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Wilkins SG, Shah R, Safranek CW, Shah HP, Mehra S. The Impact of Four Smoking Metrics on Survival After Diagnosis with HPV+ Oropharyngeal Cancer. Laryngoscope 2024; 134:3158-3164. [PMID: 38294283 DOI: 10.1002/lary.31319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE While tobacco use is understood to negatively impact HPV+ oropharyngeal squamous cell carcinoma (OPSCC) outcomes, debate remains as to how this impact differs between cohorts. Multiple smoking metrics have been identified as having the greatest prognostic significance, and some recent works have found smoking to have no significant impact. Herein, we show through an analysis of four common smoking metrics that while smoking impacts overall survival (OS), it has a limited impact on recurrence-free survival (RFS) in our cohort. METHODS We conducted a retrospective review of patients treated for HPV+ OPSCC in our health system from 2012 to 2019. Patients with metastatic disease or concurrent second primaries were excluded. Four metrics of tobacco use were assessed: current/former/never smokers, ever/never smokers, and smokers with >10 or >20 pack-year (PY) smoking histories. Our main outcomes were 3-year RFS and OS. RESULTS Three hundred and sixty-seven patients met inclusion criteria. 37.3% of patients (137/367) were never-smokers; 13.8% of patients (51/367) were currently smoking at diagnosis and 48.8% of patients (179/367) were former smokers. No tobacco-use metric significantly impacted 3-year RFS. On univariate analysis, all smoking metrics yielded inferior OS. On multivariate analysis, current and ever smoking status significantly impacted 3-year OS. CONCLUSION The impact of tobacco use on HPV+ OPSCC outcomes is not universal, but may instead be modulated by other cohort-specific factors. The impact of smoking may decrease as rates of tobacco use decline. LEVEL OF EVIDENCE 3 (Cohort and case-control studies) Laryngoscope, 134:3158-3164, 2024.
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Affiliation(s)
- Sarah G Wilkins
- Yale School of Medicine, Yale University, New Haven, Connecticut, U.S.A
| | - Rema Shah
- Yale School of Medicine, Yale University, New Haven, Connecticut, U.S.A
| | - Conrad W Safranek
- Yale School of Medicine, Yale University, New Haven, Connecticut, U.S.A
| | - Hemali P Shah
- Yale School of Medicine, Yale University, New Haven, Connecticut, U.S.A
| | - Saral Mehra
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A
- Yale Cancer Center, Yale University, New Haven, Connecticut, U.S.A
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2
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Molteni G, Bassani S, Arsie AE, Zampieri E, Mannelli G, Orlandi E, Bossi P, De Virgilio A. Role of TORS as De-Escalation Strategy in HPV-Related Oropharyngeal Cancer, What We Need to Know. Healthcare (Basel) 2024; 12:1014. [PMID: 38786424 PMCID: PMC11121063 DOI: 10.3390/healthcare12101014] [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: 03/27/2024] [Revised: 05/04/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) presents unique challenges and opportunities for treatment, particularly regarding de-escalation strategies to reduce treatment morbidity without compromising oncological outcomes. This paper examines the role of Transoral Robotic Surgery (TORS) as a de-escalation strategy in managing HPV-related OPSCC. We conducted a comprehensive literature review from January 2010 to June 2023, focusing on studies exploring TORS outcomes in patients with HPV-positive OPSCC. These findings highlight TORS's potential to reduce the need for adjuvant therapy, thereby minimizing treatment-related side effects while maintaining high rates of oncological control. TORS offers advantages such as precise tumor resection and the ability to obtain accurate pathological staging, which can guide the tailoring of adjuvant treatments. Some clinical trials provide evidence supporting the use of TORS in specific patient populations. The MC1273 trial demonstrated promising outcomes with lower doses of adjuvant radiotherapy (RT) following TORS, showing high locoregional tumor control rates and favorable survival outcomes with minimal side effects. ECOG 3311 evaluated upfront TORS followed by histopathologically directed adjuvant therapy, revealing good oncological and functional outcomes, particularly in intermediate-risk patients. The SIRS trial emphasized the benefits of upfront surgery with neck dissection followed by de-escalated RT in patients with favorable survival and excellent functional outcomes. At the same time, the PATHOS trial examined the impact of risk-adapted adjuvant treatment on functional outcomes and survival. The ongoing ADEPT trial investigates reduced-dose adjuvant RT, and the DART-HPV study aims to compare standard adjuvant chemoradiotherapy (CRT) with a reduced dose of adjuvant RT in HPV-positive OPSCC patients. These trials collectively underscore the potential of TORS in facilitating treatment de-escalation while maintaining favorable oncological and functional outcomes in selected patients with HPV-related OPSCC. The aim of this scoping review is to discuss the challenges of risk stratification, the importance of HPV status determination, and the implications of smoking on treatment outcomes. It also explores the evolving criteria for adjuvant therapy following TORS, focusing on reducing radiation dosage and volume without compromising treatment efficacy. In conclusion, TORS emerges as a viable upfront treatment option for carefully selected patients with HPV-positive OPSCC, offering a pathway toward treatment de-escalation. However, selecting the optimal candidate for TORS-based de-escalation strategies is crucial to fully leverage the benefits of treatment de-intensification.
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Affiliation(s)
- Gabriele Molteni
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Sara Bassani
- Otolaryngology-Head and Neck Surgery Department, University of Verona, 37129 Verona, Italy; (A.E.A.)
| | - Athena Eliana Arsie
- Otolaryngology-Head and Neck Surgery Department, University of Verona, 37129 Verona, Italy; (A.E.A.)
| | - Erica Zampieri
- Otolaryngology-Head and Neck Surgery Department, University of Verona, 37129 Verona, Italy; (A.E.A.)
| | - Giuditta Mannelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Firenze, Italy
| | - Ester Orlandi
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Clinical Department, National Center for Oncological Hadrontherapy (Fondazione CNAO), 27100 Pavia, Italy
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy;
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
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Lai CY, Lee TY, Lin CH. Perceptions of Taiwanese college students toward human papillomavirus infection: A qualitative descriptive study. J Pediatr Nurs 2024; 76:124-131. [PMID: 38382187 DOI: 10.1016/j.pedn.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE The aim of this study was to explore college students' perceptions of human papillomavirus (HPV) infection and their thoughts on prevention measures. DESIGN AND METHODS A qualitative descriptive design was used. The study adopted purposive sampling at two universities in northern Taiwan and one in central Taiwan. Twenty-six college students participated, and data saturation was reached. Content analysis was undertaken. RESULTS Four main themes emerged from the data narratives: 1) having very little knowledge of HPV infection, 2) being concerned about outcomes of HPV infection, 3) taking measures to protect oneself, and 4) expecting to have HPV prevention resources. CONCLUSIONS The results indicated that college students needed a more complete understanding of HPV and prevention methods to protect themselves from infection. Schools were an ideal place to provide adequate information on HPV prevention. PRACTICE IMPLICATIONS The study suggested providing HPV-related information through school health centers and government health departments to resolve common questions and misunderstandings about HPV infection. Healthcare professionals should have a complete understanding of HPV-related knowledge in order to provide detailed information to young people.
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Affiliation(s)
- Ching-Yi Lai
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan.
| | - Tzu-Ying Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Chi-Hua Lin
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
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4
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Wang P, Wang X, Zhang M, Li G, Zhao N, Qiao Q. Combining the radiomics signature and HPV status for the risk stratification of patients with OPC. Oral Dis 2024; 30:272-280. [PMID: 36135344 DOI: 10.1111/odi.14386] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to perform risk stratification of oropharyngeal cancer (OPC) for treatment de-escalation based on the radiomics analysis and human papillomavirus (HPV) status. METHODS A total of 265 patients with OPC who underwent baseline contrast-enhanced computed tomography were analyzed, and the patients were grouped into the training (n = 133) and test (n = 132) cohorts at a ratio of 1:1. Intratumoral and peritumoral radiomics features were extracted, and the radiomics signature (Rscore) was calculated using least absolute shrinkage and selection operator regression (LASSO) and Cox regression analyses. RESULTS Twelve features were selected to establish the radiomics signature (Rscore) of intratumoral regions +10-mm peritumoral regions, which yielded maximum AUCs of 0.835, 0.798, and 0.784 in the training, test, and validation cohorts, respectively. Patients with OPC were divided into the high-risk group, intermediate-risk group, and low-risk group based on the Rscore and HPV status and had different prognoses. Patients in the low-risk group benefit from radiotherapy alone, and patients in the intermediate-risk group only benefitted from chemoradiotherapy. CONCLUSION The radiomics signature appears to improve the predictive performance of clinical characteristics for oropharyngeal cancer. The combined stratification of the radiomics signature and HPV status might be preferred to select patients for de-escalated treatment.
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Affiliation(s)
- Ping Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Xuan Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Miao Zhang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Guang Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Ning Zhao
- Department of Otolaryngology, The First Hospital of China Medical University, Shenyang, China
| | - Qiao Qiao
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China
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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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Ma B, Guo J, Zhai TT, van der Schaaf A, Steenbakkers RJHM, van Dijk LV, Both S, Langendijk JA, Zhang W, Qiu B, van Ooijen PMA, Sijtsema NM. CT-based deep multi-label learning prediction model for outcome in patients with oropharyngeal squamous cell carcinoma. Med Phys 2023; 50:6190-6200. [PMID: 37219816 DOI: 10.1002/mp.16465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/23/2023] [Accepted: 05/01/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Personalized treatment is increasingly required for oropharyngeal squamous cell carcinoma (OPSCC) patients due to emerging new cancer subtypes and treatment options. Outcome prediction model can help identify low or high-risk patients who may be suitable to receive de-escalation or intensified treatment approaches. PURPOSE To develop a deep learning (DL)-based model for predicting multiple and associated efficacy endpoints in OPSCC patients based on computed tomography (CT). METHODS Two patient cohorts were used in this study: a development cohort consisting of 524 OPSCC patients (70% for training and 30% for independent testing) and an external test cohort of 396 patients. Pre-treatment CT-scans with the gross primary tumor volume contours (GTVt) and clinical parameters were available to predict endpoints, including 2-year local control (LC), regional control (RC), locoregional control (LRC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), overall survival (OS), and disease-free survival (DFS). We proposed DL outcome prediction models with the multi-label learning (MLL) strategy that integrates the associations of different endpoints based on clinical factors and CT-scans. RESULTS The multi-label learning models outperformed the models that were developed based on a single endpoint for all endpoints especially with high AUCs ≥ 0.80 for 2-year RC, DMFS, DSS, OS, and DFS in the internal independent test set and for all endpoints except 2-year LRC in the external test set. Furthermore, with the models developed, patients could be stratified into high and low-risk groups that were significantly different for all endpoints in the internal test set and for all endpoints except DMFS in the external test set. CONCLUSION MLL models demonstrated better discriminative ability for all 2-year efficacy endpoints than single outcome models in the internal test and for all endpoints except LRC in the external set.
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Affiliation(s)
- Baoqiang Ma
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Jiapan Guo
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Machine Learning Lab, Data Science Centre in Health (DASH), University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, the Netherlands
| | - Tian-Tian Zhai
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Lisanne V van Dijk
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Centre, Houston, Texas, USA
| | - Stefan Both
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Weichuan Zhang
- Institute for Integrated and Intelligent Systems, Griffith University, Queensland, Australia
| | - Bingjiang Qiu
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Machine Learning Lab, Data Science Centre in Health (DASH), University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Peter M A van Ooijen
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- Machine Learning Lab, Data Science Centre in Health (DASH), University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Ma B, Guo J, Chu H, van Dijk LV, van Ooijen PM, Langendijk JA, Both S, Sijtsema NM. Comparison of computed tomography image features extracted by radiomics, self-supervised learning and end-to-end deep learning for outcome prediction of oropharyngeal cancer. Phys Imaging Radiat Oncol 2023; 28:100502. [PMID: 38026084 PMCID: PMC10663809 DOI: 10.1016/j.phro.2023.100502] [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: 08/03/2023] [Revised: 10/02/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background and purpose To compare the prediction performance of image features of computed tomography (CT) images extracted by radiomics, self-supervised learning and end-to-end deep learning for local control (LC), regional control (RC), locoregional control (LRC), distant metastasis-free survival (DMFS), tumor-specific survival (TSS), overall survival (OS) and disease-free survival (DFS) of oropharyngeal squamous cell carcinoma (OPSCC) patients after (chemo)radiotherapy. Methods and materials The OPC-Radiomics dataset was used for model development and independent internal testing and the UMCG-OPC set for external testing. Image features were extracted from the Gross Tumor Volume contours of the primary tumor (GTVt) regions in CT scans when using radiomics or a self-supervised learning-based method (autoencoder). Clinical and combined (radiomics, autoencoder or end-to-end) models were built using multivariable Cox proportional-hazard analysis with clinical features only and both clinical and image features for LC, RC, LRC, DMFS, TSS, OS and DFS prediction, respectively. Results In the internal test set, combined autoencoder models performed better than clinical models and combined radiomics models for LC, RC, LRC, DMFS, TSS and DFS prediction (largest improvements in C-index: 0.91 vs. 0.76 in RC and 0.74 vs. 0.60 in DMFS). In the external test set, combined radiomics models performed better than clinical and combined autoencoder models for all endpoints (largest improvements in LC, 0.82 vs. 0.71). Furthermore, combined models performed better in risk stratification than clinical models and showed good calibration for most endpoints. Conclusions Image features extracted using self-supervised learning showed best internal prediction performance while radiomics features have better external generalizability.
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Affiliation(s)
- Baoqiang Ma
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jiapan Guo
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Machine Learning Lab, Data Science Center in Health (DASH), Groningen, Netherlands
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence , University of Groningen, Groningen, Netherlands
| | - Hung Chu
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Machine Learning Lab, Data Science Center in Health (DASH), Groningen, Netherlands
- Center for Information Technology, University of Groningen ,Groningen, Netherlands
| | - Lisanne V. van Dijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Peter M.A. van Ooijen
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Machine Learning Lab, Data Science Center in Health (DASH), Groningen, Netherlands
| | - Johannes A. Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Nanna M. Sijtsema
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Ozkaya Akagunduz O, Etit D, Yazici G, Veral A, Cetinayak O, Sarioglu S, Guler Tezel G, Duru Birgi S, Yuksel S, Kara G, Mustafayev TZ, Tokat F, Ceylaner Bicakli B, Basak K, Esassolak M, Akman F, Ozyar E. The effect of P53 expression and smoking/alcohol in P16(+) and P16(-) oropharyngeal carcinoma and risk classification: the Turkish Society of Radiation Oncology Head & Neck Study Group 01-002. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:80-90. [PMID: 37246057 DOI: 10.1016/j.oooo.2023.04.001] [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: 06/25/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim of this study is to categorize the risk groups of patients with oropharyngeal carcinoma (OPC) according to p16 and p53 status, smoking/alcohol consumption history, and other prognostic factors. STUDY DESIGN The immunostaining of p16 and p53 of 290 patients was retrospectively evaluated. The history of smoking/alcohol consumption of each patient was noted. p16 and p53 staining patterns were reviewed. The results were compared with demographic findings and prognostic factors. Risk groups have been classified for the p16 status of patients. RESULTS The median follow-up was 47 months (range 6-240). Five-year disease-free survival (DFS) rates for patients with p16 (+) and (-) were 76% and 36%, and overall survival rates were 83% vs 40%, respectively (HR = 0.34 [0.21-0.57], P < .0001), HR = 0.22 [0.12-0.40] P < .0001, respectively). p16(-), p53(+), heavy smoking/alcohol consumption, performance status; advanced T and N stages in patients with p16(-), and continuing smoking/alcohol consumption after treatment were found to be unfavorable risk factors. Five-year overall survival rates were 95%, 78%, and 36% for low, intermediate, and high-risk groups, respectively. CONCLUSIONS The results of our study have shown that p16 negativity in patients with oropharyngeal cancer was found to be an important prognostic factor, especially for those with lower p53 expression and not smoking/consuming alcohol.
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Affiliation(s)
| | - Demet Etit
- Department of Pathology, Istanbul Aydin University, Faculty of Medicine, Istanbul, Turkey
| | - Gozde Yazici
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ali Veral
- Department of Pathology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Oguz Cetinayak
- Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Sulen Sarioglu
- Department of Pathology, Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Gaye Guler Tezel
- Department of Pathology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Sumerya Duru Birgi
- Department of Radiation Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Seher Yuksel
- Department of Pathology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Gulsen Kara
- Department of Radiation Oncology, Ataturk Training and Research Hospital, Izmir, Turkey
| | | | - Fatma Tokat
- Department of Pathology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Beyhan Ceylaner Bicakli
- Department of Radiation Oncology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Kayhan Basak
- Department of Pathology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Esassolak
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Fadime Akman
- Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
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9
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Yang Z, Sun P, Dahlstrom KR, Gross N, Li G. Joint effect of human papillomavirus exposure, smoking and alcohol on risk of oral squamous cell carcinoma. BMC Cancer 2023; 23:457. [PMID: 37202767 DOI: 10.1186/s12885-023-10948-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Smoking, alcohol consumption, and human papillomavirus (HPV) infection are known risk factors for oral squamous cell carcinoma (OSCC) including SCC of oropharynx (SCCOP) and SCC of oral cavity (SCCOC). Researchers have examined each of these risk factors independently, but few have observed the potential risk of their interaction. This study investigated the interactions among these risk factors and risk of OSCC. METHODS Totally 377 patients with newly diagnosed SCCOP and SCCOC and 433 frequency-matched cancer-free controls by age and sex were included. Multivariable logistic regression was performed to calculate ORs and 95% CIs. RESULTS We found that overall OSCC risk was independently associated with smoking (adjusted OR(aOR), 1.4; 95%CI, 1.0-2.0), alcohol consumption (aOR, 1.6; 95%CI, 1.1-2.2), and HPV16 seropositivity (aOR, 3.3; 95%CI, 2.2-4.9), respectively. Additionally, we found that HPV16 seropositivity increased the risk of overall OSCC in ever-smokers (aOR, 6.8; 95%CI, 3.4-13.4) and ever-drinkers (aOR, 4.8; 95%CI, 2.9-8.0), while HPV16-seronegative ever-smokers and ever-drinkers had less than a twofold increase in risk of overall OSCC (aORs, 1.2; 95%CI, 0.8-1.7 and 1.8; 95%CI, 1.2-2.7, respectively). Furthermore, the increased risk was particularly high for SCCOP in HPV16-seropositive ever-smokers (aOR, 13.0; 95%CI, 6.0-27.7) and in HPV16-seropositive ever-drinkers (aOR, 10.8; 95%CI, 5.8-20.1), while the similar increased risk was not found in SCCOC. CONCLUSION These results suggest a strong combined effect of HPV16 exposure, smoking, and alcohol on overall OSCC, which may indicate a strong interaction between HPV16 infection and smoking and alcohol consumption, particularly for SCCOP.
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Affiliation(s)
- Zheng Yang
- Department of Otolaryngology Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery of the Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- Department of Head and Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Peng Sun
- Department of Head and Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
- Department of Otolaryngology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Kristina R Dahlstrom
- Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Neil Gross
- Department of Head and Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Guojun Li
- Department of Head and Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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10
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Yan EZ, Wahle BM, Massa ST, Zolkind P, Paniello RC, Pipkorn P, Jackson RS, Rich JT, Puram SV, Mazul AL. Race and socioeconomic status interact with HPV to influence survival disparities in oropharyngeal squamous cell carcinoma. Cancer Med 2023; 12:9976-9987. [PMID: 36847063 PMCID: PMC10166958 DOI: 10.1002/cam4.5726] [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: 10/06/2022] [Revised: 01/27/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is associated with a favorable prognosis, yet patients of color and low socioeconomic status (SES) continue to experience inferior outcomes. We aim to understand how the emergence of HPV has impacted race and SES survival disparities in OPSCC. METHODS A retrospective cohort of 18,362 OPSCC cases from 2010 to 2017 was assembled using the SEER (Surveillance, Epidemiology, and End Results) database. Cox proportional regression and Fine and Gray regression models were used to calculate hazard ratios (HRs) adjusting for race, SES, age, subsite, stage, and treatment. RESULTS Black patients had lower overall survival than patients of other races in HPV-positive and HPV-negative OPSCC (HR 1.31, 95% CI 1.13-1.53 and HR 1.23, 95% CI 1.09-1.39, respectively). Higher SES was associated with improved survival in all patients. Race had a diminished association with survival among high SES patients. Low SES Black patients had considerably worse survival than low SES patients of other races. CONCLUSION Race and SES interact variably across cohorts. High SES was protective of the negative effects of race, although there remains a disparity in outcomes among Black and non-Black patients, even in high SES populations. The persistence of survival disparities suggests that the HPV epidemic has not improved outcomes equally across all demographic groups.
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Affiliation(s)
- Emily Z Yan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Benjamin M Wahle
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Paul Zolkind
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason T Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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11
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Ma SJ, Yu H, Yu B, Waldman O, Khan M, Chatterjee U, Santhosh S, Gill J, Iovoli AJ, Farrugia M, Shevorykin A, Carl E, Wooten K, Gupta V, McSpadden R, Kuriakose MA, Markiewicz MR, Al-Afif A, Hicks WL, Platek ME, Seshadri M, Sheffer C, Warren GW, Singh AK. Association of Pack-Years of Cigarette Smoking With Survival and Tumor Progression Among Patients Treated With Chemoradiation for Head and Neck Cancer. JAMA Netw Open 2022; 5:e2245818. [PMID: 36480200 PMCID: PMC9856262 DOI: 10.1001/jamanetworkopen.2022.45818] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE After 10 pack-years of smoking was initially established as a threshold for risk stratification, subsequent clinical trials incorporated it to identify candidates for treatment deintensification. However, several recent studies were unable to validate this threshold externally, and the threshold for smoking exposure remains unclear. OBJECTIVE To estimate the threshold of pack-years of smoking associated with survival and tumor recurrence among patients with head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS This single-institution, cohort study included patients with nonmetastatic head and neck cancer receiving chemoradiation from January 2005 to April 2021. Data were analyzed from January to April 2022. EXPOSURES Heavy vs light smoking using 22 pack-years as a threshold based on maximizing log-rank test statistic. MAIN OUTCOMES AND MEASURES Overall survival (OS), progression-free survival (PFS), locoregional failure (LRF), and distant failure (DF). RESULTS A total of 518 patients (427 male [82.4%]; median [IQR] age, 61 [55-66] years) were included. Median (IQR) follow-up was 44.1 (22.3-72.8) months. A nonlinear Cox regression model using restricted cubic splines showed continuous worsening of OS and PFS outcomes as pack-years of smoking increased. The threshold of pack-years to estimate OS and PFS was 22. Cox multivariable analysis (MVA) showed that more than 22 pack-years was associated with worse OS (adjusted hazard ratio [aHR] 1.57; 95% CI, 1.11-2.22; P = .01) and PFS (aHR, 1.38; 95% CI, 1.00-1.89; P = .048). On Fine-Gray MVA, heavy smokers were associated with DF (aHR, 1.71; 95% CI, 1.02-2.88; P = .04), but not LRF (aHR, 1.07; 95% CI, 0.61-1.87; P = .82). When 10 pack-years of smoking were used as a threshold, there was no association for OS (aHR, 1.23; 95% CI, 0.83-1.81; P = .30), PFS (aHR, 1.11; 95% CI, 0.78-1.57; P = .56), LRF (aHR, 1.19; 95% CI, 0.64-2.21; P = .58), and DF (aHR, 1.45; 95% CI, 0.82-2.56; P = .20). Current smoking was associated with worse OS and PFS only among human papillomavirus (HPV)-positive tumors (OS: aHR, 2.81; 95% CI, 1.26-6.29; P = .01; PFS: aHR, 2.51; 95% CI, 1.22-5.14; P = .01). CONCLUSIONS AND RELEVANCE In this cohort study of patients treated with definitive chemoradiation, 22 pack-years of smoking was associated with survival and distant metastasis outcomes. Current smoking status was associated with adverse outcomes only among patients with HPV-associated head and neck cancer.
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Affiliation(s)
- Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Han Yu
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Brian Yu
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo
| | - Olivia Waldman
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo
| | - Michael Khan
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo
| | - Udit Chatterjee
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Sharon Santhosh
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo
| | - Jasmin Gill
- University at Buffalo, The State University of New York, Buffalo
| | - Austin J. Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kimberly Wooten
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Vishal Gupta
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Ryan McSpadden
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Moni A. Kuriakose
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Michael R. Markiewicz
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo
| | - Ayham Al-Afif
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Wesley L. Hicks
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Mary E. Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Department of Nutrition and Dietetics, D’Youville University, Buffalo, New York
| | - Mukund Seshadri
- Department of Oral Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Christine Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Graham W. Warren
- Hollings Cancer Center, Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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12
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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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13
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Schostag K, Lynch P, Leavitt T, Sumer B, Yang A, Shah A, Emmet T, Sher DJ, Day AT. Smoking and other patient factors in HPV-mediated oropharynx cancer: A retrospective cohort study. Am J Otolaryngol 2022; 43:103555. [DOI: 10.1016/j.amjoto.2022.103555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/18/2022] [Accepted: 07/31/2022] [Indexed: 11/01/2022]
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14
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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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15
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Bi X, French Z, Palmisiano N, Wen KY, Wilde L. The prognostic impact of cigarette smoking on survival in acute myeloid leukemia with TP53 mutations and/or 17p deletions. Ann Hematol 2022; 101:1251-1259. [PMID: 35288759 DOI: 10.1007/s00277-022-04812-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/28/2022] [Indexed: 11/01/2022]
Abstract
Cigarette smoking has been associated with increased risk of developing acute myeloid leukemia (AML) in adults. There is limited data on the impact of smoking in AML patients with certain cytogenetic abnormalities. The aim of this study is to assess whether cigarette smoking affected the survival outcome of patients with newly diagnosed AML with TP53 alterations. We conducted a retrospective study of patients who were diagnosed with AML at the Thomas Jefferson Hospital with presence of TP53 mutations and/or 17p deletions. Patients' sex, age, race, smoking status (ever vs. never), cytogenetics, mutational profile, induction regimen, and induction response were analyzed. A total of 102 patients were included in the study with a median follow-up of 27.8 months. Among 100 patients who had documentation of smoking status, 59 patients (59%) were ever-smokers and 41 (41%) were never-smokers. Kaplan-Meier survival analysis showed that never-smokers did not differ in overall survival (OS) when compared to ever-smokers (P = 0.34). Univariate analysis revealed that age and cytogenetics had a statistically significant impact on survival. In multivariate analysis incorporating sex, age, race, smoking status, cytogenetics, and induction regimen as covariates, cytogenetics and induction regimen were independent prognostic factors for OS. In summary, no significant difference in OS was found between ever- and never-smokers in AML patients with TP53 alterations. Additional studies are needed to examine the prognostic impact of cigarette smoking in AML with specific cytogenetic abnormalities.
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Affiliation(s)
- Xia Bi
- Department of Medical Oncology, Thomas Jefferson University, Sidney Kimmel Cancer Center, 834 Chestnut Street, Suite 308, Philadelphia, PA, 19107, USA.
| | - Zachary French
- Department of Medical Oncology, Thomas Jefferson University, Sidney Kimmel Cancer Center, 834 Chestnut Street, Suite 308, Philadelphia, PA, 19107, USA
| | - Neil Palmisiano
- Department of Medical Oncology, Thomas Jefferson University, Sidney Kimmel Cancer Center, 834 Chestnut Street, Suite 308, Philadelphia, PA, 19107, USA
| | - Kuang-Yi Wen
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lindsay Wilde
- Department of Medical Oncology, Thomas Jefferson University, Sidney Kimmel Cancer Center, 834 Chestnut Street, Suite 308, Philadelphia, PA, 19107, USA
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Pilar A, O’Sullivan B, Huang SH. Risk Stratification of HPV-Associated Oropharyngeal Squamous Cell Carcinoma: Are All Tumors Created Equally? CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Bozec A, Culié D, Poissonnet G, Demard F, Dassonville O. Current Therapeutic Strategies in Patients with Oropharyngeal Squamous Cell Carcinoma: Impact of the Tumor HPV Status. Cancers (Basel) 2021; 13:cancers13215456. [PMID: 34771619 PMCID: PMC8582410 DOI: 10.3390/cancers13215456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 01/19/2023] Open
Abstract
Simple Summary Contrary to other head and neck subsites, oropharyngeal squamous cell carcinoma (OPSCC) has shown a considerable increase in incidence over the past 20 years. This growing incidence is largely due to the increasing place of human papillomavirus (HPV)-related tumors. HPV-positive and HPV-negative OPSCC are two distinct entities with considerable differences in terms of treatment response and prognosis. However, there are no specific recommendations yet in the therapeutic management of OPSCC patients according to their tumor HPV-status. The aim of this review is therefore to discuss the therapeutic management of patients with OPSCC and the impact of HPV status on treatment selection. Abstract Since there is no published randomized study comparing surgical and non-surgical therapeutic strategies in patients with oropharyngeal squamous cell carcinoma (OPSCC), the therapeutic management of these patients remains highly controversial. While human papillomavirus (HPV)-positive and HPV-negative OPSCC are now recognized as two distinct diseases with different epidemiological, biological, and clinical characteristics, the impact of HPV status on the management of OPSCC patients is still unclear. In this review, we analyze the current therapeutic options in patients with OPSCC, highlighting the most recent advances in surgical and non-surgical therapies, and we discuss the impact of HPV status on the therapeutic strategy.
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