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Abou-Foul AK, Henson C, Chernock RD, Huang SH, Lydiatt WM, McDowell L, O'Sullivan B, Perez-Ordonez B, Robinson M, Nankivell PC, Ruiz-Bravo E, Chiosea SI, Green TM, Hunter KD, Hwang JS, Koljenovic S, Koppes SA, Larsen SR, Lo AWI, Costes-Martineau V, Mittal N, Mori T, Nagao T, Panayiotides IG, Pinto CAL, Scheckenbach K, Seethala RR, Ulhøi BP, Vingiani A, Zhang Y, Yom SS, Mehanna H. Standardised definitions and diagnostic criteria for extranodal extension detected on histopathological examination in head and neck cancer: Head and Neck Cancer International Group consensus recommendations. Lancet Oncol 2024; 25:e286-e296. [PMID: 38936387 DOI: 10.1016/s1470-2045(24)00143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/16/2024] [Accepted: 03/07/2024] [Indexed: 06/29/2024]
Abstract
Detection of extranodal extension on histopathology in surgically treated head and neck squamous cell carcinoma indicates poor prognosis. However, there is no consensus on the diagnostic criteria, interpretation, and reporting of histology detected extranodal extension, which has contributed to conflicting evidence in the literature, and likely clinical inconsistency. The Head and Neck Cancer International Group conducted a three-round modified Delphi process with a group of 19 international pathology experts representing 15 national clinical research groups to generate consensus recommendations for histology detected extranodal extension diagnostic criteria. The expert panel strongly agreed on terminology and diagnostic features for histology detected extranodal extension and soft tissue metastasis. Moreover, the panel reached consensus on reporting of histology detected extranodal extension and on nodal sampling. These consensus recommendations, endorsed by 19 organisations representing 34 countries, are a crucial development towards standardised diagnosis and reporting of histology detected extranodal extension, and more accurate data collection and analysis.
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Affiliation(s)
- Ahmad K Abou-Foul
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Christina Henson
- Department of Radiation Oncology, College of Medicine, University of Oklahoma Health Sciences Centre, Oklahoma City, OK, USA
| | - Rebecca D Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Shao Hui Huang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - William M Lydiatt
- Department of Surgery, Nebraska Methodist Hospital and Methodist Women's Hospital, Creighton University, Omaha, NE, USA
| | - Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Brian O'Sullivan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Bayardo Perez-Ordonez
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada
| | - Max Robinson
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Paul C Nankivell
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Elena Ruiz-Bravo
- Department of Pathology, University Hospital La Paz, Madrid, Spain
| | - Simion I Chiosea
- Department of Pathology, Presbyterian University Hospital, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | - Tina M Green
- Department of Pathology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Keith D Hunter
- Institute of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | | | - Senada Koljenovic
- Department of Pathology, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Sjors A Koppes
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Stine R Larsen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Anthony W I Lo
- Division of Anatomical Pathology, Queen Mary Hospital, Hong Kong
| | | | - Neha Mittal
- Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, India
| | | | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Ioannis G Panayiotides
- Department of Pathology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Clóvis A L Pinto
- Department of Pathological Anatomy, AC Camargo Cancer Centre, São Paulo, SP, Brazil
| | - Kathrin Scheckenbach
- Department of Otorhinolaryngology and Head and Neck Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Raja R Seethala
- Department of Pathology, Presbyterian University Hospital, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | - Benedicte P Ulhøi
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrea Vingiani
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Yan Zhang
- Department of Pathology, Fudan University Shanghai Cancer Centre, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, CA, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK.
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Kang YJ, Park G, Park SY, Kim T, Kim E, Heo Y, Lee C, Jeong HS. Extra-Capsular Spread of Lymph Node Metastasis in Oral, Oropharyngeal and Hypopharyngeal Cancer: A Comparative Subsite Analysis. Cancers (Basel) 2024; 16:659. [PMID: 38339410 PMCID: PMC10854589 DOI: 10.3390/cancers16030659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The extra-capsular spread (ECS) of lymph node metastasis (LNM) is a hallmark of aggressive primary tumor phenotype in head and neck cancer (HNC); however, the factors influencing ECS are poorly understood. PATIENTS AND METHODS This was a retrospective study, including 190 cases of oral tongue cancer (OTC), 148 cases of oropharyngeal cancer (OPC) (118 HPV-positive and 30 HPV-negative), and 100 cases of hypopharyngeal cancer (HPC). Tumor dimension, tumor biological variables (lymphovascular/perineural invasion and histologic grade), and LNM variables (LNM number and size) were analyzed according to the presence of ECS using multivariable logistic regression and receiver operating characteristic (ROC) curve analyses. RESULTS LNM variables were significant factors for ECS in all subsites of HNC (p < 0.05), except HPV-positive OPC. In OTC, tumor dimensional variables were significantly related to ECS (p < 0.01). Meanwhile, in OPC and HPC, neither the primary tumor dimension nor the T status were significant factors for ECS occurrence. The predictability of ECS by ROC curve using multiple variables was 0.819 [95% confidence interval: 0.759-0.878] in OTC, 0.687 [0.559-0.815] in HPV-positive OPC, 0.823 [0.642-1.000] in HPV-negative OPC, and 0.907 [0.841-0.973] in HPC. CONCLUSION LNM variables were correlated with ECS occurrence for most HNC subsites, and site-dependent primary tumor characteristics might contribute differentially to the ECS development of LNM in HNC.
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Affiliation(s)
- Yung Jee Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Goeun Park
- Center for Biomedical Statistics, Samsung Medical Center, Seoul 06351, Republic of Korea;
| | - Sung Yool Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Taehwan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Eunhye Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Yujin Heo
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Changhee Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
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3
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Wu B, Zhang T, Dai N, Luo D, Wang X, Qiao C, Liu J. Global research trends in tongue cancer from 2000 to 2022: bibliometric and visualized analysis. Clin Oral Investig 2024; 28:130. [PMID: 38305810 DOI: 10.1007/s00784-024-05516-6] [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: 10/10/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES This study conducts a systematic bibliometric analysis of tongue cancer publications to identify key topics, hotspots, and research distribution. METHODS We analyzed tongue cancer publications in the Web of Science core collection database, assessing their quantity and quality. We investigated contributors, including countries, affiliations, journals, authors, and categories, within collaborative networks. Additionally, we synthesized key research findings using various analytical techniques, such as alluvial flow, burstness analysis, cluster analysis, co-occurrence network of associations, and network layer overlay. RESULTS From 2000 to 2022, this bibliometric study covers 2205 articles and reviews across 617 journals, involving 72 countries, 2233 institutions, and 11,266 authors. It shows consistent growth, particularly in 2016. Key contributors include China (499 publications), Karolinska Institute (84 publications), Oral Oncology (144 publications), and Tuula Salo (47 publications). Other notable contributors are the USA (16,747 citations), the National Cancer Institute (NCI) (2597 citations), and the Memorial Sloan-Kettering Cancer Center (MSK) (2231 citations). Additionally, there are significant teams led by Tuula Salo and Dalianis. We have identified six primary clusters: #0 apoptosis, #1 depth of invasion, #2 radiotherapy, #3 hpv, #4 tongue cancer, #5 oral cancer. The top ten highly cited documents primarily pertain to epidemiology, prognostic indicators in early-stage oral tongue cancer, and HPV. Additionally, we observed 16 reference clusters, with depth of invasion (#3), young patients (#4), and tumor budding (#6) gaining prominence since 2012, indicating sustained research interests. CONCLUSIONS This analysis emphasizes the increasing scholarly interest in tongue cancer research. The bibliometric evaluation highlights pivotal recent research themes such as HPV, depth of invasion, tumor budding, and surgical margins. CLINICAL RELEVANCE The bibliometric analysis highlights the key topics and studies which have shaped the understanding and management of tongue cancer.
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Affiliation(s)
- Beibei Wu
- Department of Information and TCM Big Data Innovation Lab of Beijing Office of Academic Research and Department of Oncology and Department of Scientific Research, China Academy of Chinese Medical Science, Xiyuan Hospital, Beijing, 10091, China
| | - Tong Zhang
- Department of Information and TCM Big Data Innovation Lab of Beijing Office of Academic Research and Department of Oncology and Department of Scientific Research, China Academy of Chinese Medical Science, Xiyuan Hospital, Beijing, 10091, China
| | - Ning Dai
- Department of Information and TCM Big Data Innovation Lab of Beijing Office of Academic Research and Department of Oncology and Department of Scientific Research, China Academy of Chinese Medical Science, Xiyuan Hospital, Beijing, 10091, China
| | - Ding Luo
- Department of Information and TCM Big Data Innovation Lab of Beijing Office of Academic Research and Department of Oncology and Department of Scientific Research, China Academy of Chinese Medical Science, Xiyuan Hospital, Beijing, 10091, China
| | - Xuejie Wang
- Department of Information and TCM Big Data Innovation Lab of Beijing Office of Academic Research and Department of Oncology and Department of Scientific Research, China Academy of Chinese Medical Science, Xiyuan Hospital, Beijing, 10091, China
| | - Chen Qiao
- Department of Information and TCM Big Data Innovation Lab of Beijing Office of Academic Research and Department of Oncology and Department of Scientific Research, China Academy of Chinese Medical Science, Xiyuan Hospital, Beijing, 10091, China
| | - Jian Liu
- Department of Information and TCM Big Data Innovation Lab of Beijing Office of Academic Research and Department of Oncology and Department of Scientific Research, China Academy of Chinese Medical Science, Xiyuan Hospital, Beijing, 10091, China.
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4
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Montagne W, Thi W, Lee L, Okuyemi OT, Wang RC. Base of Tongue Squamous Cell Carcinoma With Metastasis to the Mandibular Symphysis: A Case Report. Cureus 2023; 15:e50417. [PMID: 38222157 PMCID: PMC10784428 DOI: 10.7759/cureus.50417] [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] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Squamous cell carcinoma (SCC) is the most common malignancy of the oropharynx (OP). Treatment of OP SCC includes chemotherapy, radiation, and/or surgery. OP SCC can spread via direct extension, lymphatics, or hematogenously. Although rare, distant metastases can occur in OP SCC. The most common sites of metastasis include the lungs, bone, and liver. Other less common sites include the skin, bone marrow, brain, kidneys, eyes, and heart. Patients who present with distant metastases usually have a poor prognosis. Sites of bone metastases from more common to less common include the spine, skull, ribs, and axial bones. In this article, we discuss a patient who presents with HPV+ base of tongue SCC with metastases to the lungs and mandible symphysis. Base of tongue SCC metastasizing to the mandible symphysis is a rarely reported location of metastasis.
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Affiliation(s)
- William Montagne
- Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Wanda Thi
- Otolaryngology - Head and Neck Surgery, University of Nevada Reno School of Medicine, Reno, USA
| | - Logan Lee
- Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Oluwafunmilola T Okuyemi
- Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Robert C Wang
- Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
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5
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Henson CE, Abou-Foul AK, Morton DJ, McDowell L, Baliga S, Bates J, Lee A, Bonomo P, Szturz P, Nankivell P, Huang SH, Lydiatt WM, O’Sullivan B, Mehanna H. Diagnostic challenges and prognostic implications of extranodal extension in head and neck cancer: a state of the art review and gap analysis. Front Oncol 2023; 13:1263347. [PMID: 37799466 PMCID: PMC10548228 DOI: 10.3389/fonc.2023.1263347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Extranodal extension (ENE) is a pattern of cancer growth from within the lymph node (LN) outward into perinodal tissues, critically defined by disruption and penetration of the tumor through the entire thickness of the LN capsule. The presence of ENE is often associated with an aggressive cancer phenotype in various malignancies including head and neck squamous cell carcinoma (HNSCC). In HNSCC, ENE is associated with increased risk of distant metastasis and lower rates of locoregional control. ENE detected on histopathology (pathologic ENE; pENE) is now incorporated as a risk-stratification factor in human papillomavirus (HPV)-negative HNSCC in the eighth edition of the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) TNM classification. Although ENE was first described almost a century ago, several issues remain unresolved, including lack of consensus on definitions, terminology, and widely accepted assessment criteria and grading systems for both pENE and ENE detected on radiological imaging (imaging-detected ENE; iENE). Moreover, there is conflicting data on the prognostic significance of iENE and pENE, particularly in the context of HPV-associated HNSCC. Herein, we review the existing literature on ENE in HNSCC, highlighting areas of controversy and identifying critical gaps requiring concerted research efforts.
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Affiliation(s)
- Christina E. Henson
- Department of Radiation Oncology and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ahmad K. Abou-Foul
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Daniel J. Morton
- Department of Pediatrics and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sujith Baliga
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - James Bates
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Anna Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Petr Szturz
- Department of Oncology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - William M. Lydiatt
- Department of Surgery, Creighton University, and Nebraska Methodist Health System, Omaha, NE, United States
| | - Brian O’Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
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6
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Lim YX, Mierzwa ML, Sartor MA, D'Silva NJ. Clinical, morphologic and molecular heterogeneity of HPV-associated oropharyngeal cancer. Oncogene 2023; 42:2939-2955. [PMID: 37666939 PMCID: PMC10541327 DOI: 10.1038/s41388-023-02819-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
The incidence of human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is rising rapidly and has exceeded cervical cancer to become the most common HPV-induced cancer in developed countries. Since patients with HPV + OPSCC respond very favorably to standard aggressive treatment, the emphasis has changed to reducing treatment intensity. However, recent multi-center clinical trials failed to show non-inferiority of de-escalation strategies on a population basis, highlighting the need to select low-risk patients likely to respond to de-intensified treatments. In contrast, there is a substantial proportion of patients who develop recurrent disease despite aggressive therapy. This supports that HPV + OPSCC is not a homogeneous disease, but comprises distinct subtypes with clinical and biological variations. The overall goal for this review is to identify biomarkers for HPV + OPSCC that may be relevant for patient stratification for personalized treatment. We discuss HPV + OPSCC as a heterogeneous disease from multifaceted perspectives including clinical behavior, tumor morphology, and molecular phenotype. Molecular profiling from bulk tumors as well as single-cell sequencing data are discussed as potential driving factors of heterogeneity between tumor subgroups. Finally, we evaluate key challenges that may impede in-depth investigations of HPV + OPSCC heterogeneity and outline potential future directions, including a section on racial and ethnic differences.
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Affiliation(s)
- Yvonne X Lim
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011N. University Ave, Ann Arbor, MI, USA
| | - Michelle L Mierzwa
- Rogel Cancer Center, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, USA
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maureen A Sartor
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Biostatistics, School of Public Health, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nisha J D'Silva
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011N. University Ave, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, USA.
- Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.
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7
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Chen AM. De-escalated radiation for human papillomavirus virus-related oropharyngeal cancer: evolving paradigms and future strategies. Front Oncol 2023; 13:1175578. [PMID: 37576899 PMCID: PMC10413127 DOI: 10.3389/fonc.2023.1175578] [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: 02/27/2023] [Accepted: 05/25/2023] [Indexed: 08/15/2023] Open
Abstract
The incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma has increased dramatically in recent years reaching epidemic-like proportions. Data has emerged not only showing that these cancers are a unique entity with distinct molecular characteristics but that they also have a significantly improved prognosis as a result of their exquisite radiosensitivity compared to their HPV-negative counterparts. This, it has been increasingly suggested that these tumors can be targeted with de-escalated approaches using reduced doses of radiation. The overriding goal of de-escalation is to maintain the high cure and survival rates associated with traditional approaches while reducing the incidence of both short- and long-term toxicity. Although the exact reason for the improved radiosensitivity of HPV-positive oropharyngeal carcinoma is unclear, prospective studies have now been published demonstrating that de-escalated radiation can successfully maintain the high rates of cure and preserve quality of life for appropriately selected patients with this disease. However, these studies have been complicated by such factors as the relatively limited sample sizes, as well as the variability in treatment, inclusion criteria, and follow-up. As the data continues to mature on de-escalation, it is unquestionable that treatment paradigms for this disease will evolve. The ongoing quest to define a standard regimen comprises the subject of this review.
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Affiliation(s)
- Allen M. Chen
- Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, School of Medicine, University of California- Irvine, Irvine, CA, United States
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8
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Lin C, Sharbel DD, Topf MC. Surgical clinical trials for HPV-positive oropharyngeal carcinoma. Front Oncol 2022; 12:992348. [PMID: 36439459 PMCID: PMC9682030 DOI: 10.3389/fonc.2022.992348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/21/2022] [Indexed: 07/22/2023] Open
Abstract
The treatment of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) continues to evolve as multiple ongoing and recently completed clinical trials investigate the role of surgery, radiation therapy, chemotherapy, and immunotherapy. Current trials are investigating transoral robotic surgery (TORS) in treatment de-escalation protocols in an effort to optimize quality of life, while maintaining historical survival rates. The advantage of TORS is its minimally invasive approach to primary resection of the tumor as well as valuable pathologic staging. The ORATOR trial reported poorer quality of life in patients treated with TORS compared to primary radiotherapy though this was not a clinically meaningful difference. The recently published ECOG 3311 trial showed that surgery can be used to safely de-escalate the adjuvant radiation dose to 50 Gy in intermediate-risk patients. In this review, we summarize and discuss the past and current clinical trials involving surgery in the treatment of HPV-positive OPSCC.
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Affiliation(s)
- Chen Lin
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Otolaryngology – Head and Neck Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Daniel D. Sharbel
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Michael C. Topf
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
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9
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Xu B, Saliba M, Alzumaili B, Alghamdi M, Lee N, Riaz N, Patel SG, Ganly I, Dogan S, Ghossein RA, Katabi N. Prognostic impact of extranodal extension (ENE) in surgically managed treatment-naive HPV-positive oropharyngeal squamous cell carcinoma with nodal metastasis. Mod Pathol 2022; 35:1578-1586. [PMID: 35690646 PMCID: PMC10368196 DOI: 10.1038/s41379-022-01120-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/12/2022] [Accepted: 05/28/2022] [Indexed: 11/09/2022]
Abstract
Extranodal extension (ENE) is a significant prognostic factor for human papilloma virus (HPV)-negative head and neck squamous cell carcinoma and is incorporated into AJCC 8th edition pN stage. It remains controversial whether ENE or the degree of ENE is prognostically relevant in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). A detailed clinicopathologic review was conducted in a large retrospective cohort of 232 surgically treated patients with HPV-positive OPSCC and nodal metastasis. Fifty-six patients (24%) had nodal metastasis with ENE. The median vertical extent of ENE was 2.9 mm (range 0.2-20.3 mm), and the median horizontal span of ENE was 2.5 mm (range: 0.3-14.0 mm). Comparing with patients without ENE, those with ENE were associated with a higher number of positive lymph nodes, lymphovascular invasion, perineural invasion, adjuvant chemotherapy, larger primary tumor size, and shorter follow up period. Patients with ENE had shortened overall survival (OS), disease specific survival (DSS), disease free survival (DFS), distant metastasis free survival (DMFS), and regional recurrence free survival (RRFS) on univariate survival analysis. The 5-year OS, DSS, and DFS were 95%, 97%, and 90% respectively for the group without ENE, and 64%, 71%, and 65% respectively for the group with ENE. On Multivariate survival analysis, the presence of ENE was an independent adverse prognostic factor for OS, DSS, and DFS. Additionally, major ENE defined as a vertical extent of ≥4 mm or irregular soft tissue deposit independently predicted shortened OS, DSS, and RFS. In conclusion, the presence of ENE, in particular major ENE, is an independent prognostic factor in HPV-positive OPSCC. Therefore, we propose to document the presence and extent of ENE for these tumors. Consideration may be given for AJCC 9th edition to include ENE into pN stage of HPV-positive OPSCC.
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Affiliation(s)
- Bin Xu
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Maelle Saliba
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Bayan Alzumaili
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Mohammed Alghamdi
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Nancy Lee
- Department of Radiation Oncology, New York, NY, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, New York, NY, USA
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Snjezana Dogan
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Ronald A Ghossein
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Nora Katabi
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA.
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10
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Robbins HA, Ferreiro-Iglesias A, Waterboer T, Brenner N, Nygard M, Bender N, Schroeder L, Hildesheim A, Pawlita M, D'Souza G, Visvanathan K, Langseth H, Schlecht NF, Tinker LF, Agalliu I, Wassertheil-Smoller S, Ness-Jensen E, Hveem K, Grioni S, Kaaks R, Sánchez MJ, Weiderpass E, Giles GG, Milne RL, Cai Q, Blot WJ, Zheng W, Weinstein SJ, Albanes D, Huang WY, Freedman ND, Kreimer AR, Johansson M, Brennan P. Absolute Risk of Oropharyngeal Cancer After an HPV16-E6 Serology Test and Potential Implications for Screening: Results From the Human Papillomavirus Cancer Cohort Consortium. J Clin Oncol 2022; 40:3613-3622. [PMID: 35700419 PMCID: PMC9622695 DOI: 10.1200/jco.21.01785] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/17/2021] [Accepted: 05/05/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Seropositivity for the HPV16-E6 oncoprotein is a promising marker for early detection of oropharyngeal cancer (OPC), but the absolute risk of OPC after a positive or negative test is unknown. METHODS We constructed an OPC risk prediction model that integrates (1) relative odds of OPC for HPV16-E6 serostatus and cigarette smoking from the human papillomavirus (HPV) Cancer Cohort Consortium (HPVC3), (2) US population risk factor data from the National Health Interview Survey, and (3) US sex-specific population rates of OPC and mortality. RESULTS The nine HPVC3 cohorts included 365 participants with OPC with up to 10 years between blood draw and diagnosis and 5,794 controls. The estimated 10-year OPC risk for HPV16-E6 seropositive males at age 50 years was 17.4% (95% CI, 12.4 to 28.6) and at age 60 years was 27.1% (95% CI, 19.2 to 45.4). Corresponding 5-year risk estimates were 7.3% and 14.4%, respectively. For HPV16-E6 seropositive females, 10-year risk estimates were 3.6% (95% CI, 2.5 to 5.9) at age 50 years and 5.5% (95% CI, 3.8 to 9.2) at age 60 years and 5-year risk estimates were 1.5% and 2.7%, respectively. Over 30 years, after a seropositive result at age 50 years, an estimated 49.9% of males and 13.3% of females would develop OPC. By contrast, 10-year risks among HPV16-E6 seronegative people were very low, ranging from 0.01% to 0.25% depending on age, sex, and smoking status. CONCLUSION We estimate that a substantial proportion of HPV16-E6 seropositive individuals will develop OPC, with 10-year risks of 17%-27% for males and 4%-6% for females age 50-60 years in the United States. This high level of risk may warrant periodic, minimally invasive surveillance after a positive HPV16-E6 serology test, particularly for males in high-incidence regions. However, an appropriate clinical protocol for surveillance remains to be established.
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Affiliation(s)
- Hilary A. Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Tim Waterboer
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicole Brenner
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mari Nygard
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Noemi Bender
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lea Schroeder
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Michael Pawlita
- Division of Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hilde Langseth
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Nicolas F. Schlecht
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Lesley F. Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ilir Agalliu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | - Eivind Ness-Jensen
- HUNT Research Center and K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger/Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kristian Hveem
- HUNT Research Center and K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | | | - Graham G. Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Roger L. Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | - William J. Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Aimée R. Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Mattias Johansson
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
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11
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Schrank TP, Landess L, Stepp WH, Rehmani H, Weir WH, Lenze N, Lal A, Wu D, Kothari A, Hackman TG, Sheth S, Patel S, Jefferys SR, Issaeva N, Yarbrough WG. Comprehensive Viral Genotyping Reveals Prognostic Viral Phylogenetic Groups in HPV16-Associated Squamous Cell Carcinoma of the Oropharynx. Mol Cancer Res 2022; 20:1489-1501. [PMID: 35731223 PMCID: PMC11249119 DOI: 10.1158/1541-7786.mcr-21-0443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 01/05/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022]
Abstract
Human papillomavirus-positive (HPV+) squamous cell carcinoma of the oropharynx (OPSCC) is the most prevalent HPV-associated malignancy in the United States and is primarily caused by HPV subtype 16 (HPV16). Favorable treatment outcomes have led to increasing interest in treatment deescalation to reduce treatment-related morbidity. Prognostic biomarkers are needed to identify appropriately low-risk patients for reduced treatment intensity. Targeted DNA sequencing including all HPV16 open reading frames was performed on tumors from 104 patients with HPV16+ OPSCC treated at a single center. Genotypes closely related to the HPV16-A1 reference were associated with increased numbers of somatic copy-number variants in the human genome and poor recurrence-free survival (RFS). Genotypes divergent from HPV16-A1 were associated with favorable RFS. These findings were independent of tobacco smoke exposure. Total RNA sequencing was performed on a second independent cohort of 89 HPV16+ OPSCC cases. HPV16 genotypes divergent from HPV16-A1 were again validated in this independent cohort, to be prognostic of improved RFS in patients with moderate (less than 30 pack-years) or low (no more than 10 pack-years) of tobacco smoke exposure. In summary, we show in two independent cohorts that viral sequence divergence from the HPV16-A1 reference is correlated with improved RFS in patients with moderate or low tobacco smoke exposure. IMPLICATIONS HPV16 genotype is a potential biomarker that could be easily adopted to guide therapeutic decision-making related to deescalation therapy.
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Affiliation(s)
- Travis P Schrank
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
- Linberger Comprehensive Cancer Center, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Lee Landess
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Wesley H Stepp
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Hina Rehmani
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - William H Weir
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Nicholas Lenze
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Asim Lal
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Di Wu
- Linberger Comprehensive Cancer Center, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
- Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Aditi Kothari
- Linberger Comprehensive Cancer Center, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Trevor G Hackman
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Siddharth Sheth
- Department of Medicne, Division of Oncology, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Shetal Patel
- Department of Medicne, Division of Oncology, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Stuart R Jefferys
- Linberger Comprehensive Cancer Center, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Natalia Issaeva
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
- Linberger Comprehensive Cancer Center, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
- Department of Pathology and Lab Medicine, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
| | - Wendell G Yarbrough
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
- Linberger Comprehensive Cancer Center, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
- Department of Pathology and Lab Medicine, The University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina
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12
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Mierzwa M, Schonewolf C. Less Is Not Always More. Int J Radiat Oncol Biol Phys 2022; 114:12-13. [PMID: 35964625 DOI: 10.1016/j.ijrobp.2022.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Caitlin Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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13
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Silver JA, Turkdogan S, Roy CF, Subramaniam T, Henry M, Sadeghi N. De-Escalation Strategies for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma—Where Are We Now? Curr Oncol 2022; 29:3668-3697. [PMID: 35621685 PMCID: PMC9139371 DOI: 10.3390/curroncol29050295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 12/22/2022] Open
Abstract
The prevalence of oropharyngeal squamous cell carcinoma has been increasing in North America due to human papillomavirus-associated disease. It is molecularly distinct and differs from other head and neck cancers due to the young population and high survival rate. The treatment regimens currently in place cause significant long-term toxicities. Studies have transitioned from mortality-based outcomes to patient-reported outcomes assessing quality of life. There are many completed and ongoing trials investigating alternative therapy regimens or de-escalation strategies to minimize the negative secondary effects while maintaining overall survival and disease-free survival. The goal of this review is to discuss the most recent advancements within the field while summarizing and reviewing the available evidence.
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Affiliation(s)
- Jennifer A. Silver
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, QC H4A 3JI, Canada; (J.A.S.); (S.T.); (C.F.R.); (T.S.)
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
| | - Sena Turkdogan
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, QC H4A 3JI, Canada; (J.A.S.); (S.T.); (C.F.R.); (T.S.)
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
| | - Catherine F. Roy
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, QC H4A 3JI, Canada; (J.A.S.); (S.T.); (C.F.R.); (T.S.)
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
| | - Thavakumar Subramaniam
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, QC H4A 3JI, Canada; (J.A.S.); (S.T.); (C.F.R.); (T.S.)
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
| | - Melissa Henry
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H4A 3JI, Canada
- Lady-Davis Institute for Medical Research, Montreal, QC H3T 1E2, Canada
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Nader Sadeghi
- Department of Otolaryngology—Head and Neck Surgery, McGill University Health Centre, Montreal, QC H4A 3JI, Canada; (J.A.S.); (S.T.); (C.F.R.); (T.S.)
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H4A 3JI, Canada;
- Research Institute of McGill University Health Center, McGill University, Montreal, QC H4A 3JI, Canada
- Correspondence: ; Tel.: +1-514-934-1934 (ext. 34974); Fax: +1-514-843-1403
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14
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Lu XJD, Jackson E, Chew J, Nguyen S, Wu J, Poh CF, Prisman E. Combined chemoradiotherapy showed improved outcome with early-stage HPV-positive oropharyngeal cancers. BMC Cancer 2022; 22:513. [PMID: 35525912 PMCID: PMC9077931 DOI: 10.1186/s12885-022-09515-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/24/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The revised 8th Edition American Joint Committee on Cancer (AJCC) Head and Neck Staging Manual distinguishes HPV-mediated from non-HPV-mediated oropharyngeal cancer (OpSCC). The objective was to analyze OpSCC treatment modalities and outcomes. METHODS A retrospective study of OpSCC patients treated with radiotherapy or chemoradiotherapy between January 1st, 2000, and December 31st, 2008, as identified from the BC Cancer Registry. All patients received treatment at cancer clinics and had at least 5 years follow-up post-treatment. A total of 1259 OpSCC patients were identified. After initial chart reviews, 288 patients were excluded from further analysis and the majority (n = 198) was due to not receiving curative treatment. Based on the availability of formalin-fixed, paraffin-embedded (FFPE) tissue, patients were divided into two cohorts: Study Cohort (FFPE available, n = 244) and General Cohort (FFPE unavailable, n = 727). The Study Cohort was restaged according to AJCC 8th Edition based on p16 immunohistochemistry status. Kaplan-Meier analysis was used to estimate the 5-year overall survival (OS), disease-specific survival (DSS), and locoregional recurrence-free survival (LFS). RESULTS Among 971 patients, OpSCC age-adjusted incidence rate was observed to have increased from 2.1 to 3.5 per 100,000 between 2000 and 2008. The General Cohort was relatively older than the Study Cohort (60.1 ± 10.5 vs. 57.3 ± 9.4), but both cohorts were predominantly males (78.3% vs. 76.2%). Amongst the Study Cohort, 77.5% were p16-positive, of whom 98.4% were down staged in the 8th Edition. These early-stage patients showed OS improvement for those treated with chemoradiation, compared to radiation alone (85.8% vs. 73.1%, p = 0.05). CONCLUSIONS OpSCC incidence is increasing in BC. The addition of chemotherapy to radiotherapy may portend a benefit in OS even for early-stage p16-positive OpSCC. Additional research is necessary to assess the safety of treatment de-escalation even among early-stage disease.
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Affiliation(s)
- X J David Lu
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - Emmanuel Jackson
- Division of Neuroradiology, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jason Chew
- Division of Neuroradiology, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Sally Nguyen
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jonn Wu
- Department of Radiation Oncology, BC Cancer Agency, Vancouver Center, Vancouver, British Columbia, Canada
| | - Catherine F Poh
- Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada.
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15
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Robotic vs. transoral laser surgery of malignant oropharyngeal tumors-what is best for the patient? : A contemporary review. HNO 2022; 70:371-379. [PMID: 35419634 DOI: 10.1007/s00106-022-01165-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 12/23/2022]
Abstract
Human papillomavirus (HPV)-associated squamous cell carcinoma of the oropharynx is a malignancy of increasing prevalence. The oncologic community is currently evaluating the safety and efficacy of de-intensifying treatment without compromising oncologic outcomes. Paramount to these treatment algorithms is primary surgery through transoral approaches. This article reviews the literature and concepts pertaining to transoral surgery and describes the two most common techniques, transoral laser microsurgery (TLM) and transoral robotic surgery (TORS).
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16
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Vijayvargiya P, Trivedi S, Rupji M, Song H, Liu Y, Jiang R, Kaka AS, Chen GZ, Stokes W, Steuer C, Shin DM, Beitler JJ, Patel MR, Aiken A, Saba NF. Comparison of the Seventh and Eighth Edition of American Joint Committee on Cancer (AJCC) Staging for Selected and Nonselected Oropharyngeal Squamous Cell Carcinomas. Oncologist 2022; 27:48-56. [PMID: 35305095 PMCID: PMC8842371 DOI: 10.1093/oncolo/oyab001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/15/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The eighth edition American Joint Committee on Cancer (AJCC) Staging incorporates significant changes to the seventh edition in the staging of oropharyngeal squamous cell carcinomas (OPSCC). An important change was the inclusion of OPSCC associated with the human papilloma virus (HPV). Our goal is to compare the performance of both staging systems for patients with HPV-selected and unselected clinical characteristics for OPSCC. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) database, 2004-2016, we identified patients with likely HPV-associated OPSCC based on surrogate markers (white males aged <65 years old with squamous cell carcinomas of the tonsil and base of tongue), excluding those who underwent surgery. We re-classified these patients using seventh and eighth edition staging for HPV-selected OPSCC and compared the prediction performance of both staging editions for overall survival (OS) and disease-specific survival (DSS). We performed the same analysis for clinically unselected patients with OPSCC. RESULTS Our analysis included 9554 patients with a median follow-up of 67 months. Comparing the eighth versus seventh edition for our HPV-selected cohort, clinical staging changed for 92.3% of patients and 10-year OS was 62.2%, 61.2%, 35.3%, and 15.5% for Stage I, II, III, and IV, versus 52.9%, 59.2%, 61.6%, 55.1%, 38.3%, and 15.5% for stage I, II, III, IVA, IVB, and IVC, respectively. A similar pattern was observed for 10-year DSS. The concordance statistics for our HPV-selected cohort were improved for both AJCC 7 (0.6260) and AJCC 8 (0.6846) compared with the unselected cohort, 0.5860 and 0.6457 for AJCC 7 and 8, respectively. CONCLUSION The overall performance of discrimination improved from AJCC 7 to AJCC 8 for both clinically selected and unselected patients, but more notably for our HPV-selected cohort. Despite the lack of statistically significant differentiation between Stages I and II in AJCC 8 in either groups, markedly improved discrimination was observed between Stages I/II, III, and IV in the HPV-selected cohort.
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Affiliation(s)
- Pooja Vijayvargiya
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sumita Trivedi
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Manali Rupji
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Haocan Song
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Renjian Jiang
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Azeem S Kaka
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Georgia Z Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - William Stokes
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jonathan J Beitler
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Mihir R Patel
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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17
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HPV-associated oropharyngeal cancer: epidemiology, molecular biology and clinical management. Nat Rev Clin Oncol 2022; 19:306-327. [PMID: 35105976 PMCID: PMC8805140 DOI: 10.1038/s41571-022-00603-7] [Citation(s) in RCA: 278] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/13/2022]
Abstract
Human papillomavirus (HPV)-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) has one of the most rapidly increasing incidences of any cancer in high-income countries. The most recent (8th) edition of the UICC/AJCC staging system separates HPV+ OPSCC from its HPV-negative (HPV−) counterpart to account for the improved prognosis seen in the former. Indeed, owing to its improved prognosis and greater prevalence in younger individuals, numerous ongoing trials are examining the potential for treatment de-intensification as a means to improve quality of life while maintaining acceptable survival outcomes. In addition, owing to the distinct biology of HPV+ OPSCCs, targeted therapies and immunotherapies have become an area of particular interest. Importantly, OPSCC is often detected at an advanced stage owing to a lack of symptoms in the early stages; therefore, a need exists to identify and validate possible diagnostic biomarkers to aid in earlier detection. In this Review, we provide a summary of the epidemiology, molecular biology and clinical management of HPV+ OPSCC in an effort to highlight important advances in the field. Ultimately, a need exists for improved understanding of the molecular basis and clinical course of this disease to guide efforts towards early detection and precision care, and to improve patient outcomes. The incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is increasing rapidly in most developed countries. In this Review, the authors provide an overview of the epidemiology, molecular biology and treatment of HPV-positive OPSCC, including discussions of the role of treatment de-escalation and emerging novel therapies. The incidence of human papillomavirus-associated oropharyngeal cancer (HPV+ OPSCC) is expected to continue to rise over the coming decades until the benefits of gender-neutral prophylactic HPV vaccination begin to become manifest. The incidence of HPV+ OPSCC appears to be highest in high-income countries, although more epidemiological data are needed from low- and middle-income countries, in which HPV vaccination coverage remains low. The substantially better prognosis of patients with HPV+ OPSCC compared to those with HPV– OPSCC has been recognized in the American Joint Committee on Cancer TNM8 staging guidelines, which recommend stratification by HPV status to improve staging. The molecular biology and genomic features of HPV+ OPSCC are similar to those of other HPV-associated malignancies, with HPV oncogenes (E6 and E7) acting as key drivers of pathogenesis. Treatment de-intensification is being pursued in clinical trials, although identifying the ~15% of patients with HPV+ OPSCC who have recurrent disease, and who therefore require more intensive treatment, remains a key challenge.
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Tawk B, Debus J, Abdollahi A. Evolution of a Paradigm Switch in Diagnosis and Treatment of HPV-Driven Head and Neck Cancer—Striking the Balance Between Toxicity and Cure. Front Pharmacol 2022; 12:753387. [PMID: 35126105 PMCID: PMC8810823 DOI: 10.3389/fphar.2021.753387] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
More than a decade after the discovery of p16 immunohistochemistry (IHC) as a surrogate for human papilloma virus (HPV)-driven head and neck squamous cell carcinoma (HNSCC), p16-IHC has become a routinely evaluated biomarker to stratify oropharyngeal squamous cell carcinoma (OPSCC) into a molecularly distinct subtype with favorable clinical prognosis. Clinical trials of treatment de-escalation frequently use combinations of biomarkers (p16-IHC, HPV-RNA in situ hybridization, and amplification of HPV-DNA by PCR) to further improve molecular stratification. Implementation of these methods into clinical routine may be limited in the case of RNA by the low RNA quality of formalin-fixed paraffin-embedded tissue blocks (FFPE) or in the case of DNA by cross contamination with HPV-DNA and false PCR amplification errors. Advanced technological developments such as investigation of tumor mutational landscape (NGS), liquid-biopsies (LBx and cell-free cfDNA), and other blood-based HPV immunity surrogates (antibodies in serum) may provide novel venues to further improve diagnostic uncertainties. Moreover, the value of HPV/p16-IHC outside the oropharynx in HNSCC patients needs to be clarified. With regards to therapy, postoperative (adjuvant) or definitive (primary) radiochemotherapy constitutes cornerstones for curative treatment of HNSCC. Side effects of chemotherapy such as bone-marrow suppression could lead to radiotherapy interruption and may compromise the therapy outcome. Therefore, reduction of chemotherapy or its replacement with targeted anticancer agents holds the promise to further optimize the toxicity profile of systemic treatment. Modern radiotherapy gradually adapts the dose. Higher doses are administered to the visible tumor bulk and positive lymph nodes, while a lower dose is prescribed to locoregional volumes empirically suspected to be invaded by tumor cells. Further attempts for radiotherapy de-escalation may improve acute toxicities, for example, the rates for dysphagia and feeding tube requirement, or ameliorate late toxicities like tissue scars (fibrosis) or dry mouth. The main objective of current de-intensification trials is therefore to reduce acute and/or late treatment-associated toxicity while preserving the favorable clinical outcomes. Deep molecular characterization of HPV-driven HNSCC and radiotherapy interactions with the tumor immune microenvironment may be instructive for the development of next-generation de-escalation strategies.
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Affiliation(s)
- Bouchra Tawk
- German Cancer Consortium (DKTK) Core Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Clinical Cooperation Units (CCU) Translational Radiation Oncology and Radiation Oncology, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg Faculty of Medicine (MFHD), Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), German Cancer Research Center (DKFZ), Heidelberg University Hospital (UKHD), Heidelberg, Germany
- *Correspondence: Bouchra Tawk,
| | - Jürgen Debus
- German Cancer Consortium (DKTK) Core Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Clinical Cooperation Units (CCU) Translational Radiation Oncology and Radiation Oncology, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg Faculty of Medicine (MFHD), Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), German Cancer Research Center (DKFZ), Heidelberg University Hospital (UKHD), Heidelberg, Germany
| | - Amir Abdollahi
- German Cancer Consortium (DKTK) Core Center Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Clinical Cooperation Units (CCU) Translational Radiation Oncology and Radiation Oncology, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Division of Molecular and Translational Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg Faculty of Medicine (MFHD), Heidelberg University Hospital (UKHD), Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), German Cancer Research Center (DKFZ), Heidelberg University Hospital (UKHD), Heidelberg, Germany
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Pilar A, O’Sullivan B, Huang SH. Risk Stratification of HPV-Associated Oropharyngeal Squamous Cell Carcinoma: Are All Tumors Created Equally? CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fenlon JB, Hutten RJ, Weil CR, Lloyd S, Cannon DM, Kerrigan K, Cannon RB, Hitchcock YJ. Comparing adjuvant radiation to adjuvant chemoradiation in postsurgical p16+ oropharyngeal carcinoma patients with extranodal extension or positive margins. Head Neck 2021; 44:606-614. [PMID: 34931386 DOI: 10.1002/hed.26951] [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: 08/03/2021] [Revised: 11/02/2021] [Accepted: 12/02/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Adjuvant guidelines in surgically resected p16+ oropharyngeal carcinoma (OPC) with positive surgical margins (PSM) or extranodal extension (ENE) are based on randomized controlled trials predating p16 status. It remains unclear if adjuvant chemotherapy is necessary in p16+ patients with these features. METHODS The National Cancer Database was used to identify cases of nonmetastatic p16+ OPC diagnosed from 2010 to 2017. Patients treated with surgical resection followed by adjuvant radiation (aRT) or adjuvant chemoradiation (aCRT) were eligible for analysis. RESULTS A total of 14 071 patients were eligible for analysis. Overall survival (OS) was not statistically different between aRT and aCRT in patients with PSM (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.56-1.28), ENE (HR 0.93, 95% CI 0.69-1.27) or both (HR 0.73, 95% CI 0.41-1.31). CONCLUSIONS In patients with p16+ OPC with ENE, PSM, or both, adding chemotherapy to aRT was not associated with improved OS.
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Affiliation(s)
- Jordan B Fenlon
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Ryan J Hutten
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Christopher R Weil
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Donald M Cannon
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Kathleen Kerrigan
- Division of Medical Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Richard B Cannon
- Division of Otolaryngology - Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ying J Hitchcock
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
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Schrank T, Weir W, Lal A, Landess L, Lenze N, Hackman T. Quantifying smoking exposure, genomic correlates, and related risk of treatment failure in p16+ squamous cell carcinoma of the oropharynx. Laryngoscope Investig Otolaryngol 2021; 6:1376-1382. [PMID: 34938877 PMCID: PMC8665424 DOI: 10.1002/lio2.695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/14/2021] [Accepted: 06/27/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES HPV-associated (p16+) squamous cell carcinoma of the oropharynx (OPSCC) has improved survival as compared to HPV-negative, smoking-associated disease. Intermediate outcomes have been noted in patients with p16+ tumors and smoking exposure. However, the extent of smoking exposure required for outcomes to decrease has not been delineated due to low failure rates and poor availability of quantitative tobacco smoke exposure data. Our primary objective is to characterize the dose-dependent relationship between recurrence-free survival (RFS) and tobacco smoke exposure in p16+ OPSCC and secondarily correlate tobacco smoke exposure with genomic alterations. METHODS Single institution chart review was performed of patients diagnosed with p16+ OPSCC from 2003 to 2015. Patients were excluded if staging, treatment details, recurrence status, or smoking exposure in pack-years were not available. Two hundred and forty-four patients were included. RESULTS Patients with 25 pack-years or greater smoking history exhibited a dose-dependent decrease in RFS compared to never smokers. This was robust to multivariate analysis for including staging and demographic factors. Forty-three patients with available targeted tumor sequencing data were identified. A strong trend was observed for increased C to A transversion mutations above 25 pack-years, which are known to be associated with exposure to tobacco smoke. Similarly, the proportion of COSMIC Signature 4 mutations were also found to be more common in patients with more than 25 pack-years of smoking exposure. CONCLUSION Evidence-based smoking exposure thresholds are needed to define inclusion criteria for trials of de-escalation therapy for p16+ OPSCC. Patients with smoking exposure greater than 20 pack-years have increased risk of recurrence and a distinct pattern of genomic alterations. Further studies are needed to delineate the potential consequences of mild smoking exposure. Smoking-related mutational signatures may hold potential for biomarker development in p16+ OPSCC. LEVEL OF EVIDENCE 2B.
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Affiliation(s)
- Travis Schrank
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
- Lineberger Comprehensive Cancer Center—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - William Weir
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Asim Lal
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Lee Landess
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Nicholas Lenze
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Trevor Hackman
- Department of Otolaryngology—Head and Neck SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
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Saliba M, Ghossein R, Xu B. HPV-related head and neck cancers: Pathology and biology. J Surg Oncol 2021; 124:923-930. [PMID: 34582040 DOI: 10.1002/jso.26683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/12/2021] [Indexed: 12/16/2022]
Abstract
Discovering the key role HPV plays in head and neck carcinogenesis has revolutionized our approach to cancers such as oropharyngeal carcinomas. As the role of HPV expands beyond the oropharynx, there is a pursued need to understand the oncogenic mechanisms of HPV-driven tumorigenesis and their implications. Optimizing HPV detection methods all while acknowledging their limitations will ensure our ability to diagnose HPV-driven neoplasia wherever clinically relevant.
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Affiliation(s)
- Maelle Saliba
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Dagan R, Galloway TJ. Radiation Treatment Deintensification for HPV-Associated Oropharyngeal Cancer. Semin Radiat Oncol 2021; 31:324-331. [PMID: 34455987 DOI: 10.1016/j.semradonc.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Human papillomavirus-associated oropharyngeal cancer (HPV-OPC) is a distinct clinical entity with a favorable prognosis compared with non-HPV-OPC. Surgery and radiotherapy (RT) result in adverse effects, and negative quality of life or functional outcomes, which impact a significant proportion of HPV-OPC survivors. Ongoing studies aim to reduce these negative treatment effects while maintaining high cure rates through deintensified therapy typically use either a primary surgical or RT approach. A single-day curative surgery will remain relevant for many patients with early-stage disease. However, the average patient with HPV-OPC will have indications for adjuvant therapy. A primary RT approach to deintensified therapy has more available data from patients on prospective multi-institutional trials, provides broader patient selection, and may be more cost-effective. Anticipated results from an active phase II/III NCTN trial will help guide the standard of care using primary RT. Next generation trials will help further refine patient selection and/or radical deintensification (30-50 Gy).
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Affiliation(s)
- Roi Dagan
- Department of Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, FL.
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
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Wotman MT, Miles BA, Bakst RL, Posner MR. A proposal for risk-based and strategy-adapted de-escalation in human papillomavirus-positive oropharyngeal squamous cell carcinoma. Cancer 2021; 127:4330-4338. [PMID: 34379804 DOI: 10.1002/cncr.33851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Michael T Wotman
- The Department of Internal Medicine in the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett A Miles
- The Department of Otolaryngology in the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard L Bakst
- The Department of Radiation Oncology in the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall R Posner
- The Department of Hematology/Oncology in the Icahn School of Medicine at Mount Sinai, New York, New York
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Day AT, Yang AM, Tanamal P, Blackwell JM, Wang E, Sumer BD, Bishop JA, Hughes RS, Khan SA, Sher DJ. Extracapsular extension, pathologic node status, and adjuvant treatment in primary surgery patients with human papillomavirus-mediated oropharyngeal cancer: A national hospital-based retrospective cohort analysis. Head Neck 2021; 43:3345-3363. [PMID: 34331477 DOI: 10.1002/hed.26825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The significance of extracapsular extension (ECE) and adjuvant treatment paradigm in patients with surgically managed human papillomavirus-positive (HPV+) oropharyngeal cancer (OPC) is debated. METHODS National, hospital-based, retrospective cohort study of 2663 patients pN+ HPV+ OPC who underwent primary surgery. RESULTS Patients with ECE had a 1.74-times risk of death (95% confidence interval [CI]: 1.26-2.40, p = 0.001) compared to patients without ECE. Among patients with pN1, ECE-positive disease, risk of overall mortality was similar across treatment paradigms (surgery alone: ref; adjuvant radiation therapy [RT]: aHR: 0.81; 95% CI: 0.36-1.85; p = 0.62; adjuvant CRT: aHR: 0.66; 95% CI: 0.34-1.32; p = 0.24). Patients with pN2 ECE-positive disease treated with adjuvant RT alone exhibited similar risk of all-cause mortality (hazard ratio: 1.04, 95% CI: 0.24-4.47, p = 0.96) compared to adjuvant chemoradiation (CRT). In patients with advanced, ECE-positive disease (e.g., pT3-T4pN2), adjuvant CRT did not reduce the risk of overall mortality relative to adjuvant RT. CONCLUSION Although pathologic ECE negatively predicts for survival in patients with HPV+ OPC, our analyses support expansion of postoperative de-intensification clinical trial eligibility criteria in patients with ECE-positive disease.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Alex M Yang
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Priscilla Tanamal
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - James-Michael Blackwell
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ellen Wang
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Baran D Sumer
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Justin A Bishop
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Randall S Hughes
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Saad A Khan
- Department of Internal Medicine, Stanford Health Care, Palo Alto, California, USA
| | - David J Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
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Chen SY, Sinha P, Last A, Ettyreddy A, Kallogjeri D, Pipkorn P, Rich JT, Zevallos JP, Paniello R, Puram SV, Van Abel K, Moore EJ, Oppelt P, Palka K, Adkins D, Daly M, Gay H, Thorstad WL, Jackson RS. Outcomes of Patients With Single-Node Metastasis of Human Papillomavirus-Related Oropharyngeal Cancer Treated With Transoral Surgery. JAMA Otolaryngol Head Neck Surg 2021; 147:16-22. [PMID: 33151273 DOI: 10.1001/jamaoto.2020.3870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Regional lymph node metastasis remains an important prognostic factor in patients with oropharyngeal squamous cell carcinoma (OPSCC). Although survival among patients with regional metastasis in human papillomavirus (HPV)-related OPSCC is more favorable compared with patients who are HPV negative, prognostic variables associated with failure in patients with single-node metastasis are not known. Objective To evaluate recurrence and survival in patients with HPV-related OPSCC with single-lymph node metastasis treated with transoral surgery. Design, Setting, and Participants A retrospective cohort study was conducted of 207 adults with newly diagnosed p16-positive OPSCC and pathology-confirmed single-node disease who underwent surgical resection with or without adjuvant therapy at 2 tertiary academic medical centers from January 1, 2007, to December 31, 2016. Statistical analysis was performed from September 1, 2018, to September 1, 2020. Interventions Surgery alone (n = 59), surgery with adjuvant radiation (n = 75), or surgery with adjuvant chemoradiation (n = 73). Main Outcomes and Measures The primary outcome was regional recurrence. Secondary outcomes included overall survival, any recurrence, and identification of factors associated with regional recurrence and overall survival. Results Among 207 patients, 178 (86%) were men, with a median age of 57 years (range, 35-82 years) at the time of surgery. Median follow-up was 36.2 months (range, 7-127 months). Regional recurrence occurred in 11 patients (5%). Of these, 1 patient (9%) was lost to follow-up after diagnosis, 1 (9%) was treated with palliative chemotherapy, and 9 (82%) were treated with curative intent. Ultimately, 7 patients received successful salvage treatment, and 3 died with disease. Overall, there were 21 patients (10%) with any recurrence, with 4 patients (19%) experiencing local recurrence, 11 (52%) experiencing regional recurrence, and 6 (29%) experiencing distant metastasis. The 5-year overall survival was 95% (95% CI, 89%-98%) for all patients. Older age (odds ratio [OR], 1.2; 95% CI, 1.1-1.2), advanced T stage (OR, 3.5; 95% CI, 0.9-14.0), and positive margins (OR, 10.9; 95% CI, 1.8-67.5) were associated with increased regional recurrence. Extranodal extension (OR, 0.2; 95% CI, 0.04-0.8), lymph node size greater than 3 cm (OR, 0.2; 95% CI, 0.1-0.7), and adjuvant therapy (OR, 0.08; 95% CI, 0.02-0.4) were associated with decreased regional recurrence. Advanced comorbidities (hazard ratio, 6.20; 95% CI, 1.4-27.7), lymphovascular invasion (hazard ratio, 4.7; 95% CI, 1.0-21.2), and regional recurrence (hazard ratio, 16.0; 95% CI, 3.1-82.0) were associated with worse overall survival. Conclusions and Relevance The findings of this cohort study suggest that patients with HPV-related OPSCC and single-node disease undergoing surgical resection with or without adjuvant treatment have excellent survival. Adjuvant therapy appears to improve regional control. Among patients with regional recurrence of OPSCC, there is a high rate of successful salvage treatment.
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Affiliation(s)
- Stephanie Y Chen
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Aisling Last
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Abhinav Ettyreddy
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.,Statistics Editor, JAMA Otolaryngology-Head & Neck Surgery
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jason T Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Randal Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Katheryn Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Peter Oppelt
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Kevin Palka
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Douglas Adkins
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Mackenzie Daly
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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Husain S, Lohia S, Petkov V, Blackwell T, Swisher-McClure S, Mizrachi A, Morris LG, Cohen MA, Wong RJ, Roman BR. Disparities and guideline adherence for HPV testing among patients with oropharyngeal squamous cell carcinoma, NCDB, and SEER. Head Neck 2021; 43:2110-2123. [PMID: 33851469 DOI: 10.1002/hed.26679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/28/2021] [Accepted: 03/09/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Human papilloma virus testing for oropharyngeal squamous-cell carcinoma has been recommended by the National Comprehensive Cancer Network since 2012. We examine disparities, reported rates of human papillomavirus (HPV) testing, and the impact on these findings of limitations with the variable in database registries. METHODS The HPV variable was queried for patients with oropharyngeal squamous carcinoma (OPSCC) from 2013 to 2016 in National Cancer Data Base (NCDB) and Surveillance, Epidemiology, and End Results (SEER). Multivariable regression was used to identify disparities based on sociodemographic variables. Sensitivity analyses were used to investigate limitations of the variable. RESULTS Despite limitations in the HPV variable in the databases, there was less than 100% adherence to recommended testing, and there were significant disparities in multiple sociodemographic variables. For example, in NCDB 70% of white versus 60.4% of black patients were tested (odds ratio [OR] 0.75, confidence interval [CI] 0.66-0.85, p ≤ 0.0001); in SEER 59.8% of white and 47.6% of black patients were tested (OR 0.73, CI 0.67-0.81; p ≤ 0.0001). CONCLUSIONS Disparities exist among patients undergoing testing for HPV-associated OPSCC and adherence to guideline recommended HPV testing has been suboptimal. In addition, the HPV variable definition, especially as it relates to p16 positivity, and use in these two registries should be improved.
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Affiliation(s)
- Solomon Husain
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Penn Medicine Abramson Cancer Center, Philadelphia, Pennsylvania, USA
| | - Shivangi Lohia
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Otolaryngology, Henry Ford Health Systems, Detroit, Michigan, USA
| | - Valentina Petkov
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Timothy Blackwell
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Aviram Mizrachi
- Otorhinolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Luc G Morris
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc A Cohen
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard J Wong
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Benjamin R Roman
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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28
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Schrank TP, Lenze N, Landess LP, Hoyle A, Parker J, Lal A, Sheth S, Chera BS, Patel SN, Hackman TG, Major MB, Issaeva N, Yarbrough WG. Genomic heterogeneity and copy number variant burden are associated with poor recurrence-free survival and 11q loss in human papillomavirus-positive squamous cell carcinoma of the oropharynx. Cancer 2021; 127:2788-2800. [PMID: 33819343 DOI: 10.1002/cncr.33504] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Human papillomavirus-positive (HPV+) squamous cell carcinoma of the oropharynx (OPSCC) is the most prevalent HPV-associated malignancy in the United States. Favorable treatment outcomes have led to increased interest in treatment de-escalation to reduce treatment morbidity as well as the development of prognostic markers to identify appropriately low-risk patients. Intratumoral genomic heterogeneity and copy number alteration burden have been demonstrated to be predictive of poor outcomes in many other cancers; therefore, we sought to determine whether intratumor heterogeneity and genomic instability are associated with poor outcomes in HPV+ OPSCC. METHODS Tumor heterogeneity estimates were made based on targeted exome sequencing of 45 patients with HPV+ OPSCC tumors. Analysis of an additional cohort of HPV+ OPSCC tumors lacking matched normal sequencing allowed copy number analysis of 99 patient tumors. RESULTS High intratumorally genomic heterogeneity and high numbers of copy number alterations were strongly associated with worse recurrence-free survival. Tumors with higher heterogeneity and frequent copy number alterations were associated with loss of distal 11q, which encodes key genes related to double-strand break repair, including ATM and MRE11A. CONCLUSIONS Both intratumor genomic heterogeneity and high-burden copy number alterations are strongly associated with poor recurrence-free survival in patients with HPV+ OPSCC. The drivers of genomic instability and heterogeneity in these tumors remains to be elucidated. However, 11q loss and defective DNA double-strand break repair have been associated with genomic instability in other solid tumors. Copy number alteration burden and intratumoral heterogeneity represent promising avenues for risk stratification of patients with HPV+OPSCC.
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Affiliation(s)
- Travis P Schrank
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nicholas Lenze
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lee P Landess
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alan Hoyle
- Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joel Parker
- Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Asim Lal
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Siddharth Sheth
- Division of Hematology and Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bhishamjit S Chera
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Samip N Patel
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Trevor G Hackman
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - M Ben Major
- Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Cell Biology and Physiology, Washington University in St. Louis, St. Louis, Missouri.,Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri.,Department of Otolaryngology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Natalia Issaeva
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pathology and Lab Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wendell G Yarbrough
- Department of Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Linberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pathology and Lab Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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29
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Ho AS, Luu M, Kim S, Tighiouart M, Mita AC, Scher KS, Mallen-St Clair J, Walgama ES, Lin DC, Nguyen AT, Zumsteg ZS. Nodal staging convergence for HPV- and HPV+ oropharyngeal carcinoma. Cancer 2021; 127:1590-1597. [PMID: 33595897 DOI: 10.1002/cncr.33414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Modern disease staging systems have restructured human papillomavirus (HPV)-negative (HPV-) and HPV-positive (HPV+) oropharyngeal carcinoma (OPC) into distinct pathologic nodal systems. Given that quantitative lymph node (LN) burden is the dominant prognostic factor in most head and neck cancers, we investigated whether HPV- and HPV+ OPC warrant divergent pathologic nodal classification. METHODS Multivariable Cox regression models of OPC surgical patients identified via U.S. cancer registry data were constructed to determine associations between survival and nodal characteristics. Nonlinear associations between metastatic LN number and survival were modeled with restricted cubic splines. Recursive partitioning analysis (RPA) was used to derive unbiased nodal schema. RESULTS Mortality risk escalated continuously with each successive positive LN in both OPC subtypes, with analogous slope. Survival hazard increased by 18.5% (hazard ratio [HR], 1.19 [95% CI, 1.16-1.21]; P < .001) and 19.1% (HR, 1.19 [95% CI, 1.17-1.21]; P < .001), with each added positive LN for HPV- and HPV+ OPC, respectively, up to identical change points of 5 positive LNs. Extranodal extension (ENE) was an independent predictor of HPV- OPC (HR, 1.55 [95% CI, 1.20-1.99]; P < .001) and HPV+ OPC (HR 1.73 [95% CI, 1.36-2.20]; P < .001) mortality. In RPA for both diseases, metastatic LN was the principal nodal covariate driving survival, with ENE as a secondary determinant. Given the similarities across analyses, we propose a concise, unifying HPV-/HPV+ OPC pathologic nodal classification schema: N1, 1-5 LN+/ENE-; N2, 1-5 LN+/ENE+; N3, >5 LN+. CONCLUSION HPV- and HPV+ OPC exhibit parallel relationships between nodal characteristics and relative mortality. In both diseases, metastatic LN number represents the principal nodal covariate governing survival, with ENE being an influential secondary element. A consolidated OPC pathologic nodal staging system that is based on these covariates may best convey prognosis. LAY SUMMARY The current nodal staging system for oropharyngeal carcinoma (OPC) has divided human papillomavirus (HPV)-negative (HPV-) and HPV-positive (HPV+) OPC into distinct systems that rely upon criteria that establish them as separate entities, a complexity that may undermine the core objective of staging schema to clearly communicate prognosis. Our large-scale analysis revealed that HPV- and HPV+ pathologic nodal staging systems in fact mirror each other. Multiple analyses produced conspicuously similar nodal staging systems, with metastatic lymph node number and extranodal extension delineating the highest risk groups that shape prognosis. We propose unifying HPV- and HPV+ nodal systems to best streamline prognostication and maximize staging accuracy.
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Affiliation(s)
- Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sungjin Kim
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mourad Tighiouart
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alain C Mita
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kevin S Scher
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Evan S Walgama
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - De-Chen Lin
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Anthony T Nguyen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
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30
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Becker C, Hofauer BG, Mansour N, Ketterer MC, Schulz T, Knopf A. [The 8th edition of the TNM staging system-a curse or a blessing for oropharyngeal carcinoma?]. HNO 2021; 69:89-94. [PMID: 32385531 DOI: 10.1007/s00106-020-00875-4] [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: 01/06/2023]
Abstract
At the beginning of 2017, the 8th edition of the TNM classification was presented. For oropharyngeal carcinoma, this was accompanied by a paradigm shift, as a separation of the classification depending on the association with human papillomavirus (HPV) status has been established. By considering the literature, this paper provides an overview of the characteristics of HPV-associated carcinomas, the new features of the TNM classification, and the existing points of discussion. The revision has improved the prognostic significance of the TNM classification; however, there are still tumor- and patient-dependent influencing factors that must be considered for future versions.
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Affiliation(s)
- C Becker
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland.
| | - B G Hofauer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - N Mansour
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - M C Ketterer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - T Schulz
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
| | - A Knopf
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland
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Improved survival prediction for oropharyngeal cancer beyond TNMv8. Oral Oncol 2021; 115:105140. [PMID: 33548862 DOI: 10.1016/j.oraloncology.2020.105140] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE For oropharynx squamous cell carcinoma (OPSCC) this study aimed to: (i) compare 5-year overall survival (OS) stratification by AJCC/UICC TNM versions 7 (TNMv7) and 8 (TNMv8), (ii) determine whether changes to T and N stage groupings improve prognostication and (iii) develop and validate a model incorporating additional clinical characteristics to improve 5-year OS prediction. MATERIAL AND METHODS All OPSCC treated with curative-intent at our institution between 2011 and 2017 were included. The primary endpoint was 5-year OS. Survival curves were produced for TNMv7 and TNMv8. A three-way interaction between T, N stage and p16 status was evaluated for improved prognostication. Cox proportional hazards modelling was used to derive a new predictive model. RESULTS Of 750 OPSCC cases, 574 (77%) were p16-positive. TNMv8 was more prognostic than TNMv7 (concordance probability estimate [CPE] ± SE = 0.72 ± 0.02 vs 0.53 ± 0.02). For p16-positive disease, TNMv8 discriminated stages II vs I (HR 2.32, 95% CI 1.47-3.67) and III vs II (HR 1.75, 95% CI 1.13-2.72). For p16-negative disease, TNMv7 and TNMv8 demonstrated poor hazard discrimination. Different T, N stage and p16-status combinations did not improve prognostication after adjusting for other factors (CPE = 0.79 vs 0.79, p = 0.998). A model for p16-positive and p16-negative OPSCC including additional clinical characteristics improved 5-year OS prediction beyond TNMv8 (c-index 0.76 ± 0.02). CONCLUSIONS TNMv8 is superior to TNMv7 for p16-positive OPSCC, but both performed poorly for p16-negative disease. A novel model incorporating additional clinical characteristics improved 5-year OS prediction for both p16-positive and p16-negative disease.
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Contrera KJ, Smile TD, Mahomva C, Wei W, Adelstein DJ, Broughman JR, Burkey BB, Geiger JL, Joshi NP, Ku JA, Lamarre ED, Lorenz RR, Prendes BL, Scharpf J, Schwartzman LM, Woody NM, Xiong D, Koyfman SA. Locoregional and distant recurrence for HPV-associated oropharyngeal cancer using AJCC 8 staging. Oral Oncol 2020; 111:105030. [DOI: 10.1016/j.oraloncology.2020.105030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/20/2020] [Accepted: 09/26/2020] [Indexed: 12/22/2022]
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Kim YJ, Jeong WJ, Bae YJ, Kim H, Choi BS, Jung YH, Baik SH, Sunwoo L, Kim JH. MRI-Based Assessment of the Pharyngeal Constrictor Muscle as a Predictor of Surgical Margin after Transoral Robotic Surgery in HPV-Positive Tonsillar Cancer. AJNR Am J Neuroradiol 2020; 41:2320-2326. [PMID: 33060104 DOI: 10.3174/ajnr.a6806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/29/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Transoral robotic surgery is an emerging strategy for treating human papillomavirus-positive cancers, but the role of MR imaging in predicting the surgical outcome has not been established. We aimed to identify preoperative MR imaging characteristics that predispose the outcome of transoral robotic surgery toward an insecure (positive or close) surgical margin in human papillomavirus-positive tonsillar squamous cell carcinoma. MATERIALS AND METHODS Between December 2012 and May 2019, sixty-nine patients underwent transoral robotic surgery at our institution. Among these, 29 who were diagnosed with human papillomavirus-positive tonsillar squamous cell carcinoma, did not receive neoadjuvant treatment, underwent preoperative 3T MR imaging, and had postoperative pathologic reports and were included in this retrospective study. Two neuroradiologists evaluated the preoperative MR imaging scans to determine the tumor spread through the pharyngeal constrictor muscle using a 5-point scale: 1, normal constrictor; 2, bulging constrictor; 3, thinning constrictor; 4, obscured constrictor; and 5, tumor protrusion into the parapharyngeal fat. The risk of an insecure surgical margin (involved or <1 mm) according to the MR imaging scores was predicted using logistic regression with the Firth correction. RESULTS The interobserver agreement for the MR imaging scores was excellent (κ = 0.955, P < .001). A score of ≥4 could predict an insecure margin with 87.5% sensitivity and 92.3% specificity (area under the curve = 0.899) and was the only significant factor associated with an insecure margin in the multivariable analysis (OR, 6.59; 95% CI, 3.11-22.28; P < .001). CONCLUSIONS The pre-transoral robotic surgery MR imaging scoring system for the pharyngeal constrictor muscle is a promising predictor of the surgical margin in human papillomavirus-positive tonsillar squamous cell carcinoma.
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Affiliation(s)
- Y J Kim
- From the Department of Radiology (Y.J.K., Y.J.B., B.S.C., S.H.B., L.S., J.H.K.)
| | - W-J Jeong
- Otolaryngology-Head and Neck Surgery (W.-J.J., Y.H.J.)
| | - Y J Bae
- From the Department of Radiology (Y.J.K., Y.J.B., B.S.C., S.H.B., L.S., J.H.K.)
| | - H Kim
- Pathology (H.K.), Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - B S Choi
- From the Department of Radiology (Y.J.K., Y.J.B., B.S.C., S.H.B., L.S., J.H.K.)
| | - Y H Jung
- Otolaryngology-Head and Neck Surgery (W.-J.J., Y.H.J.)
| | - S H Baik
- From the Department of Radiology (Y.J.K., Y.J.B., B.S.C., S.H.B., L.S., J.H.K.)
| | - L Sunwoo
- From the Department of Radiology (Y.J.K., Y.J.B., B.S.C., S.H.B., L.S., J.H.K.)
| | - J H Kim
- From the Department of Radiology (Y.J.K., Y.J.B., B.S.C., S.H.B., L.S., J.H.K.)
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The diagnostic performance of CT and MRI for detecting extranodal extension in patients with head and neck squamous cell carcinoma: a systematic review and diagnostic meta-analysis. Eur Radiol 2020; 31:2048-2061. [PMID: 32949282 DOI: 10.1007/s00330-020-07281-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/15/2020] [Accepted: 09/10/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To review the diagnostic performance of CT and MRI for detecting extranodal extension (ENE) in head and neck squamous cell carcinoma (HNSCC) patients. METHODS MEDLINE and EMBASE databases were searched up to October 7, 2019. Studies that evaluated the diagnostic performance of CT and/or MRI for detecting ENE in HNSCC patients were included. A 2 × 2 table was reconstructed for each study. Pooled sensitivity and specificity were calculated using the bivariate model and hierarchical summary receiver operating characteristic (HSROC) model. Subgroup analyses were performed according to HPV status and radiological features. Pooled correlation coefficient for interobserver agreement was calculated. RESULTS Twenty-two studies including 2478 patients were included. The pooled sensitivity and specificity for detecting ENE were 73% (95% CI, 62-82%) and 83% (95% CI, 75-89%), respectively, for CT, and 60% (95% CI, 49-70%) and 96% (95% CI, 85-99%), respectively, for MRI. There was substantial heterogeneity for both CT and MRI. A threshold effect was present for MRI. On subgroup analysis, the pooled specificity of CT was significantly lower in patients with HPV+ OPSCC than in patients with HPV‑ oral cavity cancer or all HNSCC (74% vs. 87%; p = 0.01). Central node necrosis showed significantly higher pooled sensitivity (81% vs. 51%; p = 0.02), while infiltration of adjacent planes showed significantly higher pooled specificity (94% vs. 65%; p = 0.03). The pooled correlation coefficient was 0.72 (95% CI, 0.60-0.81). CONCLUSION Both CT and MRI show reasonable diagnostic performance for detecting ENE in HNSCC patients and interobserver agreement was substantial. KEY POINTS • Pooled sensitivity and specificity were 73% and 83% for CT and 60% and 96% for MRI without significant difference. • Pooled specificity was lower for HPV+ OPSCC than for HPV‑ oral cavity cancer or all HNSCC (74% vs. 87%, p = 0.01), likely due to central node necrosis. • Central node necrosis showed higher sensitivity (81% vs. 51%; p = 0.02), while infiltration of adjacent planes showed higher specificity (94% vs. 65%; p = 0.03).
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Kreimer AR, Chaturvedi AK, Alemany L, Anantharaman D, Bray F, Carrington M, Doorbar J, D'Souza G, Fakhry C, Ferris RL, Gillison M, Neil Hayes D, Hildesheim A, Huang SH, Kowalski LP, Lang Kuhs KA, Lewis J, Lowy DR, Mehanna H, Ness A, Pawlita M, Pinheiro M, Schiller J, Shiels MS, Tota J, Mirabello L, Warnakulasuriya S, Waterboer T, Westra W, Chanock S, Brennan P. Summary from an international cancer seminar focused on human papillomavirus (HPV)-positive oropharynx cancer, convened by scientists at IARC and NCI. Oral Oncol 2020; 108:104736. [PMID: 32502860 PMCID: PMC7909748 DOI: 10.1016/j.oraloncology.2020.104736] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 02/08/2023]
Abstract
Cancer of the oropharynx has attracted considerable attention in recent years given: (1) an increasing incidence in selected populations over the past three decades; (2) the discovery of human papillomavirus (HPV) infection as the driver of the increase, as opposed to the traditional risk factors such as tobacco (smoking and chewing) and alcohol; and (3) the promise of new prevention and treatment strategies. As a result of such developments, the International Agency for Research on Cancer (IARC) and the US National Cancer Institute (NCI), convened the fourth Cancer Seminar meeting in November 2018 to focus on this topic. This report summarizes the proceedings: a review of recent science on the descriptive epidemiology, etiology, biology, genetics, early detection, pathology and treatment of HPV-positive oropharyngeal cancer, and the formulation of key research questions to be addressed.
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Affiliation(s)
- Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States.
| | - Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States.
| | - Laia Alemany
- Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Epidemiology and Public Health, Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
| | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France.
| | - Mary Carrington
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD, United States; Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, United States.
| | - John Doorbar
- University of Cambridge, Cambridge, United Kingdom.
| | - Gypsyamber D'Souza
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Carole Fakhry
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States.
| | | | - Maura Gillison
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - D Neil Hayes
- The University of Tennessee Health Science Center, Memphis, TN, United States.
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States.
| | - Shao Hui Huang
- University of Toronto, Princess Margaret Hospital, Toronto, Ontario, Canada.
| | | | | | - James Lewis
- Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Douglas R Lowy
- Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, United States; Office of the Director, National Cancer Institute, NIH, Bethesda, MD, United States.
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom.
| | - Andy Ness
- NIHR Bristol Biomedical Research Centre, University of Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom.
| | | | - Maisa Pinheiro
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States.
| | - John Schiller
- Laboratory of Cellular Oncology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, United States.
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States.
| | - Joseph Tota
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States.
| | - Lisa Mirabello
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States.
| | - Saman Warnakulasuriya
- King's College London, London, United Kingdom; WHO Collaborating Centre for Oral Cancer, United Kingdom.
| | - Tim Waterboer
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - William Westra
- Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Stephen Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States.
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France.
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Benchetrit L, Torabi SJ, Givi B, Haughey B, Judson BL. Prognostic Significance of Extranodal Extension in HPV-Mediated Oropharyngeal Carcinoma: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 164:720-732. [PMID: 32838649 DOI: 10.1177/0194599820951176] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the prognostic role of extranodal extension (ENE) among patients with human papilloma virus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) through a systematic review and meta-analysis of institutional studies. DATA SOURCES MEDLINE, Embase, Scopus, and PubMed. REVIEW METHODS Two independent authors searched the databases on December 3, 2019, to identify studies of HPV+ OPSCC comparing prognostic outcomes stratified by ENE. The I2 statistic was used to determine study heterogeneity. Fixed and random effects models were used to determine hazard ratios (HRs) with 95% CIs. RESULTS Eighteen observational studies met inclusion criteria, yielding 3603 patients with HPV+ OPSCC (1521 ENE+ and 2082 ENE-) with a median follow-up of 49 months. The presence of pathologic ENE (pENE) and radiologic ENE (rENE) was associated with decreased overall survival (pENE HR, 1.89 [95% CI, 1.15-3.13], I2 = 35%; rENE HR, 2.64 [95% CI, 1.46-4.78], I2 = 75%) and distant recurrence (pENE HR, 3.23 [95% CI, 1.25-8.33], I2 = 0%; rENE HR, 3.83 [95% CI, 1.88-7.80], I2 = 0%). Neither pENE nor rENE was associated with locoregional recurrence (pENE HR, 0.75 [95% CI, 0.20-2.84], I2 = 0%; rENE HR, 2.03 [95% CI, 0.86-4.79], I2 = 0%). pENE was not associated with disease-specific survival (pENE HR, 1.45 [95% CI, 0.84-2.49], I2 = 0%). CONCLUSION pENE and rENE are moderately associated with an increased risk of all-cause mortality and recurrence with distant metastasis in a cohort of patients with HPV+ OPSCC. These findings may be used to inform exclusion criteria for deintensification trials and assist in refined risk stratification.
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Affiliation(s)
| | - Sina J Torabi
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Babak Givi
- Department of Otolaryngology, School of Medicine, New York University, New York, New York, USA
| | - Bruce Haughey
- Otolaryngology-Head and Neck Surgery, Advent Health Celebration, Celebration, Florida, USA.,Department of Otolaryngology-Head and Neck Surgery (Collaborative), University of South Florida, Tampa, Florida, USA
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
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Beltz A, Zimmer S, Michaelides I, Evert K, Psychogios G, Bohr C, Künzel J. Significance of Extranodal Extension in Surgically Treated HPV-Positive Oropharyngeal Carcinomas. Front Oncol 2020; 10:1394. [PMID: 32850449 PMCID: PMC7433688 DOI: 10.3389/fonc.2020.01394] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023] Open
Abstract
Squamous cell carcinomas of the head and neck are the subject of numerous current studies, especially in view of the increasing incidence of tumors induced by human papillomavirus (HPV) and the latest changes to the TNM classification of oropharyngeal squamous cell carcinoma (OPSCC). In addition to HPV status, the presence of extranodal extension of lymph node metastases represents an important risk and prognostic factor, which has now been integrated into the staging algorithm of the eighth edition of TNM classification for HPV-negative OPSCC. In the past numerous studies had shown a lack of prognostic significance of extranodal extension in HPV-associated tumors. However, extranodal extension–as a possible risk factor even in HPV-positive OPSCC–remains an important subject of current studies, which are now particularly characterized by high numbers of cases. In this paper, diagnostic methods and the prognostic significance of extranodal extension in surgically treated HPV-positive OPSCC are presented and discussed based on relevant literature, and the results of current publications are summarized. Further development of diagnostic criteria and procedures as well as international standardization of clinical diagnostics of extranodal extension should be encouraged. Several studies demonstrate that extranodal extension results in worse survival outcomes even in HPV-positive tumors, in contrast to results of previous studies. Consequently, whether the prognostic significance of extranodal extension is not actually relevant to outcome and the staging algorithm of HPV-positive OPSCC should be questioned and further analyzed.
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Affiliation(s)
- Anna Beltz
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Germany
| | - Stefanie Zimmer
- Institute of Pathology, Tissue Bank, University Medical Center Mainz, Mainz, Germany
| | - Ioannis Michaelides
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Georgios Psychogios
- Department of Otorhinolaryngology, University Hospital of Ioannina, Ioannina, Greece
| | - Christopher Bohr
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
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Machczyński P, Majchrzak E, Niewinski P, Marchlewska J, Golusiński W. A review of the 8th edition of the AJCC staging system for oropharyngeal cancer according to HPV status. Eur Arch Otorhinolaryngol 2020; 277:2407-2412. [PMID: 32342197 PMCID: PMC7410862 DOI: 10.1007/s00405-020-05979-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/10/2020] [Indexed: 12/20/2022]
Abstract
Background The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased substantially in recent decades, particularly p16-positive human papillomavirus (HPV)-related OPSCC, which has risen by 50% in western countries. HPV-positivity is the most favourable non-anatomic predictor of oropharyngeal cancer outcomes, which underscores the importance of incorporating this variable into the cancer staging system. Methods In the present article, we review the differences between the 7th and 8th editions of the AJCC staging system, with particular focus on the role of HPV-positivity in patients with head and neck cancer. Results In the previous edition (7th edition) of the AJCC/UICC manual, HPV status and its correlation with nodal metastasis were not considered, thereby leading to incorrect lymph node (N) staging and, potentially, inadequate treatment and worse outcomes. The 8th edition of the AJCC manual addresses these issues, providing more accurate discrimination between groups and better risk stratification in patients with HPV-positive OPSCC. In the future, additional adjustments are likely to be needed, such as unification of the pathological and clinical staging models. Conclusions The new staging system is substantially more accurate than the previous system and should be widely adopted in routine clinical practice.
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Affiliation(s)
- Piotr Machczyński
- Head and Neck Surgery Department, The Greater Poland Cancer Centre, University of Medical Sciences Poznan, 15 Garbary St, 61-866, Poznan, Poland.
| | - Ewa Majchrzak
- Head and Neck Surgery Department, The Greater Poland Cancer Centre, University of Medical Sciences Poznan, 15 Garbary St, 61-866, Poznan, Poland
| | - Patryk Niewinski
- Head and Neck Surgery Department, The Greater Poland Cancer Centre, University of Medical Sciences Poznan, 15 Garbary St, 61-866, Poznan, Poland
| | - Joanna Marchlewska
- Head and Neck Surgery Department, The Greater Poland Cancer Centre, University of Medical Sciences Poznan, 15 Garbary St, 61-866, Poznan, Poland
| | - Wojciech Golusiński
- Head and Neck Surgery Department, The Greater Poland Cancer Centre, University of Medical Sciences Poznan, 15 Garbary St, 61-866, Poznan, Poland
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Baş Y, Aker FV, Gönültaş A, Akdeniz R, Turgal E, Çıkrıkçıoğlu MA. Effect of high-risk human papillomavirus in esophageal squamous cell carcinoma in Somalian and Turkish cases. Pathog Dis 2020; 77:5556942. [PMID: 31504479 DOI: 10.1093/femspd/ftz047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
This study aimed to investigate the role of high-risk human papillomavirus (Hr-HPV) in Somalian and Turkish patients with esophageal squamous cell carcinoma (ESCC). In the sections obtained from paraffin-embedded blocks, the results of invasive tumor, peripheral tumor dysplasia and normal mucosa were examined. Samples containing 45 and 47 ESCC, 46 and 42 dysplasia in Somalian (n = 52) and Turkish (n = 53) cases, respectively, were included in the study. We examined the presence of 14 types of Hr-HPV in ESCC collected from Somalia and Turkey by Aptima® Panther System. Hr-HPV types were not detected in Somalian cases. p16INK4a is positive in 5 (11.4%) tumors and 6 (13%) dysplasia. p53 is positive in 28 (62.2%) tumors and 35 (76.1%) dysplasia. HPV16-18/45 are positive only in one of the Turkish cases. p16INK4a is positive in 5 (10.6%) tumors and 4 (9.5%) dysplasia. p53 is positive in 31 (63.3%) tumors and 24 (57.1%) dysplasia. No reaction was detected in normal mucosa samples in both countries. This study is regional. Although the findings did not reflect the general population, the present study shows that the effect of HPV on carcinogenesis in Somalian and Turkish ESCC patients was not significant.
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Affiliation(s)
- Yılmaz Baş
- Hitit University, Department of Pathology, Faculty of Medicine, 19300 Çorum, Turkey
| | - Fügen Vardar Aker
- University of Health Sciences, Department of Pathology, Haydarpasa Numune Training and Research Hospital, 34668 Istanbul, Turkey
| | - Aylin Gönültaş
- University of Health Sciences, Department of Pathology, Haydarpasa Numune Training and Research Hospital, 34668 Istanbul, Turkey
| | - Raşit Akdeniz
- Hitit University, Department of Pathology, Erol Olçok Education and Research Hospital, 19300 Çorum, Turkey.,Department of Pathology, Somalia Mogadishu-Turkey Education and Research Hospital, Mogadishu, Somalia
| | - Ebru Turgal
- Hitit University, Department of Biostatistics, Faculty of Medicine, 19300 Çorum, Turkey
| | - Makbule Arar Çıkrıkçıoğlu
- University of Health Sciences, Department of Pathology, Haydarpasa Numune Training and Research Hospital, 34668 Istanbul, Turkey
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Bigelow EO, Seiwert TY, Fakhry C. Deintensification of treatment for human papillomavirus-related oropharyngeal cancer: Current state and future directions. Oral Oncol 2020; 105:104652. [PMID: 32247987 DOI: 10.1016/j.oraloncology.2020.104652] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022]
Abstract
Human papillomavirus (HPV)-related oropharyngeal squamous cell cancer (OPSCC) has emerged as a distinct clinical entity of head and neck cancer with expected high survival. This recognition has led to the investigation of whether a population of patients can be identified who can safely undergo treatment de-escalation, in an effort to minimize long-term treatment toxicity while maintaining excellent survival. The purpose of this review is to describe the rationale for treatment deintensification for HPV-related OPSCC, summarize available results from published clinical trials, explore the methods by which risk groups are assigned, and provide context for the multitude of clinical trials that are currently underway.
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Affiliation(s)
- Elaine O Bigelow
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tanguy Y Seiwert
- Department of Oncology, Johns Hopkins University, Baltimore, MD, United States
| | - Carole Fakhry
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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41
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Huang SH, O'Sullivan B, Su J, Bartlett E, Kim J, Waldron JN, Ringash J, de Almeida JR, Bratman S, Hansen A, Bayley A, Cho J, Giuliani M, Hope A, Hosni A, Spreafico A, Siu L, Chepeha D, Tong L, Xu W, Yu E. Prognostic importance of radiologic extranodal extension in HPV-positive oropharyngeal carcinoma and its potential role in refining TNM-8 cN-classification. Radiother Oncol 2020; 144:13-22. [DOI: 10.1016/j.radonc.2019.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 11/16/2022]
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42
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Freitag J, Wald T, Kuhnt T, Gradistanac T, Kolb M, Dietz A, Wiegand S, Wichmann G. Extracapsular extension of neck nodes and absence of human papillomavirus 16-DNA are predictors of impaired survival in p16-positive oropharyngeal squamous cell carcinoma. Cancer 2020; 126:1856-1872. [PMID: 32032442 DOI: 10.1002/cncr.32667] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/25/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinomas (OPSCCs) demonstrate superior outcome compared with HPV-negative OPSCCs. The eighth edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumor, lymph node, metastasis (TNM) classification (TNM 2017) modifies OPSCC staging based on p16 positivity as a surrogate for HPV-driven disease. In p16-negative OPSCCs, lymph node (N) categories include extracapsular/extranodal extension (ECE); and, in p16-positive OPSCCs, N categories are based on the number of positive neck lymph nodes omitting ECE status. The objective of the current study was to assess the prognostic impact of positive ECE status and the detection of HPV16 DNA in patients with p16-positive OPSCC. METHODS In a cohort of 92 patients with p16-positive, lymph node (N)-positive (stage III-IVB) OPSCC who underwent surgery and neck dissection, allowing for a pathologic examination of positive lymph nodes, 66 of 92 patients (71.4%) were p16-positive/HPV16 DNA-positive, 62 of 92 (67%) were ECE-positive, and 45 of 62 (72.6%) were ECE-positive, p16-positive, and HPV16 DNA-positive. Differences in outcome were assessed using Kaplan-Meier plots and Cox proportional hazard regression (CoxR) for tumor-specific survival and overall survival (OS). RESULTS The mean numbers of positive lymph nodes in ECE-positive patients (5.0 positive lymph nodes; 95% CI, 3.8-6.4 positive lymph nodes) and ECE-negative patients (2.4 positive lymph nodes; 95% CI, 1.8-2.9 positive lymph nodes) were different (P = .0007). ECE affected OS and tumor-specific survival in p16-positive patients (P = .007 and P = .047, respectively) and in p16-positive/HPV16 DNA-positive patients (P = .013 and P = .026, respectively). Related to the unequal distributions of ECE-positive/HPV16 DNA-negative tumors, the TNM 2017 failed to discriminate OS in patients with UICC stage I, II, and III disease (mean OS, 54.5, 73.4, and 45 months, respectively; median OS, 64.7 months, not reached, and 41.1 months, respectively). According to a univariate CoxR, the presence of ECE predicted impaired OS in patients with p16-positive OPSCC (hazard ratio, 3.40; 95% CI, 1.17-9.89; P = .025) and even greater impaired OS in those with p16-positive/HPV16 DNA-positive OPSCC (HR, 8.64; 95% CI, 1.12-66.40; P = .038). Multivariate CoxR confirmed ECE and HPV16 DNA detection as independent predictors. CONCLUSIONS ECE and HPV16 DNA status should be included in the prognostic staging of patients with p16-positive OPSCC because several lines of evidence demonstrate their impact on survival.
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Affiliation(s)
- Josefine Freitag
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Theresa Wald
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Kuhnt
- Department for Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Tanja Gradistanac
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Marlen Kolb
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Dietz
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Wiegand
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Gunnar Wichmann
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
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Thompson LD, Lewis JS, Skálová A, Bishop JA. Don't stop the champions of research now: a brief history of head and neck pathology developments. Hum Pathol 2020; 95:1-23. [DOI: 10.1016/j.humpath.2019.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022]
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44
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Wang Z, Li F, Rufo J, Chen C, Yang S, Li L, Zhang J, Cheng J, Kim Y, Wu M, Abemayor E, Tu M, Chia D, Spruce R, Batis N, Mehanna H, Wong DTW, Huang TJ. Acoustofluidic Salivary Exosome Isolation: A Liquid Biopsy Compatible Approach for Human Papillomavirus-Associated Oropharyngeal Cancer Detection. J Mol Diagn 2020; 22:50-59. [PMID: 31843276 PMCID: PMC6943372 DOI: 10.1016/j.jmoldx.2019.08.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/15/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022] Open
Abstract
Previous efforts to evaluate the detection of human papilloma viral (HPV) DNA in whole saliva as a diagnostic measure for HPV-associated oropharyngeal cancer (HPV-OPC) have not shown sufficient clinical performance. We hypothesize that salivary exosomes are packaged with HPV-associated biomarkers, and efficient enrichment of salivary exosomes through isolation can enhance diagnostic and prognostic performance for HPV-OPC. In this study, an acoustofluidic (the fusion of acoustics and microfluidics) platform was developed to perform size-based isolation of salivary exosomes. These data showed that this platform is capable of consistently isolating exosomes from saliva samples, regardless of viscosity variation and collection method. Compared with the current gold standard, differential centrifugation, droplet digital RT-PCR analysis showed that the average yield of salivary exosomal small RNA from the acoustofluidic platform is 15 times higher. With this high-yield exosome isolation platform, we show that HPV16 DNA could be detected in isolated exosomes from the saliva of HPV-associated OPC patients at 80% concordance with tissues/biopsies positive for HPV16. Overall, these data demonstrated that the acoustofluidic platform can achieve high-purity and high-yield salivary exosome isolation for downstream salivary exosome-based liquid biopsy applications. Additionally, HPV16 DNA sequences in HPV-OPC patients are packaged in salivary exosomes and their isolation will enhance the detection of HPV16 DNA.
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Affiliation(s)
- Zeyu Wang
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Feng Li
- Center for Oral/Head & Neck Oncology Research, School of Dentistry, University of California Los Angeles, Los Angeles, California
| | - Joseph Rufo
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Chuyi Chen
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Shujie Yang
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Liang Li
- Center for Oral/Head & Neck Oncology Research, School of Dentistry, University of California Los Angeles, Los Angeles, California; Institute of Diagnostics in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Huan, People's Republic of China
| | - Jinxin Zhang
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Jordan Cheng
- Center for Oral/Head & Neck Oncology Research, School of Dentistry, University of California Los Angeles, Los Angeles, California
| | - Yong Kim
- Center for Oral/Head & Neck Oncology Research, School of Dentistry, University of California Los Angeles, Los Angeles, California
| | - Mengxi Wu
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - Elliot Abemayor
- Department of Otolaryngology/Head & Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Michael Tu
- Center for Oral/Head & Neck Oncology Research, School of Dentistry, University of California Los Angeles, Los Angeles, California
| | - David Chia
- Department of Pathology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Rachel Spruce
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nikolaos Batis
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - David T W Wong
- Center for Oral/Head & Neck Oncology Research, School of Dentistry, University of California Los Angeles, Los Angeles, California.
| | - Tony Jun Huang
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina.
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Zhan KY, Puram SV, Li MM, Silverman DA, Agrawal AA, Ozer E, Old MO, Carrau RL, Rocco JW, Higgins KM, Enepekides DJ, Husain Z, Kang SY, Eskander A. National treatment trends in human papillomavirus–positive oropharyngeal squamous cell carcinoma. Cancer 2019; 126:1295-1305. [DOI: 10.1002/cncr.32654] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Kevin Y. Zhan
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Sidharth V. Puram
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Michael M. Li
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Dustin A. Silverman
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Amit A. Agrawal
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Enver Ozer
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Matthew O. Old
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Ricardo L. Carrau
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - James W. Rocco
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Kevin M. Higgins
- Department of Otolaryngology–Head and Neck Surgery Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada
| | - Danny J. Enepekides
- Department of Otolaryngology–Head and Neck Surgery Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada
| | - Zain Husain
- Department of Radiation Oncology Sunnybrook Health Sciences Centre and Odette Cancer Centre University of Toronto Toronto Ontario Canada
| | - Stephen Y. Kang
- Division of Head and Neck Oncology, Department of Otolaryngology–Head and Neck Surgery James Cancer Center and Solove Research Institute, Ohio State University Columbus Ohio
| | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery Sunnybrook Health Sciences Centre University of Toronto Toronto Ontario Canada
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
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Miccio JA, Verma V, Kelly J, Kann BH, An Y, Park HS, Eskander A, Burtness B, Husain Z. Impact of contralateral lymph nodal involvement and extranodal extension on survival of surgically managed HPV-positive oropharyngeal cancer staged with the AJCC eighth edition. Oral Oncol 2019; 99:104447. [DOI: 10.1016/j.oraloncology.2019.104447] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
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Han M, Stanford‐Moore GB, Larson AR, Schoppy DW, Cognetti DM, Joshi AS, Houlton JJ, Ryan WR. Predictors of Mortality in HPV‐Associated Oropharynx Carcinoma Treated With Surgery Alone. Laryngoscope 2019; 130:E423-E435. [DOI: 10.1002/lary.28344] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/13/2019] [Accepted: 09/16/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Mary Han
- Department of Otolaryngology, Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
- School of MedicineUniversity of California‐San Francisco San Francisco California
| | - Gaelen B. Stanford‐Moore
- Department of Otolaryngology, Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
| | - Andrew R. Larson
- Department of Otolaryngology, Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
| | - David W. Schoppy
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
| | - David M. Cognetti
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology–Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania
| | - Arjun S. Joshi
- Division of Head and Neck Oncologic Surgery, Department of SurgeryGeorge Washington University Washington DC
| | - Jeffery J. Houlton
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology–Head and Neck SurgeryUniversity of Washington Seattle Washington U.S.A
| | - William R. Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology–Head and Neck SurgeryUniversity of California‐San Francisco San Francisco California
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De Cicco R, de Melo Menezes R, Nicolau UR, Pinto CAL, Villa LL, Kowalski LP. Impact of human papillomavirus status on survival and recurrence in a geographic region with a low prevalence of HPV-related cancer: A retrospective cohort study. Head Neck 2019; 42:93-102. [PMID: 31633252 DOI: 10.1002/hed.25985] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/19/2019] [Accepted: 09/17/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is associated with better tumor-response rates and survival outcomes. However, in some geographic regions, the impact of HPV infection on prognosis remains unclear. The aim of this study was to describe the patterns of recurrence and survival among patients treated for OPSCC in a geographic region with a reported low prevalence of HPV-related OPSCC. METHODS We retrospectively evaluated 215 patients diagnosed with American Joint Committee on Cancer (AJCC) stages I to IV OPSCC who were treated with upfront surgery or radiation therapy with or without chemotherapy in a tertiary Cancer Center in Brazil. The collected data included demographic information, HPV status, tobacco and alcohol consumption, and pathologic and treatment variables. The patterns of recurrence were recorded according to HPV status. Disease-specific survival and recurrence-free survival were calculated. RESULTS One hundred twenty-seven (59.1%) patients were diagnosed with HPV-positive OPSCC. According to the AJCC eighth edition, 34 (15.8%), 71 (33%), 47 (21.9%), and 60 (27.9%) patients had stage I, II, III, and IV disease, respectively. Surgery was performed in 109 (50.7%) cases, and upfront chemoradiation regimens were provided in 104 (48.4%, P = .69) patients. Overall, the 5-year cancer-specific survival was 73.5% and 68.1% for patients positive and negative to HPV, respectively. Tobacco status was considered the only independent prognostic factor for survival. Furthermore, HPV status was not associated with differences in recurrence rates (P = .68). While all distant relapses were found to be lung metastases in the HPV-negative group, we observed unusual sites of distant metastases in the HPV-positive group. CONCLUSIONS HPV status was not associated with higher rates of survival among the investigated population. Moreover, smoking status was considered the only independent prognostic factor for survival. Furthermore, patients with HPV-positive tumors were more likely than patients with HPV-negative OPSCC to have unusual distant metastases.
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Affiliation(s)
- Rafael De Cicco
- Department of Otorhinolaryngology-Head and Neck Surgery, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Ulisses R Nicolau
- Department of Otorhinolaryngology-Head and Neck Surgery, AC Camargo Cancer Center, São Paulo, Brazil
| | - Clovis A L Pinto
- Department of Otorhinolaryngology-Head and Neck Surgery, AC Camargo Cancer Center, São Paulo, Brazil
| | - Luisa L Villa
- Faculdade de Medicina, Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, AC Camargo Cancer Center, São Paulo, Brazil
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Gal T, Slezak JA, Kejner AE, Chen Q, Huang B. Treatment trends in oropharyngeal carcinoma: Surgical technology meets the epidemic. Oral Oncol 2019; 97:62-68. [DOI: 10.1016/j.oraloncology.2019.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 12/28/2022]
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50
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Impact of cisplatin dose and smoking pack-years in human papillomavirus–positive oropharyngeal squamous cell carcinoma treated with chemoradiotherapy. Eur J Cancer 2019; 118:112-120. [DOI: 10.1016/j.ejca.2019.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/15/2019] [Accepted: 06/23/2019] [Indexed: 11/20/2022]
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