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Zhang DD, Lei M, Wang Y, Zeng PJ, Hong YJ, Cai CF. Cause of Death in Patients with Oropharyngeal Carcinoma by Human Papillomavirus Status: Comparative Data Analysis. JMIR Public Health Surveill 2023; 9:e47579. [PMID: 37642982 PMCID: PMC10498314 DOI: 10.2196/47579] [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: 03/25/2023] [Revised: 05/14/2023] [Accepted: 07/25/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The incidence of oropharyngeal squamous cell carcinomas (OPSCC) has increased in recent decades, and human papillomavirus (HPV) infection is the main cause of OPSCC. The data regarding causes of death (CODs) are vitally important in informing follow-up strategies and revising treatment strategies to deal with any possible preventable treatment-related COD. However, limited studies have assessed the competing COD by HPV status in patients with OPSCC. OBJECTIVE We aimed to analyze the distribution of the competing COD according to HPV status in OPSCC. METHODS We retrospectively included stage I-IVB patients with OPSCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. The association between HPV status and head and neck cancer-specific mortality (HNCSM), second primary cancer mortality (SPCM), and noncancer-caused mortality (NCCM) were analyzed. The chi-square test, Kaplan-Meier analysis, and Fine and Gray model were used for statistical analysis. RESULTS We included 5852 patients in this study and 73.2% (n=4283) of them had HPV-related tumors. A total of 1537 (26.3%) patients died, including 789 (51.3%), 333 (21.7%), and 415 (27%) patients who died from head and neck cancer, second cancer, and noncancer causes, respectively. The 5-year HNCSM, SPCM, NCCM, and overall mortality were 14.7%, 6.5%, 7.7%, and 26.4%, respectively. Those with HPV-positive disease had a lower cumulative incidence of HNCSM (subdistribution hazard ratio [sHR] 0.362, 95% CI 0.315-0.417; P<.001), SPCM (sHR 0.400, 95% CI 0.321-0.496; P<.001), and NCCM (sHR 0.460, 95% CI 0.378-0.560; P<.001) than those with HPV-negative disease. The 5-year risk of HNCSM was 26.9% and 10.7% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of SPCM was 12.4% and 4.6% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of NCCM of death was 13.7% and 5.8% in those with HPV-negative and HPV-positive disease, respectively (P<.001). Using the Fine and Gray competing-risks model, our results show that those with HPV-negative tumors had a significantly higher risk of HNCSM (P<.001), SPCM (P<.001), and NCCM (P<.001) than those with HPV-negative tumors. CONCLUSIONS HPV-positive OPSCC has a lower NCSM, SPCM, and NCCM as compared to those with HPV-negative OPSCC. HPV positivity is a favorable prognostic factor in the context of overcoming cancer as well as in terms of reducing the risk of other CODs in OPSCC. Our finding supports the need to tailor patient follow-up based on the HPV status of patients with OPSCC.
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Affiliation(s)
- Dong-Dong Zhang
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Min Lei
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Yue Wang
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Pei-Ji Zeng
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Yong-Jun Hong
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Cheng-Fu Cai
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Otolaryngology Head and Neck Surgery, Xiamen, Xiamen, China
- Department of Otorhinolaryngology, Head and Neck Surgery, Xiamen University, Xiamen, China
- Department of Otolaryngology Head and Neck Surgery, Fujian Medical University, Xiamen, China
- College of Otorhinolaryngology Head and Neck Surgery, Xiamen Haicang Hospital, Xiamen, China
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Mavragani A, Eysenbach G, Hu M, Cai CF. The Prognostic and Predictive Effects of Human Papillomavirus Status in Hypopharyngeal Carcinoma: Population-Based Study. JMIR Public Health Surveill 2022; 8:e40185. [PMID: 36525304 PMCID: PMC9804097 DOI: 10.2196/40185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/23/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of the Human Papillomavirus (HPV) status in patients with hypopharyngeal squamous cell carcinoma (HSCC) remains controversial. OBJECTIVE Our aim was to determine the prognostic and predictive effects of HPV status in patients with locally advanced HSCC (stage III-IVB) receiving primary radiotherapy. METHODS Patients diagnosed with stage III-IVB HSCC between 2010 and 2016 were identified. HPV status, demographics, clinicopathological characteristics, treatment, and survival data were captured. Kaplan-Meier analysis, multivariable Cox regression analysis, and propensity score matching analysis were performed. RESULTS We identified 531 patients in this study and 142 (26.7%) patients with HPV-positive diseases. No significant differences were observed between those with HPV-negative and HPV-positive diseases with regard to demographics, clinicopathological characteristics, and chemotherapy use. HPV-positive HSCC had better head and neck cancer-specific survival (HNCSS; P=.001) and overall survival (OS; P<.001) compared to those with HPV-negative tumors. Similar results were found using the multivariable Cox regression analysis. Sensitivity analyses showed that the receipt of chemotherapy was associated with significantly improving HNCSS (P<.001) and OS (P<.001) compared to not receiving chemotherapy in HPV-negative HSCC, whereas comparable HNCSS (P=.59) and OS (P=.12) were found between both treatment arms in HPV-positive HSCC. Similar results were found after propensity score matching. CONCLUSIONS Approximately one-quarter of HSCC may be HPV-related, and HPV-positive HSCC is associated with improved survival outcomes. Furthermore, additional chemotherapy appears to be not related to a survival benefit in patients with HPV-positive tumors who received primary radiotherapy.
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Affiliation(s)
| | | | - Min Hu
- School of Medicine, Xiamen University, Xiamen, China
| | - Cheng-Fu Cai
- Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, China
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Zeng X, Peng L, Wen W, Sun W. Comparison of Survival of Patients With T 1 -2 cN 0 Oropharyngeal Cancer Treated With or Without Elective Neck Dissection. Laryngoscope 2021; 132:1205-1212. [PMID: 34797566 DOI: 10.1002/lary.29951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/18/2021] [Accepted: 11/08/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to examine the prognostic value of elective neck dissection (END) in T1-2 clinical negative cervical lymph node (cN0 ) oropharyngeal cancer (OPC) patients. STUDY DESIGN An observational retrospective study. METHODS This retrospective study included 845 patients diagnosed with T1-2 cN0 OPC during 2010-2015 from Surveillance, Epidemiology, and End Results database. Univariable and multivariable Cox regression models were used to evaluate the prognostic roles of END. Furthermore, propensity score matching was used to balance the covariates between the END and observation (OBS) groups, and subgroup analyses were conducted in the matched cohorts. The primary endpoint was overall survival (OS). RESULTS Our study showed that END was an independent prognostic factor associated with a better 3-year OS compared with OBS in human papillomavirus (HPV)-positive cohort (adjusted hazard ratio [HR], 0.464; 95% confidence interval [CI], 0.235-0.916; P = .027). However, we found no prognostic value of END in HPV-negative cohort (adjusted HR, 0.837; 95% CI, 0.535-1.310; P = .435). In the subgroup analyses, we found that younger patients (≤65 years old) and patients with nontonsillar tumors in HPV-positive cohort were more likely to benefit from END, while patients with tonsillar tumors in HPV-negative cohort may benefit from END. CONCLUSIONS We found that patients with HPV-positive T1-2 cN0 OPC could benefit from END in terms of OS, especially younger patients and those with nontonsillar tumors. Patients with HPV-negative T1-2 cN0 OPC could not benefit from END in terms of OS, while those with tonsillar tumors may benefit from END. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Xuelan Zeng
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Otolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China
| | - Liang Peng
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Otolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China
| | - Weiping Wen
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Otolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China.,Department of Otolaryngology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Sun
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Otolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, China
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Genome of Helicobacter pylori and Serotype of HPV Detected in Oropharyngeal and Laryngeal Cancer and Chronic Inflammation Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189545. [PMID: 34574466 PMCID: PMC8470705 DOI: 10.3390/ijerph18189545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
Objective: Oropharyngeal/laryngeal carcinoma are common cancers of the upper aerodigestive system. Human papillomavirus (HPV) is described as the most frequent in the cancer of unknown primary. The presence of Helicobacter pylori (HP) in the oral cavity is discussed in some papers. The aim of study: To analyze the incidence of HPV and HP in oropharyngeal/laryngeal cancer persons versus persons with chronic tonsillar inflammation and healthy persons. Methods: The samples were taken in three groups: (1) tissue of oropharynx/larynx cancer (103 specimens); (2) tissue of palatine tonsils (85 specimens); and (3) healthy control group (50 specimens). We analyzed the presence of HP (PCR) and HPV genomic DNA (Sacace HPV High-Risk Screen Real-TM Quant) in the samples. Results: HP was detected in 86 samples (83.5%) and high-risk HPV in 62 samples (60.2%). We found a very high incidence of HP. In the cancer group, HP was detected in 82.5% cases and HPV positivity in 57.8%. In total, 7.2% of the cancer patients were negative for HP and HPV together. In turn, 53.6% of the cancer patients were positive for HP and HPV together. Four cases (4.2%) were positive for HPV only. VacA positivity was detected in 82 (79.6%) of the cancer cases and VacA negativity in 21 (20.4%) if the cancer cases. The incidence of HP in chronic inflammation (n = 85) was 65 cases (76.5%) and the incidence of HPV was 38 cases (44.7%). VacA positivity was detected in 59 (69.4%) of the chronic inflammation cases and VacA negativity was found in 26 (30.6%) of the chronic inflammation cases. Regarding the control group, we found HP positivity in 5 cases (11.1%) and HPV positivity in 19 cases (42.2%). There was VacA positivity in 6 cases (50.0%) of the control group. Statistically significantly lower prevalence of HP (p < 0.001) and HPV (p = 0.006) was found in the control group. Conclusions: We suggest that the palatine tonsils are colonized by HP. In our study, HP was present in oropharyngeal cancer in more cases in comparison with HPV infection. The presence of VacA from HP can have an influence on the human epithelial and immune cells’ regulation ways. Our results do not support idea that the CagA-positive HP is a primary carcinogen in oropharyngeal area.
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Zhou P, Yu YF, Lian CL, Wang J, Zhuo RG, Wu SG. Survival Outcomes and Treatment Decision by Human Papillomavirus Status Among Patients With Stage IVC Head and Neck Squamous Cell Carcinoma. Front Oncol 2021; 11:668066. [PMID: 34136400 PMCID: PMC8201515 DOI: 10.3389/fonc.2021.668066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To investigate the influence of human papillomavirus (HPV) status on survival outcomes and treatment decisions for patients with de novo stage IV head and neck squamous cell cancers (HNSCC). Methods Patients initially diagnosed with de novo stage IVC HNSCC between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results database. Cox multivariable analyses were performed to determine prognostic factors associated with head and neck cancers specific survival (HNCSS) and overall survival (OS). Results We identified 303 patients who received chemotherapy in this study, including 52.5% of them had HPV-positive disease. HPV-positive HNSCC had better HNCSS (P < 0.001) and OS (P < 0.001) compared to those with HPV-negative disease. The results of Cox multivariable analyses showed that HPV-negative status (P = 0.007), N3 stage (P = 0.004), bone metastases (P < 0.001), and lung metastases (P = 0.003) were associated with worse HNCSS. Similar results were found regarding the OS. The sensitivity analyses indicated that HPV-positive HNSCC patients who were treated with radiotherapy had better survival outcomes. However, no survival benefits were found in those with HPV-positive disease receiving surgery. For HPV-negative patients, no survival benefit was observed among those treated with radiotherapy or surgery. Conclusions Approximately half of the stage IVC HNSCC patients are HPV-related. The presence of HPV infection appears to be strongly associated with the survival outcome in patients with de novo stage IV HNSCC. Determination of HPV status may help guide clinicians in prognostic assessment and treatment decision-making in this population.
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Affiliation(s)
- Ping Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yi-Feng Yu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Chen-Lu Lian
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ren-Gong Zhuo
- Xiamen Key Laboratory of Chiral Drugs, Medical College, Xiamen University, Xiamen, China
| | - San-Gang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
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Choosing surgery or radiotherapy for oropharyngeal squamous cell carcinoma: is the issue definitely settled? Lancet Oncol 2019; 20:1328-1329. [PMID: 31416686 DOI: 10.1016/s1470-2045(19)30495-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/21/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022]
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Posso H, León-Maldonado L, Allen-Leigh B, Salmerón J, Quiterio M, Giuliano AR, Sudenga SL, Nyitray AG, Torres BN, Abrahamsen M, Lazcano-Ponce E. Prevalence and incidence of anal human papillomavirus infection in Mexican men: Need for universal prevention policies. SALUD PUBLICA DE MEXICO 2019; 60:645-652. [PMID: 30699269 DOI: 10.21149/8454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 08/30/2018] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Describe the natural history of anal HPV among men. MATERIALS AND METHODS Prospective study among men 18-70 years (n=665), from Cuernavaca, Mexico who completed questionnaires and provided specimens (HPV genotyped) at enrollment and 1+ follow-up visit. HPV prevalence and incidence were estimated. Prevalence ratios were calculated with Poisson regression using robust variance estimation. Person-time for incident HPV infection was estimated using number of events modeled as Poisson variable for total person-months. RESULTS Anal infection prevalence: any HPV type=15%, high-risk=8.4%, HPV16=1.4%, tetravalent vaccine types (4vHPV)=4.4%, nonavalent vaccine types (9vHPV)=6.3%. Factors associated with prevalence: 50+ lifetime female sex partners (adjusted prevalence ratio, a PR=3.25, 95% CI:1.12- 9.47), 10+ lifetime male sex partners (aPR=3.06, 95%CI:1.4- 6.68), and 1+ recent male anal sex partners (aPR=2.28, 95%CI:1.15-4.5). Anal incidence rate: high-risk HPV=7.8/1000 person-months (95%CI:6.0-10.1), HPV16=1.8/1000 personmonths (95%CI:1.1-2.9),4vHPV=3.4/1000 person-months (95%CI:2.3-4.9) and 9vHPV=5.5/1000 person-months (95%CI:4.1-7.5). CONCLUSIONS Implementation of universal HPV vaccination programs, including men, is a public health priority.
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Affiliation(s)
- Hector Posso
- Universidad de la Sabana. Chia-Cundinamarca, Colombia
| | - Leith León-Maldonado
- Cátedra Conacyt, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Betania Allen-Leigh
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Jorge Salmerón
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México. Ciudad de México, México.,Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Manuel Quiterio
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social. Cuernavaca, Morelos, México
| | - Anna R Giuliano
- Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute.Tampa, Florida
| | - Staci L Sudenga
- Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute.Tampa, Florida
| | - Alan G Nyitray
- Department of Epidemiology, The University of Texas School of Public Health. Houston, Texas, USA
| | - B Nelson Torres
- Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute.Tampa, Florida
| | - Martha Abrahamsen
- Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute.Tampa, Florida
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
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Wittekindt C, Wagner S, Sharma SJ, Würdemann N, Knuth J, Reder H, Klußmann JP. [HPV - A different view on Head and Neck Cancer]. Laryngorhinootologie 2018; 97:S48-S113. [PMID: 29905354 PMCID: PMC6540966 DOI: 10.1055/s-0043-121596] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Head and neck cancer is the sixth most common cancer with over 500000 annually reported incident cases worldwide. Besides major risk factors tobacco and alcohol, oropharyngeal squamous cell carcinomas (OSCC) show increased association with human papillomavirus (HPV). HPV-associated and HPV-negative OSCC are 2 different entities regarding biological characteristics, therapeutic response, and patient prognosis. In HPV OSCC, viral oncoprotein activity, as well as genetic (mutations and chromosomal aberrations) and epigenetic alterations plays a key role during carcinogenesis. Based on improved treatment response, the introduction of therapy de-intensification and targeted therapy is discussed for patients with HPV OSCC. A promising targeted therapy concept is immunotherapy. The use of checkpoint inhibitors (e.g. anti-PD1) is currently investigated. By means of liquid biopsies, biomarkers such as viral DNA or tumor mutations in the will soon be available for disease monitoring, as well as detection of treatment failure. By now, primary prophylaxis of HPV OSCC can be achieved by vaccination of girls and boys.
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Affiliation(s)
- Claus Wittekindt
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Steffen Wagner
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Shachi Jenny Sharma
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Nora Würdemann
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Jennifer Knuth
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Henrike Reder
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Jens Peter Klußmann
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
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The role of prostate tumor overexpressed 1 in cancer progression. Oncotarget 2017; 8:12451-12471. [PMID: 28029646 PMCID: PMC5355357 DOI: 10.18632/oncotarget.14104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/14/2016] [Indexed: 12/15/2022] Open
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Würdemann N, Wagner S, Sharma SJ, Prigge ES, Reuschenbach M, Gattenlöhner S, Klussmann JP, Wittekindt C. Prognostic Impact of AJCC/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma. Front Oncol 2017; 7:129. [PMID: 28713770 PMCID: PMC5491554 DOI: 10.3389/fonc.2017.00129] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/01/2017] [Indexed: 12/31/2022] Open
Abstract
Introduction The purpose of this study was to test whether the 8th edition of the AJCC/UICC TNM staging system (UICC) precisely differentiates between stages and reflects disease outcome in human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). Patients and methods OPSCC patients that were diagnosed between 2000 and 2016 were included in this analysis and HPV status was determined by combined DNA and p16 testing. Stratification was done according to 7th and 8th UICC staging rules. Incidence trends of HPV-associated tumorigenesis, 5-year overall survival (OS) according to tumor stages as well as the influence of therapy and prognostic factors toward the outcome were calculated using Kaplan–Meier method and Cox proportional-hazards model. Results A significant increase [2000; n = 8/39 (21%)–2015; n = 17/32 (53%); p = 0.002] in HPV-associated OPSCC was seen in the observation period. Together, 150/599 (25.0%) of the patients had HPV-driven OPSCC and 64.7% of curative treatments in all OPSCC patients included upfront surgery of the primary and the neck. 7th edition staging rules led to no discrimination in all respective four UICC stages in HPV OPSCC underlining the need for new staging rules. However, only discrimination between stages I vs. II and III vs. IV was significant in our patients with HPV-OPSCC (94.4 vs. 77.5%; p = 0.031 and 63.9 vs. 25.0%; p = 0.013), and stages II vs. III did not differ in OS rates (p = 0.257), when applying the new staging rules. For HPV-negative OPSCC, significant outcome differences were only seen between UICC stages III vs. IV (57.6 vs. 35.2%; p = 0.012). Discussion While the 7th edition of UICC shows invalid discrimination between stages, the 8th edition is more suitable for HPV-associated carcinoma. Due to lack of differentiation between stages II and III further adaption is essential.
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Affiliation(s)
- Nora Würdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen, Giessen, Germany
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen, Giessen, Germany
| | - Shachi Jenny Sharma
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen, Giessen, Germany
| | - Elena-Sophie Prigge
- Department of Applied Tumor Biology, University of Heidelberg, Heidelberg, Germany
| | - Miriam Reuschenbach
- Department of Applied Tumor Biology, University of Heidelberg, Heidelberg, Germany
| | | | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen, Giessen, Germany
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Giessen, Giessen, Germany
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