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Muijlwijk T, Nijenhuis DNLM, Ganzevles SH, Ekhlas F, Ballesteros-Merino C, Peferoen LAN, Bloemena E, Fox BA, Poell JB, Leemans CR, Brakenhoff RH, van de Ven R. Immune cell topography of head and neck cancer. J Immunother Cancer 2024; 12:e009550. [PMID: 39053947 DOI: 10.1136/jitc-2024-009550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Approximately 50% of head and neck squamous cell carcinomas (HNSCC) recur after treatment with curative intent. Immune checkpoint inhibitors are treatment options for recurrent/metastatic HNSCC; however, less than 20% of patients respond. To increase this response rate, it is fundamental to increase our understanding of the spatial tumor immune microenvironment (TIME). METHODS In total, 53 HNSCC specimens were included. Using a seven-color multiplex immunohistochemistry panel we identified tumor cells, CD163+macrophages, B cells, CD8+T cells, CD4+T helper cells and regulatory T cells (Tregs) in treatment-naive surgical resection specimens (n=29) and biopsies (n=18). To further characterize tumor-infiltrating CD8+T cells, we stained surgical resection specimens (n=12) with a five-color tumor-resident panel including CD103, Ki67, CD8 and pan-cytokeratin. Secretome analysis was performed on matched tumor suspensions (n=11) to measure protein levels. RESULTS Based on CD8+T cell infiltrates, we identified four different immunotypes: fully infiltrated, stroma-restricted, immune-excluded, and immune-desert. We found higher cytokine levels in fully infiltrated tumors compared with other immunotypes. While the highest immune infiltrates were observed in the invasive margin for all immune cells, CD163+macrophages and Tregs had the highest tendency to infiltrate the tumor center. Within the tumor center, especially B cells stayed at the tumor stroma, whereas CD163+macrophages, followed by T cells, were more often localized within tumor fields. Also, B cells were found further away from other cells and often formed aggregates while T cells and CD163+macrophages tended to be more closely located to each other. Across resection specimens from various anatomical sites within the head and neck, oral cavity tumors exhibited the highest densities of Tregs. Moreover, the distance from B cells and T cells to tumor cells was shortest in oral cavity squamous cell carcinoma (OCSCC), suggesting more interaction between lymphocytes and tumor cells. Also, the fraction of T cells within 10 µm of CD163+macrophages was lowest in OCSCC, indicating fewer myeloid/T-cell suppressive interactions in OCSCC. CONCLUSIONS We comprehensively described the TIME of HNSCC using a unique data set of resection specimens. We discovered that the composition, as well as the relative localization of immune cells in the TIME, differed in distinct anatomical sites of the head and neck.
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Affiliation(s)
- Tara Muijlwijk
- Otolaryngology / Head and Neck Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Cancer Biology and Immunology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
- Cancer Immunology, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
| | - Dennis N L M Nijenhuis
- Otolaryngology / Head and Neck Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Cancer Biology and Immunology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
- Cancer Immunology, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
| | - Sonja H Ganzevles
- Otolaryngology / Head and Neck Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Cancer Biology and Immunology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
- Cancer Immunology, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
| | - Fatima Ekhlas
- Otolaryngology / Head and Neck Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Cancer Biology and Immunology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
- Cancer Immunology, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
| | - Carmen Ballesteros-Merino
- Molecular and Tumor Immunology Laboratory, Providence Cancer Institute, Robert W. Franz Research Center at the Earle A. Chiles Research Institute, Portland, Oregon, USA
| | - Laura A N Peferoen
- Cancer Biology and Immunology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
- Pathology, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
- Maxillofacial Surgery/ Oral Pathology, Academic Center for Dentistry, Amsterdam, The Netherlands
| | - Elisabeth Bloemena
- Cancer Biology and Immunology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
- Pathology, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
- Maxillofacial Surgery/ Oral Pathology, Academic Center for Dentistry, Amsterdam, The Netherlands
| | - Bernard A Fox
- Molecular and Tumor Immunology Laboratory, Providence Cancer Institute, Robert W. Franz Research Center at the Earle A. Chiles Research Institute, Portland, Oregon, USA
| | - Jos B Poell
- Otolaryngology / Head and Neck Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Cancer Biology and Immunology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - C René Leemans
- Otolaryngology / Head and Neck Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Cancer Biology and Immunology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Ruud H Brakenhoff
- Otolaryngology / Head and Neck Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Cancer Biology and Immunology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Rieneke van de Ven
- Otolaryngology / Head and Neck Surgery, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
- Cancer Biology and Immunology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
- Cancer Immunology, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
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2
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Ekanayaka RP, Tilakaratne WM. Impact of histopathological parameters in prognosis of oral squamous cell carcinoma. Oral Dis 2024. [PMID: 38938003 DOI: 10.1111/odi.15035] [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: 01/31/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Squamous cell carcinomas comprise approximately 90% of all oral malignancies. There is a wide geographical variation in the incidence of oral cancer, with South and South East Asia (SSEA) accounting for almost two third of new cases. The prognosis of oral cancer is influenced by a vast array of factors including demographic, clinical, histopathological and molecular factors. The objective this review is to analyse the impact of histopathological features assessed in hematoxylin and eosin stained sections on the prognosis of OSCC. MATERIALS AND METHODS Medline and Scopus data base search was performed in order to identify related articles on histopathological parameters in predicting prognosis of oral squamous cell carcinoma. The primary emphasis is on the studies conducted in SSEA, with an accompanying comparison of their findings with those from research conducted in other parts of the world. RESULTS It has been shown that the number of studies conducted in SSEA is not proportionate to the high prevalence of Oral Cancer in the region. There is no significant difference between the findings from SSEA compared to the rest of the world. It is clearly shown that most histopathological parameters can be accurately used to predict nodal metastasis and prognosis. CONCLUSIONS Histopathological parameters can be used reliably in planning treatment of Oral cancer. Clinicians should combine clinical and histopathological parameters in drawing treatment plan for Oral Cancer.
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Affiliation(s)
- R P Ekanayaka
- Department of Oral Pathology, Faculty of Dental Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - W M Tilakaratne
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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3
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Tangthongkum M, Phisalmongkhon S, Leelasawatsuk P, Supanimitjaroenporn P, Kirtsreesakul V, Tantipisit J. Impact of human papillomavirus status on survival in patients with oral cancer. Laryngoscope Investig Otolaryngol 2024; 9:e1294. [PMID: 38867852 PMCID: PMC11168070 DOI: 10.1002/lio2.1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/24/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
Objectives To examine the association between the human papillomavirus (HPV) infection and overall survival rate in patients with oral cancer. Methods This retrospective cohort study examined HPV status in 454 patients who were diagnosed with oral squamous cell carcinoma (OSCC) using the records of patients who underwent an initial treatment for OSCC between 2012 and 2021 at our institution as retrieved from the Cancer Registry database. The survival rates of the HPV-positive and HPV-negative groups were assessed and compared, and independent factors associated with survival were analyzed using multivariate Cox regression models. Results Of the 454 patients with OSCC included in this study, 73 were excluded for invalid HPV tests. Of the remaining patients, 39 and 342 patients were categorized into HPV-positive and HPV-negative groups, respectively. The prevalence of HPV-positive in the patients with OSCC was 10.2% (95% confidence interval 7.2%-13.2%). The 3-year overall survival rates were 56.2% and 53.9% in the HPV-positive and HPV-negative groups, respectively. The 3-year disease-specific survival rates in the HPV-positive and HPV-negative groups were 60.2% and 56.9%, respectively. The survival differences were not statistically significant. HPV-positive status was not a significant predictor of overall survival in the multivariable Cox regression analyses (p = 0.728). Conclusion The prevalence of HPV-positivity among patients with OSCC in the study was 10.2%. No association was found between HPV-positive status and 3-year overall survival in patients with oral cancer. Level of evidence Level 3.
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Affiliation(s)
- Manupol Tangthongkum
- Department of Otolaryngology Head and Neck SurgeryFaculty of Medicine, Prince of Songkla UniversityHat YaiSongkhlaThailand
| | - Suwapat Phisalmongkhon
- Department of Otolaryngology Head and Neck SurgeryFaculty of Medicine, Prince of Songkla UniversityHat YaiSongkhlaThailand
| | - Peesit Leelasawatsuk
- Department of Otolaryngology Head and Neck SurgeryFaculty of Medicine, Prince of Songkla UniversityHat YaiSongkhlaThailand
| | - Pasawat Supanimitjaroenporn
- Department of Otolaryngology Head and Neck SurgeryFaculty of Medicine, Prince of Songkla UniversityHat YaiSongkhlaThailand
| | - Virat Kirtsreesakul
- Department of Otolaryngology Head and Neck SurgeryFaculty of Medicine, Prince of Songkla UniversityHat YaiSongkhlaThailand
| | - Jarukit Tantipisit
- Department of PathologyFaculty of Medicine, Prince of Songkla UniversityHat YaiSongkhlaThailand
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Lamouroux C, Brochet L, Zrounba P, Charbotel B, Fervers B. Gingiva squamous-cell carcinoma in a non-smoking patient with occupational exposure to solvent siphoning using mouth: case report and literature review. Front Public Health 2024; 12:1370767. [PMID: 38756897 PMCID: PMC11098034 DOI: 10.3389/fpubh.2024.1370767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Background While overall head and neck cancer incidence decreases due to reduced tobacco and alcohol consumption, the incidence of HPV negative oral cavity squamous cell carcinoma (SCC) is raising in several industrialized countries, especially in non-smoking and non-drinking patients. Case presentation We document a case of gingiva SCC in a 56 years old never-smoker patient reporting low alcohol consumption and unusual occupational solvent exposure. The HPV-negative lesion was surgically removed in 2018, and the patient remains in complete remission 4 years after recurrent surgery in 2019. In 2021, the patient was referred to the occupational cancer consultation. The patient worked as screen printer for 18 years. He reported mouth siphoning every 2-3 days to transfer organic solvents (mainly aromatic hydrocarbons and ketones) from containers into smaller recipients, with regular passage of solvents into his mouth. Conclusion According to the literature, the frequency of solvent siphoning using mouth is likely to be underestimated. While our review did not find studies reporting longterm consequences to the oral cavity of mouth siphoning, current evidence supports a positive association of upper aero digestive tract SCC with occupational exposures to organic solvents and printing processes. In absence of major extraprofessional factors, the HPV-negative gingiva SCC of this patient might be attributable to the regular occupational oral solvent exposure. While the available evidence remains limited to formally establish a causal relationship, clinicians should investigate this hazardous work practice in patients with OSCC and history of solvent exposures.
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Affiliation(s)
- Céline Lamouroux
- Université de Lyon, Université Lyon 1, Université Gustave Eiffel-IFSTTAR, UMRESTTE, UMR T 9405, Domaine Rockefeller, Lyon, France
- Hospices Civils de Lyon, CRPPE-Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Louis Brochet
- Surgical Oncology Department, Centre Léon Bérard, Lyon, France
| | | | - Barbara Charbotel
- Université de Lyon, Université Lyon 1, Université Gustave Eiffel-IFSTTAR, UMRESTTE, UMR T 9405, Domaine Rockefeller, Lyon, France
- Hospices Civils de Lyon, CRPPE-Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Béatrice Fervers
- Department Prevention Cancer Environment, Centre Léon Bérard, U1296 INSERM Radiation, Defense, Health and Environment, Lyon, France
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Anaya-Saavedra G, Vázquez-Garduño M. Oral HPV-associated dysplasia: is koilocytic dysplasia a separate entity? FRONTIERS IN ORAL HEALTH 2024; 5:1363556. [PMID: 38433947 PMCID: PMC10904607 DOI: 10.3389/froh.2024.1363556] [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: 12/31/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
Oral epithelial dysplasia associated with high-risk HPV infection has received different names since its initial description, such as oral Bowenoid lesions, HPV-associated intraepithelial neoplasia, and oral koilocytic dysplasia. Some features, identified in more or less quantity in some of the descriptions, like apoptotic keratinocytes, karyorrhexis, and mitosoid figures, are intricately connected to viral transcriptional status and, consequently, viral load. Since the variety in terminology has introduced diagnostic confusion within medical and research communities, establishing a uniform and standardized approach to diagnosing HPV-oral epithelial dysplasia is crucial for accurate and early diagnoses and holds significant implications for patient outcomes, particularly in high-risk individuals.
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Affiliation(s)
- Gabriela Anaya-Saavedra
- Oral Pathology and Medicine Postgraduate Program, Health Care Department, Metropolitan Autonomous University, Mexico City, Mexico
| | - Marcela Vázquez-Garduño
- Oral Pathology and Medicine Postgraduate Program, Health Care Department, Metropolitan Autonomous University, Mexico City, Mexico
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Agelaki S, Boukovinas I, Athanasiadis I, Trimis G, Dimitriadis I, Poughias L, Morais E, Sabale U, Bencina G, Athanasopoulos C. A systematic literature review of the human papillomavirus prevalence in locally and regionally advanced and recurrent/metastatic head and neck cancers through the last decade: The "ALARM" study. Cancer Med 2024; 13:e6916. [PMID: 38247106 PMCID: PMC10905345 DOI: 10.1002/cam4.6916] [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: 07/18/2023] [Revised: 11/29/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
AIMS The aim of this systematic literature review was to provide updated information on human papillomavirus (HPV) prevalence in locally and regionally advanced (LA) and recurrent/metastatic (RM) head and neck cancer (HNC) worldwide. METHODS Electronic searches were conducted on clinicaltrials.gov, MEDLINE/PubMed, Embase, and ASCO/ESMO journals of congresses for interventional studies (IS; Phase I-III trials) as well as MEDLINE and Embase for non-interventional studies (NIS) of LA/RM HNC published between January 01, 2010 and December 31, 2020. Criteria for study selection included: availability of HPV prevalence data for LA/RM HNC patients, patient enrollment from January 01, 2010 onward, and oropharyngeal cancer (OPC) included among HNC types. HPV prevalence per study was calculated as proportion of HPV+ over total number of enrolled patients. For overall HPV prevalence across studies, mean of reported HPV prevalence rates across studies and pooled estimate (sum of all HPV+ patients over sum of all patients enrolled) were assessed. RESULTS Eighty-one studies (62 IS; 19 NIS) were included, representing 9607 LA/RM HNC cases, with an overall mean (pooled) HPV prevalence of 32.6% (25.1%). HPV prevalence was 44.7% (44.0%) in LA and 24.3% (18.6%) in RM. Among 2714 LA/RM OPC patients from 52 studies with available data, mean (pooled) value was 55.8% (50.7%). The majority of data were derived from Northern America and Europe, with overall HPV prevalence of 46.0% (42.1%) and 24.7% (25.3%) across studies conducted exclusively in these geographic regions, respectively (Northern Europe: 31.9% [63.1%]). A "p16-based" assay was the most frequently reported HPV detection methodology (58.0%). CONCLUSION Over the last decade, at least one quarter of LA/RM HNC and half of OPC cases studied in IS and NIS were HPV+. This alarming burden is consistent with a potential implication of HPV in the pathogenesis of at least a subgroup of HNC, underscoring the relevance of HPV testing and prophylaxis to HNC prevention and management.
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Affiliation(s)
- Sofia Agelaki
- Laboratory of Translational Oncology, School of MedicineUniversity of CreteHerakleionGreece
- Department of Medical OncologyUniversity General Hospital of HerakleionHerakleionGreece
| | | | | | | | | | | | - Edith Morais
- MSD, Center for Observational and Real‐World Evidence (CORE)LyonFrance
| | - Ugne Sabale
- MSD, Center for Observational and Real‐World Evidence (CORE)StockholmSweden
| | - Goran Bencina
- MSD, Center for Observational and Real‐World Evidence (CORE)MadridSpain
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7
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Rich BJ, Samuels SE, Azzam GA, Kubicek G, Freedman L. Oral Cavity Squamous Cell Carcinoma: Review of Pathology, Diagnosis, and Management. Crit Rev Oncog 2024; 29:5-24. [PMID: 38683151 DOI: 10.1615/critrevoncog.2023050055] [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: 05/01/2024]
Abstract
Squamous cell carcinoma of the oral cavity presents a significant global health burden, primarily due to risk factors such as tobacco smoking, smokeless tobacco use, heavy alcohol consumption, and betel quid chewing. Common clinical manifestations of oral cavity cancer include visible lesions and sores, often accompanied by pain in advanced stages. Diagnosis relies on a comprehensive assessment involving detailed history, physical examination, and biopsy. Ancillary imaging studies and functional evaluations aid in accurate staging and facilitate treatment planning. Prognostic information is obtained from histopathological factors, such as tumor grade, depth of invasion, lymphovascular invasion, and perineural invasion. Notably, lymph node metastasis, found in approximately half of the patients, carries significant prognostic implications. Effective management necessitates a multidisciplinary approach to optimize patient outcomes. Surgical resection is the backbone of treatment, aimed at complete tumor removal while preserving functional outcomes. Adjuvant therapies, including radiation and chemotherapy, are tailored according to pathological factors. Further work in risk stratification and treatment is necessary to optimize outcomes in squamous cell carcinoma of the oral cavity.
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Affiliation(s)
| | | | - Gregory A Azzam
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Gregory Kubicek
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Laura Freedman
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
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Ullah MI, Mikhailova MV, Alkhathami AG, Carbajal NC, Zuta MEC, Rasulova I, Najm MAA, Abosoda M, Alsalamy A, Deorari M. Molecular pathways in the development of HPV-induced oropharyngeal cancer. Cell Commun Signal 2023; 21:351. [PMID: 38098017 PMCID: PMC10722793 DOI: 10.1186/s12964-023-01365-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 12/17/2023] Open
Abstract
Oropharyngeal cancer, a subset of head and neck cancer, is increasingly recognized as a unique clinical entity primarily influenced by high-risk human papillomavirus (HPV) infections, particularly HPV-16. This review delves into the viral life cycle of HPV-16 and its interactions with host cells, with a specific focus on the crucial roles played by the viral oncoproteins E6 and E7. These oncoproteins drive cellular proliferation by targeting critical tumor suppressor proteins like p53 and Rb, resulting in uncontrolled cell growth and genomic instability. Furthermore, the significance of epigenetic modifications induced by HPV-16 and their implications is important for cancer progression. This comprehensive review provides valuable insights into the intricate molecular landscape of HPV-induced oropharyngeal cancer, shedding light on the development of targeted therapies and preventive strategies for this emerging global health concern. Video Abstract.
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Affiliation(s)
- Muhammad Ikram Ullah
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka-72388, Aljouf, Saudi Arabia
| | - Maria V Mikhailova
- Department of Prosthetic Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Ali G Alkhathami
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Nestor Cuba Carbajal
- Doctor en Gestión Pública y Gobernabilidad, Docente en La Universidad Norbert Wiener, Lima, Perú.
| | | | - Irodakhon Rasulova
- School of Humanities, Natural & Social Sciences, New Uzbekistan University, 54 Mustaqillik Ave, 100007, Tashkent, Uzbekistan
- Department of Public Health, Tashkent Pediatric Medical Institute, Bogishamol Street 223, Tashkent, Uzbekistan
| | - Mazin A A Najm
- Pharmaceutical Chemistry Department, College of Pharmacy, Al-Ayen University, Thi-Qar, Nasiriyah, Iraq
| | - Munther Abosoda
- College of Pharmacy, the Islamic University, Najaf, Iraq
- College of Pharmacy, the Islamic University of Al Diwaniyah, Al Diwaniyah, Iraq
- College of Pharmacy, the Islamic University of Babylon, Hillah, Iraq
| | - Ali Alsalamy
- College of Pharmacy, Imam Ja'afar Al-Sadiq University, Al-Muthanna, 66002, Iraq
| | - Mahamedha Deorari
- Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun, India
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Ramadan S, Lee JJ, Wang R, Jackson RS, Pipkorn P, Rich J, Harbison RA, Zolkind P, Kang SY, Puram SV, Mazul AL. Neighborhood socioeconomic status and race are associated with incidence disparities in oral cavity cancers. Oral Oncol 2023; 147:106607. [PMID: 37897859 DOI: 10.1016/j.oraloncology.2023.106607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES To determine the association between neighborhood socioeconomic status (nSES), race and incidence rate trends of oral cavity cancer (OCC). MATERIALS AND METHODS We used data from the SEER (Surveillance, Epidemiology, and End Results) 18 Census Tract-level SES and Rurality Database (2006-2018) database of the National Cancer Institute to create cohorts of OCC patients between 2006 and 2018. Annual incidence rates were calculated and trends in rates were estimated using joinpoints regression. RESULTS The incidence of OCC is the highest among low nSES White Americans (2.86 per 100 000 persons) and the lowest among high nSES Black Americans (1.17 per 100 000 persons). Incidence has significantly increased among Asian Americans (annual percent change [APC]: low nSES-2.4, high nSES-2.6) and White Americans (APC: low nSES-1.4, high nSES-1.6). Significant increases in the incidence of oral tongue cancer in these groups primarily drive this increase. Other increases were noted in alveolar ridge cancer among White Americans and hard palate cancer among Asian Americans. OCC incidence decreased significantly in Hispanic Americans of high nSES (APC: -2.5) and Black Americans of low nSES (APC: -2.7). Floor of mouth cancer incidence decreased among most groups. CONCLUSION Despite the overall decreasing incidence of OCC, these trends are inconsistent among all OCC subsites. Differences are seen by race, nSES, and subsite, indicating intersectional barriers that extend beyond nSES and race and ethnicity alone. Further research on risk factors and developing interventions targeting vulnerable groups is needed.
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Affiliation(s)
- Salma Ramadan
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jake J Lee
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ray Wang
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ryan S Jackson
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Patrik Pipkorn
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jason Rich
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - R Alex Harbison
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Paul Zolkind
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Stephen Y Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Sidharth V Puram
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA; Department of Genetics, Washington University School of Medicine, Saint Louis, MO, USA.
| | - Angela L Mazul
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA; Department of Otolaryngology, University of Pittsburgh, and UPMC Hillman Cancer Center, Pittsburgh, PA, 15260, USA
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Novack R, Chapman E, Gao J, Horst B, Hoang LN, Ng TL, Ko YCK. Utilization of p53 and p16 Immunohistochemistry in the Classification of Human Papillomavirus-Associated, p53 Wild-Type, and p53 Abnormal Oral Epithelial Dysplasia. Mod Pathol 2023; 36:100348. [PMID: 37820765 DOI: 10.1016/j.modpat.2023.100348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/12/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
p53 immunohistochemistry (IHC) has recently been shown to be a clinically useful marker for predicting risk of progression to invasive squamous cell carcinoma in oral epithelial dysplasia (OED). The literature supports the use of p53 IHC as a marker to identify TP53 mutation in in situ and invasive vulvar lesions and as a surrogate marker for high-risk human papillomavirus (HPV) infection, but there is little documentation for similar use in OED. The purpose of this study was to determine whether p53 IHC is a reliable surrogate marker for detecting both TP53 mutation and high-risk HPV infection in OED. We studied 57 cases of OED (11 mild, 18 moderate, and 28 severe), and all were stained for p16 and p53 IHC. High-risk HPV RNA in situ hybridization (ISH) was performed in selected cases (all p16-positive cases and all OED showing abundant apoptotic cells and karyorrhectic cells; N = 27). Targeted next-generation sequencing (NGS) was performed in 33 p16-negative cases and all high-risk HPV RNA ISH-negative cases (N = 36). We identified 21 cases with p53 basal sparing patterns (mid-epithelial and markedly reduced [null-like]), 14 cases with p53 wild-type patterns (scattered basal and patchy basal/parabasal), and 22 cases with p53 abnormal patterns (18 overexpression, 3 null, and 1 novel cytoplasmic pattern). Among cases with p53 basal sparing patterns, 20 were positive for p16 (20/21, 95%), and all were positive for high-risk HPV RNA ISH (21/21, 100%). The 36 sequenced cases had IHC patterns concordant with TP53 mutation status in 92% (33/36) of lesions. This study demonstrates that p53 IHC expression patterns are sensitive and specific for detection of both high-risk HPV infection and TP53 mutation. Coupled with selective p16 IHC testing, this IHC panel can accurately subclassify OED into HPV-associated, p53 wild-type (conventional), and p53 abnormal OED.
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Affiliation(s)
- Rachel Novack
- Department of Anatomical Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Erin Chapman
- Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Jiangyuan Gao
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Basil Horst
- Department of Anatomical Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn N Hoang
- Department of Anatomical Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tony L Ng
- Department of Anatomical Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yen Chen Kevin Ko
- Department of Anatomical Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Laboratory Medicine and Pathology, BC Oral Biopsy Service, Vancouver General Hospital, Vancouver, British Columbia, Canada.
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11
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Petrelli F, Cin ED, Ghidini A, Carioli D, Falasca V, De Stefani A, Moleri G, Ardito R, Luciani A, Nardone M, Capriotti V. Human papillomavirus infection and non-oropharyngeal head and neck cancers: an umbrella review of meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:3921-3930. [PMID: 37212863 DOI: 10.1007/s00405-023-08027-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The causative and prognostic roles of human papillomavirus (HPV) in non-oropharyngeal squamous cell carcinoma of the head and neck are uncertain. This umbrella review assessed the strength and quality of evidence and graded the evidence derived from published meta-analyses on this subject. DATA SOURCES MEDLINE, Embase, and the Cochrane Library were searched. Meta-analyses of observational studies and randomized trials were included. REVIEW METHODS Evidence of association was graded according to the established criteria: strong, highly suggestive, suggestive, weak, or not significant. RESULTS 15 meta-analyses were evaluated. The association with HPV was highly suggestive of oral (OR = 2.40, [1.87-3.07], P < 0.00001) and nasopharyngeal cancers (OR = 17.82 [11.20-28.35], P < 0.00001). Improved survival emerged only in hypopharyngeal carcinoma and was confirmed in studies in which only p16 + cancers were considered. CONCLUSION HPV infection may increase the risk of oral cavity and nasopharyngeal cancer. However, the prognosis was not influenced, except in hypopharyngeal carcinoma.
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Affiliation(s)
- Fausto Petrelli
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy.
| | - Elisa Dal Cin
- ENT Unit, Head and Neck Department, Mestre Hospital, ULSS 3, Venice, VE, Italy
| | | | - Daniela Carioli
- Otorhinolaringology Unit, Department of Neuroscience, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Vincenzo Falasca
- Otorhinolaringology Unit, Department of Neuroscience, ASST Bergamo Ovest, Treviglio, BG, Italy
| | | | - Giovanna Moleri
- Ufficio Relazioni Col Pubblico, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Raffaele Ardito
- IRCCS Centro Di Riferimento Oncologico Della Basilicata (CROB), Oncological Day Hospital, Via Padre Pio 1, 85028, Rionero in Vulture, PZ, Italy
| | - Andrea Luciani
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, BG, Italy
| | - Massimiliano Nardone
- Otorhinolaringology Unit, Department of Neuroscience, ASST Bergamo Ovest, Treviglio, BG, Italy
| | - Vincenzo Capriotti
- Otorhinolaringology Unit, Department of Neuroscience, ASST Bergamo Ovest, Treviglio, BG, Italy
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12
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Shigeishi H. Association between human papillomavirus and oral cancer: a literature review. Int J Clin Oncol 2023; 28:982-989. [PMID: 36929094 DOI: 10.1007/s10147-023-02327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
HPV plays a vital role in the development of cervical cancers and oropharyngeal cancers, but it is controversial whether HPV is involved in oral cancer development and to what extent. In this review, the clinical characteristics, diagnosis, treatment, and prognosis of HPV-positive oral cancers are summarized, and the mechanisms of HPV-related oral cancer development are discussed. HPV DNA positivity rates are 20-30% in oral squamous cell carcinoma (OSCC), and HPV16 is the most common high-risk HPV. E6/E7 mRNA positivity rates are 2-6% in OSCC. Detection of both high-risk HPV DNA and E6/E7 mRNA is recommended to determine the presence of active HPV, in agreement with high-risk HPV infection in OSCC. Surgical treatment is the first-line therapy for HPV-positive and -negative oral cancer, but there is no unified view about the prognosis of HPV-positive OSCC patients. HPV16 may play a vital role in malignant transformation in oral epithelial dysplasia, and a model of synergistic carcinogenic impact of HPV and tobacco smoking is predicted. Additionally, it is hypothesized that there are different HPV-associated oral cancers, such as integrated HPV DNA-positive OSCC with stable E6/E7 expression and episomal HPV DNA-positive OSCC. In summary, the role of HPV in oral carcinogenesis seems to be limited because of the low E6/E7 positivity in OSCCs; however, episomal HPV DNA may play a vital role in the malignant transformation of HPV-positive oral premalignant lesions. Further investigation is required to promote new insights into the role of episomal HPV DNA in oral carcinogenesis.
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Affiliation(s)
- Hideo Shigeishi
- Department of Public Oral Health, Program of Oral Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
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13
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Nokovitch L, Maquet C, Crampon F, Taihi I, Roussel LM, Obongo R, Virard F, Fervers B, Deneuve S. Oral Cavity Squamous Cell Carcinoma Risk Factors: State of the Art. J Clin Med 2023; 12:jcm12093264. [PMID: 37176704 PMCID: PMC10179259 DOI: 10.3390/jcm12093264] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Head and neck (HN) squamous cell carcinomas (SCCs) originate from the epithelial cells of the mucosal linings of the upper aerodigestive tract, which includes the oral cavity, the pharynx, the larynx, and the sinonasal cavities. There are many associated risk factors, including alcohol drinking coupled with tobacco use, which accounts for 70% to 80% of HNSCCs. Human papilloma virus (HPV) is another independent risk factor for oropharyngeal SCC, but it is only a minor contributor to oral cavity SCC (OSCC). Betel quid chewing is also an established risk factor in southeast Asian countries. However, OSCC, and especially oral tongue cancer, incidence has been reported to be increasing in several countries, suggesting risk factors that have not been identified yet. This review summarizes the established risk factors for oral cavity squamous cell carcinomas and examines other undemonstrated risk factors for HNSCC.
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Affiliation(s)
- Lara Nokovitch
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
| | - Charles Maquet
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
| | - Frédéric Crampon
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
| | - Ihsène Taihi
- Oral Surgery Department, Rothschild Hospital, 75012 Paris, France
- URP 2496, Laboratory of Orofacial Pathologies, Imaging and Biotherapies, UFR Odontology, Health Department, Université Paris Cité, 92120 Montrouge, France
| | - Lise-Marie Roussel
- Department of Head and Neck Cancer and ENT Surgery, Centre Henri Becquerel, 76038 Rouen, France
- Rouen Cancer Federation, 76000 Rouen, France
| | - Rais Obongo
- Department of Head and Neck Cancer and ENT Surgery, Centre Henri Becquerel, 76038 Rouen, France
- Rouen Cancer Federation, 76000 Rouen, France
| | - François Virard
- INSERM U1052-CNRS UMR5286, Cancer Research Center, Centre Léon Bérard, University Claude Bernard Lyon 1, 69008 Lyon, France
- Faculté d'Odontologie, Hospices Civils de Lyon, University of Lyon, 69002 Lyon, France
| | - Béatrice Fervers
- Département Prévention Cancer Environnement, Centre Léon Bérard, 69008 Lyon, France
- INSERM UMR 1296, "Radiations: Défense, Santé, Environnement", Centre Léon Bérard, 69008 Lyon, France
| | - Sophie Deneuve
- Department of Otolaryngology-Head and Neck Surgery, CHU Rouen, 76000 Rouen, France
- Rouen Cancer Federation, 76000 Rouen, France
- Quantification en Imagerie Fonctionnelle-Laboratoire d'Informatique, du Traitement de l'Information et des Systèmes Equipe d'Accueil 4108 (QuantIF-LITIS EA4108), University of Rouen, 76000 Rouen, France
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14
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Imbesi Bellantoni M, Picciolo G, Pirrotta I, Irrera N, Vaccaro M, Vaccaro F, Squadrito F, Pallio G. Oral Cavity Squamous Cell Carcinoma: An Update of the Pharmacological Treatment. Biomedicines 2023; 11:biomedicines11041112. [PMID: 37189730 DOI: 10.3390/biomedicines11041112] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Oral cavity squamous cell carcinoma (OCSCC) represents a serious health and socio-economic problem in different geographical areas of the world. It is characterized by a high rate of mortality, recurrence and metastasis. Despite the therapeutic strategies implemented for its management and resolution, currently the survival estimate for locally advanced disease is about 50%. The available therapeutic options comprise surgery and pharmacological treatment. Recently, an increased emphasis has been placed on the drugs that might be of benefit in this life-threatening disease. Therefore, the aim of this present review was to offer a general survey of the current available pharmacological treatment for OCSCC. The PubMed database was used to retrieve the papers using "OCSCC" as the search terms. We limited our search to the last 5 years to give a more updated and recent picture of the state of the art, including preclinical and clinical investigations. We found that 77 out of 201 papers were on the surgical treatment of OCSCC, 43 out of 201 focused on the radiotherapy and 81 out of 201 underwent evaluation for the aim of our review. We excluded the case reports, editorial letters, observational studies and papers written in languages other than English. A total of 12 articles were included in the final review. Our results showed that nanotechnologies use to enhance the efficacy of anticancer drugs such as: cisplatin, paclitaxel, cetuximab, EGFR antagonists, MEK1/2 and immune check inhibitors combination could have promising anti-cancer activity. However, the paucity of available data on drugs suggests the urgent need to improve the pharmacological armamentarium for OCSCC treatment.
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Affiliation(s)
- Martina Imbesi Bellantoni
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via C. Valeria, 98125 Messina, Italy
| | - Giacomo Picciolo
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy
| | - Igor Pirrotta
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy
| | - Federico Vaccaro
- Department of Dermatology, University of Modena and Reggio Emilia, Via Del Pozzo, 41124 Modena, Italy
| | - Francesco Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy
| | - Giovanni Pallio
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy
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15
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Alshami ML, Al‐Maliky MA, Alsagban AA, Alshaeli AJ. Epidemiology and incidence of oral squamous cell carcinoma in the Iraqi population over 5 years (2014-2018). Health Sci Rep 2023; 6:e1205. [PMID: 37064317 PMCID: PMC10090270 DOI: 10.1002/hsr2.1205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 04/18/2023] Open
Abstract
Background Oral squamous cell carcinoma is one of the most common and life-threatening neoplasms worldwide, and is responsible for approximately 90% of all oral malignancies. Aim This study was aimed at providing updated information on oral squamous cell carcinoma in all Iraqi governorates for the 5-year period from 2014 to 2018, including the annual incidence and demographic variables. Materials and Methods The total number of oral squamous cell carcinoma cases in Iraq, along with associated demographic information (age, sex, and site), for the 5-year period from 2014 to 2018 was obtained. The statistical analysis consisted of descriptive analysis, including frequency, percentage, and mean ± standard deviation. A χ 2 test was performed to compare frequencies between male and female patients, among age groups, and among different OSCC sites. The χ 2 test was also used to assess the association of each OSCC site with age and sex. The significance threshold was set at p < 0.05, and the confidence interval was set at 95%. The incidence rate of oral squamous cell carcinoma for each year was calculated by dividing the number of OSCC cases per year by the population of Iraq, then multiplying the result by 100,000. Results A total of 722 cases were recorded. Statistically, oral squamous cell carcinoma was found to be more prevalent in males and individuals over 40 years of age. The tongue was the most common site of occurrence. Lip squamous cell carcinoma cases were high in males. The incidence rate of oral squamous cell carcinoma was estimated to be 0.4 per 100,000 people. Conclusion Males and older people are at relatively higher risk of developing oral cancer. The tongue is the most affected site, but any site in the oral cavity may be involved. Further exploration of the causes of oral malignancy in Iraq is necessary to improve prevention strategies.
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16
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van Beers MA, Schreuder WH, Balm AJM, van Dijk BAC. Is locally advanced head and neck cancer 'increasing' in the Netherlands? The paradox of absolute numbers, standardized incidence rates and proportional share. Oral Oncol 2023; 138:106316. [PMID: 36709706 DOI: 10.1016/j.oraloncology.2023.106316] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Several reports have indicated that locally advanced head and neck cancer (LAHNC) has increased in the past decade. However, incidence trends cannot be easily compared because slightly different definitions of LAHNC were used. AIM To investigate if the incidence of locally advanced disease (LAD) in the oral cavity, oropharynx, hypopharynx and larynx is indeed increasing over time, considering the growing and ageing population in the Netherlands. PATIENTS AND METHODS Data were obtained from the Netherlands Cancer Registry (NCR). Primary head and neck squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx and larynx diagnosed between 1989 and 2017 were included. Yearly numbers and European standardized incidence rates (ESRs) were reported by extent of disease. The annual percentage change (APC) over time in ESRs was calculated to assess trends. RESULTS Absolute numbers and ESRs of LAD increased over time for oral cavity and most prominently for oropharynx carcinomas (before 1996, APC: 0.4, 95%CI: 0.1; 0.8 and APC: 5.7 (95%CI: 3.1; 8.4) after 1996: 1.5 (1.0; 2.0) respectively. For hypopharynx cancer the absolute number and ESR of LAD increased until 1997 and declined with 0.8% per year since 1997. Absolute numbers of patients with larynx cancer stayed stable over time, while ESR decreased (APC: -0.8 (95%CI: -1.1; -0.6)). CONCLUSION The perception of an increasing trend in LAD in the Netherlands can be attributed to the increasing incidence of oral cavity and oropharynx carcinomas. For LAD of the hypopharynx a decreasing trend was observed. In larynx cancer, the proportional share of LAD of the larynx increased, even though incidence rates declined.
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Affiliation(s)
- M A van Beers
- Department of Head and Neck Oncology & Surgery, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - W H Schreuder
- Department of Head and Neck Oncology & Surgery, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, AmsterdamUMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A J M Balm
- Department of Head and Neck Oncology & Surgery, Antoni van Leeuwenhoek/Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, AmsterdamUMC, University of Amsterdam, Amsterdam, The Netherlands
| | - B A C van Dijk
- Netherlands Comprehensive Cancer Organization (IKNL), Department of Research and Development, Utrecht, The Netherlands; University of Groningen, University Medical Centre Groningen, Department of Epidemiology, Groningen, The Netherlands
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17
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Katirachi SK, Grønlund MP, Jakobsen KK, Grønhøj C, von Buchwald C. The Prevalence of HPV in Oral Cavity Squamous Cell Carcinoma. Viruses 2023; 15:v15020451. [PMID: 36851665 PMCID: PMC9964223 DOI: 10.3390/v15020451] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Human papillomavirus (HPV) is an important risk factor in a subset of head and neck squamous cell carcinomas (HNSCC), but the association with oral cavity squamous cell carcinomas (OCSCC) remains controversial. This study aimed to identify the prevalence of HPV infection in OCSCC. A systematic search on PubMed and EMBASE was performed, including articles assessing the prevalence of HPV-positive (HPV+) OCSCC published from January 2017 to December 2022. OCSCC was considered HPV+ by the detection of HPV DNA, HPV RNA, and/or p16 overexpression in the tumor mass. A meta-analysis was made determining the overall HPV+ OCSCC prevalence. We included 31 studies comprising 5007 patients from 24 countries. The study size ranged from 17 to 940 patients. The HPV+ OCSCC proportion variated widely and ranged from 0% to 37%. Tumors in the tongue were the predominant sublocation for HPV in the oral cavity. The meta-analysis revealed that the overall HPV+ OCSCC prevalence is 6% (95% CI; 3-10%), and only one study found HPV and OCSCC significantly associated. Thus, HPV may not be a necessary or a strong risk factor in OCSCC oncogenesis, and the possibility of a site misclassification of a mobile tongue with the root of the tongue cannot be excluded.
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18
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Mazul AL, Chidambaram S, Zevallos JP, Massa ST. Disparities in head and neck cancer incidence and trends by race/ethnicity and sex. Head Neck 2023; 45:75-84. [PMID: 36200577 PMCID: PMC9742317 DOI: 10.1002/hed.27209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The epidemiology of head and neck cancer (HNC) sites differ substantially. This study compares HNC incidence trends by site and demographic subgroups. METHODS We used the U.S. Cancer Statistics Public Use Database to calculate HNC incidence rates per 100 000. We assessed trends with annual percent change (APC) longitudinally from 2001 to 2017. RESULTS The oropharyngeal cancer incidence APC decreased from 4.38% (95% CI: 3.6, 5.1) to 2.93% (2.5, 3.3) in 2008 among White males. Oral cavity cancer incidence rose in Other race males (APC 2.5% [1.6, 3.36]) and White females (APC: 0.96% [0.7, 1.2]). Although decreasing (APC: -1.15% [-1.48, -0.83]), laryngeal cancer incidence remained disproportionately high among Black males. CONCLUSIONS Notable incidence trends occurred in non-White groups at non-oropharyngeal sites. With parity of smoking rates by race, differing sexual behaviors, and shifting demographics by race and sex, future studies of HNC trends should consider stratifying analyses to understand health disparities.
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Affiliation(s)
- Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Smrithi Chidambaram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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19
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Viral Integration Plays a Minor Role in the Development and Prognostication of Oral Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14215213. [PMID: 36358632 PMCID: PMC9656962 DOI: 10.3390/cancers14215213] [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: 08/14/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
Viruses are well known drivers of several human malignancies. A causative factor for oral cavity squamous cell carcinoma (OSCC) in patients with limited exposure to traditional risk factors, including tobacco use, is yet to be identified. Our study aimed to comprehensively evaluate the role of viral drivers in OSCC patients with low cumulative exposure to traditional risk factors. Patients under 50 years of age with OSCC, defined using strict anatomic criteria were selected for WGS. The WGS data was interrogated using viral detection tools (Kraken 2 and BLASTN), together examining >700,000 viruses. The findings were further verified using tissue microarrays of OSCC samples using both immunohistochemistry and RNA in situ hybridisation (ISH). 28 patients underwent WGS and comprehensive viral profiling. One 49-year-old male patient with OSCC of the hard palate demonstrated HPV35 integration. 657 cases of OSCC were then evaluated for the presence of HPV integration through immunohistochemistry for p16 and HPV RNA ISH. HPV integration was seen in 8 (1.2%) patients, all middle-aged men with predominant floor of mouth involvement. In summary, a wide-ranging interrogation of >700,000 viruses using OSCC WGS data showed HPV integration in a minority of male OSCC patients and did not carry any prognostic significance.
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20
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Borgmann M, Oetting A, Meyer F, Möckelmann N, Droste C, von Bargen CM, Möller-Koop C, Witt M, Borgmann K, Rothkamm K, Betz C, Münscher A, Clauditz TS, Rieckmann T. The prognostic impact of B7-H3 and B7-H4 in head and neck squamous cell carcinoma. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04244-2. [PMID: 35941227 DOI: 10.1007/s00432-022-04244-2] [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: 05/25/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Immune checkpoint inhibition is a therapeutic option in many cancer entities. In head and neck squamous cell carcinoma (HNSCC) targeting of the PD-1/PD-L1 (B7-H1) axis is approved in recurrent/metastatic disease and is being explored in the curative setting. Here, we evaluated two related members of the B7 family, B7-H3 & B7-H4, for their prognostic impact under standard treatment. METHODS A tissue microarray (TMA) of a single center HNSCC cohort was stained for B7-H3 and B7-H4. Staining intensity and the number of tumor cells stained were assessed, and the expression was scored according to an established algorithm. Staining scores were correlated with clinicopathological parameters and associated with patient survival. mRNA levels of both proteins were associated with patient outcome using the TCGA dataset. RESULTS mRNA levels of B7-H3 and B7-H4 were not significantly associated with patient survival. TMA analysis revealed interpretable protein staining in 408 samples. Strong staining was the most frequent category for B7-H3 and no staining for B7-H4. In patients with p16-negative oropharyngeal SCC (OPSCC) and in a pooled cohort consisting of p16-negative OPSCC, laryngeal, hypopharyngeal and oral cavity SCC, strong B7-H3 expression was associated with better overall survival. For the latter cohort, this was in part due to reduced lymph node involvement. B7-H3 expression in p16-positive OPSCC and B7-H4 expression were not associated with outcome. CONCLUSION Despite a possible role in tumor immune escape, B7-H3 was associated with favorable prognosis in HPV-negative HNSCC in our cohort. The underlying mechanisms and a potential impact for B7-H3 targeting remain to be elucidated.
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Affiliation(s)
- Mara Borgmann
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Otorhinolaryngology, Asklepios Klinik Nord, Hamburg, Germany
| | - Agnes Oetting
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Meyer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaus Möckelmann
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Otorhinolaryngology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Conrad Droste
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Christina Möller-Koop
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Melanie Witt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Borgmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Rothkamm
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Betz
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adrian Münscher
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Otorhinolaryngology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | | | - Thorsten Rieckmann
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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21
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Mena M, Wang X, Tous S, Quiros B, Clavero O, Alejo M, Morey F, Taberna M, Leon Vintro X, Lloveras Rubio B, Alos L, Mehanna H, Quint W, Pawlita M, Tommasino M, Pavón MA, Muñoz N, De Sanjose S, Bosch FX, Alemany L. Concordance of p16 INK4a and E6*I mRNA among HPV-DNA-Positive Oropharyngeal, Laryngeal, and Oral Cavity Carcinomas from the ICO International Study. Cancers (Basel) 2022; 14:3787. [PMID: 35954451 PMCID: PMC9367257 DOI: 10.3390/cancers14153787] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Tests or test algorithms for diagnosing HPV-driven oral cavity and laryngeal head and neck carcinomas (HNC) have not been yet validated, and the differences among oral cavity and laryngeal sites have not been comprehensively evaluated. We aimed to assess the utility of a diagnostic algorithm for the detection of HPV-driven oral cavity (OCC), oropharyngeal (OPC) and laryngeal (LC) carcinomas using HPV-DNA testing followed by p16INK4a immunohistochemistry, taking E6*I mRNA detection as the reference standard. Methods: Formalin-fixed paraffin-embedded OCC, OPC, and LC carcinomas were collected from pathology archives in 29 countries. All samples were subjected to histopathological evaluation, DNA quality control, and HPV-DNA detection. All HPV-DNA-positive samples (including 78 OCC, 257 OPC, and 51 LC out of 3680 HNC with valid HPV-DNA results) were also tested for p16INK4a immunohistochemistry and E6*I mRNA. Three different cutoffs of nuclear and cytoplasmic staining were evaluated for p16INK4a: (a) >25%, (b) >50%, and (c) ≥70%. The concordance of p16INK4a and E6*I mRNA among HPV-DNA-positive OCC, OPC, and LC cases was assessed. Results: A total of 78 OCC, 257 OPC, and 51 LC were HPV-DNA-positive and further tested for p16INK4a and E6*I mRNA. The percentage of concordance between p16INK4a (cutoff ≥ 70%) and E6*I mRNA among HPV-DNA-positive OCC, OPC, and LC cases was 79.5% (95% CI 69.9−89.1%), 82.1% (95% CI 77.2−87.0%), and 56.9% (95% CI 42.3−71.4%), respectively. A p16INK4a cutoff of >50% improved the concordance although the improvement was not statistically significant. For most anatomical locations and p16INK4a cutoffs, the percentage of discordant cases was higher for HPV16- than HPV-non16-positive cases. Conclusions: The diagnostic algorithm of HPV-DNA testing followed by p16INK4a immunohistochemistry might be helpful in the diagnosis of HPV-driven OCC and OPC, but not LC. A different p16INK4a expression pattern was observed in those cases HPV-DNA-positive for types other than HPV16, as compared to HPV16-positive cases. Our study provides new insights into the use HPV-DNA, p16INK4a, and HPV-E6*I mRNA for diagnosing an HPV-driven HNC, including the optimal HPV test or p16INK4a cutoffs to be used. More studies are warranted to clarify the role of p16INK4a and HPV status in both OPC and non-OPC HNC.
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Affiliation(s)
- Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Xin Wang
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Sara Tous
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Beatriz Quiros
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Omar Clavero
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maria Alejo
- Pathology Department, Hospital de Vic, 08500 Vic, Spain
- Pathology Department, Hospital General de l’Hopitalet, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Francisca Morey
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Miren Taberna
- Oncology Department, Catalan Institute of Oncology (ICO)-IDIBELL, ONCOBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Xavier Leon Vintro
- Otorhinolaryngology Department, Hospital Sant Pau, 08026 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | - Llúcia Alos
- Pathology Department, Hospital Clinic, 08036 Barcelona, Spain
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham B15 2TT, UK
| | - Wim Quint
- DDL Diagnostic Laboratory, 2288 ER Rijswijk, The Netherlands
| | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - Miguel Angel Pavón
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Nubia Muñoz
- National Cancer Institute, Bogotá 111511, Colombia
| | - Silvia De Sanjose
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- ISGlobal, 08036 Barcelona, Spain
| | - Francesc Xavier Bosch
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Universitat Oberta de Catalunya, 08035 Barcelona, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
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22
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Human Papillomavirus-Associated Oral Cavity Squamous Cell Carcinoma: An Entity with Distinct Morphologic and Clinical Features. Head Neck Pathol 2022; 16:1073-1081. [PMID: 35802245 PMCID: PMC9729477 DOI: 10.1007/s12105-022-01467-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/15/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND HPV-associated oral cavity squamous cell carcinoma (SCC) is not well-characterized in the literature, and also has a clinical significance that is poorly understood. METHODS We gathered a cohort of oral cavity (OC) SCC with nonkeratinizing morphology, either in the invasive or in situ carcinoma (or both), tested for p16 by immunohistochemistry and high risk HPV E6/E7 mRNA by RTPCR (reference standard for transcriptionally-active high risk HPV) and gathered detailed morphologic and clinicopathologic data. RESULTS Thirteen patients from two institutions were proven to be HPV-associated by combined p16 and high risk HPV mRNA positivity. All 13 patients (100%) were males, all were heavy smokers (average 57 pack/year), and most were active drinkers (9/11 or 81.8%). All 13 (100%) involved the tongue and/or floor of mouth. All had nonkeratinizing features, but maturing squamous differentiation varied widely (0-90%; mean 37.3%). Nonkeratinizing areas had high N:C ratios and larger nests, frequently with pushing borders, and minimal (or no) stromal desmoplasia. The carcinoma in situ, when present, was Bowenoid/nonkeratinizing with cells with high N:C ratios, full thickness loss of maturation, and abundant apoptosis and mitosis. HPV was type 16 in 11 patients (84.6%) and type 33 in two (15.4%). Nine patients had treatment data available. These underwent primary surgical resection with tumors ranging from 1.6 to 5.2 cm. Most had bone invasion (6/9-66.7% were T4a tumors), and most (6/9-66.7%) had extensive SCC in situ with all 6 of these patients having final margins positive for in situ carcinoma. CONCLUSIONS HPV-associated OCSCC is an uncommon entity that shows certain distinct clinical and pathologic features. Recognition of these features may help pathologic diagnosis and could potentially help guide clinical management.
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23
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Tissue Microarray Analyses Suggest Axl as a Predictive Biomarker in HPV-Negative Head and Neck Cancer. Cancers (Basel) 2022; 14:cancers14071829. [PMID: 35406601 PMCID: PMC8997923 DOI: 10.3390/cancers14071829] [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: 02/26/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Despite many efforts, no predictive biomarkers that could guide clinical decision making and personalized treatment have been established for patients with head and neck squamous cell carcinoma. We propose that high expression of the tyrosine kinase receptor Axl identifies patients as being at enhanced risk for treatment failure under surgery alone and, hence, should be treated by primary or adjuvant radiotherapy. Abstract The receptor tyrosine kinase Axl is described to promote migration, metastasis and resistance against molecular targeting, radiotherapy, and chemotherapy in various tumor entities, including head and neck squamous cell carcinoma (HNSCC). Since clinical data on Axl and its ligand Gas6 in HNSCC are sparse, we assessed the association of Axl and Gas6 expression with patient survival in a single center retrospective cohort in a tissue microarray format. Expression was evaluated manually using an established algorithm and correlated with clinicopathological parameters and patient survival. A number of 362 samples yielded interpretable staining, which did not correlate with T- and N-stage. Protein expression levels were not associated with the survival of patients with p16-positive oropharyngeal SCC. In HPV-negative tumors, Axl expression did not impact patients treated with primary or adjuvant radio(chemo)therapy, but was significantly associated with inferior overall and recurrence-free survival in patients treated with surgery alone. Gas6 was a positive predictor of survival in patients whose treatment included radiotherapy. Associations remained significant in multivariable analysis. Our data question a meaningful contribution of the Axl/Gas6 pathway to radio-resistance in HNSCC and instead suggest that strong Axl expression identifies tumors requiring adjuvant radio(chemo)therapy after surgery.
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24
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Deneuve S, Dentand L, Pannard M, Dupret-Bories A, Roux Pierre E, Nokovitch L, Renno T, Perol O, Virard F, Fervers B, Marie P. Oral cavity squamous cell carcinomas in patients with no identified risk factors: Feeling like an outsider. Eur J Cancer Care (Engl) 2022; 31:e13558. [PMID: 35170126 DOI: 10.1111/ecc.13558] [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: 06/22/2021] [Revised: 01/03/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Head and neck squamous cell carcinomas (HNSCCs) mainly affect smokers and drinkers. However, oral cavity squamous cell cancers (OCSCCs) are increasingly affecting patients with no identified risk factors (NIRFs). This study aimed at characterising their experience of the disease. METHODS Qualitative study based on semi-structured interviews of 20 survivors of OCSCC with NIRF. Methods used in grounded theory approach were applied. RESULTS Patients with NIRF had a similar experience to that of patients with risk factors regarding treatments. The absence of identified causes led to stigma and led the patients to distance themselves, both from the stereotypic HNSCC cancer patient and the identity as a cancer patient. Furthermore, having no identified risk factors seemed to reinforce the fear of recurrence. CONCLUSION This study is the first to address key gaps in knowledge regarding patients with NIRF having survived OCSCC. Their experience is similar to that of patients with orphan diseases. Owing to confrontation with other patients and the repeated questions of caregivers about tobacco/alcohol consumption, these patients felt stigmatised during their treatment. OCSCC patients with NIRF may benefit from guidance and support on how to engage in prevention.
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Affiliation(s)
- Sophie Deneuve
- Surgical Oncology Department, Léon Bérard Cancer Comprehensive Center, Lyon, France.,INSERM 1296, Radiations: Defense, Health and Environment, Léon Bérard Cancer Center, Lyon, France
| | - Lolane Dentand
- GRePS Groupe d'Etude, Lumière University Lyon 2, Lyon, France
| | - Myriam Pannard
- GRePS Groupe d'Etude, Lumière University Lyon 2, Lyon, France
| | - Agnes Dupret-Bories
- Head and Neck Department, Toulouse University Cancer Institute, Toulouse, France
| | - Eric Roux Pierre
- Surgical Oncology Department, Léon Bérard Cancer Comprehensive Center, Lyon, France
| | - Lara Nokovitch
- Surgical Oncology Department, Léon Bérard Cancer Comprehensive Center, Lyon, France
| | - Toufic Renno
- Cancer Research Center of Lyon, INSERM 1052, Claude Bernard University Lyon 1, Villeurbanne, France
| | - Olivia Perol
- INSERM 1296, Radiations: Defense, Health and Environment, Léon Bérard Cancer Center, Lyon, France.,Prevention Cancer Environnement Department, Léon Bérard Cancer Comprehensive Center, Lyon, France
| | - François Virard
- Cancer Research Center of Lyon, INSERM 1052, Claude Bernard University Lyon 1, Villeurbanne, France.,University of Lyon, Faculty of Odontology, Hospices Civils de Lyon, Lyon, France
| | - Beatrice Fervers
- Prevention Cancer Environnement Department, Léon Bérard Cancer Comprehensive Center, Lyon, France.,University of Lyon, Faculty of Odontology, Hospices Civils de Lyon, Lyon, France
| | - Preau Marie
- INSERM 1296, Radiations: Defense, Health and Environment, Léon Bérard Cancer Center, Lyon, France
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25
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Kirschnick LB, Schuch LF, Pérez‐de‐Oliveira ME, Normando AGC, Mariz BALA, Guerra ENS, Silveira FM, Vasconcelos ACU, Simonato LE, Khurram A, Lopes MA, Vargas PA, Martins MD, Santos‐Silva AR. Transcriptionally active HPV in OPMD and OSCC: a systematic review following the CAP/ASCO guidelines. Oral Dis 2022; 28:2309-2313. [DOI: 10.1111/odi.14154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Laura Borges Kirschnick
- Oral Diagnosis Department Piracicaba Dental School Universidade Estadual de Campinas Piracicaba SP Brazil
| | - Lauren Frenzel Schuch
- Oral Diagnosis Department Piracicaba Dental School Universidade Estadual de Campinas Piracicaba SP Brazil
| | | | | | | | | | - Felipe Martins Silveira
- Molecular Pathology Area School of Dentistry Universidad de la República (UDELAR) Montevideo Uruguay
- Department of Oral Pathology Dental School Universidade Federal do Rio Grande do Sul Porto Alegre RS Brazil
| | | | | | - Ali Khurram
- Unit of Oral and Maxillofacial Pathology School of Clinical Dentistry University of Sheffield Sheffield UK
| | - Márcio Ajudarte Lopes
- Oral Diagnosis Department Piracicaba Dental School Universidade Estadual de Campinas Piracicaba SP Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department Piracicaba Dental School Universidade Estadual de Campinas Piracicaba SP Brazil
| | - Manoela Domingues Martins
- Oral Diagnosis Department Piracicaba Dental School Universidade Estadual de Campinas Piracicaba SP Brazil
- Department of Oral Pathology Dental School Universidade Federal do Rio Grande do Sul Porto Alegre RS Brazil
| | - Alan Roger Santos‐Silva
- Oral Diagnosis Department Piracicaba Dental School Universidade Estadual de Campinas Piracicaba SP Brazil
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26
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Gallus R, Gheit T, Holzinger D, Petrillo M, Rizzo D, Petrone G, Miccichè F, Mattiucci GC, Arciuolo D, Capobianco G, Delogu G, Valentini V, Tommasino M, Bussu F. Prevalence of HPV Infection and p16 INK4a Overexpression in Surgically Treated Laryngeal Squamous Cell Carcinoma. Vaccines (Basel) 2022; 10:204. [PMID: 35214663 PMCID: PMC8874711 DOI: 10.3390/vaccines10020204] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background: The mucosal high-risk (HR) human papillomavirus (HPV) is associated with oropharyngeal carcinogenesis. Aims of this study were to evaluate the prevalence of HR-HPV infection in laryngeal squamous cell carcinoma (LSCC) from different subsites, and the clinico-biological meaning of p16 overexpression. Methods: Ninety-seven LSCCs submitted to primary surgery (n = 75) or to post-irradiation salvage laryngectomy (n = 22) were evaluated for HR-HPV DNA and RNA using Luminex-based assays. p16 immunohistochemistry was performed. Results: HR-HPV DNA from HPV16 was detected in seven cases (8.75%), without significant differences between supraglottic and glottic lesions. HPV RNA was never detected. p16 overexpression correlated with HR-HPV DNA, but the kappa agreement score was poor. HPV DNA showed no impact on prognosis. p16 overexpression was associated with a better survival (OS, RFS) in primarily operated cases, while an inverse association with OS was observed in the salvage surgery group. Conclusions: HR-HPV infection appears to have a marginal role in LSCC independent of the anatomical subsite. p16 expression is deregulated in LSCC independent of HPV but displays a prognostic role in patients submitted to primary surgery. The negative predictive role of p16 overexpression in patients undergoing salvage surgery deserves more investigations for validation and elucidation of its clinical relevance.
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Affiliation(s)
- Roberto Gallus
- Otolaryngology, Mater Olbia Hospital, 07026 Olbia, Italy;
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer, World Health Organization, 69008 Lyon, France; (T.G.); (M.T.)
| | - Dana Holzinger
- German Cancer Research Center (DKFZ), Division of Molecular Diagnostics of Oncogenic Infections, 69120 Heidelberg, Germany;
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Davide Rizzo
- Otolaryngology Division, Azienda Ospedaliero Universitaria di Sassari, 07100 Sassari, Italy; (D.R.); (F.B.)
- Dipartimento delle Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, 07100 Sassari, Italy
| | - Gianluigi Petrone
- Department of Women and Child Health and Public Health, Pathology Area, Fondazione Policlinico Universitario A. Gemelli–IRCCS, 00168 Rome, Italy; (G.P.); (D.A.)
| | - Francesco Miccichè
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, UOC di Radioterapia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (G.C.M.); (V.V.)
| | - Gian Carlo Mattiucci
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, UOC di Radioterapia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (G.C.M.); (V.V.)
- Radiation Oncology Unit, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Damiano Arciuolo
- Department of Women and Child Health and Public Health, Pathology Area, Fondazione Policlinico Universitario A. Gemelli–IRCCS, 00168 Rome, Italy; (G.P.); (D.A.)
| | - Giampiero Capobianco
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Giovanni Delogu
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
- Mater Olbia Hospital, 07026 Olbia, Italy
| | - Vincenzo Valentini
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, UOC di Radioterapia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (G.C.M.); (V.V.)
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer, World Health Organization, 69008 Lyon, France; (T.G.); (M.T.)
| | - Francesco Bussu
- Otolaryngology Division, Azienda Ospedaliero Universitaria di Sassari, 07100 Sassari, Italy; (D.R.); (F.B.)
- Dipartimento delle Scienze Mediche, Chirurgiche e Sperimentali, Università di Sassari, 07100 Sassari, Italy
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27
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Pupo–Marrugo S, Carmona–Lorduy M, Sánchez–Tatis A, Cecilia Werner L, Rocha–Herrera B. Tipificación del virus del papiloma humano en lesiones de cavidad bucal. Estudio desarrollado en los servicios de estomatología, Facultad de Odontología de la Universidad de Cartagena y el Hospital Alemán de Buenos Aires. ACTA ODONTOLÓGICA COLOMBIANA 2022. [DOI: 10.15446/aoc.v12n1.97247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: describir las características clínicas epidemiológicas en cavidad bucal de la infección por VPH y la asociación con su tipificación molecular. Métodos: se realizó un estudio analítico de corte transversal en 52 pacientes que acudieron a los servicios de estomatología en la Facultad de Odontología de la Universidad de Cartagena y al Hospital Alemán de Buenos Aires, a quienes se les abrió historia clínica y se les practicó prueba de PCR en tiempo real para la tipificación del VPH. Resultados: el análisis de los datos se efectuó a través de frecuencia y porcentaje. En cuanto a la parte inferencial, se usó la prueba chi cuadrado con un nivel de confianza P<0,05. De los 52 pacientes analizados, 67.3% eran mujeres con un predominio de edad entre los 50-59 años. El serotipo mayormente encontrado fue VPH 6, seguido del VPH 11 y otros tipos de VPH. La lesión elemental más preponderante fue la verrugosidad y la ubicación de predominio, la lengua. Conclusión: las infecciones por VPH se manifiestan frecuentemente en cavidad bucal con verrugosidades en lengua. Su estudio epidemiológico, incluyendo su tipificación, permitiría encontrar lesiones características para un diagnóstico, seguimiento y tratamiento oportuno.
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28
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Deneuve S, Pérol O, Dantony E, Guizard AV, Bossard N, Virard F, Fervers B. Diverging incidence trends of oral tongue cancer compared to other head and neck cancers in young adults in France. Int J Cancer 2021; 150:1301-1309. [PMID: 34889463 DOI: 10.1002/ijc.33896] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/18/2021] [Accepted: 11/02/2021] [Indexed: 01/02/2023]
Abstract
While head and neck cancer incidence decreased worldwide due to reduced tobacco and alcohol consumption, oral tongue cancer (OTC) incidence has been reported to be increasing in several countries. Our study examines the incidence trends of OTC in France from 1990 to 2018, globally and by age; and compares the incidence trends with the evolution of the incidence of other human papilloma virus-unrelated head and neck squamous cell carcinoma, that is, cancers of the remaining subsites of the oral cavity (RSOCC) and laryngeal cancers for the period 1990 to 2018. World age-standardized incidence rates of oral tongue cancers (C02), cancers of the remaining subsites of the oral cavity (RSOCC, C03-06) and laryngeal cancers (C32) were estimated using the French National Network of Cancer Registries for the period 1990 to 2018. Trends in national incidence rates were estimated from a mixed-effect Poisson model including age and year effects using penalized splines and a district-random effect. In women aged 30 and 40, a significant increase in OTC incidence was observed, while ROSCC showed a nonsignificant incidence decrease. In young men aged 25, a marginally significant increase of OTC incidence years was observed, while incidence rates of RSOCC significantly declined. The results suggest a tendency towards diverging incidence trends for OTC compared to RSOCC and laryngeal cancer in young adults. The observed trends may reflect changes in underlying exposures or emerging exposures not yet identified, and stress the need to further investigate the etiology of oral tongue cancers.
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Affiliation(s)
- Sophie Deneuve
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France.,INSERM 1296 Unit, Radiations: Defense, Health and Environment, Centre Léon Bérard, Lyon, France
| | - Olivia Pérol
- INSERM 1296 Unit, Radiations: Defense, Health and Environment, Centre Léon Bérard, Lyon, France.,Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France
| | - Emmanuelle Dantony
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Biométrie et Biologie Évolutive, UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
| | - Anne-Valérie Guizard
- Calvados General Tumor Registry, Centre Francois Baclesse, Caen, France.,U1086 INSERM-UCN "ANTICIPE", Centre Francois Baclesse, Caen, France
| | - Nadine Bossard
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Biométrie et Biologie Évolutive, UMR 5558, CNRS, Université Lyon 1, Université de Lyon, Villeurbanne, France
| | - François Virard
- Cancer Research Center of Lyon, INSERM 1052, Claude Bernard University, Lyon, France.,Faculté d'Odontologie, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Béatrice Fervers
- INSERM 1296 Unit, Radiations: Defense, Health and Environment, Centre Léon Bérard, Lyon, France.,Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France
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29
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Golusinski P, Corry J, Poorten VV, Simo R, Sjögren E, Mäkitie A, Kowalski LP, Langendijk J, Braakhuis BJM, Takes RP, Coca-Pelaz A, Rodrigo JP, Willems SM, Forastiere AA, De Bree R, Saba NF, Teng Y, Sanabria A, Di Maio P, Szewczyk M, Ferlito A. De-escalation studies in HPV-positive oropharyngeal cancer: How should we proceed? Oral Oncol 2021; 123:105620. [PMID: 34798575 DOI: 10.1016/j.oraloncology.2021.105620] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/26/2022]
Abstract
Human papilloma virus (HPV) is a well-established causative factor in a subset of squamous cell carcinomas of the head and neck (HNSCC). Although HPV can be detected in various anatomical subsites, HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) is the most common HPV-related malignancy of the head and neck, and its worldwide incidence is constantly rising. Patients with OPSCC are generally younger, have less co-morbidities and generally have better prognosis due to different biological mechanisms of carcinogenesis. These facts have generated hypotheses on potential treatment modifications, aiming to minimize treatment-related toxicities without compromising therapy efficacy. Numerous randomized clinical trials have been designed to verify this strategy and increasingly real-world evidence data from retrospective, observational studies is becoming available. Until now, the data do not support any modification in contemporary treatment protocols. In this narrative review, we outline recent data provided by both randomized controlled trials and real-world evidence of HPV-positive OPSCC in terms of clinical value. We critically analyze the potential value and drawbacks of the available data and highlight future research directions. This article was written by members and invitees of the International Head and Neck Scientific Group.(www.IHNSG.com).
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Affiliation(s)
- Pawel Golusinski
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora; Department of Maxillofacial Surgery Poznan University of Medical Sciences, Poland.
| | - June Corry
- Department Radiation Oncology, GenesisCare St Vincent's Hospital, Melbourne, Australia
| | - Vincent Vander Poorten
- Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Ricard Simo
- Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Elisabeth Sjögren
- Otolaryngology, Head and Neck Surgery Department, Leidse Universitaire Medisch Centrum (LUMC), University of Leiden, Leiden, The Netherlands
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Finland; Division of Ear, Nose, Finland
| | - Luis Paulo Kowalski
- Head and Neck Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Johannes Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Remco De Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yong Teng
- Department of Hematology and Medical Oncology Emory University School of Medicine; Winship Cancer Institute of Emory University, Georgia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - Pasquale Di Maio
- Department of Otolaryngology-Head and Neck Surgery, Giovanni Borea Civil Hospital, San Remo, Italy
| | - Mateusz Szewczyk
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Circulating p16-Positive and p16-Negative Tumor Cells Serve as Independent Prognostic Indicators of Survival in Patients with Head and Neck Squamous Cell Carcinomas. J Pers Med 2021; 11:jpm11111156. [PMID: 34834510 PMCID: PMC8624430 DOI: 10.3390/jpm11111156] [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: 10/03/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Decisions regarding the staging, prognosis, and treatment of patients with head and neck squamous cell carcinomas (HNSCCs) are made after determining their p16 expression levels and human papillomavirus (HPV) infection status. METHODS We investigated the prognostic roles of p16-positive and p16-negative circulating tumor cells (CTCs) and their cell counts in HNSCC patients. We enrolled patients with locally advanced HNSCCs who received definitive concurrent chemoradiotherapy for final analysis. We performed CTC testing and p16 expression analysis before chemoradiotherapy. We analyzed the correlation between p16-positive and p16-negative CTCs and HPV genotyping, tissue p16 expression status, response to chemoradiotherapy, disease-free survival, and overall survival. RESULTS Forty-one patients who fulfilled the study criteria were prospectively enrolled for final analysis. The detection rates of p16-positive (>0 cells/mL blood) and p16-negative (≥3 cells/mL blood) CTCs were 51.2% (n = 21/41) and 70.7%, respectively. The best responses of chemoradiotherapy and the p16 positivity of CTCs are independent prognostic factors of disease progression, with hazard ratios of 1.738 (95% confidence interval (CI): 1.031-2.927), 5.497 (95% CI: 1.818-16.615), and 0.176 (95% CI: 0.056-0.554), respectively. The p16 positivity of CTCs was a prognostic factor for cancer death, with a hazard ratio of 0.294 (95% CI: 0.102-0.852). CONCLUSIONS The p16-positive and p16-negative CTCs could predict outcomes in HNSCC patients receiving definitive chemoradiotherapy. This non-invasive CTC test could help stratify the risk and prognosis before chemoradiotherapy in clinical practice and enable us to perform de-intensifying therapies.
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Powell SF, Vu L, Spanos WC, Pyeon D. The Key Differences between Human Papillomavirus-Positive and -Negative Head and Neck Cancers: Biological and Clinical Implications. Cancers (Basel) 2021; 13:5206. [PMID: 34680354 PMCID: PMC8533896 DOI: 10.3390/cancers13205206] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 12/17/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a unique malignancy associated with two distinct risk factors: exposure to typical carcinogens and infection of human papillomavirus (HPV). HPV encodes the potent oncoproteins E6 and E7, which bypass many important oncogenic processes and result in cancer development. In contrast, HPV-negative HNSCC is developed through multiple mutations in diverse oncogenic driver genes. While the risk factors associated with HPV-positive and HPV-negative HNSCCs are discrete, HNSCC patients still show highly complex molecular signatures, immune infiltrations, and treatment responses even within the same anatomical subtypes. Here, we summarize the current understanding of biological mechanisms, treatment approaches, and clinical outcomes in comparison between HPV-positive and -negative HNSCCs.
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Affiliation(s)
- Steven F. Powell
- Cancer Biology and Immunotherapies Group, Sanford Research, Sioux Falls, SD 57104, USA;
| | - Lexi Vu
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA;
| | - William C. Spanos
- Cancer Biology and Immunotherapies Group, Sanford Research, Sioux Falls, SD 57104, USA;
| | - Dohun Pyeon
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA;
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Wu Q, Wang M, Liu Y, Wang X, Li Y, Hu X, Qiu Y, Liang W, Wei Y, Zhong Y. HPV Positive Status Is a Favorable Prognostic Factor in Non-Nasopharyngeal Head and Neck Squamous Cell Carcinoma Patients: A Retrospective Study From the Surveillance, Epidemiology, and End Results Database. Front Oncol 2021; 11:688615. [PMID: 34631523 PMCID: PMC8497986 DOI: 10.3389/fonc.2021.688615] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023] Open
Abstract
Objective To investigate the impact of the human papillomavirus (HPV) status on head and neck squamous cell carcinoma (HNSCC) arising from different anatomic subsites. Methods HNSCC patients with known HPV status from the Surveillance, Epidemiology, and End Results (SEER) database between 2010–2015 were included in our analysis. Patients were classified into three categories of HNSCC according to Site recode ICD-O-3/WHO 2008 and Primary Site-labeled, namely, oropharynx, hypopharynx, and nasopharynx. Logistic regression model was conducted to evaluate the relationship between patient characteristics and HPV status. Kaplan-Meier methods and COX regression analysis were used to analyze survival data. Results A total of 9,943 HNSCC patients with known HPV status from the SEER database were enrolled, with 6,829 (68.7%) HPV-positive patients. HPV-positive and HPV-negative HNSCC were distinct and had different clinical and socioeconomic features (all P < 0.001). Primary sites, socioeconomical factors (age, sex, marital status, and race), and pathological features (TNM stage and grade) were closely related with HPV status (all P < 0.001). HPV-positive status was a favorable prognostic marker in HNSCC patients with cancers of the oropharynx and hypopharynx (all P < 0.001), but was not in nasopharyngeal carcinoma patients (P = 0.843). A total of 8,933 oropharyngeal carcinoma (OPC) and 558 hypopharyngeal carcinoma (HPC) patients were divided into the training and validation cohorts with a ratio of 1:1. Significant prognostic factors of the OS yielded by multivariate COX analysis in the training cohort were integrated to construct nomograms for OPC and HPC patients. The prognostic models showed a good discrimination with a C-index of 0.79 ± 0.007 and 0.73 ± 0.023 in OPC and HPC, respectively. Favorable calibration was reflected by the calibration curves. Additionally, corresponding risk classification systems for OPC and HPC patients based on the nomograms were built and could perfectly classify patients into low-risk, intermediated-risk, high-risk groups. OS in the three risk groups was accurately differentiated and showed a good discrimination. Conclusion HPV positivity was associated with an improved survival in HNSCC patients with cancers of the oropharynx and hypopharynx. Nomograms and corresponding risk classification systems were constructed to assist clinicians in evaluating the survival of OPC and HPC patients.
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Affiliation(s)
- Qiuji Wu
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Miao Wang
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yixin Liu
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Xulong Wang
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yi Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Xiaoyan Hu
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Ye Qiu
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Wenjing Liang
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yongchang Wei
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yahua Zhong
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
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Hoes L, Dok R, Verstrepen KJ, Nuyts S. Ethanol-Induced Cell Damage Can Result in the Development of Oral Tumors. Cancers (Basel) 2021; 13:cancers13153846. [PMID: 34359747 PMCID: PMC8345464 DOI: 10.3390/cancers13153846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Alcohol consumption is linked to 26.4% of all lip and oral cavity cancer cases worldwide. Despite this clear causal relationship, the exact molecular mechanisms by which ethanol damages cells are still under investigation. It is well-established that the metabolism of ethanol plays an important role. Ethanol metabolism yields reactive metabolites that can directly damage the DNA. If the damage is repaired incorrectly, mutations can be fixed in the DNA sequence. Whenever mutations affect key regulatory genes, for instance cell cycle regulating genes, uncontrolled cell growth can be the consequence. Recently, global patterns of mutations have been identified. These so-called mutational signatures represent a fingerprint of the different mutational processes over time. Interestingly, there were ethanol-related signatures discovered that did not associate with ethanol metabolism. This finding highlights there might be other molecular effects of ethanol that are yet to be discovered. Abstract Alcohol consumption is an underestimated risk factor for the development of precancerous lesions in the oral cavity. Although alcohol is a well-accepted recreational drug, 26.4% of all lip and oral cavity cancers worldwide are related to heavy drinking. Molecular mechanisms underlying this carcinogenic effect of ethanol are still under investigation. An important damaging effect comes from the first metabolite of ethanol, being acetaldehyde. Concentrations of acetaldehyde detected in the oral cavity are relatively high due to the metabolization of ethanol by oral microbes. Acetaldehyde can directly damage the DNA by the formation of mutagenic DNA adducts and interstrand crosslinks. Additionally, ethanol is known to affect epigenetic methylation and acetylation patterns, which are important regulators of gene expression. Ethanol-induced hypomethylation can activate the expression of oncogenes which subsequently can result in malignant transformation. The recent identification of ethanol-related mutational signatures emphasizes the role of acetaldehyde in alcohol-associated carcinogenesis. However, not all signatures associated with alcohol intake also relate to acetaldehyde. This finding highlights that there might be other effects of ethanol yet to be discovered.
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Affiliation(s)
- Lore Hoes
- Laboratory for Systems Biology, VIB-KU Leuven Center for Microbiology, 3000 Leuven, Belgium; (L.H.); (K.J.V.)
- Laboratory of Genetics and Genomics, Centre for Microbial and Plant Genetics, KU Leuven, 3000 Leuven, Belgium
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, 3000 Leuven, Belgium;
| | - Rüveyda Dok
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, 3000 Leuven, Belgium;
| | - Kevin J. Verstrepen
- Laboratory for Systems Biology, VIB-KU Leuven Center for Microbiology, 3000 Leuven, Belgium; (L.H.); (K.J.V.)
- Laboratory of Genetics and Genomics, Centre for Microbial and Plant Genetics, KU Leuven, 3000 Leuven, Belgium
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, 3000 Leuven, Belgium;
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospital Leuven, 3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-1634-7600; Fax: +32-1634-7623
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Diao P, Jiang Y, Li Y, Wu X, Li J, Zhou C, Jiang L, Zhang W, Yan E, Zhang P, Ding X, Wu H, Yuan H, Ye J, Song X, Wan L, Wu Y, Jiang H, Wang Y, Cheng J. Immune landscape and subtypes in primary resectable oral squamous cell carcinoma: prognostic significance and predictive of therapeutic response. J Immunother Cancer 2021; 9:jitc-2021-002434. [PMID: 34130988 PMCID: PMC8208002 DOI: 10.1136/jitc-2021-002434] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Immune landscape of cancer has been increasingly recognized as a key feature affecting disease progression, prognosis and therapeutic response. Here, we sought to comprehensively characterize the patterns of tumor-infiltrating immune cells (TIIs) in primary oral squamous cell carcinoma (OSCC) and develop immune features-derived models for prognostication and therapeutic prediction. METHODS A total number of 392 patients with OSCC receiving ablative surgery at three independent centers were retrospectively enrolled and defined as training, testing and validation cohorts. Detailed features of 12 types of TIIs at center of tumor and invasive margin were assessed by immunohistochemistry coupled with digital quantification. TIIs abundance in OSCC was also estimated by bioinformatics approaches using multiple publicly available data sets. Prognostic models based on selected immune features were trained via machine learning approach, validated in independent cohorts and evaluated by time-dependent area under the curves and concordance index (C-index). Immune types of OSCC were further identified by consensus clustering and their associations with genetic, molecular features and patient survival were clarified. RESULTS Patterns of TIIs infiltration varied among patients and dynamically evolved along with tumor progression. Prognostic models based on selected TIIs were identified as efficient and sensitive biomarkers to stratify patients into subgroups with favorable or inferior survival as well as responders or non-responders to postoperative radiotherapy or immunotherapy. These models outperformed multiple conventional biomarkers and immune-related scores in prognostic prediction. Furthermore, we identified two main immune subtypes of OSCC (immune-hot and immune-cold) which harbored characteristic TIIs infiltrations and genomic and molecular features, and associated with patient survival. CONCLUSIONS Our results delineated immune landscape and subtypes in OSCC, consolidated their clinical values as robust biomarkers to predict patient survival and therapeutic benefits and reinforced key roles of TIIs and tumor-immune interactions underlying oral tumorigenesis, ultimately facilitating development of tailed immunotherapeutic strategies.
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Affiliation(s)
- Pengfei Diao
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Yue Jiang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Yuanyuan Li
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Xiang Wu
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Jin Li
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Chen Zhou
- Department of Oral and Maxillofacial Surgery, Jiangnan University, Wuxi, Jiangsu, China
| | - Lei Jiang
- Department of Oral and Maxillofacial Surgery, Lianyungang No 1 People's Hospital, Lianyungang, Jiangsu, China
| | - Wei Zhang
- Department of Oral Pathology, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Enshi Yan
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Ping Zhang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Xu Ding
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Heming Wu
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Hua Yuan
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Jinhai Ye
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaomeng Song
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Linzhong Wan
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Yunong Wu
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Hongbing Jiang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Yanling Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China
| | - Jie Cheng
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Nanjing, China .,Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
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Santos EM, Fraga CADC, Xavier AREDO, Xavier MADS, Souza MG, Jesus SFD, Paula AMBD, Farias LC, Santos SHS, Santos TG, Beraldo FH, Guimarães ALS. Prion protein is associated with a worse prognosis of head and neck squamous cell carcinoma. J Oral Pathol Med 2021; 50:985-994. [PMID: 33896033 DOI: 10.1111/jop.13188] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSC) etiopathogenesis remains unclear, and the biological changes with the activation of heat shock proteins (HSPs) and prion protein (PRNP) promoted by hypoxia in HNSC are undetermined. This study investigates hypoxia's effect in lymph node metastasis by PRNP expression changes and its main partners. METHODS The study combined a theoretical/cell culture study with a case-control study. First, bioinformatics and cell culture were performed. A case-control study was performed in a second step by comparing HNSC patients with and without lymph node metastasis. ANALYSES The Cancer Genome Atlas (TCGA) data source validates the theory in the global population study. RESULTS Bioinformatics analysis suggests that hypoxia-inducible factor-1α (HIF1A) is associated with HSPA4, HSP90AA1 and PRNP expression. TCGA data validate the hypothesis that higher HSP90AA1, HSPA4 and PRNP are related to metastases and low survival. Herein, the cell study demonstrated that muted PRNP did not respond to hypoxia. DISCUSSION Our results collectively provide the first evidence that PRNP promotes HNSC lymph node metastasis progression through the upregulation of HSPA4, HSP90AA1 and HIF1A. Our findings may provide a molecular basis for the promoting Role of PRNP in HNSC progression.
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Affiliation(s)
- Eloa Mangabeira Santos
- Department of Dentistry, Universidade Estadual de Montes Claros (Unimontes), Montes Claros, Brazil
| | | | | | | | - Marcela Gonçalves Souza
- Department of Dentistry, Universidade Estadual de Montes Claros (Unimontes), Montes Claros, Brazil
| | | | | | - Lucyana Conceição Farias
- Department of Dentistry, Universidade Estadual de Montes Claros (Unimontes), Montes Claros, Brazil
| | | | - Tiago Goss Santos
- International Research Center, A.C.Camargo Cancer Center, São Paulo, Brazil
| | - Flavio H Beraldo
- Robarts Research Institute and the Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - André Luiz Sena Guimarães
- Department of Dentistry, Universidade Estadual de Montes Claros (Unimontes), Montes Claros, Brazil.,Dilson Godinho Hospital, Montes Claros, Brazil
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36
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Nauta IH, Heideman DAM, Brink A, van der Steen B, Bloemena E, Koljenović S, Baatenburg de Jong RJ, Leemans CR, Brakenhoff RH. The unveiled reality of human papillomavirus as risk factor for oral cavity squamous cell carcinoma. Int J Cancer 2021; 149:420-430. [PMID: 33634865 PMCID: PMC8251537 DOI: 10.1002/ijc.33514] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/27/2020] [Accepted: 01/19/2021] [Indexed: 12/25/2022]
Abstract
The prognostic impact of human papillomavirus (HPV) in oropharyngeal cancer is generally acknowledged, and HPV-status is assessed routinely in clinical practice. Paradoxically, while the oral cavity seems the predilection site for productive HPV-infections, figures on HPV-attribution in oral cavity squamous cell carcinoma (OCSCC) differ widely, and prognostic impact is uncertain. Major obstacles are the lack of reproducible assays to detect HPV in nonoropharyngeal cancers, the relatively small cohorts studied and consequently the shortfall of convincing data. In our study, we used a validated, nucleic acid-based workflow to assess HPV-prevalence in a consecutive cohort of 1016 OCSCCs, and investigated its prognostic impact. In parallel, we analyzed p16-immunohistochemistry (p16-IHC) as surrogate marker for transforming HPV-infection and independent prognosticator. All OCSCC-patients diagnosed between 2008 and 2014 at two Dutch university medical centers were included (N = 1069). Formalin-fixed, paraffin-embedded (FFPE)-samples of 1016 OCSCCs could be retrieved. Punch biopsies were taken from the tumor area in the FFPE-blocks and tested for HPV. P16-IHC was performed on 580 OCSCCs, including all HPV-positive tumors. From 940 samples (92.5%), nucleic acids were of sufficient quality for HPV-testing. In total, 21 (2.2%) OCSCCs were HPV DNA-positive. All HPV DNA-positive tumors were E6 mRNA-positive and considered as true HPV-positive. There was no difference in survival between HPV-positive and HPV-negative OCSCCs. In total, 46 of 580 (7.9%) OCSCCs were p16-immunopositive, including all HPV-positive tumors. Survival was comparable in p16-positive and p16-negative OCSCCs. To conclude, HPV-prevalence is very low in OCSCC and neither HPV-status nor p16-status affects outcome. Based on these data, determining HPV-status in OCSCC seems irrelevant for clinical management.
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Affiliation(s)
- Irene H Nauta
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Daniëlle A M Heideman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Arjen Brink
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Berdine van der Steen
- Department of Otorhinolaryngology/Head and Neck Surgery, Erasmus Medical Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Elisabeth Bloemena
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Maxillofacial Surgery/Oral Pathology, Academic Medical Centre for Dentistry, Amsterdam, The Netherlands
| | - Senada Koljenović
- Department of Pathology, Erasmus Medical Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology/Head and Neck Surgery, Erasmus Medical Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - C René Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ruud H Brakenhoff
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam, The Netherlands
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