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Brewczyński A, Jabłońska B, Mazurek AM, Mrochem-Kwarciak J, Mrowiec S, Śnietura M, Kentnowski M, Kołosza Z, Składowski K, Rutkowski T. Comparison of Selected Immune and Hematological Parameters and Their Impact on Survival in Patients with HPV-Related and HPV-Unrelated Oropharyngeal Cancer. Cancers (Basel) 2021; 13:cancers13133256. [PMID: 34209764 PMCID: PMC8268778 DOI: 10.3390/cancers13133256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 01/21/2023] Open
Abstract
Simple Summary This is a research article on oropharyngeal cancer (OPC). The aim of the study was to assess and compare basic immune parameters and ratios in patients with Human Papilloma Virus (HPV)+ and HPV− OPC, before and after radiotherapy (RT) or chemoradiotherapy (CRT), and to investigate their impact on overall survival (OS) and disease-free survival (DFS). The higher neutrophil-lymphocyte ratio (NLR) and systemic immune inflammation (SII) are significant adverse prognostic factors for HPV+ OPC patients, because they are significantly associated with both inferior OS and DFS in this group, whereas the higher platelet cells (PLT) count is significant adverse prognostic factor for HPV− OPC patients, because it is significantly associated with inferior OS and DFS in this group. This study confirmed that determination of HPV etiology as well as analysis of various hematological and immune parameters should be a standard management in OPC patients in order to properly treat them for improved prognosis. Abstract Several immune and hematological parameters are associated with survival in patients with oropharyngeal cancer (OPC). The aim of the study was to analyze selected immune and hematological parameters of patients with HPV-related (HPV+) and HPV-unrelated (HPV−) OPC, before and after radiotherapy/chemoradiotherapy (RT/CRT) and to assess the impact of these parameters on survival. One hundred twenty seven patients with HPV+ and HPV− OPC, treated with RT alone or concurrent chemoradiotherapy (CRT), were included. Patients were divided according to HPV status. Confirmation of HPV etiology was obtained from FFPE (Formalin-Fixed, Paraffin-Embedded) tissue samples and/or extracellular circulating HPV DNA was determined. The pre-treatment and post-treatment laboratory blood parameters were compared in both groups. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), and systemic immune inflammation (SII) index were calculated. The impact of these parameters on overall (OS) and disease-free (DFS) survival was analyzed. In HPV+ patients, a high pre-treatment white blood cells (WBC) count (>8.33 /mm3), NLR (>2.13), SII (>448.60) significantly correlated with reduced OS, whereas high NLR (>2.29), SII (>462.58) significantly correlated with reduced DFS. A higher pre-treatment NLR and SII were significant poor prognostic factors for both OS and DFS in the HPV+ group. These associations were not apparent in HPV− patients. There are different pre-treatment and post-treatment immune and hematological prognostic factors for OS and DFS in HPV+ and HPV− patients. The immune ratios could be considered valuable biomarkers for risk stratification and differentiation for HPV− and HPV+ OPC patients.
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Affiliation(s)
- Adam Brewczyński
- I Radiation and Clinical Oncology Department of Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice Branch, Poland; (A.B.); (M.K.); (K.S.); (T.R.)
| | - Beata Jabłońska
- Department of Digestive Tract Surgery, Medical University of Silesia, 40-752 Katowice, Poland;
- Correspondence:
| | - Agnieszka Maria Mazurek
- Centre for Translational Research and Molecular Biology of Cancer of Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice Branch, Poland;
| | - Jolanta Mrochem-Kwarciak
- The Analytics and Clinical Biochemistry Department of Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice Branch, Poland;
| | - Sławomir Mrowiec
- Department of Digestive Tract Surgery, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Mirosław Śnietura
- Tumor Pathology Department of Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice Branch, Poland;
| | - Marek Kentnowski
- I Radiation and Clinical Oncology Department of Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice Branch, Poland; (A.B.); (M.K.); (K.S.); (T.R.)
| | - Zofia Kołosza
- Department of Biostatistics and Bioinformatics of Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice Branch, Poland;
| | - Krzysztof Składowski
- I Radiation and Clinical Oncology Department of Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice Branch, Poland; (A.B.); (M.K.); (K.S.); (T.R.)
| | - Tomasz Rutkowski
- I Radiation and Clinical Oncology Department of Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice Branch, Poland; (A.B.); (M.K.); (K.S.); (T.R.)
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Hoffmann M, Quabius ES. Relevance of Human Papillomaviruses in Head and Neck Cancer-What Remains in 2021 from a Clinician's Point of View? Viruses 2021; 13:v13061173. [PMID: 34207440 PMCID: PMC8235461 DOI: 10.3390/v13061173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022] Open
Abstract
Human papillomaviruses (HPV) cause a subset of head and neck cancers (HNSCC). HPV16 predominantly signs responsible for approximately 10% of all HNSCC and over 50% of tonsillar (T)SCCs. Prevalence rates depend on several factors, such as the geographical region where patients live, possibly due to different social and sexual habits. Smoking plays an important role, with non-smoking patients being mostly HPV-positive and smokers being mostly HPV-negative. This is of unparalleled clinical relevance, as the outcome of (non-smoking) HPV-positive patients is significantly better, albeit with standard and not with de-escalated therapies. The results of the first prospective de-escalation studies have dampened hopes that similar superior survival can be achieved with de-escalated therapy. In this context, it is important to note that the inclusion of p16INK4A (a surrogate marker for HPV-positivity) in the 8th TMN-classification has only prognostic, not therapeutic, intent. To avoid misclassification, highest precision in determining HPV-status is of utmost importance. Whenever possible, PCR-based methods, still referred to as the "gold standard”, should be used. New diagnostic antibodies represent some hope, e.g., to detect primaries and recurrences early. Prophylactic HPV vaccination should lead to a decline in HPV-driven HNSCC as well. This review discusses the above aspects in detail.
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Affiliation(s)
- Markus Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Christian-Albrechts-University Kiel, D24105 Kiel, Germany;
- Quincke-Forschungszentrum (QFZ), Medical Faculty, Christian-Albrechts-University Kiel, D24105 Kiel, Germany
- Correspondence: ; Tel.: +49-431-500-21701; Fax: +49-431-500-19028
| | - Elgar Susanne Quabius
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Christian-Albrechts-University Kiel, D24105 Kiel, Germany;
- Quincke-Forschungszentrum (QFZ), Medical Faculty, Christian-Albrechts-University Kiel, D24105 Kiel, Germany
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Reid P, Staudacher AH, Marcu LG, Olver I, Moghaddasi L, Brown MP, Li Y, Bezak E. Intrinsic Radiosensitivity Is Not the Determining Factor in Treatment Response Differences between HPV Negative and HPV Positive Head and Neck Cancers. Cells 2020; 9:E1788. [PMID: 32727072 PMCID: PMC7464531 DOI: 10.3390/cells9081788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/18/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCC) resulting from human papillomavirus (HPV) are increasing in incidence but demonstrate significantly better treatment response than HNSCC from other causes such as tobacco and alcohol. This study sought to identify differences in HNSCC, intrinsic to HPV status, in their response to radiation dose. Previously unexamined changes in radio-responsiveness following fractionated X-ray irradiation were compared between HPV positive and negative statuses of HNSCC. Six HNSCC cell lines, 3 of each HPV status, were investigated for radiosensitivity by clonogenic assay and modelled by response as a function of dose. Generational cultures of each cell line were developed to follow changes in radiosensitivity after repeated irradiations simulating fractionated radiation therapy. As a group, the HPV positive cell lines were more radiosensitive, but with changes following repeated fractions of dose, and modelling of response as a function of dose, both statuses displayed large radiobiological heterogeneity. These findings challenge current radiobiological assumptions of head and neck cancers as early responding tissue to radiation and may go some way in explaining difficulties reaching consensus in stratification of treatment by HPV status. Consequently, results from this study do not support stratifying radiation therapy by HPV status.
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Affiliation(s)
- Paul Reid
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (L.G.M.); (E.B.)
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia;
| | - Alexander H. Staudacher
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, SA 5000, Australia; (A.H.S.); (M.P.B.)
- School of Psychology, University of Adelaide, Adelaide, SA 5000, Australia;
| | - Loredana G. Marcu
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (L.G.M.); (E.B.)
- Faculty of Science, University of Oradea, 410087 Oradea, Romania
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, SA 5000, Australia;
| | - Leyla Moghaddasi
- Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia;
- Genesis Care, Adelaide Radiotherapy Centre, Adelaide, SA 5000, Australia
| | - Michael P. Brown
- Translational Oncology Laboratory, Centre for Cancer Biology, SA Pathology and University of South Australia, Adelaide, SA 5000, Australia; (A.H.S.); (M.P.B.)
- School of Medicine, University of Adelaide, Adelaide, SA 5000, Australia
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Yanrui Li
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia;
| | - Eva Bezak
- School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia; (L.G.M.); (E.B.)
- Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia;
- Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia;
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Hoffmann M, Tribius S. HPV and Oropharyngeal Cancer in the Eighth Edition of the TNM Classification: Pitfalls in Practice. Transl Oncol 2019; 12:1108-1112. [PMID: 31176088 PMCID: PMC6556492 DOI: 10.1016/j.tranon.2019.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/23/2022] Open
Abstract
This review is a call for mindfulness and precision when applying TNM 8 in oropharyngeal cancers. Implications, intentions, and weaknesses of TNM 8 are addressed in light of our own investigations and the published literature. In TNM 8, the impact of p16INK4A status on the staging of oropharyngeal SCC highlights i) that underlying evidence is scarce, ii) its stage grouping exclusively has prognostic intention, and iii) that a noncritical application of TNM 8 might negatively impact the patients' survival as the perception of TNM 8 as having therapeutic intention may lead to de-escalating treatment regimens in p16INK4A-positive cases, specifically when grouped into stage I despite the presence of neck metastasis. If other parameters from HPV positivity that also have a negative impact on the patient's survival, such as smoking or the presence of comorbidity, are neglected in therapy planning, survival outcomes might even become worse. Future studies applying TNM 8 and further investigating the value of p16INK4A as surrogate marker for active HPV infections will identify whether or not changes in TNM 8 should have therapeutic implications in HPV-associated, only p16INK4A-positive cases or whether this impact additionally holds true for nontonsillar cancers.
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Affiliation(s)
- Markus Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts University Kiel, Kiel, Germany.
| | - Silke Tribius
- Hermann-Holthusen-Institute for Radiation Oncology, Asklepios Hospital St. Georg, Hamburg, Germany.
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Persky MJ, Albergotti WG, Rath TJ, Kubik MW, Abberbock S, Geltzeiler M, Kim S, Duvvuri U, Ferris RL. Positive Margins by Oropharyngeal Subsite in Transoral Robotic Surgery for T1/T2 Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 158:660-666. [PMID: 29182490 DOI: 10.1177/0194599817742852] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective To compare positive margin rates between the 2 most common subsites of oropharyngeal transoral robotic surgery (TORS), the base of tongue (BOT) and the tonsil, as well as identify preoperative imaging characteristics that predispose toward positive margins. Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods We compared the final and intraoperative positive margin rate between TORS resections for tonsil and BOT oropharyngeal squamous cell carcinoma (OPSCC), as well as the effect of margins on treatment. A blinded neuroradiologist examined the preoperative imaging of BOT tumors to measure their dimensions and patterns of spread and provided a prediction of final margin results. Results Between January 2010 and May 2016, a total of 254 patients underwent TORS for OPSCC. A total of 140 patients who underwent TORS for T1/T2 OPSCC met inclusion criteria. A final positive margin is significantly more likely for BOT tumors than tonsil tumors (19.6% vs 4.5%, respectively, P = .004) and likewise for intraoperative margins of BOT and tonsil tumors (35.3% vs 12.4%, respectively; P = .002). A positive final margin is 10 times more likely to receive chemoradiation compared to a negative margin, controlling for extracapsular spread and nodal status (odds ratio, 9.6; 95% confidence interval, 1.6-59.6; P = .02). Preoperative imaging characteristics and subjective radiologic examination of BOT tumors did not correlate with final margin status. Conclusion Positive margins are significantly more likely during TORS BOT resections compared to tonsil resections. More research is needed to help surgeons predict which T1/T2 tumors will be difficult to completely extirpate.
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Affiliation(s)
- Michael J Persky
- 1 Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, USA
| | - William G Albergotti
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tanya J Rath
- 3 Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mark W Kubik
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shira Abberbock
- 4 Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Mathew Geltzeiler
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Singh AK, Mimikos C, Groman A, Dibaj S, Platek AJ, Cohan DM, Hicks WL, Gupta V, Arshad H, Kuriakose MA, Warren GW, Platek ME. Combined surgery and radiation improves survival of tonsil squamous cell cancers. Oncotarget 2017; 8:112442-112450. [PMID: 29348837 PMCID: PMC5762522 DOI: 10.18632/oncotarget.20122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/31/2017] [Indexed: 01/07/2023] Open
Abstract
Objective The study evaluated the addition of surgery (S) to radiation (RT) on survival of squamous cell carcinomas (SCC) of tonsillar-fossa (TF) in a modern cohort with similar epidemiology and treatment as current patients. Study Design Retrospective analysis utilizing Surveillance, Epidemiology, and End Results (SEER) Program data. Results For all stages combined TF patients who received S+RT had superior OS (p < 0.01) and DSS (p < 0.01). For each stage OS and DSS was superior for S+RT (p < 0.05). In multivariate analysis, HRs for OS were statistically significantly higher for TF patients (stage 2, 3, and 4) receiving RT alone (p < 0.001). Materials and Methods TF SCC patients treated with either S+RT or RT alone between 2004 and 2011 were examined (n = 6,476). Primary outcome measures included overall survival (OS) and disease specific survival (DSS). Cox proportional hazard ratios (HR) were estimated for patients treated with S+RT compared to RT alone. Conclusions OS and DSS were superior for all stages combined and for stages 2, 3, and 4 in TF patients who received S+RT compared to RT alone.
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Affiliation(s)
- Anurag K Singh
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Christina Mimikos
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Adrienne Groman
- Department of Biostatistics, Roswell Park Cancer Institute, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Shiva Dibaj
- Department of Biostatistics, Roswell Park Cancer Institute, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Alexis J Platek
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - David M Cohan
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Wesley L Hicks
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Vishal Gupta
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Hassan Arshad
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Moni A Kuriakose
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA.,Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC, USA
| | - Mary E Platek
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Health, Nutrition and Dietetics, Buffalo State College (SUNY), Buffalo, NY, USA
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Platek ME, Jayaprakash V, Gupta V, Cohan DM, Hicks WL, Winslow TB, Platek AJ, Groman A, Dibaj S, Arshad H, Kuriakose MA, Warren GW, Singh AK. Subsite variation in survival of oropharyngeal squamous cell carcinomas 2004 to 2011. Laryngoscope 2016; 127:1087-1092. [PMID: 27808409 DOI: 10.1002/lary.26369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate subsite-specific differences in survival between squamous cell carcinomas of the base of tongue and tonsillar fossa in a modern cohort likely to have been treated with intensity-modulated radiation therapy, chemotherapy for stage III and IV, and have had a high incidence of human papillomavirus-associated tumors. STUDY DESIGN Retrospective cohort analysis utilizing data from the Surveillance, Epidemiology, and End Results program of patients with base of tongue and tonsillar fossa squamous cell carcinoma from 2004 to 2011. METHODS The cohort included 15,299 primary base of tongue and tonsillar fossa squamous cell carcinoma patients without distant metastases treated between 2004 and 2011. Subsite differences in overall survival and disease-specific survival were examined with Kaplan-Meier curves. Multivariate cox proportional hazard ratios were estimated for overall and disease-specific survival. RESULTS The cohort included 7,220 (47.2%) base of tongue and 8,079 (52.8%) tonsillar fossa squamous cell carcinoma patients. Overall survival with all stages combined favored tonsillar fossa (P < .001) and remained superior when stratified by stage. In multivariate analyses adjusted for age, gender, race, and treatment, the hazard ratio for overall survival was superior for tonsillar fossa tumors compared to base of tongue tumors for all stages (stage 1, P = .041; stage 2, P = .006; stages 3 and 4, P < .001). Disease-specific survival also favored improved outcomes for tonsillar fossa. CONCLUSIONS In this large modern cohort, overall and disease-specific survival favored outcomes in tonsillar fossa compared with base of tongue. Further study is required to evaluate factors that influence survival differences between tonsillar fossa and base of tongue despite modern therapy. LEVEL OF EVIDENCE 4 Laryngoscope, 127:1087-1092, 2017.
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Affiliation(s)
- Mary E Platek
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Vijayvel Jayaprakash
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Vishal Gupta
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - David M Cohan
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Wesley L Hicks
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Timothy B Winslow
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Alexis J Platek
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Adrienne Groman
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Shiva Dibaj
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Hassan Arshad
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Moni A Kuriakose
- Department of Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Graham W Warren
- Department of Radiation Oncology and Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
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8
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Platek AJ, Jayaprakash V, Merzianu M, Platek ME, Cohan DM, Hicks WL, Marimuthu SP, Winslow TB, Gupta V, Arshad H, Kuriakose MA, Dibaj S, Marshall JR, Reid ME, Warren GW, Singh AK. Smoking cessation is associated with improved survival in oropharynx cancer treated by chemoradiation. Laryngoscope 2016; 126:2733-2738. [PMID: 27346612 DOI: 10.1002/lary.26083] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The effect of smoking and human papillomavirus (HPV) on overall survival (OS) of oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing concurrent chemotherapy (CCRT) remains unclear. STUDY DESIGN Retrospective review. METHODS Clinical characteristics of OPSCC patients treated between 2008 and 2015 with CCRT were abstracted from medical records. OS curves and multivariate cox proportional hazard ratios (HRs) were examined. RESULTS Of 120 evaluable patients, 71% had HPV+ tumors. Median follow-up duration for the entire cohort was 41.5 months (range = 6-88 months). HPV+ current smokers experienced significantly worse 5-year OS (73% alive vs. 36% alive, P = .01) and there was a similar trend in HPV- current smokers (66% alive vs. 31% alive, P = .28) compared to former/never smokers undergoing CCRT. In a multivariate cox proportional hazard model adjusted for age, gender, and overall tumor stage, HPV+ current smokers experienced nearly a fourfold increase in overall mortality in comparison to HPV+ never/former smokers (HR = 3.68, 95% CI = 1.35-10.0). Similarly, current smokers with HPV- tumors (HR = 6.80, 95% CI = 1.11-41.67) had increased mortality compared to never/former smokers. CONCLUSIONS Current smoking is associated with poor prognosis, independent of HPV status, in CCRT-treated OPSCC patients. Current smoking produced an approximately four- to sevenfold increase in risk of mortality for HPV+ and HPV- patients, respectively. Regardless of pack years and HPV status, efforts should be made to achieve smoking cessation before CCRT. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2733-2738, 2016.
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Affiliation(s)
- Alexis J Platek
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Vijayvel Jayaprakash
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Mihai Merzianu
- Pathology, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Mary E Platek
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - David M Cohan
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Wesley L Hicks
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Sathiya P Marimuthu
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Timothy B Winslow
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Vishal Gupta
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Hassan Arshad
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Moni A Kuriakose
- Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Shiva Dibaj
- Biostatistics, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - James R Marshall
- Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Mary E Reid
- Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A
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9
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Potential Diagnostic, Prognostic and Therapeutic Targets of MicroRNAs in Human Gastric Cancer. Int J Mol Sci 2016; 17:ijms17060945. [PMID: 27322246 PMCID: PMC4926478 DOI: 10.3390/ijms17060945] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/01/2016] [Accepted: 06/07/2016] [Indexed: 12/11/2022] Open
Abstract
Human gastric cancer (GC) is characterized by a high incidence and mortality rate, largely because it is normally not identified until a relatively advanced stage owing to a lack of early diagnostic biomarkers. Gastroscopy with biopsy is the routine method for screening, and gastrectomy is the major therapeutic strategy for GC. However, in more than 30% of GC surgical patients, cancer has progressed too far for effective medical resection. Thus, useful biomarkers for early screening or detection of GC are essential for improving patients’ survival rate. MicroRNAs (miRNAs) play an important role in tumorigenesis. They contribute to gastric carcinogenesis by altering the expression of oncogenes and tumor suppressors. Because of their stability in tissues, serum/plasma and other body fluids, miRNAs have been suggested as novel tumor biomarkers with suitable clinical potential. Recently, aberrantly expressed miRNAs have been identified and tested for clinical application in the management of GC. Aberrant miRNA expression profiles determined with miRNA microarrays, quantitative reverse transcription-polymerase chain reaction and next-generation sequencing approaches could be used to establish sample specificity and to identify tumor type. Here, we provide an up-to-date summary of tissue-based GC-associated miRNAs, describing their involvement and that of their downstream targets in tumorigenic and biological processes. We examine correlations among significant clinical parameters and prognostic indicators, and discuss recurrence monitoring and therapeutic options in GC. We also review plasma/serum-based, GC-associated, circulating miRNAs and their clinical applications, focusing especially on early diagnosis. By providing insights into the mechanisms of miRNA-related tumor progression, this review will hopefully aid in the identification of novel potential therapeutic targets.
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Dvoryaninova OY, Chainzonov EL, Litvyakov NV. [The clinical aspects of HPV-positive cancer of the oral cavity and oropharynx]. Vestn Otorinolaringol 2016; 81:72-77. [PMID: 27166483 DOI: 10.17116/otorino201681172-77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This review was designed to focus on the prevalence and the magnitude of infection with human papilloma virus (HPV) among healthy subjects and patients presenting with cancer of the oral cavity and oropharynx. We compare the data on the relative frequency of HPV-positive and HPV-negative cancer of the oral cavity and oropharynx in different populations, peculiarities of the clinical course of this pathology, and methods of its treatment. Much emphasis is placed on the specific clinical and morphological features of HPV-positive cancer of the oral cavity and oropharynx. The general and relapse-free survival rates are considered with special reference to the outcome and prognosis of this disease. The currently accepted approaches to the treatment of HPV-positive cancer of the oral cavity and oropharynx are discussed. It is concluded that HPV-positive cancer of the oral cavity and oropharynx should be regarded as an autonomous pathological condition requiring specific approaches to its management, such as the application of adequate treatment schemes and algorithms.
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Affiliation(s)
| | - E L Chainzonov
- Tomsk Research Institute of Oncology, Tomsk, Russia, 634050
| | - N V Litvyakov
- Tomsk Research Institute of Oncology, Tomsk, Russia, 634050; Tomsk National Research University, Tomsk, Russia, 634050
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Levovitz C, Chen D, Ivansson E, Gyllensten U, Finnigan JP, Alshawish S, Zhang W, Schadt EE, Posner MR, Genden EM, Boffetta P, Sikora AG. TGFβ receptor 1: an immune susceptibility gene in HPV-associated cancer. Cancer Res 2014; 74:6833-44. [PMID: 25273091 DOI: 10.1158/0008-5472.can-14-0602-t] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Only a minority of those exposed to human papillomavirus (HPV) develop HPV-related cervical and oropharyngeal cancer. Because host immunity affects infection and progression to cancer, we tested the hypothesis that genetic variation in immune-related genes is a determinant of susceptibility to oropharyngeal cancer and other HPV-associated cancers by performing a multitier integrative computational analysis with oropharyngeal cancer data from a head and neck cancer genome-wide association study (GWAS). Independent analyses, including single-gene, gene-interconnectivity, protein-protein interaction, gene expression, and pathway analysis, identified immune genes and pathways significantly associated with oropharyngeal cancer. TGFβR1, which intersected all tiers of analysis and thus selected for validation, replicated significantly in the head and neck cancer GWAS limited to HPV-seropositive cases and an independent cervical cancer GWAS. The TGFβR1 containing p38-MAPK pathway was significantly associated with oropharyngeal cancer and cervical cancer, and TGFβR1 was overexpressed in oropharyngeal cancer, cervical cancer, and HPV(+) head and neck cancer tumors. These concordant analyses implicate TGFβR1 signaling as a process dysregulated across HPV-related cancers. This study demonstrates that genetic variation in immune-related genes is associated with susceptibility to oropharyngeal cancer and implicates TGFβR1/TGFβ signaling in the development of both oropharyngeal cancer and cervical cancer. Better understanding of the immunogenetic basis of susceptibility to HPV-associated cancers may provide insight into host/virus interactions and immune processes dysregulated in the minority of HPV-exposed individuals who progress to cancer.
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Affiliation(s)
- Chaya Levovitz
- The Icahn School of Medicine at Mount Sinai, New York, New York. Department of Immunology, Icahn School of Medicine at Mount Sinai, New York, New York. Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dan Chen
- SciLifeLab Uppsala, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Emma Ivansson
- SciLifeLab Uppsala, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - Ulf Gyllensten
- SciLifeLab Uppsala, Rudbeck Laboratory, Uppsala University, Uppsala, Sweden
| | - John P Finnigan
- The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sara Alshawish
- The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Weijia Zhang
- Mount Sinai Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric E Schadt
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York. Mount Sinai Institute for Genomics and Multiscale Biology, New York, New York
| | - Marshal R Posner
- The Icahn School of Medicine at Mount Sinai, New York, New York. Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric M Genden
- The Icahn School of Medicine at Mount Sinai, New York, New York. Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. Department of Immunology, Genetics and Pathology, Tisch Cancer Institute, New York, New York
| | - Paolo Boffetta
- The Icahn School of Medicine at Mount Sinai, New York, New York. Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York. Department of Immunology, Genetics and Pathology, Tisch Cancer Institute, New York, New York
| | - Andrew G Sikora
- The Icahn School of Medicine at Mount Sinai, New York, New York. Department of Immunology, Icahn School of Medicine at Mount Sinai, New York, New York. Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York. Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. Department of Immunology, Genetics and Pathology, Tisch Cancer Institute, New York, New York.
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12
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Outcome and prognostic factors in T4a oropharyngeal carcinoma, including the role of HPV infection. BIOMED RESEARCH INTERNATIONAL 2014; 2014:390825. [PMID: 24800220 PMCID: PMC3988966 DOI: 10.1155/2014/390825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 01/24/2023]
Abstract
Background. The prognosis of patients with advanced oropharyngeal carcinoma (OPSCC) is generally poor. The aim of this study is to investigate the different therapeutic approaches and identify prognostic factors associated with a worse outcome for patients treated for T4a OPSCC, in order to improve treatment selection for the individual. Methods. A retrospective study was conducted on 426 patients with T4a OPC treated between 1980 and 2010. Eleven prognostic factors including treatment modality, lymph node staging, and p16 status as a surrogate marker for human papillomavirus (HPV) infection were analyzed. Results. Univariate analysis showed a significant difference in DSS between N0 and N+ (57.1% versus 26.9%, P < 0.001), primary surgical and primary nonsurgical treatment (52.7% versus 31.4%, P < 0.001), and perinodal invasion (51.7% versus 19.9%, P = 0.011). P16-negative patients tended towards a worse DSS than p16-positive patients (40.2% versus 64.6%, P = 0.126) but responded better to primary surgery than to nonsurgical treatment (71.4% versus 34.0%, P = 0.113). Multivariate analysis identified the N category as an independent prognostic factor for survival. Conclusion. The survival of p16-negative patients was worse than p16-positive patients, although they seem to respond better to primary surgery. The strongest independent prognostic factor for T4a carcinomas proved to be the presence of lymph node metastases.
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Orth M, Lauber K, Niyazi M, Friedl AA, Li M, Maihöfer C, Schüttrumpf L, Ernst A, Niemöller OM, Belka C. Current concepts in clinical radiation oncology. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2014; 53:1-29. [PMID: 24141602 PMCID: PMC3935099 DOI: 10.1007/s00411-013-0497-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/05/2013] [Indexed: 05/04/2023]
Abstract
Based on its potent capacity to induce tumor cell death and to abrogate clonogenic survival, radiotherapy is a key part of multimodal cancer treatment approaches. Numerous clinical trials have documented the clear correlation between improved local control and increased overall survival. However, despite all progress, the efficacy of radiation-based treatment approaches is still limited by different technological, biological, and clinical constraints. In principle, the following major issues can be distinguished: (1) The intrinsic radiation resistance of several tumors is higher than that of the surrounding normal tissue, (2) the true patho-anatomical borders of tumors or areas at risk are not perfectly identifiable, (3) the treatment volume cannot be adjusted properly during a given treatment series, and (4) the individual heterogeneity in terms of tumor and normal tissue responses toward irradiation is immense. At present, research efforts in radiation oncology follow three major tracks, in order to address these limitations: (1) implementation of molecularly targeted agents and 'omics'-based screening and stratification procedures, (2) improvement of treatment planning, imaging, and accuracy of dose application, and (3) clinical implementation of other types of radiation, including protons and heavy ions. Several of these strategies have already revealed promising improvements with regard to clinical outcome. Nevertheless, many open questions remain with individualization of treatment approaches being a key problem. In the present review, the current status of radiation-based cancer treatment with particular focus on novel aspects and developments that will influence the field of radiation oncology in the near future is summarized and discussed.
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Affiliation(s)
- Michael Orth
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Kirsten Lauber
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Anna A. Friedl
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Minglun Li
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Cornelius Maihöfer
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Lars Schüttrumpf
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Anne Ernst
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Olivier M. Niemöller
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
- Present Address: Clinic for Radiation Oncology, St. Elisabeth Hospital Ravensburg, Ravensburg, Germany
| | - Claus Belka
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-University of Munich, Munich, Germany
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Psychogios G, Mantsopoulos K, Agaimy A, Koch M, Zenk J, Waldfahrer F, Iro H. Prognostic factors in limited (T1-2, N0-1) oropharyngeal carcinoma treated with surgery ± adjuvant therapy. Head Neck 2013; 35:1752-8. [DOI: 10.1002/hed.23229] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2012] [Indexed: 11/08/2022] Open
Affiliation(s)
- Georgios Psychogios
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Abbas Agaimy
- Institute of Pathology; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Michael Koch
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Frank Waldfahrer
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
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Coughlan D, Frick KD. Economic impact of human papillomavirus-associated head and neck cancers in the United States. Otolaryngol Clin North Am 2012; 45:899-917. [PMID: 22793859 DOI: 10.1016/j.otc.2012.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cases of human papillomavirus (HPV)-associated head and neck cancers are rapidly increasing in the United States. Little is known about the economic burden of these cancers. A literature review identified 7 studies that characterized aspects of the overall economic burden of HPV-associated head and neck cancers in the United States. Other cost studies are detailed to highlight the clinical reality in treating these patients. As the clinical awareness of the role of HPV in head and neck cancers continues, the economic impact of cancers caused by this virus will have implications for the role of various preventive measures.
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Affiliation(s)
- Diarmuid Coughlan
- Department of Health Policy & Management, Johns Hopkins School of Public Health (JHSPH), 624 North Broadway Street, Baltimore, MD 21205, USA
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Erovic BM, Al Habeeb A, Harris L, Goldstein DP, Ghazarian D, Irish JC. Significant overexpression of the Merkel cell polyomavirus (MCPyV) large T antigen in Merkel cell carcinoma. Head Neck 2012; 35:184-9. [PMID: 22307956 DOI: 10.1002/hed.22942] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the expression pattern of the Merkel cell polyomavirus (MCPyV) large T-protein antigen in patients with Merkel cell carcinoma. METHODS A tissue microarray (TMA) containing 30 specimens was constructed and stained for the MCPyV large T protein. Immunohistochemical expression was determined semiquantitively and was compared to patients' outcome. RESULTS Nuclear expression of MCPyV large T protein was detected in 29 of 30 specimens (97%). In particular, 60% to 100%, 30% to 60%, and 10% to 30% of tumor cells were positive in 27 specimens (90%), 1 (3%), and 1 (3%), respectively. There was no difference in positivity between primary and metastatic lesions. Clinical data could not be correlated to MCPyV large T-protein expression. CONCLUSION MCPyV large T protein was significantly overexpressed in 97% of all specimens. Although we could not demonstrate a predictive effect, MCPyV large T protein may represent a molecular marker with utility in pathological diagnosis as well as a potential new therapeutic target in patients with Merkel cell carcinoma.
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Affiliation(s)
- Boban M Erovic
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada
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Sharma A, Méndez E, Yueh B, Lohavanichbutr P, Houck J, Doody DR, Futran ND, Upton MP, Schwartz SM, Chen C. Human papillomavirus-positive oral cavity and oropharyngeal cancer patients do not have better quality-of-life trajectories. Otolaryngol Head Neck Surg 2012; 146:739-45. [PMID: 22275190 DOI: 10.1177/0194599811434707] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine the role of human papillomavirus (HPV) status on quality of life (QOL) in patients with oral cavity and oropharyngeal squamous cell carcinoma (OSCC). Since OSCC that are associated with high-risk HPV have an improved response to treatment and survival, we hypothesized that patients with these tumors would have better QOL trajectories. STUDY DESIGN Prospective cohort study. SETTING Tertiary care academic medical center and 2 affiliated hospitals. SUBJECTS AND METHODS Head and neck-specific QOL was determined using the University of Washington Quality of Life scale version 4 in patients with newly diagnosed invasive OSSC (N = 228). RESULTS Pretreatment QOL was higher in patients with high-risk HPV-associated tumors compared with patients with HPV-negative or low-risk HPV-associated tumors (P = .015). Patients with high-risk HPV-associated tumors had larger decreases in QOL from pretreatment to immediate posttreatment compared with patients with HPV-negative or low-risk HPV-associated tumors (P = .041). There was no association between HPV status and 1-year posttreatment QOL. CONCLUSION Among OSCC patients, high-risk HPV-associated tumors were associated with higher pretreatment QOL and a larger decrease in QOL from pretreatment to immediate posttreatment, suggesting that treatment intensity in this unique population may adversely affect QOL.
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Affiliation(s)
- Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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Hunt JL. An update on molecular diagnostics of squamous and salivary gland tumors of the head and neck. Arch Pathol Lab Med 2011; 135:602-9. [PMID: 21526958 DOI: 10.5858/2010-0655-rair.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Molecular testing in anatomic pathology is becoming standardized and can contribute valuable diagnostic, therapeutic, and prognostic information for the clinical management of patients. In head and neck pathology, recent advances in molecular testing have provided important targets in several different diagnostic areas, with particular emerging clinical applications in squamous and salivary gland pathology. In squamous mucosal-derived lesions, human papilloma virus has emerged as an important pathogenic etiology in a subset of oropharyngeal squamous cell carcinomas. Within the category of salivary gland tumors, 3 tumors have recently been recognized that contain oncogenic translocations. OBJECTIVE To describe the current state of information about the molecular alterations in squamous lesions and in salivary gland tumors of the head and neck. DATA SOURCES Published literature on squamous and salivary gland tumors of the head and neck. CONCLUSIONS The different approaches to identification of viral-associated tumors include assays using polymerase chain reaction, in situ hybridization, and immunohistochemistry. Most mucoepidermoid carcinomas harbor MECT1-MAML2 gene rearrangement. The MYB-NFIB translocations have recently been identified in adenoid cystic carcinomas. Finally, a newly described tumor of salivary gland, mammary analogue secretory carcinoma, harbors the ETV6-NTRK3 translocation. Although these translocations are just emerging as diagnostic targets, future roles may evolve as potential therapeutic targets.
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Affiliation(s)
- Jennifer L Hunt
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
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Impact of HPV status on treatment of squamous cell cancer of the oropharynx: what we know and what we need to know. Cancer Lett 2011; 304:71-9. [PMID: 21376458 DOI: 10.1016/j.canlet.2011.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 02/02/2011] [Indexed: 11/21/2022]
Abstract
Studies report an increasing incidence of oropharyngeal cancers linked to infection by human papillomavirus (HPV). We reviewed trials assessing outcomes by HPV DNA status in patients with locally advanced oropharyngeal cancer. Seven of the eight studies identified showed significantly better survival in patients with HPV DNA-positive tumors vs. HPV DNA-negative tumors. The review also describes what needs to be defined regarding optimal treatments. Future trials should incorporate HPV DNA status as a risk determinant and explore treatments for high-risk patients needing therapy intensification, and low- and intermediate-risk patients needing treatment de-intensification to improve tolerability, without compromising survival.
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