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Dabán-López P, Fernández-Martínez NF, Petrova D, Rodríguez-Barranco M, Jiménez-Moleón JJ, Gutierrez J, Sánchez MJ. Epidemiology of human papillomavirus-associated anogenital cancers in Granada: a three-decade population-based study. Front Public Health 2023; 11:1205170. [PMID: 37780447 PMCID: PMC10537955 DOI: 10.3389/fpubh.2023.1205170] [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: 04/13/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction HPV infection is a common risk factor for all anogenital cancers. However, there are important differences in the epidemiology of anogenital cancers and these have not been compared considering diverse epidemiological indicators over a long period of time. To fill this gap, we investigated incidence, mortality, and survival trends of anogenital cancers over a period of three decades. Methods We conducted an observational registry-based study using data from the population-based cancer registry of Granada in southern Spain. We collected data on all incident cases of anogenital cancer (cervical, anal, penile, vulvar, and vaginal cancer) diagnosed between 1985 and 2017. We calculated crude and age-standardized incidence and mortality rates, and 1, 3, and 5-year overall and net survival. We further conducted time-trend analysis calculating annual percent changes (APC) for each cancer site. Results The incidence of anogenital cancers decreased slightly during the past 30 years, with the exception of vulvar cancer, where a slight increase was observed. Mortality decreased significantly for cervical cancer over the study period but increased non-significantly for the remaining cancer sites. Survival rates were similar to those reported in comparable countries and increased for cervical and vulvar cancer. Discussion Cervical cancer was the greatest contributor to the burden of anogenital cancers and showed a marked improvement in all indicators in comparison to the remaining cancer sites.
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Affiliation(s)
- Pablo Dabán-López
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario San Cecilio, Granada, Spain
| | - Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jose Juan Jiménez-Moleón
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Javier Gutierrez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario San Cecilio, Granada, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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Kuga R, Yamamoto H, Jiromaru R, Hongo T, Yasumatsu R, Matsuo M, Hashimoto K, Taniguchi M, Nakagawa T, Oda Y. HPV Infection in Squamous Cell Carcinoma of the Hypopharynx, Larynx, and Oropharynx With Multisite Involvement. Am J Surg Pathol 2023; 47:955-966. [PMID: 37357948 DOI: 10.1097/pas.0000000000002086] [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: 06/27/2023]
Abstract
The prevalence and prognostic significance of high-risk human papillomavirus (HR-HPV) have been well-established in oropharyngeal squamous cell carcinoma (OPSCC), but not in hypopharyngeal squamous cell carcinoma (HPSCC) or laryngeal squamous cell carcinoma (LSCC). Moreover, HR-HPV infection in squamous cell carcinoma with multisite involvement has not been examined. To clarify these issues, we retrospectively collected 480 invasive tumors from 467 patients with HPSCC, LSCC, or OPSCC, and comprehensively analyzed the detailed tumor localization, transcriptionally active HR-HPV infection by messenger RNA in situ hybridization, and immunohistochemical staining for p16 and Rb. HR-HPV infection was observed in 115/480 tumors (24%). Human papillomavirus (HPV)-positive cases were closely related with p16 positivity and the partial loss pattern of Rb. HR-HPV was detected in 104 of 161 tumors (64.6%) in the pure OPSCC group and only 1 of 253 tumors (0.4%) in the pure HP/LSCC group; the positive case occurred in the vocal cords. In the multisite-involving combined-type squamous cell carcinoma group, HPV infection was observed in 10/40 (25%) cases, and the 10 HPV-positive cases had OPSCC extending to the larynx or hypopharynx. Among high T-stage (T3/T4) cases of pure OPSCC, HPV-positive cases showed a better prognosis ( P =0.0144), whereas the HPV-positive combined OPSCC group did not show a better prognosis ( P =0.9428), as compared with HPV-negative counterpart. The results suggest that HR-HPV infection in pure HPSCC and LSCC may be extremely rare. HR-HPV infection seems to be present in a substantial proportion of patients with combined OPSCC and HPSCC/LSCC, but it may not improve prognosis at such advanced disease stages. Confirmation of these points awaits future studies with larger cohorts.
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Affiliation(s)
| | | | - Rina Jiromaru
- Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Takahiro Hongo
- Departments of Anatomic Pathology
- Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Ryuji Yasumatsu
- Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Mioko Matsuo
- Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Kazuki Hashimoto
- Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | | | - Takashi Nakagawa
- Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka
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Kakkar A, Satapathy S, Sikka K, Tanwar P, Deo S, Jain D. Evaluation of high-risk human papillomavirus in sinonasal papillomas and squamous cell carcinomas. Virchows Arch 2023; 483:381-392. [PMID: 37452847 DOI: 10.1007/s00428-023-03601-x] [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: 02/16/2023] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
The sinonasal tract is considered a second hotspot for human papillomavirus (HPV)-related tumors in the head and neck, with HPV being identified in up to 62% of squamous cell carcinomas (SCCs) and 38% of papillomas. There is limited data from geographical regions with low prevalence of high-risk (HR)-HPV on the association of HR-HPV in sinonasal neoplasms and on utility of p16 as a surrogate marker. p16 immunohistochemistry, HR-HPV mRNA ISH and quantitative real-time PCR (qPCR) were performed on a retrospective cohort of sinonasal papillomas and SCCs. KRAS mutation analysis was done in oncocytic papillomas. p16 positivity was present in 22/142 cases (15.5%) including eight inverted papillomas, one oncocytic papilloma (OP), and 13 SCC. Among these, mRNA ISH showed HR-HPV in the OP and two SCC, while another SCC was found to harbour HPV18 by qPCR. Two HPV-associated SCCs had foci of OP. mRNA ISH was negative in all p16 negative cases. p16 immunohistochemistry showed 68% concordance with mRNA ISH, and had sensitivity and negative predictive value of 100%; specificity was 67%, and positive predictive value was 14.3%. Association with HR-HPV in sinonasal papillomas and SCC is rare, and may be seen in cases demonstrating oncocytic morphology. p16 immunohistochemistry has low specificity and positive predictive value in low-prevalence populations; thus, reflex direct HR-HPV testing should be performed in p16 immunopositive cases. This two-step approach is viable in resource-limited settings, as the proportion of p16 positive cases is small.
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Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, 110029, New Delhi, India
| | | | - Kapil Sikka
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, 110029, New Delhi, India
| | - Pranay Tanwar
- Department of Laboratory Oncology, All India Institute of Medical Sciences, 110029, New Delhi, India
| | - Svs Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, 110029, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, 110029, New Delhi, India.
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Lu XJD, Liu KYP, Prisman E, Wu J, Zhu YS, Poh C. Prognostic value and cost benefit of HPV testing for oropharyngeal cancer patients. Oral Dis 2023; 29:483-490. [PMID: 34129700 DOI: 10.1111/odi.13938] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/17/2021] [Accepted: 05/29/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES High-risk human papillomavirus (HR-HPV) can cause oropharyngeal squamous cell carcinoma (OpSCC). The revised 8th edition of the AJCC Staging Manual now stages OpSCC by incorporating p16 immunohistochemistry (IHC), the surrogate marker for HPV status. This study assessed the prognostic values of p16 and HPV markers. METHODS We identified 244 OpSCC patients diagnosed between 2000 and 2008 from the British Columbia Cancer Registry with enough tissue to conduct experiments. Formalin-fixed, paraffin-embedded tissue sections were stained for p16 IHC, RNA in situ hybridization (ISH) HPV 16 and 18, and DNA ISH HR-HPV. Electronic charts were reviewed to collect clinical and outcome data. Combined positive RNA and/or DNA ISH was used to denote HPV status. RESULTS Human papillomavirus was positive among 77.9% of samples. Using HPV as the benchmark, p16 IHC had high sensitivity (90.5%), but low specificity (68.5%). Distinct subgroups of patients were identified by sequential separation of p16 then HPV status. Among both p16-positive and p16-negative groups, HPV-positive patients were younger, more males, and had better clinical outcomes, especially 5-year overall survival. We further evaluated the technical costs associated with HPV testing. CONCLUSION Human papillomavirus is more prognostic than p16 for OpSCC. Clinical laboratories can adopt HPV RNA ISH for routine analysis.
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Affiliation(s)
- Xian Jun David Lu
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada.,Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Kelly Yi Ping Liu
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada.,Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Eitan Prisman
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada
| | - Jonn Wu
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Center, Vancouver, BC, Canada
| | - Yuqi Sarah Zhu
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Catherine Poh
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada.,Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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5
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Ferris RL, Westra W. Oropharyngeal Carcinoma with a Special Focus on HPV-Related Squamous Cell Carcinoma. ANNUAL REVIEW OF PATHOLOGY 2023; 18:515-535. [PMID: 36693202 DOI: 10.1146/annurev-pathmechdis-031521-041424] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-OPSCC) has one of the most rapidly increasing incidences of any cancer in high-income countries. The most recent (8th) edition of the Union for International Cancer Control/American Joint Committee on Cancer staging system separates HPV-OPSCC from its HPV-negative counterpart to account for the improved prognosis seen in the former. Indeed, owing to its improved prognosis and greater prevalence in younger individuals, numerous ongoing trials are examining the potential for treatment deintensification as a means to improve quality of life while maintaining acceptable survival outcomes. Owing to the distinct biology of HPV-OPSCCs, targeted therapies and immunotherapies have become an area of particular interest. Importantly, OPSCC is often detected at an advanced stage, highlighting the need for diagnostic biomarkers to aid in earlier detection. In this review, we highlight important advances in the epidemiology, pathology, diagnosis, and clinical management of HPV-OPSCC and underscore the need for a progressive understanding of the molecular basis of this disease toward early detection and precision care.
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Affiliation(s)
| | - William Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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6
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Murphy RM, Tasoulas J, Porrello A, Carper MB, Tsai YH, Coffey AR, Kumar S, Zeng PYF, Schrank TP, Midkiff BR, Cohen S, Salazar AH, Hayward MC, Hayes DN, Olshan A, Gupta GP, Nichols AC, Yarbrough WG, Pecot CV, Amelio AL. Tumor Cell Extrinsic Synaptogyrin 3 Expression as a Diagnostic and Prognostic Biomarker in Head and Neck Cancer. CANCER RESEARCH COMMUNICATIONS 2022; 2:987-1004. [PMID: 36148399 PMCID: PMC9491693 DOI: 10.1158/2767-9764.crc-21-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/15/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022]
Abstract
Over 70% of oropharyngeal head and neck squamous cell carcinoma (HNSC) cases in the United States are positive for human papillomavirus (HPV) yet biomarkers for stratifying oropharyngeal head and neck squamous cell carcinoma (HNSC) patient risk are limited. We used immunogenomics to identify differentially expressed genes in immune cells of HPV(+) and HPV(-) squamous carcinomas. Candidate genes were tested in clinical specimens using both quantitative RT-PCR and IHC and validated by IHC using the Carolina Head and Neck Cancer Study (CHANCE) tissue microarray of HNSC cases. We performed multiplex immunofluorescent staining to confirm expression within the immune cells of HPV(+) tumors, receiver operating characteristic (ROC) curve analyses, and assessed survival outcomes. The neuronal gene Synaptogyrin-3 (SYNGR3) is robustly expressed in immune cells of HPV(+) squamous cancers. Multiplex immunostaining and single cell RNA-seq analyses confirmed SYNGR3 expression in T cells, but also unexpectedly in B cells of HPV(+) tumors. ROC curve analyses revealed that combining SYNGR3 and p16 provides more sensitivity and specificity for HPV detection compared to p16 IHC alone. SYNGR3-high HNSC patients have significantly better prognosis with five-year OS and DSS rates of 60% and 71%, respectively. Moreover, combining p16 localization and SYNGR3 expression can further risk stratify HPV(+) patients such that high cytoplasmic, low nuclear p16 do significantly worse (Hazard Ratio, 8.6; P = 0.032) compared to patients with high cytoplasmic, high nuclear p16. SYNGR3 expression in T and B cells is associated with HPV status and enhanced survival outcomes of HNSC patients.
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Affiliation(s)
- Ryan M. Murphy
- Graduate Curriculum in Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jason Tasoulas
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alessandro Porrello
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Miranda B. Carper
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yi-Hsuan Tsai
- Bioinformatics Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alisha R. Coffey
- Bioinformatics Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sunil Kumar
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Technology Development, Naveris Inc., Natick, Massachusetts
| | - Peter YF. Zeng
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Travis P. Schrank
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Bentley R. Midkiff
- Pathology Services Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie Cohen
- Pathology Services Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ashley H. Salazar
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michele C. Hayward
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - D. Neil Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Center for Cancer Research, University of Tennessee Health Sciences, Memphis, Tennessee
| | - Andrew Olshan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gaorav P. Gupta
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Radiation Oncology, UNC School of Medicine, Chapel Hill, North Carolina
| | - Anthony C. Nichols
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Wendell G. Yarbrough
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Department of Pathology and Lab Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Chad V. Pecot
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Antonio L. Amelio
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Cell Biology and Physiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Cancer Cell Biology Program, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Sjöblom A, Carpén T, Stenman UH, Jouhi L, Haglund C, Syrjänen S, Mattila P, Mäkitie A, Hagström J. The Role of Human Chorionic Gonadotropin Beta (hCGβ) in HPV-Positive and HPV-Negative Oropharyngeal Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14122830. [PMID: 35740496 PMCID: PMC9221036 DOI: 10.3390/cancers14122830] [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: 05/07/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background: This study was carried out to observe the upregulation of the free β-subunit of human chorionic gonadotropin (hCGβ) and its prognostic significance in human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC). Materials and methods: A total of 90 patients with OPSCC treated with curative intent at the Helsinki University Hospital (HUS), Helsinki, Finland, during 2012−2016 were included. Serum samples were collected prospectively, and their hCGβ concentrations (S-hCGβ) were determined by an immunofluorometric assay. The expression of hCGβ in tumor tissues was defined by immunohistochemistry (IHC). HPV determination was performed by combining p16-INK4 IHC and HPV DNA PCR genotyping. Overall survival (OS) and disease-specific survival (DSS) were used as survival endpoints. Results: S-hCGβ positivity correlated with poor OS in the whole patient cohort (p < 0.001) and in patients with HPV-negative OPSCC (p < 0.001). A significant correlation was seen between S-hCGβ and poor DSS in the whole cohort (p < 0.001) and in patients with HPV-negative OPSCC (p = 0.007). In a multivariable analysis, S-hCGβ was associated with poor DSS. Of the clinical characteristics, higher cancer stage and grade were associated with S-hCGβ positivity. No statistically significant correlation with tissue positivity of hCGβ was seen in these analyses. Conclusion: S-hCGβ may be a potential independent factor indicating poor prognosis, notably in HPV-negative OPSCC.
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Affiliation(s)
- Anni Sjöblom
- Department of Pathology, University of Helsinki and Helsinki University Hospital, P.O. Box 21, FI-00014 Helsinki, Finland
| | - Timo Carpén
- Department of Pathology, University of Helsinki and Helsinki University Hospital, P.O. Box 21, FI-00014 Helsinki, Finland
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, P.O. Box 63, FI-00014 Helsinki, Finland
| | - Ulf-Håkan Stenman
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, P.O. Box 63, FI-00014 Helsinki, Finland
| | - Lauri Jouhi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS Helsinki, Finland
| | - Caj Haglund
- Research Programs Unit, Translational Cancer Medicine, University of Helsinki, P.O. Box 63, FI-00014 Helsinki, Finland
- Department of Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 440, FI-00029 Helsinki, Finland
| | - Stina Syrjänen
- Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, P.O. Box 63, FI-00014 Helsinki, Finland
- Department of Pathology, Turku University Hospital, Kiinamyllynkatu 10, 20520 Turku, Finland
| | - Petri Mattila
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, P.O. Box 63, FI-00014 Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, SE-171 76 Stockholm, Sweden
| | - Jaana Hagström
- Department of Pathology, University of Helsinki and Helsinki University Hospital, P.O. Box 21, FI-00014 Helsinki, Finland
- Research Programs Unit, Translational Cancer Medicine, University of Helsinki, P.O. Box 63, FI-00014 Helsinki, Finland
- Department of Oral Pathology and Oral Radiology, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
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Overview of Candida albicans and Human Papillomavirus (HPV) Infection Agents and their Biomolecular Mechanisms in Promoting Oral Cancer in Pediatric Patients. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7312611. [PMID: 34765678 PMCID: PMC8577934 DOI: 10.1155/2021/7312611] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/16/2021] [Indexed: 12/28/2022]
Abstract
Oral carcinoma represents one of the most common malignancies worldwide. Oral squamous cell carcinomas (OSCCs) account over 90% of all oral malignant tumors and are characterized by high mortality in the advanced stages. Early diagnosis is often a challenge for its ambiguous appearance in early stages. Mucosal infection by the human papillomavirus (HPV) is responsible for a growing number of malignancies, particularly cervical cancer and oropharyngeal carcinomas. In addition, Candida albicans (C. albicans), which is the principal fungi involved in the oral cancer development, may induce carcinogenesis through several mechanisms, mainly promoting inflammation. Medical knowledge and research on adolescent/pediatric patients' management and prevention are in continuous evolution. Besides, microbiota can play an important role in maintaining oral health and therefore all human health. The aim of this review is to evaluate epidemiological and pathophysiological characteristics of the several biochemical pathways involved during HPV and C. albicans infections in pediatric dentistry.
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Beulque E, Cortese S, Mastronicola R, Dolivet G. [Surgical de-escalation for head and neck cancer surgery]. Bull Cancer 2021; 108:948-952. [PMID: 34556292 DOI: 10.1016/j.bulcan.2021.06.008] [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: 04/30/2021] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
Head and neck cancer surgery often has functional and aesthetic consequences. De-escalation surgery is a major concern for surgeons with a constant desire to develop surgical techniques with less invasive approaches and to preserve anatomical structures as much as possible. This was made possible by the appearance of minimally transoral and endonasal surgery as well as by the limitation of the surgical procedure by neoadjuvant treatments or by the limitation of surgical excision without compromising the oncological outcome and patient survival. This evolution continues with the arrival of new technologies such as virtual reality or artificial intelligence.
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Affiliation(s)
- Emilie Beulque
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France.
| | - Sophie Cortese
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France
| | - Romina Mastronicola
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France
| | - Gilles Dolivet
- Institut de cancérologie de Lorraine, département de chirurgie, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy cedex, France
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10
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Turchan WT, Liauw SL. Chemoradiation for Anal Cancer: Clinical Outcomes and Strategies to Optimize the Therapeutic Ratio According to HPV Status. Semin Radiat Oncol 2021; 31:349-360. [PMID: 34455990 DOI: 10.1016/j.semradonc.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The incidence of anal cancer in the United States has increased in recent years, primarily related to the increasing incidence of HPV-associated anal squamous cell carcinoma, which is estimated to represent 80%-95% of anal cancers. Similar to head and neck cancer, HPV association has been demonstrated to be a strong positive prognostic factor in patients with anal cancer. Encouraging results from a number of studies investigating treatment de-escalation for HPV-associated oropharyngeal cancer support the notion that similar attempts may be feasible in HPV-associated anal cancer; however, the data to support this hypothesis are currently lacking. Studies are needed to determine how, if at all, HPV status should impact the management of patients with anal cancer. This review summarizes the relationship between HPV association and outcomes for patients with anal cancer, and how HPV status may impact the treatment of patients with anal cancer going forward.
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Affiliation(s)
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL.
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11
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Jiromaru R, Yamamoto H, Yasumatsu R, Hongo T, Nozaki Y, Nakano T, Hashimoto K, Nakagawa T, Oda Y. p16 overexpression and Rb loss correlate with high-risk HPV infection in oropharyngeal squamous cell carcinoma. Histopathology 2021; 79:358-369. [PMID: 33450095 DOI: 10.1111/his.14337] [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: 08/19/2020] [Revised: 01/04/2021] [Accepted: 01/12/2021] [Indexed: 11/27/2022]
Abstract
AIMS p16 is a sensitive surrogate marker for transcriptionally active high-risk human papillomavirus (HR-HPV) infection in oropharyngeal squamous cell carcinoma (OPSCC), but it is not sufficient in all clinical settings. METHODS AND RESULTS We examined the p16 and Rb expression status in 177 OPSCC cases by immunohistochemistry and the presence of transcriptionally active HR-HPV infection by mRNA in-situ hybridisation. The 177 cases were divided into p16+ /HPV+ (n = 105, 59.3%), p16+ /HPV- (n = 8, 4.5%) and p16- /HPV- (n = 64, 36.2%) groups. The p16+ /HPV- and p16- /HPV- groups had a trend towards worse overall survival (OS) or significantly worse OS than the p16+ /HPV+ group (n = 105) (P = 0.0610, P = 0.0004, respectively). We divided the Rb status into preserved expression (> 90%, n = 68), partial loss (PL) (10-90%, n = 97) and complete loss (CL) (< 10%, n = 12). Among the HPV-positive cases (n = 105), the Rb pattern was typically PL (n = 97, 92.4%) and rarely CL (n = 8, 7.6%), but never preserved expression (0%). In contrast, among the HPV-negative cases (n = 72), the Rb pattern was typically preserved expression (n = 68, 94.4%) and rarely CL (n = 4, 5.6%), but never PL (0%). Compared to p16 alone, the combination of p16 overexpression and Rb-PL/CL showed equally excellent sensitivity (each 100%) and improved specificity (97.2 versus 88.9%) and positive predictive values (98.1 versus 92.9%). CONCLUSIONS These results suggest that the combined use of p16 and Rb immunohistochemistry could be a reliable, cost-effective method to predict HR-HPV infection in OPSCCs; however, HPV specific testing is necessary on inconclusive cases. We propose a diagnostic algorithm for practical use of these markers.
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Affiliation(s)
- Rina Jiromaru
- Department of Anatomic Pathology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan.,Department of Otorhinolaryngology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Ryuji Yasumatsu
- Department of Otorhinolaryngology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takahiro Hongo
- Department of Anatomic Pathology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yui Nozaki
- Department of Anatomic Pathology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takafumi Nakano
- Department of Otorhinolaryngology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kazuki Hashimoto
- Department of Otorhinolaryngology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Kyushu University, Graduate School of Medical Sciences, Fukuoka, Japan
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12
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Lorenzatti Hiles G, Chang KP, Bellile EL, Wang CI, Yen WC, Goudsmit CM, Briggs HL, Thomas TB, Peters L, Afsari MA, Pinatti LM, Morris AC, Jawad N, Carey TE, Walline HM. Understanding the impact of high-risk human papillomavirus on oropharyngeal squamous cell carcinomas in Taiwan: A retrospective cohort study. PLoS One 2021; 16:e0250530. [PMID: 33891627 PMCID: PMC8064583 DOI: 10.1371/journal.pone.0250530] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) is increasing globally. In Taiwan, HPV-positive OPSCC is obscured by tobacco, alcohol, and betel quid use. We investigated the role of high-risk HPV (hrHPV) in a large retrospective Taiwan OPSCC cohort. METHODS AND RESULTS The cohort of 541 OPSCCs treated at Chang Gung Memorial Hospital from 1998-2016 consisted of 507 men (94%) and 34 women (6%). Most used tobacco (81%), alcohol (51%), and betel quid (65%). Formalin-fixed, paraffin-embedded tissue was used for p16 staining (a surrogate marker for HPV) and testing for HPV DNA presence and type by Multiplex HPV PCR-MassArray. HPV DNA and/or p16 staining (HPV-positive) was found in 28.4% (150/528) tumors. p16 and HPV DNA were strongly correlated (F < 0.0001). HPV16 was present in 82.8%, and HPV58 in 7.5% of HPV-positive tumors. HPV was associated with higher age (55.5 vs. 52.7 years, p = 0.004), lower T-stage (p = 0.008) better overall survival (OS) (hazard ratio [HR] 0.58 [95% CI 0.42-0.81], p = 0.001), and disease-free survival (DFS) (HR 0.54 [95% CI 0.40-0.73], p < 0.0001). Alcohol was strongly associated with recurrence and death (OS: HR 2.06 [95% CI 1.54-2.74], p < 0.0001; DFS: HR 1.72 [95% CI 1.33-2.24], p < 0.0001). OS and DFS in HPV-positive cases decreased for alcohol users (p < 0.0001). Obscured by the strong alcohol effect, predictive associations were not found for tobacco or betel quid. CONCLUSIONS As with HPV-positive OPSCC globally, HPV is an increasingly important etiological factor in Taiwanese OPSCC. HPV-positive OPSCC has considerable survival benefit, but this is reduced by alcohol, tobacco, and betel quid use. hrHPV is a cancer risk factor in males and females. Vaccinating both sexes with a multivalent vaccine including HPV58, combined with alcohol and tobacco cessation policies will be effective cancer-prevention public health strategies in Taiwan.
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Affiliation(s)
- Guadalupe Lorenzatti Hiles
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Kai-Ping Chang
- Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital (Linkou Medical Center), Taoyuan, Taiwan, Republic of China
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Emily L. Bellile
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Chun-I Wang
- Radiation Biology Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
| | - Wei-Chen Yen
- Department of Otolaryngology-Head & Neck Surgery, Chang Gung Memorial Hospital (Linkou Medical Center), Taoyuan, Taiwan, Republic of China
| | - Christine M. Goudsmit
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Hannah L. Briggs
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Trey B. Thomas
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Lila Peters
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Macy A. Afsari
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Lisa M. Pinatti
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
- Cancer Biology Program, Rackham Graduate School, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Anna C. Morris
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Nadine Jawad
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Thomas E. Carey
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
| | - Heather M. Walline
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, United States of America
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13
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Yin LX, Karp EE, Elias A, O'Byrne TJ, Routman DM, Price DL, Kasperbauer JL, Neben-Wittich M, Chintakuntlawar AV, Price KA, Ma DJ, Foote RL, Moore EJ, Van Abel KM. Disease Profile and Oncologic Outcomes After Delayed Diagnosis of Human Papillomavirus-Associated Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2021; 165:830-837. [PMID: 33752487 DOI: 10.1177/01945998211000426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Diagnostic delay in human papillomavirus-associated oropharynx squamous cell carcinoma (HPV(+)OPSCC) is common due to nonspecific symptoms. We aim to describe the disease burden and oncologic outcomes of patients with HPV(+)OPSCC diagnosed >12 months after symptom onset. STUDY DESIGN This is a retrospective cohort study of HPV(+)OPSCC patients receiving intent-to-cure treatment (including surgery ± adjuvant therapy or primary chemoradiation). SETTING 2006-2016, tertiary care center. METHODS Tumor stage was compared between patients with and without delayed diagnosis using χ2 tests. Kaplan-Meier survival analysis with univariate and multivariable Cox regressions were used to determine the effect of diagnostic delay on oncologic outcomes. RESULTS In total, 664 patients were included. Compared to patients diagnosed <12 months from symptom onset (n = 601), those diagnosed at >12 months (n = 63) were more likely to have T4 disease and higher overall American Joint Committee on Cancer (AJCC) clinical stage at presentation (P < .01 for both). At 5 years, rates of overall survival, cancer-specific survival, progression-free survival, and distant metastases-free survival in the delayed diagnosis cohort were 80%, 90%, 80%, and 89%, respectively. A >12-month delay in diagnosis did not significantly impact overall survival (adjusted hazard ratio [aHR], 1.16; 95% CI, 0.58-2.31), cancer-specific survival (aHR, 0.83; 95% CI, 0.29-2.39), progression-free survival (aHR, 1.15; 95% CI, 0.56-2.37), or distant metastases-free survival (aHR, 1.00; 95% CI, 0.42-2.40) after adjusting for age, sex, and clinical AJCC stage (P > .05 for all). CONCLUSIONS Delayed diagnosis of HPV(+)OPSCC is associated with greater burden of disease at presentation, but oncologic outcomes remain favorable across treatment modalities. When appropriate, intent-to-cure therapy should be pursued despite diagnostic delay. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily E Karp
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anna Elias
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J O'Byrne
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Katharine A Price
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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14
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Abi-Raad R, Prasad ML, Gilani S, Garritano J, Barlow D, Cai G, Adeniran AJ. Quantitative assessment of p16 expression in FNA specimens from head and neck squamous cell carcinoma and correlation with HPV status. Cancer Cytopathol 2020; 129:394-404. [PMID: 33369885 DOI: 10.1002/cncy.22399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study investigated p16 by immunohistochemistry (IHC) on cellblocks (CBs) and human papillomavirus (HPV) by polymerase chain reaction (PCR) in fine-needle aspiration (FNA) of head and neck squamous cell carcinoma (HNSCC). METHODS Receiver operating characteristic (ROC) curve analysis was used to assess test performance in CBs compared with p16 IHC in 42 surgical specimens from patients with HNSCC and in correlation with HPV by PCR in cytology specimens. The study assessed HPV by PCR in FNA specimens as a substitute for p16 IHC in surgical specimens. RESULTS Of 42 cases, 38 CBs showed malignant cells as cohesive clusters of viable cells with or without single tumor cells, whereas 4 specimens were composed exclusively of single tumor cells and degenerated cells. All p16-negative surgical specimens showed an absence of p16 staining in the corresponding CBs (n = 16). In the p16-positive surgical cases (n = 26), corresponding CBs with tumor clusters (n = 23) showed heterogeneous p16 expression ranging from 40% to 100%; however, scoring single cells was challenging and unreliable because of cellular degradation. ROC curve inspection showed the optimal threshold to be at least 40% p16 staining in tumor clusters with 100% sensitivity and specificity. In cases with inadequate CBs, HPV by PCR on needle rinse showed 88% sensitivity and 100% specificity for p16 expression in surgical specimens. CONCLUSIONS A cutoff of at least 40% p16 expression in tumor clusters may be appropriate for p16 positivity in cytology CB specimens. A positive HPV finding by PCR on needle rinse can be used as a substitute for p16 expression in surgical specimens.
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Affiliation(s)
- Rita Abi-Raad
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Manju L Prasad
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Syed Gilani
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - James Garritano
- Applied Mathematics Program, Yale University, New Haven, Connecticut.,Medical Scientist Training Program, Yale School of Medicine, New Haven, Connecticut
| | - Deborah Barlow
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Guoping Cai
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
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15
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Ishida H, Kasajima A, Fujishima F, Akaishi R, Ueki S, Yamazaki Y, Onodera Y, Gao X, Okamoto H, Taniyama Y, Kamei T, Sasano H. p16 in highly malignant esophageal carcinomas: the correlation with clinicopathological factors and human papillomavirus infection. Virchows Arch 2020; 478:219-229. [PMID: 32556556 PMCID: PMC7969492 DOI: 10.1007/s00428-020-02865-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/15/2020] [Accepted: 06/07/2020] [Indexed: 12/12/2022]
Abstract
p16 is generally considered to be a surrogate maker of human papillomavirus (HPV) infection and also a predictive marker of favorable clinical outcome of patients with squamous cell carcinoma of the oropharynx. p16 overexpression is also known to be induced by deregulation of RB1 in neuroendocrine carcinomas. In highly malignant esophageal neoplasms, however, the status of p16 has remained largely unknown. We immunolocalized p16 and Rb1 in 82 surgically resected esophageal high-grade squamous cell carcinomas (46 poorly differentiated and 36 basaloid squamous cell carcinomas) and 15 esophageal small-cell carcinomas in order to clarify the clinical and biological significance of p16. p16 immunoreactivity was detected in 7/82 (9%) high-grade squamous cell carcinomas and 15 (100%) small-cell carcinomas. p16 immunoreactivity was significantly associated with Rb1 protein loss in both groups (P < 0.001). HPV was detected in none of the p16-positive cases examined. Clinical outcome of the p16-positive high-grade squamous cell carcinomas was not different from that of the p16-negative counterparts (P = 0.687) but significantly better than those with the small-cell carcinomas (P = 0.023). p16 was therefore considered to be induced through an inactivation of the RB1 signaling pathway and not through HPV infection in highly malignant esophageal neoplasms. Nevertheless, patients’ clinical outcome of these neoplasms significantly differs; therefore, small-cell carcinomas have to be carefully differentiated from other neoplasms. In addition, p16 overexpression is not predictive of favorable clinical outcome in high-grade squamous cell carcinomas of the esophagus.
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Affiliation(s)
- Hirotaka Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Atsuko Kasajima
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan. .,Department of Pathology, Technical University Munich, Trogerstr. 18, 81675, Munich, Germany. .,German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Fumiyoshi Fujishima
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryujiro Akaishi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunsuke Ueki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuto Yamazaki
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Onodera
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Xin Gao
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Okamoto
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Taniyama
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
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16
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Lahmamssi C, Guy JB, Benchekroun N, Bouchbika Z, Taoufik N, Jouhadi H, Sahraoui S, Benider A, Ben Mrad M, Jmour O, Bousarsar A, Lan ML, Lei Q, Benna M, Moslemi D, Vallard A, Magné N. [Treatment de-intensification strategies for HPV-driven oropharyngeal cancer: A short review]. Cancer Radiother 2020; 24:258-266. [PMID: 32229067 DOI: 10.1016/j.canrad.2019.12.003] [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: 11/15/2019] [Revised: 12/09/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022]
Abstract
The incidence of oropharyngeal cancer induced by human papillomavirus (HPV) infection is steadily increasing in developed countries. These tumors are more chemoradiosensitive and have a better prognosis than HPV-negative one. In addition, they occur in younger and better-off patients with longer life expectancy. Current radiotherapy and chemotherapy protocols are currently being questioned as they may expose HPV-positive patients to excessive treatment and unnecessary toxic effects. Less intensive treatment regimens could possibly achieve similar efficacy with lower toxicity and improved quality of life. The aim of this work was to summarize the knowledge on these tumors and their implications for radiation oncologists. In this update, we will discuss ongoing de-escalation trials and highlight the issues raised by these studies. We will also comment on the results of recently published de-intensification studies. Three main strategies are analyzed in the present article: the de-escalation of the drug associated with radiotherapy, the de-escalation of the radiotherapy dose (in concomitant chemoradiotherapy, after induction chemotherapy, in a postoperative setting) and de-escalation of radiation target volumes. Our findings ultimately indicate that clinicians should not change the management of oropharyngeal cancer patients outside of clinical trials.
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Affiliation(s)
- C Lahmamssi
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, Saint-Priest-en-Jarez, France; Centre Mohammed VI de cancérologie CHU IBN Rochd de Casablanca, université HASSAN II, Casablanca, Maroc
| | - J-B Guy
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, Saint-Priest-en-Jarez, France
| | - N Benchekroun
- Centre Mohammed VI de cancérologie CHU IBN Rochd de Casablanca, université HASSAN II, Casablanca, Maroc
| | - Z Bouchbika
- Centre Mohammed VI de cancérologie CHU IBN Rochd de Casablanca, université HASSAN II, Casablanca, Maroc
| | - N Taoufik
- Centre Mohammed VI de cancérologie CHU IBN Rochd de Casablanca, université HASSAN II, Casablanca, Maroc
| | - H Jouhadi
- Centre Mohammed VI de cancérologie CHU IBN Rochd de Casablanca, université HASSAN II, Casablanca, Maroc
| | - S Sahraoui
- Centre Mohammed VI de cancérologie CHU IBN Rochd de Casablanca, université HASSAN II, Casablanca, Maroc
| | - A Benider
- Centre Mohammed VI de cancérologie CHU IBN Rochd de Casablanca, université HASSAN II, Casablanca, Maroc
| | - M Ben Mrad
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, Saint-Priest-en-Jarez, France
| | - O Jmour
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, Saint-Priest-en-Jarez, France
| | - A Bousarsar
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, Saint-Priest-en-Jarez, France
| | - M L Lan
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, Saint-Priest-en-Jarez, France
| | - Q Lei
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, Saint-Priest-en-Jarez, France
| | - M Benna
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, Saint-Priest-en-Jarez, France
| | - D Moslemi
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, Saint-Priest-en-Jarez, France; Department of radiation Oncology, Babol University of Medical Science, Babol, Iran
| | - A Vallard
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, Saint-Priest-en-Jarez, France
| | - N Magné
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, Saint-Priest-en-Jarez, France.
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17
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Altenhofen B, DeWees TA, Ahn JW, Yeat NC, Goddu S, Chen I, Lewis JS, Thorstad WL, Chole RA, Gay HA. Childhood tonsillectomy alters the primary distribution of HPV-related oropharyngeal squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2020; 5:210-216. [PMID: 32337351 PMCID: PMC7178443 DOI: 10.1002/lio2.342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/25/2019] [Accepted: 12/10/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES We investigated how tonsillectomy during childhood may influence the distribution of human papillomavirus (HPV) positive cancer of the tonsils in adult life using p16 as a surrogate marker for HPV infection. STUDY DESIGN Retrospective observational study. METHODS A total of 280 patients diagnosed with oropharyngeal squamous cell carcinoma (OPSCC) and known p16 status were eligible for this study. Each participant was called to obtain the childhood tonsillectomy history. Respondents were subgrouped by p16 status and the primary tumor location. Patient demographic and clinical information was analyzed for association with Fisher's exact and Wilcoxon rank sum tests. Location of tumor was modeled using univariate (UVA) and multivariate (MVA) logistic regression with associated odds ratios (OR) and 95% confidence intervals. RESULTS Of the 280 patients, 115 (41%) were respondents: 104 (90.4%) were p16 positive and 11 (9.6%) were p16 negative. For p16 positive patients, we observed a majority (93%) of intact tonsils in those with tonsil cancer, compared to 45% of intact tonsils in patients with p16 positive cancer elsewhere in the oropharynx (P < .001). MVA logistic regression showed that female gender (OR = 4.16, P = .0675), prior smoking history (OR = 2.6, P = .0367), and intact tonsils (OR = 15.2, P < .0001) were associated with tonsillar OPSCC. CONCLUSION We found that patients with p16 positive OPSCC at a non-tonsil site were much more likely to have had prior tonsillectomy vs those with p16 positive OPSCC arising within the tonsil. Nevertheless, we do not advocate tonsillectomies as a public health policy to reduce HPV-related OPSCC. LEVEL OF EVIDENCE 6.
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Affiliation(s)
- Brannon Altenhofen
- Department of Anesthesia and Perioperative MedicineUCLALos AngelesCalifornia
| | - Todd A. DeWees
- Division of Health Sciences ResearchMayo ClinicScottsdaleArizona
| | - Ji W. Ahn
- Department of DermatologyUniversity of Michigan HospitalsAnn ArborMichigan
| | - Nai C. Yeat
- Department of Internal MedicineMontefiore Medical CenterBronxNew York
| | - Shreya Goddu
- Washington University in St. LouisSt. LouisMissouri
| | - Ishita Chen
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - James S. Lewis
- Department of Pathology, Microbiology and ImmunologyVanderbilt University School of MedicineNashvilleTennessee
- Department of OtolaryngologyVanderbilt University School of MedicineNashvilleTennessee
| | - Wade L. Thorstad
- Department of Radiation OncologyWashington University School of Medicine in St. LouisSt. LouisMissouri
| | - Richard A. Chole
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine in St. LouisSt. LouisMissouri
| | - Hiram A. Gay
- Department of Radiation OncologyWashington University School of Medicine in St. LouisSt. LouisMissouri
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18
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Choi JS, Tang L, Yu AJ, Swanson MS, Chambers TN, Kokot NC, Sinha UK. Prevalence of oral human papillomavirus infections by race in the United States: An association with sexual behavior. Oral Dis 2020; 26:930-940. [DOI: 10.1111/odi.13292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Janet S. Choi
- Caruso Department of Otolaryngology‐Head and Neck Surgery Keck School of Medicine of the University of Southern California Los Angeles CA USA
| | - Liyang Tang
- Caruso Department of Otolaryngology‐Head and Neck Surgery Keck School of Medicine of the University of Southern California Los Angeles CA USA
| | - Alison J. Yu
- Caruso Department of Otolaryngology‐Head and Neck Surgery Keck School of Medicine of the University of Southern California Los Angeles CA USA
| | - Mark S. Swanson
- Caruso Department of Otolaryngology‐Head and Neck Surgery Keck School of Medicine of the University of Southern California Los Angeles CA USA
| | - Tamara N. Chambers
- Caruso Department of Otolaryngology‐Head and Neck Surgery Keck School of Medicine of the University of Southern California Los Angeles CA USA
| | - Niels C. Kokot
- Caruso Department of Otolaryngology‐Head and Neck Surgery Keck School of Medicine of the University of Southern California Los Angeles CA USA
| | - Uttam K. Sinha
- Caruso Department of Otolaryngology‐Head and Neck Surgery Keck School of Medicine of the University of Southern California Los Angeles CA USA
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Kato K, Miyazawa H, Kobayashi H, Noguchi N, Lambert D, Kawashiri S. Caveolin-1 Expression at Metastatic Lymph Nodes Predicts Unfavorable Outcome in Patients with Oral Squamous Cell Carcinoma. Pathol Oncol Res 2020; 26:2105-2113. [PMID: 31907776 DOI: 10.1007/s12253-019-00791-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/30/2019] [Indexed: 12/17/2022]
Abstract
We evaluated the clinical and prognostic value of the protein expression of caveolin-1 (CAV1) and p16 at the primary site and metastatic lymph nodes of oral squamous cell carcinoma (OSCC). Primary site specimens from 80 OSCC cases were randomly selected and lymph node specimens from 15 preserved metastatic lymph nodes from among those patients were selected for examination. We evaluated the CAV1 and p16 expression at both the primary site and metastatic lymph nodes, and analyzed the patients' clinicopathological data in relation to CAV1 and p16 expression. Our analysis revealed significant positive correlations between CAV1 expression at the primary site and pathological metastasis, cell differentiation, and mode of invasion (p = 0.019, p = 0.002, p = 0.015, respectively), but p16 expression was not associated with any clinicopathological factors. Patients with high CAV1 expression at the primary sites showed significantly worse prognoses than those with low or negative CAV1 expression (p = 0.002), and multivariate analysis showed that the T classification and CAV1 expression were independent OSCC prognostic factors. CAV1 expression was also present in the metastatic lymph nodes of the OSCC cases with particularly poor differentiation and high invasive grade, and patients with CAV1-positive metastatic lymph nodes showed significantly worse prognoses than those with CAV1-negative metastatic lymph nodes (p = 0.018). CAV1 may activate metastaticity and the invasive capacity of OSCC cells. CAV1 expression, particularly at metastatic lymph nodes, predicts a worse outcome for OSCC, suggesting that CAV1 could be used as a prognostic marker for OSCC.
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Affiliation(s)
- Koroku Kato
- Department of Oral and Maxillofacial Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Hiroki Miyazawa
- Department of Oral and Maxillofacial Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hisano Kobayashi
- Department of Oral and Maxillofacial Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Natsuyo Noguchi
- Department of Oral and Maxillofacial Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Daniel Lambert
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Shuichi Kawashiri
- Department of Oral and Maxillofacial Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Thompson LDR, Burchette R, Iganej S, Bhattasali O. Oropharyngeal Squamous Cell Carcinoma in 390 Patients: Analysis of Clinical and Histological Criteria Which Significantly Impact Outcome. Head Neck Pathol 2019; 14:666-688. [PMID: 31741151 PMCID: PMC7413975 DOI: 10.1007/s12105-019-01096-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/03/2019] [Indexed: 12/12/2022]
Abstract
This study evaluates the prognostic impact of several factors in oropharyngeal squamous cell carcinoma (OPSCC), controlling for human papillomavirus (HPV)-associated tumors and stage (American Joint Committee on Cancer 8th edition). All patients in Southern California Permanente Medical Group diagnosed with OPSCC between 2006 and 2012 tested for p16 immunohistochemistry were included. Review of all pathology materials was combined with central p16 testing. Multivariable analyses were performed. The cohort of 390 patients included 342 p16-positive and 48 p16-negative tumors. For all-comers, on univariate analysis, the following factors, when present, were associated with improved patient survival: p16-positive tumor (n = 324, p < 0.001); crypt versus surface tumor location (n = 312, p = 0.004); nonkeratinizing type (n = 309, p < 0.0001); nonkeratinizing with maturation type (n = 37, p < 0.0001); basaloid pattern (n = 284, p = 0.005); and a broad, pushing border of infiltration (n = 282, p = 0.004). Inferior survival outcomes were observed with: age ≥ 55 years (p < 0.0001); ≥ 10 pack-year smoking history (n = 183, p = 0.003); increasing tumor stage (p < 0.0001); overt radiographic extranodal extension (ORENE) (n = 58, p < 0.0001); low level IV/Vb lymph node involvement (n = 45, p = 0.0002); a jagged pattern of infiltration (n = 76, p = 0.0004); tumor ulceration (n = 76, p = 0.0004); absent lymphocytic infiltrate (p < 0.0001); and concurrent dysplasia (n = 125, p = 0.009). On multivariable analysis, accounting for patient age, smoking history ≥ 10 pack-years, and TNM stage, for patients with p16-positive disease, advanced TNM stage (p = 0.007), the presence of ORENE (p = 0.0002), and low-neck lymphadenopathy (p = 0.0001) were independent negative prognostic factors for disease free survival (DFS). Older age (p < 0.0001), smoking history ≥ 10 pack-years (p = 0.02), advanced TNM stage (p = 0.0002), ORENE (p = 0.004), and low-neck lymphadenopathy (p = 0.002) were independent negative prognostic factors for OS. Among patients with p16-positive OPSCC, older age, smoking history, advanced stage, ORENE, and low-neck lymphadenopathy were significant negative prognostic factors for DFS and/or OS. Further refinement of staging to incorporate additional lymph node findings may be warranted.
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Affiliation(s)
- Lester D. R. Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
| | - Raoul Burchette
- Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA USA
| | - Shawn Iganej
- Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles, CA USA
| | - Onita Bhattasali
- Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles, CA USA
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22
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Focal Adhesion Kinase (FAK) Overexpression and Phosphorylation in Oral Squamous Cell Carcinoma and their Clinicopathological Significance. Pathol Oncol Res 2019; 26:1659-1667. [PMID: 31522363 DOI: 10.1007/s12253-019-00732-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Abstract
Focal adhesion kinase (FAK) is involved in progression of various cancers, and FAK overexpression has been associated with cancer invasion and metastasis. However, the involvement of FAK expression in the clinicopathological malignancy of oral squamous cell carcinoma (OSCC) remains unknown. In addition, there is no consensus regarding the role of p16 expression in OSCC. In this study, the immunohistochemically measured expression of FAK, phosphorylated FAK (FAKpY397) and p16 expressions and their associations with clinicopathological features and 5-year survival rates were examined in surgical samples from 70 patients with primary OSCC. FAK and FAKpY397 were expressed at high levels in 42 cases (60.0%) and 34 cases (48.6%), respectively, and 9 cases (12.9%) were positive for p16. FAK expression was significantly correlated with local recurrence, subsequent metastasis, and the mode of invasion. FAKpY397 expression was significantly correlated with both N classification and the mode of invasion. p16 expression was significantly correlated with clinical stage only. Patients having high expression of FAK, FAKpY397, or both showed significantly worse prognosis, but p16 expression showed no significant relation to prognosis. The results suggested that overexpression and phosphorylation of FAK in OSCC may affect cancer progression, such as local invasion and lymph node metastasis, and thereby contribute to life prognosis.
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Raman A, Sen N, Ritz E, Fidler MJ, Revenaugh P, Stenson K, Al-khudari S. Heterogeneity in the clinical presentation, diagnosis, and treatment initiation of p16-positive oropharyngeal cancer. Am J Otolaryngol 2019; 40:626-630. [PMID: 31174931 DOI: 10.1016/j.amjoto.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/13/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has a patient demographic, presentation, and clinical treatment response distinct from HPV-unassociated OPSCC. The heterogeneity in presentation and diagnosis within a patient population with HPV-positive OPSCC and its impact on times to presentation, diagnosis, and treatment have yet to be characterized. PARTICIPANTS Patients with biopsy-proven p16-positive OPSCC seen and/or treated at our institution between 2008 and 2018. Of 136 patients with OPSCC seen and/or treated at our institution, 101 met criteria for inclusion. METHODS Patients were grouped by several parameters including presenting symptom category (asymptomatic neck mass, neck mass with primary-site symptoms, or primary-site symptoms without a neck mass), p16 status on fine-needle aspiration (FNA), and date of presentation. Median time intervals between presentation to imaging, biopsy, and treatment were compared within each parameter using the Kruskal-Wallis test with a significance level of 0.05. RESULTS Sixty-five of the 101 study patients presented with a neck mass. Patients without a neck mass had a longer interval from presentation to imaging than patients with a neck mass (median 4 vs 0 days, p = 0.025). Initial FNA obtained on 61 patients was positive for p16 in 19 patients. Unknown or negative p16 status on FNA was associated with shorter intervals from initial imaging to treatment initiation (39 vs 46.5 days, p = 0.045). Patients presenting in the final three years had a longer interval from presentation to treatment initiation (55 vs 41 days, p = 0.024). CONCLUSION A neck mass is absent from the clinical picture of a substantial proportion of HPV-associated OPSCC patients. Primary-site symptom category and regional metastasis were not associated with differences in times to diagnosis or treatment initiation at this major referral center. The increased awareness and complexity of treatment decisions related to OPSCC may contribute to the delays in treatment initiation observed in patients with p16-positive FNAs and those who presented in more recent years.
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Venkatesan AM, Menias CO, Jones KM, Rauch GM, Stafford RJ, Klopp AH. MRI for Radiation Therapy Planning in Human Papillomavirus-associated Gynecologic Cancers. Radiographics 2019; 39:1476-1500. [PMID: 31498740 DOI: 10.1148/rg.2019180121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Locally advanced human papillomavirus (HPV)-associated gynecologic cancers, including cervical, vaginal, and vulvar cancers, are treated primarily with radiation therapy (RT). Cervical cancer remains a leading cause of cancer death among women worldwide. The superior soft-tissue resolution of MRI compared with other imaging modalities makes it an ideal modality for RT planning, execution, and follow-up of these malignancies. This superiority has been corroborated in the literature when comparing MRI-based RT planning to radiography-based conventional treatment planning approaches. In 2005, the Groupe Européen de Curiethérapie and the European Society for Radiation Therapy and Oncology guidelines underscored the central role of MRI for successful implementation of three-dimensional image-based cervical cancer brachytherapy. The delineation of both gross tumor volume and clinical tumor volume for brachytherapy is performed at the time of each brachytherapy application, on the basis of the findings depicted on anatomic MR images. Contemporary knowledge concerning the role of MRI for RT planning in HPV-associated gynecologic cancers warrants an understanding of the epidemiology and clinical manifestations of these cancers, as well as knowledge of MRI protocol for cancer staging, selection of RT candidates, brachytherapy implant assessment, posttreatment surveillance, and delineation of treatment-related complications. Technical requirements, patient preparation, and image acquisition protocols are detailed in this review, and imaging-based treatment protocols are summarized. Knowledge of these fundamental concepts enables the radiologist to play an important role in diagnosis, staging, and posttreatment follow-up, helping to guide radiation oncologists and other clinicians in the management of these malignancies.©RSNA, 2019.
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Affiliation(s)
- Aradhana M Venkatesan
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
| | - Christine O Menias
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
| | - Kyle M Jones
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
| | - Gaiane M Rauch
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
| | - R Jason Stafford
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
| | - Ann H Klopp
- From the Section of Abdominal Imaging, Department of Diagnostic Radiology (A.M.V., K.M.J., G.M.R.) and Department of Radiation Oncology (A.H.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 15.6074, MSC 1182, Houston, TX 77030; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M., R.J.S.)
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Randén-Brady R, Carpén T, Jouhi L, Syrjänen S, Haglund C, Tarkkanen J, Remes S, Mäkitie A, Mattila PS, Silén S, Hagström J. In situ hybridization for high-risk HPV E6/E7 mRNA is a superior method for detecting transcriptionally active HPV in oropharyngeal cancer. Hum Pathol 2019; 90:97-105. [PMID: 31121191 DOI: 10.1016/j.humpath.2019.05.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 12/23/2022]
Abstract
Current human papillomavirus (HPV) detection methods in oropharyngeal squamous cell carcinoma (OPSCC) have varying sensitivity and specificity. We aimed to compare different HPV-detection methods against the test used in clinical practice, ie, p16 immunohistochemistry (IHC) and to evaluate whether another HPV-detection test additional to p16 IHC would be worthwhile in OPSCC specimens. The study cohort comprised 357 consecutive OPSCC patients during two time periods: 2000-2009 and 2012-2016. From tumor tissue slides, HPV mRNA via in situ hybridization (ISH), HPV DNA via ISH and HPV DNA via polymerase chain reaction (PCR) were detected. The results of these methods were compared with p16 IHC results. Additionally, clinicopathological factors were compared with the methods studied. The sensitivity of HPV mRNA ISH, HPV DNA ISH and HPV DNA PCR were 93.4%, 86.3%, and 83.5%, respectively. The corresponding specificity was 92.4%, 95.3%, and 89.1%, respectively. The negative predictive value for p16 IHC was highest (89.0%) when using mRNA ISH, and followed by DNA ISH (83.5%). ISH for high-risk HPV E6/E7 mRNA was found to be a highly specific and sensitive method for detecting HPV in OPSCC. As p16 protein may be overexpressed due to HPV-independent mechanisms, all p16 IHC-positive OPSCCs should be considered for retesting using mRNA ISH in order to verify transcriptionally active HPV. This is especially critical when considering de-escalated treatment approaches for patients with HPV-positive tumors and still maintaining favorable outcomes for this subgroup of patients.
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Affiliation(s)
- Reija Randén-Brady
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, FI-00014 HUS, Helsinki, Finland.
| | - Timo Carpén
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, FI-00014 HUS, Helsinki, Finland; Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, FI-00029 HUS, Helsinki, Finland
| | - Lauri Jouhi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, FI-00029 HUS, Helsinki, Finland
| | - Stina Syrjänen
- Department of Oral Pathology and Oral Radiology, University of Turku and Department of Pathology, Turku University Hospital, Lemminkäisenkatu 2, F, IN-20520, Turku, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 440, FI-00029 HUS, Helsinki, Finland; Research Programs Unit, Translational Cancer Biology, University of Helsinki, P.O.Box 63, FI-00014, Helsinki, Finland
| | - Jussi Tarkkanen
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, FI-00014 HUS, Helsinki, Finland
| | - Satu Remes
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, FI-00014 HUS, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, FI-00029 HUS, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, SE-171 76, Stockholm, Sweden; Research Programme in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Petri S Mattila
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, FI-00029 HUS, Helsinki, Finland
| | - Suvi Silén
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 263, FI-00029 HUS, Helsinki, Finland; Department of Biosciences and Nutrition, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Jaana Hagström
- Department of Pathology, University of Helsinki and HUS Helsinki University Hospital, P.O.Box 21, FI-00014 HUS, Helsinki, Finland; Research Programs Unit, Translational Cancer Biology, University of Helsinki, P.O.Box 63, FI-00014, Helsinki, Finland
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Bauer E, Mazul A, Chernock R, Rich J, Jackson RS, Paniello R, Pipkorn P, Oppelt P, Gay H, Daly M, El-Mofty S, Thorstad W, Adkins D, Zevallos J. Extranodal extension is a strong prognosticator in HPV-positive oropharyngeal squamous cell carcinoma. Laryngoscope 2019; 130:939-945. [PMID: 31077394 DOI: 10.1002/lary.28059] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/29/2019] [Accepted: 04/22/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To comprehensively examine the prognostic significance of extranodal extension (ENE) in human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-positive OPSCC). METHODS Retrospective cohort of cases diagnosed with HPV-positive OPSCC from 2010 to 2015 in the National Cancer Database. Inclusion of all OPSCC HPV-positive cases with appropriate International Classification of Diseases-0-3 codes that received surgery with a neck dissection. Univariate and multivariable analyses were conducted. Hazard ratios (HR) for the independent effects of ENE and N stage on overall survival were estimated by Cox proportional hazards regression. RESULTS Cases that were ENE-negative had the highest 5-year survival (92.6%; 95% confidence interval [CI]: 90.5%-94.7%). ENE-positive cases had the lowest 5-year survival (84.0%; 95% CI: 80.7%-87.4%). After adjusting for confounding variables, ENE-positivity was associated with almost twice the hazard of death (HR = 1.90; 95% CI: 1.35-2.67) compared to ENE-negative cases. Nodal (N) category 1, ENE-positive status was associated with an increased risk of death (HR = 1.88; 95% CI: 1.26-2.80) compared with N1, ENE-negative status. Compared to N1/ENE-negative cases, N2/ENE-positive cases had the poorest survival (HR: 2.93; 95% CI: 1.94-4.43). Both microscopic and macroscopic ENE were associated with worse outcomes compared to node-positive/ENE-negative status. CONCLUSION The implementation of the American Joint Committee on Cancer 8th edition staging system provides a much-improved framework to develop and discuss treatment plans for HPV-positive OPSCC. We feel that careful consideration should be given to the importance of ENE in patients with HPV-positive OPSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 130:939-945, 2020.
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Affiliation(s)
- Eric Bauer
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Angela Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Rebecca Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Jason Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Randal Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Peter Oppelt
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Mackenzie Daly
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Samir El-Mofty
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Wade Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Douglas Adkins
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Jose Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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Xu MJ, Plonowska KA, Gurman ZR, Humphrey AK, Ha PK, Wang SJ, El‐Sayed IH, Heaton CM, George JR, Yom SS, Algazi AP, Ryan WR. Treatment modality impact on quality of life for human papillomavirus–associated oropharynx cancer. Laryngoscope 2019; 130:E48-E56. [DOI: 10.1002/lary.27937] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/05/2019] [Accepted: 02/27/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Mary Jue Xu
- Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | | | - Zev R. Gurman
- School of MedicineUniversity of Virginia Charlottesville Virginia
| | - Amanda K. Humphrey
- Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | - Patrick K. Ha
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | - Steven J. Wang
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Arizona Phoenix Arizona U.S.A
| | - Ivan H. El‐Sayed
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | - Chase M. Heaton
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | - Jonathan R. George
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery San Francisco California
| | - Sue S. Yom
- Department of Otolaryngology–Head and Neck Surgery San Francisco California
- Department of Radiation Oncology San Francisco California
| | - Alain P. Algazi
- Department of Medicine (Hematology/Oncology)University of California–San Francisco San Francisco California
| | - William R. Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery San Francisco California
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Plonowska KA, Strohl MP, Wang SJ, Ha PK, George JR, Heaton CM, El-Sayed IH, Mallen-St. Clair J, Ryan WR. Human Papillomavirus–Associated Oropharyngeal Cancer: Patterns of Nodal Disease. Otolaryngol Head Neck Surg 2018; 160:502-509. [DOI: 10.1177/0194599818801907] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective To characterize patterns of neck lymph node (LN) metastases in human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma, represented by p16 positivity (p16+OPSCC). Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Neck dissection (ND) specimens of nonirradiated p16+OPSCC patients were analyzed for frequencies of clinically evident and occult LNs by neck level. Local, regional, and distant recurrences were reviewed. Results Seventy p16+OPSCC patients underwent primary site transoral robotic surgery and 82 NDs of varying levels. Metastatic pathologic LNs were found at the following frequencies: 0% (0/28) in level I, 75.6% (62/82) in level II with 57.4% (35/61) in level IIA and 13.1% (8/61) in level IIB, 22.0% (18/82) in level III, 7.0% (5/71) in level IV, and 6.3% (1/16) in level V. The level V LN was clinically evident preoperatively. Five of 21 (23.8%) elective NDs contained occult LNs, all of which were in level II and without extranodal extension. Twenty-seven (38.6%) patients underwent adjuvant radiation; 19 (27.1%) patients underwent adjuvant chemoradiation. With a mean follow-up of 29 months, 3 patients had developed recurrences, with all but 1 patient still alive. All patients who recurred had refused at least a component of indicated adjuvant treatment. Conclusions For p16+OPSCC, therapeutic NDs should encompass any levels bearing suspicious LNs and levels IIA-B, III, and IV, while elective NDs should be performed and encompass at least levels IIA-B and III. These selective ND plans, followed by indicated adjuvant treatment, are associated with a low nodal recurrence rate.
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Affiliation(s)
- Karolina A. Plonowska
- School of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Madeleine P. Strohl
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Steven J. Wang
- Department of Otolaryngology–Head and Neck Surgery, University of Arizona, Phoenix, Arizona, USA
| | - Patrick K. Ha
- Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Jonathan R. George
- Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Chase M. Heaton
- Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Ivan H. El-Sayed
- Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Jon Mallen-St. Clair
- Department of Otolaryngology–Head and Neck Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - William R. Ryan
- Division of Head and Neck Oncologic and Endocrine, Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
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Gurin D, Slavik M, Hermanova M, Shatokhina T, Sana J, Kazda T, Selingerova I, Ahmad P, Smilek P, Horakova Z, Hendrych M, Slampa P, Slaby O. Prognostic impact of combined immunoprofiles in oropharyngeal squamous cell carcinoma patients with respect to AJCC 8th edition. J Oral Pathol Med 2018; 47:864-872. [PMID: 30079604 DOI: 10.1111/jop.12772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/24/2018] [Accepted: 08/01/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To examine combined immunoprofiles of epidermal growth factor receptor (EGFR), CD44, and p16 in oropharyngeal squamous cell carcinoma (OPSCC) and to correlate them with radiotherapy treatment outcomes and clinicopathological parameters. Prognostic impact of the American Joint Committee on Cancer (AJCC) 8th edition staging system in comparison with 7th edition was analyzed. METHODS The study included 77 OPSCC patients treated by definitive intensity-modulated radiotherapy (IMRT). Clinical staging was assessed according to the AJCC, both 7th and 8th edition. Immunohistochemical (IHC) analysis of CD44 and EGFR was performed on primary biopsy tumor tissues. To evaluate the HPV status, IHC detection of p16 was employed. RESULTS The AJCC 8th edition staging system revealed correlations between overall survival (OS), progression-free survival (PFS), locoregional control (LRC), and clinical stage. EGFR and CD44 positivity (+) and p16 negativity (-) were associated with clinical stage IV of the disease. CD44+ and EGFR+ OPSCC displayed worse OS and LRC, and these cases also showed the worst 3-year OS and LRC. Combined analysis of protein expressions identified an association between p16- and EGFR+, p16- and CD44+, EGFR+, and CD44+. Combined immunoprofiles CD44+/p16-, EGFR+/p16-, and EGFR+/CD44+ were associated with worst OS and LRC. CONCLUSIONS Combined immunoprofiles of p16, EGFR, and CD44 might provide valuable prognostic and predictive information for the individual OPSCC patients, especially in terms of response to IMRT and prediction of treatment outcomes. Application of the AJCC 8th edition staging for HPV+ OPSCC proved to improve hazard discrimination and prognostication of OPSCC.
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Affiliation(s)
- Dominik Gurin
- 1st Department of Pathology, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Marek Slavik
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Marketa Hermanova
- 1st Department of Pathology, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Tetiana Shatokhina
- 1st Department of Pathology, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Jiri Sana
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic.,Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute and Medical Faculty, Masaryk University, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Iveta Selingerova
- Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Department of Mathematics and Statistics, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Parwez Ahmad
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Pavel Smilek
- Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Zuzana Horakova
- Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Michal Hendrych
- 1st Department of Pathology, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic.,Department of Physiology, Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Ondrej Slaby
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic.,Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
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30
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Human papillomavirus prevalence and clinicopathological associations in oropharyngeal squamous cell carcinoma in the Lebanese population. The Journal of Laryngology & Otology 2018; 132:636-641. [PMID: 29954474 DOI: 10.1017/s0022215118001019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate for the first time the prevalence of human papillomavirus in oropharyngeal squamous cell carcinoma in a Middle-Eastern population, and to determine associations between human papillomavirus profiles and clinicopathological characteristics. METHODS A retrospective chart review was conducted of all patients treated for oropharyngeal squamous cell carcinoma at the Hotel Dieu de France University Hospital (Beirut, Lebanon) between January 2010 and 2016. Existing formalin-fixed paraffin-embedded tumour samples were analysed. Human papillomavirus DNA viral load and p16 expression were evaluated using polymerase chain reaction and immunohistochemistry respectively. RESULTS Thirty patients (mean age of 60 years) were included. Twenty-seven per cent of patients were p16-positive/human papillomavirus DNA positive, 53 per cent were p16-negative/human papillomavirus DNA negative and 20 per cent were p16-positive/human papillomavirus DNA negative. Human papillomavirus 16 was the most frequent subtype (75 per cent). Smoking and alcohol consumption were significantly lower in the human papillomavirus positive group compared to the human papillomavirus negative group (p = 0.049 and 0.004, respectively). CONCLUSION Human papillomavirus rate was lower than reported rates in Western populations. Possible explanations include differences in social and cultural behaviours.
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31
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Bandhary SK, Shetty V, Saldanha M, Gatti P, Devegowda D, R PS, Shetty AK. Detection of Human Papilloma Virus and Risk Factors among Patients with Head and Neck Squamous Cell Carcinoma Attending a Tertiary Referral Centre in South India. Asian Pac J Cancer Prev 2018; 19:1325-1330. [PMID: 29802694 PMCID: PMC6031850 DOI: 10.22034/apjcp.2018.19.5.1325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Head and Neck Squamous Cell Carcinomas (HNSCC) is the sixth most common cancer globally. In India, on an average 25-30% of all cancer cases affect the head and neck. The etiological factors associated with HNSCC are tobacco, alcohol and environmental carcinogens. However there are few cases, where there are no obvious risk factors involved. In western counties, there are many reports of human papilloma virus (HPV) association with HNSCC. Hence, we conducted a study to determine the role of HPV infection and risk factors among patients with HNSCC. Materials and Methods: A prospective, cross-sectional study was conducted in a tertiary referral centre from January 2014 to March 2016. 88 patients were enrolled in the study. Socio- demographic, behavioural data, site and subsite involvement, histopathology, staging and treatment were documented. Polymerase chain reaction (PCR) was performed to detect the presence of HPV DNA using consensus primers MY 09/11 and GP5+/GP6+ and further the samples were subjected to PCR for detecting HPV type 16 and 18. Results: The study included 88 participants with HNSCC. 57 had oral and oropharyngeal squamous cell carcinoma, 11 with laryngeal malignancy and 20 involving hypopharynx. Among the participants buccal mucosa (n=22) was the most common subsite involved, majority (50%) had moderately differentiated squamous cell carcinoma and 53.4% presented in stage IV. 2 (2.6%) cases were positive for HPV consensus and both were positive for HPV 16, one case each in larynx and hypopharynx. There was statistical significance in the association between betel nut chewing, cigarette smoking and alcohol intake as risk factors in the carcinogenesis of HNSCC. Conclusion: In our setting in South India, HPV does not play a major role in the carcinogenesis of HNSCC but betel nut chewing, tobacco exposure and alcohol consumption remain major risk factors for HNSCC.
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Affiliation(s)
- Satheesh K Bandhary
- Department of Otorhinolaryngology and Head and Neck Surgery, K.S.Hegde Medical Academy, NITTE University-575018 Mangalore, Karnataka, India.
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Human papilloma virus (HPV) 18 proteins E6 and E7 up-regulate ABC transporters in oropharyngeal carcinoma. Involvement of the nonsense-mediated decay (NMD) pathway. Cancer Lett 2018; 428:69-76. [PMID: 29715486 DOI: 10.1016/j.canlet.2018.04.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 02/08/2023]
Abstract
Oropharyngeal cancer incidence increased dramatically in the last decades, being infection with human papillomaviruses (HPV) a determinant of this trend. Concerning etiology, treatment response and prognosis, HPV+ and HPV- oropharyngeal cancers constitute different disease entities. The underlying molecular background is not completely understood. ATP-binding cassette (ABC) transporters mediate the efflux of anticancer drugs and are regulated by changes in the intracellular milieu. Furthermore, a role in cancer pathogenesis besides drug transport was reported. We evaluated the effect of transfection with E6 and E7 oncogenes from HPV16 and HPV18 on ABC transporters in oropharyngeal cancer cells. HPV18E6/E7 up-regulated P-glycoprotein (P-gp), multidrug resistance-associated protein 1 (MRP1) and MRP2 expression in HNO206 cells and breast cancer resistance protein (BCRP) in HNO206 and HNO413 cells. While P-gp was regulated translationally, MRP1, MRP2 and BCRP up-regulation resulted from mRNA stabilization. For MRP1 and MRP2, the nonsense-mediated decay pathway was involved. In general, resistance to substrates of up-regulated transporters was increased. Transfection with oncogenes individually indicated a major role of HPV18E7. Our findings suggest ABC transporters as molecular players leading to differences in the pathogenesis of HPV+ and HPV- oropharyngeal cancer.
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33
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Sudoko CK, Polacco MA, Gosselin BJ, Paydarfar JA. Diagnostic Value of Lingual Tonsillectomy in Unknown Primary Head and Neck Carcinoma Identification After a Negative Clinical Workup and Positron Emission Tomography-Computed Tomography. Front Oncol 2018; 8:118. [PMID: 29732318 PMCID: PMC5919999 DOI: 10.3389/fonc.2018.00118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/03/2018] [Indexed: 01/15/2023] Open
Abstract
Objective Diagnostic rates of unknown primary head and neck carcinoma (UPHNC) using lingual tonsillectomy (LT) are highly variable. This study sought to determine the diagnostic value of LT in UPHNC identification using strict inclusion criteria and definitions to produce a more accurate estimate of diagnosis rate. Methods In this retrospective chart review, records of patients who underwent LT for UPHNC were reviewed. Inclusion criteria included absence of suspicious findings on physical exam and positron emission tomography-computed tomography as well as negative biopsies after panendoscopy and palatine tonsillectomy. Following inclusion criteria, 16 patients were reviewed. A systematic literature review on LT for the workup of CUP was also performed. Results LT was performed using transoral robotic surgery (TORS), transoral laser microsurgery (TLM), or transoral microsurgery with cautery (TMC). Following LT, primary tumor was identified in 4 patients out of 16. Detection rate by technique was 1/6, 2/7, and 1/3 for TORS, TLM, and TMC respectively. Postoperative bleeding occurred in three patients (19%); however, this was not related to the LT. Following literature review, 12 studies were identified; however, only 3 had enough data to compare against. All three studies had a cohort with suspicious findings on clinical exam. A total of 34 patients had a negative workup, with no suspicious findings on clinical exam and subsequently received an LT. Conclusion This study suggests that LT should be considered initially in the diagnostic algorithm for UPHNC. This study can increase the patient size in this cohort by approximately 47%.
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Affiliation(s)
- Chad K Sudoko
- Geisel School of Medicine at Dartmouth College, Hanover, NH, United States
| | - Marc A Polacco
- Section of Otolaryngology, Audiology & Maxillofacial Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Benoit J Gosselin
- Section of Otolaryngology, Audiology & Maxillofacial Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States
| | - Joseph A Paydarfar
- Section of Otolaryngology, Audiology & Maxillofacial Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.,Norris Cotton Cancer Center, Lebanon, NH, United States
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Jouhi L, Halme E, Irjala H, Saarilahti K, Koivunen P, Pukkila M, Hagström J, Haglund C, Lindholm P, Hirvikoski P, Vaittinen S, Ellonen A, Tikanto J, Blomster H, Laranne J, Grénman R, Mäkitie A, Atula T. Epidemiological and treatment-related factors contribute to improved outcome of oropharyngeal squamous cell carcinoma in Finland. Acta Oncol 2018; 57:541-551. [PMID: 29145765 DOI: 10.1080/0284186x.2017.1400688] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Treatment for oropharyngeal squamous cell carcinoma (OPSCC) has changed, as the proportion of human papilloma virus (HPV)-related disease has increased. We evaluated nationwide information on its management and outcome during the treatment paradigm change period. METHODS We included all patients diagnosed and treated for OPSCC at the five Finnish university hospitals from 2000 to 2009. Patient records and pathology registries provided the clinicopathological data. p16 staining was performed on primary tumor samples of patients who had received treatment with curative intent. RESULTS A total of 674 patients were diagnosed and treated for OPSCC and the incidence increased along the study period. Of the evaluable tumors 58.5% were p16-positive and the number of p16-positive tumors increased along the years. The treatment was given with curative intent for 600 patients and it was completed in 564. Of them, 47.9% underwent primary surgery and 52.1% received definitive oncological treatment. Also, the treatment protocol changed towards a more oncological approach. Among patients treated with curative intent the five-year overall, disease-specific and disease-free survival rates were 60.1, 71.5 and 57.0%. In multivariate analysis, p16-positivity seemed to relate to reduced disease mortality in lateral and anterior-wall disease. Depending on primary tumor localization, also sex, classes T3-4, presence of regional metastasis and radiotherapy modality had an association with disease mortality. CONCLUSION The incidence of p16-positive OPSCC and delivery of definitive oncological treatment increased in Finland during the study period. An improved survival outcome compared with the previous nationwide investigation was observed in this subset of patients.
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Affiliation(s)
- Lauri Jouhi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Elina Halme
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Heikki Irjala
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Kauko Saarilahti
- Department of Oncology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology-Head and Neck Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Matti Pukkila
- Department of Otorhinolaryngology-Head and Neck Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Jaana Hagström
- Department of Pathology, University of Helsinki, HUSLAB, Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - Paula Lindholm
- Department of Oncology, Turku University Hospital, University of Turku, Turku, Finland
| | - Pasi Hirvikoski
- Department of Pathology, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Samuli Vaittinen
- Department of Pathology, Turku University Hospital, University of Turku, Turku, Finland
| | - Anna Ellonen
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Jukka Tikanto
- Department of Otorhinolaryngology-Head and Neck Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Henry Blomster
- Department of Otorhinolaryngology-Head and Neck Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Jussi Laranne
- Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Reidar Grénman
- Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Foster CC, Lee AY, Furtado LV, Hart J, Alpert L, Xiao SY, Hyman NH, Sharma MR, Liauw S. Treatment outcomes and HPV characteristics for an institutional cohort of patients with anal cancer receiving concurrent chemotherapy and intensity-modulated radiation therapy. PLoS One 2018. [PMID: 29522569 PMCID: PMC5844568 DOI: 10.1371/journal.pone.0194234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) has been used to limit treatment-related toxicity for patients with anal squamous cell carcinoma (SCC). The treatment outcomes and HPV characteristics for a cohort of patients receiving definitive concurrent chemotherapy and IMRT are reported. MATERIALS AND METHODS 52 patients with anal SCC were treated with IMRT and concurrent chemotherapy. Radiation was delivered sequentially to the pelvis and inguinal lymph nodes (45 Gy) and anal tumor (median dose, 54 Gy). Multiplex real-time PCR for 7 high-risk HPV subtypes (n = 22) and p16 immunohistochemistry (n = 21, rated on a 0, 1, and 2+ scale) were performed on available specimens. Survival was estimated using Kaplan-Meier analysis, and toxicities were recorded. RESULTS Median follow-up was 33 months. Three-year freedom from locoregional failure (FFLRF), freedom from distant metastasis (FFDM), freedom from colostomy (FFC), and overall survival (OS) were 94%, 85%, 91%, and 90%, respectively. Acute grade 2+ skin, GI, and GU toxicities occurred in 83%, 71%, and 19% of evaluable patients, respectively. The rates of late grade 2+ GI and GU toxicities for evaluable patients (n = 32) were 28% and 9%, respectively. Of patients with available pathology, 91% and 71% were positive for HPV and p16 (2+), respectively. HPV genotypes included 16 (n = 17), 33 (n = 2), 18 (n = 1), and 45 (n = 1). HPV and p16 status were associated on Chi-square analysis (p = 0.07). Neither HPV nor p16 status was significantly associated with any clinical outcome. For HPV+ patients, 3-year FFLRF, FFDM, FFC, and OS were 100%, 69%, 100%, and 88%, respectively. CONCLUSIONS In this patient cohort, disease control was excellent for anal SCC treated with definitive concurrent chemotherapy and IMRT, and treatment was well tolerated. HPV and p16 status were not prognostic for treatment outcomes which may be related to our small sample size.
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Affiliation(s)
- Corey C. Foster
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Andrew Y. Lee
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Larissa V. Furtado
- Department of Pathology, University of Utah/ARUP Laboratories, Salt Lake City, Utah, United States of America
| | - John Hart
- Department of Pathology, The University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Lindsay Alpert
- Department of Pathology, The University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Shu-Yuan Xiao
- Department of Pathology, The University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Neil H. Hyman
- Department of Colon and Rectal Surgery, The University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Manish R. Sharma
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Stanley Liauw
- Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, Illinois, United States of America
- * E-mail:
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Rieth KKS, Gill SR, Lott-Limbach AA, Merkley MA, Botero N, Allen PD, Miller MC. Prevalence of High-Risk Human Papillomavirus in Tonsil Tissue in Healthy Adults and Colocalization in Biofilm of Tonsillar Crypts. JAMA Otolaryngol Head Neck Surg 2018; 144:231-237. [PMID: 29372248 PMCID: PMC5885877 DOI: 10.1001/jamaoto.2017.2916] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/05/2017] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The pathogenesis of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma is currently an important topic of elucidation. The presence of latent HPV infection in tonsil tissue of healthy adults may provide an explanation for a component of this process and contribute to the understanding of HPV-associated squamous cell carcinoma oncogenesis of the oropharynx. OBJECTIVE To determine the prevalence of oropharyngeal HPV and to determine the spatial relationship between the virus and crypt biofilm in tonsil tissue. DESIGN, SETTING, AND PARTICIPANTS A retrospective, cross-sectional study was carried out using samples obtained from tonsils that were archived at a university hospital following elective nononcologic tonsillectomy from 2012 to 2015. Samples consisted of formalin-fixed paraffin embedded samples of tumor-free tonsil tissue from 102 adults between the ages of 20 and 39 years. EXPOSURES Human papillomavirus status was assessed by polymerase chain reaction, and high-risk subtypes 16 and 18 were assessed with quantitative polymerase chain reaction assay. Samples that demonstrated presence of HPV were then analyzed by in situ hybridization to localize the viral capsid protein. These samples were then stained with concanavalin A to establish biofilm presence and morphology. These samples were also stained with diamidino-phenylindole (DAPI) to visualize location of the virus in relation to cell nuclei. These data were then assembled for aggregate analysis to colocalize HPV in the biofilm of the tonsillar crypts. MAIN OUTCOMES AND MEASURES Outcome measurements were determined prior to data collection and include prevalence of high-risk HPV types 16 and 18 in tonsil tissue of otherwise healthy adults, as well as demonstration with immunohistochemistry of HPV in tonsillar crypt biofilm. RESULTS In 102 otherwise healthy adults (55 [53.9%] female; age range, 20-39 years), the overall prevalence of HPV in tonsils was 4.9% (n = 5); and high-risk type 16 or 18, 3.9% (n = 4). In this sample population, in situ hybridization colocalized HPV virus to the biofilm of the tonsillar crypts. CONCLUSIONS AND RELEVANCE Biofilm is present in the tonsillar crypts in a considerable proportion of tonsil tissues and may be reproducibly identified. Human papillomavirus is demonstrated to colocalize to the crypt biofilm. This has important implications with respect to the determination of HPV prevalence rates in the oropharynx. It may also play a role in the pathogenesis of HPV-related oropharyngeal carcinoma.
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Affiliation(s)
- Katherine K. S. Rieth
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
| | - Steven R. Gill
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York
| | | | - Mark A. Merkley
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
| | | | - Paul D. Allen
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
| | - Matthew C. Miller
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
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Is p16 an adequate surrogate for human papillomavirus status determination? Curr Opin Otolaryngol Head Neck Surg 2018; 25:108-112. [PMID: 28141601 DOI: 10.1097/moo.0000000000000341] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW In head and neck cancer management, immunoexpression of protein p16 is widely used as a surrogate marker for human papillomavirus (HPV) positivity due to challenges of direct HPV testing. Previously p16 has been reported to have good sensitivity but only moderate specificity in HPV-status determination. The aim of this review is to evaluate the existing information on sensitivity and specificity of p16 immunohistochemistry (IHC) in HPV-status determination among the recent studies. RECENT FINDINGS We searched the time period from October 2014 to April 2016 and included 28 studies (a total of 31 analyses), which reported both p16 and HPV status in their series. The sensitivity of p16 in HPV determination ranged between 28.2 and 100.0%. The mean and median sensitivities were 90.5 and 95.4%, respectively. The specificity ranged between 31.1 and 100.0%. The mean and median specificities were 83.3 and 87.3%, respectively. SUMMARY Our review presents current information on the feasibility of p16 IHC in HPV status determination, which is in line with previous studies. Patients with HPV-positive tumors can be identified with p16 IHC, but a risk for misclassification of HPV-negative tumors as HPV positive exists. This fact has to be taken into consideration if HPV status will influence treatment planning.
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Kuta V, Williams B, Rigby M, Hart R, Trites J, MacKay C, Taylor SM. Management of head and neck primary unknown squamous cell carcinoma using combined positron emission tomography-computed tomography and transoral laser microsurgery. Laryngoscope 2017; 128:2307-2311. [PMID: 29214640 DOI: 10.1002/lary.27034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/29/2017] [Accepted: 11/06/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS The unknown primary of the neck is commonly encountered by the head and neck surgeon. Despite the exhaustive diagnostic tools employed in traditional detection protocols, many unknown primaries are not found, and the patient is subjected to wide-field radiation and chemotherapy during treatment. Localizing the primary tumor has demonstrated therapeutic benefits, improved quality of life, and overall survival. The authors' objective was to determine the efficacy of a new management protocol for unknown primaries of the head and neck. STUDY DESIGN Prospective cohort study. METHODS Our technique involved a preoperative positron emission tomography-computed tomography (PET-CT) followed by a planned transoral laser microsurgery (TLM) approach. Efficacy was assessed based on survival statistics, disease control, detection rates, the proportion of patients not receiving adjuvant therapy, and the proportion of PET-CT scans helpful for detection of the primary cancer. RESULTS The occult primary was located in 25 of the 27 patients (93%), with the majority found in the palatine tonsil (52%). Both overall survival and disease-specific survival was 80% at 36 months. Local control was achieved in 100% of patients. After surgery, 37.0% (n = 10) received adjuvant radiation alone and 33.3% (n = 9) of patients went on to receive adjuvant chemoradiation. On imaging, 72% (n = 18) of PET-CT scans correctly localized the primary tumor. CONCLUSIONS Occult head and neck primaries present a diagnostic challenge that is not adequately overcome using traditional detection protocols. The current study presents our unique protocol at Dalhousie University, which demonstrates the efficacy of the PET-CT TLM protocol from both a detection and therapeutic perspective. LEVEL OF EVIDENCE 4. Laryngoscope, 128:2307-2311, 2018.
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Affiliation(s)
- Victoria Kuta
- Faculty of Medicine, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Blair Williams
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew Rigby
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert Hart
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan Trites
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Colin MacKay
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Mark Taylor
- Division of Otolaryngology, Victoria General Hospital, Dalhousie University, Halifax, Nova Scotia, Canada
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Horn D, Freudlsperger C, Holzinger D, Kunzmann K, Plinkert P, Dyckhoff G, Hoffmann J, Freier K, Hess J. Upregulation of pAKT(Ser473) expression in progression of HPV-positive oropharyngeal squamous cell carcinoma. Head Neck 2017; 39:2397-2405. [DOI: 10.1002/hed.24910] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 06/06/2017] [Accepted: 07/06/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Dominik Horn
- Department of Oral and Cranio-Maxillofacial Surgery; Heidelberg University Hospital; Heidelberg Germany
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery; Heidelberg University Hospital; Heidelberg Germany
| | - Dana Holzinger
- Molecular Diagnostics of Oncogenic Infections; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Kevin Kunzmann
- Institute for Medical Biometry and Informatics; Heidelberg University Hospital; Heidelberg Germany
| | - Peter Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery; Heidelberg University Hospital; Heidelberg Germany
| | - Gerhard Dyckhoff
- Department of Otorhinolaryngology, Head and Neck Surgery; Heidelberg University Hospital; Heidelberg Germany
| | - Jürgen Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery; Heidelberg University Hospital; Heidelberg Germany
| | - Kolja Freier
- Department of Oral and Cranio-Maxillofacial Surgery; Heidelberg University Hospital; Heidelberg Germany
| | - Jochen Hess
- Department of Otorhinolaryngology, Head and Neck Surgery; Heidelberg University Hospital; Heidelberg Germany
- Research Group Molecular Mechanisms of Head and Neck Tumors; German Cancer Research Center (DKFZ); Heidelberg Germany
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40
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Furlan C, Polesel J, Barzan L, Franchin G, Sulfaro S, Romeo S, Colizzi F, Rizzo A, Baggio V, Giacomarra V, Dei Tos AP, Boscolo-Rizzo P, Vaccher E, Dolcetti R, Sigalotti L, Fratta E. Prognostic significance of LINE-1 hypomethylation in oropharyngeal squamous cell carcinoma. Clin Epigenetics 2017; 9:58. [PMID: 28572862 PMCID: PMC5450111 DOI: 10.1186/s13148-017-0357-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/18/2017] [Indexed: 01/13/2023] Open
Abstract
Background Inclusion of new biomarkers to improve a personalized treatment approach for oropharyngeal squamous cell carcinoma (OPSCC) is urgently needed. Hypomethylation of the Long interspersed nucleotide element-1 (LINE-1) repetitive elements, a widely accepted surrogate of overall genomic DNA methylation content, was found to be associated with a poor prognosis in several cancers. At present, no studies have investigated the influence of LINE-1 methylation levels on OPSCC relapse. The main goal of this study was the evaluation of the prognostic value of LINE-1 methylation status in predicting early tumor relapse in locally advanced OPSCC. Methods We retrospectively reviewed a cohort of 77 patients with stage III–IVB OPSCC. Methylation of LINE-1 repetitive sequences was evaluated by real-time quantitative methylation-specific PCR in formalin-fixed paraffin-embedded tissues. The prognostic relevance of LINE-1 methylation was assessed by comparing patients who relapsed within 2 years from the end of treatment (cases) with those who did not (controls). Results were validated in an independent cohort of 33 patients with OPSCC. Results With respect to early OPSCC relapse, the mean LINE-1 methylation level was significantly lower in relapsed cases than in control group (p < 0.01). Interestingly, LINE-1 methylation was lower in relapsed cases than in controls in both HPV16-negative and HPV16-positive OPSCC patients, even if statistical significance was reached only for the former group (p = 0.01). LINE-1 methylation levels were also significantly reduced in relapsed cases with respect to the controls in OPSCC current smokers (p = 0.02). Consistently, in HPV16-negative current smokers, OPSCC relapse was significantly associated with decreased levels of LINE-1 methylation (p = 0.02). Using logistic regression model, we found that patients with hypomethylated LINE-1 were associated with a 3.5 higher risk of early relapse than hypermethylated ones (OR = 3.51; 95% CI 1.03–12.00). Adjustment for potential confounders did not substantially change the risk magnitude. Results from the validation cohort confirmed the lower LINE-1 methylation in patients who early relapsed compared to relapse-free patients. Conclusions LINE-1 hypomethylation is associated with higher risk of early relapse in stage III–IVB OPSCC. Further validation in a prospective study is needed for its application in daily clinical practice.
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Affiliation(s)
- Carlo Furlan
- Division of Radiotherapy, Centro di Riferimento Oncologico, IRCCS-National Cancer Institute, Aviano, PN Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico, IRCCS-National Cancer Institute, Aviano, PN Italy
| | - Luigi Barzan
- Department of Surgery, Centro di Riferimento Oncologico, IRCCS-National Cancer Institute, Aviano, PN Italy
| | - Giovanni Franchin
- Division of Radiotherapy, Centro di Riferimento Oncologico, IRCCS-National Cancer Institute, Aviano, PN Italy
| | - Sandro Sulfaro
- Division of Pathology, General Hospital "S. Maria degli Angeli", Pordenone, Italy
| | - Salvatore Romeo
- Department of Pathology, San Donà di Piave Hospital, San Donà di Piave, Italy
| | - Francesca Colizzi
- Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico, IRCCS-National Cancer Institute, Aviano, PN Italy
| | - Aurora Rizzo
- Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico, IRCCS-National Cancer Institute, Aviano, PN Italy
| | - Vittorio Baggio
- Department of Radiation Oncology, Treviso Regional Hospital, Treviso, Italy
| | - Vittorio Giacomarra
- Unit of Otolaryngology, General Hospital "S. Maria degli Angeli", Pordenone, Italy
| | | | - Paolo Boscolo-Rizzo
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, Treviso Regional Hospital, University of Padua, Treviso, Italy
| | - Emanuela Vaccher
- Division of Medical Oncology A, Centro di Riferimento Oncologico, IRCCS-National Cancer Institute, Aviano, PN Italy
| | - Riccardo Dolcetti
- Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico, IRCCS-National Cancer Institute, Aviano, PN Italy.,Translational Research Institute, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - Luca Sigalotti
- Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico, IRCCS-National Cancer Institute, Aviano, PN Italy.,Institute of Clinical Pathology, University Hospital of Udine, Udine, Italy
| | - Elisabetta Fratta
- Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico, IRCCS-National Cancer Institute, Aviano, PN Italy
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Mizumachi T, Homma A, Sakashita T, Kano S, Hatakeyama H, Fukuda S. Confirmation of the eighth edition of the AJCC/UICC TNM staging system for HPV-mediated oropharyngeal cancer in Japan. Int J Clin Oncol 2017; 22:682-689. [PMID: 28271391 DOI: 10.1007/s10147-017-1107-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/25/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Several studies have demonstrated that the seventh edition of the American Joint Committee on Cancer/American Joint Committee on Cancer (AJCC/UICC) TNM staging system does not consistently distinguish between prognostic subgroups for human papillomavirus (HPV)-mediated oropharyngeal squamous cell carcinoma (OPSCC). The eighth edition of the AJCC/UICC TNM staging system came into effect for use with HPV-mediated OPSCC on or after 1 January 2017. This study confirms that the eighth edition of the AJCC/UICC TNM staging system for HPV-mediated OPSCC accurately reflects disease outcomes. PATIENTS AND METHODS We retrospectively analyzed 195 patients with OPSCC treated at Hokkaido University Hospital, Sapporo, Japan between 1998 and 2015. HPV status was evaluated by immunohistochemical analysis of p16. RESULTS Of the 195 OPSCC patients evaluated, 111 (56.9%) were p16 positive and 84 (43.1%) were p16 negative. The 3-year overall survival rate (OS) was significantly lower in the p16-negative patients with stage III-IV in comparison with those with stage I-II (55.0 vs. 93.1%, respectively; p < 0.01). The 3-year OS did not differ significantly between stage I-II and stage III-IV in the p16-positive patients (86.7 vs 87.7%). According to the eighth edition of the AJCC/UICC TNM staging system, stage I-II and stage III can be differentiated on the basis of the 3-year OS in the p16-positive patients (90.9 vs 70.2%, respectively; p < 0.01). CONCLUSIONS The seventh edition of the AJCC/UICC TNM staging system is suitable for use with p16-negative patients; however, it does not effectively discriminate between p16-positive patients. Therefore, the eighth edition of the AJCC/UICC TNM staging system is more suitable for HPV-mediated OPSCC in Japan.
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Affiliation(s)
- Takatsugu Mizumachi
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Tomohiro Sakashita
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiromitsu Hatakeyama
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoshi Fukuda
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
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Zenga J, Haughey BH, Jackson RS, Adkins DR, Aranake-Chrisinger J, Bhatt N, Gay HA, Kallogjeri D, Martin EJ, Moore EJ, Paniello RC, Rich JT, Thorstad WL, Nussenbaum B. Outcomes of surgically treated human papillomavirus-related oropharyngeal squamous cell carcinoma with N3 disease. Laryngoscope 2016; 127:2033-2037. [PMID: 28008626 DOI: 10.1002/lary.26455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/29/2016] [Accepted: 11/14/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Bruce H. Haughey
- Department of Surgery; University of Auckland Faculty of Medicine; Auckland New Zealand
- Head and Neck Surgery Center of Florida; Celebration Hospital, Celebration; Florida U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Douglas R. Adkins
- Department of Medical Oncology; Washington University; St. Louis Missouri U.S.A
| | | | - Neel Bhatt
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Hiram A. Gay
- Department of Radiation Oncology; Washington University; St. Louis Missouri U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Eliot J. Martin
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Randal C. Paniello
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Jason T. Rich
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Wade L. Thorstad
- Department of Radiation Oncology; Washington University; St. Louis Missouri U.S.A
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
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Ou P, Gear K, Rahnama F, Thomas S, Nagappan R, Kee D, Waldvogel-Thurlow S, Jain R, McIvor N, Izzard M, Douglas R. Human papillomavirus and oropharyngeal squamous cell carcinoma: a New Zealand cohort study. ANZ J Surg 2016; 88:E278-E283. [DOI: 10.1111/ans.13759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/04/2016] [Accepted: 07/18/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Peter Ou
- Department of Surgery; The University of Auckland; Auckland New Zealand
| | - Kim Gear
- Department of Oto-rhinolaryngology; Head and Neck Surgery, Auckland District Health Board; Auckland New Zealand
| | - Fahimeh Rahnama
- Department of Virology and Anatomical Pathology; LabPLUS, Auckland District Health Board; Auckland New Zealand
| | - Stephen Thomas
- Department of Virology and Anatomical Pathology; LabPLUS, Auckland District Health Board; Auckland New Zealand
| | - Radhika Nagappan
- Department of Virology and Anatomical Pathology; LabPLUS, Auckland District Health Board; Auckland New Zealand
| | - Dennis Kee
- Department of Virology and Anatomical Pathology; LabPLUS, Auckland District Health Board; Auckland New Zealand
| | | | - Ravi Jain
- Department of Surgery; The University of Auckland; Auckland New Zealand
| | - Nick McIvor
- Department of Oto-rhinolaryngology; Head and Neck Surgery, Auckland District Health Board; Auckland New Zealand
| | - Mark Izzard
- Department of Oto-rhinolaryngology; Head and Neck Surgery, Auckland District Health Board; Auckland New Zealand
| | - Richard Douglas
- Department of Surgery; The University of Auckland; Auckland New Zealand
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Zenga J, Jackson RS, Graboyes EM, Sinha P, Lindberg M, Martin EJ, Ma D, Thorstad WL, Rich JT, Moore EJ, Haughey BH. Oncologic outcomes of selective neck dissection in HPV-related oropharyngeal squamous cell carcinoma. Laryngoscope 2016; 127:623-630. [DOI: 10.1002/lary.26272] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/01/2016] [Accepted: 07/21/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Miranda Lindberg
- Washington University School of Medicine; Saint Louis Missouri U.S.A
| | - Eliot J. Martin
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Daniel Ma
- Department of Radiation Oncology; Mayo Clinic; Rochester Minnesota U.S.A
| | - Wade L. Thorstad
- Department of Radiation Oncology; Washington University; Saint Louis Missouri U.S.A
| | - Jason T. Rich
- Department of Otolaryngology-Head and Neck Surgery; Washington University; Saint Louis Missouri U.S.A
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Bruce H. Haughey
- Head and Neck Surgery Center of Florida; Celebration Hospital; Celebration Florida U.S.A
- Department of Surgery; University of Auckland Faculty of Medicine; Auckland New Zealand
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Okami K. Clinical features and treatment strategy for HPV-related oropharyngeal cancer. Int J Clin Oncol 2016; 21:827-835. [PMID: 27380170 DOI: 10.1007/s10147-016-1009-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/19/2016] [Indexed: 12/30/2022]
Abstract
Among head and neck squamous cell carcinoma (HNSCC), the incidence of oropharyngeal SCC (OPSCC) is increasing in contrast to carcinoma with origin in other subsites. Human papillomavirus (HPV) is now recognized as a significant risk factor of the carcinogenesis of OPSCC. The HPV-related OPSCC patients tend to be relatively young, less exposed to tobacco and alcohol, and have a relatively high socioeconomic status and education level, which is distinct from HPV-unrelated classical OPSCC. The neck metastases tend to be aggressive and cystic. The better response to treatment resulting in improved prognosis of HPV-related OPSCC led to reconsidering the clinical staging and treatment approaches. Clinical trials of treatment deintensification to reduce the acute and late toxicity without compromising efficacy have been conducted. This review of HPV-related OPSCC focuses on current and generally accepted facts regarding the biology, epidemiology, and therapeutic strategy of this new disease entity.
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Affiliation(s)
- Kenji Okami
- Department of Otolaryngology, Center of Head and Neck Surgery, Tokai University, 143 Shimokasuya, Isehara, 259-1193, Japan.
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Nakahara S, Takenaka Y, Ogawa K, Nishiike S, Yamamoto Y, Seo Y, Isohashi F, Suzuki O, Yoshioka Y, Sumida I, Yoshii T, Tomiyama Y, Inohara H. Phase II study of docetaxel, cisplatin, and concurrent radiation followed by platinum-based adjuvant chemotherapy for technically unresectable, locally advanced head and neck squamous cell carcinoma. Int J Clin Oncol 2016; 21:1030-1037. [DOI: 10.1007/s10147-016-0997-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 05/27/2016] [Indexed: 12/17/2022]
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Sadeghi N, Li NW, Taheri MR, Easley S, Siegel RS. Neoadjuvant chemotherapy and transoral surgery as a definitive treatment for oropharyngeal cancer: A feasible novel approach. Head Neck 2016; 38:1837-1846. [DOI: 10.1002/hed.24526] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nader Sadeghi
- Division of Otolaryngology - Head and Neck Surgery; George Washington University; Washington DC
| | - Ning-Wei Li
- Division of Otolaryngology - Head and Neck Surgery; George Washington University; Washington DC
| | - M. Reza Taheri
- Department of Radiology; George Washington University; Washington DC
| | - Samantha Easley
- Department of Pathology; George Washington University; Washington DC
| | - Robert S. Siegel
- Division of Medical Oncology; George Washington University; Washington DC
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Michel L, Ley J, Wildes TM, Schaffer A, Robinson A, Chun SE, Lee W, Lewis J, Trinkaus K, Adkins D. Phase I trial of palbociclib, a selective cyclin dependent kinase 4/6 inhibitor, in combination with cetuximab in patients with recurrent/metastatic head and neck squamous cell carcinoma. Oral Oncol 2016; 58:41-8. [PMID: 27311401 DOI: 10.1016/j.oraloncology.2016.05.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To test the safety of the CDK4/6 inhibitor palbociclib with cetuximab in patients with recurrent/metastatic head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS A phase I trial using 3+3 design was performed to determine the dose limiting toxicity (DLT) and maximum tolerated dose (MTD) of palbociclib with standard dose weekly cetuximab. Palbociclib was administered orally days 1-21 every 28days: dose level 1 (100mg/d) and 2 (125mg/d; approved monotherapy dose). Pharmacokinetic assessments were performed on cycle 2, day 15. Cyclin D1, p16(INK4a), and Rb protein expression were measured on pre-treatment tumor. Tumor response was assessed using RECIST1.1. RESULTS Nine patients (five p16(INK4a) negative; four positive) were enrolled across dose levels 1 (n=3) and 2 (n=6) and none experienced a DLT. A MTD of palbociclib was not reached. Myelosuppression was the most common adverse event. Six of nine patients had cetuximab-resistant and 4/9 had platin-resistant disease. Disease control (DC) occurred in 89%, including partial response (PR) in two (22%) and stable disease in six (67%) patients. PRs occurred in p16(INK4a) negative HNSCC. Five patients (56%) had measurable decreases in tumor target lesions. In cetuximab-resistant HNSCC, best tumor response was PR in 1 and DC in 5 and median TTP was 112days (range: 28-168). In platin-resistant HNSCC, best tumor response: PR in 1, DC in 3 and median TTP was 112days (range: 28-112). The Cmax and AUC0-24h appeared comparable in patients receiving 125 vs 100mg dose of palbociclib. CONCLUSION This trial, the first to evaluate a CDK4/6 inhibitor in HNSCC, determined that palbociclib 125mg/day on days 1-21 every 28days with cetuximab was safe. Tumor responses were observed, even in cetuximab- or platin-resistant disease.
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Affiliation(s)
- Loren Michel
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, United States; Alvin J. Siteman Cancer Center, Washington University School of Medicine, United States
| | - Jessica Ley
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Tanya M Wildes
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, United States; Alvin J. Siteman Cancer Center, Washington University School of Medicine, United States
| | - András Schaffer
- Department of Pathology and Immunology, Washington University School of Medicine, United States
| | - Anthony Robinson
- Department of Medicine, Washington University School of Medicine, United States
| | - Se-Eun Chun
- Department of Pharmaceutical Sciences, Seoul National University College of Pharmacy, Seoul, Republic of Korea
| | - Wooin Lee
- Department of Pharmaceutical Sciences, Seoul National University College of Pharmacy, Seoul, Republic of Korea
| | - James Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, United States
| | - Kathryn Trinkaus
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, United States; Division of Biostatistics, Washington University School of Medicine, United States
| | - Douglas Adkins
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, United States; Alvin J. Siteman Cancer Center, Washington University School of Medicine, United States.
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Nakano T, Yamamoto H, Nakashima T, Nishijima T, Satoh M, Hatanaka Y, Shiratsuchi H, Yasumatsu R, Toh S, Komune S, Oda Y. Molecular subclassification determined by human papillomavirus and epidermal growth factor receptor status is associated with the prognosis of oropharyngeal squamous cell carcinoma. Hum Pathol 2016; 50:51-61. [DOI: 10.1016/j.humpath.2015.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 01/04/2023]
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