Head and neck squamous cell carcinoma and metachronous second primaries

Prognostic significance of preoperative anaemia on occurrence of regional metastases and second primary tumours in patients with early-stage oral squamous cell carcinoma

The aim of this study was to evaluate the effect of preoperative anaemia on the risk of occurrence of regional metastases and second primary tumours in patients with early-stage (cT1-T2N0M0) oral squamous cell carcinoma (OSCC) after primary surgical treatment. Consecutive patients with OSCC who were referred to University Hospital Dubrava and University Clinical Centre of Kosovo between January 1, 2000 and December 31, 2010, and who met the following criteria, were included: adult> 18 years of age; verified cT1-T2N0M0 stage; available data on clinical and laboratory work-up allowing the assessment of demographics, lifestyle/habits, anaemia, and comorbidities. The inclusion time-frame allowed a maximum potential censored observation of 15 years and minimum censored observation of 5 years (patients treated by the end of 2010). Microcytic anaemia was significantly associated with a higher risk of regional metastases (60% vs 40%, P = 0.030), with an odds ratio of 3.65 (95% confidence interval 1.33-9.97, P = 0.028). Alcohol consumption was independently associated with an increased risk of second primary tumour, with an odds ratio of 2.79 (95% confidence interval 1.32-5.87, P = 0.007). In patients with OSCC, microcytic anaemia was found to be an independent predictor of regional metastases, and alcohol consumption an independent predictor of second primary tumour.

Risk of second primary cancer in patients with head and neck squamous cell carcinoma: a systemic review and meta-analysis

OBJECTIVES

Second primary cancer is a common event in patients with head and neck squamous cell carcinoma. However, the incidence and relevant factors vary by studies. We conducted a systematic review and meta-analysis of observational studies to estimate the incidence and relevant risk factors.

MATERIALS AND METHODS

PubMed and Web of Science were searched for studies published between January 2000 and December 2020 that reported the incidence of SPC in HNSCC patients. Per 1000-person-year incidence and odds ratios were used to estimate the incidence and potential risk factors. Due to the high heterogeneity, random-effects models were used to estimate the incidence and 95% confidence interval.

RESULTS

Seven thousand seven hundred thirteen articles were identified from the databases, in which 60 studies were included in this meta-analysis. The pooled incidence of the total, synchronous, and metachronous SPC in patients with HNSCC were 29.116 per 1000-person-year, 6.960 per 1000-person-year, and 26.025 per 1000-person-year, respectively. The head and neck region was the most common area where SPC occurred, followed by the lung (7.472 per 1000-person-year) and upper digestive tract (2.696 per 1000-person-year). Smoking, alcohol consumption, betel quid chewing, primary cancer of T1-2, and N0 were risk factors, while HPV infection (OR 0.47, 95% CI 0.30-0.72) was the protective factor.

CONCLUSIONS

SPC is frequently observed in HNSCC patients and had great impact on the prognosis. The findings could promote a more individualized follow-up strategy for SPC in HNSCC patients.

CLINICAL RELEVANCE

This systemic review and meta-analysis provide sufficient evidence for the establishment of the follow-up strategy for head and neck squamous cancer patients.

Metachronous second primary neoplasia in oropharyngeal cancer patients: Impact of tumor HPV status. A GETTEC multicentric study

INTRODUCTION

Patients with oropharyngeal squamous cell carcinoma (OPSCC) display a significant risk to develop a metachronous second primary neoplasia (MSPN). HPV and non-HPV-related OPSCC are 2 distinct entities with biological, clinical and prognostic differences. The aims of our study were to analyze the impact of tumor HPV status and other relevant clinical factors, such as tobacco and/or alcohol (T/A) consumption, on the risk and distribution of MSPN in OPSCC patients and to assess the impact of MSPN on patient survival.

MATERIAL AND METHODS

All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. P16 immunohistochemical expression was used as a surrogate maker of tumor HPV status. The impact of tumor p16 status on the risk of MSPN was assessed in uni- and multivariate analyses. Overall survival (OS) was determined by Kaplan-Meier analysis.

RESULTS

Among the 1291 patients included in this study, 138 (10.7%) displayed a MSPN which was preferentially located in the head and neck area (H&N), lung and esophagus. Multivariate analyses showed that p16- tumor status (p = 0.003), T/A consumption (p = 0.005) and soft palate tumor site (p = 0.009) were significantly associated with a higher risk of MSPN. We found no impact of p16 tumor status on the median time between index OPSCC diagnosis and MSPN development, but a higher proportion of MSPN arising outside the H&N, lung and esophagus was found in p16 + than in p16- patients. MSPN development had an unfavorable impact (p = 0.04) on OS only in the p16 + patient group.

CONCLUSION

P16 tumor status and T/A consumption were the main predictive factors of MSPN in OPSCC patients. This study provides crucial results with a view to tailoring global management and follow-up of OPSCC patients.