Head & Neck Study Group 01-002. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:80-90. [PMID: 37246057 DOI: 10.1016/j.oooo.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim of this study is to categorize the risk groups of patients with oropharyngeal carcinoma (OPC) according to p16 and p53 status, smoking/alcohol consumption history, and other prognostic factors. STUDY DESIGN The immunostaining of p16 and p53 of 290 patients was retrospectively evaluated. The history of smoking/alcohol consumption of each patient was noted. p16 and p53 staining patterns were reviewed. The results were compared with demographic findings and prognostic factors. Risk groups have been classified for the p16 status of patients. RESULTS The median follow-up was 47 months (range 6-240). Five-year disease-free survival (DFS) rates for patients with p16 (+) and (-) were 76% and 36%, and overall survival rates were 83% vs 40%, respectively (HR = 0.34 [0.21-0.57], P < .0001), HR = 0.22 [0.12-0.40] P < .0001, respectively). p16(-), p53(+), heavy smoking/alcohol consumption, performance status; advanced T and N stages in patients with p16(-), and continuing smoking/alcohol consumption after treatment were found to be unfavorable risk factors. Five-year overall survival rates were 95%, 78%, and 36% for low, intermediate, and high-risk groups, respectively. CONCLUSIONS The results of our study have shown that p16 negativity in patients with oropharyngeal cancer was found to be an important prognostic factor, especially for those with lower p53 expression and not smoking/consuming alcohol.
Collapse
Affiliation(s)
| | - Demet Etit
- Department of Pathology, Istanbul Aydin University, Faculty of Medicine, Istanbul, Turkey
| | - Gozde Yazici
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ali Veral
- Department of Pathology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Oguz Cetinayak
- Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Sulen Sarioglu
- Department of Pathology, Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Gaye Guler Tezel
- Department of Pathology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Sumerya Duru Birgi
- Department of Radiation Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Seher Yuksel
- Department of Pathology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Gulsen Kara
- Department of Radiation Oncology, Ataturk Training and Research Hospital, Izmir, Turkey
| | | | - Fatma Tokat
- Department of Pathology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Beyhan Ceylaner Bicakli
- Department of Radiation Oncology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Kayhan Basak
- Department of Pathology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Esassolak
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Fadime Akman
- Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| |
Collapse
|
2
|
León X, Farré N, Montezuma L, Holgado A, Vásquez R, Neumann E, Quer M. Resultados de la radioterapia en los carcinomas de orofaringe. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
3
|
Fakhry C, Tewari SR, Zhang L, Windon MJ, Bigelow EO, Drake VE, Rooper LM, Troy T, Ha P, Miles BA, Mydlarz WK, Eisele DW, D'Souza G. RTOG-0129 risk groups are reproducible in a prospective multicenter heterogeneously treated cohort. Cancer 2021; 127:3523-3530. [PMID: 34143891 DOI: 10.1002/cncr.33682] [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: 01/10/2021] [Revised: 04/21/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recursive partitioning analysis (RPA) from the Radiation Therapy Oncology Group (RTOG)-0129 has identified a low-risk group of patients with oropharynx cancer (OPC) who might benefit from therapeutic de-intensification. These risk groups have not yet been reproduced in an independent cohort treated heterogeneously. Therefore, the objective of this analysis was to validate the RPA risk groups and examine the prognostic impact of novel factors. METHODS Patients with OPC were enrolled in a prospective study at 3 academic medical centers from 2013 to 2018. Medical record abstraction was used to ascertain clinical variables including staging and survival according to the 7th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual. Human papillomavirus-positive tumor status was determined by p16 immunohistochemistry and/or HPV RNA in situ hybridization. Kaplan-Meier and log-rank methods were used to compare survival. Cox proportional hazards were used to generate univariate and multivariable hazard ratios (HRs). RESULTS Median follow-up time was 3.2 years. The low-, intermediate-, and high-risk groups had significant differences in 2-year overall survival (OS, 99.1%; 95% CI, 94.4%-99.9% vs OS, 93.0%; 95% CI, 74.7%-98.2% vs OS, 80.0%; 95% CI, 40.9%-94.6%; Poverall = .0001) and 2-year progression-free survival (PFS, 97.5%; 95% CI, 92.4%-99.2% vs PFS, 89.3%; 95% CI, 70.3%-96.4% vs PFS, 80.0%; 95% CI, 40.9%-94.6%; Poverall < .002). After adjustment for age, sex, and level of educational attainment, OS and PFS were significantly lower for the intermediate- (OS adjusted hazard ratio [aHR], 5.0; 95% CI, 1.0-23.0; PFS aHR, 3.4; 95% CI, 1.0-11.5), and high- (OS aHR, 7.3; 95% CI, 1.4-39; PFS aHR, 5.0; 95% CI, 1.2-21.6) risk groups compared with the low-risk group. Lower education was also independently significantly associated with worse OS (aHR, 8.9; 95% CI, 1.8-44.3) and PFS (aHR, 3.1; 95% CI, 1.0-9.6). CONCLUSIONS In patients with OPC, the RTOG-0129 RPA model is associated with OS and PFS in a heterogeneously treated cohort.
Collapse
Affiliation(s)
- Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sakshi R Tewari
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa Zhang
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Melina J Windon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Elaine O Bigelow
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Virginia E Drake
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Lisa M Rooper
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tanya Troy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Patrick Ha
- Department of Otolaryngology Head and Neck Surgery, University of California, San Francisco, California
| | - Brett A Miles
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wojciech K Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
4
|
Benzerdjeb N, Tantot J, Blanchet C, Philouze P, Mekki Y, Lopez J, Devouassoux-Shisheboran M. Oropharyngeal squamous cell carcinoma: p16/p53 immunohistochemistry as a strong predictor of HPV tumour status. Histopathology 2021; 79:381-390. [PMID: 33560536 DOI: 10.1111/his.14350] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 12/13/2022]
Abstract
AIMS Oropharyngeal squamous cell carcinomas (OPSCC) related to human papillomavirus (HPV) infection have a better prognosis than those without HPV infection. Although p16INK4a overexpression is used as a surrogate marker for HPV infection, 5-20% of p16-positive OPSCC are described as being unrelated to HPV infection, with worse overall survival compared to OPSCC-related HPV. There is therefore a risk of undertreating a proportion of OPSCC patients falsely considered to be HPV-driven because of p16 positivity. TP53 mutations are highly prevalent in OPSCC driven by mutagens in tobacco and alcohol. We describe herein a combined p16/p53 algorithm to predict HPV tumour status in OPSCC. METHODS AND RESULTS A total of 110 OPSCC were identified in the database of the pathology department and were studied using p16 and p53 immunohistochemistry. For p16-positive or p16-negative/wild-type patterns-p53 (WT-p53) cases (n = 63), DNA in-situ hybridisation for high-risk HPV was performed, and if negative the HPV status was controlled by HPV DNA polymerase chain reaction (PCR) (n = 19). A significant association between TP53 mutation and pattern of p53 expression was found (WT-p53, seven of 16, P < 0.001). The p16-positive/WT-p53 was significantly associated with HPV+ tumour status (p16-positive/WT-p53, 50 of 110, P < 0.001). Interestingly, a subset of p16-positive OPSCC was unrelated to HPV (13.5%, eight of 59), and showed mutant-type staining of p53 expression. CONCLUSIONS The p16 protein immunopositivity in conjunction with the mutant-type pattern of p53 staining helped to reclassify a subset of p16-positive OPSCC as OPSCC-unrelated HPV. This approach could be routinely applied by pathologists involved in the management of OPSCC, because of their potential therapeutic implications.
Collapse
Affiliation(s)
- Nazim Benzerdjeb
- Department of Pathology, Institut de Pathologie Multisite, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Université Lyon 1, Villeurbanne, Hôpital La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Juliet Tantot
- Department of Pathology, Institut de Pathologie Multisite, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Christophe Blanchet
- Department of Pathology, Institut de Pathologie Multisite, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Université Lyon 1, Villeurbanne, Hôpital La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Pierre Philouze
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yahia Mekki
- Laboratoire de Virologie, Institut des Agents Infectieux, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, Lyon, France
| | - Jonathan Lopez
- Biochemistry and Molecular Biology Department, Hospital Lyon-Sud, Université Lyon I, Lyon, Pierre-Bénite, France
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Institut de Pathologie Multisite, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Université Lyon 1, Villeurbanne, Hôpital La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
5
|
Businello G, Fassan M, Degasperi S, Traverso G, Scarpa M, Angriman I, Kotsafti A, Castagliuolo I, Sbaraglia M, Bardini R, Scarpa M. Esophageal squamous cell carcinoma metachronous to head and neck cancers. Pathol Res Pract 2021; 219:153346. [PMID: 33545655 DOI: 10.1016/j.prp.2021.153346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND In some HNSCC patients, a metachronous ESCC may develop. No information is available on the HNSCC-associated ESCCs microenvironment and etiology. METHODS Among 134 ESCCs surgically treated between 2009 and 2015, a series of 6 HNSCC-associated ESCCs was collected. A series of 12 sex-, age- and stage-matched ESCCs with no previous oncological medical history was selected for comparison. Histologic assessment of intratumoral inflammatory infiltration and immunohistochemistry for CD4, CD8, CD80, PD1, PD-L1 and p53 were performed. HPV detection/genotyping was assessed by PCR single step and reverse line blot. RESULTS HPV DNA was negative in all the HNSCC-associated ESCCs. In comparison to non-HNSCC-associated carcinomas, the 6 cases presented a lower lymphomonocytic infiltration, which also corresponded to a lower prevalence of CD4 + T cell infiltration and, 5/6 cases presented a PD-L1 CPS ≥ 1. All the HNSCC-associated ESCCs resulted positive for p53 immunostaining in ≥50 % of cancer cells. CONCLUSION Our study suggests that HPV infection is not an etiological factor associated to ESCC after HNSCC. On the other hand, p53 overexpression is a common finding. Moreover, our data suggest that an altered immune microenvironment, conditioned by a dysregulation in lymphomonocytic infiltration, may be a crucial factor allowing the occurrence of a metachronous ESCC.
Collapse
Affiliation(s)
| | - Matteo Fassan
- Dept. of Medicine, Pathology Unit, University of Padua, Padua, Italy
| | - Silvia Degasperi
- General Surgery Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | - Giulia Traverso
- Dept. of Medicine, Pathology Unit, University of Padua, Padua, Italy
| | - Melania Scarpa
- Lab. of AdvancedTraslationalResearch, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Imerio Angriman
- General Surgery Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | - Andromachi Kotsafti
- Lab. of AdvancedTraslationalResearch, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | | | - Marta Sbaraglia
- Dept. of Medicine, Pathology Unit, University of Padua, Padua, Italy
| | - Romeo Bardini
- General Surgery Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | - Marco Scarpa
- General Surgery Unit, Azienda Ospedaliera di Padova, Padua, Italy.
| |
Collapse
|
6
|
Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2020; 278:1321-1335. [DOI: 10.1007/s00405-020-06224-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/16/2020] [Indexed: 01/18/2023]
|
7
|
Nurimba M, Hines W, Sinha U, Mathew A, Kokot N, Swanson M. Evaluation of lymph node ratio and lymph node yield as prognosticators of locoregional recurrence in p16-associated oropharyngeal squamous cell carcinoma. Head Neck 2020; 42:2811-2820. [PMID: 32542889 DOI: 10.1002/hed.26324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/31/2020] [Accepted: 05/27/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prognostic value of lymph node yield (LNY) and lymph node ratio (LNR), or the ratio of number of metastatic LNs to total number dissected, has not been well established in p16-associated oropharyngeal squamous cell carcinoma (OPSCC). METHODS This retrospective cohort study evaluated locoregional disease-free survival (LRDFS) in 82 patients with p16+ OPSCC who underwent neck dissection at a single institution from 2009 to 2017. LNR and LNY cutoffs were estimated using time-dependent receiver operator characteristic (ROC) curves. Prognostic significance of these cutoffs was compared with Eighth Edition AJCC Nodal Staging. RESULTS An increased LNR ≥ 0.129 was associated with worse 2-year LRDFS (66.9% vs 96.8%, P = .005). LNY was not significantly associated with LRDFS (P = .304). An LNR-based risk model was a better prognosticator than Eighth Edition AJCC Nodal Staging (Harrell's C, 0.9065 vs 0.7668). CONCLUSIONS LNR has good prognostic utility in predicting LRDFS in p16+ OPSCC, but further evaluation of this measure is warranted.
Collapse
Affiliation(s)
- Margaret Nurimba
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - William Hines
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Uttam Sinha
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Anna Mathew
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Niels Kokot
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Mark Swanson
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| |
Collapse
|
8
|
Viros Porcuna D, Pollan Guisasola C, Viña Soria C, Cirauqui Cirauqui B, Pardo Muñoz L, Collurá F, Mesia Nin R. Transoral robotic surgery for squamous cell carcinoma of the oropharynx in a primarily human papillomavirus-negative patient population. Clin Transl Oncol 2019; 22:1303-1311. [PMID: 31858433 DOI: 10.1007/s12094-019-02256-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/02/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Transoral robotic surgery (TORS) is one of the main treatment options for non-locally advanced primary oropharyngeal cancer in the United States. However, its use is more limited in countries with a low incidence of human papillomavirus (HPV), such as Spain, in patients with advanced disease, and as salvage surgery. To shed light on the use and potential benefit of TORS in Spanish patients, we analyzed the functional and oncologic outcomes of TORS as both primary and salvage surgery in a primarily HPV-negative population which is representative of oropharyngeal squamous cell carcinoma (OPSCC) patients in Spain. MATERIAL AND METHODS This is a retrospective analysis of prospectively collected data on OPSCC patients treated with TORS at our center between February 2017 and February 2019. RESULTS Fifty-four OPSCC patients were included; 79.6% were males and 80.5% were HPV negative. Median age was 62 years. Primary surgery was performed on 73.7% (48.1% stage I-II; 51.9% stage III-IV) and salvage surgery on 25.9% of patients. Positive margin rates were 4.3% for T1-2 and 25.8% for T3-4. None of the stage I-II patients and 27.7% of stage III-IV patients required adjuvant treatment. Reconstructive surgery was performed in 19.2% of all patients. Normal swallowing was achieved in 92.7% of patients at 6 months after surgery. 1- and 2-year survival rates for all patients were 94.5% and 89%, respectively. The overall complication rate was 16.1%. Bleeding occurred in 11.5% of patients. Longer hospitalization time was associated with surgical complications (P = 0.03) and reconstructive surgery (P = 0.03) but not with salvage surgery. CONCLUSION TORS is a safe and effective treatment for HPV-negative T1-2 OPSCC patients. The positive margin rate was worse in T3-4 patients, indicating the need for careful patient selection in this subgroup.
Collapse
Affiliation(s)
- D Viros Porcuna
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain.
| | - C Pollan Guisasola
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
| | - C Viña Soria
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
| | - B Cirauqui Cirauqui
- Medical Oncology Department, Institut Català d'Oncologia, Badalona Applied Research Group in Oncology (B-ARGO), Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
| | - L Pardo Muñoz
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
| | - F Collurá
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
| | - R Mesia Nin
- Medical Oncology Department, Institut Català d'Oncologia, Badalona Applied Research Group in Oncology (B-ARGO), Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
| |
Collapse
|
9
|
Götz C, Bischof C, Wolff KD, Kolk A. Detection of HPV infection in head and neck cancers: Promise and pitfalls in the last ten years: A meta-analysis. Mol Clin Oncol 2019; 10:17-28. [PMID: 30655973 PMCID: PMC6313947 DOI: 10.3892/mco.2018.1749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 08/09/2018] [Indexed: 12/16/2022] Open
Abstract
The current controversial discussion on the disease-specific survival of patients with human papillomavirus (HPV)-positive (+) and -negative (-) squamous cell carcinoma (SCC) of the head neck region was the motivation for the present meta-analysis. Different detection methods for HPV are available, though these often lack sensitivity. As a consequence, there may be false interpretation of HPV positivity. A bias concerning HPV status and therefore also survival rates is serving a non-durable relevance in the discussion of tailored therapies. A literature search was performed via the online database PubMed/NCBI, and data extraction and statistical analysis were conducted. A total of 139 studies published between 2004 and 2014 were evaluated in the present meta-analysis. The HPV detection methods, patient characteristics, tumor localizations and stages, as well as (neo-) adjuvant therapies and survival times were analyzed. The average incidence rates of HPV+ patients with oropharyngeal tumors were higher than those of patients with cancers of other regions of the head and neck. Upon evaluating the results of different detection methods no significant differences were identified. We have compared the HPV incidence rates of each detection method, when studies have used more than one. Regarding overall survival, the pooled adjusted hazard ratio (HR) for oropharyngeal SCC was 0.31 [95% confidence interval (CI)=0.27-0.36]. Unfortunately, only 3 equivalent studies were available on nonoropharyngeal tumors, for which the pooled adjusted HR was 1 (95% CI=0.73-1.36). Overall, the evaluation demonstrated that the survival rates reported in numerous studies were not evaluated multifactorially and important confounders were excluded from the statistics. The HPV detection methods used were often not sufficient in representing HPV positivity. In addition, oropharyngeal and oral SCCs were assessed together in the localization. The widely differing number of HPV+ patients in each of the various studies may be explained by insufficient detection methods and by a lack of localization distinction. The considerations of a tailored therapy according to HPV status should be rejected based on the present information. The previously published studies should be read critically and do not represent a basis for therapeutic decisions.
Collapse
Affiliation(s)
- Carolin Götz
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, D-81675 Munich, Germany
| | - Clara Bischof
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, D-81675 Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, D-81675 Munich, Germany
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, D-81675 Munich, Germany
| |
Collapse
|
10
|
Survival for HPV-positive oropharyngeal squamous cell carcinoma with surgical versus non-surgical treatment approach: A systematic review and meta-analysis. Oral Oncol 2018; 86:121-131. [DOI: 10.1016/j.oraloncology.2018.09.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 02/07/2023]
|
11
|
Kiessling SY, Broglie MA, Soltermann A, Huber GF, Stoeckli SJ. Comparison of PI3K Pathway in HPV-Associated Oropharyngeal Cancer With and Without Tobacco Exposure. Laryngoscope Investig Otolaryngol 2018; 3:283-289. [PMID: 30186959 PMCID: PMC6119789 DOI: 10.1002/lio2.175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/23/2018] [Accepted: 04/30/2018] [Indexed: 12/21/2022] Open
Abstract
Objectives The aim of the study was to evaluate whether HPV associated OPSCC with tobacco exposure follows a different carcinogenic pathway compared to HPV associated OPSCC without tobacco exposure and to investigate its prognostic significance. The question was addressed with focus on components of the PI3K pathway. Methods 184 patients with newly diagnosed OPSCC treated with curative intent were consecutively enrolled. The expression level of p16, p53, PI3K, mTOR, and PTEN was assessed by immunohistochemistry and analyzed in relation to the risk factors HPV status and tobacco exposure. Results 94 of 184 (51%) patients were p16 positive, p53 overexpression was detected in 48 of 184 (26%) cases. PI3K overexpression with 70 of 184 (38%) cases was significantly higher in p16 positive tumors. mTOR overexpression was present in 90 of 184 (49%) cases and significantly higher in p16 negative tumors. PTEN loss was found in 42 of 184 (23%) cases without association to p16 expression. p16 positive OPSCC showed lower rates of p53 expression and mTOR expression as well as higher rates of PI3K expression irrespective of tobacco exposure. Survival analysis showed a distinct intermediate survival rate of p16 positive smokers. The markers PI3K, mTOR, and PTEN did not have a significant impact on survival. Conclusion HPV associated OPSCC with tobacco exposure follows the same expression level of the PI3K pathway as HPV associated OPSCC without tobacco exposure. The impaired survival rate of the intermediate risk group cannot be explained by different expression patterns of PI3K, mTOR, and PTEN. Level of Evidence 2b
Collapse
Affiliation(s)
- Si-Young Kiessling
- Department of Otorhinolaryngology, Head and Neck Surgery Cantonal Hospital of St. Gallen St. Gallen Switzerland
| | - Martina Anja Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery Cantonal Hospital of St. Gallen St. Gallen Switzerland
| | - Alex Soltermann
- Institute of Pathology and Molecular Pathology University Hospital of Zurich Zurich Switzerland
| | - Gerhard Frank Huber
- Department of Otorhinolaryngology, Head and Neck Surgery University Hospital of Zurich Zurich Switzerland.,University of Zurich Zurich Switzerland
| | - Sandro Johannes Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery Cantonal Hospital of St. Gallen St. Gallen Switzerland
| |
Collapse
|
12
|
Maqsood S, Jameson MB, De Groot C, Hartopeanu C, Yasin NABHM, Thotathil Z. Outcomes after primary intensity-modulated radiation therapy for oropharyngeal squamous cell carcinoma at a New Zealand regional cancer centre: Impact of p16 status. Cancer Rep (Hoboken) 2018; 1:e1001. [PMID: 32729235 DOI: 10.1002/cnr2.1001] [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: 12/28/2017] [Revised: 01/21/2018] [Accepted: 01/22/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The rising incidence of oropharyngeal squamous cell carcinoma (OPSCC) in New Zealand is due to an increase in the numbers of human papilloma virus (HPV)-associated OPSCC. We evaluated the impact of positive p16 immunohistochemistry, as a surrogate for HPV positivity, on OPSCC outcomes after primary intensity-modulated radiotherapy (IMRT) with or without concurrent chemotherapy. METHODS Retrospective review was undertaken of electronic medical records of 90 patients with OPSCC who received primary IMRT with or without chemotherapy between 2008 and mid-2015 at the Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand. RESULTS Median age was 57.5 years. Immunohistochemistry for p16 was positive in 53 (59%) OPSCC while 37 (41%) had negative or unknown p16 status. Median radiotherapy dose was 70 Gy. Chemotherapy was administered to 78 (87%) patients, most receiving high-dose cisplatin. Nine patients had residual disease following treatment completion. Seven patients relapsed, and 26 died during the study period. Five patients with p16-positive OPSCC had persistent or recurrent disease. Actuarial 3-year locoregional control, disease-free survival, and overall survival for all patients were 80.7%, 74.7%, and 77.1%, respectively. Among p16-positive OPSCC patients, 3-year locoregional control, disease-free survival, and overall survival were 89.5%, 80.8%, and 90.9%, respectively. CONCLUSION Outcomes after IMRT for OPSCC at Waikato Hospital are in line with the reported literature. Human papilloma virus-related OPSCC has better outcomes compared with patients with unknown or HPV-unrelated OPSCC. Trials are underway evaluating reduced intensity of treatment for HPV-related OPSCC.
Collapse
Affiliation(s)
- Saad Maqsood
- Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand
| | - Michael B Jameson
- Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand.,Waikato Clinical Campus, Faculty of Medical and Health Sciences, University of Auckland, Hamilton, New Zealand
| | | | | | | | - Ziad Thotathil
- Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand
| |
Collapse
|
13
|
Sims JR, Moore EJ. Primary surgical management with radial forearm free flap reconstruction in T4 oropharyngeal cancer: Complications and functional outcomes. Am J Otolaryngol 2018; 39:116-121. [PMID: 29279248 DOI: 10.1016/j.amjoto.2017.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 12/18/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE Functional outcomes and complication rates after open surgery for advanced-stage oropharyngeal cancers are rarely reported. These measures are critical for choice of treatment modality and patient counseling. We describe the long term functional outcomes and associated complications of primary surgical management of T4 oropharyngeal cancers reconstructed with radial forearm free flaps. MATERIALS AND METHODS A retrospective review was performed of 40 patients with T4 oropharyngeal cancers treated between 2005 and 2015 at a tertiary care center. RESULTS Forty patients with T4 oropharyngeal cancers underwent open surgical resection and radial forearm free flap reconstruction at the time of surgery. Mandibulotomy was required in 33 (82.5%) cases. Thirty-five (87.5%) patients received adjuvant radiation or combined chemotherapy and radiation. Tracheostomy was performed in all patients, but every patient was eventually decannulated. Twenty (57.1%) patients required gastrostomy tube placement at some point during treatment; however, 91.4% were on a completely oral diet with a mean FOSS score of 1.6 by 1year after completion of treatment. The addition of adjuvant treatment was the only factor significantly associated with poorer FOSS scores. The overall rates of short and long-term complications were 60.0% and 57.1% respectively. The most common short and long-term complications were infection (30.0%) and velopharyngeal insufficiency (25.7%) respectively. CONCLUSIONS Traditional open surgical approaches to large tumors of the oropharynx carry higher complication rates than more recent advanced transoral approaches. However, they can still be utilized with excellent long-term functional results in certain cases of advance oropharyngeal cancers not amenable to transoral approaches. With careful reconstruction of oropharyngeal defects, over 90% of patients can achieve a completely oral diet.
Collapse
Affiliation(s)
- John R Sims
- Mayo Clinic, Department of Otorhinolaryngology, Rochester, MN, United States
| | - Eric J Moore
- Mayo Clinic, Department of Otorhinolaryngology, Rochester, MN, United States.
| |
Collapse
|
14
|
Haeggblom L, Ramqvist T, Tommasino M, Dalianis T, Näsman A. Time to change perspectives on HPV in oropharyngeal cancer. A systematic review of HPV prevalence per oropharyngeal sub-site the last 3 years. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 4:1-11. [PMID: 29179862 PMCID: PMC5883233 DOI: 10.1016/j.pvr.2017.05.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/12/2017] [Accepted: 05/18/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Human papillomavirus (HPV) as a risk factor in oropharyngeal squamous cell carcinoma (OPSCC) is well established. However, accumulating data imply that the OPSCC concept is too unspecific with regard to HPV prevalence and clinical importance. To further study the role of HPV in OPSCC by sub-site, a systematic review and meta-analysis was performed. MATERIAL AND METHOD PubMed was searched and all studies reporting HPV data (p16/HPV DNA/RNA) in both "lymphoepithelial associated" (i.e. tonsillar and base of tongue cancer; TSCC and BOTSCC respectively) and "non-lymphoepithelial" ("other" OPSCC) OPSCC were included. Pooled odds ratios by HPV detection method were analysed using a random effects model. RESULTS In total, 58 unique patient cohorts were identified. Total HPV prevalence in TSCC/BOTSCC was 56%, 95%CI: 55-57% (59%, 95%CI: 58-60% for TSCC only) as compared to 19%, 95%CI: 17-20%, in "other" OPSCC. Significant association of HPV to TSCC/BOTSCC vs. "other" OPSCC was observed no matter HPV detection method used, but statistical homogeneity was only observed when studies using algorithm based HPV detection were pooled. CONCLUSION HPV prevalence differs markedly between OPSCC sub-sites and while the role of HPV in TSCC/BOTSCC is strong, the role in "other" OPSCC is more uncertain and needs further evaluation.
Collapse
Affiliation(s)
- Linnea Haeggblom
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Torbjörn Ramqvist
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
| | | | - Tina Dalianis
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Anders Näsman
- Dept. of Oncology-Pathology, Karolinska Institutet, 171 76 Stockholm, Sweden; Dept. of Clinical Pathology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| |
Collapse
|
15
|
Hobbs AJ, Brockton NT, Matthews TW, Chandarana SP, Bose P, Guggisberg K, Fick GH, Dort JC. Primary treatment for oropharyngeal squamous cell carcinoma in Alberta, Canada: A population-based study. Head Neck 2017; 39:2187-2199. [DOI: 10.1002/hed.24889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 04/19/2017] [Accepted: 06/15/2017] [Indexed: 01/21/2023] Open
Affiliation(s)
- Amy J. Hobbs
- Department of Community Health Sciences; Cumming School of Medicine, University of Calgary; Calgary Alberta Canada
- The Ohlson Research Initiative; Arnie Charbonneau Cancer Institute, University of Calgary; Calgary Alberta Canada
| | - Nigel T. Brockton
- Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services; Calgary Alberta Canada
- The Ohlson Research Initiative; Arnie Charbonneau Cancer Institute, University of Calgary; Calgary Alberta Canada
| | - T. Wayne Matthews
- Department of Surgery; Section of Otolaryngology, Cumming School of Medicine, University of Calgary; Calgary Alberta Canada
- The Ohlson Research Initiative; Arnie Charbonneau Cancer Institute, University of Calgary; Calgary Alberta Canada
| | - Shamir P. Chandarana
- Department of Surgery; Section of Otolaryngology, Cumming School of Medicine, University of Calgary; Calgary Alberta Canada
- The Ohlson Research Initiative; Arnie Charbonneau Cancer Institute, University of Calgary; Calgary Alberta Canada
| | - Pinaki Bose
- Department of Surgery; Section of Otolaryngology, Cumming School of Medicine, University of Calgary; Calgary Alberta Canada
- The Ohlson Research Initiative; Arnie Charbonneau Cancer Institute, University of Calgary; Calgary Alberta Canada
| | - Kelly Guggisberg
- The Ohlson Research Initiative; Arnie Charbonneau Cancer Institute, University of Calgary; Calgary Alberta Canada
- Department of Anatomic Pathology; Calgary Laboratory Services, Rockyview General Hospital; Calgary Alberta Canada
| | - Gordon H. Fick
- Department of Community Health Sciences; Cumming School of Medicine, University of Calgary; Calgary Alberta Canada
| | - Joseph C. Dort
- Department of Community Health Sciences; Cumming School of Medicine, University of Calgary; Calgary Alberta Canada
- Department of Surgery; Section of Otolaryngology, Cumming School of Medicine, University of Calgary; Calgary Alberta Canada
- The Ohlson Research Initiative; Arnie Charbonneau Cancer Institute, University of Calgary; Calgary Alberta Canada
| |
Collapse
|
16
|
Broglie MA, Stoeckli SJ, Sauter R, Pasche P, Reinhard A, de Leval L, Huber GF, Pezier TF, Soltermann A, Giger R, Arnold A, Dettmer M, Arnoux A, Müller M, Spreitzer S, Lang F, Lutchmaya M, Stauffer E, Espeli V, Martucci F, Bongiovanni M, Foerbs D, Jochum W. Impact of human papillomavirus on outcome in patients with oropharyngeal cancer treated with primary surgery. Head Neck 2017; 39:2004-2015. [DOI: 10.1002/hed.24865] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 03/09/2017] [Accepted: 05/22/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Martina A. Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Rafael Sauter
- Clinical Trials Unit; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Philippe Pasche
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital of Lausanne; Lausanne Switzerland
| | - Antoine Reinhard
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital of Lausanne; Lausanne Switzerland
| | - Laurence de Leval
- Department of Pathology; University Hospital of Lausanne; Lausanne Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital of Zurich; Switzerland
| | - Thomas F. Pezier
- Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital of Zurich; Switzerland
| | - Alex Soltermann
- Institute of Surgical Pathology; University Hospital of Zurich; Zurich Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery; Bern University Hospital; Inselspital Switzerland
| | - Andreas Arnold
- Department of Otorhinolaryngology, Head and Neck Surgery; Bern University Hospital; Inselspital Switzerland
| | - Matthias Dettmer
- Department of Pathology; Bern University Hospital; Inselspital Switzerland
| | - Andre Arnoux
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital Aarau; Switzerland
| | - Martin Müller
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital Aarau; Switzerland
| | | | - Florian Lang
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital Fribourg; Switzerland
| | - Mathieu Lutchmaya
- Department of Otorhinolaryngology, Head and Neck Surgery; Kantonsspital Fribourg; Switzerland
| | | | - Vittoria Espeli
- Oncology Institute of Southern Switzerland (IOSI); Bellinzona Switzerland
| | - Francesco Martucci
- Department of Radiooncology; Oncology Institute of Southern Switzerland (IOSI); Bellinzona Switzerland
| | - Massimo Bongiovanni
- Department of Pathology; University Hospital of Lausanne; Lausanne Switzerland
| | - Diana Foerbs
- Institute of Pathology; Kantonsspital St. Gallen; Switzerland
| | - Wolfram Jochum
- Institute of Pathology; Kantonsspital St. Gallen; Switzerland
| |
Collapse
|
17
|
Sawabe M, Ito H, Oze I, Hosono S, Kawakita D, Tanaka H, Hasegawa Y, Murakami S, Matsuo K. Heterogeneous impact of alcohol consumption according to treatment method on survival in head and neck cancer: A prospective study. Cancer Sci 2017; 108:91-100. [PMID: 27801961 PMCID: PMC5276823 DOI: 10.1111/cas.13115] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/18/2016] [Accepted: 10/27/2016] [Indexed: 12/11/2022] Open
Abstract
Alcohol consumption is an established risk factor, and also a potential prognostic factor, for squamous cell carcinoma of the head and neck (HNSCC). However, little is known about whether the prognostic impact of alcohol consumption differs by treatment method. We evaluated the association between alcohol drinking and survival by treatment method to the primary site in 427 patients with HNSCC treated between 2005 and 2013 at Aichi Cancer Center Central Hospital (Nagoya, Japan). The impact of alcohol on prognosis was measured by multivariable Cox regression analysis adjusted for established prognostic factors. Among all HNSCC patients, the overall survival rate was significantly poorer with increased levels of alcohol consumption in multivariable analysis (trend P = 0.038). Stratification by treatment method and primary site revealed that the impact of drinking was heterogeneous. Among laryngopharyngeal cancer (laryngeal, oropharyngeal, and hypopharyngeal cancer) patients receiving radiotherapy (n = 141), a significant dose-response relationship was observed (trend P = 0.034). In contrast, among laryngopharyngeal cancer patients treated with surgery (n = 80), no obvious impact of alcohol was observed. This heterogeneity in the impact of alcohol between surgery and radiotherapy was significant (for interaction, P = 0.048). Furthermore, among patients with oral cavity cancer treated by surgery, a significant impact of drinking on survival was seen with tongue cancer, but not with non-tongue oral cancer. We observed a significant inverse association between alcohol drinking and prognosis among HNSCC patients, and its impact was heterogeneous by treatment method and primary site.
Collapse
Affiliation(s)
- Michi Sawabe
- Division of Molecular and Clinical EpidemiologyAichi Cancer Center Research InstituteNagoyaJapan
- Department of Otolaryngology, Head and Neck SurgeryNagoya City University Graduate School of MedicineNagoyaJapan
| | - Hidemi Ito
- Division of Epidemiology and PreventionAichi Cancer Center Research InstituteNagoyaJapan
- Department of EpidemiologyNagoya City University Graduate School of MedicineNagoyaJapan
| | - Isao Oze
- Division of Epidemiology and PreventionAichi Cancer Center Research InstituteNagoyaJapan
| | - Satoyo Hosono
- Division of Epidemiology and PreventionAichi Cancer Center Research InstituteNagoyaJapan
| | - Daisuke Kawakita
- Division of Molecular and Clinical EpidemiologyAichi Cancer Center Research InstituteNagoyaJapan
- Department of Otolaryngology, Head and Neck SurgeryNagoya City University Graduate School of MedicineNagoyaJapan
| | - Hideo Tanaka
- Division of Epidemiology and PreventionAichi Cancer Center Research InstituteNagoyaJapan
- Department of EpidemiologyNagoya City University Graduate School of MedicineNagoyaJapan
| | - Yasuhisa Hasegawa
- Department of Head and Neck SurgeryAichi Cancer Center HospitalNagoyaJapan
| | - Shingo Murakami
- Department of Otolaryngology, Head and Neck SurgeryNagoya City University Graduate School of MedicineNagoyaJapan
| | - Keitaro Matsuo
- Division of Molecular and Clinical EpidemiologyAichi Cancer Center Research InstituteNagoyaJapan
- Department of EpidemiologyNagoya City University Graduate School of MedicineNagoyaJapan
| |
Collapse
|
18
|
Zhu X, Wang Y, Zhu H, Lou W. The role of human papillomavirus in head and neck cancer and the impact on radiotherapy outcome. Acta Otolaryngol 2016; 136:1291-1298. [PMID: 27472193 DOI: 10.1080/00016489.2016.1208366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONCLUSION HPV + HNSCC patients have improved Overall Survival (OS), Disease Specific Survival (DSS), Disease Free Survival (DFS), and Progression Free Survival (PFS). The radiotherapy treatment can't improve the Survival of the HPV-negative HNSCC patients. OBJECTIVE To investigate the role of Human papillomavirus in head and neck cancer and the impact on radiotherapy outcome. METHODS A search in PubMed and Chinese CNKI (2000-2015) was performed. This meta-analysis was done using RevMan 5.1 software. Outcomes included OS, DSS, DFS, PFS, and Treatment responses rates (RR). RESULTS A total of 2620 patients in 10 studies were included. The Positive detective rates of HPV and P16 are 32.5% (425/1309) and 42.5% (526/1239). OS and PFS were improved in HPV + patients compared to HPV - patients (HR = 0.48; 95% CI = 0.37-0.62, p < 0.0001) and (HR = 0.49; 95% CI = 0.31-0.78, p < 0.0001). The survival benefit was similar in HPV-16 + patients (adjusted HR = 0.39; 95% CI = 0.21-0.60, p < 0.0001). The DFS of P16 + patients improved (HR = 0.70; 95% CI = 0.55-0.89, p < 0.0001). The treatment response of p16 + patients didn't significantly improve compared with p16- patients (HR = 1.44; 95% CI = 1.01-2.05, p = 0.05).
Collapse
|
19
|
Marcu LG. Future treatment directions for HPV-associated head and neck cancer based on radiobiological rationale and current clinical evidence. Crit Rev Oncol Hematol 2016; 103:27-36. [DOI: 10.1016/j.critrevonc.2016.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/11/2016] [Accepted: 05/10/2016] [Indexed: 12/30/2022] Open
|
20
|
Bird T, De Felice F, Michaelidou A, Thavaraj S, Jeannon JP, Lyons A, Oakley R, Simo R, Lei M, Guerrero Urbano T. Outcomes of intensity-modulated radiotherapy as primary treatment for oropharyngeal squamous cell carcinoma - a European singleinstitution analysis. Clin Otolaryngol 2016; 42:115-122. [DOI: 10.1111/coa.12674] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/12/2022]
Affiliation(s)
- T. Bird
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - F. De Felice
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - A. Michaelidou
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - S. Thavaraj
- Department of Pathology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - J.-P. Jeannon
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - A. Lyons
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - R. Oakley
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - R. Simo
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - M. Lei
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - T. Guerrero Urbano
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| |
Collapse
|
21
|
Karpathiou G, Monaya A, Forest F, Froudarakis M, Casteillo F, Marc Dumollard J, Prades JM, Peoc'h M. p16 and p53 expression status in head and neck squamous cell carcinoma: a correlation with histological, histoprognostic and clinical parameters. Pathology 2016; 48:341-8. [DOI: 10.1016/j.pathol.2016.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/22/2015] [Accepted: 01/27/2016] [Indexed: 01/08/2023]
|
22
|
Chen YP, Zhao BC, Chen C, Lei XX, Shen LJ, Chen G, Yan F, Wang GN, Chen H, Jiang YQ, Xia YF. Alcohol drinking as an unfavorable prognostic factor for male patients with nasopharyngeal carcinoma. Sci Rep 2016; 6:19290. [PMID: 26776301 PMCID: PMC4725964 DOI: 10.1038/srep19290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 12/09/2015] [Indexed: 11/15/2022] Open
Abstract
The relationship between alcohol drinking and the prognosis of nasopharyngeal carcinoma (NPC) is unknown. To investigate the prognostic value of alcohol drinking on NPC, this retrospective study was conducted on 1923 male NPC patients. Patients were classified as current, former and non-drinkers according to their drinking status. Furthermore, they were categorized as heavy drinkers and mild/none drinkers based on the intensity and duration of alcohol drinking. Survival outcomes were compared using Kaplan–Meier analysis and Cox proportional hazards model. We found that current drinkers had significantly lower overall survival (OS) rate (5-year OS: 70.2% vs. 76.4%, P < 0.001) and locoregional recurrence-free survival (LRFS) rate (5-year LRFS: 69.3% vs. 77.5%, P < 0.001) compared with non-drinkers. Drinking ≥14 drinks/week, and drinking ≥20 years were both independent unfavorable prognostic factors for OS (hazard ratio [HR] = 1.38, 95% confidence interval [CI] 1.05–1.81, P = 0.022; HR = 1.38, 95% CI 1.09–1.75, P = 0.007). Stratified analyses further revealed that the negative impacts of alcohol were manifested mainly among older patients and among smokers. In conclusion, alcohol drinking is a useful predictor of prognosis in male NPC patients; drinkers, especially heavy drinkers have poorer prognosis.
Collapse
Affiliation(s)
- Yu-Pei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China
| | - Bing-Cheng Zhao
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
| | - Chen Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China
| | - Xin-Xing Lei
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China
| | - Lu-Jun Shen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China
| | - Gang Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China.,Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
| | - Fang Yan
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China.,Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
| | - Guan-Nan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China.,Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
| | - Han Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
| | - Yi-Quan Jiang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, P. R. China
| | - Yun-Fei Xia
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong 510060, P. R. China
| |
Collapse
|
23
|
Sedghizadeh PP, Billington WD, Paxton D, Ebeed R, Mahabady S, Clark GT, Enciso R. Is p16-positive oropharyngeal squamous cell carcinoma associated with favorable prognosis? A systematic review and meta-analysis. Oral Oncol 2016; 54:15-27. [PMID: 26794879 DOI: 10.1016/j.oraloncology.2016.01.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/30/2015] [Accepted: 01/01/2016] [Indexed: 12/29/2022]
Abstract
The purpose of this systematic review and meta-analysis was to compare the prognosis of patients with p16 expressing oropharyngeal squamous cell cancers to patients with p16 non-expressing cancers. Clinical outcomes that were evaluated included overall survival, local recurrence, disease-free survival, disease-specific survival, and event-free survival. The following electronic databases were searched: Cochrane Library, MEDLINE (via Pubmed), and Web of Science. Publications were restricted to English language. Studies were limited to controlled clinical trials on the survival rates of patients with oropharyngeal tumors that were p16 expressing, compared to patients with p16 non-expressing tumors, and at least one clinical endpoint reported by trial authors (hazard ratios). Specific ascertainment criteria were applied for inclusion and exclusion of eligible studies. Data was independently extracted in duplicate. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis PRISMA checklist. Risk of bias was assessed for all included studies, and disagreements between review authors were discussed until an agreement was reached. Eighteen studies were included for final review and meta-analysis. The subgroup meta-analyses, which included survival and recurrence data, showed significantly favorable outcomes for patients with p16 expressing tumors. There is strong evidence to support that patients with p16 expressing oropharyngeal squamous cell cancers have favorable clinical outcomes and prognosis.
Collapse
Affiliation(s)
- Parish P Sedghizadeh
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States.
| | - William D Billington
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
| | - Dain Paxton
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
| | - Rabeh Ebeed
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
| | - Susan Mahabady
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
| | - Glenn T Clark
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
| | - Reyes Enciso
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
| |
Collapse
|
24
|
Yeh DH, Tam S, Fung K, MacNeil SD, Yoo J, Winquist E, Palma DA, Nichols AC. Transoral robotic surgery vs. radiotherapy for management of oropharyngeal squamous cell carcinoma - A systematic review of the literature. Eur J Surg Oncol 2015; 41:1603-14. [PMID: 26461255 DOI: 10.1016/j.ejso.2015.09.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/14/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) with or without concurrent chemotherapy is widely utilized for the treatment of oropharyngeal squamous cell carcinoma (OPSCC). However, due to significant acute and late toxicities there has been increasing interest in minimally invasive surgical approaches, particularly transoral robotic surgery (TORS) in an attempt to preserve patient quality of life while maintaining oncologic outcomes. The aim of this study was to review the current literature in order to compare primary IMRT versus TORS in the management of OPSCC. METHODS A MEDLINE search was conducted to identify studies reporting on the outcomes of TORS or IMRT in the treatment of OPSCC. Reference lists were also reviewed for relevant articles. Oncologic, functional, and quality of life data is summarized and discussed. RESULTS One hundred-ninety papers were identified through the MEDLINE search. An additional 52 papers were retrieved by hand searching the reference lists. Ultimately, 44 papers were identified that discussed outcomes after IMRT or TORS for OPSCC. No outcomes from randomized trials were identified. CONCLUSION No randomized trials comparing TORS versus IMRT to each other were identified. Uncontrolled reports from the current literature suggest comparable oncologic outcomes with TORS compared to IMRT and functional outcomes may be superior. However, the median follow-up was relatively short and the TORS studies included patients with earlier stage OPSCC on average compared to IMRT studies. Prospective, randomized controlled trials and direct, well-matched comparisons are needed to further elucidate the role for TORS in the treatment of oropharyngeal squamous cell carcinoma.
Collapse
Affiliation(s)
- D H Yeh
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada
| | - S Tam
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada
| | - K Fung
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - S D MacNeil
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - J Yoo
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - E Winquist
- London Health Sciences Centre, London, Ontario, Canada; Division of Medical Oncology, Western University, London, Ontario Canada
| | - D A Palma
- London Health Sciences Centre, London, Ontario, Canada; Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - A C Nichols
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| |
Collapse
|
25
|
Whang SN, Filippova M, Duerksen-Hughes P. Recent Progress in Therapeutic Treatments and Screening Strategies for the Prevention and Treatment of HPV-Associated Head and Neck Cancer. Viruses 2015; 7:5040-65. [PMID: 26393639 PMCID: PMC4584304 DOI: 10.3390/v7092860] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/17/2015] [Accepted: 08/27/2015] [Indexed: 12/11/2022] Open
Abstract
The rise in human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) has elicited significant interest in the role of high-risk HPV in tumorigenesis. Because patients with HPV-positive HNSCC have better prognoses than do their HPV-negative counterparts, current therapeutic strategies for HPV+ HNSCC are increasingly considered to be overly aggressive, highlighting a need for customized treatment guidelines for this cohort. Additional issues include the unmet need for a reliable screening strategy for HNSCC, as well as the ongoing assessment of the efficacy of prophylactic vaccines for the prevention of HPV infections in the head and neck regions. This review also outlines a number of emerging prospects for therapeutic vaccines, as well as for targeted, molecular-based therapies for HPV-associated head and neck cancers. Overall, the future for developing novel and effective therapeutic agents for HPV-associated head and neck tumors is promising; continued progress is critical in order to meet the challenges posed by the growing epidemic.
Collapse
Affiliation(s)
- Sonia N Whang
- Department of Basic Science, Loma Linda University, Loma Linda, CA 92354, USA.
| | - Maria Filippova
- Department of Basic Science, Loma Linda University, Loma Linda, CA 92354, USA.
| | | |
Collapse
|
26
|
Wang HM, Cheng NM, Lee LY, Fang YHD, Chang JTC, Tsan DL, Ng SH, Liao CT, Yang LY, Yen TC. Heterogeneity of (18)F-FDG PET combined with expression of EGFR may improve the prognostic stratification of advanced oropharyngeal carcinoma. Int J Cancer 2015; 138:731-8. [PMID: 26311121 DOI: 10.1002/ijc.29811] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/14/2015] [Indexed: 01/03/2023]
Abstract
The Ang's risk profile (based on p16, smoking and cancer stage) is a well-known prognostic factor in oropharyngeal squamous cell carcinoma (OPSCC). Whether heterogeneity in (18)F-fluorodeoxyglucose (FDG) positron emission tomographic (PET) images and epidermal growth factor receptor (EGFR) expression could provide additional information on clinical outcomes in advanced-stage OPSCC was investigated. Patients with stage III-IV OPSCC who completed primary therapy were eligible. Zone-size nonuniformity (ZSNU) extracted from pretreatment FDG PET scans was used as an index of image heterogeneity. EGFR and p16 expression were examined by immunohistochemistry. Disease-specific survival (DSS) and overall survival (OS) served as outcome measures. Kaplan-Meier estimates and Cox proportional hazards regression models were used for survival analysis. A bootstrap resampling technique was applied to investigate the stability of outcomes. Finally, a recursive partitioning analysis (RPA)-based model was constructed. A total of 113 patients were included, of which 28 were p16-positive. Multivariate analysis identified the Ang's profile, EGFR and ZSNU as independent predictors of both DSS and OS. Using RPA, the three risk factors were used to devise a prognostic scoring system that successfully predicted DSS in both p16-positive and -negative cases. The c-statistic of the prognostic index for DSS was 0.81, a value which was significantly superior to both AJCC stage (0.60) and the Ang's risk profile (0.68). In patients showing an Ang's high-risk profile (N = 77), the use of our scoring system clearly identified three distinct prognostic subgroups. It was concluded that a novel index may improve the prognostic stratification of patients with advanced-stage OPSCC.
Collapse
Affiliation(s)
- Hung-Ming Wang
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Nai-Ming Cheng
- Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, 33305, Taiwan.,Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu City, 30071, Taiwan
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Yu-Hua Dean Fang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, 70101, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Din-Li Tsan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology, Head & Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Lan-Yan Yang
- Chang Gung Memorial Hospital, Biostatistics Unit, Clinical Trial Center, Taoyuan City, 33305, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, 33305, Taiwan
| |
Collapse
|
27
|
Möckelmann N, Kriegs M, Lörincz BB, Busch CJ, Knecht R. Molecular targeting in combination with platinum-based chemoradiotherapy in head and neck cancer treatment. Head Neck 2015; 38 Suppl 1:E2173-81. [DOI: 10.1002/hed.24031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 01/13/2023] Open
Affiliation(s)
- Nikolaus Möckelmann
- Department of Otorhinolaryngology and Head and Neck Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Malte Kriegs
- Laboratory of Radiobiology and Experimental Radiooncology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Balazs B. Lörincz
- Department of Otorhinolaryngology and Head and Neck Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Chia-Jung Busch
- Department of Otorhinolaryngology and Head and Neck Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Rainald Knecht
- Department of Otorhinolaryngology and Head and Neck Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| |
Collapse
|
28
|
Sandulache VC, Hamblin J, Lai S, Pezzi T, Skinner HD, Khan NA, Dioun SM, Hartman C, Kramer J, Chiao E, Zhou X, Zevallos JP. Oropharyngeal squamous cell carcinoma in the veteran population: Association with traditional carcinogen exposure and poor clinical outcomes. Head Neck 2015; 37:1246-53. [PMID: 24801106 DOI: 10.1002/hed.23740] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND A significant fraction of oropharyngeal squamous cell carcinoma (SCC) cases is associated with traditional carcinogens; in these patients, treatment response and clinical outcomes remain poor. METHODS We evaluated patient, tumor, and treatment characteristics for 200 veterans with oropharyngeal SCC treated at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) between 2000 and 2012. RESULTS Most patients (77%) were white and heavy smokers. Twenty-seven patients required tracheostomy and 63 required gastrostomy placement during treatment. Overall survival (OS) at 5 years was 40%. Survival was impacted by T classification, treatment intensity, completion of treatment, and p16 tumor status. Almost 30% of patients were unable to complete a treatment regimen consistent with National Comprehensive Cancer Network (NCCN) guidelines. CONCLUSION Oropharyngeal SCC in veterans is associated with traditional carcinogens and poor clinical outcomes. Despite heavy smoking exposure, p16 tumor status significantly impacts survival. Careful consideration must be given to improving treatment paradigms for this cohort given their limited tolerance for treatment escalation.
Collapse
Affiliation(s)
- Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - John Hamblin
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Syeling Lai
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Houston Veterans Affairs Health Services Research and Development Center, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Todd Pezzi
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Heath D Skinner
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Numan A Khan
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Shayan M Dioun
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Christine Hartman
- Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Jennifer Kramer
- Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Elizabeth Chiao
- Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Xiaodong Zhou
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Jose P Zevallos
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
29
|
No benefit for regional control and survival by planned neck dissection in primary irradiated oropharyngeal cancer irrespective of p16 expression. Eur Arch Otorhinolaryngol 2015; 273:1841-8. [DOI: 10.1007/s00405-015-3675-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/25/2015] [Indexed: 11/26/2022]
|
30
|
Theurer JA, Yoo J, Nichols AC. Human papillomavirus-related oropharyngeal squamous cell carcinoma: a new context for dysphagia rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0058-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
31
|
Kikuchi M, Koyasu S, Shinohara S, Usami Y, Imai Y, Hino M, Itoh K, Tona R, Kanazawa Y, Kishimoto I, Harada H, Naito Y. Prognostic value of pretreatment18F-fluorodeoxyglucose positron emission tomography/CT volume-based parameters in patients with oropharyngeal squamous cell carcinoma with known p16 and p53 status. Head Neck 2014; 37:1524-31. [DOI: 10.1002/hed.23784] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 05/02/2014] [Accepted: 05/28/2014] [Indexed: 01/19/2023] Open
Affiliation(s)
- Masahiro Kikuchi
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Sho Koyasu
- Department of Diagnostic Imaging and Nuclear Medicine; Graduate School of Medicine, Kyoto University; Kobe City Japan
| | - Shogo Shinohara
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Yu Usami
- Department of Clinical Laboratory; Osaka University Dental Hospital; Osaka Japan
| | - Yukihiro Imai
- Department of Clinical Pathology; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Megumu Hino
- Department of Radiology; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Kyo Itoh
- Department of Radiology; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Risa Tona
- Institute of Biomedical Research and Innovation; Kobe City Japan
| | - Yuji Kanazawa
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Ippei Kishimoto
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Hiroyuki Harada
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
| | - Yasushi Naito
- Department of Otolaryngology-Head and Neck Surgery; Kobe City Medical Center General Hospital; Kobe City Japan
| |
Collapse
|
32
|
Shinohara S, Kikuchi M, Tona R, Kanazawa Y, Kishimoto I, Harada H, Imai Y, Usami Y. Prognostic impact of p16 and p53 expression in oropharyngeal squamous cell carcinomas. Jpn J Clin Oncol 2014; 44:232-40. [PMID: 24470584 DOI: 10.1093/jjco/hyt223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUNDS A p16 protein is known to be overexpressed in human papillomavirus-positive head and neck squamous cell carcinoma specimens. p53 is a tumor suppressor protein detectable by immunohistochemistry in carcinogen-associated head and neck squamous cell carcinoma as a result of gene mutations. The purpose of this study is to investigate the prognostic impact of p16 and p53 expression in oropharyngeal squamous cell carcinomas. METHODS We retrospectively examined the relationship between prognosis, and p16 and p53 expression levels of oropharyngeal squamous cell carcinoma specimens in 53 patients using immunohistochemistry. RESULTS Overall, 55% of patients were p16 positive and 45% p16 negative, while 28% were p53 positive and 72% p53 negative. The p16 status showed an inverse relationship with the p53 status. A survival analysis by p16 status, p53 status, Union for International Cancer Control stage and main treatment modality demonstrated that only p16 status was related to better prognosis in terms of overall survival and disease-specific survival (3-year overall survival, 87 vs. 62%, P = 0.02; 3-year disease-specific survival, 90 vs. 62%, P = 0.02). To evaluate the practical prognostic factors in oropharyngeal squamous cell carcinoma patients, we classified patients as either p16-positive or p53-negative oropharyngeal squamous cell carcinomas, representing human papillomavirus-related oropharyngeal squamous cell carcinoma with wild-type p53 or the remaining patients with p16-negative or p53-positive OPSCCs, respectively. The former group showed survival advantages in terms of overall survival and disease-specific survival by log-tank test compared with the latter group (3-year overall survival, 96 vs. 58%, P = 0.005; 3-year disease-specific survival, 96 vs. 63%, P = 0.02). CONCLUSIONS A group of patients who were p16 positive/p53 negative had better prognoses in terms of overall survival and disease-specific survival than that who were p16-positive alone.
Collapse
Affiliation(s)
- Shogo Shinohara
- *Minatojima-minamimachi 2-1-1, Chuo-ku, Kobe 650-0047, Japan.
| | | | | | | | | | | | | | | |
Collapse
|