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Dietz A, Wichmann G, Wiegand S, Waterboer T, Budach W, Klußmann JP. [Update: Epidemiology and Prevention of Oropharyngeal Cancer]. Laryngorhinootologie 2024; 103:296-313. [PMID: 38565110 DOI: 10.1055/a-2133-2348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Due to the association with the causal HPV-16 infection, the oropharyngeal carcinoma spreads into two separate entities depending on HPV-16 positivity. More recent data show a diversified picture of the importance and prevalence of the surrogate parameter p16 (discordance) for a definitive HPV-16 association, which varies worldwide. In the context of prevention options, vaccination is of major and HPV screening of healthy people only of little importance.
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Wichmann G, Vetter N, Lehmann C, Landgraf R, Doxiadis I, Großmann R, Vorobeva E, Dietz A, Zebralla V, Wiegand S, Wald T. Outcome differences in HPV-driven head and neck squamous cell carcinoma attributable to altered human leukocyte antigen frequencies. Front Oncol 2023; 13:1212454. [PMID: 38192630 PMCID: PMC10772155 DOI: 10.3389/fonc.2023.1212454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
Background Effective immune surveillance requires a functioning immune system and natural killer (NK) and T cells for adequate innate and antigen-specific immune responses critically depending on human leukocyte antigens (HLAs) and haplotypes representing advantageous combinations of HLA antigens. Recently, we reported a link between altered frequencies of HLA alleles and haplotypes and developing head and neck squamous cell carcinoma (HNSCC). Whereas the majority of HNSCCs seem to be related to classical risk factors alcohol and tobacco, a subset of HNSCC and especially oropharyngeal squamous cell carcinoma (OPSCC) were etiologically linked to human papillomavirus (HPV) recently. Here, we demonstrate in HPV-driven (p16-positive high risk-HPV DNA-positive) HNSCC a deviating distribution of HLA antigens and haplotypes and their relevance to outcome. Methods Leukocyte DNA of n = 94 HPV-driven HNSCC patients (n = 57 OPSCC, n = 37 outside oropharynx) underwent HLA SSO typing, allowing allele, antigen (allele group), and haplo-typing. Besides comparing these frequencies with those of German blood donors, we analyzed their impact on outcome using Kaplan-Meier plots and Cox proportional hazard regression. Results Antigen and haplotype frequencies demonstrate enrichment of rare antigens and haplotypes. The HLA score for unselected HNSCC patients was not predictive for outcome here. However, together with alcohol consumption, tobacco smoking, T category, and extranodal extension of locoregional metastases and treatment applied, eight HLA traits allow for predicting progression-free and tumor-specific survival. Conclusion Patients can be categorized into low, intermediate-low, intermediate-high, and high risk groups. Using a new PFS risk score for HPV-driven HNSCC may allow to improve prognostication.
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Affiliation(s)
- Gunnar Wichmann
- Department of Otorhinolaryngology, Head and Neck surgery, University Hospital Leipzig, Leipzig, Germany
| | - Nathalie Vetter
- Department of Otorhinolaryngology, Head and Neck surgery, University Hospital Leipzig, Leipzig, Germany
| | - Claudia Lehmann
- Institute for Transfusion Medicine, Transplantation Immunology, University Hospital Leipzig, Leipzig, Germany
| | - Ramona Landgraf
- Institute for Transfusion Medicine, Transplantation Immunology, University Hospital Leipzig, Leipzig, Germany
| | - Ilias Doxiadis
- Institute for Transfusion Medicine, Transplantation Immunology, University Hospital Leipzig, Leipzig, Germany
| | - Rebecca Großmann
- Institute for Transfusion Medicine, Transplantation Immunology, University Hospital Leipzig, Leipzig, Germany
| | - Ekaterina Vorobeva
- Department of Otorhinolaryngology, Head and Neck surgery, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, Head and Neck surgery, University Hospital Leipzig, Leipzig, Germany
| | - Veit Zebralla
- Department of Otorhinolaryngology, Head and Neck surgery, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck surgery, University Hospital Leipzig, Leipzig, Germany
| | - Theresa Wald
- Department of Otorhinolaryngology, Head and Neck surgery, University Hospital Leipzig, Leipzig, Germany
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Balk M, Rupp R, Sievert M, Mantsopoulos K, Allner M, Grundtner P, Mueller SK, Eckstein M, Iro H, Hecht M, Gostian AO. A comparison between p16-positive head and neck cancer of unknown primary (HPV-HNCUP) and oropharyngeal squamous cell carcinoma (HPV-OPSCC): are they the same disease? Eur Arch Otorhinolaryngol 2023; 280:5489-5497. [PMID: 37505261 PMCID: PMC10620243 DOI: 10.1007/s00405-023-08115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION The following study aimed to answer the question if HPV-HNCUP and HPV-OPSCC are the same disease. Propensity score matching (PSM) was used to compare the oncological outcomes of both groups, in particular the 5-year overall survival rate (OS), the 5-year disease specific survival rate (DSS) and the 5-year progression free survival rate (PFS). MATERIALS AND METHODS Firstly, between January 1st, 2007, and March 31st, 2020 a total of 131 patients were treated with HNCUP at our Department. Out of these, 21 patients with a confirmed positive p16 status were referred to surgery followed by adjuvant therapy. Secondly, between January 1st, 2000, and January 31st, 2017, a total of 1596 patients were treated with an OPSSC at our Department. Out of these, 126 patients with a confirmed positive p16 status were referred to surgery followed by adjuvant therapy. After PSM, 84 patients with HPV-OPSCC and 21 HPV-HNCUP remained in the study for further comparison. RESULTS The OS was 63.5% (95% CI 39.4-87.6) for HPV-HNCUP and 88.9% (95% CI 90.4-100.0) for HPV-OPSCC patients and therefore, significantly lower for the first mentioned (p = 0.013). The DSS was also significantly impaired for HPV-HNCUP (71.0%, 95% CI 46.3-95.7), in comparison with HPV-OPSCC patients (95.5%, 95% CI 90.4-100.0; p = 0.002). The PFS for HPV-HNCUP patients was lower (75.6%, 95% CI 54.0-97.2) yet not significantly different to HPV-OPSCC (90.4%, 95% CI 83.5-97.3; p = 0.067). CONCLUSIONS The results presented demonstrate a significant reduced OS and DSS for HPV-HNCUP patients. Accordingly, in our study HPV-HNCUP and HPV-OPSCC are two different entities with a different oncological outcome.
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Affiliation(s)
- Matthias Balk
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Department of Otolaryngology, Head & Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany.
| | - Robin Rupp
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Department of Otolaryngology, Head & Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany
| | - Matti Sievert
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Department of Otolaryngology, Head & Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Department of Otolaryngology, Head & Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany
| | - Moritz Allner
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Department of Otolaryngology, Head & Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany
| | - Philipp Grundtner
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Department of Otolaryngology, Head & Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany
| | - Sarina K Mueller
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Department of Otolaryngology, Head & Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany
| | - Markus Eckstein
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Department of Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Krankenhausstraße 8-10, 91054, Erlangen, Germany
| | - Heinrich Iro
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Department of Otolaryngology, Head & Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany
| | - Markus Hecht
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Department of Radiation Oncology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Universitätsstraße 27, 91054, Erlangen, Germany
| | - Antoniu-Oreste Gostian
- Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Department of Otolaryngology, Head & Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), University Hospital Erlangen, Waldstraße 1, 91054, Erlangen, Germany
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Faisal M, Le NS, Grasl S, Pammer J, Janik S, Heiduschka G, Schratter-Sehn AU, Franz P, Königswieser M, Grasl MC, Erovic BM. Survival Outcome in True Carcinoma of Unknown Primary (tCUP) with p16 + Cervical Metastasis. Int Arch Otorhinolaryngol 2023; 27:e687-e693. [PMID: 37876688 PMCID: PMC10593513 DOI: 10.1055/s-0042-1759575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 08/22/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Age and lymph node ratio have been attributed as independent predictors for survival and recurrence in carcinoma of unknown primary (CUP). Objective The purpose of this study was to analyze the prognostic value of p16 overexpression for CUP in the absence of true primary (TP). Methods The study involved 43 patients who underwent therapeutic lymph node dissection (LND) from 2000 to 2015 after all the diagnostic work up for CUP. Immunohistochemistry for p16 overexpression was performed. Cox proportional hazard regression analysis was used to analyze the prognostic impact on 5-year overall survival (OS) and recurrence-free survival (RFS). Results The male-to-female ratio was 5.1:1, with a median age of 62 years. The clinicopathological data, except for p16 overexpression, did not differ significantly in terms of 5-year OS and RFS. The Cox regression analysis proposed p16 positivity to be an independent prognosticator of regional recurrence-free survival (RRFS) (hazard ratio [HR] 6.180, p = 0.21). The median time to recurrence and death were 10 and 25 months, respectively. Conclusion Cervical metastasis with p16 overexpression is a significant prognostic factor of improved RFS after surgery in CUP. The prognostic significance of lymph node p16 positivity should be further studied.
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Affiliation(s)
- Muhammad Faisal
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
| | - Nguyen-Son Le
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Pammer
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Gregor Heiduschka
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Peter Franz
- Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Hospital, Vienna, Austria
| | - Meinhard Königswieser
- Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Hospital, Vienna, Austria
| | - Matthaeus Ch. Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
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Filippini DM, Broseghini E, Carosi F, Molin DD, Riefolo M, Fabbri L, Abeshi A, Fernandez IJ, Ferracin M. A Systematic Review of Diagnostic and Prognostic Biomarkers for Head and Neck Cancer of Unknown Primary: An Unmet Clinical Need. Diagnostics (Basel) 2023; 13:diagnostics13081492. [PMID: 37189593 DOI: 10.3390/diagnostics13081492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/27/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Head and neck cancer of unknown primary (HNCUP) is defined as cervical lymph node metastases without a detectable primary tumor. The management of these patients presents a challenge to clinicians since guidelines in the diagnosis and treatment of HNCUP remain controversial. An accurate diagnostic workup is fundamental for the search for the hidden primary tumor to allow the best adequate treatment strategy. The purpose of this systematic review is to present the currently available data about the diagnostic and prognostic molecular biomarkers for HNCUP. Systematic research in an electronic database was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and identified 704 articles, of which 23 studies were selected and included in the analysis. Fourteen studies investigated HNCUP diagnostic biomarkers and focused on the human papilloma virus (HPV) and the Epstein-Barr virus (EBV) due to the strong associations with oropharyngeal cancer and nasopharyngeal cancer, respectively. HPV status was shown to possess prognostic value, correlating with longer disease-free survival and overall survival. HPV and EBV are the only available HNCUP biomarkers, and they are already used in clinical practice. A better characterization of the molecular profiling and the development of tissue-of-origin classifiers are necessary to improve the diagnosis, staging, and therapeutic management of patients with HNCUP.
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Affiliation(s)
- Daria Maria Filippini
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, 40138 Bologna, Italy
| | - Elisabetta Broseghini
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, 40138 Bologna, Italy
| | - Francesca Carosi
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Davide Dal Molin
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy
| | - Mattia Riefolo
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Laura Fabbri
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Andi Abeshi
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy
| | - Ignacio Javier Fernandez
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, 40138 Bologna, Italy
- Department of Otorhinolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy
| | - Manuela Ferracin
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, 40138 Bologna, Italy
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Wagner S, Langer C, Wuerdemann N, Reiser S, Abing H, Pons-Kühnemann J, Prigge ES, von Knebel Doeberitz M, Gattenlöhner S, Waterboer T, Schroeder L, Arens C, Klussmann JP, Wittekindt C. Predictors for Survival of Patients with Squamous Cell Carcinoma of Unknown Primary in the Head and Neck Region. Cancers (Basel) 2023; 15:cancers15072167. [PMID: 37046829 PMCID: PMC10093301 DOI: 10.3390/cancers15072167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/26/2023] [Accepted: 03/17/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Human papillomavirus (HPV) status is the most important predictor of survival in oropharyngeal squamous cell carcinoma (OPSCC). In patients with cervical lymph node metastases of squamous cell carcinoma of unknown origin (CUPHNSCC), much less is known. Methods: We assessed a consecutive cohort of CUPHNSCC diagnosed from 2000–2018 for HPV DNA, mRNA, p16INK4a (p16) expression, and risk factors to identify prognostic classification markers. Results: In 32/103 (31%) CUPHNSCC, p16 was overexpressed, and high-risk HPV DNA was detected in 18/32 (56.3%). This was mostly consistent with mRNA detection. In recursive partitioning analysis, CUPHNSCC patients were classified into three risk groups according to performance status (ECOG) and p16. Principal component analysis suggests a negative correlation of p16, HPV DNA, and gender in relation to ECOG, as well as a correlation between N stage, extranodal extension, and tobacco/alcohol consumption. Conclusions: Despite obvious differences, CUPHNSCC shares similarities in risk profile with OPSCC. However, the detection of p16 alone appears to be more suitable for the classification of CUPHNSCC than for OPSCC and, in combination with ECOG, allows stratification into three risk groups. In the future, additional factors besides p16 and ECOG may become important in larger studies or cases with special risk profiles.
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Affiliation(s)
- Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Christine Langer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Nora Wuerdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Susanne Reiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Helen Abing
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Jörn Pons-Kühnemann
- Medical Statistics, Institute of Medical Informatics, University of Giessen, 35392 Giessen, Germany
| | - Elena-Sophie Prigge
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | | | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Lea Schroeder
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
- Department of Otorhinolaryngology, Klinikum Dortmund gGmbH, University Hospital Witten/Herdecke, 44137 Dortmund, Germany
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Johnson L, Ha DT, Hall MB, Shoemaker G, Bevins PA, Strickley J, Demehri S, Redman RA, Joh J. Trending Anti-E7 Serology Predicts Mortality and Recurrence of HPV-Associated Cancers of the Oropharynx. JOURNAL OF ONCOLOGY 2022; 2022:3107990. [PMID: 36199787 PMCID: PMC9529406 DOI: 10.1155/2022/3107990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022]
Abstract
High-risk human papillomavirus (HPV) is among the most common causes of head and neck cancer (HNC) with increasing incidence. HPV-associated HNC patients' clinical response to treatment varies drastically, which has made treatment de-escalation clinical trials challenging. To address the need for noninvasive biomarkers that differentiate patient outcomes, serum antibodies to E7 oncoprotein levels were evaluated in serial serum specimens from HPV-positive HNC patients (n = 48). We have found that increasing antibodies to E7 throughout treatment correlates with increased cancer recurrence or progression to mortality (p = .004) with 100% specificity as a predictive test.
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Affiliation(s)
- Luke Johnson
- Department of Medicine, University of Louisville School of Medicine, KY 40202, USA
| | - Dat T. Ha
- Brown Cancer Center, University of Louisville School of Medicine, KY 40202, USA
| | - Melissa B. Hall
- Brown Cancer Center, University of Louisville School of Medicine, KY 40202, USA
| | - Gregory Shoemaker
- Department of Medicine, University of Louisville School of Medicine, KY 40202, USA
| | - Paul A. Bevins
- Department of Medicine, University of Louisville School of Medicine, KY 40202, USA
| | - John Strickley
- John T Milliken Department of Internal Medicine, Washington University School of Medicine in St. Louis, MO 63110, USA
| | - Shadmehr Demehri
- Center for Cancer Immunology, Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Rebecca A. Redman
- Department of Medicine, University of Louisville School of Medicine, KY 40202, USA
- Brown Cancer Center, University of Louisville School of Medicine, KY 40202, USA
| | - Joongho Joh
- Department of Medicine, University of Louisville School of Medicine, KY 40202, USA
- Brown Cancer Center, University of Louisville School of Medicine, KY 40202, USA
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Serum HPV16 E7 Oncoprotein Is a Recurrence Marker of Oropharyngeal Squamous Cell Carcinomas. Cancers (Basel) 2021; 13:cancers13133370. [PMID: 34282779 PMCID: PMC8268104 DOI: 10.3390/cancers13133370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary Classical markers alone, such as HPV DNA, p16 and HPV mRNA expression, are not enough to stratify HPV-positive head and neck squamous cell carcinoma (HNSCC) patients, but when combined with serological markers, the latter are strong indicators of prognosis in oropharyngeal squamous cell carcinoma (OPSCC) patients. Specifically, HPV16 E7 oncoprotein in serum at the time of diagnosis, correlates with disease recurrence and patient overall survival. To our knowledge, this is the first study to investigate HPV E7 oncoprotein in patient serum. The E7 oncoprotein detection in serum at the time of diagnosis may be useful as a non-invasive procedure for HPV-positive OPSCC patient stratification and follow-up, helping to identify patients at risk for tumor recurrence and metastasis during follow-up, and ultimately, providing a tool for clinicians to identify patients for de-escalation treatment or those to be kept under close surveillance. Abstract Despite improved prognosis for many HPV-positive head and neck squamous cell carcinomas (HNSCCs), some cases are still marked by recurrence and metastasis. Our study aimed to identify novel biomarkers for patient stratification. Classical HPV markers: HPV-DNA, p16 and HPV mRNA expression were studied in HNSCC (n = 67) and controls (n = 58) by qPCR. Subsequently, ELISA tests were used for HPV16 L1 antibody and HPV16 E7 oncoprotein detection in serum at diagnosis and follow-up. All markers were correlated to relapse-free survival (RFS) and overall survival (OS). HPV-DNA was found in HNSCCs (29.85%), HPV16-DNA in 95% of cases, HPV16 E7 mRNA was revealed in 93.75%. p16 was overexpressed in 75% of HPV-positive HNSCC compared to negative samples and controls (p < 0.001). Classical markers correlated with improved OS (p < 0.05). Serological studies showed similar proportions of HPV16 L1 antibodies in all HNSCCs (p > 0.05). Serum E7 oncoprotein was present in 30% HPV-positive patients at diagnosis (p > 0.05) and correlated to HNSCC HPV16 E7 mRNA (p < 0.01), whereas it was associated to worse RFS and OS, especially for oropharyngeal squamous cell carcinoma (OPSCC) (p < 0.01). Detection of circulating HPV16 E7 oncoprotein at diagnosis may be useful for stratifying and monitoring HPV-positive HNSCC patients for worse prognosis, providing clinicians a tool for selecting patients for treatment de-escalation.
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9
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Wichmann G, Willner M, Kuhnt T, Kluge R, Gradistanac T, Wald T, Fest S, Lordick F, Dietz A, Wiegand S, Zebralla V. Standardized Diagnostics Including PET-CT Imaging, Bilateral Tonsillectomy and Neck Dissection Followed by Risk-Adapted Post-Operative Treatment Favoring Radio-Chemotherapy Improve Survival of Neck Squamous Cell Carcinoma of Unknown Primary Patients. Front Oncol 2021; 11:682088. [PMID: 34026656 PMCID: PMC8138574 DOI: 10.3389/fonc.2021.682088] [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: 03/17/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND About five to 10% of cancers in the head and neck region are neck squamous cell carcinoma of unknown primary (NSCCUP). Their diagnosis and treatment are challenging given the risk of missing occult tumors and potential relapse. Recently, we described human papillomavirus (HPV)-related NSCCUP-patients (NSCCUP-P) as a subgroup with superior survival. However, standardized diagnostic workup, novel diagnostic procedures, decision-making in the multidisciplinary tumor board (MDTB) and multimodal therapy including surgery and post-operative radio-chemotherapy (PORCT) may also improve survival. METHODS For assessing the impact of standardized diagnostic processes simultaneously established with the MDTB on outcome, we split our sample of 115 NSCCUP-P into two cohorts treated with curative intent from 1988 to 2006 (cohort 1; n = 53) and 2007 to 2018 (cohort 2; n = 62). We compared diagnostic processes and utilized treatment modalities applying Chi-square tests, and outcome by Kaplan-Meier plots and Cox regression. RESULTS In cohort 2, the standardized processes (regular use of [18F]-FDG-PET-CT imaging followed by examination under anesthesia, EUA, bilateral tonsillectomy and neck dissection, ND, at least of the affected site) improved detection of primaries (P = 0.026) mostly located in the oropharynx (P = 0.001). From 66.0 to 87.1% increased ND frequency (P = 0.007) increased the detection of extracapsular extension of neck nodes (ECE+) forcing risk factor-adapted treatment by increased utilization of cisplatin-based PORCT that improved 5-years progression-free and overall survival from 60.4 and 45.3 to 67.7% (P = 0.411) and 66.1% (P = 0.025). CONCLUSIONS Standardized diagnostic workup followed by ND and risk-factor adapted therapy improves survival of NSCCUP-P.
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Affiliation(s)
- Gunnar Wichmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Maria Willner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Kuhnt
- Department of Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Tanja Gradistanac
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Theresa Wald
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Sandra Fest
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Florian Lordick
- Department of Internal Medicine II, Division of Oncology, University Cancer Center Leipzig (UCCL), Leipzig University Medicine, Leipzig, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Veit Zebralla
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
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10
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Dong Z, Hu R, Du Y, Tan L, Li L, Du J, Bai L, Ma Y, Cui H. Immunodiagnosis and Immunotherapeutics Based on Human Papillomavirus for HPV-Induced Cancers. Front Immunol 2021; 11:586796. [PMID: 33488587 PMCID: PMC7820759 DOI: 10.3389/fimmu.2020.586796] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/24/2020] [Indexed: 12/27/2022] Open
Abstract
Infection with human papillomavirus (HPV) is one of the main causes of malignant neoplasms, especially cervical, anogenital, and oropharyngeal cancers. Although we have developed preventive vaccines that can protect from HPV infection, there are still many new cases of HPV-related cancers worldwide. Early diagnosis and therapy are therefore important for the treatment of these diseases. As HPVs are the major contributors to these cancers, it is reasonable to develop reagents, kits, or devices to detect and eliminate HPVs for early diagnosis and therapeutics. Immunological methods are precise strategies that are promising for the accurate detection and blockade of HPVs. During the last decades, the mechanism of how HPVs induce neoplasms has been extensively elucidated, and several oncogenic HPV early proteins, including E5, E6, and E7, have been shown to be positively related to the oncogenesis and malignancy of HPV-induced cancers. These oncoproteins are promising biomarkers for diagnosis and as targets for the therapeutics of HPV-related cancers. Importantly, many specific monoclonal antibodies (mAbs), or newly designed antibody mimics, as well as new immunological kits, devices, and reagents have been developed for both the immunodiagnosis and immunotherapeutics of HPV-induced cancers. In the current review, we summarize the research progress in the immunodiagnosis and immunotherapeutics based on HPV for HPV-induced cancers. In particular, we depict the most promising serological methods for the detection of HPV infection and several therapeutical immunotherapeutics based on HPV, using immunological tools, including native mAbs, radio-labelled mAbs, affitoxins (affibody-linked toxins), intracellular single-chain antibodies (scFvs), nanobodies, therapeutical vaccines, and T-cell-based therapies. Our review aims to provide new clues for researchers to develop novel strategies and methods for the diagnosis and treatment of HPV-induced tumors.
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Affiliation(s)
- Zhen Dong
- State Key Laboratory of Silkworm Genome Biology, Institute of Sericulture and Systems Biology, College of Sericulture & Textile & Biomass Science, Southwest University, Chongqing, China.,Cancer Center, Reproductive Medicine Center, Medical Research Institute, Southwest University, Chongqing, China.,NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, China
| | - Renjian Hu
- State Key Laboratory of Silkworm Genome Biology, Institute of Sericulture and Systems Biology, College of Sericulture & Textile & Biomass Science, Southwest University, Chongqing, China.,School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Yan Du
- Department of Ultrasound, Chongqing University Central Hospital (Chongqing Emergency Medical Center), Chongqing, China
| | - Li Tan
- State Key Laboratory of Silkworm Genome Biology, Institute of Sericulture and Systems Biology, College of Sericulture & Textile & Biomass Science, Southwest University, Chongqing, China.,Cancer Center, Reproductive Medicine Center, Medical Research Institute, Southwest University, Chongqing, China
| | - Lin Li
- State Key Laboratory of Silkworm Genome Biology, Institute of Sericulture and Systems Biology, College of Sericulture & Textile & Biomass Science, Southwest University, Chongqing, China.,Cancer Center, Reproductive Medicine Center, Medical Research Institute, Southwest University, Chongqing, China.,Department of Immunology, School of Basic Medicine, Southwest Medical University, Luzhou, China
| | - Juan Du
- State Key Laboratory of Silkworm Genome Biology, Institute of Sericulture and Systems Biology, College of Sericulture & Textile & Biomass Science, Southwest University, Chongqing, China.,Department of Dermatology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Longchang Bai
- State Key Laboratory of Silkworm Genome Biology, Institute of Sericulture and Systems Biology, College of Sericulture & Textile & Biomass Science, Southwest University, Chongqing, China.,Cancer Center, Reproductive Medicine Center, Medical Research Institute, Southwest University, Chongqing, China
| | - Yingkang Ma
- State Key Laboratory of Silkworm Genome Biology, Institute of Sericulture and Systems Biology, College of Sericulture & Textile & Biomass Science, Southwest University, Chongqing, China.,Cancer Center, Reproductive Medicine Center, Medical Research Institute, Southwest University, Chongqing, China
| | - Hongjuan Cui
- State Key Laboratory of Silkworm Genome Biology, Institute of Sericulture and Systems Biology, College of Sericulture & Textile & Biomass Science, Southwest University, Chongqing, China.,Cancer Center, Reproductive Medicine Center, Medical Research Institute, Southwest University, Chongqing, China.,NHC Key Laboratory of Birth Defects and Reproductive Health (Chongqing Key Laboratory of Birth Defects and Reproductive Health, Chongqing Population and Family Planning Science and Technology Research Institute), Chongqing, China
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11
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[Tumor biology of oropharyngeal carcinoma]. HNO 2020; 69:249-255. [PMID: 33215226 DOI: 10.1007/s00106-020-00964-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Etiologically, oropharyngeal squamous cell carcinoma (OPSCC) can be divided into OPSCC caused by noxious agents and human papillomavirus (HPV)-driven carcinoma. These types differ with regard to clinical features and prognosis-differences which are rooted in the underlying molecular biology of the tumor. OBJECTIVE The aim of this work is to provide an overview of the molecular biological characteristics of the genetics, epigenetics, and immunology of OPSCC. MATERIALS AND METHODS A literature review was performed on a selection of genetic, epigenetic, and immunological factors characterizing OPSCC. RESULTS The understanding of genetic aberrations and their consequences for cancerogenesis and tumor biology is increasing. Epigenetic phenomena are complementing functional relationships. However, epigenetic mechanisms of gene regulation are complex and much research is still required in this field. Immunological aspects of cancer molecular biology have moved into the focus in light of recent advances in the field of immunotherapy. CONCLUSION The tumor biology of OPSCC is primarily defined by its HPV status. Additionally, HPV-independent genetic, epigenetic, and immunological signatures are being defined. From these advances, rationales for new treatment concepts may evolve.
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12
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Menegaldo A, Schroeder L, Holzinger D, Tirelli G, Dal Cin E, Tofanelli M, Rigo S, Mantovani M, Stellin M, Del Mistro A, Dei Tos AP, Guerriero A, Niero M, Borsetto D, Da Mosto MC, Polesel J, Pawlita M, Waterboer T, Boscolo-Rizzo P. Detection of HPV16/18 E6 Oncoproteins in Head and Neck Squamous Cell Carcinoma Using a Protein Immunochromatographic Assay. Laryngoscope 2020; 131:1042-1048. [PMID: 33103777 DOI: 10.1002/lary.29184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/24/2020] [Accepted: 09/25/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES/HYPOTHESIS The accurate diagnostic assessment of clinically relevant human papillomavirus (HPV) infections in patients with head and neck squamous cell carcinoma represents an urgent unmet medical need. The aim of this study was to determine feasibility, accuracy, and clinical significance of HPV16/18 E6 oncoprotein detection on cytological specimens from oropharyngeal squamous cell carcinoma (OPSCC) and neck lymph node metastasis of SCC from unknown primary tumor (CUP) via a protein immunochromatographic assay. STUDY DESIGN Cross-sectional study. METHODS Cytological specimens from primary tumor and neck metastases were collected from 34 patients with OPSCC or CUP and applied to a lateral flow format test that detects HPV16 and HPV18 E6 oncoproteins. E6 oncoprotein positivity or negativity in these specimens was compared to the specimens' "HPV-driven" reference status, defined by presence of HPV-DNA in combination with p16INK4a overexpression and/or HPV E6 seropositivity. RESULTS Eighteen of 29 OPSCC (62%) and three of five CUP (60%) were HPV-driven according to our reference method. The E6 oncoprotein lateral flow test had a sensitivity of 94% (95% CI: 70%-100%) and a specificity of 100% (95% CI: 66%-100%) on primary tumor, and a sensitivity of 88% (95% CI: 64%-99%) and a specificity of 100% (95% CI: 74%-100%) on neck metastases. Test agreement between the E6 lateral flow test and the clinical reference method, HPV-DNA plus p16INK4a was excellent, both for primary lesion and neck metastases. CONCLUSIONS We found the detection of HPV16/18 E6 oncoproteins to be a feasible, highly reliable, and low-invasive method to assess "HPV-driven" status in OPSCC and CUP. LEVEL OF EVIDENCE II Laryngoscope, 131:1042-1048, 2021.
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Affiliation(s)
- Anna Menegaldo
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Lea Schroeder
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dana Holzinger
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Elisa Dal Cin
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Margherita Tofanelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Stefania Rigo
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Monica Mantovani
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Marco Stellin
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Annarosa Del Mistro
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | | | | | - Monia Niero
- Department of Pathology, University of Padova, Treviso, Italy
| | | | - Maria C Da Mosto
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Michael Pawlita
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
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13
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Blatt S, Pabst A, Zimmer S, Walter C, Al-Nawas B, Krüger M. Clinical efficacy of an antibody-based detection system for human papilloma virus infection in oral squamous cell carcinoma. Clin Oral Investig 2020; 25:2837-2843. [PMID: 33098030 PMCID: PMC8060226 DOI: 10.1007/s00784-020-03601-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/17/2020] [Indexed: 11/26/2022]
Abstract
Objectives There is an increasing number of oral squamous cell carcinoma (OSCC) associated with HPV-16. However, p16 expression by immunohistochemistry as the current gold standard for a surrogate marker for virus infection reveals unsatisfying diagnostic accuracy. The aim of this study was to investigate a new rapid test for L1 antibody detection (Prevocheck®) and to validate its diagnostic performance. Materials and methods In a prospective study, the HPV 16 association of all consecutive patients with an OSCC treated between 2015 and 2019 were analyzed by L1 seropositivity (via PrevoCheck®), p16 immunostaining, and partly multiplex PCR for subtype analysis. Results Overall (n = 107), p16 expression was positive in 17 cases (15.9%), and L1 antibody seropositivity in 7 cases (6.5%). In PCR analysis, two cases of HPV35 and 50 were found. Total HPV prevalence was 8.4% overall and 6.5% for HPV-16. An inferior diagnostic accuracy for HPV-16-associated OSCC in comparison to PrevoCheck® was revealed. Conclusion The rapid test for L1 antibodies showed an optimal sensitivity and specificity, positive and negative predictive value, and an overall diagnostic accuracy of 100%. However, HPV prevalence seems low in OSCC. Clinical relevance L1 rapid test may represent an additional diagnostic staging method to detect HPV-16 association rather than p16 immunohistochemistry.
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Affiliation(s)
- Sebastian Blatt
- Department of Oral- and Maxillofacial Surgery - Plastic Surgery, University Medical Centre, Augustusplatz 2, 55131, Mainz, Germany.
| | - Andreas Pabst
- Department of Oral- and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacher Straße 170, 56072, Koblenz, Germany
| | - Stefanie Zimmer
- Department of Pathology, University Medical Centre, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Christian Walter
- Oral- and Maxillofacial Surgery - Facial Plastic Surgery, Mediplus Clinic, Haifa-Allee 20, 55128, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral- and Maxillofacial Surgery - Plastic Surgery, University Medical Centre, Augustusplatz 2, 55131, Mainz, Germany
| | - Maximilian Krüger
- Department of Oral- and Maxillofacial Surgery - Plastic Surgery, University Medical Centre, Augustusplatz 2, 55131, Mainz, Germany
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14
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Marra E, Siegenbeek van Heukelom ML, Leeman A, Waterboer T, Meijer CJLM, Snijders PJF, King AJ, Cairo I, van Eeden A, Brokking W, van der Weele P, Quint W, Prins JM, de Vries HJC, Schim van der Loeff MF. Virological and Serological Predictors of Anal High-grade Squamous Intraepithelial Lesions Among Human Immunodeficiency Virus-positive Men Who Have Sex With Men. Clin Infect Dis 2020; 68:1377-1387. [PMID: 30165551 DOI: 10.1093/cid/ciy719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/27/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Our objective was to identify virological and serological predictors of anal high-grade squamous intraepithelial lesions (HSIL) in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). METHODS HIV-positive MSM were recruited from a longitudinal study during which anal self-swabs and serum were collected at up to 5 bi-annual visits. Swabs were human papillomavirus (HPV) genotyped, and the type-specific HPV viral load in the anal swabs was determined. Serum antibodies to the E6, E7, E1, E2, and L1 proteins of 7 high-risk HPV (hrHPV) types and HPV6 and 11 were analyzed. The participants who had a high-resolution anoscopy after the last study visit were included in the current analysis. Anal HSIL was diagnosed by histopathological examinations of anal biopsies. The causative HPV type of anal HSIL was determined in whole tissue sections (WTS) and by laser capture micro-dissection if more than one HPV-type was found in WTS. Multivariable logistic regression was used to study whether persistent anal HPV infections, HPV viral loads, and seropositivity for HPV were predictors of anal HSIL, either in general or caused by the concordant HPV type. RESULTS Of 193 HIV-positive MSM, 50 (26%) were diagnosed with anal HSIL. HrHPV persistence in anal swabs was common, varying by hrHPV type between 3-21%. Anal HPV persistence was the only determinant independently associated with anal HSIL, both in general and by concordant, causative HPV type. CONCLUSIONS Persistent HPV infections were strongly associated with anal HSIL, in general as well as for the concordant HPV type.
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Affiliation(s)
- Elske Marra
- Department of Infectious Diseases, Public Health Service Amsterdam
| | | | | | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Chris J L M Meijer
- Department of Pathology, Vrije Universiteit-University Medical Center, Amsterdam
| | - Peter J F Snijders
- Department of Pathology, Vrije Universiteit-University Medical Center, Amsterdam
| | - Audrey J King
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Irina Cairo
- Department of Dermatology, Onze Lieve Vrouwe Gasthuis (OLVG)
| | - Arne van Eeden
- Department of Internal Medicine, Diagnostisch Centrum (DC) Klinieken
| | - Wilma Brokking
- Department of Internal Medicine, Diagnostisch Centrum (DC) Klinieken
| | - Pascal van der Weele
- Department of Pathology, Vrije Universiteit-University Medical Center, Amsterdam.,Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Wim Quint
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam
| | - Henry J C de Vries
- Department of Infectious Diseases, Public Health Service Amsterdam.,Department of Dermatology, University of Amsterdam.,Amsterdam Infection and Immunity Institute, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam.,Amsterdam Infection and Immunity Institute, Academic Medical Center, University of Amsterdam, the Netherlands
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15
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Mayland CR, Ingarfield K, Rogers SN, Dey P, Thomas S, Waylen A, Leary SD, Pring M, Hurley K, Waterboer T, Pawlita M, Ness AR. Disease trajectories, place and mode of death in people with head and neck cancer: Findings from the 'Head and Neck 5000' population-based prospective clinical cohort study. Palliat Med 2020; 34:639-650. [PMID: 32103703 PMCID: PMC7238508 DOI: 10.1177/0269216320904313] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few large studies describe initial disease trajectories and subsequent mortality in people with head and neck cancer. This is a necessary first step to identify the need for palliative care and associated services. AIM To analyse data from the Head and Neck 5000 study to present mortality, place and mode of death within 12 months of diagnosis. DESIGN Prospective cohort study. PARTICIPANTS In total, 5402 people with a new diagnosis of head and neck cancer were recruited from 76 cancer centres in the United Kingdom between April 2011 and December 2014. RESULTS Initially, 161/5402 (3%) and 5241/5402 (97%) of participants were treated with 'non-curative' and 'curative' intent, respectively. Within 12 months, 109/161 (68%) in the 'non-curative' group died compared with 482/5241 (9%) in the 'curative' group. Catastrophic bleed was the terminal event for 10.4% and 9.8% of people in 'non-curative' and 'curative' groups, respectively; terminal airway obstruction was recorded for 7.5% and 6.3% of people in the same corresponding groups. Similar proportions of people in both groups died in a hospice (22.9% 'non-curative'; 23.5% 'curative') and 45.7% of the 'curative' group died in hospital. CONCLUSION In addition to those with incurable head and neck cancer, there is a small but significant 'curative' subgroup of people who may have palliative needs shortly following diagnosis. Given the high mortality, risk of acute catastrophic event and frequent hospital death, clarifying the level and timing of palliative care services engagement would help provide assurance as to whether palliative care needs are being met.
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Affiliation(s)
- Catriona R Mayland
- Department of Oncology and Metabolism,
University of Sheffield, Sheffield, UK
- Palliative Care Institute, University of
Liverpool, Liverpool, UK
| | - Kate Ingarfield
- National Institute of Health (NIHR)
Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation
Trust and University of Bristol, Bristol, UK
- Centre for Trials Research, Cardiff
University, Cardiff, UK
- Community Oral Health, University of
Glasgow Dental School, Glasgow, UK
| | - Simon N Rogers
- Aintree University Hospitals NHS
Foundation Trust, Liverpool, UK
- Edge Hill University, Ormskirk, UK
| | | | - Steven Thomas
- National Institute of Health (NIHR)
Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation
Trust and University of Bristol, Bristol, UK
- Bristol Dental School, Faculty of Health
Sciences, University of Bristol, Bristol, UK
| | - Andrea Waylen
- Bristol Dental School, Faculty of Health
Sciences, University of Bristol, Bristol, UK
| | - Sam D Leary
- National Institute of Health (NIHR)
Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation
Trust and University of Bristol, Bristol, UK
- Bristol Dental School, Faculty of Health
Sciences, University of Bristol, Bristol, UK
| | - Miranda Pring
- National Institute of Health (NIHR)
Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation
Trust and University of Bristol, Bristol, UK
- Bristol Dental School, Faculty of Health
Sciences, University of Bristol, Bristol, UK
| | - Katrina Hurley
- National Institute of Health (NIHR)
Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation
Trust and University of Bristol, Bristol, UK
| | - Tim Waterboer
- Infections and Cancer Epidemiology,
Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ),
Heidelberg, Germany
| | - Michael Pawlita
- Infections and Cancer Epidemiology,
Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ),
Heidelberg, Germany
| | - Andy R Ness
- National Institute of Health (NIHR)
Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation
Trust and University of Bristol, Bristol, UK
- Bristol Dental School, Faculty of Health
Sciences, University of Bristol, Bristol, UK
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16
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Schroeder L, Pring M, Ingarfield K, Pawlita M, Leary SD, Thomas SJ, Waylen A, Waterboer T, Ness AR. HPV driven squamous cell head and neck cancer of unknown primary is likely to be HPV driven squamous cell oropharyngeal cancer. Oral Oncol 2020; 107:104721. [PMID: 32361566 DOI: 10.1016/j.oraloncology.2020.104721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/07/2020] [Accepted: 04/11/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare risk factors and survival in people with oropharyngeal cancer (OPC) and cancer unknown primary (CUP). MATERIALS AND METHODS We recruited 5511 people with head and neck cancer between 2011 and 2014. We collected data on age, gender, smoking, sexual behaviour, treatment intent, stage, co-morbidity, p16 protein overexpression and biological samples. We assessed human papillomavirus (HPV) status using serological response and p16 immunohistochemistry. We followed up participants to identify those who had died. We used Cox proportional hazards regression models to estimate survival and adjust for confounders. RESULTS Of the 4843 people with squamous cell cancer 196 had CUP - a prevalence of 4.0% (95% CI 3.5% to 4.6%). Of those people with OPC and CUP 69% (1150/1668) and 60% (106/178) respectively had HPV driven tumours. People with HPV driven tumours were likely to be younger, male, non-smokers, with higher stage disease, a history of oral sex and less co-morbidity. People with HPV negative CUP and HPV driven CUP had the survival of people with a stage II/III HPV negative OPC and a stage I/II HPV driven OPC respectively. The adjusted hazard ratio for HPV driven OPC and CUP compared with HPV negative OPC and CUP was 0.46 (95% CI 0.35 to 0.59) and 0.34 (95% CI 0.14 to 0.82) respectively. CONCLUSION HPV driven CUP is likely to be HPV driven OPC. Identifying effective methods of detecting occult OPC could improve CUP management and allow the detection of early lesions in high risk groups.
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Affiliation(s)
- Lea Schroeder
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Miranda Pring
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Kate Ingarfield
- Bristol Dental School, University of Bristol, Bristol, United Kingdom; Centre for Trials Research, College of Biomedical and Life Science, Cardiff University, Cardiff, United Kingdom; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Michael Pawlita
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sam D Leary
- National Institute of Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Steve J Thomas
- Bristol Dental School, University of Bristol, Bristol, United Kingdom; National Institute of Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Andrea Waylen
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andy R Ness
- Bristol Dental School, University of Bristol, Bristol, United Kingdom; National Institute of Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom.
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17
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Layman H, Rickert KW, Wilson S, Aksyuk AA, Dunty JM, Natrakul D, Swaminathan N, DelNagro CJ. Development and validation of a multiplex immunoassay for the simultaneous quantification of type-specific IgG antibodies to E6/E7 oncoproteins of HPV16 and HPV18. PLoS One 2020; 15:e0229672. [PMID: 32214362 PMCID: PMC7098588 DOI: 10.1371/journal.pone.0229672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 02/11/2020] [Indexed: 01/24/2023] Open
Abstract
More than 170 types of human papilloma viruses (HPV) exist with many causing proliferative diseases linked to malignancy in indications such as cervical cancer and head and neck squamous cell carcinoma. Characterization of antibody levels toward HPV serology is challenging due to complex biology of oncoproteins, pre-existing titers to multiple HPV types, cross-reactivity, and low affinity, polyclonal responses. Using multiplex technology from MSD, we have developed an assay that simultaneously characterizes antibodies against E6 and E7 oncoproteins of HPV16 and 18, the primary drivers of HPV-associated oncogenesis. We fusion tagged our E6 and E7 proteins with MBP via two-step purification, spot-printed an optimized concentration of protein into wells of MSD 96-well plates, and assayed various cynomolgus monkey, human and HPV+ cervical cancer patient serum to validate the assay. The dynamic range of the assay covered 4-orders of magnitude and antibodies were detected in serum at a dilution up to 100,000-fold. The assay was very precise (n = 5 assay runs) with median CV of human serum samples ~ 5.3% and inter-run variability of 11.4%. The multiplex serology method has strong cross-reactivity between E6 oncoproteins from human serum samples as HPV18 E6 antigens neutralized 5 of 6 serum samples as strongly as HPV16 E6. Moderate concordance (Spearman’s Rank = 0.775) was found between antibody responses against HPV16 E7 in the multiplex assay compared to standard ELISA serology methods. These results demonstrate the development of a high-throughput, multi-plex assay that requires lower sample quantity input with greater dynamic range to detect type-specific anti-HPV concentrations to E6 and E7 oncoproteins of HPV16 and 18.
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Affiliation(s)
- Hans Layman
- AstraZeneca plc, South San Francisco, California, United States of America
- * E-mail:
| | - Keith W. Rickert
- AstraZeneca plc, Gaithersburg, Maryland, United States of America
| | - Susan Wilson
- AstraZeneca plc, Gaithersburg, Maryland, United States of America
| | | | - Jill M. Dunty
- Meso Scale Diagnostics, LLC., Rockville, Maryland, United States of America
| | - Dusit Natrakul
- Meso Scale Diagnostics, LLC., Rockville, Maryland, United States of America
| | - Nithya Swaminathan
- AstraZeneca plc, South San Francisco, California, United States of America
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18
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Molecular Diagnostics in Human Papillomavirus-Related Head and Neck Squamous Cell Carcinoma. Cells 2020; 9:cells9020500. [PMID: 32098320 PMCID: PMC7072739 DOI: 10.3390/cells9020500] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023] Open
Abstract
The incidence of human papillomavirus (HPV)-related head and neck squamous cell carcinoma continues to increase. Accurate diagnosis of the HPV status of a tumor is vital, as HPV+ versus HPV- tumors represent two unique biological and clinical entities with different treatment strategies. High-risk HPV subtypes encode oncoproteins E6 and E7 that disrupt cellular senescence and ultimately drive tumorigenesis. Current methods for detection of HPV take advantage of this established oncogenic pathway and detect HPV at various biological stages. This review article provides an overview of the existing technologies employed for the detection of HPV and their current or potential future role in management and prognostication.
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19
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Cho WK, Roh JL, Cho KJ, Choi SH, Nam SY, Kim SY. Predictors of survival and recurrence after primary surgery for cervical metastasis of unknown primary. J Cancer Res Clin Oncol 2019; 146:925-933. [PMID: 31858242 DOI: 10.1007/s00432-019-03111-x] [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: 11/07/2019] [Accepted: 12/12/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Cervical metastasis from unknown primary (CUP) is commonly classified as an advanced overall stage. P16 or human papillomavirus (HPV) positivity in metastatic lymph nodes (LN) might be associated with a favorable survival outcome of CUP. Therefore, we evaluated the prognostic values of p16 immuno-positivity in LN and other clinicopathological factors in patients with squamous cell carcinoma CUP (SCCUP). METHODS This study involved 83 patients who underwent therapeutic neck dissection and panendoscopic examination and biopsy for suspected CUP. P16 immunostaining and HPV typing in LN were performed in 56 patients. Cox proportional hazard regression analyses were used to identify factors associated with overall survival (OS) and disease-free survival (DFS). RESULTS Postoperatively, primary tumors (PT) were found in 32 (38.6%) patients, mainly (90.6%) in the oropharynx, and not found in 51 (61.4%) patients. The clinicopathological data (except for histological grade) and 5-year OS and DFS rates did not significantly differ between patients with and without PT identification (all P > 0.05). P16 positivity was associated with favorable OS and DFS outcomes in the patients with PT (P < 0.05) but not in those without PT (P > 0.1). Multivariate analyses showed that age (> 60 years) and LN ratio (≥ 0.1) were the independent predictors of OS and DFS outcomes (all P < 0.05). P16 positivity or other factors were not independent factors. CONCLUSION Age and LN ratio are significant risk factors of survival and recurrence after primary surgery for SCCUP. Prognostic significance of LN p16 positivity should be further studied.
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Affiliation(s)
- Won Ki Cho
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| | - Kyung-Ja Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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20
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Lehtinen M, Apter D, Eriksson T, Harjula K, Hokkanen M, Lehtinen T, Natunen K, Damaso S, Soila M, Bi D, Struyf F. Effectiveness of the AS04-adjuvanted HPV-16/18 vaccine in reducing oropharyngeal HPV infections in young females-Results from a community-randomized trial. Int J Cancer 2019; 147:170-174. [PMID: 31736068 PMCID: PMC7318585 DOI: 10.1002/ijc.32791] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/08/2019] [Accepted: 10/29/2019] [Indexed: 01/03/2023]
Abstract
We studied effectiveness of the AS04-adjuvanted HPV-16/18 (AS04-HPV-16/18) vaccine against human papillomavirus (HPV) oropharyngeal infections associated with the increase of head/neck cancers in western countries. All 38,631 resident adolescents from 1994 to 1995 birth cohorts of 33 Finnish communities were invited in this community-randomized trial (NCT00534638). During 2008-2009, 11,275 girls and 6,129 boys were enrolled in three arms of 11 communities each. In Arm A, 90% of vaccinated girls/boys, and in Arm B, 90% of vaccinated girls received AS04-HPV-16/18 vaccine. Other Arm A/B and all Arm C vaccinated participants received control vaccine. All Arm A participants and Arm B female participants were blinded to vaccine allocation. Oropharyngeal samples were analyzed from 4,871 18.5-year-old females who attended follow-up visit 3-6 years postvaccination. HPV DNA prevalence was determined by SPF-10 LiPA and Multiplex type-specific PCR. Total vaccine effectiveness (VE) was defined as relative reduction of oropharyngeal HPV prevalence in pooled Arms A/B HPV-vaccinated females vs. all Arm C females. VE against oropharyngeal HPV-16/18, HPV-31/45 and HPV-31/33/45 infections were 82.4% (95% confidence intervals [CI]: 47.3-94.1), 75.3% (95%CI: 12.7-93.0) and 69.9% (95% CI: 29.6-87.1), respectively. In conclusion, the AS04-HPV-16/18 vaccine showed effectiveness against vaccine and nonvaccine HPV-types oropharyngeal infections in adolescent females up to 6 years postvaccination.
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Affiliation(s)
- Matti Lehtinen
- Department of Infections and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Tiina Eriksson
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Katja Harjula
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Mari Hokkanen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Tuomas Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Kari Natunen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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21
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Gangkofner DS, Holzinger D, Schroeder L, Eichmüller SB, Zörnig I, Jäger D, Wichmann G, Dietz A, Broglie MA, Herold-Mende C, Dyckhoff G, Boscolo-Rizzo P, Ezic J, Marienfeld RB, Möller P, Völkel G, Kraus JM, Kestler HA, Brunner C, Schuler PJ, Wigand M, Theodoraki MN, Doescher J, Hoffmann TK, Pawlita M, Butt J, Waterboer T, Laban S. Patterns of antibody responses to nonviral cancer antigens in head and neck squamous cell carcinoma patients differ by human papillomavirus status. Int J Cancer 2019; 145:3436-3444. [PMID: 31407331 DOI: 10.1002/ijc.32623] [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: 05/29/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 12/24/2022]
Abstract
There have been hints that nonviral cancer antigens are differentially expressed in human papillomavirus (HPV)-positive and HPV-negative head and neck squamous cell carcinoma (HNSCC). Antibody responses (AR) to cancer antigens may be used to indirectly determine cancer antigen expression in the tumor using a noninvasive and tissue-saving liquid biopsy. Here, we set out to characterize AR to a panel of nonviral cancer antigens in HPV-positive and HPV-negative HNSCC patients. A fluorescent microbead multiplex serology to 29 cancer antigens (16 cancer-testis antigens, 5 cancer-retina antigens and 8 oncogenes) and 29 HPV-antigens was performed in 382 HNSCC patients from five independent cohorts (153 HPV-positive and 209 HPV-negative). AR to any of the cancer antigens were found in 272/382 patients (72%). The ten most frequent AR were CT47, cTAGE5a, c-myc, LAGE-1, MAGE-A1, -A3, -A4, NY-ESO-1, SpanX-a1 and p53. AR to MAGE-A3, MAGE-A9 and p53 were found at significantly different prevalences by HPV status. An analysis of AR mean fluorescent intensity values uncovered remarkably different AR clusters by HPV status. To identify optimal antigen selections covering a maximum of patients with ≤10 AR, multiobjective optimization revealed distinct antigen selections by HPV status. We identified that AR to nonviral antigens differ by HPV status indicating differential antigen expression. Multiplex serology may be used to characterize antigen expression using serum or plasma as a tissue-sparing liquid biopsy. Cancer antigen panels should address the distinct antigen repertoire of HPV-positive and HPV-negative HNSCC.
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Affiliation(s)
- Dominik S Gangkofner
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Ulm, Head & Neck Cancer Center of the Comprehensive Cancer Center Ulm, Ulm, Germany
| | - Dana Holzinger
- Infections and Cancer Epidemiology (F022), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lea Schroeder
- Infections and Cancer Epidemiology (F022), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan B Eichmüller
- Research Group GMP & T Cell Therapy (D210), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Inka Zörnig
- National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Applied Tumor Immunity (D120), Heidelberg, Germany
| | - Dirk Jäger
- National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany.,National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Applied Tumor Immunity (D120), Heidelberg, Germany
| | - Gunnar Wichmann
- Department of Otorhinolaryngology, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, University Hospital Leipzig, Leipzig, Germany
| | - Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Christel Herold-Mende
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany.,Department of Neurosurgery, Division of Experimental Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Dyckhoff
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso, Italy
| | - Jasmin Ezic
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Ulm, Head & Neck Cancer Center of the Comprehensive Cancer Center Ulm, Ulm, Germany
| | | | - Peter Möller
- Institute of Pathology, University Medical Center Ulm, Ulm, Germany
| | - Gunnar Völkel
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Johann M Kraus
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Hans A Kestler
- Institute of Medical Systems Biology, Ulm University, Ulm, Germany
| | - Cornelia Brunner
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Ulm, Head & Neck Cancer Center of the Comprehensive Cancer Center Ulm, Ulm, Germany
| | - Patrick J Schuler
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Ulm, Head & Neck Cancer Center of the Comprehensive Cancer Center Ulm, Ulm, Germany
| | - Marlene Wigand
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Ulm, Head & Neck Cancer Center of the Comprehensive Cancer Center Ulm, Ulm, Germany
| | - Marie N Theodoraki
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Ulm, Head & Neck Cancer Center of the Comprehensive Cancer Center Ulm, Ulm, Germany
| | - Johannes Doescher
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Ulm, Head & Neck Cancer Center of the Comprehensive Cancer Center Ulm, Ulm, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Ulm, Head & Neck Cancer Center of the Comprehensive Cancer Center Ulm, Ulm, Germany
| | - Michael Pawlita
- Infections and Cancer Epidemiology (F022), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julia Butt
- Infections and Cancer Epidemiology (F022), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Infections and Cancer Epidemiology (F022), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Simon Laban
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Ulm, Head & Neck Cancer Center of the Comprehensive Cancer Center Ulm, Ulm, Germany
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22
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Antibody Responses to Cancer Antigens Identify Patients with a Poor Prognosis among HPV-Positive and HPV-Negative Head and Neck Squamous Cell Carcinoma Patients. Clin Cancer Res 2019; 25:7405-7412. [DOI: 10.1158/1078-0432.ccr-19-1490] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/27/2019] [Accepted: 08/20/2019] [Indexed: 12/24/2022]
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23
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Boscolo-Rizzo P, Schroeder L, Sacchetto V, Holzinger D, Da Mosto MC, Tirelli G, Dal Cin E, Mantovani M, Menegaldo A, Del Mistro A, Romeo S, Dei Tos AP, Niero M, Rigo S, Dyckhoff G, Hess J, Alemany L, Quer M, León X, Polesel J, Pawlita M, Bertorelle R. Absence of disruptive TP53 mutations in high-risk human papillomavirus-driven neck squamous cell carcinoma of unknown primary. Head Neck 2019; 41:3833-3841. [PMID: 31414564 DOI: 10.1002/hed.25915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/06/2019] [Accepted: 07/30/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To enforce the evidence for causality between high-risk human papillomavirus (hrHPV) infections and neck squamous cell carcinoma from unknown primary (NSCCUP) and provide biological basis for treatment de-intensification, we searched for TP53 mutations in association with HPV status. METHODS TP53 mutations were searched for by amplification of exons 4 to 10. RESULTS Of the 70 NSCCUP, 27 (39%) harbored HPV infection. TP53 sequencing resulted in the identification of 19 patients harboring single mutations including 16 disruptive alterations (84%). The association of TP53 mutations and HPV could be evaluated in 48 NSCCUP including those with disruptive mutation in any exon (n = 16) and those without mutations but with complete sequence of exons 4 to 9 (n = 32): no disruptive mutations were found in the 17 HPV-driven NSCCUP but in 16 of the 31 non-HPV-driven NSCCUP (P = .0002). CONCLUSION In a fraction of cases, NSCCUP is an HPV-driven entity harboring wild-type TP53 gene or nondisruptive TP53 mutations. HPV-driven NSCCUP might benefit from treatment de-intensification.
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Affiliation(s)
- Paolo Boscolo-Rizzo
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Lea Schroeder
- Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Valeria Sacchetto
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Dana Holzinger
- Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maria Cristina Da Mosto
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Elisa Dal Cin
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Monica Mantovani
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Anna Menegaldo
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Annarosa Del Mistro
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Salvatore Romeo
- Department of Pathology, San Donà di Piave Hospital, Azienda ULSS 4 Veneto Orientale, San Donà di Piave, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, University of Padova, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Monia Niero
- Department of Pathology, University of Padova, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Stefania Rigo
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Gerhard Dyckhoff
- Molecular Cell Biology Group, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jochen Hess
- Section Experimental and Translational Head and Neck Oncology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg and Molecular Mechanism of Head and Neck Tumors, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laia Alemany
- Unit of Infections and Cancer, Institut Català d'Oncologia (ICO), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, Barcelona, Spain
| | - Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, Barcelona, Spain
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Michael Pawlita
- Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roberta Bertorelle
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
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24
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Rassy E, Nicolai P, Pavlidis N. Comprehensive management of HPV‐related squamous cell carcinoma of the head and neck of unknown primary. Head Neck 2019; 41:3700-3711. [DOI: 10.1002/hed.25858] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/09/2019] [Accepted: 06/12/2019] [Indexed: 01/19/2023] Open
Affiliation(s)
- Elie Rassy
- Department of Medical OncologyInstitut Gustave Roussy Villejuif France
- Department of Medical OncologyHotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University Beirut Lebanon
| | - Piero Nicolai
- Department of OtorhinolaryngologyHead and Neck Surgery, University of Brescia Brescia Italy
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25
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Ren J, Yang W, Su J, Ren X, Fazelzad R, Albert T, Habbous S, Goldstein DP, de Almeida JR, Hansen A, Jang R, Bratman SV, Hope A, Chen R, Wang J, Xu Y, Cheng D, Zhao Y, Xu W, Liu G. Human papillomavirus and p16 immunostaining, prevalence and prognosis of squamous carcinoma of unknown primary in the head and neck region. Int J Cancer 2019; 145:1465-1474. [PMID: 30698281 DOI: 10.1002/ijc.32164] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/19/2018] [Accepted: 12/21/2018] [Indexed: 02/05/2023]
Abstract
The prevalence of human papillomavirus (HPV) in squamous cell carcinoma of unknown primary in the head and neck (SCCUPHN), and prognosis by HPV status of SCCUPHN patients has been difficult to estimate because of the rarity of this subtype. In MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, EMBASE, Cochrane library and Web of Science searches, observational studies and clinical trials that reported survival rates of patients with SCCUPHN by HPV status were identified. Meta-analysis estimated the prevalence and prognosis (overall survival, OS; progression-free survival, PFS) of SCCUPHN by HPV status, and compared them to studies of oropharyngeal squamous cell carcinoma (OPSCC) from the same institutions and across continents. In 17 SCCUPHN studies (n = 1,149) and 17 institution-matched OPSCC studies (n = 6,522), the pooled HPV prevalence of SCCUPHN was 49%, which was only 10% (95%CI: 1-19%) lower than OPSCC prevalence in the underlying population. Estimated 5-year OS for HPV-negative SCCUPHN was 44% (95%CI: 36-51%) vs. HPV-positive SCCUPHN of 91% (95%CI: 86-96%); hazard ratio (HR) for OS was 3.25 (95%CI: 2.45-4.31) and PFS was 4.49 (95%CI: 2.88-7.02). HRs by HPV status for OPSCC were similar to that in SCCUPHN. While North American SCCUPHNs had higher HPV prevalence than European SCCUPHNs (OR = 2.68 (95%CI: 1.3-5.6)), HR of OS for HPV-negative vs. HPV-positive patients were similar in both continents (HRs of 3.78-4.09). Prevalence of HPV among SCCUPHN patients were lower than in OPSCC. The survival benefit conferred by being HPV-positive was similar in SCCUPHN as in OPSCCs, independent of continent.
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Affiliation(s)
- Jianjun Ren
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China.,Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Wen Yang
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Xue Ren
- Department of Economic Statistics, School of Statistics and Management, Shanghai University of Finance and Economics, Shanghai, China
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Tiong Albert
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Steven Habbous
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology- Head and Neck Surgery, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology- Head and Neck Surgery, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aaron Hansen
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Raymond Jang
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, University of Toronto, and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ruiqi Chen
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jing Wang
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yang Xu
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Danni Cheng
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Liu
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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26
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Ursu RG, Danciu M, Spiridon IA, Ridder R, Rehm S, Maffini F, McKay-Chopin S, Carreira C, Lucas E, Costan VV, Popescu E, Cobzeanu B, Ghetu N, Iancu LS, Tommasino M, Pawlita M, Holzinger D, Gheit T. Role of mucosal high-risk human papillomavirus types in head and neck cancers in Romania. PLoS One 2018; 13:e0199663. [PMID: 29940024 PMCID: PMC6016945 DOI: 10.1371/journal.pone.0199663] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/12/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Limited information is available about the involvement of human papillomavirus (HPV) in head and neck squamous cell carcinomas (HNSCCs) in Romanian patients. OBJECTIVE To evaluate the HPV-attributable fraction in HNSCCs collected in Northeastern Romania. MATERIALS AND METHODS In total, 189 formalin-fixed paraffin-embedded tissue samples (99 oral cavity tumors, 28 oropharynx, 48 pharynx, and 14 larynx/hypopharynx) were analyzed for HPV DNA and RNA using Luminex-based assays, and for overexpression of p16INK4a (p16) by immunohistochemistry. RESULTS Of the 189 cases, 23 (12.2%) were HPV DNA-positive, comprising half of the oropharyngeal cases (14/28, 50.0%) and 9/161 (5.6%) of the non-oropharyngeal cases. HPV16 was the most prevalent HPV type (20/23, 86.9%), followed by HPV18 (5/23, 21.7%) and HPV39 (1/23, 4.3%). Only two (2/189, 1.1%) HNSCC cases were HPV-driven, i.e. positive for both HPV DNA and RNA. CONCLUSION A very small subset of HNSCC cases within this cohort from Northeastern Romania appeared to be HPV-driven.
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Affiliation(s)
- Ramona Gabriela Ursu
- University of Medicine and Pharmacy “Grigore T. Popa”, Discipline of Microbiology, Iași, Romania
| | - Mihai Danciu
- University of Medicine and Pharmacy “Grigore T. Popa”, Department of Pathology, Iași, Romania
| | | | - Ruediger Ridder
- Roche MTM Laboratories, Mannheim, Germany
- Ventana Medical Systems, Inc., Tucson, Arizona, United States of America
| | - Susanne Rehm
- Roche MTM Laboratories, Mannheim, Germany
- Ventana Medical Systems, Inc., Tucson, Arizona, United States of America
| | - Fausto Maffini
- Department of Pathology, European Institute of Oncology, Milan, Italy
| | - Sandrine McKay-Chopin
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Christine Carreira
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Eric Lucas
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Victor-Vlad Costan
- University of Medicine and Pharmacy “Grigore T. Popa”, Department of Oral and Maxillofacial Surgery, Iași, Romania
| | - Eugenia Popescu
- University of Medicine and Pharmacy “Grigore T. Popa”, Department of Oral and Maxillofacial Surgery, Iași, Romania
| | - Bogdan Cobzeanu
- University of Medicine and Pharmacy “Grigore T. Popa”, Department of Otorhinolaryngology, Iași, Romania
| | - Nicolae Ghetu
- University of Medicine and Pharmacy “Grigore T. Popa”, Department of Plastic surgery, Iași, Romania
| | - Luminita Smaranda Iancu
- University of Medicine and Pharmacy “Grigore T. Popa”, Discipline of Microbiology, Iași, Romania
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Michael Pawlita
- German Cancer Research Center (DKFZ), Division of Molecular Diagnostics of Oncogenic Infections, Heidelberg, Germany
| | - Dana Holzinger
- German Cancer Research Center (DKFZ), Division of Molecular Diagnostics of Oncogenic Infections, Heidelberg, Germany
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
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