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Bang HJ, Kim HJ, Lee SH, Shim HJ, Hwang JE, Bae WK, Chung IJ, Cho SH. Clinical prognostic factors to guide treatment strategy for HPV‑positive oropharyngeal cancer using treatment outcomes of induction chemotherapy: A real‑world experience. Oncol Lett 2024; 28:391. [PMID: 38966576 PMCID: PMC11223009 DOI: 10.3892/ol.2024.14524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/02/2024] [Indexed: 07/06/2024] Open
Abstract
The role of induction chemotherapy (IC) in locally advanced oropharyngeal cancer (OPC) remains debatable, and suitable candidates for de-escalation treatment in these patients have not been fully identified. Therefore, the present study aimed to identify high-risk candidates for human papillomavirus (HPV)-positive OPC by analyzing patients who underwent IC followed by chemoradiotherapy (CRT) to guide optimal treatment strategies. Patients diagnosed with stage III-IVA OPC and treated with a minimum of two cycles of IC followed by CRT, between 2004 and 2020, were retrospectively reviewed. All the patients were restaged according to the American Joint Committee on Cancer, 8th edition. The overall response rate and survival outcomes associated with clinical factors based on HPV status were analyzed using univariate and multivariate analyses. The present study analyzed 105 patients with a median age of 60 years (range, 40-76 years). Among 105 patients, 40 (38.1%) were HPV-negative and 65 (61.9%) HPV-positive. In all patients, survival outcomes were notably poorer in patients aged ≥60 years (P=0.006) and those who did not achieve complete response post-CRT (P<0.001), irrespective of the HPV status. The median relative dose intensity of IC was ≥80%, indicating adequate treatment, regardless of age. In contrast to patients with HPV-negative OPC, age ≥60 years (P=0.011) and T4 stage (P=0.019) emerged as substantial poor prognostic factors for survival outcomes in patients with HPV-positive OPC. Patients with HPV-positive OPC were categorized into three groups based on the number of clinical factors at diagnosis (such as age and T4 stage). The progression-free and overall survival showed significant stratification across each group as the number of high-risk factors increased despite IC and CRT. The findings indicated that patients with these high-risk factors require a cautious therapeutic strategy even when they are diagnosed with HPV-positive OPC, and the role of combined modality, including IC, will need to be investigated in a randomized trial to be routinely incorporated into clinical practice.
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Affiliation(s)
- Hyun Jin Bang
- Division of Hemato-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 58128, Republic of Korea
| | - Hyeon-Jong Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 58128, Republic of Korea
| | - Seung Hyuk Lee
- Division of Hemato-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 58128, Republic of Korea
| | - Hyun Jeong Shim
- Division of Hemato-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 58128, Republic of Korea
| | - Jun Eul Hwang
- Division of Hemato-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 58128, Republic of Korea
| | - Woo Kyun Bae
- Division of Hemato-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 58128, Republic of Korea
| | - Ik-Joo Chung
- Division of Hemato-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 58128, Republic of Korea
| | - Sang-Hee Cho
- Division of Hemato-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Jeollanam 58128, Republic of Korea
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Nyirjesy SC, McCrary HC, Zhao S, Judd RT, Farlow JL, Seim NB, Ozer E, Agrawal A, Old MO, Rocco JW, Kang SY, Haring CT. National Trends in 30-Day Readmission Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2024; 150:133-141. [PMID: 38153724 PMCID: PMC10853828 DOI: 10.1001/jamaoto.2023.4025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/27/2023] [Indexed: 12/29/2023]
Abstract
Importance As the incidence of oropharyngeal squamous cell carcinoma (OPSCC) continues to rise in the US, an increasing number of patients are being treated with transoral robotic surgery (TORS). Readmission following surgery can potentially delay initiation of adjuvant treatment and affect survival outcomes. Objective To identify risk factors for 30-day postoperative readmission in patients undergoing TORS for OPSCC. Design, Setting, and Participants This retrospective, population-based cohort study used data from the Nationwide Readmissions Database from 2010 to 2017. All patients undergoing TORS for OPSCC were identified using International Classification of Diseases codes and included. Exclusion criteria were age younger than 18 years or incomplete information regarding index admission or readmission. The analysis was performed from April to October 2023. Exposure TORS for OPSCC. Main Outcomes and Measures Univariate and multivariate analyses were performed to determine factors associated with 30-day readmission. Covariates included demographics and medical comorbidities, socioeconomic factors, hospital characteristics, and surgical details. Trends in readmission over time, reasons for readmission, and characteristics of the readmission were also examined. Results A weighted total of 5544 patients (mean [SD] age, 60.7 [0.25] years; 4475 [80.7%] male) underwent TORS for OPSCC. The overall readmission rate was 17.5% (n = 971), and these rates decreased over the study period (50 of 211 patients [23.7%] in 2010 vs 58 of 633 patients [9.1%] in 2017). Risk factors associated with readmission included male sex (adjusted odds ratio [AOR], 1.54; 95% CI, 1.07-2.20) and a diagnosis of congestive heart failure (AOR, 2.42; 95% CI, 1.28-4.58). Factors associated with decreased rate of readmission included undergoing concurrent selective neck dissection (AOR, 0.30; 95% CI, 0.22-0.41). Among the 971 readmissions, the most common readmission diagnoses were bleeding (151 [15.6%]), electrolyte and digestive problems (44 [4.5%]), pneumonia (44 [4.5%]), and sepsis (26 [2.7%]). Conclusions and Relevance In this cohort study, readmission rates following TORS for oropharynx cancer decreased over time; however, a subset of patients required readmission most commonly related to bleeding, infection, and electrolyte imbalance. Concurrent neck dissection may be protective against readmission. Elucidation of risk factors for readmission after TORS for OPSCC offers opportunities for evidence-based shared decision-making, quality improvement initiatives, and improved patient counseling.
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Affiliation(s)
- Sarah C. Nyirjesy
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Hilary C. McCrary
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University College of Medicine, Columbus
| | - Ryan T. Judd
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Janice L. Farlow
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Nolan B. Seim
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Enver Ozer
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Amit Agrawal
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Matthew O. Old
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - James W. Rocco
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Stephen Y. Kang
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
| | - Catherine T. Haring
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University College of Medicine, Columbus
- The James Cancer Hospital and Solove Research Institute, Columbus, Ohio
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von Witzleben A, Ellis M, Thomas GJ, Hoffmann TK, Jackson R, Laban S, Ottensmeier CH. Tumor-Infiltrating CD103+ Tissue-Resident Memory T Cells and CD103-CD8+ T Cells in HNSCC Are Linked to Outcome in Primary but not Metastatic Disease. Clin Cancer Res 2024; 30:224-234. [PMID: 37874322 DOI: 10.1158/1078-0432.ccr-23-0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/14/2023] [Accepted: 10/23/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE High numbers of tumor-infiltrating lymphocytes (TIL) are linked to better survival in patients with cancer. Tissue-resident memory T cells (TRM; CD8+CD103+) are recognized as a key player of anticancer immune response. To assess TRM cells in primary, metastatic, and recurrent head and neck squamous cell carcinoma (HNSCC), we developed a tissue microarray (TMA) and used multiplex IHC (MxIHC). EXPERIMENTAL DESIGN Samples from primary tumors of 379 HNSCC cases treated at Southampton Hospitals between 2000 and 2016 were collected and analyzed. Of these, 105 cases had lymph node metastases and 82 recurrences. A TMA was generated with triplicate cores for each sample. MxIHC with a stain-and-strip approach was performed using CD8, CD103, and TIM3. Scanned slides were analyzed (digital image analysis) and quality checked (QC). RESULTS After QC, 194 primary tumors, 76 lymph node metastases, and 65 recurrences were evaluable. Alcohol consumption was statistically significantly correlated with a reduction of TRM cells in primary tumors (nondrinker vs. heavy drinker: P = 0.0036). The known survival benefit of TRM cell infiltration in primary tumors was not found for lymph node metastasis. In recurrences, a high TRM cell number led to a favorable outcome after 12 months. The checkpoint molecule TIM3, was expressed significantly higher on TRM and non-TRM cells in the lymph node compared with primary tumors (P < 0.0001), which was also seen in recurrences (P = 0.0134 and P = 0.0007, respectively). CONCLUSIONS We confirm the prognostic impact of TIL in primary tumors and in recurrences. TRM cell density in lymph node metastases was not linked to outcome. The role of TIM3, as a therapeutic target remains to be defined.
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Affiliation(s)
- Adrian von Witzleben
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Ulm, Ulm, Germany
- CRUK and NIHR Experimental Cancer Medicine Center and School of Cancer Sciences, Faculty of Medicine, H, Southampton, United Kingdom
| | - Matthew Ellis
- CRUK and NIHR Experimental Cancer Medicine Center and School of Cancer Sciences, Faculty of Medicine, H, Southampton, United Kingdom
| | - Gareth J Thomas
- CRUK and NIHR Experimental Cancer Medicine Center and School of Cancer Sciences, Faculty of Medicine, H, Southampton, United Kingdom
- Southampton University Hospitals NHS Foundation Trust, Southampton, United Kingdom
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Ulm, Ulm, Germany
| | - Richard Jackson
- Liverpool Clinical Trials Center, University of Liverpool, Liverpool, United Kingdom
| | - Simon Laban
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Ulm, Ulm, Germany
| | - Christian H Ottensmeier
- Liverpool Head and Neck Center, Institute of Systems, Molecular and Integrative Biology and Liverpool CRUK and NIHR Experimental Cancer Medicine Center, UK University of Liverpool, Liverpool, United Kingdom
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Chen Z, Chan ABW, Kam LS, Chan MH, Chan JYK, Lee WT, Chow C, Boon SS, Xia C, Lam B, Lam S, Ng RWY, Ho WCS, Lam EWH, Lai CKC, Chan PKS. Changes in the Incidence and Human Papillomavirus-Positive Portion of Oropharyngeal Squamous Cell Carcinoma in Hong Kong. Cancers (Basel) 2024; 16:226. [PMID: 38201653 PMCID: PMC10778352 DOI: 10.3390/cancers16010226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
The incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is rising in the West, but little is known in Asia. This study elucidated changes in the incidence and HPV-positive portion of OPSCC in Hong Kong. Data from population-based cancer registry were used to analyze the incidence of OPSCC in association with other head and neck cancers. Archived tumor tissues were tested for HPV. From 1986 to 2020, there was a marked decrease in the incidence of nasopharyngeal and laryngeal cancers, but a persistent increase in OPSCC from 36 cases in 1986 to 116 cases in 2020. The average positive rate for high-risk HPV was 36.1% (112/310) among OPSCC diagnosed in 2010-2020. The HPV-positive rate in recent years was significantly higher than earlier cases (tonsil SCC: 64.7% (55/85) in 2016-2020 vs. 40.4% (19/47) in 2010-2015, p = 0.007). Patients with HPV-positive tonsil cancers were significantly younger than those negative (mean [SD]: 58.9 [9.9] vs. 64.3 [13.3] years, p = 0.006), but no significant difference was observed between genders. A persistent increase in the incidence of oropharyngeal cancer over the last few decades was observed in Hong Kong, which can be explained by the remarkable increase in HPV-positive tonsil cancers.
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Affiliation(s)
- Zigui Chen
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Amy B. W. Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China; (A.B.W.C.); (C.C.)
| | - Lok-Sang Kam
- Department of Anatomical Pathology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Man-Hin Chan
- Department of ENT, Yan Chai Hospital, Hong Kong SAR, China; (M.-H.C.); (B.L.); (E.W.H.L.)
| | - Jason Y. K. Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wai-Tung Lee
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong SAR, China;
| | - Chit Chow
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China; (A.B.W.C.); (C.C.)
| | - Siaw S. Boon
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Chichao Xia
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Brian Lam
- Department of ENT, Yan Chai Hospital, Hong Kong SAR, China; (M.-H.C.); (B.L.); (E.W.H.L.)
| | - Suki Lam
- Department of ENT, Yan Chai Hospital, Hong Kong SAR, China; (M.-H.C.); (B.L.); (E.W.H.L.)
| | - Rita W. Y. Ng
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Wendy C. S. Ho
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Eddy W. H. Lam
- Department of ENT, Yan Chai Hospital, Hong Kong SAR, China; (M.-H.C.); (B.L.); (E.W.H.L.)
| | - Christopher K. C. Lai
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
| | - Paul K. S. Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China; (Z.C.); (S.S.B.); (C.X.); (R.W.Y.N.); (W.C.S.H.); (C.K.C.L.)
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Lee JJW, Alamleh S, Zhan LJ, Hueniken K, Mahler MB, Billfalk-Kelly A, Davies J, Brown MC, Spreafico A, Huang SH, Hope A, Xu W, Goldstein DP, Liu G. Clinical Predictors of Cisplatin Chemoradiation-Induced Ototoxicity in HPV-Positive Oropharyngeal Squamous Cell Carcinoma: A Case-Control Study. J Otolaryngol Head Neck Surg 2024; 53:19160216241248671. [PMID: 39056507 PMCID: PMC11282567 DOI: 10.1177/19160216241248671] [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: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Cisplatin-based chemoradiation is a standard treatment for many patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC), an etiologically distinct subset of head and neck cancer. Although associated with good long-term survival, clinical risk factors for ototoxicity have been understudied in this population. This study aimed to evaluate clinical predictors associated with ototoxicity in HPV-positive OPSCC patients treated with cisplatin chemoradiation. METHODS This retrospective case-control study included 201 adult patients (>18 years) with histologically confirmed HPV-positive OPSCC who received cisplatin chemoradiation as their primary treatment from 2001 and 2019 at a single tertiary cancer center. Ototoxicity was determined using baseline and follow-up audiometry and the Common Terminology Criteria for Adverse Events v5.0 grading criteria (Grade ≥2). Multivariable logistic regression [adjusted odds ratio (aOR)] identified significant predictors that increased the odds of ototoxicity. RESULTS A total of 201 patients [165 males; median (IQR) age, 57 (11) years] were included in the study. The incidence of ototoxicity in the worst ear was 56.2%, with the greatest hearing loss occurring at high frequencies (4-8 kHz), resulting in a loss of 12.5 dB at 4 to 6 kHz and 20 dB at 6 to 8 kHz. High-dose cisplatin administration compared to weekly administration [aOR 4.93 (95% CI: 1.84-14.99), P = .003], a higher mean cochlear radiation dose [aOR 1.58 (95% CI: 1.12-2.30), P = .01], smoking history [aOR 2.89 (95% CI: 1.51-5.63), P = .001], and a 10 year increase in age [aOR 2.07 (95% CI: 1.25-3.52), P = .006] were each independently associated with increased odds of ototoxicity. CONCLUSIONS Clinical predictors of ototoxicity in HPV-positive OPSCC patients treated with cisplatin-based chemoradiation include the use of a high-dose cisplatin regimen, higher cochlear radiation doses, a history of smoking, and older age. With the rising incidence of this malignancy in Western countries and overall improved survivorship, our research motivates future studies into risk stratification and earlier interventions to mitigate and reduce the risk of ototoxicity.
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Affiliation(s)
- John JW. Lee
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Luna Jia Zhan
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Katrina Hueniken
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Mary B. Mahler
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Astrid Billfalk-Kelly
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Joel Davies
- Department of Otolaryngology—Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - M. Catherine Brown
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David P. Goldstein
- Department of Otolaryngology—Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
- Department of Otolaryngology—Head and Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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6
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Cunha ARD, Compton K, Xu R, Mishra R, Drangsholt MT, Antunes JLF, Kerr AR, Acheson AR, Lu D, Wallace LE, Kocarnik JM, Fu W, Dean FE, Pennini A, Henrikson HJ, Alam T, Ababneh E, Abd-Elsalam S, Abdoun M, Abidi H, Abubaker Ali H, Abu-Gharbieh E, Adane TD, Addo IY, Ahmad A, Ahmad S, Ahmed Rashid T, Akonde M, Al Hamad H, Alahdab F, Alimohamadi Y, Alipour V, Al-Maweri SA, Alsharif U, Ansari-Moghaddam A, Anwar SL, Anyasodor AE, Arabloo J, Aravkin AY, Aruleba RT, Asaad M, Ashraf T, Athari SS, Attia S, Azadnajafabad S, Azangou-Khyavy M, Badar M, Baghcheghi N, Banach M, Bardhan M, Barqawi HJ, Bashir NZ, Bashiri A, Benzian H, Bernabe E, Bhagat DS, Bhojaraja VS, Bjørge T, Bouaoud S, Braithwaite D, Briko NI, Calina D, Carreras G, Chakraborty PA, Chattu VK, Chaurasia A, Chen MX, Cho WCS, Chu DT, Chukwu IS, Chung E, Cruz-Martins N, Dadras O, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Darvishi Cheshmeh Soltani R, Darwesh AM, Debela SA, Derbew Molla M, Dessalegn FN, Dianati-Nasab M, Digesa LE, Dixit SG, Dixit A, Djalalinia S, El Sayed I, El Tantawi M, Enyew DB, Erku DA, Ezzeddini R, Fagbamigbe AF, Falzone L, Fetensa G, Fukumoto T, Gaewkhiew P, Gallus S, Gebrehiwot M, Ghashghaee A, Gill PS, Golechha M, Goleij P, Gomez RS, Gorini G, Guimaraes ALS, Gupta B, Gupta S, Gupta VB, Gupta VK, Haj-Mirzaian A, Halboub ES, Halwani R, Hanif A, Hariyani N, Harorani M, Hasani H, Hassan AM, Hassanipour S, Hassen MB, Hay SI, Hayat K, Herrera-Serna BY, Holla R, Horita N, Hosseinzadeh M, Hussain S, Ilesanmi OS, Ilic IM, Ilic MD, Isola G, Jaiswal A, Jani CT, Javaheri T, Jayarajah U, Jayaram S, Joseph N, Kadashetti V, Kandaswamy E, Karanth SD, Karaye IM, Kauppila JH, Kaur H, Keykhaei M, Khader YS, Khajuria H, Khanali J, Khatib MN, Khayat Kashani HR, Khazeei Tabari MA, Kim MS, Kompani F, Koohestani HR, Kumar GA, Kurmi OP, La Vecchia C, Lal DK, Landires I, Lasrado S, Ledda C, Lee YH, Libra M, Lim SS, Listl S, Lopukhov PD, Mafi AR, Mahumud RA, Malik AA, Mathur MR, Maulud SQ, Meena JK, Mehrabi Nasab E, Mestrovic T, Mirfakhraie R, Misganaw A, Misra S, Mithra P, Mohammad Y, Mohammadi M, Mohammadi E, Mokdad AH, Moni MA, Moraga P, Morrison SD, Mozaffari HR, Mubarik S, Murray CJL, Nair TS, Narasimha Swamy S, Narayana AI, Nassereldine H, Natto ZS, Nayak BP, Negru SM, Nggada HA, Nouraei H, Nuñez-Samudio V, Oancea B, Olagunju AT, Omar Bali A, Padron-Monedero A, Padubidri JR, Pandey A, Pardhan S, Patel J, Pezzani R, Piracha ZZ, Rabiee N, Radhakrishnan V, Radhakrishnan RA, Rahmani AM, Rahmanian V, Rao CR, Rao SJ, Rath GK, Rawaf DL, Rawaf S, Rawassizadeh R, Razeghinia MS, Rezaei N, Rezaei N, Rezaei N, Rezapour A, Riad A, Roberts TJ, Romero-Rodríguez E, Roshandel G, S M, S N C, Saddik B, Saeb MR, Saeed U, Safaei M, Sahebazzamani M, Sahebkar A, Salek Farrokhi A, Samy AM, Santric-Milicevic MM, Sathian B, Satpathy M, Šekerija M, Senthilkumaran S, Seylani A, Shafaat O, Shahsavari HR, Shamsoddin E, Sharew MM, Sharifi-Rad J, Shetty JK, Shivakumar KM, Shobeiri P, Shorofi SA, Shrestha S, Siddappa Malleshappa SK, Singh P, Singh JA, Singh G, Sinha DN, Solomon Y, Suleman M, Suliankatchi Abdulkader R, Taheri Abkenar Y, Talaat IM, Tan KK, Tbakhi A, Thiyagarajan A, Tiyuri A, Tovani-Palone MR, Unnikrishnan B, Vo B, Volovat SR, Wang C, Westerman R, Wickramasinghe ND, Xiao H, Yu C, Yuce D, Yunusa I, Zadnik V, Zare I, Zhang ZJ, Zoladl M, Force LM, Hugo FN. The Global, Regional, and National Burden of Adult Lip, Oral, and Pharyngeal Cancer in 204 Countries and Territories: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol 2023; 9:1401-1416. [PMID: 37676656 PMCID: PMC10485745 DOI: 10.1001/jamaoncol.2023.2960] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/04/2023] [Indexed: 09/08/2023]
Abstract
Importance Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning. Objective To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates. Evidence Review The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019. Findings In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia. Conclusions and Relevance In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.
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Affiliation(s)
| | - Kelly Compton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Rixing Xu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Data and Tooling, Sage Bionetworks, Seattle, Washington
| | - Rashmi Mishra
- Department of Oral Medicine, School of Dentistry, University of Washington, Seattle
| | - Mark Thomas Drangsholt
- Department of Oral Medicine, School of Dentistry, University of Washington, Seattle
- Oral Medicine Clinic, School of Dentistry, University of Washington, Seattle
| | | | - Alexander R Kerr
- Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, College of Dentistry, New York University, New York, New York
| | - Alistair R Acheson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Dan Lu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Lindsey E Wallace
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Jonathan M Kocarnik
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Weijia Fu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Frances E Dean
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Mathematics, University of California, Berkeley
| | - Alyssa Pennini
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Hannah Jacqueline Henrikson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Tahiya Alam
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Emad Ababneh
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sherief Abd-Elsalam
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Meriem Abdoun
- Department of Medicine, University of Setif Algeria, Setif, Algeria
| | - Hassan Abidi
- Laboratory Technology Sciences Department, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Hiwa Abubaker Ali
- Department of Banking and Finance, University of Human Development, Sulaymaniyah, Iraq
| | - Eman Abu-Gharbieh
- Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
| | - Tigist Demssew Adane
- Department of Clinical and Psychosocial Epidemiology, University of Groningen, Groningen, the Netherlands
| | - Isaac Yeboah Addo
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- Quality and Systems Performance Unit, Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Aqeel Ahmad
- Department of Medical Biochemistry, Shaqra University, Shaqra, Saudi Arabia
| | - Sajjad Ahmad
- Department of Health and Biological Sciences, Abasyn University, Peshawar, Pakistan
| | - Tarik Ahmed Rashid
- Department of Computer Science and Engineering, University of Kurdistan Hewler, Erbil, Iraq
| | - Maxwell Akonde
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Hanadi Al Hamad
- Geriatric and Long Term Care Department, Hamad Medical Corporation, Doha, Qatar
- Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fares Alahdab
- Evidence-Based Practice Center Program, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota
| | - Yousef Alimohamadi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Health Economics, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Alireza Ansari-Moghaddam
- Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sumadi Lukman Anwar
- Department of Surgery, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aleksandr Y Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Applied Mathematics, College of Arts & Sciences, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Raphael Taiwo Aruleba
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Malke Asaad
- Department of Plastic Surgery, University of Texas, Houston
| | - Tahira Ashraf
- University Institute of Radiological Sciences and Medical Imaging Technology, The University of Lahore, Lahore, Pakistan
| | | | - Sameh Attia
- Department of Oral and Maxillofacial Surgery, Justus Liebig University of Giessen, Giessen, Germany
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Azangou-Khyavy
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Muhammad Badar
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
| | - Nayereh Baghcheghi
- Department of Nursing, Saveh University of Medical Sciences, Saveh, Iran
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
- Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
| | - Mainak Bardhan
- Department of Molecular Microbiology and Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, India
- Department of Molecular Microbiology, Indian Council of Medical Research, New Delhi, India
| | - Hiba Jawdat Barqawi
- Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
| | - Nasir Z Bashir
- School of Oral and Dental Sciences, University of Bristol, Bristol, England, United Kingdom
| | - Azadeh Bashiri
- Health Information Management, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Habib Benzian
- Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, New York
| | - Eduardo Bernabe
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, England, United Kingdom
| | - Devidas S Bhagat
- Department of Forensic Chemistry, Government Institute of Forensic Science, Aurangabad, India
| | - Vijayalakshmi S Bhojaraja
- Department of Anatomy, Royal College of Surgeons in Ireland Medical, University of Bahrain, Busaiteen, Bahrain
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Souad Bouaoud
- Department of Medicine, University Ferhat Abbas of Setif, Setif, Algeria
- Department of Epidemiology and Preventive Medicine, University Hospital Saadna Abdenour, Setif, Algeria
| | - Dejana Braithwaite
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville
- Cancer Control and Population Sciences Program, University of Florida Health Cancer Center, Gainesville
| | - Nikolay Ivanovich Briko
- Department of Epidemiology and Evidence-Based Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Daniela Calina
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Giulia Carreras
- Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Promit Ananyo Chakraborty
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Vijay Kumar Chattu
- Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Sawangi, India
- Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
| | - Akhilanand Chaurasia
- Department of Oral Medicine and Radiology, King George's Medical University, Lucknow, India
| | - Meng Xuan Chen
- Department of Oral Biological and Medical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - William C S Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Dinh-Toi Chu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi, Vietnam
| | | | - Eunice Chung
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Natália Cruz-Martins
- Department of Therapeutic and Diagnostic Technologies, Polytechnic and University Higher Education Cooperative, Gandra, Portugal
- Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Omid Dadras
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Section Global Health and Rehabilitation, Western Norway University of Applied Sciences, Bergen, Norway
| | - Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Public Health Foundation of India, Gurugram, India
- Indian Council of Medical Research, New Delhi, India
| | - Rakhi Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
- Public Health Foundation of India, Gurugram, India
| | - Parnaz Daneshpajouhnejad
- Department of Pathology, Johns Hopkins Medicine, Baltimore, Maryland
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Aso Mohammad Darwesh
- Department of Information Technology, University of Human Development, Sulaymaniyah, Iraq
| | | | | | - Fikadu Nugusu Dessalegn
- Department of Public Health, College of Medicine, Madda Walabu University, Bale Goba, Ethiopia
| | - Mostafa Dianati-Nasab
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Lankamo Ena Digesa
- Department of Comprehensive Nursing, Arba Minch University, Arba Minch, Ethiopia
| | - Shilpi Gupta Dixit
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhinav Dixit
- Department of Physiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Shirin Djalalinia
- Development of Research and Technology Center, Ministry of Health and Medical Education, Tehran, Iran
| | - Iman El Sayed
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | | | - Daniel Asfaw Erku
- Centre for Applied Health Economics, Griffith University, Gold Coast, Queensland, Australia
| | - Rana Ezzeddini
- Department of Clinical Biochemistry, Tarbiat Modares University, Tehran, Iran
| | - Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Luca Falzone
- Epidemiology and Biostatistics Unit, National Cancer Institute IRCCS Fondazione G. Pascale, Naples, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Getahun Fetensa
- Department of Nursing, College of Medical and Health Sciences, Wollega University, Nekemte, Ethiopia
| | | | - Piyada Gaewkhiew
- Department of Community Dentistry, Faculty of Dentistry, Mahidol University, Ratchathewi, Thailand
- Population and Patient Health Group, King's College London, London, England, United Kingdom
| | - Silvano Gallus
- Department of Environmental Health Sciences, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Mesfin Gebrehiwot
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ahmad Ghashghaee
- School of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Paramjit Singh Gill
- Warwick Medical School, University of Warwick, Coventry, England, United Kingdom
| | - Mahaveer Golechha
- Department of Health Systems and Policy Research, Indian Institute of Public Health, Gandhinagar, India
| | - Pouya Goleij
- Department of Genetics, Sana Institute of Higher Education, Sari, Iran
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Giuseppe Gorini
- Oncological Network, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | | | - Bhawna Gupta
- Department of Public Health, Torrens University Australia, Melbourne, Victoria, Australia
| | - Sapna Gupta
- Toxicology Department, Shriram Institute for Industrial Research, Delhi, India
| | - Veer Bala Gupta
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Vivek Kumar Gupta
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Arvin Haj-Mirzaian
- Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esam S Halboub
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
- School of Dentistry, Sana'a University, Sana'a, Yemen
| | - Rabih Halwani
- Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Asif Hanif
- University Institute of Public Health, The University of Lahore, Lahore, Pakistan
| | - Ninuk Hariyani
- Department of Dental Public Health, Airlangga University, Surabaya, Indonesia
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Mehdi Harorani
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Hamidreza Hasani
- Department of Ophthalmology, Iran University of Medical Sciences, Karaj, Iran
| | - Abbas M Hassan
- Department of Plastic Surgery, University of Texas, Houston
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammed Bheser Hassen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- National Data Management Center for Health (NDMC), Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- Department of Pharmacy Administration and Clinical Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | | | - Ramesh Holla
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University, Yokohama, Japan
- National Human Genome Research Institute (NHGRI), National Institutes of Health, Bethesda, Maryland
| | - Mehdi Hosseinzadeh
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
- Department of Computer Science, University of Human Development, Sulaymaniyah, Iraq
| | - Salman Hussain
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Masaryk University, Brno, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Olayinka Stephen Ilesanmi
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Community Medicine, University College Hospital, Ibadan, Ibadan, Nigeria
| | - Irena M Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milena D Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy
| | - Abhishek Jaiswal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chinmay T Jani
- Department of Internal Medicine, Mount Auburn Hospital, Harvard University, Cambridge, Massachusetts
| | - Tahereh Javaheri
- Health Informatics Lab, Boston University, Boston, Massachusetts
| | - Umesh Jayarajah
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Shubha Jayaram
- Department of Biochemistry, Government Medical College, Mysuru, India
| | - Nitin Joseph
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| | - Vidya Kadashetti
- Department of Oral and Maxillofacial Pathology, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, India
| | - Eswar Kandaswamy
- Department of Periodontics, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans
| | | | - Ibraheem M Karaye
- School of Health Professions and Human Services, Hofstra University, Hempstead, New York
| | - Joonas H Kauppila
- Surgery Research Unit, University of Oulu, Oulu, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - Mohammad Keykhaei
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Saleh Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Himanshu Khajuria
- Amity Institute of Forensic Sciences, Amity University, Noida, India
| | - Javad Khanali
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahalaqua Nazli Khatib
- Global Consortium for Public Health Research, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | | | - Mohammad Amin Khazeei Tabari
- Department of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- MAZUMS Office, Universal Scientific Education and Research Network, Tehran, Iran
| | - Min Seo Kim
- Department of Genomics and Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, South Korea
- Public Health Center, Ministry of Health and Welfare, Wando, South Korea
| | - Farzad Kompani
- Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Koohestani
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
| | - Om P Kurmi
- Faculty of Health and Life Sciences, Coventry University, Coventry, England, United Kingdom
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Iván Landires
- Unit of Genetics and Public Health, Institute of Medical Sciences, Las Tablas, Panama
- Ministry of Health, Herrera, Panama
| | - Savita Lasrado
- Department of Otorhinolaryngology, Father Muller Medical College, Mangalore, India
| | - Caterina Ledda
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Yo Han Lee
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Stefan Listl
- Department of Dentistry, Radboud University, Nijmegen, the Netherlands
- Department of Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - Platon D Lopukhov
- Department of Epidemiology and Evidence-Based Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ahmad R Mafi
- Department of Clinical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ahmad Azam Malik
- University Institute of Public Health, The University of Lahore, Lahore, Pakistan
- Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Manu Raj Mathur
- Department of Health Policy Research, Public Health Foundation of India, Gurugram, India
- Institute of Population Health Sciences, University of Liverpool, Liverpool, England, United Kingdom
| | - Sazan Qadir Maulud
- Department of Biology, College of Science, Salahaddin University, Erbil, Iraq
| | - Jitendra Kumar Meena
- Department of Preventive Oncology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Tomislav Mestrovic
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Reza Mirfakhraie
- Department of Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Awoke Misganaw
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
- National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| | - Yousef Mohammad
- Internal Medicine Department, King Saud University, Riyadh, Saudi Arabia
| | - Mokhtar Mohammadi
- Department of Information Technology, Lebanese French University, Erbil, Iraq
| | - Esmaeil Mohammadi
- Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Mohammad Ali Moni
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Paula Moraga
- Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Shane Douglas Morrison
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
| | - Hamid Reza Mozaffari
- Department of Oral and Maxillofacial Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Medicine, Wuhan University, Wuhan, China
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | | | | | | | - Hasan Nassereldine
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Zuhair S Natto
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Oral Health Policy and Epidemiology, School of Dental Medicine, Harvard University, Boston, Massachusetts
| | | | - Serban Mircea Negru
- Department of Oncology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Haruna Asura Nggada
- Department of Histopathology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
- Department of Human Pathology, University of Maiduguri, Maiduguri, Nigeria
| | - Hasti Nouraei
- Department of Medical Mycology and Parasitology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Virginia Nuñez-Samudio
- Unit of Microbiology and Public Health, Institute of Medical Sciences, Las Tablas, Panama
- Department of Public Health, Ministry of Health, Herrera, Panama
| | - Bogdan Oancea
- Department of Applied Economics and Quantitative Analysis, University of Bucharest, Bucharest, Romania
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry, Faculty of Clinical Science, University of Lagos, Lagos, Nigeria
| | - Ahmed Omar Bali
- Diplomacy and Public Relations Department, University of Human Development, Sulaymaniyah, Iraq
| | | | - Jagadish Rao Padubidri
- Department of Forensic Medicine and Toxicology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| | | | - Shahina Pardhan
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, England, United Kingdom
| | - Jay Patel
- Global Health Governance Programme, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- School of Dentistry, University of Leeds, Leeds, England, United Kingdom
| | - Raffaele Pezzani
- Endocrinology Unit, Department of Medicine, University of Padova, Padova, Italy
- Associazione Italiana Ricerca Oncologica di Base (AIROB), Padova, Italy
| | | | - Navid Rabiee
- School of Engineering, Macquarie University, Sydney, New South Wales, Australia
- Pohang University of Science and Technology, Pohang, South Korea
| | | | | | - Amir Masoud Rahmani
- Future Technology Research Center, National Yunlin University of Science and Technology, Yunlin, Taiwan
| | - Vahid Rahmanian
- Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran
| | - Chythra R Rao
- Department of Community Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sowmya J Rao
- Department of Oral Pathology and Microbiology, Sharavathi Dental College and Hospital, Shimogga, India
| | - Goura Kishor Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - David Laith Rawaf
- WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, England, United Kingdom
- Inovus Medical, St Helens, England, United Kingdom
| | - Salman Rawaf
- Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, London, England, United Kingdom
- Academic Public Health England, Public Health England, London, England, United Kingdom
| | - Reza Rawassizadeh
- Department of Computer Science, College of Arts & Sciences, Boston University, Boston, Massachusetts
| | - Mohammad Sadegh Razeghinia
- Department of Immunology and Laboratory Sciences, Sirjan School of Medical Sciences, Sirjan, Iran
- Department of Immunology, Kerman University of Medical Sciences, Kerman, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abanoub Riad
- Department of Public Health, Masaryk University, Brno, Czech Republic
- Czech National Centre for Evidence-based Healthcare and Knowledge Translation, Masaryk University, Brno, Czech Republic
| | - Thomas J Roberts
- Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Esperanza Romero-Rodríguez
- Clinical and Epidemiological Research in Primary Care (GICEAP), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Manjula S
- Department of Oral and Maxillofacial Surgery, JSS Academy of Higher Education and Research, Mysore, India
| | - Chandan S N
- Department of Oral and Maxillofacial Surgery, JSS Academy of Higher Education and Research, Mysore, India
| | - Basema Saddik
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohammad Reza Saeb
- Department of Polymer Technology, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
| | - Umar Saeed
- International Center of Medical Sciences Research, Islamabad, Pakistan
- Multidisciplinary Laboratory Foundation University School of Health Sciences (FUSH), Foundation University, Islamabad, Pakistan
| | - Mohsen Safaei
- Advanced Dental Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Sahebazzamani
- Department of Medical Biochemistry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Medical Laboratory Sciences, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Abdallah M Samy
- Department of Entomology, Faculty of Science, Ain Shams University, Cairo, Egypt
- Medical Ain Shams Research Institute (MARSI), Ain Shams University, Cairo, Egypt
| | - Milena M Santric-Milicevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia
| | - Brijesh Sathian
- Geriatric and Long Term Care Department, Hamad Medical Corporation, Doha, Qatar
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, England, United Kingdom
| | - Maheswar Satpathy
- UGC Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India
- Udyam-Global Association for Sustainable Development, Bhubaneswar, India
| | - Mario Šekerija
- Department of Medical Statistics, University of Zagreb, Zagreb, Croatia
- Department of Epidemiology and Prevention of Chronic Noncommunicable Diseases, Croatian Institute of Public Health, Zagreb, Croatia
| | | | - Allen Seylani
- National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville, Maryland
| | - Omid Shafaat
- Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland
- Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid R Shahsavari
- Department of Chemistry, Institute for Advanced Studies in Basic Sciences (IASBS), Zanjan, Iran
| | - Erfan Shamsoddin
- Department of Oral Health, Non-Communicable Diseases Research Center (NCDRC), Tehran, Iran
- Non-Communicable Diseases Committee, National Institute for Medical Research Development (NIMAD), Tehran, Iran
| | | | | | - Jeevan K Shetty
- Department of Biochemistry, Royal College of Surgeons in Ireland Medical University of Bahrain, Busaiteen, Bahrain
| | - K M Shivakumar
- Department of Public Health Dentistry, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, India
| | - Parnian Shobeiri
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of International Studies, Non-Communicable Diseases Research Center (NCDRC), Tehran, Iran
| | - Seyed Afshin Shorofi
- Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Sunil Shrestha
- School of Pharmacy, Monash University, Selangor Darul Ehsan, Malaysia
| | | | - Paramdeep Singh
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, India
| | - Jasvinder A Singh
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham
- Department of Medicine Service, US Department of Veterans Affairs, Birmingham, Alabama
| | - Garima Singh
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
- Department of Community Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Dhirendra Narain Sinha
- Department of Epidemiology, School of Preventive Oncology, Patna, India
- Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
| | - Yonatan Solomon
- Department of Nursing, Dire Dawa University, Dire Dawa, Ethiopia
| | - Muhammad Suleman
- Center for Biotechnology and Microbiology, University of Swat, Mingora, Pakistan
- School of Life Sciences, Xiamen University, Xiamen, China
| | | | | | - Iman M Talaat
- Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
- Pathology Department, Alexandria University, Alexandria, Egypt
| | - Ker-Kan Tan
- Department of Surgery, National University of Singapore, Singapore, Singapore
| | - Abdelghani Tbakhi
- Department of Cell Therapy and Applied Genomics, King Hussein Cancer Center, Amman, Jordan
| | - Arulmani Thiyagarajan
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Amir Tiyuri
- Department of Epidemiology and Biostatistics, Birjand University of Medical Sciences, Birjand, Iran
- Department of Epidemiology and Biostatistics, Iran University of Medical Sciences, Tehran, Iran
| | - Marcos Roberto Tovani-Palone
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
- Modestum LTD, Eastbourne, England, United Kingdom
| | - Bhaskaran Unnikrishnan
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, India
| | - Bay Vo
- Faculty of Information Technology, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, Vietnam
| | - Simona Ruxandra Volovat
- Department of Medical Oncology, University of Medicine and Pharmacy "Grigore T Popa" Iaşi, Iaşi, Romania
- Department of Medical Oncology, Regional Institute of Oncology, Iaşi, Romania
| | - Cong Wang
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Ronny Westerman
- Competence Center of Mortality-Follow-Up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany
| | - Nuwan Darshana Wickramasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Hong Xiao
- School of Public Health, Zhejiang University, Zhejiang, China
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Medicine, Wuhan University, Wuhan, China
| | - Deniz Yuce
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Ismaeel Yunusa
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia
| | - Vesna Zadnik
- Epidemiology and Cancer Registry Sector, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Iman Zare
- Research and Development Department, Sina Medical Biochemistry Technologies, Shiraz, Iran
| | - Zhi-Jiang Zhang
- School of Medicine, Faculty of Medical Sciences, Wuhan University, Wuhan, China
| | - Mohammad Zoladl
- Department of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Lisa M Force
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
- Division of Hematology-Oncology, Department of Pediatrics, University of Washington, Seattle
| | - Fernando N Hugo
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Letafati A, Sakhavarz T, Khosravinia MM, Ardekani OS, Sadeghifar S, Norouzi M, Naseri M, Ghaziasadi A, Jazayeri SM. Exploring the correlation between progression of human papillomavirus infection towards carcinogenesis and nutrition. Microb Pathog 2023; 183:106302. [PMID: 37567326 DOI: 10.1016/j.micpath.2023.106302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/13/2023]
Abstract
Human papillomavirus (HPV) is a common sexually transmitted virus that can lead to the development of various types of cancer. While there are vaccines available to prevent HPV infection, there is also growing interest in the role of nutrition in reducing the risk of HPV-related cancers in HPV positive patients. Diet and nutrition play a critical role in maintaining overall health and preventing various diseases. A healthy diet can strengthen the immune system, which is essential for fighting off infections, including HPV infections, and preventing the growth and spread of cancer cells. Therefore, following a healthy diet and maintaining a healthy weight are important components of HPV and cancer prevention. This article explores the current scientific evidence on the relationship between nutrition and HPV, including the impact of specific nutrients, dietary patterns, and supplements on HPV infection toward cancer progression.
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Affiliation(s)
- Arash Letafati
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Tannaz Sakhavarz
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran.
| | - Mohammad Mahdi Khosravinia
- Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Omid Salahi Ardekani
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran.
| | - Samira Sadeghifar
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran.
| | - Mehdi Norouzi
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran.
| | - Mona Naseri
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran.
| | - Azam Ghaziasadi
- Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran.
| | - Seyed Mohammad Jazayeri
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran.
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8
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Lee JJW, Kunaratnam V, Kim CJH, Pienkowski M, Hueniken K, Sahovaler A, Lam ACL, Davies JC, Brown CM, De Almeida JR, Huang SH, Waldron JN, Spreafico A, Hung RJ, Xu W, Goldstein DP, Liu G. Cigarette smoking cessation, duration of smoking abstinence, and head and neck squamous cell carcinoma prognosis. Cancer 2023; 129:867-877. [PMID: 36653915 DOI: 10.1002/cncr.34620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Tobacco use is a major risk factor for developing head and neck squamous cell carcinoma (HNSCC). However, the prognostic associations with smoking cessation are limited. The authors assessed whether smoking cessation and increased duration of abstinence were associated with improved overall (OS) and HNSCC-specific survival. METHODS Clinicodemographic and smoking data from patients with HNSCC at Princess Margaret Cancer Center (2006-2019) were prospectively collected. Multivariable Cox and Fine and Gray competing-risk models were used to assess the impact of smoking cessation and duration of abstinence on overall mortality and HNSCC-specific/noncancer mortality, respectively. RESULTS Among 2482 patients who had HNSCC, former smokers (adjusted hazard ratio [aHR], 0.71; 95% CI, 0.58-0.87; p = .001; N = 841) had a reduced risk of overall mortality compared with current smokers (N = 931). Compared with current smokers, former smokers who quit >10 years before diagnosis (long-term abstinence; n = 615) had the most improved OS (aHR, 0.72; 95% CI, 0.56-0.93; p = .001). The 5-year actuarial rates of HNSCC-specific and noncancer deaths were 16.8% and 9.4%, respectively. Former smokers (aHR, 0.71; 95% CI, 0.54-0.95; p = .019) had reduced HNSCC-specific mortality compared with current smokers, but there was no difference in noncancer mortality. Abstinence for >10 years was associated with decreased HNSCC-specific death compared with current smoking (aHR, 0.64; 95% CI, 0.46-0.91; p = .012). Smoking cessation with a longer duration of quitting was significantly associated with reduced overall and HNSCC-specific mortality in patients who received primary radiation. CONCLUSIONS Smoking cessation before the time of diagnosis reduced overall mortality and cancer-specific mortality among patients with HNSCC, but no difference was observed in noncancer mortality. Long-term abstinence (>10 pack-years) had a significant OS and HNSCC-specific survival benefit.
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Affiliation(s)
- John J W Lee
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Vijay Kunaratnam
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Christina J H Kim
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Martha Pienkowski
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hueniken
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Head and Neck Surgery, University College London Hospitals, London, UK
| | - Andrew C L Lam
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel C Davies
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Catherine M Brown
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - John R De Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - John N Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Rayjean J Hung
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Department of Biostatistics, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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9
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Zech HB, Betz CS, Hoffmann TK, Klussmann JP, Deitmer T, Guntinas-Lichius O. [Radiation or Surgery for HPV-positive oropharyngeal cancer? The ORATOR2 Trial - Comparing apples and oranges]. Laryngorhinootologie 2023; 102:169-176. [PMID: 36858059 DOI: 10.1055/a-2014-5733] [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: 03/03/2023]
Abstract
ORATOR2 was a randomized phase II trial aiming to assess an optimal approach for therapy de-escalation in early (T1-T2, N0-N2) human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCC). Radiotherapy (RT) (consisting of a reduced dose of 60 Gy with concurrent weekly cisplatin in N+ patients) was compared to trans-oral surgery (TOS) and neck dissection (ND) (with adjuvant reduced-dose RT depending on pathologic findings) in 61 patients. The primary endpoint, overall survival, favored the radiotherapy approach. This was mainly due to 3 mortality events in the surgery arm (2 surgery-related) which resulted in an early trial termination. The authors, who speak on behalf of the German Society of Otorhinolaryngology, Head & Neck Surgery (working group for oncology) warn to draw conclusions for clinical practice pointing out the main shortages/weaknesses of this trial especially in the surgery arm (at least 1 cm margins, recommending re-operation if not achieved, prohibition of regional or free flaps, high rates of tracheotomy, low rate of TLM). Small patient numbers, a highly selected patient cohort and a short follow-up time further limit this study's relevance. Therefore, patients with HPV-related OPSCC should not receive de-escalating (radiation) therapy outside of clinical trials. When deciding between a surgical or a radio-therapeutical approach, patients should be informed about the pros and cons of both modalities after interdisciplinary consent in a tumor board, as long as clinical trial results` (e. g. EORTC 1420) are pending.
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Affiliation(s)
- H B Zech
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
- Mildred-Scheel Cancer Career Center HaTriCS4
| | - C S Betz
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - T K Hoffmann
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - J P Klussmann
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Medizinische Fakultät, Universität zu Köln
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V
| | - O Guntinas-Lichius
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena
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10
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Polverini PJ, Nör F, Nör JE. Crosstalk between cancer stem cells and the tumor microenvironment drives progression of premalignant oral epithelium. FRONTIERS IN ORAL HEALTH 2023; 3:1095842. [PMID: 36704239 PMCID: PMC9872128 DOI: 10.3389/froh.2022.1095842] [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: 11/11/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Cancer stem cells (CSC) are a subpopulation of cancer cells that exhibit properties of self-renewal and differentiation and have been implicated in metastasis and treatment failures. There is mounting evidence that carcinogen-initiated mucosal epithelial stem cells acquire the CSC phenotype following exposure to environmental or infectious mutagens and are responsible for promoting the malignant transformation of premalignant (dysplastic) epithelium. CSC further contribute to the progression of dysplasia by activating signaling pathways through crosstalk with various cell populations in the tumor microenvironment. Two cell types, tumor-associated macrophages (TAM) and vascular endothelial cells (EC) nurture CSC development, support CSC stemness, and contribute to tumor progression. Despite mounting evidence implicating CSC in the initiation and progression of dysplastic oral epithelium to squamous cell carcinoma (SCC), the molecular mechanisms underlying these synergistic biological processes remain unclear. This review will examine the mechanisms that underlie the transformation of normal epithelial stem cells into CSC and the mechanistic link between CSC, TAM, and EC in the growth and the malignant conversation of dysplastic oral epithelium.
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Affiliation(s)
- Peter J. Polverini
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States,Correspondence: Peter J. Polverini
| | - Felipe Nör
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Jacques E. Nör
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
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11
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Dougherty EL, Corliss HL, Kritz-Silverstein D, Strong DR, Crespo NC, Finlayson TL. Relationship Between Sexual Orientation and Human Papillomavirus-Related Oral Cancer Knowledge and Awareness. LGBT Health 2023; 10:41-50. [PMID: 35917560 DOI: 10.1089/lgbt.2021.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose: Human papillomavirus (HPV)-related oral cancers are increasing, and lesbian, gay, bisexual, and other people with a minority sexual orientation may be disproportionately impacted. This study examined the relationship between sexual orientation and HPV-related oral cancer knowledge. Methods: Data from 10,859 adult participants in the 2017-2019 Health Information National Trends Survey 5, cycles 1-3, were obtained. The three data sets were merged, and weighted multiple imputation (n = 15) was applied to address missingness. Weighted logistic regression analyses examined differences in HPV-related oral cancer knowledge between sexual minority versus heterosexual participants by sex, after adjustment for race, ethnicity, age, education, income, insurance, regular medical provider, and smoking status. Results: In this weighted sample, age ranged from 18 to 101 years (mean = 56.3 years); 42% were males, 5.2% were sexual minority men/women, and 94.8% were heterosexual/straight. Overall, only 19% of respondents were aware that HPV can cause oral cancer. After controlling for sociodemographic factors, there were no significant differences in HPV-related oral cancer knowledge for sexual minority men (adjusted odds ratio [AOR]: 1.10; 95% confidence interval [95% CI]: 0.86-1.42) or women (AOR: 0.98; 95% CI: 0.76-1.26) compared with those who were heterosexual/straight. Conclusion: Overall, knowledge of HPV-related oral cancer was low, regardless of sexual orientation. There were no differences in HPV-related oral cancer knowledge between sexual minority men and women compared with their heterosexual counterparts. Educational programs are needed to increase awareness of the HPV/oral cancer link. Further research on differences in HPV-related oral cancer knowledge and attitudes by sexual orientation and the intersection of other demographic factors is warranted.
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Affiliation(s)
- Erin L Dougherty
- School of Public Health, San Diego State University, San Diego, California, USA.,Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Heather L Corliss
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Donna Kritz-Silverstein
- Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, California, USA.,Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Noe C Crespo
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Tracy L Finlayson
- School of Public Health, San Diego State University, San Diego, California, USA
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12
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Predictive Value of 18F-Fluorodeoxyglucose Positron-Emission Tomography Metabolic and Volumetric Parameters for Systemic Metastasis in Tonsillar Cancer. Cancers (Basel) 2022; 14:cancers14246242. [PMID: 36551727 PMCID: PMC9777518 DOI: 10.3390/cancers14246242] [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: 11/21/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Although the prognosis of tonsillar cancer (human papillomavirus-positive oropharyngeal squamous cell carcinoma) is improving, disease control failure (distant metastasis) still occurs in some cases. We explored whether several 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) parameters can predict metastasis. We retrospectively reviewed the medical records of 55 patients with tonsil squamous cell carcinoma who underwent pretreatment 18F-FDG positron-emission tomography/computed tomography (PET/CT) followed by primary surgery. During the follow-up period, systemic metastases were found in 7 of the 55 patients. The most common sites were the lungs (33%), bone (22%), brain/skull base (22%), small bowel (11%), and liver (11%). Pathologically, P53 mutation was less common in patients with systemic metastasis (41.7% vs. 14.3%, p = 0.054) than without systemic metastasis. In terms of PET parameters, the metabolic tumor volume (MTV2.5) and total lesion glycolysis (TLG2.5) values were lower in the primary tumor, and higher in the metastatic lymph nodes, of human papillomavirus (HPV)-positive compared to HPV-negative patients (all p < 0.05). The MTV2.5, TLG2.5, and tumor−to−liver uptake ratio were 36.07 ± 54.24 cm3, 183.46 ± 298.62, and 4.90 ± 2.77, respectively, in the systemic metastasis group, respectively; all of these values were higher than those of the patients without systemic metastasis (all p < 0.05). The MTV2.5 value was significantly different between the groups even when the values for the primary tumor and metastatic lymph nodes were summed (53.53 ± 57.78 cm3, p = 0.036). The cut-off value, area under the curve (95% confidence interval), sensitivity, and specificity of MTV2.5 for predicting systemic metastasis were 11.250 cm3, 0.584 (0.036−0.832), 0.571, and 0.565, respectively. The MTV2.5 of metastatic lymph nodes and summed MTV2.5 values of the primary tumor and metastatic lymph nodes were significantly higher in tonsillar cancer patients with than without systemic metastases. We suggest PET/CT scanning for pre-treatment cancer work-up and post-treatment surveillance to consider additional systemic therapy in patients with a high risk of disease control failure.
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Lai YH, Su CC, Wu SY, Hsueh WT, Wu YH, Chen HHW, Hsiao JR, Liu CH, Tsai YS. Impact of Alcohol and Smoking on Outcomes of HPV-Related Oropharyngeal Cancer. J Clin Med 2022; 11:6510. [PMID: 36362736 PMCID: PMC9655073 DOI: 10.3390/jcm11216510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate the impact of adverse lifestyle factors on outcomes in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). METHODS From 2010 to 2019, 150 consecutive non-metastatic OPSCC patients receiving curative treatment in our institution were retrospectively enrolled. HPV positivity was defined as p16 expression ≥75%. The effects of adverse lifestyle factors on overall survival (OS) and disease-free survival (DFS) on OPSCC patients were determined. RESULTS The median follow-up duration was 3.6 years. Of the 150 OPSCCs, 51 (34%) patients were HPV-positive and 99 (66%) were HPV-negative. The adverse lifestyle exposure rates were 74.7% (n = 112) alcohol use, 57.3% (n = 86) betel grid chewing, and 78% (n = 117) cigarette smoking. Alcohol use strongly interacted with HPV positivity (HR, 6.00; 95% CI, 1.03-35.01), leading to an average 26.1% increased risk of disease relapse in patients with HPV-positive OPSCC. Heavy smoking age ≥30 pack-years was associated with increased risk of death (HR, 2.05; 95% CI, 1.05-4.00) and disease relapse (HR, 1.99; 95% CI, 1.06-3.75) in OPSCC patients. In stratified analyses, the 3-year absolute risk of disease relapse in HPV-positive OPSCC patients reached up to 50% when alcohol use and heavy smoking for ≥30 pack-years were combined. CONCLUSIONS Alcohol acted as a significant treatment-effect modifier for DFS in HPV-positive OPSCC patients, diluting the favorable prognostic effect of HPV positivity. Heavy smoking age ≥30 pack-years was an independent adverse prognostic factor of OS and DFS in OPSCC patients. De-intensification treatment for HPV-related OPSCC may be avoided when these adverse lifestyle factors are present.
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Affiliation(s)
- Yu-Hsuan Lai
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Clinical Innovation and Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
| | - Chien-Chou Su
- Clinical Innovation and Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Shang-Yin Wu
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
| | - Wei-Ting Hsueh
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Yuan-Hua Wu
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Helen H. W. Chen
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Ching-Hsun Liu
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Yi-Shan Tsai
- Clinical Innovation and Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
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Krutz M, Acharya P, Chissoe G, Raj V, Driskill L, Krempl G, Zhao D, Mhawej R, Queimado L. Tobacco cessation after head and neck cancer diagnosis is an independent predictor of treatment response and long-term survival. Oral Oncol 2022; 134:106072. [PMID: 35995005 PMCID: PMC10427030 DOI: 10.1016/j.oraloncology.2022.106072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 10/31/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) patients who are current smokers when diagnosed have inferior clinical outcomes compared to never-smokers or previous smokers. However, the impact of quitting after HNSCC diagnosis has not been quantified. In this retrospective, case-control study (n = 134), the odds of complete response to first-line therapy were 3.7 times higher among smokers at diagnosis who quit before treatment initiation (quitters; n = 55) than among those continuing to smoke (p = 0.03). Disease-free survival was also higher among quitters (aHR, 0.33; 95 % CI, 0.12-0.90; p = 0.029). Quitters were 67 % less likely to die of all causes than active smokers (aHR, 0.33; 95 % CI, 0.15-0.71; p = 0.004). These data show for the first time that, smoking cessation after HNSCC diagnosis is predictive of higher therapy efficacy and long-term survival.
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Affiliation(s)
- Matthew Krutz
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Pawan Acharya
- Department of Biostatistics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Geraldine Chissoe
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Vijay Raj
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lane Driskill
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Greg Krempl
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Daniel Zhao
- Department of Biostatistics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rachad Mhawej
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Lurdes Queimado
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Cell Biology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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15
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Arif RT, Mogaddam MA, Merdad LA, Farsi NJ. Does human papillomavirus modify the risk of oropharyngeal cancer related to smoking and alcohol drinking? A systematic review and meta‐analysis. Laryngoscope Investig Otolaryngol 2022; 7:1391-1401. [PMID: 36258880 PMCID: PMC9575072 DOI: 10.1002/lio2.877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/09/2022] Open
Abstract
Objective To synthesize evidence for interactions of traditional oropharyngeal squamous cell carcinoma (OPSCC) risk factors—tobacco smoking and alcohol drinking—with human papillomavirus (HPV). Data Sources MEDLINE, Embase, Cochrane Database of Systematic Reviews, ProQuest, and Global Health were searched with no restrictions on language or publication date. Methods All case–control studies assessing interactions between these factors in OPSCC were considered. Quality was assessed using the Newcastle‐Ottawa Scale for case–control studies. The main outcome was the OR for developing OPSCC for the following interactions: (1) HPV and smoking, (2) HPV and alcohol drinking, and (3) HPV, alcohol drinking, and smoking. Interactions were assessed from stratified analysis (by HPV status) and/or joint effect analysis (synergy index and multiplicative index). Results The search provided 3084 relevant studies, of which 9 were included. In the stratified analysis, the OR of developing OPSCC among smokers with HPV was less than that among smokers without HPV. A similar pattern was observed for alcohol drinking. This effect persisted among smokers and heavy alcohol drinkers with HPV compared with those without HPV. Joint effect analysis on the additive scale showed sub‐additive antagonistic interactions between HPV and smoking, and between HPV and alcohol. On the multiplicative scale, sub‐multiplicative interactions were found between HPV and smoking, and HPV and alcohol. Conclusions This meta‐analysis suggests a negative directed interaction of HPV and smoking; and HPV and heavy alcohol drinking in the development of primary OPSCC on stratified analysis and joint effect analysis. Level of Evidence 3A.
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Affiliation(s)
- Rawan T. Arif
- Department of Otolaryngology–Head and Neck Surgery McGill University Montreal Canada
- Department of Otolaryngology–Head and Neck Surgery King Abdulaziz University Jeddah Saudi Arabia
| | - Meaad A. Mogaddam
- Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine Boston Massachusetts USA
| | - Leena A. Merdad
- Department of Dental Public Health, Faculty of Dentistry King Abdulaziz University Jeddah Saudi Arabia
| | - Nada J. Farsi
- Department of Dental Public Health, Faculty of Dentistry King Abdulaziz University Jeddah Saudi Arabia
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McKeon MG, Gallant JN, Kim YJ, Das SR. It Takes Two to Tango: A Review of Oncogenic Virus and Host Microbiome Associated Inflammation in Head and Neck Cancer. Cancers (Basel) 2022; 14:cancers14133120. [PMID: 35804891 PMCID: PMC9265087 DOI: 10.3390/cancers14133120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/04/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Certain viruses, specifically, human papillomavirus (HPV) and Epstein–Barr virus (EBV), have been linked with the development of head and neck cancer. In this study, we review the mechanisms by which (these) viruses lead to cellular transformation and a chronic inflammatory state. Given that the head and neck host a rich microbiome (which itself is intrinsically linked to inflammation), we scrutinize the literature to highlight the interplay between viruses, cellular transformation, inflammation, and the local host microbiome in head and neck cancer. Abstract While the two primary risk factors for head and neck squamous cell carcinoma (HNSCC) are alcohol and tobacco, viruses account for an important and significant upward trend in HNSCC incidence. Human papillomavirus (HPV) is the causative agent for a subset of oropharyngeal squamous cell carcinoma (OPSCC)—a cancer that is impacting a rapidly growing group of typically middle-aged non-smoking white males. While HPV is a ubiquitously present (with about 1% of the population having high-risk oral HPV infection at any one time), less than 1% of those infected with high-risk strains develop OPSCC—suggesting that additional cofactors or coinfections may be required. Epstein–Barr virus (EBV) is a similarly ubiquitous virus that is strongly linked to nasopharyngeal carcinoma (NPC). Both of these viruses cause cellular transformation and chronic inflammation. While dysbiosis of the human microbiome has been associated with similar chronic inflammation and the pathogenesis of mucosal diseases (including OPSCC and NPC), a significant knowledge gap remains in understanding the role of bacterial-viral interactions in the initiation, development, and progression of head and neck cancers. In this review, we utilize the known associations of HPV with OPSCC and EBV with NPC to investigate these interactions. We thoroughly review the literature and highlight how perturbations of the pharyngeal microbiome may impact host-microbiome-tumor-viral interactions—leading to tumor growth.
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Affiliation(s)
- Mallory G. McKeon
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, Suite A2200, Nashville, TN 37232, USA;
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.-N.G.); (Y.J.K.)
| | - Jean-Nicolas Gallant
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.-N.G.); (Y.J.K.)
| | - Young J. Kim
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (J.-N.G.); (Y.J.K.)
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Suman R. Das
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North, Suite A2200, Nashville, TN 37232, USA;
- Correspondence: ; Tel.: +1-(615)-322-0322; Fax: +1-(615)-343-6160
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Wahle BM, Zolkind P, Ramirez RJ, Skidmore ZL, Anderson SR, Mazul A, Hayes DN, Sandulache VC, Thorstad WL, Adkins D, Griffith OL, Griffith M, Zevallos JP. Integrative genomic analysis reveals low T-cell infiltration as the primary feature of tobacco use in HPV-positive oropharyngeal cancer. iScience 2022; 25:104216. [PMID: 35494251 PMCID: PMC9044176 DOI: 10.1016/j.isci.2022.104216] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/20/2021] [Accepted: 04/05/2022] [Indexed: 11/15/2022] Open
Abstract
Although tobacco use is an independent adverse prognostic feature in HPV(+) oropharyngeal squamous cell carcinoma (OPSCC), the biologic features associated with tobacco use have not been systematically investigated. We characterized genomic and immunologic features associated with tobacco use through whole exome sequencing, mRNA hybridization, and immunohistochemical staining in 47 HPV(+) OPSCC tumors. Low expression of transcripts in a T cell-inflamed gene expression profile (TGEP) was associated with tobacco use at diagnosis and lower overall and disease-free survival. Tobacco use was associated with an increased proportion of T > C substitutions and a lower proportion of expected mutational signatures, but not with increases in mutational burden or recurrent oncogenic mutations. Our findings suggest that rather than increased mutational burden, tobacco's primary and clinically relevant association in HPV(+) OPSCC is immunosuppression of the tumor immune microenvironment. Quantitative assays of T cell infiltration merit further study as prognostic markers in HPV(+) OPSCC.
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Affiliation(s)
- Benjamin M. Wahle
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Paul Zolkind
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Ricardo J. Ramirez
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Zachary L. Skidmore
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Sydney R. Anderson
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Angela Mazul
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - D. Neil Hayes
- Department of Medicine, Division of Hematology-Oncology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Vlad C. Sandulache
- Bobby R. Alford Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, TX 77030, USA
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030
| | - Wade L. Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO 63108, USA
| | - Douglas Adkins
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - Obi L. Griffith
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO 63108, USA
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Malachi Griffith
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO 63108, USA
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO 63110 USA
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri
| | - Jose P. Zevallos
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, 660 South Euclid Avenue, St. Louis, MO 63110, USA
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Itami J, Kobayashi K, Mori T, Honma Y, Kubo Y, Murakami N, Omura G, Okuma K, Inaba K, Takahashi K, Kashihara T, Shimizu Y, Takahashi A, Nakayama Y, Matsumoto F, Yoshimoto S, Igaki H. Non-Robustness of Ang’s Risk Classification in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma in Japanese Patients. Cancers (Basel) 2022; 14:cancers14102442. [PMID: 35626047 PMCID: PMC9139843 DOI: 10.3390/cancers14102442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Validity of the risk classification by Ang for human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) remains to be studied in the patients treated by modalities other than chemoradiotherapy and in Japanese patients. Materials and Methods: Between 2010 and 2018, 122 patients with HPV-related OPSCC in stages III and IV by the TNM classification 7th edition (TNM-7) were treated curatively at a single institution in Japan. The median age was 62.7 years. Over 50% of the patients underwent surgery with or without adjuvant therapy. The influence of multiple factors on survival was analyzed. Results: The amount of smoking dichotomized at 10 pack-year, which was used in Ang’s risk classification, was not predictive of prognosis, and Ang’s risk classification was not significantly influential on prognosis in multivariate analysis. In the patients treated with definitive radiation therapy, Ang’s risk classification was not predictive of the prognosis in univariate analysis. The impact of smoking was significant only in the patients undergoing the definitive operation. Conclusions: Ang’s risk classification was not robust in predicting the prognosis of general Japanese HPV-related OPSCC patients. The amount of smoking might have different prognostic influences depending on the therapeutic method.
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Affiliation(s)
- Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (N.M.); (K.O.); (K.I.); (K.T.); (T.K.); (Y.S.); (A.T.); (Y.N.); (H.I.)
- Shin-Matsudo Accuracy Radiation Therapy Center, Shin-Matsudo Central General Hospital, Chiba 270-0034, Japan
- Correspondence: ; Tel.: +81-47-345-1111
| | - Kenya Kobayashi
- Department of Head and Neck Surgical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (K.K.); (G.O.); (F.M.); (S.Y.)
| | - Taisuke Mori
- Department of Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan;
| | - Yoshitaka Honma
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan;
| | - Yuko Kubo
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan;
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (N.M.); (K.O.); (K.I.); (K.T.); (T.K.); (Y.S.); (A.T.); (Y.N.); (H.I.)
| | - Go Omura
- Department of Head and Neck Surgical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (K.K.); (G.O.); (F.M.); (S.Y.)
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (N.M.); (K.O.); (K.I.); (K.T.); (T.K.); (Y.S.); (A.T.); (Y.N.); (H.I.)
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (N.M.); (K.O.); (K.I.); (K.T.); (T.K.); (Y.S.); (A.T.); (Y.N.); (H.I.)
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (N.M.); (K.O.); (K.I.); (K.T.); (T.K.); (Y.S.); (A.T.); (Y.N.); (H.I.)
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (N.M.); (K.O.); (K.I.); (K.T.); (T.K.); (Y.S.); (A.T.); (Y.N.); (H.I.)
| | - Yuri Shimizu
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (N.M.); (K.O.); (K.I.); (K.T.); (T.K.); (Y.S.); (A.T.); (Y.N.); (H.I.)
| | - Ayaka Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (N.M.); (K.O.); (K.I.); (K.T.); (T.K.); (Y.S.); (A.T.); (Y.N.); (H.I.)
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (N.M.); (K.O.); (K.I.); (K.T.); (T.K.); (Y.S.); (A.T.); (Y.N.); (H.I.)
| | - Fumihiko Matsumoto
- Department of Head and Neck Surgical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (K.K.); (G.O.); (F.M.); (S.Y.)
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (K.K.); (G.O.); (F.M.); (S.Y.)
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan; (N.M.); (K.O.); (K.I.); (K.T.); (T.K.); (Y.S.); (A.T.); (Y.N.); (H.I.)
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Muller RG, Weidenbecher M, Ludlow D. PET/CT versus triple endoscopy in initial workup of HPV+ oropharyngeal squamous cell carcinoma. Head Neck 2022; 44:1164-1171. [PMID: 35212072 DOI: 10.1002/hed.27016] [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: 08/11/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Synchronous primary tumors (SPTs) are detected via triple endoscopy or positron emission tomography/computed tomography (PET/CT). Patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) lack risk factors for SPTs. METHODS We performed a single institution retrospective review of the efficacy of triple endoscopy and PET/CT in HPV+ OPSCC patients. RESULTS Sixty-five HPV+ OPSCC patients underwent triple endoscopy and PET/CT. Patients were white (n = 48, 72.7%), male (n = 53, 81.5%), mean 58.7 ± 8.1 years old. SPT was detected in 1 (1.5%) patient via PET/CT. No SPTs were detected on triple endoscopy. PET/CT had 100% and 95.3% sensitivity and specificity, respectively. PET/CT positive predictive value (PPV) and negative predictive value (NPV) were 25.0% and 100%, respectively. Triple endoscopy specificity and NPV was 90.2% and 93.2%, respectively. CONCLUSIONS PET/CT is superior to triple endoscopy in ruling out SPTs. With negative PET/CT, only direct laryngoscopy with biopsy may be necessary.
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Affiliation(s)
- Richard Grant Muller
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mark Weidenbecher
- Department of Otolaryngology-Head and Neck Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - David Ludlow
- Department of Otolaryngology-Head and Neck Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
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Oliveira AC, Cavalcanti de Lima IC, Frez Marques VM, Alves de Araújo WH, De Campos Ferreira C. Human papillomavirus prevalence in oral and oropharyngeal squamous cell carcinoma in South America. Oncol Rev 2022; 16:552. [PMID: 35432780 PMCID: PMC9012143 DOI: 10.4081/oncol.2022.552] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
Some studies have addressed the prevalence of human papillomavirus (HPV) in head and neck cancer in South America; however, no studies have systematically gathered prevalence and conducted a meta-analysis. This study aims to estimate the prevalence of HPV in oral and oropharyngeal squamous cell carcinomas in South America. We performed a systematic review and metaanalysis using the following databases: PubMed, Embase, Lilacs, Medline, Scopus, and Web of Science. Data were extracted and analyzed using random-effects models to estimate the pooled prevalence of HPV. We identified 209 nonduplicated studies, of which 38 were selected. The overall prevalence of HPV was 24.31% (95% CI 16.87–32.64; I2 = 96%, pheterogeneity <0.001). HPV prevalence in oropharyngeal cancer was 17.9% (95% CI 7.6–31.4; I2 = 96%, pheterogeneity <0.001) and that in oral cavity cancer was 23.19% (95% CI 14.94–32.63; I2 = 94%, pheterogeneity <0.001). We found an overall prevalence of HPV in 24.31% of oral and oropharyngeal squamous cell carcinomas in South American patients. The prevalence of HPV was 17.9% for oropharyngeal cancer and 23.19% for oral cavity cancer.
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22
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HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management. Nat Rev Clin Oncol 2022; 19:306-327. [PMID: 35105976 PMCID: PMC8805140 DOI: 10.1038/s41571-022-00603-7] [Citation(s) in RCA: 272] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/13/2022]
Abstract
Human papillomavirus (HPV)-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) has one of the most rapidly increasing incidences of any cancer in high-income countries. The most recent (8th) edition of the UICC/AJCC staging system separates HPV+ OPSCC from its HPV-negative (HPV−) 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 de-intensification as a means to improve quality of life while maintaining acceptable survival outcomes. In addition, 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 owing to a lack of symptoms in the early stages; therefore, a need exists to identify and validate possible diagnostic biomarkers to aid in earlier detection. In this Review, we provide a summary of the epidemiology, molecular biology and clinical management of HPV+ OPSCC in an effort to highlight important advances in the field. Ultimately, a need exists for improved understanding of the molecular basis and clinical course of this disease to guide efforts towards early detection and precision care, and to improve patient outcomes. The incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is increasing rapidly in most developed countries. In this Review, the authors provide an overview of the epidemiology, molecular biology and treatment of HPV-positive OPSCC, including discussions of the role of treatment de-escalation and emerging novel therapies. The incidence of human papillomavirus-associated oropharyngeal cancer (HPV+ OPSCC) is expected to continue to rise over the coming decades until the benefits of gender-neutral prophylactic HPV vaccination begin to become manifest. The incidence of HPV+ OPSCC appears to be highest in high-income countries, although more epidemiological data are needed from low- and middle-income countries, in which HPV vaccination coverage remains low. The substantially better prognosis of patients with HPV+ OPSCC compared to those with HPV– OPSCC has been recognized in the American Joint Committee on Cancer TNM8 staging guidelines, which recommend stratification by HPV status to improve staging. The molecular biology and genomic features of HPV+ OPSCC are similar to those of other HPV-associated malignancies, with HPV oncogenes (E6 and E7) acting as key drivers of pathogenesis. Treatment de-intensification is being pursued in clinical trials, although identifying the ~15% of patients with HPV+ OPSCC who have recurrent disease, and who therefore require more intensive treatment, remains a key challenge.
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23
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Patient derived ex vivo tissue slice cultures demonstrate a profound DNA double-strand break repair defect in HPV-positive oropharyngeal head and neck cancer. Radiother Oncol 2022; 168:138-146. [DOI: 10.1016/j.radonc.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 12/11/2022]
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24
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Alotaibi M, Valova V, HÄnsel T, Stromberger C, Kofla G, Olze H, Piwonski I, Albers A, Ochsenreither S, Coordes A. Impact of Smoking on the Survival of Patients With High-risk HPV-positive HNSCC: A Meta-analysis. In Vivo 2021; 35:1017-1026. [PMID: 33622897 DOI: 10.21873/invivo.12345] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM High risk Human papillomavirus (hr-HPV) and smoking are independant risk factors for head and neck squamous cell carcinomas (HNSCC). While hr-HPV+ HNSCC has a better prognosis than smoking-associated HNSCC no systematic data are yet available about the combined risk. PATIENTS AND METHODS We performed a meta-analysis to assess the overall survival of HNSCC patients relative to the hr-HPV and smoking status. A literature review up to November 2019 was conducted in PubMed and Cochrane Library using the search terms 'HPV, Smoking and HNSCC'. RESULTS Nine out of 748 articles were included, 1,436 out of 2,080 patients were hr-HPV+ The prevalence of hr-HPV+ smokers was 36%. The meta-analysis showed a significantly better 5-year overall survival for HPV+ non-smokers compared to smokers with risk ratio of 1.94 (95% confidence intervaI=1.46-2.58). CONCLUSION Smoking is a negative prognostic factor for overall survival in patients with hr-HPV+ HNSCC and should thus be an important part of staging and treatment.
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Affiliation(s)
- Moonef Alotaibi
- Department of Otorhinolaryngology, Head and Neck Surgery (CVK and CCM), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,King Fahad Medical City, Department of Otorhinolaryngology, Head and Neck Surgery, Riyadh, Kingdom of Saudi Arabia
| | - Valeria Valova
- Department of Otorhinolaryngology, Head and Neck Surgery (CVK and CCM), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Toni HÄnsel
- Department of Otorhinolaryngology, Head and Neck Surgery (CVK and CCM), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carmen Stromberger
- Department of Radiooncology (CVK), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Grzegorz Kofla
- Department of Oncology (CVK), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery (CVK and CCM), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Iris Piwonski
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Albers
- Department of Otorhinolaryngology (CBF), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Ochsenreither
- Department of Oncology (CBF), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Charité Comprehensive Cancer Center, Berlin, Germany
| | - Annekatrin Coordes
- Department of Otorhinolaryngology, Head and Neck Surgery (CVK and CCM), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany;
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25
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Ferris RL, Spanos WC, Leidner R, Gonçalves A, Martens UM, Kyi C, Sharfman W, Chung CH, Devriese LA, Gauthier H, Chiosea SI, Vujanovic L, Taube JM, Stein JE, Li J, Li B, Chen T, Barrows A, Topalian SL. Neoadjuvant nivolumab for patients with resectable HPV-positive and HPV-negative squamous cell carcinomas of the head and neck in the CheckMate 358 trial. J Immunother Cancer 2021; 9:jitc-2021-002568. [PMID: 34083421 PMCID: PMC8183204 DOI: 10.1136/jitc-2021-002568] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Head and neck squamous cell carcinomas (HNSCCs) are common malignancies caused by carcinogens, including tobacco and alcohol, or infection with human papillomavirus (HPV). Immune checkpoint inhibitors targeting the programmed cell death 1 (PD-1) pathway are effective against unresectable recurrent/metastatic HNSCC. Here, we explored the safety and efficacy of anti-PD-1 therapy in at-risk resectable HPV-positive and HPV-negative HNSCC in the neoadjuvant setting. METHODS The phase I/II CheckMate 358 trial in virus-associated cancers assessed neoadjuvant nivolumab in patients with previously untreated, resectable HPV-positive or HPV-negative HNSCC. Patients received nivolumab 240 mg intravenously on days 1 and 15, with surgery planned by day 29. Safety/tolerability (primary endpoint) was assessed by monitoring adverse events (AEs) and surgical delays. Radiographic response was measured before surgery using RECIST v1.1, adapted for a single post-nivolumab evaluation. Pathologic specimens were examined for treatment response using immune-based criteria. RESULTS From November 2015 to December 2017, 52 patients with AJCC (seventh edition) stage III-IV resectable HNSCC received neoadjuvant nivolumab (26 HPV-positive, 26 HPV-negative). Any-grade treatment-related AEs (TRAEs) occurred in 19 patients (73.1%) and 14 patients (53.8%) in the HPV-positive and HPV-negative cohorts, respectively; grade 3-4 TRAEs occurred in five (19.2%) and three patients (11.5%), respectively. No patient had a protocol-defined TRAE-related surgical delay (>4 weeks). Thirty-eight patients were reported as undergoing complete surgical resection, 10 had a planned post-nivolumab biopsy instead of definitive surgery due to a protocol misinterpretation, and four did not undergo surgery or biopsy, including two with tumor progression. Radiographic response rates in 49 evaluable patients were 12.0% and 8.3% in the HPV-positive and HPV-negative cohorts, respectively. There were no complete pathologic responses by site or central review in operated patients. Among 17 centrally evaluable HPV-positive tumors, one (5.9%) achieved major pathological response and three (17.6%) achieved partial pathologic response (pPR); among 17 centrally evaluable HPV-negative tumors, one (5.9%) achieved pPR. CONCLUSIONS Neoadjuvant nivolumab was generally safe and induced pathologic regressions in HPV-positive (23.5%) and HPV-negative (5.9%) tumors. Combinatorial neoadjuvant treatment regimens, and continued postoperative therapy for high-risk tumors, are warranted in future trials to enhance the efficacy of this approach. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02488759; https://clinicaltrials.gov/ct2/show/NCT02488759.
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Affiliation(s)
| | - William C Spanos
- Sanford Cancer Center, Sanford Health, Sioux Falls, South Dakota, USA
| | - Rom Leidner
- Providence Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Chrisann Kyi
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Sharfman
- Johns Hopkins Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Lot A Devriese
- Department of Medical Oncology, University Medical Center Utrecht, Cancer Center, Utrecht, The Netherlands
| | - Helene Gauthier
- Department of Medical Oncology, Université de Paris, Saint Louis Hospital, Paris, France
| | | | | | - Janis M Taube
- Johns Hopkins Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Julie E Stein
- Johns Hopkins Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Jun Li
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Bin Li
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Tian Chen
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Adam Barrows
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Suzanne L Topalian
- Johns Hopkins Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
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26
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Horwich P, Gundale A, Patin S, Flores J, Moore Medlin T, Chang BA, Nathan CAO. Impact of smoking on stage-specific survival in human papilloma virus-associated oropharyngeal squamous cell carcinoma. Head Neck 2021; 43:2698-2704. [PMID: 34002904 DOI: 10.1002/hed.26745] [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] [Received: 08/16/2020] [Revised: 04/25/2021] [Accepted: 05/04/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The American Joint Committee on Cancer (AJCC) released a new staging system for human papilloma virus (HPV) positive oropharyngeal cancer (OPC) in their eighth edition. The role of smoking in HPV positive oropharyngeal cancer remains controversial and is not factored into the updated staging system. METHODS Single institutional, retrospective chart review of patients with HPV positive OPC from 2009 to 2017 was completed. Dichotomized smoking data were collected into 0-9 and ≥10 pack-year histories. Kaplan-Meier survival curves compared overall survival (OS) for smokers and nonsmokers. RESULTS Five-year OS was not statistically different in stage I or stage II HPV positive OPC comparing nonsmokers versus smokers, but worse in stage III smokers (38% vs. 76%, p < 0.05). CONCLUSION Greater than 10 pack-year smoking status may negatively affect survival in late stage HPV positive OPC but not in early stage disease. HPV positive smokers may require additional risk stratification.
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Affiliation(s)
- Peter Horwich
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center & Feist-Weiller Cancer Center, Shreveport, Louisiana, USA
| | - Abhijit Gundale
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center & Feist-Weiller Cancer Center, Shreveport, Louisiana, USA
| | - Stephen Patin
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center & Feist-Weiller Cancer Center, Shreveport, Louisiana, USA
| | - Jose Flores
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tara Moore Medlin
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center & Feist-Weiller Cancer Center, Shreveport, Louisiana, USA
| | - Brent A Chang
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center & Feist-Weiller Cancer Center, Shreveport, Louisiana, USA
| | - Cherie-Ann O Nathan
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center & Feist-Weiller Cancer Center, Shreveport, Louisiana, USA
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27
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Ryan WR, Xu MJ, Ochoa E, Plonowska-Hirschfeld KA, Zebolsky AL, Ha PK, Bewley AF, Mallen-St Clair J, Joshi AS, Coffey CS, Faraji F, MacDonald BV, Houlton JJ, Gobillot TA, Curry JM, Philips R, Hackman TG, Richmon JD, Holcomb AJ, Coughlin AM, Panwar A, Smith RB, Herberg ME, Fakhry C, Cognetti DM. Oncologic outcomes of human papillomavirus-associated oropharynx carcinoma treated with surgery alone: A 12-institution study of 344 patients. Cancer 2021; 127:3092-3106. [PMID: 33957701 DOI: 10.1002/cncr.33611] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The oncologic outcomes of surgery alone for patients with American Joint Committee on Cancer 7th edition (AJCC 7th) pN2a and pN2b human papillomavirus-associated oropharynx squamous cell carcinoma (HPV+OPSCC) are not clear. METHODS The authors performed a 12-institution retrospective study of 344 consecutive patients with HPV+OPSCC (AJCC 7th pT0-3 N3 M0) treated with surgery alone with 6 months or more of follow-up using univariate and multivariate analyses. RESULTS The 2-year outcomes for the entire cohort were 91% (182 of 200) disease-free survival (DFS), 100% (200 of 200) disease-specific survival (DSS), and 98% (200 of 204) overall survival (OS). The 18 recurrences within 2 years were 88.9% (16 of 18) local and/or regional recurrences and 11.1% (2 of 18) distant metastases. Recurrences were not significantly associated with smoking, pT stage, or pN stage. The 16 patients with locoregional recurrences within 2 years all underwent successful salvage treatments (median follow-up after salvage: 13.1 months), 43.8% (7 of 16) of whom underwent salvage surgery alone for a 2-year overall salvage radiation need of 4.5% (9 of 200). The 2-year outcomes for the 59 evaluable patients among the 109 AJCC 7th pT0-2 N2a-N2b patients with 1 to 3 pathologic lymph nodes (LNs) were as follows: local recurrence, 3.4% (2 of 59); regional recurrence, 8.4% (5 of 59); distant metastases, 0%; DFS, 88.1% (52 of 59); DSS, 100% (59 of 59); OS, 96.7% (59 of 61); and salvage radiation, 5.1% (3 of 59). CONCLUSIONS With careful selection, surgery alone for AJCC 7th pT0-T2N0-N2b HPV+OPSCC with zero to 3 pathologic LNs without perineural invasion, extranodal extension, or positive margins results in high DFS, DSS, OS, and salvage treatment success. Because of the short-term follow-up, these data support further investigation of treatment de-escalation in this population.
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Affiliation(s)
- William R Ryan
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Mary J Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Edgar Ochoa
- School of Medicine, University of California San Francisco, San Francisco, California
| | | | - Aaron L Zebolsky
- Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, Michigan
| | - Patrick K Ha
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Arnaud F Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, California
| | | | - Arjun S Joshi
- Division of Head and Neck Oncologic Surgery, Department of Surgery, George Washington University School of Medicine, Washington, DC
| | - Charles S Coffey
- Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California
| | - Farhoud Faraji
- Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, California
| | - Bridget V MacDonald
- School of Medicine, University of California San Diego, La Jolla, California
| | - Jeffrey J Houlton
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington
| | - Theodore A Gobillot
- School of Medicine, University of Washington Medical Center, Seattle, Washington
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ramez Philips
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Trevor G Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Andrew J Holcomb
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts.,Head and Neck Surgical Oncology, Nebraska Methodist Health System, Omaha, Nebraska
| | - Andrew M Coughlin
- Head and Neck Surgical Oncology, Nebraska Methodist Health System, Omaha, Nebraska
| | - Aru Panwar
- Head and Neck Surgical Oncology, Nebraska Methodist Health System, Omaha, Nebraska
| | - Russell B Smith
- Section of Head and Neck Surgical Oncology, Baptist MD Anderson Cancer Physicians, Baptist Medical Center, Jacksonville, Florida
| | - Matthew E Herberg
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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20 pack-year smoking history as strongest smoking metric predictive of HPV-positive oropharyngeal cancer outcomes. Am J Otolaryngol 2021; 42:102915. [PMID: 33482566 DOI: 10.1016/j.amjoto.2021.102915] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES While smoking is associated with worse outcomes in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC), the magnitude of this association is unclear given the heterogenous smoking definitions and outcomes. Our objective was to investigate the association between smoking, survival, and recurrence in HPV-related OPSCC using multiple smoking metrics reported in the literature. MATERIALS AND METHODS This was a retrospective cohort study of 375 adults with p16+ OPSCC undergoing surgical resection (n = 272) or definitive chemoradiation (n = 103) at a tertiary academic institution from 2006 to 2017. The primary outcome was overall survival (OS). Secondary outcomes included disease-free survival (DFS), disease-specific survival (DSS), and recurrence. We used multiple smoking metrics commonly cited in previous studies, including ever versus never smokers, current versus former/never smokers, ≤10 versus >10 pack-year, ≤20 versus >20 pack-year, and continuous pack-year. RESULTS There were 375 patients, median age 58 years, with 326 (87%) males, and median follow-up of 52 months. Of all smoking metrics, >20 pack-year history was the strongest predictor of both OS (HR 2.24, 95% CI: 1.19-4.20) and DFS (HR 1.67, 95% CI: 1.04-2.66) on univariable and multivariable analysis after adjusting for age, overall stage, and comorbidities. Patients with >20 pack-year smoking history were also more likely to have recurrence (HR 1.59, 95% CI: 0.95-2.67) after adjusting for overall stage. CONCLUSION Heavier smoking >20 pack-years was the strongest smoking metric associated with 2-times worse survival and recurrence. Our findings suggest that >20 pack-year smoking history may be a more useful cutoff for risk stratification models but requires further validation.
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29
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Belcastro A, Smith BD, Heidel RE, Hechler BL. Incidence of pain complaints in oropharyngeal squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:626-632. [PMID: 33958314 DOI: 10.1016/j.oooo.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/27/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of throat pain and otalgia as presenting symptoms in patients with oropharyngeal squamous cell carcinoma (OPSCC) stratified by the cancer being their first or recurrent/second primary head and neck cancer (fHNC or rsHNC). STUDY DESIGN A retrospective analysis of patients operated on for OPSCC was performed. The primary predictor variable was HNC instance (fHNC/rsHNC) with outcome variables of throat pain and/or otalgia. Chi-square analysis was performed to test for significant associations between HNC instance and pain variables. Unadjusted odds ratios were calculated. RESULTS Eighty-nine patients met the inclusion criteria. Patients with OPSCC as an rsHNC had 4.67 times higher odds of throat pain (95% confidence interval [CI], 1.45-15.06) than those with OPSCC as an fHNC and had 20.22 times higher odds of simultaneous throat pain and otalgia (95% CI, 4.76-85.97) than those presenting with an fHNC. Current smoking status and human papillomavirus (HPV)-negative disease were also significantly predictive of rsHNC. HPV-negative disease was also predictive of pain. CONCLUSIONS In addition to the known associations of smoking and HPV status on recurrence and pain, there is a statistically significant association between cancer instance and pain in patients presenting with newly diagnosed, operable OPSCC.
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Affiliation(s)
- Alexandra Belcastro
- Resident, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Blaine D Smith
- Resident, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - R Eric Heidel
- Associate Professor of Biostatistics, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Benjamin L Hechler
- Assistant Professor, Department of Surgery - Division of Plastic, Maxillofacial, and Oral Surgery, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA.
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30
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Evolving Profile of HPV-Driven Oropharyngeal Squamous Cell Carcinoma in a National Cancer Institute in Italy: A 10-Year Retrospective Study. Microorganisms 2020; 8:microorganisms8101498. [PMID: 33003378 PMCID: PMC7599861 DOI: 10.3390/microorganisms8101498] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 11/17/2022] Open
Abstract
Globally, 30% of oropharyngeal carcinomas (OPSCC) are caused by Human Papillomavirus (HPV). Recently, increasing incidence trends for HPV-driven OPSCC have been reported in many countries and changes in the typical HPV-positive OPSCC patient have been recorded, with an increase in the median age and diagnoses in women. We investigated the characteristics of the OPSCC patients attending an Italian Cancer Institute from 2010 to 2019 and assessed possible changes overtime of demographic, behavioral, and clinico-pathologic variables of HPV-driven OPSCC. Overall, 339 OPSCCs were evaluated. HPV-DNA and p16 positivity were 48.7% and 55.2%, respectively, with an HPV-driven fraction (i.e., HPV-DNA+/p16+) of 48.3%. We observed a significant increase overtime in the rate of HPV-associated cases (53.7% in 2015–2019 vs. 40.3% in 2010–2014, p = 0.019). The rate of HPV-driven cases was significantly higher among women, never smokers, patients with T1–T2 tumors, and with nodal involvement. A trend was also observed toward an increase in HPV-driven OPSCCs among patients >61 years, women, former smokers, and patients with no nodal involvement in 2015–2019. Our findings consolidate the observation that HPV-associated OPSCCs are also increasing in Italy. Moreover, they suggest that the profile of the HPV-driven OPSCC patient might be changing.
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