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Head and neck squamous cell carcinoma in HIV patients. Curr Opin Otolaryngol Head Neck Surg 2023; 31:78-82. [PMID: 36912219 DOI: 10.1097/moo.0000000000000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW The introduction of antiretroviral therapy has significantly impacted the incidence of head and neck squamous cell carcinoma (HNSCC) in people living with HIV (PLWH). This manuscript aims to give an overview of the evidence in the literature about this population. RECENT FINDINGS PLWH have an increased incidence of HNSCC, with earlier age and more advanced stage at diagnosis. This epidemiologic trend may be explained by combining traditional and HIV-related risk factors. With the improvement of global health status, more patients are candidate for complex therapeutic strategies with curative intent. To date, it is still debated whether HIV-infected patients possess a profile of increased risk regarding treatment-related toxicity and survival outcomes, with the literature still lacking substantial evidence. Among the prognostic factors that can guide the clinician in selecting the most appropriate treatment strategy, age, site/subsite, stage, HIV viral load, and CD4+ T-cell count at diagnosis are the most relevant. SUMMARY Pathogenesis, treatment characteristics, oncologic outcomes, and prognostic factors of HNSCC in PLWH are still debated. Given the increasing incidence of HNSCC in PLWH, the need for dedicated evidence-based studies represents a significant research gap to be addressed.
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Weinreb SF, Piersiala K, Dhar SI, Hillel AT, Akst L, Best SRA. Impact of human immunodeficiency virus status on laryngeal cancer survival and locoregional control. Laryngoscope Investig Otolaryngol 2022; 7:153-160. [PMID: 35155793 PMCID: PMC8823145 DOI: 10.1002/lio2.736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To compare long-term outcomes of laryngeal cancer (LC) in people living with HIV (PLWH) versus uninfected individuals and determine how clinical and viral factors-such as demographics, cancer stage, HIV viral load, and CD4 nadir-contribute to these outcomes. METHODS This was a retrospective case-control study of 749 patients seen for LC at a single tertiary care center between 2003 and 2017. Of these, 22 had HIV at the time of LC diagnosis, and they were matched in a 1:4 ratio to uninfected controls based on sex, presence of smoking history, and age at cancer diagnosis. Kaplan-Meier survival curves and Cox proportional hazards models were constructed to identify overall and disease-free survival differences based on HIV status, as well as other clinical and viral factors. RESULTS Compared to all uninfected individuals, PLWH were diagnosed with LC approximately 6 years younger (p = .013). 1-, 2-, and 5-year overall survival for PLWH were 86.4% (63.4%-95.4%), 77.3% (53.7%-89.9%), and 65.8% (40.8%-82.2%), respectively following LC diagnosis, and HIV was not significantly associated with overall (HR = 3.34 [0.59-18.79]) or disease-free survival (HR = 2.12 [0.71-6.36]). The incidence rate of locoregional recurrence among PLWH was 541 compared to 371 per 10,000 person-years in controls, which were not significantly different (p = .420). Furthermore, among PLWH, peak viral load and CD4 nadir were not associated with overall or disease-free survival. CONCLUSION While previous work has shown that HIV is associated with elevated risk of LC, survival did not differ significantly between PLWH and uninfected individuals in this study. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Samuel Franklin Weinreb
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Krzysztof Piersiala
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Division of ENT Diseases, Department of Clinical Sciences, Intervention, and TechnologyKarolinska InstituteStockholmSweden
- Department of OtorhinolaryngologyKarolinska University HospitalStockholmSweden
| | - Shumon Ian Dhar
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Alexander T. Hillel
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Lee Akst
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Simon R. A. Best
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Haase K, Piwonski I, Stromberger C, Thieme N, Heiland M, Beck-Broichsitter B, Hofmann VM, Kofla G, Sander S, Keilholz U, Neumann K, Stölzel K, Olze H, Arens P, Dommerich S, Coordes A. Incidence and survival of HNSCC patients living with HIV compared with HIV-negative HNSCC patients. Eur Arch Otorhinolaryngol 2021; 278:3941-3953. [PMID: 33492419 PMCID: PMC8382606 DOI: 10.1007/s00405-020-06573-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Abstract
Purpose The aim was to analyze the incidence and survival of patients living with HIV (PLWH) with head and neck squamous cell carcinoma (HNSCC) and to compare with a control group of HIV-negative HNSCC patients. Methods Clinicopathological data and predictors for overall survival (OS) and disease-free survival (DFS) were investigated (2009–2019). Results 50 of 5151 HNSCC patients (0.97%) were PLWH, and 76% were smokers. Age ≤ 60 years, HIV-PCR ≤ 50 copies, CD4 cells ≤ 200/mm3, cART treatment, T and UICC classification, oral cavity and nasal/paranasal sinuses, and therapy were significantly associated with OS in univariate analysis. In the multivariate analysis, only age and HIV-PCR independently predicted OS. The OS of the 50 PLWH was not significantly altered compared with the 5101 HIV-negative controls. However, OS and DFS were significantly inferior in advanced tumor stages of PLWH compared with an age-matched control group of 150 HIV-negative patients. Conclusions PLWH were diagnosed with HNSCC at a significantly younger age compared to HIV-negative patients. Taking into account patient age at initial diagnosis, both OS and DFS rates in PLWH are significantly worse compared with a matched control group of HIV-negative patients in advanced tumor stages UICC III/IV. The prognosis (OS) is improved when taking cART treatment, the HIV viral load is undetectable and CD4 count is high. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-020-06573-9.
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Affiliation(s)
- Katharina Haase
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Iris Piwonski
- Department of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carmen Stromberger
- Department of Radiooncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Germany
| | - Nadine Thieme
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Benjamin Franklin, Berlin, Germany
| | - Benedicta Beck-Broichsitter
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Benjamin Franklin, Berlin, Germany
| | - Veit M Hofmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Grzegorz Kofla
- Department of Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Germany
| | - Steffen Sander
- Clinical Cancer Registry, Charité Comprehensive Center (CCCC), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Ullrich Keilholz
- Department of Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Konrad Neumann
- Institute for Biometrics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Katharina Stölzel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Heidi Olze
- Department of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philipp Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Steffen Dommerich
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Annekatrin Coordes
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Augustenburger Platz 1, 13353, Berlin, Germany.
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Nayyar SS, Thiagarajan S, Malik A, D'Cruz A, Chaukar D, Patil P, Alahari AD, Lashkar SG, Prabhash K. Head and neck squamous cell carcinoma in HIV, HBV and HCV seropositive patients - Prognosis and its predictors. J Cancer Res Ther 2020; 16:619-623. [PMID: 32719277 DOI: 10.4103/jcrt.jcrt_166_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Patients receiving treatment for head-and-neck squamous cell carcinoma (HNSCC) also may have coexisting viral infections caused by HIV, HBV, and HCV (seropositive). There is scarce literature regarding the clinical presentation and treatment outcomes for these patients with coexisting viral infections (seropositive HNSCC). We conducted this study to assess the clinical presentation and treatment outcomes (overall survival [OS] and disease-specific survival [DSS]) of seropositive HNSCC patients. Methodology This was a retrospective cohort study on seropositive HNSCC patients registered at our center from 2012 to 2014. The viral infections were identified by the presence of the antibodies to these viruses in the patient's blood samples. Results Out of the 19,137 HNSCC patients registered, 156 patients had HBV, HCV, and/or HIV infection. Among these, HBV infection was the most common (n = 86/156, 55.1%) followed by HIV infection (n = 36/156, 23.1%) and HCV infection (n = 29/156, 18.6%). The oral cavity was the most common subsite involved. Majority of these patients presented at an advanced stage (advanced T stage - 71.8% and node positive - 62.2%). The majority of the patients received curative-intent treatment (65.4%). The OS at 3 years for these HNSCC patients with coexisting HIV, HBV, and HCV infection was 60%, 62.6%, and 57.5%, respectively, and their DSS at 3 years was 58.8%, 78.6%, and 53.8%, respectively. Conclusions Seropositive patients with HNSCC often present in the advanced stage but have a good survival if treated appropriately.
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Affiliation(s)
- Supreet Singh Nayyar
- Department of Head and Neck Oncology, Tata Memorial Centre, Homibhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Oncology, Tata Memorial Centre, Homibhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Akshat Malik
- Department of Head and Neck Oncology, Tata Memorial Centre, Homibhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Anil D'Cruz
- Department of Head and Neck Oncology, Tata Memorial Centre, Homibhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Devendra Chaukar
- Department of Head and Neck Oncology, Tata Memorial Centre, Homibhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Prachi Patil
- Department of Medical Gastroenterology, Tata Memorial Centre, Homibhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Aruna Dhir Alahari
- Department of Medicine, Tata Memorial Centre, Homibhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Sarbani Ghosh Lashkar
- Department of Radiation Oncology, Tata Memorial Centre, Homibhabha National Institute (HBNI), Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Radiation Oncology, Tata Memorial Centre, Homibhabha National Institute (HBNI), Mumbai, Maharashtra, India
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