Improved survival among patients with base of tongue and tonsil cancer in the United States

Risk of lymph node metastasis in T1 tonsil squamous cell carcinomas patients according to age stratification at diagnosis

BACKGROUND

The objective of this study is to assess the association between age and lymph nodes metastasis (LNM) in T1 tonsil squamous cell carcinomas (TSCC) patients.

METHODS

Patients with T1 TSCC were extracted from the SEER database between 2005 and 2014. Univariate and multivariate logistic regression models were produced to recognize the association between age and risk factors of LNM.

RESULTS

A total of 2430 patients were analyzed. Younger patients more frequently presented with LNM compared to their older peers (P < 0.01, respectively.). In multivariate analyses, older age was associated with a significantly lower risk of LNM. Compared to patients aged 29-39-years-old, the hazard ratios for patients aged 40-49, 50-59, 60-69, and 70-88 years old were 0.911 (95 % confidence interval [CI] 0.370-2.245), 0.641 (95 % CI 0.268-1.535), 0.511 (95 % CI 0.212-1.231), and 0.236 (95 % CI 0.095-0.584), respectively. Subgroups analysis shows that the effect of older age was significantly associated with a lower risk of LNM in all groups except for Asian patients (P < 0.05, respectively).

CONCLUSION

Our study demonstrates that younger patients with T1 TSCC had a higher risk of LNM than their old peers and the effect of older age was significantly associated with a lower risk of LNM in all groups except for Asian patients. More accurate assessments of LNM and prophylactic neck dissection or prophylactic adjuvant radiation therapy to neck will be imperative for reducing recurrence in younger T1 TSCC.

Mortality patterns of patients with tonsillar squamous cell carcinoma: a population-based study

Objective

Tonsillar squamous cell carcinoma (TSCC) and second primary malignancies (SPMs) are the most common causes of mortality in patients with primary TSCC. However, the competing data on TSCC-specific death (TSD) or SPM-related death in patients with TSCC have not been evaluated. This study aimed to analyze the mortality patterns and formulate prediction models of mortality risk caused by TSCC and SPMs.

Methods

Data on patients with a first diagnosis of TSCC were extracted as the training cohort from the 18 registries comprising the Surveillance, Epidemiology, and End Results (SEER) database. A competing risk approach of cumulation incidence function was used to estimate cumulative incidence curves. Fine and gray proportional sub-distributed hazard model analyses were performed to investigate the risk factors of TSD and SPMs. A nomogram was developed to predict the 5- and 10-year risk probabilities of death caused by TSCC and SPMs. Moreover, data from the 22 registries of the SEER database were also extracted to validate the nomograms.

Results

In the training cohort, we identified 14,530 patients with primary TSCC, with TSCC (46.84%) as the leading cause of death, followed by SPMs (26.86%) among all causes of death. In the proportion of SPMs, the lungs and bronchus (22.64%) were the most common sites for SPM-related deaths, followed by the larynx (9.99%), esophagus (8.46%), and Non-Melanoma skin (6.82%). Multivariate competing risk model showed that age, ethnicity, marital status, primary site, summary stage, radiotherapy, and surgery were independently associated with mortality caused by TSCC and SPMs. Such risk factors were selected to formulate prognostic nomograms. The nomograms showed preferable discrimination and calibration in both the training and validation cohorts.

Conclusion

Patients with primary TSCC have a high mortality risk of SPMs, and the competing risk nomogram has an ideal performance for predicting TSD and SPMs-related mortality. Routine follow-up care for TSCC survivors should be expanded to monitor SPMs.

Taiwanin E Induces Cell Cycle Arrest and Apoptosis in Arecoline/4-NQO-Induced Oral Cancer Cells Through Modulation of the ERK Signaling Pathway

Taiwanin E is a bioactive compound extracted from Taiwania cryptomerioides Hayata. In this research endeavor, we studied the anti-cancer effect of Taiwanin E against arecoline and 4-nitroquinoline-1-oxide-induced oral squamous cancer cells (OSCC), and elucidated the underlying intricacies. OSCC were treated with Taiwanin E and analyzed through MTT assay, Flow cytometry, TUNEL assay, and Western blotting for their efficacy against OSCC. Interestingly, it was found that Taiwanin E significantly attenuated the cell viability of oral cancer cells (T28); however, no significant cytotoxic effects were found for normal oral cells (N28). Further, Flow cytometry analysis showed that Taiwanin E induced G1cell cycle arrest in T28 oral cancer cells and Western blot analysis suggested that Taiwanin E considerably downregulated cell cycle regulatory proteins and activated p53, p21, and p27 proteins. Further, TUNEL and Western blot studies instigated that it induced cellular apoptosis and attenuated the p-PI3K/p-Akt survival mechanism in T28 oral cancer cells seemingly through modulation of the ERK signaling cascade. Collectively, the present study highlights the prospective therapeutic efficacy of Taiwanin E against arecoline and 4-nitroquinoline-1-oxide-induced oral cancer.

Comparative Analysis of Radial Forearm Free Flap and Anterolateral Thigh Flap in Tongue Reconstruction after Radical Resection of Tongue Cancer

BACKGROUND

Surgery is still the preferred treatment for tongue cancer. Reconstruction should be performed immediately after extensive resection of the tumor. The purpose of this study was to investigate the clinical effect, advantages, and disadvantages of radial forearm free (RFF) flap and anterolateral thigh (ALT) flap in tongue reconstruction after radical resection of tongue cancer.

METHODS

Thirty-nine cases of tongue reconstruction with RFF flap or ALT flap from 2014 to 2018 were analyzed. The survival of the flap, the functional status after repair, and the influence on the donor area were examined, in addition to the advantages and disadvantages of the flap and the critical points of the technique.

RESULTS

Twenty-one cases with RFF flaps and 18 cases with ALT flaps showed complete flap survival. Among them, 1 case involved a venous vessel crisis after an ALT operation, and the flap survived after reoperation after thrombus removal and anastomosis. The recovery of tongue function was as follows: 41.0% patients exhibited normal speech, 43.6% patients exhibited near-normal speech, 12.8% patients exhibited vague speech, and 2.6% patients could not speak. There was no significant difference between the 2 groups (p = 0.134). The recovery of tongue flexibility was as follows: 41.0% of the patients had normal postoperative tongue flexibility, 43.6% of the patients had slightly limited tongue flexibility, 12.8% of the patients had severely limited tongue flexibility, and 2.6% of the patients were completely limited. The difference between the 2 groups was statistically significant (p = 0.045). The postoperative diet of patients was as follows: 51.3% of patients had a regular diet, 33.3% of patients had soft foods, 12.8% of patients received a fluid diet, and 2.6% of patients could not eat after the operation. There was no significant difference between the 2 groups (p = 0.209). The satisfaction of donor area was as follows: 46.2% of the patients were satisfied with the donor area, 51.3% of the patients were basically satisfied with the donor area satisfaction, and 2.6% of the patients were not satisfied with the donor area satisfaction. There was no significant difference between the 2 groups (p = 0.809).

CONCLUSION

The RFF flap is the most widely used technique in tongue reconstruction, especially in patients with tongue defects less than half of tongue tissue. However, for a large number of tissue defects caused by radical resection of advanced tongue cancer, the ALT flaps can provide a sufficient tissue volume, conceal scars after the operation, cause fewer complications in the donor area, and facilitate tongue function and aesthetic quality.

Aurora kinase A induces chemotherapy resistance through revival of dormant cells in laryngeal squamous cell carcinoma

BACKGROUND

Chemotherapy resistance was an important tumor metastasis mechanism.

METHODS

Cell Counting Kit-8 assay and plate colony formation assay were applied to examine the proliferation of laryngeal squamous cell carcinoma (LSCC). Immunofluorescent staining and Western blotting were carried out to show the expression of related proteins. Wound healing, migration, and invasion assays were used to examine the mobility, migration, and invasion of LSCC.

RESULTS

Downregulated Aurora kinase A (AURKA) increased chemotherapy sensitivity and reduced the ability of mobility, migration, and invasion of Hep2 cells, while upregulated AURKA possessed opposite results. Hep2/5-Fu cells possessed dormancy-like properties and upregulated AURKA in Hep2/5-Fu cells (Hep2/5-Fu/AURKA cells) revived dormant state. Furthermore, Erk1/2 was restrained in Hep2/5-Fu cells and activated in Hep2/5-Fu/AURKA cells. Moreover, Erk1/2 accelerated the ability of mobility, migration, and invasion in Hep2/5-Fu/AURKA cells.

CONCLUSION

AURKA activated dormant state to induce chemotherapy resistance and promoted metastasis of LSCC through Erk1/2 pathway.

Aurora kinase A revives dormant laryngeal squamous cell carcinoma cells via FAK/PI3K/Akt pathway activation

Revival of dormant tumor cells may be an important tumor metastasis mechanism. We hypothesized that aurora kinase A (AURKA), a cell cycle control kinase, promotes the transition of laryngeal squamous cell carcinoma (LSCC) cells from G0 phase to active division. We therefore investigated whether AURKA could revive dormant tumor cells to promote metastasis. Western blotting revealed that AURKA expression was persistently low in dormant laryngeal cancer Hep2 (D-Hep2) cells and high in non-dormant (T-Hep2) cells. Decreasing AURKA expression in T-Hep2 cells induced dormancy and reduced FAK/PI3K/Akt pathway activity. Increasing AURKA expression in D-Hep2 cells increased FAK/PI3K/Akt pathway activity and enhanced cellular proliferation, migration, invasion and metastasis. In addition, FAK/PI3K/Akt pathway inhibition caused dormancy-like behavior and reduced cellular mobility, migration and invasion. We conclude that AURKA may revive dormant tumor cells via FAK/PI3K/Akt pathway activation, thereby promoting migration and invasion in laryngeal cancer. AURKA/FAK/PI3K/Akt inhibitors may thus represent potential targets for clinical LSCC treatment.

Is Oral Biopsy Associated With Change in Tobacco or Alcohol Use?

PURPOSE

Tobacco and alcohol remain the predominant risk factors for oral cancer, but the relation between having an oral biopsy and cessation of these risk factors is unknown. Therefore, this investigation examined whether there might be an association between oral biopsy and change in risk factor use.

MATERIALS AND METHODS

A survey was sent to a cohort consisting of a consecutive sample of subjects identified in the University of North Carolina Oral Pathology database. The predictor variable was oral biopsy diagnosis, with 3 levels consisting of hyperkeratosis, dysplasia, or carcinoma. The outcome variable was change in risk factor use, coded as "no change in usage," "decreased usage" or "quit." Other study variables included age, gender, and race. The proportional odds model was used to assess the effect of explanatory variables on change in use, and the P value was set at .05.

RESULTS

The response rate was 37.4% for a total sample of 605 subjects. White non-Hispanics composed 85% of respondents and women composed 49.5%, with no significant difference among diagnostic categories. The global test for change in cigarette use was significant, with age contributing to variability in behavioral change. Although not statistically significant, larger percentages of patients with more severe diagnoses quit cigarettes and alcohol following biopsy. The youngest respondents were 3.7 times more likely not to quit before biopsy or to continue to smoke following biopsy (95% confidence interval, 1.98-6.91).

CONCLUSION

The results of this study suggest that oral biopsy provides an ideal opportunity to focus on risk factor cessation. Different diagnoses provide objective data on which to base a discussion about carcinogenesis and the roles played by the risk factors in this process. Differences in risk factor cessation associated with demographics emphasize the need for all clinicians to address cessation with all patients.

Molecular analyses of unselected head and neck cancer cases demonstrates that human papillomavirus transcriptional activity is positively associated with survival and prognosis

Background

Human papillomavirus DNA detection in head and neck squamous cell carcinoma has been linked to improved patient prognosis. The main aims of the study was to test the hypotheses that HPV16 E6/E7 oncogene and p53 function within tumours were associated with the widely reported improved patient survival and prognosis in head and neck cancer.

Methods

HPV16 DNA, mRNA and p53 mRNA presence were analysed in a prospective study of 42 unselected HNSCC patients; correlating the data with patient age, tumour staging/grade, treatment response, disease recurrence and survival.

Results

HPV16 DNA and HPV16 mRNA were present in 45.2 % and 21.4 % of patients, respectively. There was a significant positive association between the detection of HPV16 E6/E7 mRNA and p53 mRNA (p = 0.032), but this was not replicated for HPV16 DNA. Five-year disease free survival for the whole cohort was 63 % (CI 52.5–73.5 %). Multivariable analysis revealed only HPV16 E6/E7 mRNA expression to have significant prognostic influence (p = 0.04).

Conclusions

Our study suggests that HPV16 oncogenic transcriptional activity within HNSCC tumours is associated with improved patient survival and better prognosis in a German population. Simple HPV DNA detection alone did not demonstrate this association. The significant association of full-length (wild-type) p53 with HPV16 E6/E7 mRNA is further evidence for a functional relationship, which could contribute to the widely reported improved survival and prognosis. Larger studies are required to validate the frequency of HPV16 mRNA expression in HNSCC.

Human papillomavirus and oropharyngeal cancer in Greenland in 1994-2010

Background

Oropharyngeal squamous cell carcinoma (OPSCC) is associated with the sexually transmitted human papillomavirus (HPV), smoking and alcohol. In Greenland, a high rate of HPV-induced cervical cancer and venereal diseases are found, which exposes the population for high risk of HPV infection. In Greenland, only girls are included in the mandatory HPV vaccination program.

Objective

To investigate the annual incidence of OPSCC and the proportion of HPV-associated OPSCC (HPV+ OPSCC) in Greenland in 1994–2010.

Design

At Rigshospitalet, University of Copenhagen, we identified all Greenlandic patients diagnosed and treated for OPSCC from 1994 to 2010. Sections were cut from the patient's paraffin-embedded tissue blocks and investigated for p16 expression by immunohistochemistry. HPV analyses were performed with 2 sets of general HPV primers and 1 set of HPV16-specific primer. HPV+ OPSCC was defined as both >75% p16+ cells and PCR positive for HPV.

Results

Of 26 Greenlandic patients diagnosed with OPSCC, 17 were males and 9 were females. The proportion of HPV+ OPSCC in the total study period was 22%, without significant changes in the population in Greenland. We found an increase in the proportion of HPV+ OPSCC from 14% in 1994–2001 to 25% in 2002–2010 (p=0.51). Among males from 20 to 27% (p=0.63) and in females from 0 to 20% (p=0.71). The annual OPSCC incidence increased from 2.3/100,000 (CI=1.2–4.2) in 1994–2001 to 3.8/100,000 (CI=2.4–6.2) in 2002–2010: among males from 2.4/100,000 (CI=1.0–5.7) to 5.0/100,000 (CI=2.9–8.9).

Conclusion

Even though the population is at high risk of HPV infection, the proportion of 22% HPV+ OPSCC in the total study period is low compared to Europe and the United States. This might be explained by our small study size and/or by ethnic, geographical, sexual and cultural differences. Continuing observations of the OPSCC incidence and the proportion of HPV+ OPSCC in Greenland are needed.

National prevalence of oral HPV infection and related risk factors in the U.S. adult population

This article reviews the rapidly growing evidence that oral human papilloma viruses (HPV) infection contributes to the risk of oral squamous cell carcinoma. It also reports the first nationally representative estimates of oral HPV prevalence in the United States adult population. An estimated 7.3% (95% CI: 6.0, 8.9) of the U.S. population had one or more oral HPV types detected in oral rinse; 3.1% (95%CI: 2.4, 3.9) of the U.S. population had one or more oncogenic HPV types. A substantial excess risk of HPV infection in men is not explained by education, smoking, age of sexual debut, or number of lifetime sex partners. Based on the published finding from a case-control study, where there was an odds ratio of 2.6 (95% CI: 1.5, 4.2) for the association of head and neck cancer oncogenic oral HPV infection, the estimated population attributable risk for head and neck cancer in the U.S. population was 4.7%. In other words, there would be a 4.7% reduction in incidence rate of head and neck cancer in the United States if oncogenic HPV infection could be prevented. The results also provide population data that help evaluate the likely public health benefits of prophylactic vaccination against oral HPV acquisition.