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Barlow J, Gilja S, Ferrandino RM, Berger MH, Posner MR, Bakst RL, Khan MN, Teng MS, Genden EM, Chai RL, Roof SA. Evaluating human papillomavirus testing, prevalence, and association with prognosis in head and neck squamous cell carcinoma by subsite: A national cancer database study. Am J Otolaryngol 2024; 45:104243. [PMID: 38442460 DOI: 10.1016/j.amjoto.2024.104243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To compare human papillomavirus (HPV) testing, prevalence, and association with prognosis between head and neck squamous cell carcinoma (HNSCC) subsites. MATERIALS AND METHODS This study utilized the National Cancer Database (NCDB) to identify patients diagnosed with HNSCC between 2010 and 2017. Rates of HPV testing, HPV-positivity, and changes in these rates over time were measured by subsite. The impact of HPV-positivity on overall survival across six head and neck subsites was assessed using multivariable-adjusted Cox proportional hazards analysis. RESULTS A total of 121,550 patients were included. Of this cohort, 87,575 (72.1%) were tested for HPV, with the oropharynx (55,049/64,158; 85.8%) displaying the highest rates of testing and the sinonasal tract (1519/2853; 53.2%) displaying the lowest testing rates. Of the 86,136 with a definitive result, 46,878 (54.4%) were HPV-positive, with the oropharynx (40,313/54,205; 74.4%) displaying the highest rates of HPV-positivity and the oral cavity (1818/11,505; 15.8%) displaying the lowest. HPV-positive malignancy was associated with significantly improved adjusted overall survival in the oropharynx (HR = 0.42 [95% CI: 0.43-0.47]), oral cavity (HR = 0.86 [95% CI: 0.79-0.95]), sinonasal tract (HR = 0.63 [95% CI: 0.48-0.83]), larynx (HR = 0.78 [95% CI: 0.71-0.87]), and hypopharynx (HR = 0.56 [95% CI: 0.48-0.66]), but not the nasopharynx (HR = 0.93 [95% CI: 0.77-1.14]). CONCLUSION HPV testing rates were significantly lower in non-oropharyngeal subsites. This is relevant as HPV-associated disease displayed significantly improved overall survival in both the oropharynx and four of five non-oropharyngeal subsites. While validation with prospective studies is necessary, these findings may warrant HPV testing in all HNSCC subsites.
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Affiliation(s)
- Joshua Barlow
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
| | - Shivee Gilja
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Rocco M Ferrandino
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Michael H Berger
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Marshall R Posner
- Department of Hematology/Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Mohemmed N Khan
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Marita S Teng
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Eric M Genden
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Raymond L Chai
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Scott A Roof
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
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Tasoulas J, Farquhar DR, Sheth S, Hackman T, Yarbrough WG, Agala CB, Koric A, Giraldi L, Fabianova E, Lissowska J, Świątkowska B, Vilensky M, Wünsch-Filho V, de Carvalho MB, López RVM, Holcátová I, Serraino D, Polesel J, Canova C, Richiardi L, Zevallos JP, Ness A, Pring M, Thomas SJ, Dudding T, Lee YCA, Hashibe M, Boffetta P, Olshan AF, Divaris K, Amelio AL. Poor oral health influences head and neck cancer patient survival: an International Head and Neck Cancer Epidemiology Consortium pooled analysis. J Natl Cancer Inst 2024; 116:105-114. [PMID: 37725515 PMCID: PMC10777670 DOI: 10.1093/jnci/djad156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/07/2023] [Accepted: 08/02/2024] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Poor oral health has been identified as a prognostic factor potentially affecting the survival of patients with head and neck squamous cell carcinoma. However, evidence to date supporting this association has emanated from studies based on single cohorts with small-to-modest sample sizes. METHODS Pooled analysis of 2449 head and neck squamous cell carcinoma participants from 4 studies of the International Head and Neck Cancer Epidemiology Consortium included data on periodontal disease, tooth brushing frequency, mouthwash use, numbers of natural teeth, and dental visits over the 10 years prior to diagnosis. Multivariable generalized linear regression models were used and adjusted for age, sex, race, geographic region, tumor site, tumor-node-metastasis stage, treatment modality, education, and smoking to estimate risk ratios (RR) of associations between measures of oral health and overall survival. RESULTS Remaining natural teeth (10-19 teeth: RR = 0.81, 95% confidence interval [CI] = 0.69 to 0.95; ≥20 teeth: RR = 0.88, 95% CI = 0.78 to 0.99) and frequent dental visits (>5 visits: RR = 0.77, 95% CI = 0.66 to 0.91) were associated with better overall survival. The inverse association with natural teeth was most pronounced among patients with hypopharyngeal and/or laryngeal, and not otherwise specified head and neck squamous cell carcinoma. The association with dental visits was most pronounced among patients with oropharyngeal head and neck squamous cell carcinoma. Patient-reported gingival bleeding, tooth brushing, and report of ever use of mouthwash were not associated with overall survival. CONCLUSIONS Good oral health as defined by maintenance of the natural dentition and frequent dental visits appears to be associated with improved overall survival among head and neck squamous cell carcinoma patients.
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Affiliation(s)
- Jason Tasoulas
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Douglas R Farquhar
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Siddharth Sheth
- Division of Hematology/Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Trevor Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wendell G Yarbrough
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chris B Agala
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alzina Koric
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Luca Giraldi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Beata Świątkowska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Marta Vilensky
- Institute of Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires, Argentina
| | - Victor Wünsch-Filho
- Epidemiology Department, School of Public Health, University of São Paulo, São Paulo, Brazil
- Oncocentro Foundation of São Paulo, São Paulo, Brazil
| | | | | | - Ivana Holcátová
- Institute of Hygiene and Epidemiology, Charles University in Prague, Prague, Czech Republic
| | - Diego Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | | | - Jose P Zevallos
- Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh, PA, USA
| | - Andy Ness
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Miranda Pring
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Steve J Thomas
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Tom Dudding
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Yuan-Chin Amy Lee
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
- Department of Medical and Surgical Sciences, University of BolognaItaly
| | - Andrew F Olshan
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kimon Divaris
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Antonio L Amelio
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Vangelov B, Smee R, Moses D, Bauer J. Thoracic skeletal muscle index is effective for CT-defined sarcopenia evaluation in patients with head and neck cancer. Eur Arch Otorhinolaryngol 2023; 280:5583-5594. [PMID: 37573279 PMCID: PMC10620319 DOI: 10.1007/s00405-023-08162-y] [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: 03/30/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Computed tomography (CT)-defined sarcopenia, as a measurement of low skeletal muscle (SM), is a poor prognostic indicator in patients with head and neck cancer (HNC), independent of weight or nutritional status. We used SM measures at the second thoracic vertebra (T2) to determine T2-SM index (SMI) thresholds for sarcopenia, and investigate the impact of low T2-SMI on overall survival (OS), and weight loss during radiotherapy (RT). METHODS Adult patients with newly diagnosed HNC with a diagnostic PET-CT or RT planning CT scan were included. SM was analysed at T2 and a model applied to predict SM at L3. T2-SMI thresholds for sarcopenia were established with predicted measures, stratified by BMI and sex. Impact of sarcopenia and low T2-SMI on OS and weight loss during RT was investigated. RESULTS A total of 361 scans were analysed (84% males, 54% oropharynx tumours). Sarcopenia was found in 49%, demonstrating worse OS (p = 0.037). T2-SMI cutoff values were: females-74 cm2/m2 [area under the curve (AUC): 0.89 (95%CI 0.80-0.98)], males (BMI < 25)-63 cm2/m2 [AUC 0.93 (95%CI 0.89-0.96)], males (BMI ≥ 25)-88cm2/m2 [AUC 0.86 (95%CI 0.78-0.93)]. No difference in OS with T2-SMI categories. Lowest T2-SMI quartile of < 63 cm2/m2 demonstrated worse OS (p = 0.017). Weight loss during RT was higher in patients; who were not sarcopenic (6.2% vs 4.9%, p = 0.023); with higher T2-SMI (6.3% vs 4.9%, p = 0.014) and; in the highest quartiles (3.6% vs 5.7% vs 7.2%, p < 0.001). CONCLUSIONS These T2-SMI thresholds are effective in assessing CT-defined sarcopenia in HNC. Further assessment of clinical application is warranted.
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Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Services, Level 1, Bright Building, Avoca St, Randwick, NSW, 2031, Australia.
- School of Clinical Medicine, Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Randwick, NSW, 2031, Australia.
| | - Robert Smee
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Services, Level 1, Bright Building, Avoca St, Randwick, NSW, 2031, Australia
- School of Clinical Medicine, Randwick Campus, Faculty of Medicine and Health, University of New South Wales, Randwick, NSW, 2031, Australia
- Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, 2340, Australia
| | - Daniel Moses
- Graduate School of Biomedical Engineering, University of New South Wales, Randwick, NSW, 2031, Australia
- Department of Radiology, Prince of Wales Hospital and Community Health Services, Randwick, NSW, 2031, Australia
| | - Judith Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
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Patton LL, Helgeson ES, Brennan MT, Treister NS, Sollecito TP, Schmidt BL, Lin A, Chera BS, Lalla RV. Oral health-related quality of life after radiation therapy for head and neck cancer: the OraRad study. Support Care Cancer 2023; 31:286. [PMID: 37079106 PMCID: PMC11216743 DOI: 10.1007/s00520-023-07750-2] [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: 07/17/2022] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Head and neck cancer (HNC) treatment results in morbidity impacting quality of life (QOL) in survivorship. This analysis evaluated changes in oral health-related QOL (OH-QOL) up to 2 years after curative intent radiation therapy (RT) for HNC patients and factors associated with these changes. METHODS 572 HNC patients participated in a multicenter, prospective observational study (OraRad). Data collected included sociodemographic, tumor, and treatment variables. Ten single-item questions and 2 composite scales of swallowing problems and senses problems (taste and smell) from a standard QOL instrument were assessed before RT and at 6-month intervals after RT. RESULTS The most persistently impacted OH-QOL variables at 24 months included: dry mouth; sticky saliva, and senses problems. These measures were most elevated at the 6-month visit. Aspects of swallowing were most impacted by oropharyngeal tumor site, chemotherapy, and non-Hispanic ethnicity. Problems with senses and dry mouth were worse with older age. Dry mouth and sticky saliva increased more among men and those with oropharyngeal cancer, nodal involvement, and use of chemotherapy. Problems with mouth opening were increased by chemotherapy and were more common among non-White and Hispanic individuals. A 1000 cGy increase in RT dose was associated with a clinically meaningful change in difficulty swallowing solid food, dry mouth, sticky saliva, sense of taste, and senses problems. CONCLUSIONS Demographic, tumor, and treatment variables impacted OH-QOL for HNC patients up to 2 years after RT. Dry mouth is the most intense and sustained toxicity of RT that negatively impacts OH-QOL of HNC survivors. CLINICALTRIALS GOV IDENTIFIER NCT02057510; first posted February 7, 2014.
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Affiliation(s)
- Lauren L Patton
- Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, CB 7450, USA.
| | - Erika S Helgeson
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA
| | - Michael T Brennan
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
- Department of Otolaryngology/Head and Neck Surgery, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Nathaniel S Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA, 02120, USA
- Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, 02115, USA
| | - Thomas P Sollecito
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, 240 South 40Th Street, Philadelphia, PA, 19104, USA
- Division of Oral Medicine, University of Pennsylvania Health System, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Brian L Schmidt
- Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, New York, NY, 10010, USA
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, 101 Manning Drive, CB 7512, Chapel Hill, NC, 27599-7512, USA
- Department of Radiation Oncology, Hollings Cancer Center, Medical University South Carolina, 169 Ashley Ave. MSC 318, Charleston, SC, 29425, USA
| | - Rajesh V Lalla
- Section of Oral Medicine, MC3912, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT, 06030-3912, USA
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Kang JJ, Yu Y, Chen L, Zakeri K, Gelblum DY, McBride SM, Riaz N, Tsai CJ, Kriplani A, Hung T, Fetten JV, Dunn LA, Ho A, Boyle JO, Ganly IS, Singh B, Sherman EJ, Pfister DG, Wong RJ, Lee NY. Consensuses, controversies, and future directions in treatment deintensification for human papillomavirus-associated oropharyngeal cancer. CA Cancer J Clin 2023; 73:164-197. [PMID: 36305841 PMCID: PMC9992119 DOI: 10.3322/caac.21758] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 01/19/2023] Open
Abstract
The most common cancer caused by human papillomavirus (HPV) infection in the United States is oropharyngeal cancer (OPC), and its incidence has been rising since the turn of the century. Because of substantial long-term morbidities with chemoradiation and the favorable prognosis of HPV-positive OPC, identifying the optimal deintensification strategy for this group has been a keystone of academic head-and-neck surgery, radiation oncology, and medical oncology for over the past decade. However, the first generation of randomized chemotherapy deintensification trials failed to change the standard of care, triggering concern over the feasibility of de-escalation. National database studies estimate that up to one third of patients receive nonstandard de-escalated treatments, which have subspecialty-specific nuances. A synthesis of the multidisciplinary deintensification data and current treatment standards is important for the oncology community to reinforce best practices and ensure optimal patient outcomes. In this review, the authors present a summary and comparison of prospective HPV-positive OPC de-escalation trials. Chemotherapy attenuation compromises outcomes without reducing toxicity. Limited data comparing transoral robotic surgery (TORS) with radiation raise concern over toxicity and outcomes with TORS. There are promising data to support de-escalating adjuvant therapy after TORS, but consensus on treatment indications is needed. Encouraging radiation deintensification strategies have been reported (upfront dose reduction and induction chemotherapy-based patient selection), but level I evidence is years away. Ultimately, stage and HPV status may be insufficient to guide de-escalation. The future of deintensification may lie in incorporating intratreatment response assessments to harness the powers of personalized medicine and integrate real-time surveillance.
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Affiliation(s)
- Jung Julie Kang
- Yale University School of Medicine, Department of Therapeutic Radiology
| | - Yao Yu
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - Linda Chen
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - Kaveh Zakeri
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | | | | | - Nadeem Riaz
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - C. Jillian Tsai
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Tony Hung
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - James V. Fetten
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Lara A. Dunn
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Alan Ho
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Jay O. Boyle
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Ian S. Ganly
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Bhuvanesh Singh
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Eric J. Sherman
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | | | - Richard J. Wong
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Nancy Y. Lee
- Memorial Sloan Kettering Cancer Center, Department of Medicine
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Ramkumar SP, Simpson MC, Adjei Boakye E, Bukatko AR, Antisdel JL, Massa ST, Osazuwa-Peters N. High-risk human papillomavirus 16/18 associated with improved survival in sinonasal squamous cell carcinoma. Cancer 2023; 129:1372-1383. [PMID: 36808090 DOI: 10.1002/cncr.34690] [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: 11/16/2022] [Revised: 12/21/2022] [Accepted: 01/15/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND There has been conflicting evidence on the independent prognostic role of human papillomavirus (HPV) status in sinonasal cancer. The objective of this study was to assess whether the survival of patients with sinonasal cancer differs based on various HPV statuses, including HPV-negative, positive for the high-risk HPV-16 and HPV-18 (HPV16/18) subtypes, and positive for other high-risk and low-risk HPV subtypes. METHODS In this retrospective cohort study, data from the National Cancer Database were extracted from the years 2010-2017 for patients who had primary sinonasal cancer (N = 12,009). The outcome of interest was overall survival based on HPV tumor status. RESULTS Study included an analytic cohort of 1070 patients with sinonasal cancer who had confirmed HPV tumor status (732 [68.4%] HPV-negative; 280 [26.2%] HPV16/18-positive; 40 [3.7%] positive for other high-risk HPV; and 18 [1.7%] positive for low-risk HPV). HPV-negative patients had the lowest all-cause survival probability at 5 years postdiagnosis (0.50). After controlling for covariates, HPV16/18-positive patients had a 37% lower mortality hazard than HPV-negative patients (adjusted hazard ratio, 0.63; 95% confidence interval [CI], 0.48-0.82). Patients aged 64-72 years (crude prevalence ratio, 0.66; 95% CI, 0.51-0.86) and 73 years and older (crude prevalence ratio, 0.43; 95% CI, 0.31-0.59) presented with lower rates of HPV16/18-positive sinonasal cancer than those aged 40-54 years. In addition, Hispanic patients had a 2.36 times higher prevalence of non-HPV16/18 sinonasal cancer than non-Hispanic White patients. CONCLUSIONS These data suggest that, for patients with sinonasal cancer, HPV16/18-positive disease may confer a significant survival advantage compared with HPV-negative disease. Other high-risk and low-risk HPV subtypes have survival rates similar to the rates for HPV-negative disease. HPV status might be an important independent prognostic factor in sinonasal cancer that could be used in patient selection and clinical decisions.
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Affiliation(s)
- Shreya P Ramkumar
- St Louis University School of Medicine, St Louis, Missouri, USA.,Department of Otolaryngology Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri, USA
| | - Matthew C Simpson
- Department of Otolaryngology Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri, USA
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA.,Department of Otolaryngology Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Jastin L Antisdel
- Department of Otolaryngology Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri, USA
| | - Sean T Massa
- Department of Otolaryngology Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina, USA.,Duke Cancer Institute, Duke University, Durham, North Carolina, USA
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7
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Yamamoto V, Wang B, Lee AS. Suppression of head and neck cancer cell survival and cisplatin resistance by GRP78 small molecule inhibitor YUM70. Front Oncol 2023; 12:1044699. [PMID: 36713577 PMCID: PMC9875086 DOI: 10.3389/fonc.2022.1044699] [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: 09/14/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
Background Head and neck squamous cell carcinoma (HNSCC) is one of the leading causes of cancer-related death worldwide. Surgical resection, radiation and chemotherapy are the mainstay of HNSCC treatment but are often unsatisfactory. Cisplatin is a commonly used chemotherapy in HNSCC; however, cisplatin resistance is a major cause of relapse and death. The 78-kD glucose-regulated protein (GRP78) is the master regulator of the unfolded protein response (UPR) and is implicated in therapeutic resistance in cancer. The role of GRP78 in cisplatin resistance in HNSCC remains unclear. YUM70 is a newly discovered hydroxyquinoline analogue and found to be an inhibitor of GRP78. The effect of YUM70 in HNSCC cell lines is unknown. Method Knockdown of GRP78 by siRNAs was performed to investigate the effect of GRP78 reduction in endoplasmic reticulum (ER)-stress induced and general apoptosis. Western blots examining apoptotic markers were performed on three HPV-negative HNSCC cell lines. WST-1 assay was performed to determine cell viability. In reverse, we utilized AA147, an ER proteostasis regulator to upregulate GRP78, and apoptotic markers and cell viability were determined. To test the ability of YUM70 to reverse cisplatin resistance, cisplatin-resistant HNSCC cell lines were generated by prolonged, repeated exposure to increasing concentrations of cisplatin. Colony formation assay using the cisplatin-resistant HNSCC cell line was performed to assess the in vitro reproductive cell survival. Furthermore, to test the ability of YUM70 to reverse cisplatin resistance in a physiologically relevant system, we subjected the 3D spheroids of the cisplatin-resistant HNSCC cell line to cisplatin treatment with or without YUM70 and monitored the onset of apoptosis. Results Reduction of GRP78 level induced HNSCC cell death while GRP78 upregulation conferred higher resistance to cisplatin. Combined cisplatin and YUM70 treatment increased apoptotic markers in the cisplatin-resistant HNSCC cell line, associating with reduced cell viability and clonogenicity. The combination treatment also increased apoptotic markers in the 3D spheroid model. Conclusion The GRP78 inhibitor YUM70 reduced HNSCC cell viability and re-sensitized cisplatin-resistant HNSCC cell line in both 2D and 3D spheroid models, suggesting the potential use of YUM70 in the treatment of HNSCC, including cisplatin-resistant HNSCC.
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Affiliation(s)
- Vicky Yamamoto
- Department of Biochemistry and Molecular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, United States,USC Norris Comprehensive Cancer Center, Los Angeles, CA, United States
| | - Bintao Wang
- Department of Biochemistry and Molecular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | - Amy S. Lee
- Department of Biochemistry and Molecular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, United States,USC Norris Comprehensive Cancer Center, Los Angeles, CA, United States,*Correspondence: Amy S. Lee,
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8
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Yang Y, Feng L, Wang R, Ma H, He S, Fang J. Integrated analysis of lncRNA-associated ceRNA network in p16-positive and p16-negative head and neck squamous cell carcinoma. Medicine (Baltimore) 2022; 101:e26120. [PMID: 35984201 PMCID: PMC9388012 DOI: 10.1097/md.0000000000026120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Determination of human papillomavirus (HPV) status has become clinically relevant for head and neck squamous cell carcinoma (HNSCC) patients. p16 immunohistochemistry is one of the recommended methods for classifying HPV status. However, long noncoding RNAs (lncRNAs) and related competing endogenous RNA (ceRNA) networks linked to different p16-status HNSCC are still absent. In the present study, The Cancer Genome Atlas database provided RNA profiles as well as clinical information from 26 p16-positive HNSCC samples, 71 p16-negative HNSCC samples, and 44 adjacent normal control samples. Differentially expressed RNAs (DERNAs) between HNSCC samples and normal samples were identified by limma package in R. Functional enrichment analysis of differentially expressed mRNAs was performed using Clusterprofiler package in R. Survival analysis of DERNAs was carried out by survival package in R. The ceRNA network was constructed using GDCRNATools package in R. A total of 102 lncRNAs, 196 microRNAs (miRNAs), and 2282 mRNAs were identified as p16-positive-specific DERNAs. There were 90 lncRNAs, 153 miRNAs, and 2038 mRNAs were identified as p16-negative-specific DERNAs. Functional enrichment analysis revealed that the differentially expressed mRNAs in the p16-positive and the p16-negative group were mainly enriched in the "DNA replication" and "extracellular matrix -receptor interaction" pathway, respectively. Among the top 25 DERNAs, there were 1 key lncRNA, 1 key miRNA, and 1 key messenger RNA in the p16-positive group and 2 key lncRNAs, 1 key miRNA, and 2 key mRNAs in the p16-negative group were significantly related to the overall survival. Then the ceRNA network in the p16-positive and p16-negative group was constructed. There were 5 lncRNAs, 16 miRNAs, and 66 mRNAs included in the p16-positive group ceRNA network and 1 lncRNA, 4 miRNAs, and 28 mRNAs included in the p16-negative group ceRNA network. Among the RNAs in the ceRNA network, 5 mRNAs were significantly related to the overall survival. Taken together, we revealed the differential RNA expression profiling and the differential ceRNA network in the p16-positive and p16-negative group of HNSCC. Our findings provided a novel insight into this HPV-related cancer and potential biomarkers and therapeutic targets for HNSCC based on p16 status.
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Affiliation(s)
- Yifan Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Ling Feng
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Ru Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Hongzhi Ma
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Shizhi He
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, People's Republic of China
| | - Jugao Fang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
- Key Laboratory of Otolaryngology Head and Neck Surgery (Ministry of Education of China), Beijing Institute of Otolaryngology, Beijing, People's Republic of China
- Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, People's Republic of China
- *Correspondence: Jugao Fang, Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, NO.1 Dongjiaominxiang Street, Dongcheng District, Beijing 100730, People's Republic of China (e-mail: )
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9
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Scott-Wittenborn N, D'Souza G, Tewari S, Rooper L, Troy T, Drake V, Bigelow EO, Windon MJ, Ryan WR, Ha PK, Kiess AP, Miles B, Westra WH, Mydlarz WK, Eisele DW, Fakhry C. Prevalence of human papillomavirus in head and neck cancers at tertiary care centers in the United States over time. Cancer 2022; 128:1767-1774. [PMID: 35132635 PMCID: PMC9007835 DOI: 10.1002/cncr.34124] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/30/2021] [Accepted: 01/04/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is responsible for a growing proportion of oropharyngeal squamous cell carcinomas (OPSCCs) among men and White individuals. Whether similar trends apply to women, non‐Whites, and non‐oropharyngeal squamous cell carcinomas (non‐OPSCCs) is unknown. METHODS This is a cross‐sectional analysis combining 2 multi‐institutional case series of incident head and neck squamous cell carcinoma (HNSCC) cases. Incident HNSCCs from 1995 to 2012 were enrolled retrospectively using banked tumor samples and medical record abstraction. Incident HNSCCs from 2013 to 2019 were enrolled prospectively. The prevalence of tumor HPV biomarkers was tested over 3 time periods (1995‐2003, 2004‐2012, and 2013‐2019). Centralized testing was done for p16 immunohistochemistry (p16) and oncogenic HPV in situ hybridization (ISH). RESULTS A total of 1209 incident cases of HNSCC were included. Prevalence of p16‐ and ISH‐positive tumors increased significantly for oropharynx cancers over time. The majority were positive after 2013 for White patients (p16, 92%; P < .001; ISH 94%; P < .001), Black patients (p16, 72%; P = .021; ISH 67%; P = .011), and Hispanic patients (p16, 100%; P = .04; ISH 100%; P = .013). For women with OPSCC, the prevalence of p16‐ and ISH‐positive tumors increased significantly to 82% (P < .001) and 78% (P = .004), respectively. For non‐OPSCCs, there was increased p16 and ISH positivity overall with 24% p16 and 16% ISH positivity in the most recent time period (P < .001 for both). CONCLUSIONS The majority of OPSCCs in US tertiary care centers are now p16 and ISH positive for all sex and race groups. In some populations in the United States, 91% of OPSCCs are now caused by HPV. Few non‐OPSCCs are p16 and ISH positive. This study evaluates the prevalence of p16 and in situ hybridization positivity in head and neck cancers over time. This study shows an increase in prevalence over time among women and non‐Whites, 2 groups that are understudied in the epidemiology of human papillomavirus.
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Affiliation(s)
| | - Gypsyamber D'Souza
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sakshi Tewari
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa Rooper
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Tanya Troy
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Virginia Drake
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Elaine O Bigelow
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Melina J Windon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Ana P Kiess
- Department of Radiation Oncology and Molecular Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - William H Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Wojciech K Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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10
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Epidemiology and Prevention of HPV-Associated Squamous Cell Carcinoma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00385-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Patel EJ, Oliver JR, Jacobson AS, Li Z, Hu KS, Tam M, Vaezi A, Morris LGT, Givi B. Human Papillomavirus in Patients With Hypopharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2022; 166:109-117. [PMID: 33845656 DOI: 10.1177/01945998211004586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/03/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Assess the testing rates and prognostic significance of human papilloma virus (HPV) status in hypopharynx malignancies. STUDY DESIGN Historical cohort study. SETTING National Cancer Database. METHODS Review of the National Cancer Database was conducted between 2010 and 2017 for squamous cell carcinomas (SCCs) of the hypopharynx. We investigated how often the tumors were tested for HPV and whether it was associated with survival outcomes. RESULTS A total of 13,269 patients with hypopharynx malignancies were identified. Most cases were not tested for HPV status (n = 8702, 65.6%). Of those tested, 872 (19.1%) were positive for HPV and 3695 (80.9%) were negative. The proportion of nonoropharyngeal SCCs tested for HPV increased nearly every year during the study, with roughly one-third of cases (31.9%) being tested in 2017. In the facilities classified as high-testing centers of nonoropharyngeal SCCs of the head and neck, 18.7% of hypopharyngeal tumors were HPV positive. HPV-negative status was associated with worse survival on multivariable analysis. In propensity score-matched analysis controlling for all factors significant in multivariable regression, 2-year survival remained higher in the HPV-positive cohort (77.7% vs 63.1%, P < .001). CONCLUSIONS HPV-positive tumors constitute a sizable minority of hypopharynx tumors and are associated with improved survival. Expansion of HPV testing to hypopharynx malignancies may be warranted.
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Affiliation(s)
- Evan J Patel
- Department of Otolaryngology-Head and Neck Surgery, NYU School of Medicine, New York, New York, USA
| | - Jamie R Oliver
- Department of Otolaryngology-Head and Neck Surgery, NYU School of Medicine, New York, New York, USA
| | - Adam S Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU School of Medicine, New York, New York, USA
| | - Zujun Li
- Department of Medical Oncology, NYU School of Medicine, New York, New York, USA
| | - Kenneth S Hu
- Department of Radiation Oncology, NYU School of Medicine, New York, New York, USA
| | - Moses Tam
- Department of Radiation Oncology, NYU School of Medicine, New York, New York, USA
| | - Alec Vaezi
- Department of Otolaryngology-Head and Neck Surgery, NYU School of Medicine, New York, New York, USA
| | - Luc G T Morris
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Babak Givi
- Department of Otolaryngology-Head and Neck Surgery, NYU School of Medicine, New York, New York, USA
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12
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Sichero L, Tagliabue M, Mota G, Ferreira S, Nunes RAL, Castañeda CA, Castillo M, Correa RM, Perdomo S, Rodríguez-Urrego PA, Matos LL, Mohssen A, Gheit T, Tommasino M, Chiocca S, Villa LL. Biomarkers of human papillomavirus (HPV)-driven head and neck cancer in Latin America and Europe study: Study design and HPV DNA/p16 INK4a status. Head Neck 2022; 44:122-133. [PMID: 34726297 DOI: 10.1002/hed.26912] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/02/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-driven head/neck squamous cell carcinomas (HNSCC) prevalence varies globally. We evaluated HPV DNA and p16INK4a in formalin fixed paraffin embedded (FFPE) HNSCC from Argentina, Brazil, Colombia, and Peru. METHODS HPV was genotyped by PCR-hybridization. All HPV DNA positive and some HPV DNA negative cases underwent p16INK4a immunohistochemistry. RESULTS HPV DNA was detected in 32.8%, 11.1%, and 17.8% of oropharyngeal (OPC), oral cavity (OCC) and laryngeal (LC) cancers, respectively. OPC HPV prevalence was higher in Colombia (94.7%), and Argentina (42.6%) compared to Brazil (10.6%) and Peru (0.0%). HPV-16 was the most detected. Other HPVs were found in LC. Higher rates of p16INK4a positivity were observed among HPV positive OPC/OCC cases compared to LC cases. CONCLUSIONS Our results support a role for HPV-16 in a subset of HNSCC, corroborate the heterogeneity observed in samples from different countries, and contribute additional etiological and biomarkers information in tumors of significant impact worldwide.
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Affiliation(s)
- Laura Sichero
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo FMUSP HC, Sao Paulo, Brazil
| | - Marta Tagliabue
- Division of Otolaryngology - Head and Neck Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Giana Mota
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo FMUSP HC, Sao Paulo, Brazil
| | - Silvaneide Ferreira
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo FMUSP HC, Sao Paulo, Brazil
| | - Rafaella A L Nunes
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo FMUSP HC, Sao Paulo, Brazil
| | - Carlos Arturo Castañeda
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Universidad Cientifica del Sur, Lima, Peru
| | - Miluska Castillo
- Department of Research, Instituto Nacional de Enfermedades Neoplásicas, Universidad Cientifica del Sur, Lima, Peru
| | - Rita Mariel Correa
- Servicio Virus Oncogénicos, Instituto Nacional de Enfermedades Infecciosas-ANLIS "Dr. Malbrán", Buenos Aires, Argentina
| | - Sandra Perdomo
- University Hospital Foundation Santa Fe de Bogotá, Bogotá, Colombia
- Genomic Epidemiology Branch, International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Leandro Luongo Matos
- Department of Head and Neck Surgery, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Ansarin Mohssen
- Division of Otolaryngology - Head and Neck Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer (IARC), Lyon, France
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer (IARC), Lyon, France
| | - Susanna Chiocca
- Department of Experimental Oncology, IRCCS European Institute of Oncology, Milan, Italy
| | - Luisa Lina Villa
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo FMUSP HC, Sao Paulo, Brazil
- Department of Radiology and Oncology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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13
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Zhu G, Amin N, Herberg ME, Maroun CA, Wang H, Guller M, Gourin CG, Rooper LM, Vosler PS, Tan M, D'Souza G, Koch WM, Eisele DW, Seiwert TY, Fakhry C, Pardoll DM, Mandal R. Association of Tumor Site With the Prognosis and Immunogenomic Landscape of Human Papillomavirus-Related Head and Neck and Cervical Cancers. JAMA Otolaryngol Head Neck Surg 2021; 148:70-79. [PMID: 34792560 DOI: 10.1001/jamaoto.2021.3228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Human papillomavirus (HPV)-positive status in patients with oropharyngeal squamous cell carcinoma (OPSCC) is associated with improved survival compared with HPV-negative status. However, it remains controversial whether HPV is associated with improved survival among patients with nonoropharyngeal and cervical squamous cell tumors. Objective To investigate differences in the immunogenomic landscapes of HPV-associated tumors across anatomical sites (the head and neck and the cervix) and their association with survival. Design, Setting, and Participants This cohort study used genomic and transcriptomic data from the Cancer Genome Atlas (TCGA) for 79 patients with OPSCC, 435 with nonoropharyngeal head and neck squamous cell carcinoma (non-OP HNSCC), and 254 with cervical squamous cell carcinoma and/or endocervical adenocarcinoma (CESC) along with matched clinical data from TCGA. The data were analyzed from November 2020 to March 2021. Main Outcomes and Measures Positivity for HPV was classified by RNA-sequencing reads aligned with the HPV reference genome. Gene expression profiles, immune cell phenotypes, cytolytic activity scores, and overall survival were compared by HPV tumor status across multiple anatomical sites. Results The study comprised 768 patients, including 514 (66.9%) with HNSCC (380 male [73.9%]; mean [SD] age, 59.5 [10.8] years) and 254 (33.1%) with CESC (mean [SD] age, 48.7 [14.1] years). Human papillomavirus positivity was associated with a statistically significant improvement in overall survival for patients with OPSCC (adjusted hazard ratio [aHR], 0.06; 95% CI, 0.02-0.17; P < .001) but not for those with non-OP HNSCC (aHR, 0.64; 95% CI, 0.31-1.27; P = .20) or CESC (aHR, 0.50; 95% CI, 0.15-1.67; P = .30). The HPV-positive OPSCCs had increased tumor immune infiltration and immunomodulatory receptor expression compared with HPV-negative OPSCCs. Compared with HPV-positive non-OP HNSCCs, HPV-positive OPSCCs showed greater expression of immune-related metrics including B cells, T cells, CD8+ T cells, T-cell receptor diversity, B-cell receptor diversity, and cytolytic activity scores, independent of tumor variant burden. The immune-related metrics were similar when comparing HPV-positive non-OP HNSCCs and HPV-positive CESCs with their HPV-negative counterparts. The 2-year overall survival rate was significantly higher for patients with HPV-positive OPSCC compared with patients with HPV-negative OPSCC (92.0% [95% CI, 84.8%-99.9%] vs 45.8% [95% CI, 28.3%-74.1%]; HR, 0.10 [95% CI, 0.03-0.30]; P = .009). Conclusions and Relevance In this cohort study, tumor site was associated with the immune landscape and survival among patients with HPV-related tumors despite presumed similar biologic characteristics. These tumor site-related findings provide insight on possible outcomes of HPV positivity for tumors in oropharyngeal and nonoropharyngeal sites and a rationale for the stratification of HPV-associated tumors by site and the subsequent development of strategies targeting immune exclusion in HPV-positive nonoropharyngeal cancer.
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Affiliation(s)
- Gangcai Zhu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Neha Amin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Matthew E Herberg
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Christopher A Maroun
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Hao Wang
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Meytal Guller
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Lisa M Rooper
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Peter S Vosler
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Marietta Tan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Wayne M Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Tanguy Y Seiwert
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Drew M Pardoll
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Rajarsi Mandal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Bloomberg-Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
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14
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Sharma A, Tang AL, Takiar V, Wise-Draper TM, Langevin SM. Human Papillomavirus and Survival of Sinonasal Squamous Cell Carcinoma Patients: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13153677. [PMID: 34359578 PMCID: PMC8345036 DOI: 10.3390/cancers13153677] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/05/2021] [Accepted: 07/17/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary Human papillomavirus (HPV) has been associated with multiple cancers in the anogenital and upper aerodigestive tracts. In the head and neck region, HPV-positive cancers are common in oropharynx, with rising incidence and a well-established association with more favorable patient outcomes. However, the relationship with prognosis of sinonasal squamous cell carcinoma (SNSCC) has been much less often studied and is presently unclear. To better elucidate this relationship, we performed a systematic review and meta-analysis of the biomedical literature to determine the aggregate effect across studies. In doing so, we observed significantly better overall survival associated with HPV-positive SNSCC. Therefore, we conclude that HPV testing may be useful for determining patient prognosis and potentially guiding treatment decisions. Abstract Human papillomavirus (HPV) is detectable in a subset of sinonasal squamous cell carcinoma (SNSCC), but the impact on patient outcomes is presently unclear due to a modest number of studies with limited statistical power. Therefore, we conducted a systematic review and meta-analysis to better clarify this relationship. A PubMed search was conducted to identify all studies reporting on overall (OS) or disease-free survival (DFS) for SNSCC by HPV status. Hazard ratios (HR) and corresponding 95% confidence intervals (CI) were extracted or, when not provided, indirectly estimated from each manuscript. Summary survival curves for 5-year OS and estimating survival probability by HPV status at pre-specified time intervals from study-specific Kaplan-Meier curves generated 2-year DFS. Log HRs and log CIs were combined across studies to generate summary estimates and a corresponding 95% CIs for OS and DFS. We identified ten unique studies reporting on OS and four for DFS. We observed a significant association between HPV and OS (summary HR = 0.51, 95% CI: 0.38–0.70) with relatively low heterogeneity between studies. These results indicate that HPV is a significant predictor of more favorable survival for SNSCC, and thus may be a useful biomarker for prognostication and, potentially, treatment modulation.
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Affiliation(s)
- Anish Sharma
- Medical Sciences Program, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Alice L. Tang
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
- University of Cincinnati Cancer Center, Cincinnati, OH 45267, USA; (V.T.); (T.M.W.-D.)
| | - Vinita Takiar
- University of Cincinnati Cancer Center, Cincinnati, OH 45267, USA; (V.T.); (T.M.W.-D.)
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Cincinnati VA Medical Center, Cincinnati, OH 45220, USA
| | - Trisha M. Wise-Draper
- University of Cincinnati Cancer Center, Cincinnati, OH 45267, USA; (V.T.); (T.M.W.-D.)
- Department of Internal Medicine, Division of Hematology & Oncology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Scott M. Langevin
- University of Cincinnati Cancer Center, Cincinnati, OH 45267, USA; (V.T.); (T.M.W.-D.)
- Department of Environmental & Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Correspondence:
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15
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Campo F, Zocchi J, Moretto S, Mazzola F, Petruzzi G, Donà MG, Benevolo M, Iocca O, De Virgilio A, Pichi B, Manciocco V, Pellini R. Cell-Free Human Papillomavirus-DNA for Monitoring Treatment Response of Head and Neck Squamous Cell Carcinoma: Systematic Review and Meta-Analysis. Laryngoscope 2021; 132:560-568. [PMID: 34236084 DOI: 10.1002/lary.29739] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to assess the value of cell-free human papillomavirus-DNA (cfHPV-DNA) as a diagnostic test for the post-treatment surveillance of patients with HPV-positive head and neck squamous cell carcinoma (HNSCC) through a systematic review and meta-analysis. STUDY DESIGN Systematic review and meta-analysis. METHODS A literature search was conducted in three databases (MEDLINE, Embase, and Scopus) in January 2021. The population included patients with HPV-positive HNSCC. The intervention was the use of the repeated liquid biopsy with circulating HPV-DNA detection during follow-up. The outcome was to establish the value of cfHPV-DNA as a diagnostic test for the post-treatment surveillance of patients with HPV-positive HNSCC. RESULTS Ten studies included in the meta-analysis provided a total of 457 patients with HPV-positive HNSCC. The meta-analytic study estimated the diagnostic performance of cfHPV-DNA as follows: pooled sensitivity and specificity of 0.65 (95% confidence interval [CI]: 0.40-0.84) and 0.99 (99% CI: 0.96-0.99), respectively; positive and negative likelihood ratios of 62.5 (99% CI: 22.9-170.2) and 0.05 (99% CI: 0.013-0.24), respectively; and pooled diagnostic odds ratio of 371.66 (99% CI: 60.4-2286.7). CONCLUSION Currently, the follow-up protocol for HNSCC patients includes routine clinical evaluation and radiological imaging. Biomarkers to monitor this disease are not established. Considering its high specificity, cfHPV-DNA represents a potential confirmatory test in the case of positive positron emission tomography and computed tomography. In the near future, cfHPV-DNA could be used as a biomarker for monitoring the treatment response during the clinical trials of de-escalation therapy or immunotherapy. Larger sample sizes and the homologation of study protocols and methodology are needed to better establish its utility in the clinical practice. Laryngoscope, 2021.
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Affiliation(s)
- Flaminia Campo
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Silvia Moretto
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Francesco Mazzola
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Maria G Donà
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Maria Benevolo
- Department of Pathology, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Oreste Iocca
- Division of Maxillofacial Surgery, Surgical Science Department, University of Torino, Torino, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Barbara Pichi
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Valentina Manciocco
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
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16
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Adesina A, Olufemi E, Oluwatosin O, Kayode O, Babatunde A, Babalola C, Michael G. Do Health-Seeking Populations Know the Link Between Human Papillomavirus and Oropharyngeal Cancer? A Cross-Sectional Study in a Nigerian Population. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 43:153-160. [PMID: 33818212 DOI: 10.1177/0272684x211006616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The human papillomavirus (HPV) has been causally linked to oropharyngeal cancers. The extent to which the population is aware of this link has not been explored in Nigeria. We aim to investigate the knowledge of the link between HPV and oropharyngeal cancers in a health-seeking population in Nigeria.Methodology: We used a cross-sectional study design, with a multi-stage sampling method comprising a cluster of four health facilities and first-time adult patients attending the general outpatient clinics of the selected health facilities. An interviewer-administered questionnaire was be used to obtain demographic information, social history, HPV awareness, HPV vaccination and the link between HPV and oropharyngeal cancer. RESULTS A total of 1,000 respondents completed the survey from four health facilities in Lagos, Nigeria. Majority of respondents were below 40 years (61.5%), and female (53.4%). About 13.4% of the study population were aware of HPV, and 7.9% of HPV vaccines. The most common source of HPV information for respondents who were aware of HPV was the internet (65.4%). Only 7.7% of respondents knew the link between HPV and oropharyngeal cancer. Significant predictors of knowledge of the link between HPV and oropharyngeal cancer were higher education [p: 0.012], higher overall knowledge of HPV risk factors and complications [p: 0.000]; and awareness of HPV vaccine [p: 0.020]. CONCLUSIONS Our findings suggest a lack of public knowledge of the link between HPV and oropharyngeal cancer. These findings could inform health promotion measures for oropharyngeal cancer, particularly for groups where knowledge is lowest.
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Affiliation(s)
- Ayodele Adesina
- Department of Oral and Maxillofacial Surgery, General Hospital Odan, Lagos State, Nigeria
| | - Erinoso Olufemi
- Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital, Lagos State, Nigeria
| | - Odukoya Oluwatosin
- Department of Oral and Maxillofacial Surgery, General Hospital Odan, Lagos State, Nigeria
| | - Obigbesan Kayode
- Department of Oral and Maxillofacial Surgery, General Hospital Odan, Lagos State, Nigeria
| | - Alli Babatunde
- Faculty of Dental Sciences, McGill University, Montreal, Canada
| | - Castano Babalola
- Department of Oral and Maxillofacial Surgery, General Hospital Odan, Lagos State, Nigeria
| | - Gbotolorun Michael
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos State, Nigeria
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17
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de Lima NRB, de Souza Junior FG, Roullin VG, Pal K, da Silva ND. Head and Neck Cancer Treatments from Chemotherapy to Magnetic Systems: Perspectives and Challenges. Curr Radiopharm 2021; 15:2-20. [PMID: 33511961 DOI: 10.2174/1874471014999210128183231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cancer is one of the diseases causing society's fears as a stigma of death and pain. Head and Neck Squamous Cell Carcinoma (HNSCC) is a group of malignant neoplasms of different locations in this region of the human body. It is one of the leading causes of morbidity and mortality in Brazil, because these malignant neoplasias, in most cases, are diagnosed in late phases. Surgical excision, chemotherapy and radiotherapy encompass the forefront of antineoplastic therapy; however, the numerous side effects associated with these therapeutic modalities are well known. Some treatments present enough potential to help or replace conventional treatments, such as Magnetic Hyperthermia and Photodynamic Therapy. Such approaches require the development of new materials at the nanoscale, able to carry out the loading of their active components while presenting characteristics of biocompatibility mandatory for biomedical applications. OBJECTIVE This work aims to make a bibliographical review of HNSCC treatments. Recent techniques proven effective in other types of cancer were highlighted and raised discussion and reflections on current methods and possibilities of enhancing the treatment of HNSCC. METHOD The study was based on a bibliometric research between the years 2008 and 2019 using the following keywords: Cancer, Head and Neck Cancer, Chemotherapy, Radiotherapy, Photodynamic Therapy, and Hyperthermia. RESULTS A total of 5.151.725 articles were found, 3.712.670 about cancer, 175.470 on Head and Neck Cancer, 398.736 on Radiotherapy, 760.497 on Chemotherapy, 53.830 on Hyperthermia, and 50.522 on Photodynamic Therapy. CONCLUSION The analysis shows that there is still much room for expanding research, especially for alternative therapies since most of the studies still focus on conventional treatments and on the quest to overcome their side effects. The scientific community needs to keep looking for more effective therapies generating fewer side effects for the patient. Currently, the so-called alternative therapies are being used in combination with the conventional ones, but the association of these new therapies shows great potential, in other types of cancer, to improve the treatment efficacy.
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Affiliation(s)
- Nathali R B de Lima
- Biopolymer & Sensors Lab. - Instituto de Macromoléculas Professora Eloisa Mano, Centro de Tecnologia-Cidade Universitária, Av. Horacio Macedo, 2030, bloco J. Universidade Federal de Rio de Janeiro, Zip code 21941-909,. Brazil
| | - Fernando G de Souza Junior
- Biopolymer & Sensors Lab. - Instituto de Macromoléculas Professora Eloisa Mano, Centro de Tecnologia-Cidade Universitária, Av. Horacio Macedo, 2030, bloco J. Universidade Federal de Rio de Janeiro, Zip code 21941-909,. Brazil
| | - Valérie G Roullin
- Faculté de Pharmacie Université de Montréal, Pavillon Jean-Coutu, 2940 chemin de la polytechnique Montreal QC, H3T 1J4,. Canada
| | - Kaushik Pal
- Wuhan University, Hubei Province, 8 East Lake South Road. Wuchang 430072,. China
| | - Nathalia D da Silva
- Programa de Engenharia da Nanotecnologia, COPPE, Centro de Tecnologia-Cidade Universitária, Av. Horacio Macedo, 2030, bloco I. Universidade Federal de Rio de Janeiro,. Brazil
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18
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Sheth S, Farquhar DR, Lenze NR, Mazul A, Brennan P, Anantharaman D, Abedi-Ardekani B, Zevallos JP, Hayes DN, Olshan F. Decreased overall survival in black patients with HPV-associated oropharyngeal cancer. Am J Otolaryngol 2021; 42:102780. [PMID: 33152576 PMCID: PMC7988501 DOI: 10.1016/j.amjoto.2020.102780] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Racial disparities for overall survival (OS) in head and neck cancer have been well described. However, the extent to which these disparities exist for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC), and the contribution of demographic, clinical, and socioeconomic status (SES) variables, is unknown. MATERIALS AND METHODS Patients were identified from the Carolina Head and Neck Cancer Epidemiology Study (CHANCE), a population-based study in North Carolina. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for OS in black versus white patients with sequential adjustment sets. RESULTS A total of 157 HPV-associated OPSCC patients were identified. Of these, 93% were white and 7% were black. Black patients with HPV-associated OPSCC were more likely to be younger, have an income <$20,000, live farther away from clinic where biopsy was performed, and have advanced T stage at diagnosis. Black patients had worse OS in the unadjusted analysis (HR 4.9, 95% CI 2.2-11.1, p < 0.0001). The racial disparity in OS slightly decreased when sequentially adjusting for demographic, clinical, and SES variables. However, HR for black race remained statistically elevated in the final adjustment set which controlled for age, sex, stage, smoking, alcohol use, and individual-level household income, insurance, and education level (HR 3.4, 95% CI 1.1-10.1, p = 0.028). CONCLUSION This is the first population-based study that confirms persistence of racial disparities in HPV-associated OPSCC after controlling for demographic, clinical, and individual-level socioeconomic factors.
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Affiliation(s)
- Siddharth Sheth
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Douglas R Farquhar
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Nicholas R Lenze
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Angela Mazul
- Department of Otolaryngology, Washington University in Saint Louis, School of Medicine, St. Louis, MO 63110, USA
| | - Paul Brennan
- International Agency for Research on Cancer, France
| | | | | | - Jose P Zevallos
- Department of Otolaryngology, Washington University in Saint Louis, School of Medicine, St. Louis, MO 63110, USA
| | - D Neil Hayes
- Department of Medicine, Division of Hematology-Oncology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; UTHSC Center for Cancer Research, University of Tennessee, Memphis, TN 38163, USA
| | - F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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19
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Ju X, Canfell K, Smith M, Sethi S, Garvey G, Hedges J, Logan RM, Antonsson A, Jamieson LM. High-Risk Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma Among Non-Indigenous and Indigenous Populations: A Systematic Review. Otolaryngol Head Neck Surg 2020; 165:23-32. [PMID: 33228443 DOI: 10.1177/0194599820975042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To estimate the prevalence of oral high-risk human papillomavirus (hr-HPV) infection and the proportion of hr-HPV-related oropharyngeal squamous cell carcinoma (OPSCC) among Indigenous and non-Indigenous populations. DATA SOURCE Electronic database searches of PubMed, PubMed Central, Embase, MEDLINE, Scope, and Google Scholar were conducted for articles published from January 2000 until November 2019. REVIEW METHODS Studies were included with a minimum of 100 cases assessing hr-HPV infection in either population samples or oropharyngeal cancer tumor series. The objective was to conduct meta-analyses to calculate the pooled prevalence of oral hr-HPV infection by adjusting for age group or sex in primary studies, the incidence of OPSCC, and the proportion of hr-HPV-related OPSCC in Indigenous people and non-Indigenous/general populations. RESULTS We identified 47 eligible studies from 157 articles for meta-analyses. The pooled prevalence of oral hr-HPV infection was 7.494% (95% CI, 5.699%-9.289%) in a general population, with a higher prevalence among men (10.651%) than women (5.176%). The pooled incidence rate was 13.395 (95% CI, 9.315-17.475) and 7.206 (95% CI, 4.961-9.450) per 100,000 person-years in Indigenous and non-Indigenous populations, respectively. The overall pooled proportion of hr-HPV-related OPSCC was 50.812% (95 CI, 41.656%-59.969%). The highest proportion was in North America (60.221%), while the lowest proportion was in the Asia-Pacific (34.246%). CONCLUSION Our findings suggest that in the general population, the prevalence of oral hr-HPV infection is lower among females and those in younger age groups. The incidence of OPSCC was higher among Indigenous than non-Indigenous populations, with the proportion being highest in North America.
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Affiliation(s)
- Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Karen Canfell
- Cancer Council NSW, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Megan Smith
- Cancer Council NSW, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sneha Sethi
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Gail Garvey
- Menzies School of Health Research, Spring Hill, Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Richard M Logan
- Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Annika Antonsson
- QIMR Berghofer Medical Research Institute, Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
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20
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Swartz JE, Wegner I, Noorlag R, van Kempen PMW, van Es RJJ, de Bree R, Willems SMW. HIF-1a expression and differential effects on survival in patients with oral cavity, larynx, and oropharynx squamous cell carcinomas. Head Neck 2020; 43:745-756. [PMID: 33155375 DOI: 10.1002/hed.26530] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hypoxia is a negative prognostic factor in head and neck squamous cell carcinomas. Under hypoxia, the hypoxia-inducible factor (HIF)-1a transcription factor is overexpressed. We investigated whether there were site differences in HIF-1a expression and its effect on patient outcomes per subsite. DESIGN/METHOD A total of 941 patients with HNSCC in the squamous cell carcinoma of the oropharynx (OPSCC, n = 302), oral cavity (OSCC, n = 391), or larynx (LSCC, n = 248) were included. Expression of HIF-1a in tissue samples was investigated using immunohistochemistry. Overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were analyzed. RESULTS HIF-1a expression was higher in OSCC than in LSCC and OPSCC. High HIF-1a expression led to worse prognosis in OPSCC (OS P = .029, DFS P = .085) and LSCC (OS P = .041, DFS P = .011) and better in OSCC (OS P = .055, DFS P = .012). There was no association between HIF-1a and LRC. CONCLUSIONS High HIF-1a expression is related to poor outcome in OPSCC and LSCC and better outcome in OSCC.
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Affiliation(s)
- Justin E Swartz
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rob Noorlag
- Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pauline M W van Kempen
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Robert J J van Es
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Oral and Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Stefan M W Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
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21
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Dwedar RA, Omar NM, Eissa SAL, Badawy AYA, El-Kareem DA, Ahmed Madkour LAEF. Diagnostic and prognostic impact of E6/E7 mRNA compared to HPV DNA and p16 expression in head and neck cancers: an Egyptian study. ALEXANDRIA JOURNAL OF MEDICINE 2020. [DOI: 10.1080/20905068.2020.1827944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Reham Ali Dwedar
- Department of Microbiology and Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha Mohamed Omar
- Department of Microbiology and Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Dalia Abd El-Kareem
- Department of Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
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22
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Fernández-Mateos J, Pérez-García J, Seijas-Tamayo R, Mesía R, Rubió-Casadevall J, García-Girón C, Iglesias L, Carral Maseda A, Adansa Klain JC, Taberna M, Vazquez S, Gómez MA, Del Barco E, Ocana A, González-Sarmiento R, Cruz-Hernández JJ. Oncogenic driver mutations predict outcome in a cohort of head and neck squamous cell carcinoma (HNSCC) patients within a clinical trial. Sci Rep 2020; 10:16634. [PMID: 33024167 PMCID: PMC7539152 DOI: 10.1038/s41598-020-72927-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022] Open
Abstract
234 diagnostic formalin-fixed paraffin-embedded (FFPE) blocks from homogeneously treated patients with locally advanced head and neck squamous cell carcinoma (HNSCC) within a multicentre phase III clinical trial were characterised. The mutational spectrum was examined by next generation sequencing in the 26 most frequent oncogenic drivers in cancer and correlated with treatment response and survival. Human papillomavirus (HPV) status was measured by p16INK4a immunohistochemistry in oropharyngeal tumours. Clinicopathological features and response to treatment were measured and compared with the sequencing results. The results indicated TP53 as the most mutated gene in locally advanced HNSCC. HPV-positive oropharyngeal tumours were less mutated than HPV-negative tumours in TP53 (p < 0.01). Mutational and HPV status influences patient survival, being mutated or HPV-negative tumours associated with poor overall survival (p < 0.05). No association was found between mutations and clinicopathological features. This study confirmed and expanded previously published genomic characterization data in HNSCC. Survival analysis showed that non-mutated HNSCC tumours associated with better prognosis and lack of mutations can be identified as an important biomarker in HNSCC. Frequent alterations in PI3K pathway in HPV-positive HNSCC could define a promising pathway for pharmacological intervention in this group of tumours.
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Affiliation(s)
- Javier Fernández-Mateos
- Medical Oncology Service, University Hospital of Salamanca-IBSAL, 37007, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), SACYL-University of Salamanca-CSIC, 37007, Salamanca, Spain.,Molecular Medicine Unit-IBSAL, Department of Medicine, University of Salamanca, 37007, Salamanca, Spain.,Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-CSIC, 37007, Salamanca, Spain
| | - Jéssica Pérez-García
- Molecular Medicine Unit-IBSAL, Department of Medicine, University of Salamanca, 37007, Salamanca, Spain.,Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-CSIC, 37007, Salamanca, Spain
| | - Raquel Seijas-Tamayo
- Medical Oncology Service, University Hospital of Salamanca-IBSAL, 37007, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), SACYL-University of Salamanca-CSIC, 37007, Salamanca, Spain
| | - Ricard Mesía
- Medical Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Universitat de Barcelona, IDIBELL, 08908, Barcelona, Spain
| | | | - Carlos García-Girón
- Medical Oncology Service, Hospital Universitario de Burgos, 09006, Burgos, Spain
| | - Lara Iglesias
- Medical Oncology Service, Hospital Universitario 12 de Octubre, 28041, Madrid, Spain
| | | | - Juan Carlos Adansa Klain
- Medical Oncology Service, University Hospital of Salamanca-IBSAL, 37007, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), SACYL-University of Salamanca-CSIC, 37007, Salamanca, Spain
| | - Miren Taberna
- Medical Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Universitat de Barcelona, IDIBELL, 08908, Barcelona, Spain
| | - Silvia Vazquez
- Medical Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Universitat de Barcelona, IDIBELL, 08908, Barcelona, Spain
| | | | - Edel Del Barco
- Medical Oncology Service, University Hospital of Salamanca-IBSAL, 37007, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), SACYL-University of Salamanca-CSIC, 37007, Salamanca, Spain
| | - Alberto Ocana
- Hospital Clínico San Carlos, IdISSC, CIBERONC, 28040, Madrid, Spain.,Centro Regional de Investigaciones Biomédicas, Universidad de Castilla La Mancha, 13071, Albacete, Spain
| | - Rogelio González-Sarmiento
- Biomedical Research Institute of Salamanca (IBSAL), SACYL-University of Salamanca-CSIC, 37007, Salamanca, Spain. .,Molecular Medicine Unit-IBSAL, Department of Medicine, University of Salamanca, 37007, Salamanca, Spain. .,Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-CSIC, 37007, Salamanca, Spain.
| | - Juan Jesús Cruz-Hernández
- Medical Oncology Service, University Hospital of Salamanca-IBSAL, 37007, Salamanca, Spain. .,Biomedical Research Institute of Salamanca (IBSAL), SACYL-University of Salamanca-CSIC, 37007, Salamanca, Spain. .,Molecular Medicine Unit-IBSAL, Department of Medicine, University of Salamanca, 37007, Salamanca, Spain. .,Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-CSIC, 37007, Salamanca, Spain.
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23
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Evolving Profile of HPV-Driven Oropharyngeal Squamous Cell Carcinoma in a National Cancer Institute in Italy: A 10-Year Retrospective Study. Microorganisms 2020; 8:microorganisms8101498. [PMID: 33003378 PMCID: PMC7599861 DOI: 10.3390/microorganisms8101498] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 11/17/2022] Open
Abstract
Globally, 30% of oropharyngeal carcinomas (OPSCC) are caused by Human Papillomavirus (HPV). Recently, increasing incidence trends for HPV-driven OPSCC have been reported in many countries and changes in the typical HPV-positive OPSCC patient have been recorded, with an increase in the median age and diagnoses in women. We investigated the characteristics of the OPSCC patients attending an Italian Cancer Institute from 2010 to 2019 and assessed possible changes overtime of demographic, behavioral, and clinico-pathologic variables of HPV-driven OPSCC. Overall, 339 OPSCCs were evaluated. HPV-DNA and p16 positivity were 48.7% and 55.2%, respectively, with an HPV-driven fraction (i.e., HPV-DNA+/p16+) of 48.3%. We observed a significant increase overtime in the rate of HPV-associated cases (53.7% in 2015–2019 vs. 40.3% in 2010–2014, p = 0.019). The rate of HPV-driven cases was significantly higher among women, never smokers, patients with T1–T2 tumors, and with nodal involvement. A trend was also observed toward an increase in HPV-driven OPSCCs among patients >61 years, women, former smokers, and patients with no nodal involvement in 2015–2019. Our findings consolidate the observation that HPV-associated OPSCCs are also increasing in Italy. Moreover, they suggest that the profile of the HPV-driven OPSCC patient might be changing.
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24
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Augustin JG, Lepine C, Morini A, Brunet A, Veyer D, Brochard C, Mirghani H, Péré H, Badoual C. HPV Detection in Head and Neck Squamous Cell Carcinomas: What Is the Issue? Front Oncol 2020; 10:1751. [PMID: 33042820 PMCID: PMC7523032 DOI: 10.3389/fonc.2020.01751] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Besides classic tobacco and alcohol risk factors, human papillomavirus (HPV) plays a role in the development of a subset of head and neck squamous cell carcinomas (HNSCCs), and notably oropharynx squamous cell carcinomas (OPSCCs). HPV-induced OPSCCs have a different biological behavior and a better prognosis compared to non-HPV-induced OPSCCs and the eighth-edition TNM classification now separates these two entities. Therefore, determining the HPV status of patients with OPSCC is now essential for treatment, prognosis, and development of clinical trials. In this review, after reminding essential steps of HPV implication in the cell cycle, we describe the existing tools that are currently feasible in routine practice according to facilities available in health structures, with their benefits and drawbacks: HPV PCR, E6/E7 mRNA RT-PCR, E6/E7 mRNA in situ hybridization, HPV DNA in situ hybridization, and P16 immunochemistry. Besides these traditional HPV detection tools, novel diagnostic approaches are being evaluated for HPV-induced OPSCC “ultrastaging.” E6 humoral response and ddPCR-detecting HPVct DNA are two techniques performed on blood and are therefore non-invasive. Baseline E6 humoral levels could have a prognostic value, and HPVct DNA could be helpful for HPV OPSCC recurrence monitoring. At last, next-generation sequencing (NGS)-based “capture HPV” is a technique feasible on biopsies and circulating DNA material. It helps characterize HPV integration status and sites, and it could define prognostic subgroups in HPV-induced OPSCC. These novel precision detection tools could be further integrated in the care of patients with HPV-induced OPSCC.
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Affiliation(s)
| | - Charles Lepine
- Department of Pathology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France.,INSERM U970, Université de Paris, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France
| | - Aurelien Morini
- Department of Pathology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - Anais Brunet
- Department of Pathology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - David Veyer
- Department of Virology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - Camille Brochard
- Department of Pathology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - Haitham Mirghani
- Department of Head and Neck Surgery, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - Hélène Péré
- INSERM U970, Université de Paris, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France.,Department of Virology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France
| | - Cécile Badoual
- Department of Pathology, European Georges Pompidou Hospital, APHP, Université de Paris, Paris, France.,INSERM U970, Université de Paris, Paris, France.,Equipe Labellisée Ligue Contre le Cancer, Paris, France
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Stanford-Moore GB, Ochoa E, Larson A, Han M, Hoppe K, Ryan WR. Patterns of Nodal Metastases and Predictors of Occult Disease in HPV-Associated Oropharynx Cancer. Otolaryngol Head Neck Surg 2020; 164:624-630. [PMID: 32894979 DOI: 10.1177/0194599820951473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE For human papilloma virus-associated oropharynx squamous cell carcinoma (HPV+ OPSCC), we evaluated the distribution of neck-level lymph node (LN) metastasis, based on postsurgical histopathology, and the incidence of and risk factors for occult LN metastases, as these patterns need clarification for this newer cancer subset. STUDY DESIGN Retrospective cohort study. SETTING National Cancer Database (NCDB). METHODS We analyzed 2358 patients in the NCDB with HPV+ OPSCC who underwent neck dissection (ND) from 2010 to 2015. Incidence and distribution of LN metastases were calculated for neck levels I to V. Variables associated with occult LN metastasis were assessed by multivariate logistic regression. RESULTS In therapeutic NDs (n = 1935), the following proportions of positive LNs were found: level I, 9.0% (n = 175); level II, 81.0% (n = 1568); level III, 29.6% (n = 573); level IV, 11.9% (n = 230); and level V, 4.9% (n = 95). In elective NDs (n = 423), occult-positive LNs were found in 35.8% (n = 152), with the following proportions by level: level I, 3.3% (n = 14); level II, 26.9% (n = 114); level III, 8.7% (n = 37); level IV, 4.0% (n = 17); and level V, 0.2% (n = 1). The presence of occult LNs was independently associated with a Charlson-Deyo score of 1 (odds ratio, 2.26; 95% CI, 1.18-4.31; P = .014) and lymphovascular invasion (odds ratio, 5.91; 95% CI, 3.21-11.18; P < .001). Occult LN metastases were not significantly associated with pT classification, primary site, or number of LNs resected. CONCLUSION For HPV+ OPSCC, occult nodal disease is common. Therapeutic NDs should encompass at least levels II, III, and IV and possibly I, whereas elective NDs could possibly encompass levels II and III. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - Edgar Ochoa
- School of Medicine, University of California-San Francisco, California, USA
| | - Andrew Larson
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, California, USA
| | - Mary Han
- School of Medicine, University of California-San Francisco, California, USA
| | - Kathryn Hoppe
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, California, USA
| | - William R Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, California, USA
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Five- and ten-year survival of squamous cell carcinoma of the head and neck in northern Thailand: a multivariate analysis. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractAim:To report 5- and 10-year overall survival (OS) outcomes of squamous cell carcinoma of the head and neck and identify prognostic factors.Methods:Data on 2,095 patients at Maharaj Nakorn Chiang Mai Hospital, Thailand between 2007 and 2014 were analysed using the Kaplan–Meyer method to estimate 5- and 10-year OS rates. Cox proportional hazard regression models were applied to assess the independent prognostic factors of survival.Results:8·7% had hypopharyngeal cancer, 19·7% laryngeal, 53·3% oral cavity and 18·3% oropharyngeal. Two-thirds of the patients had locally advanced stage (III–IVB). Five- and ten-year OS rates were 30·1 and 22·8%, respectively.Conclusions:Cancer site, stage and age at diagnosis were associated with mortality, highlighting the importance of prevention and early detection.
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Stevenson A, Wakeham K, Pan J, Kavanagh K, Millan D, Bell S, McLellan D, Graham SV, Cuschieri K. Droplet digital PCR quantification suggests that higher viral load correlates with improved survival in HPV-positive oropharyngeal tumours. J Clin Virol 2020; 129:104505. [PMID: 32604039 DOI: 10.1016/j.jcv.2020.104505] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although HPV-positive oropharyngeal cancer (OPC) patients have improved prognosis compared to HPV negative patients; there remains an HPV-positive group who have poor outcomes. Biomarkers to stratify discrete patient outcomes are thus desirable. Our objective was to analyse viral load (VL) by droplet digital PCR (ddPCR), in HPV-positive patients with OPC on whom clinical outcome data were available. METHODS In a cohort of patients that had previously tested HPV positive via conventional PCR, VL was determined using ddPCR assays for HPV16 L1 and E6 genes. VL was classed as "medium/high" if more than 5.57 copies or 8.68 copies of the HPV 16 L1 or E6 gene were detected respectively. Effect of VL on overall survival and hazard of death & disease progression was performed with adjustments made for sex, age, deprivation, smoking, alcohol consumption and stage. RESULTS L1 VL ranged from 0.0014-304 gene copies per cell with a mean of 30.9; comparatively E6 VL ranged from 0.0012-356 copies per cell with a mean of 37.9. Univariate analysis showed those with a medium/high VL had a lower hazard of death; this was significant for L1 (p = 0.02) but not for E6 (p = 0.67). The ratio of E6 to L1 deviated from n = 1 in most samples but had no influence on clinical outcomes. CONCLUSIONS HPV viral load may be informative for the further stratification of clinical outcomes in HPV positive OPC patients.
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Affiliation(s)
- A Stevenson
- Centre for Virus Research, Institute of Infection Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - J Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - D Millan
- Department of Pathology, The Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - S Bell
- Department of Pathology, The Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - D McLellan
- Department of Pathology, The Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - S V Graham
- Centre for Virus Research, Institute of Infection Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - K Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK.
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Casarotto M, Fanetti G, Guerrieri R, Palazzari E, Lupato V, Steffan A, Polesel J, Boscolo-Rizzo P, Fratta E. Beyond MicroRNAs: Emerging Role of Other Non-Coding RNAs in HPV-Driven Cancers. Cancers (Basel) 2020; 12:cancers12051246. [PMID: 32429207 PMCID: PMC7281476 DOI: 10.3390/cancers12051246] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
Persistent infection with high-risk Human Papilloma Virus (HPV) leads to the development of several tumors, including cervical, oropharyngeal, and anogenital squamous cell carcinoma. In the last years, the use of high-throughput sequencing technologies has revealed a number of non-coding RNA (ncRNAs), distinct from micro RNAs (miRNAs), that are deregulated in HPV-driven cancers, thus suggesting that HPV infection may affect their expression. However, since the knowledge of ncRNAs is still limited, a better understanding of ncRNAs biology, biogenesis, and function may be challenging for improving the diagnosis of HPV infection or progression, and for monitoring the response to therapy of patients affected by HPV-driven tumors. In addition, to establish a ncRNAs expression profile may be instrumental for developing more effective therapeutic strategies for the treatment of HPV-associated lesions and cancers. Therefore, this review will address novel classes of ncRNAs that have recently started to draw increasing attention in HPV-driven tumors, with a particular focus on ncRNAs that have been identified as a direct target of HPV oncoproteins.
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Affiliation(s)
- Mariateresa Casarotto
- Division of Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081 Aviano (PN), Italy; (M.C.); (R.G.); (A.S.)
| | - Giuseppe Fanetti
- Division of Radiotherapy, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081 Aviano (PN), Italy; (G.F.); (E.P.)
| | - Roberto Guerrieri
- Division of Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081 Aviano (PN), Italy; (M.C.); (R.G.); (A.S.)
| | - Elisa Palazzari
- Division of Radiotherapy, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081 Aviano (PN), Italy; (G.F.); (E.P.)
| | - Valentina Lupato
- Division of Otolaryngology, General Hospital “Santa Maria degli Angeli”, 33170 Pordenone, Italy;
| | - Agostino Steffan
- Division of Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081 Aviano (PN), Italy; (M.C.); (R.G.); (A.S.)
| | - Jerry Polesel
- Division of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081 Aviano (PN), Italy;
| | - Paolo Boscolo-Rizzo
- Section of Otolaryngology, Department of Neurosciences, University of Padova, 31100 Treviso, Italy;
| | - Elisabetta Fratta
- Division of Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, National Cancer Institute, 33081 Aviano (PN), Italy; (M.C.); (R.G.); (A.S.)
- Correspondence: ; Tel.: +390434659569
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Special Issue about Head and Neck Cancers: HPV Positive Cancers. Int J Mol Sci 2020; 21:ijms21093388. [PMID: 32403287 PMCID: PMC7246980 DOI: 10.3390/ijms21093388] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022] Open
Abstract
The oropharynx has become the leading primary site for Human Papilloma Virus (HPV)-associated head and neck cancer. HPV positive oropharyngeal squamous cell carcinoma (HPV+ OSCC) has emerged as an epidemic not easily recognized by many physicians, resulting in delays in diagnosis and management. HPV+ OSCC traditionally refers to younger, healthier patients with high economic status and high-risk sexual behavior and is related to improved prognosis. De-intensification strategies are being evaluated in ongoing clinical trials and if validated, might help spare severe morbidity associated with current cisplatin-based chemoradiotherapy, which is the standard of care for all patients with locally advanced head and neck cancer. On the other hand, whether HPV status represents an important prognostic factor for non-oropharyngeal sites remains to be elucidated.
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Janecka-Widła A, Mucha-Małecka A, Majchrzyk K, Halaszka K, Przewoźnik M, Słonina D, Biesaga B. Active HPV infection and its influence on survival in head and neck squamous-cell cancer. J Cancer Res Clin Oncol 2020; 146:1677-1692. [PMID: 32372145 PMCID: PMC7256081 DOI: 10.1007/s00432-020-03218-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/11/2020] [Indexed: 01/04/2023]
Abstract
Purpose HPV is involved in the development of some head and neck squamous-cell carcinomas (HNSCC). It was suggested that only transcriptionally active virus can induce carcinogenesis, therefore, the aim of our study was to analyze the frequency of active HPV infection, virus type, and its prognostic role in HNSCC patients. Methods Status of active HPV infection was assessed for 155 HNSCC patients based on p16 expression and HPV DNA presence. Univariate and multivariate analyses with Cox proportional regression model were performed to select independent prognostic factors. Results Active HPV infection was detected in 20.65% of patients. We identified 16.0, 40.9 and 1.7% of HPV positive oral cavity, oropharyngeal, and laryngeal cancer cases, respectively. HPV16 was dominant (81.25%) followed by HPV35 (9.38%) and double infections with HPV16 and 35 (6.25%) or HPV35 and 18 (3.12%). Patients with active HPV infection demonstrated significantly higher survival than HPV negative ones (OS 80.89% vs. 37.08%, p = 0.000; DFS 93.0% vs. 53.35%, p = 0.000, respectively). Longer OS and DFS were maintained for infected patients when oropharyngeal and non-oropharyngeal cases were analyzed separately. Interestingly, all patients infected with other than HPV16 types survived 5 years without cancer progression. In the analyzed group of 155 patients the strongest independent favourable prognostic factor for both OS and DFS was HPV presence. Conclusions High prevalence of HPV-driven HNSCC (mostly within oropharynx) was detected, with HPV16 type the most frequent, followed by HPV35 and HPV18. The presence of active HPV infection improved survival of both oropharyngeal and non-oropharyngeal cancer patients and should be taken into account in treatment planning.
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Affiliation(s)
- Anna Janecka-Widła
- Department of Tumour Pathology, Maria Sklodowska-Curie Institute - Oncology Center, Cracow Branch, Cracow, Poland.
| | - Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie Institute - Oncology Center, Cracow Branch, Cracow, Poland
| | - Kaja Majchrzyk
- Department of Tumour Pathology, Maria Sklodowska-Curie Institute - Oncology Center, Cracow Branch, Cracow, Poland
| | - Krzysztof Halaszka
- Department of Tumour Pathology, Maria Sklodowska-Curie Institute - Oncology Center, Cracow Branch, Cracow, Poland
| | - Marcin Przewoźnik
- Department of Tumour Pathology, Maria Sklodowska-Curie Institute - Oncology Center, Cracow Branch, Cracow, Poland
| | - Dorota Słonina
- Department of Tumour Pathology, Maria Sklodowska-Curie Institute - Oncology Center, Cracow Branch, Cracow, Poland.,Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Beata Biesaga
- Department of Tumour Pathology, Maria Sklodowska-Curie Institute - Oncology Center, Cracow Branch, Cracow, Poland.,Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, Gliwice, Poland
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Capote-Moreno A, Brabyn P, Muñoz-Guerra MF, Sastre-Pérez J, Escorial-Hernandez V, Rodríguez-Campo FJ, García T, Naval-Gías L. Oral squamous cell carcinoma: epidemiological study and risk factor assessment based on a 39-year series. Int J Oral Maxillofac Surg 2020; 49:1525-1534. [PMID: 32360101 DOI: 10.1016/j.ijom.2020.03.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 03/08/2020] [Accepted: 03/11/2020] [Indexed: 12/13/2022]
Abstract
Oral squamous cell carcinoma (OSCC) remains a challenge for head and neck surgeons, with low 5-year survival rates despite improvements in diagnostic techniques and therapies. This retrospective observational study was performed to evaluate the epidemiology and risk factors in a cohort of 666 patients with invasive OSCC over a 39-year period. Risk factors assessed were age, sex, toxic habits, premalignant lesions, tumour location and size, and neck involvement, and pathological factors such as surgical margins, tumour thickness, perineural invasion, and bone invasion. These factors were analysed over time, and their influence on recurrence and survival rates examined. Results were compared with those of current epidemiological studies in the literature. This series showed a tendency to diagnosis at older ages (P<0.001) and decreased differences in sex distribution (P<0.001) over time. Regarding risk factors, tobacco and alcohol drinking increased significantly in females, but remained stable in males. Forty percent of the patients developed recurrences during follow-up; the relapse rate did not improve over time (45.6% in the 1980s to 36.1% in 2010-2017). The 5-year survival rate also remained stable over time, ranging from 62.7% (1980s) to 71.7% (2010-2017). This epidemiological study analysed trends across four decades in a stable cohort, with results that may be extrapolated to the populations of European countries. The results confirmed that recurrence rates and survival rates have not improved over time, despite better surgical treatments and new therapies. Further studies are needed to improve knowledge about genetics and tumour behaviour in oral cancer.
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Affiliation(s)
- A Capote-Moreno
- Oral and Maxillofacial Surgery Department, University Hospital "La Princesa", Universidad Autónoma de Madrid, Madrid, Spain.
| | - P Brabyn
- Oral and Maxillofacial Surgery Department, University Hospital "La Princesa", Universidad Autónoma de Madrid, Madrid, Spain
| | - M F Muñoz-Guerra
- Oral and Maxillofacial Surgery Department, University Hospital "La Princesa", Universidad Autónoma de Madrid, Madrid, Spain
| | - J Sastre-Pérez
- Oral and Maxillofacial Surgery Department, University Hospital "La Princesa", Universidad Autónoma de Madrid, Madrid, Spain
| | - V Escorial-Hernandez
- Oral and Maxillofacial Surgery Department, University Hospital "La Princesa", Universidad Autónoma de Madrid, Madrid, Spain
| | - F J Rodríguez-Campo
- Oral and Maxillofacial Surgery Department, University Hospital "La Princesa", Universidad Autónoma de Madrid, Madrid, Spain
| | - T García
- Oral and Maxillofacial Surgery Department, University Hospital "La Princesa", Universidad Autónoma de Madrid, Madrid, Spain
| | - L Naval-Gías
- Oral and Maxillofacial Surgery Department, University Hospital "La Princesa", Universidad Autónoma de Madrid, Madrid, Spain
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Abrahão R, Perdomo S, Pinto LFR, Nascimento de Carvalho F, Dias FL, de Podestá JRV, Ventorin von Zeidler S, Marinho de Abreu P, Vilensky M, Giglio RE, Oliveira JC, Mineiro MS, Kowalski LP, Ikeda MK, Cuello M, Munyo A, Rodríguez-Urrego PA, Hakim JA, Suarez-Zamora DA, Cayol F, Figari MF, Oliver J, Gaborieau V, Keogh RH, Brennan P, Curado MP. Predictors of Survival After Head and Neck Squamous Cell Carcinoma in South America: The InterCHANGE Study. JCO Glob Oncol 2020; 6:486-499. [PMID: 32213095 PMCID: PMC7113075 DOI: 10.1200/go.20.00014] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2020] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Head and neck squamous cell carcinoma (HNSCC) incidence is high in South America, where recent data on survival are sparse. We investigated the main predictors of HNSCC survival in Brazil, Argentina, Uruguay, and Colombia. METHODS Sociodemographic and lifestyle information was obtained from standardized interviews, and clinicopathologic data were extracted from medical records and pathologic reports. The Kaplan-Meier method and Cox regression were used for statistical analyses. RESULTS Of 1,463 patients, 378 had a larynx cancer (LC), 78 hypopharynx cancer (HC), 599 oral cavity cancer (OC), and 408 oropharynx cancer (OPC). Most patients (55.5%) were diagnosed with stage IV disease, ranging from 47.6% for LC to 70.8% for OPC. Three-year survival rates were 56.0% for LC, 54.7% for OC, 48.0% for OPC, and 37.8% for HC. In multivariable models, patients with stage IV disease had approximately 7.6 (LC/HC), 11.7 (OC), and 3.5 (OPC) times higher mortality than patients with stage I disease. Current and former drinkers with LC or HC had approximately 2 times higher mortality than never-drinkers. In addition, older age at diagnosis was independently associated with worse survival for all sites. In a subset analysis of 198 patients with OPC with available human papillomavirus (HPV) type 16 data, those with HPV-unrelated OPC had a significantly worse 3-year survival compared with those with HPV-related OPC (44.6% v 75.6%, respectively), corresponding to a 3.4 times higher mortality. CONCLUSION Late stage at diagnosis was the strongest predictor of lower HNSCC survival. Early cancer detection and reduction of harmful alcohol use are fundamental to decrease the high burden of HNSCC in South America.
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Affiliation(s)
- Renata Abrahão
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
- Division of Hematology/Oncology and Center for Healthcare Policy Research, University of California, Davis, Sacramento, CA
| | - Sandra Perdomo
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
- Institute of Nutrition, Genetics, and Metabolism Research, Faculty of Medicine, Universidad El Bosque, Bogotá, Colombia
- University Hospital Foundation Santa Fe de Bogotá, Bogotá, Colombia
| | | | | | | | | | | | | | - Marta Vilensky
- Angel Roffo Institute of Oncology, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Valerie Gaborieau
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Ruth H. Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Paul Brennan
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | | | - on behalf of the InterCHANGE Group
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
- Division of Hematology/Oncology and Center for Healthcare Policy Research, University of California, Davis, Sacramento, CA
- Institute of Nutrition, Genetics, and Metabolism Research, Faculty of Medicine, Universidad El Bosque, Bogotá, Colombia
- University Hospital Foundation Santa Fe de Bogotá, Bogotá, Colombia
- National Cancer Institute, Rio de Janeiro, Brazil
- Santa Rita de Cassia Hospital (AFECC), Vitória, Brazil
- Biotechnology Postgraduation Program, Federal University of Espírito Santo, Vitória, Brazil
- Angel Roffo Institute of Oncology, Buenos Aires, Argentina
- Araújo Jorge Hospital, Goiania, Brazil
- A.C. Camargo Cancer Center, São Paulo, Brazil
- Hospital de Clínicas, Montevideo, Uruguay
- Italiano Hospital, Buenos Aires, Argentina
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
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An integrated nomogram combining lncRNAs classifier and clinicopathologic factors to predict the recurrence of head and neck squamous cell carcinoma. Sci Rep 2019; 9:17460. [PMID: 31767907 PMCID: PMC6877726 DOI: 10.1038/s41598-019-53811-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/05/2019] [Indexed: 12/31/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) which have little or no protein-coding capacity, due to their potential roles in the cancer disease, caught a particular interest. Our study aims to develop an lncRNAs-based classifier and a nomogram incorporating the lncRNAs classifier and clinicopathologic factors to help to improve the accuracy of recurrence prediction for head and neck squamous cell carcinoma (HNSCC) patients. The HNSCC lncRNAs profiling data and the corresponding clinicopathologic information were downloaded from TANRIC database and cBioPortal. Using univariable Cox regression and Least absolute shrinkage and selection operator (LASSO) analysis, we developed 15-lncRNAs-based classifier related to recurrence. On the basis of multivariable Cox regression analysis results, a nomogram integrating the genomic and clinicopathologic predictors was built. The predictive accuracy and discriminative ability of the inclusive nomogram were confirmed by calibration curve and a concordance index (C-index), and compared with TNM stage system by C-index, receiver operating characteristic (ROC) analysis. Decision curve analysis (DCA) was conducted to evaluate clinical value of our nomogram. Consequently, fifteen recurrence-free survival (RFS) -related lncRNAs were identified, and the classifier consisting of the established 15 lncRNAs could effectively divide patients into high-risk and low-risk subgroup. The prediction ability of the 15-lncRNAs-based classifier for predicting 3- year and 5-year RFS were 0.833 and 0.771. Independent factors derived from multivariable analysis to predict recurrence were number of positive LNs, margin status, mutation count and lncRNAs classifier, which were all embedded into the nomogram. The calibration curve for the recurrence probability showed that the predictions based on the nomogram were in good coincide with practical observations. The C-index of the nomogram was 0.76 (0.72–0.79), and the area under curve (AUC) of nomogram in predicting RFS was 0.809, which were significantly higher than traditional TNM stage and 15-lncRNAs-based classifier. Decision curve analysis further demonstrated that our nomogram had larger net benefit than TNM stage and 15-lncRNAs-based classifier. The results were confirmed externally. In summary, a visually inclusive nomogram for patients with HNSCC, comprising genomic and clinicopathologic variables, generates more accurate prediction of the recurrence probability when compared TNM stage alone, but more additional data remains needed before being used in clinical practice.
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Potential of Melatonin as Adjuvant Therapy of Oral Cancer in the Era of Epigenomics. Cancers (Basel) 2019; 11:cancers11111712. [PMID: 31684096 PMCID: PMC6895876 DOI: 10.3390/cancers11111712] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/16/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
Abstract
The wide variety of epigenetic controls available is rapidly expanding the knowledge of molecular biology even overflowing it. At the same time, it can illuminate unsuspected ways of understanding the etiology of cancer. New emerging therapeutic horizons, then, promise to overcome the current antitumor strategies need. The translational utility of this complexity is particularly welcome in oral cancer (OC), in which natural history is alarmingly disappointing due to the invasive and mutilating surgery, the high relapsing rate, the poor quality of life and the reduced survival after diagnosis. Melatonin activates protective receptor-dependent and receptor-independent processes that prevent tissue cancerisation and inhibit progressive tumor malignancy and metastasis. Related evidence has shown that melatonin pleiotropy encompasses gene expression regulation through all the three best-characterized epigenetic mechanisms: DNA methylation, chromatin modification, and non-coding RNA. OC has received less attention than other cancers despite prognosis is usually negative and there are no significant therapy improvements recorded in the past decade. However, a large research effort is being carried out to elucidate how melatonin´s machinery can prevent epigenetic insults that lead to cancer. In the light of recent findings, a comprehensive examination of biochemistry through which melatonin may reverse epigenetic aberrations in OC is an extraordinary opportunity to take a step forward in the clinical management of patients.
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Du E, Mazul AL, Farquhar D, Brennan P, Anantharaman D, Abedi-Ardekani B, Weissler MC, Hayes DN, Olshan AF, Zevallos JP. Long-term Survival in Head and Neck Cancer: Impact of Site, Stage, Smoking, and Human Papillomavirus Status. Laryngoscope 2019; 129:2506-2513. [PMID: 30637762 PMCID: PMC6907689 DOI: 10.1002/lary.27807] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES/HYPOTHESIS Literature examining long-term survival in head and neck squamous cell carcinoma (HNSCC) with human papillomavirus (HPV) status is lacking. We compare 10-year overall survival (OS) rates for cases to population-based controls. STUDY DESIGN Prospective cohort study. METHODS Cases surviving 5 years postdiagnosis were identified from the Carolina Head and Neck Cancer Study. We examined 10-year survival by site, stage, p16, and treatment using Kaplan-Meier and Cox proportional hazard models. Cases were compared to age-matched, noncancer controls with stratification by p16 and smoking status. RESULTS Ten-year OS for HNSCC is less than controls. In 581 cases, OS differed between sites with p16+ oropharynx having the most favorable prognosis (87%), followed by oral cavity (69%), larynx (67%), p16- oropharynx (56%), and hypopharynx (51%). Initial stage, but not treatment, also impacted OS. When compared to controls matched on smoking status, the hazard ratio (HR) for death in p16+ oropharynx cases was 1.5 (95% confidence interval [CI]: 0.7-3.1) for smokers and 2.4 (95% CI: 0.7-8.8) for nonsmokers. Similarly, HR for death in non-HPV-associated HNSCC was 2.2 (95% CI: 1.7-3.0) for smokers and 2.4 (95% CI: 1.4-4.9) for nonsmokers. CONCLUSIONS OS for HNSCC cases continues to decrease 5 years posttreatment, even after stratification by p16 and smoking status. Site, stage, smoking, and p16 status are significant factors. These data provide important prognostic information for HNSCC. LEVEL OF EVIDENCE 2 Laryngoscope, 129:2506-2513, 2019.
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Affiliation(s)
- Eugenie Du
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| | - Doug Farquhar
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Devasena Anantharaman
- International Agency for Research on Cancer, Lyon, France
- Cancer Research Program (HPV Research), Rajiv Gandhi Centre for Biotechnology, Trivandrum, India
| | | | - Mark C Weissler
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - David N Hayes
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
- Department of Medicine, Division of Hematology and OncologyUniversity of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Andrew F Olshan
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
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A Prospective Cohort Study of Human Papillomavirus-Driven Oropharyngeal Cancers: Implications for Prognosis and Immunisation. Clin Oncol (R Coll Radiol) 2019; 31:e132-e142. [PMID: 31248692 DOI: 10.1016/j.clon.2019.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/26/2019] [Accepted: 04/12/2019] [Indexed: 12/29/2022]
Abstract
AIMS Oropharyngeal cancer (OPC) is increasing on a global scale, including the component driven by high-risk human papillomavirus (HR-HPV); contemporary data that provides insight into the prognosis of this disease in addition to the fraction attributable to HR-HPV are essential to inform primary and secondary disease management strategies. MATERIALS AND METHODS A population-based cohort of 235 patients diagnosed with OPC between 2013 and 2015 in Scotland was assessed for HPV status using molecular genotyping. Associations between HR-HPV status and key clinical and demographic variables were estimated using the Pearson chi-squared test. Rates of overall survival and progression-free survival were estimated and visualised using Kaplan-Meier curves. RESULTS HPV DNA (largely HPV 16) was identified in 60% of cases. After adjustment for age, gender, deprivation, smoking, alcohol consumption and tumour stage, patients with HR-HPV-positive OPC had an 89% reduction in the risk of death (hazard ratio = 0.11, 95% confidence interval 0.05-0.25) and an 85% reduction in the risk of disease progression (hazard ratio = 0.15, 95% confidence interval 0.07-0.30). HPV positivity was not associated with age, deprivation or smoking status, whereas those who reported excess alcohol consumption were less likely to be positive for HR-HPV. CONCLUSIONS The prevalence of HR-HPV-associated OPC is high in Scotland and strongly associated with dramatically improved clinical outcomes, including survival. Demographic/behavioural variables did not reliably predict HPV positivity in this cohort, which underlines the importance of laboratory confirmation. Finally, the dominance of HPV 16 in OPC indicates the significant impact of prophylactic immunisation on this disease.
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Tian S, Switchenko JM, Jhaveri J, Cassidy RJ, Ferris MJ, Press RH, Pfister NT, Patel MR, Saba NF, McDonald MW, Higgins KA, Yu DS, Curran WJ, Gillespie TW, Beitler JJ. Survival outcomes by high-risk human papillomavirus status in nonoropharyngeal head and neck squamous cell carcinomas: A propensity-scored analysis of the National Cancer Data Base. Cancer 2019; 125:2782-2793. [PMID: 31012957 DOI: 10.1002/cncr.32115] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND The prognostic relevance of human papillomavirus (HPV) status in patients with nonoropharyngeal (OPX) squamous cell cancer (SCC) of the head and neck is controversial. In the current study, the authors evaluated the impact of high-risk HPV status on overall survival (OS) in patients with non-OPX SCC using a large database approach. METHODS The National Cancer Data Base was queried to identify patients diagnosed from 2004 through 2014 with SCC of the OPX, hypopharynx (HPX), larynx, and oral cavity (OC) with known HPV status. Survival was estimated using Kaplan-Meier methods; distributions were compared using log-rank tests. Propensity score-matching and inverse probability of treatment weighing (IPTW) methods were used; cohorts were matched based on age, sex, Charlson-Deyo score, clinical American Joint Committee on Cancer (AJCC) group stage, treatments received, and anatomic subsite. Propensity analyses were stratified by group stage of disease. RESULTS A total of 24,740 patients diagnosed from 2010 through 2013 were analyzed: 1085 patients with HPX, 4804 with laryngeal, 4,018 with OC, and 14,833 with OPX SCC. The percentages of HPV-positive cases by disease site were 17.7% for HPX, 11% for larynx, 10.6% for OC, and 62.9% for OPX. HPV status was found to be prognostic in multiple unadjusted and propensity-adjusted non-OPX populations. HPV positivity was associated with superior OS in patients with HPX SCC with a hazard ratio (HR) of 0.61 (P < .001 by IPTW), in patients with AJCC stage III to IVB laryngeal SCC (HR, 0.79; P = .019 by IPTW), and in patients with AJCC stage III to IVB OC SCC (HR, 0.78; P = .03 by IPTW). CONCLUSIONS Positive high-risk HPV status appears to be associated with longer OS in multiple populations of patients with non-OPX head and neck disease (HPX, locally advanced larynx, and OC). If prospectively validated, these findings have implications for risk stratification.
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Affiliation(s)
- Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Heath, Emory University, Atlanta, Georgia
| | - Jaymin Jhaveri
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Richard J Cassidy
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Matthew J Ferris
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Robert H Press
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Neil T Pfister
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mihir R Patel
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mark W McDonald
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - David S Yu
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Theresa W Gillespie
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jonathan J Beitler
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia.,Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Kennedy R, Kuvshinov D, Sdrolia A, Kuvshinova E, Hilton K, Crank S, Beavis AW, Green V, Greenman J. A patient tumour-on-a-chip system for personalised investigation of radiotherapy based treatment regimens. Sci Rep 2019; 9:6327. [PMID: 31004114 PMCID: PMC6474873 DOI: 10.1038/s41598-019-42745-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/01/2019] [Indexed: 01/22/2023] Open
Abstract
Development of personalised cancer models to predict response to radiation would benefit patient care; particularly in malignancies where treatment resistance is prevalent. Herein, a robust, easy to use, tumour-on-a-chip platform which maintains precision cut head and neck cancer for the purpose of ex vivo irradiation is described. The device utilises sintered discs to separate the biopsy and medium, mimicking in vivo microvascular flow and diffusion, maintaining tissue viability for 68 h. Integrity of tissues is demonstrated by the low levels of lactate dehydrogenase release and retained histology, accompanied by assessment of cell viability by trypan blue exclusion and flow cytometry; fluid dynamic modelling validates culture conditions. An irradiation jig is described for reproducible delivery of clinically-relevant doses (5 × 2 Gy) to newly-presenting primary tumours (n = 12); the addition of concurrent cisplatin is also investigated (n = 8) with response analysed by immunohistochemistry. Fractionated irradiation reduced proliferation (BrdU, p = 0.0064), increased DNA damage (ƴH2AX, p = 0.0043) and caspase-dependent apoptosis (caspase-cleaved cytokeratin-18) compared to control; caspase-dependent apoptosis was further increased by concurrent cisplatin compared to control (p = 0.0063). This is a proof of principle study showing the response of cancer tissue to irradiation ex vivo in a bespoke system. The novel platform described has the potential to personalise treatment for patients in a cost-effective manner with applicability to any solid tumour.
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Affiliation(s)
- R Kennedy
- Department of Biomedical Sciences, The University of Hull, Cottingham Road, Hull, UK
| | - D Kuvshinov
- School of Engineering & Computer Science, The University of Hull, Cottingham Road, Hull, UK
| | - A Sdrolia
- Department of Medical Physics, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, UK
| | - E Kuvshinova
- Department of Chemical & Biological Engineering, The University of Sheffield, Sheffield, UK
| | - K Hilton
- Department of Medical Physics, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, UK
| | - S Crank
- Department of Maxillofacial Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - A W Beavis
- Department of Biomedical Sciences, The University of Hull, Cottingham Road, Hull, UK
- Department of Medical Physics, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, UK
- Faculty of Health and Well Being, Sheffield-Hallam University, Sheffield, UK
| | - V Green
- Department of Biomedical Sciences, The University of Hull, Cottingham Road, Hull, UK
| | - J Greenman
- Department of Biomedical Sciences, The University of Hull, Cottingham Road, Hull, UK.
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Martin-Gomez L, Fulp WJ, Schell MJ, Sirak B, Abrahamsen M, Isaacs-Soriano KA, Lorincz A, Wenig B, Chung CH, Caudell JJ, Giuliano AR. Oral gargle-tumor biopsy human papillomavirus (HPV) agreement and associated factors among oropharyngeal squamous cell carcinoma (OPSCC) cases. Oral Oncol 2019; 92:85-91. [PMID: 31010629 DOI: 10.1016/j.oraloncology.2019.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/28/2019] [Accepted: 03/30/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Assess oral gargle-tumor human papillomavirus (HPV) agreement among oropharyngeal squamous cell carcinoma (OPSCC) cases by several disease characteristics. MATERIALS AND METHODS 171 treatment naïve OPSCC were enrolled 2014-2017. Tumors were categorized as early or late disease with early disease defined as T1-2 with no nodal involvement or at most a single ipsilateral positive node <3 cm. Oral gargle samples were obtained via a 30-second rinse and gargle. The RHA Kit HPV SP10-LiPA25 was utilized for HPV genotyping of tumor (FFPE) and oral gargle specimens. Sensitivity, specificity, positive and negative predictive value, percent agreement, and 95% exact binomial confidence intervals were estimated. Multivariable logistic regression models were fit to predict agreement. RESULTS 83.0% and 93.0% of oral gargle and tumor specimens were HPV positive. Oral gargle-tumor agreement for any oncogenic HPV type and HPV 16 was 73.7%. High oncogenic HPV oral gargle-tumor agreement was observed for late disease presentation, p16 positive cases, and tumors at the tonsils (74.5-80.8%). Similar trends were observed for HPV 16. Agreement for any oncogenic HPV and HPV 16 was significantly higher for late vs. early disease (77.9% vs 57.1%, p = 0.01). Oral gargle-tumor oncogenic HPV and HPV 16 agreement was independently associated with age ≥50 years and late disease presentation. CONCLUSION Overall, oral-tumor HPV agreement among OPSCC was relatively high. However, oral-tumor HPV agreement was significantly lower among younger cases and those diagnosed with earlier disease. Additional biomarkers are needed to improve oral HPV test characteristics to identify OPSCC early.
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Affiliation(s)
- Laura Martin-Gomez
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, United States
| | - William J Fulp
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, United States
| | - Michael J Schell
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, United States
| | - Bradley Sirak
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, United States
| | - Martha Abrahamsen
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, United States
| | | | - Attila Lorincz
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, United Kingdom
| | - Bruce Wenig
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, United States
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, United States
| | - Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, United States
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, United States.
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Clinical relevance of human papillomavirus outside of oropharynx. Curr Opin Otolaryngol Head Neck Surg 2019; 27:80-84. [DOI: 10.1097/moo.0000000000000518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tealab SH, Sedhom NFH, Hassouna A, Gouda I, Ismail H. Prevalence of human papilloma virus in oropharyngeal, tongue and lip squamous cell carcinoma: an experience from the Egyptian National Cancer Institute. J Investig Med 2019; 67:1061-1066. [PMID: 30867228 DOI: 10.1136/jim-2018-000968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 01/01/2023]
Abstract
Human papilloma virus (HPV) is now a well-known risk factor for head and neck cancer besides smoking and alcohol. Most studies mentioned that patients affected with high-risk HPV cancers have a better outcome, and many clinical trials are trying to prove that such group of patients can receive a different and less aggressive treatment than the HPV-negative group. Although such field has received great interest within different countries and continents, African and Egyptian populations are not yet well studied within the literature. Our aim was to detect the prevalence of HPV in oropharyngeal (OP), lip and tongue squamous cell carcinoma (SSC) and correlate the viral prevalence with different clinicopathologic parameters as well as patients' outcome. HPV detection was done on 99 cases from the lip (29), tongue (38) and oropharynx (32) diagnosed at the Pathology Department of the National Cancer Institute, Cairo University. p16 immunohistochemistry was performed on all cases, followed by HPV DNA in situ hybridization (ISH) for p16-positive cases. The prevalence of HPV in OPSSC was 28% and in lip and tongue cancers lumped together was 37%. There was more than 90% concordance between p16 and HPV DNA ISH results. HPV positivity showed a statistically significant correlation with better disease-free survival (DFS), which was also maintained for OP cases. HPV is highly prevalent in OP and common oral cavity cancers in the Egyptian population. HPV positivity correlated significantly with better DFS, especially in OP cancers.
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Affiliation(s)
| | | | | | - Iman Gouda
- Surgical Pathology, National Cancer Institute, Cairo, Egypt
| | - Hoda Ismail
- Surgical Pathology, National Cancer Institute, Cairo, Egypt
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Human papillomavirus in head and neck squamous cell carcinomas in a South African cohort. PAPILLOMAVIRUS RESEARCH 2018; 6:58-62. [PMID: 30391364 PMCID: PMC6232649 DOI: 10.1016/j.pvr.2018.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/05/2018] [Accepted: 10/26/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Most tumours of the head and neck are attributable to smoking and alcohol use, but an increasing proportion of head and neck tumours are caused by human papillomaviruses (HPVs). The aim of this study was to use in house molecular assays to detect and genotype HPV in biopsies from patients with histologically confirmed head and neck squamous cell carcinomas. In addition, the results were compared with p16 immunohistochemistry staining, which has been described as a potential marker for HPV infection. METHODS Biopsies of squamous cell carcinomas of the oropharynx, nasopharynx, larynx and hypopharynx from 112 South African patients were screened using three PCR assays targeting the L1 and E6 regions of HPV and p16 immunohistochemical staining. RESULTS AND CONCLUSION HPV was identified in 7 (6.3%) tumours, while 22 (19.6%) had positive p16 immunohistochemical staining. There was concordance between the results obtained using the three PCR assays. There was substantial agreement between the results of molecular tests and p16 immunohistochemistry for hypopharyngeal carcinomas, but only fair agreement for laryngeal and oropharyngeal carcinomas.
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Lai YC, Tang PL, Chu CH, Kuo TJ. Effects of income and residential area on survival of patients with head and neck cancers following radiotherapy: working age individuals in Taiwan. PeerJ 2018; 6:e5591. [PMID: 30245932 PMCID: PMC6147123 DOI: 10.7717/peerj.5591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/16/2018] [Indexed: 01/29/2023] Open
Abstract
Objectives The five-year survival rate of head and neck cancer (HNC) after radiotherapy (RT) varies widely from 35% to 89%. Many studies have addressed the effect of socioeconomic status and urban dwelling on the survival of HNC, but a limited number of studies have focused on the survival rate of HNC patients after RT. Materials and methods During the period of 2000–2013, 40,985 working age individuals (20 < age < 65 years) with HNC patients treated with RT were included in this study from a registry of patients with catastrophic illnesses maintained by the Taiwan National Health Insurance Research Database (NHIRD). Results The cumulative survival rate of HNC following RT in Taiwan was 53.2% (mean follow-up period, 3.75 ± 3.31 years). The combined effects of income and geographic effect on cumulative survival rates were as follows: high income group > medium income group > low income group and northern > central > southern > eastern Taiwan. Patients with moderate income levels had a 36.9% higher risk of mortality as compared with patients with high income levels (hazard ratio (HR) = 1.369; p < 0.001). Patients with low income levels had a 51.4% greater risk of mortality than patients with high income levels (HR = 1.514, p < 0.001). Conclusion In Taiwan, income and residential area significantly affected the survival rate of HNC patients receiving RT. The highest income level group had the best survival rate, regardless of the geographic area. The difference in survival between the low and high income groups was still pronounced in more deprived areas.
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Affiliation(s)
- Yu Cheng Lai
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Department of Occupational Therapy, Shu Zen junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Pei Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan.,College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi Hsiang Chu
- Department of Clinical Trial Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tsu Jen Kuo
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Department of Dental Technology, Shu-Zen junior College of Medicine and Management, Kaohsiung, Taiwan.,Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Abstract
Epidemiological methods are essential for the discovery of cancer risks and prognostic factors as well as for the evaluation of cancer prevention measures. In this review, we discuss epidemiological surveillance procedures for data collection and processing to guide and evaluate the consequences of anticancer efforts for populations, assess the identification of cancer risk factors, examine barriers to cancer screening and recommended rules for early diagnosis programs. Epidemiological studies have shown that hindrances to cancer information assessment are currently encountered in developing countries. Known cancer risk factors include social determinants, lifestyle factors, occupational exposures, infectious agents, and genetic and epigenetic alterations. Challenges remain in studying the effectiveness of cancer screening; screening can have detrimental effects, and few cancers clearly benefit from screening. Currently, epidemiology faces the challenge of dealing with distinct levels of data, including factors related to social status, lifestyle and genetics, to reconstruct the causal traits of cancer. Additionally, translating epidemiological knowledge into cancer control demands more implementation studies in the population.
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Affiliation(s)
- Tatiana N Toporcov
- Departamento de Epidemiologia, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Victor Wünsch Filho
- Departamento de Epidemiologia, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Khalid MB, Ting P, Pai A, Russo JL, Bakst R, Chai RL, Teng MS, Genden EM, Miles BA. Initial presentation of human papillomavirus‐related head and neck cancer: A retrospective review. Laryngoscope 2018; 129:877-882. [DOI: 10.1002/lary.27296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Mian B. Khalid
- Icahn School of Medicine at Mount SinaiNew York New York U.S.A
| | - Peter Ting
- Icahn School of Medicine at Mount SinaiNew York New York U.S.A
| | - Akila Pai
- Icahn School of Medicine at Mount SinaiNew York New York U.S.A
| | - Jack L. Russo
- Department of Otolaryngology Head and Neck SurgeryNew York New York U.S.A
| | - Richard Bakst
- Department of Radiation OncologyIcahn School of MedicineNew York New York U.S.A
| | - Raymond L. Chai
- Department of Otolaryngology Head and Neck SurgeryNew York New York U.S.A
| | - Marita S. Teng
- Department of Otolaryngology Head and Neck SurgeryNew York New York U.S.A
| | - Eric M. Genden
- Department of Otolaryngology Head and Neck SurgeryNew York New York U.S.A
| | - Brett A. Miles
- Department of Otolaryngology Head and Neck SurgeryNew York New York U.S.A
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47
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Stanford-Moore G, Bradshaw PT, Weissler MC, Zevallos JP, Brennan P, Anantharaman D, Abedi-Ardekani B, Olshan AF. Interaction between known risk factors for head and neck cancer and socioeconomic status: the Carolina Head and Neck Cancer Study. Cancer Causes Control 2018; 29:863-873. [PMID: 30069657 PMCID: PMC6133180 DOI: 10.1007/s10552-018-1062-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 07/24/2018] [Indexed: 12/19/2022]
Abstract
Prior studies of squamous cell carcinoma of the head and neck (SCCHN) have explored the effect of socioeconomic status (SES) as an independent risk factor; however, none have investigated the interaction of known risk factors with SES. We examined this using the North Carolina Head and Neck Cancer Epidemiology Study, a population-based case-control study. Incident cases of SCCHN from North Carolina between 2002 and 2006 (n = 1,153) were identified and age, sex, and race-matched controls (n = 1,267) were selected from driver license records. SES measures included household income, educational attainment, and health insurance. Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Current smoking was more strongly associated with SCCHN among those households making < $20,000/year [OR 5.11 (3.61-6.61)] compared to household incomes > $50,000/year [OR 2.47 (1.69-3.25); p interaction < 0.001]. Current drinking was more strongly associated with SCCHN in household incomes < $20,000 [OR 2.91 (2.05-3.78)] compared to > $50,000/year [1.28 (0.97-1.58); p interaction < 0.001]. Current drinkers with less than high school education or income < $20,000 had nearly threefold odds of never-drinkers in the same SES category [OR 2.91 (2.05-3.78); 2.09 (1.39-2.78), respectively]. Our results suggest that the relationship of smoking and alcohol use may be stronger among those of lower SES.
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Affiliation(s)
- Gaelen Stanford-Moore
- Department of Epidemiology, Cambridge University, Cambridge, UK.
- Department of Otolaryngology/Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA.
| | - Patrick T Bradshaw
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Mark C Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Jose P Zevallos
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, MO, USA
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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48
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Abrahão R, Anantharaman D, Gaborieau V, Abedi-Ardekani B, Lagiou P, Lagiou A, Ahrens W, Holcatova I, Betka J, Merletti F, Richiardi L, Kjaerheim K, Serraino D, Polesel J, Simonato L, Alemany L, Agudo Trigueros A, Macfarlane TV, Macfarlane GJ, Znaor A, Robinson M, Canova C, Conway DI, Wright S, Healy CM, Toner M, Cadoni G, Boccia S, Gheit T, Tommasino M, Scelo G, Brennan P. The influence of smoking, age and stage at diagnosis on the survival after larynx, hypopharynx and oral cavity cancers in Europe: The ARCAGE study. Int J Cancer 2018; 143:32-44. [PMID: 29405297 DOI: 10.1002/ijc.31294] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/19/2018] [Accepted: 01/23/2018] [Indexed: 01/23/2023]
Abstract
Head and neck cancer (HNC) is a preventable malignancy that continues to cause substantial morbidity and mortality worldwide. Using data from the ARCAGE and Rome studies, we investigated the main predictors of survival after larynx, hypopharynx and oral cavity (OC) cancers. We used the Kaplan-Meier method to estimate overall survival, and Cox proportional models to examine the relationship between survival and sociodemographic and clinical characteristics. 604 larynx, 146 hypopharynx and 460 OC cancer cases were included in this study. Over a median follow-up time of 4.6 years, nearly 50% (n = 586) of patients died. Five-year survival was 65% for larynx, 55% for OC and 35% for hypopharynx cancers. In a multivariable analysis, we observed an increased mortality risk among older (≥71 years) versus younger (≤50 years) patients with larynx/hypopharynx combined (LH) and OC cancers [HR = 1.61, 95% CI 1.09-2.38 (LH) and HR = 2.12, 95% CI 1.35-3.33 (OC)], current versus never smokers [HR = 2.67, 95% CI 1.40-5.08 (LH) and HR = 2.16, 95% CI 1.32-3.54 (OC)] and advanced versus early stage disease at diagnosis [IV versus I, HR = 2.60, 95% CI 1.78-3.79 (LH) and HR = 3.17, 95% CI 2.05-4.89 (OC)]. Survival was not associated with sex, alcohol consumption, education, oral health, p16 expression, presence of HPV infection or body mass index 2 years before cancer diagnosis. Despite advances in diagnosis and therapeutic modalities, survival after HNC remains low in Europe. In addition to the recognized prognostic effect of stage at diagnosis, smoking history and older age at diagnosis are important prognostic indicators for HNC.
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Affiliation(s)
- Renata Abrahão
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Devasena Anantharaman
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
| | - Valérie Gaborieau
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Behnoush Abedi-Ardekani
- Genetic Cancer Susceptibility Group, International Agency for Research on Cancer, Lyon, France
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Areti Lagiou
- Department of Public Health and Community Health, School of Health Professions, Athens University of Applied Sciences, Athens, Greece
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - Ivana Holcatova
- Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University of Prague, Prage, Czech Republic
| | - Jaroslav Betka
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University of Prague, Prague, Czech Republic
| | - Franco Merletti
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Diego Serraino
- Unit of Cancer Epidemiology, Aviano National Cancer Institute, IRCCS, Aviano, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Aviano National Cancer Institute, IRCCS, Aviano, Italy
| | - Lorenzo Simonato
- Department of Cardiovascular and Thoracic Sciences, University of Padova, Padova, Italy
| | - Laia Alemany
- Institut Català d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Catalonia, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Tatiana V Macfarlane
- Epidemiology Group, University of Aberdeen, Aberdeen, United Kingdom
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Gary J Macfarlane
- Epidemiology Group, University of Aberdeen, Aberdeen, United Kingdom
| | - Ariana Znaor
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Max Robinson
- Center for Oral Health Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Cristina Canova
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - David I Conway
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Sylvia Wright
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Claire M Healy
- Trinity College School of Dental Science, Dublin, Ireland
| | - Mary Toner
- Trinity College School of Dental Science, Dublin, Ireland
| | - Gabriella Cadoni
- Institute of Othorinolaringoiatry, Università Cattolica del Sacro Cuore, Fondazione Policlinico 'Agostino Gemelli', Rome, Italy
| | - Stefania Boccia
- Section of Hygiene - Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico 'Agostino Gemelli', Rome, Italy
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Ghislaine Scelo
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Paul Brennan
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
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49
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Anantharaman D, Billot A, Waterboer T, Gheit T, Abedi-Ardekani B, Lagiou P, Lagiou A, Ahrens W, Holcátová I, Merletti F, Kjaerheim K, Polesel J, Simonato L, Alemany L, Mena Cervigon M, Macfarlane TV, Znaor A, Thomson PJ, Robinson M, Canova C, Conway DI, Wright S, Healy CM, Toner ME, Pawlita M, Tommasino M, Brennan P. Predictors of oropharyngeal cancer survival in Europe. Oral Oncol 2018; 81:89-94. [PMID: 29884419 DOI: 10.1016/j.oraloncology.2018.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/10/2018] [Accepted: 04/22/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES HPV16-positive oropharyngeal cancer (OPC) patients experience better outcomes compared to HPV16-negative patients. Currently, strategies for treatment de-escalation are based on HPV status, smoking history and disease stage. However, the appropriate cut-point for smoking and the role of other non-clinical factors in OPC survival remains uncertain. MATERIALS AND METHODS We examined factors associated with OPC outcome in 321 patients recruited in a large European multi-center study. Seropositivity for HPV16 E6 was used as a marker of HPV16 positive cancer. Hazard ratios (HR) and confidence intervals (CI) were estimated using Cox proportional models adjusted for potential confounders. RESULTS Overall 5-year survival following OPC diagnosis was 50%. HPV16-positive OPC cases were at significantly lower risk of death (aHR = 0.51, 95% CI: 0.32-0.80). A significant effect on OPC survival was apparent for female sex (aHR 0.50: 95% CI: 0.29-0.85) and being underweight at diagnosis (aHR: 2.41, 95% CI: 1.38-4.21). A 10 pack year smoking history was not associated with overall survival. Higher stage at diagnosis appeared as the only factor significantly associated with OPC recurrence (aHR: 4.88, 95% CI: 2.12-11.21). CONCLUSION This study confirms that HPV16 status is an independent prognostic factor for OPC survival while female sex lowers risk of death and being underweight at diagnosis increases the risk of death. Smoking was not an independent predictor of OPC survival.
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Affiliation(s)
- D Anantharaman
- International Agency for Research on Cancer, Lyon, France; Cancer Research Program, Rajiv Gandhi Center for Biotechnology, Thiruvananthapuram, India
| | - A Billot
- International Agency for Research on Cancer, Lyon, France
| | - T Waterboer
- Division of Molecular Diagnostics of Oncogenic Infections, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Gheit
- International Agency for Research on Cancer, Lyon, France
| | | | - P Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - A Lagiou
- Department of Public Health and Community Health, School of Health Professions, Athens Technological Educational Institute, Athens, Greece
| | - W Ahrens
- BIPS - Institute for Epidemiology and Prevention Research, Bremen, Germany; Institute for Statistics, University Bremen, Bremen, Germany
| | - I Holcátová
- Institute of Hygiene and Epidemiology, Charles University of Prague, 1st Faculty of Medicine, Prague, Czech Republic
| | - F Merletti
- Unit of Cancer Epidemiology, CeRMS and University of Turin, Turin, Italy
| | | | - J Polesel
- Unit of Epidemiology and Biostatistics, National Cancer Institute, IRCCS, Aviano, Italy
| | - L Simonato
- Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy
| | - L Alemany
- Institut Català d'Oncologia, IDIBELL, CIBERESP, L'Hospitalet de Llobregat, Spain
| | - M Mena Cervigon
- Institut Català d'Oncologia, IDIBELL, CIBERESP, L'Hospitalet de Llobregat, Spain
| | - T V Macfarlane
- Epidemiology Group, University of Aberdeen, Aberdeen, UK; Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - A Znaor
- International Agency for Research on Cancer, Lyon, France
| | - P J Thomson
- School of Dentistry, The University of Queensland, Herston, Australia
| | - M Robinson
- Center for Oral Health Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - C Canova
- Respiratory Epidemiology and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - D I Conway
- Dental School, University of Glasgow, Glasgow, UK; Information Services Division (ISD), NHS National Services Scotland, Edinburgh, UK
| | - S Wright
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - C M Healy
- Trinity College School of Dental Science, Dublin, Ireland
| | - M E Toner
- Trinity College School of Dental Science, Dublin, Ireland
| | - M Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Tommasino
- International Agency for Research on Cancer, Lyon, France
| | - P Brennan
- International Agency for Research on Cancer, Lyon, France.
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50
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Leoncini E, Vukovic V, Cadoni G, Giraldi L, Pastorino R, Arzani D, Petrelli L, Wünsch-Filho V, Toporcov TN, Moyses RA, Matsuo K, Bosetti C, La Vecchia C, Serraino D, Simonato L, Merletti F, Boffetta P, Hashibe M, Lee YCA, Boccia S. Tumour stage and gender predict recurrence and second primary malignancies in head and neck cancer: a multicentre study within the INHANCE consortium. Eur J Epidemiol 2018; 33:1205-1218. [PMID: 29779202 PMCID: PMC6290648 DOI: 10.1007/s10654-018-0409-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 05/09/2018] [Indexed: 12/23/2022]
Abstract
Recurrence and second primary cancer (SPC) continue to represent major obstacles to long-term survival in head and neck cancer (HNC). Our aim was to evaluate whether established demographics, lifestyle-related risk factors for HNC and clinical data are associated with recurrence and SPC in HNC. We conducted a multicentre study by using data from five studies members of the International Head and Neck Cancer Epidemiology consortium—Milan, Rome, Western Europe, Sao Paulo, and Japan, totalling 4005 HNC cases with a median age of 59 (interquartile range 52–67). Multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for recurrence and SPC. During follow-up, 1161 (29%) patients had recurrence and 343 (8.6%) developed SPC. Advanced tumour stage was associated with increased risk of recurrence in HNC overall (HR = 1.76, 95% CI 1.41–2.19). Women with laryngeal cancer had a reduced risk of recurrence compared to men (HR = 0.39, 95% CI: 0.24–0.74). Concerning predictors of SPC, advanced age (HR = 1.02; 95% CI: 1.00–1.04) and alcohol consumption (> 1 drink per day, HR = 2.11; 95% CI: 1.13–3.94) increased the risk of SPC among patients with laryngeal cancer. Additionally, women were at higher risk of SPC, in HNC overall group (HR = 1.68; 95% CI: 1.13–2.51) and oropharyngeal cancer group (HR = 1.74; 95% CI: 1.02–2.98). Tumour stage and male gender (larynx only) were positive predictors of cancer recurrence in HNC patients. Predictors of SPC were advanced age and alcohol use among laryngeal cancer cases, and female gender for oropharyngeal and HNC overall.
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Affiliation(s)
- Emanuele Leoncini
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vladimir Vukovic
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriella Cadoni
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Giraldi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Pastorino
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Arzani
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Livia Petrelli
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Raquel Ayub Moyses
- Cirurgia de Cabeça e Pescoço (LIM 28), Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | | | - Cristina Bosetti
- Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Diego Serraino
- SOC Epidemiologia e Biostatistica, IRCCS Centro di Riferimento Oncologico, Aviano, Italy
| | - Lorenzo Simonato
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, Padua, Italy
| | - Franco Merletti
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Boffetta
- The Tisch Cancer Institute and Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Yuan-Chin Amy Lee
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stefania Boccia
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico "Agostino Gemelli" IRCCS, Largo F. Vito, 1, 00168, Rome, Italy.
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