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Yin J, Li Y, Song C, Liu Y, Zhao J, Zhao D, Zhang S, Zhang X, Zhao F, Qiao Y. Evaluation of an E6/E7 PCR-capillary electrophoresis fragment analysis in the genotyping of human papillomavirus in archival FFPE samples of oropharyngeal cancer. J Med Virol 2024; 96:e29716. [PMID: 38818787 DOI: 10.1002/jmv.29716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/27/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
Accumulating evidence has demonstrated that high-risk human papillomaviruses (HR-HPVs) are involved in the etiology of a subset of oropharyngeal squamous cell carcinoma (OPSCC). In this regard, the International Agency for Research on Cancer (IARC) has recommended direct molecular HPV testing. So far, there is no agreement on the most appropriate method for HPV detection on OPSCC formalin-fixed paraffin-embedded (FFPE) materials. In this study, we aimed to evaluate the performance of the high-sensitive SureX HPV assay in OPSCC FFPE tissues compared with LiPA-25 and p16ink4a immunostaining. A retrospective series of FFPE primary OPSCC cases were diagnosed between 2008 and 2019 and provided by the Henan Cancer Hospital, China. The level of agreement of two assays was determined using Cohen's Kappa (κ) statistics. A total of 230 FFPE OPSCC samples from tumor resections (n = 160) and diagnostic biopsies (n = 70) were detected. Sixty-six (28.7%) and 70 (30.4%) samples were identified as HPV-DNA-positive by LiPA-25 and SureX, respectively, of which HPV16 was largely the most common type (95.5% vs 94.3%). We found a perfect concordance between LiPA-25 and SureX for HPV-DNA status (κ = 0.906, 95% CI: 0.875-0.937) and for HPV16 (κ = 0.925, 95% CI: 0.897-0.953). In addition, SureX and p16ink4a immunostaining had a perfect concordance (κ = 0.917, 95% CI: 0.888-0.946). Moreover, the HPV-driven fraction, based on double positivity for HPV-DNA and p16ink4a, was similar between SureX (63 of 230, 27.4%) and LiPA-25 (60 of 230, 26.1%). Similar results were found in samples from resections and biopsies. SureX and LiPA-25 are comparable. SureX could be used for routine HPV-DNA detection and genotyping on archival OPSCC FFPE tissues.
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Affiliation(s)
- Jian Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yufei Li
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng Song
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Liu
- Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jingjing Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongmei Zhao
- Department of Pathology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Shaokai Zhang
- Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Xun Zhang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fanghui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zupancic M, Kostopoulou ON, Holzhauser S, Lukoseviciute M, Jylhä C, Marklund L, Näsman A, Sivars L, Dalianis T. Human papillomavirus (HPV) load is higher in HPVDNA/p16 positive than in HPVDNA positive/p16 negative oropharyngeal squamous cell carcinoma but does not differ significantly between various subsites or correlate to survival. Oral Oncol 2024; 151:106749. [PMID: 38461771 DOI: 10.1016/j.oraloncology.2024.106749] [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: 10/28/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Patients with human papillomavirus DNA positive (HPVDNA+) and p16ink4a overexpressing (p16+) oropharyngeal squamous cell carcinoma (OPSCC), especially those with cancer in the tonsillar and base of tongue subsites as compared to other OPSCC subsites have a better outcome than those with only HPVDNA+ or only p16+ cancer. Likewise having a high viral load has been suggested to be a positive prognostic factor. We therefore hypothesized, that HPV viral load could vary depending on OPSCC subsite, as well as with regard to whether the cancer was HPVDNA+ and p16+, or only HPVDNA+, or only p16+ and that this affected outcome. MATERIAL AND METHODS To address these issues HPV viral load was determined by HPV digital droplet (dd) PCR in tumor biopsies with previously known HPVDNA/p16 status from 270 OPSCC patients diagnosed 2000-2016 in Stockholm, Sweden. More specifically, of these patients 235 had HPVDNA+/p16+, 10 had HPVDNA+/p16-, 13 had HPVDNA-/p16+ and 12 had HPVDNA-/p16- cancer. RESULTS We found that HPVDNA+/p16+ OPSCC had a significantly higher viral load than HPVDNA+/p16- OPSCC. Moreover, there was a tendency for a higher viral load in the tonsillar and base of tongue OPSCC subsites compared to the other subsites and for a low viral load to correlate to a better clinical outcome but none of these tendencies reached statistical significance. CONCLUSION To conclude, the mean viral load in HPVDNA+/p16+ OPSCC was higher than in HPVDNA+/p16- OPSCC, but there was no statistically significant difference in viral load depending on OPSCC subsite or on clinical outcome.
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Affiliation(s)
- Mark Zupancic
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | | | - Stefan Holzhauser
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Cecilia Jylhä
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Dept of Clinical Genetics, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Linda Marklund
- Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Intervention and Technology, Division of ENT Diseases, Karolinska Institutet, Sweden; Department of Surgical Sciences, Section of Otolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Anders Näsman
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Dept of Clinical Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Sivars
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - Tina Dalianis
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
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Tirelli G, Marcuzzo AV, Gardenal N, Tofanelli M, Degrassi F, Cova MA, Sacchet E, Giudici F, Polesel J, Boscolo-Rizzo P. Prognostic role of the MRI-based involvement of superior pharyngeal constrictor muscle in oropharyngeal squamous cell carcinoma. Head Neck 2024; 46:161-170. [PMID: 37909147 DOI: 10.1002/hed.27566] [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: 04/11/2023] [Revised: 08/23/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine the impact of the involvement of the superior pharyngeal constrictor muscle (SPCM) evaluated by magnetic resonance imaging (MRI) on outcome in oropharyngeal squamous cell carcinomas (OPSCCs). METHODS A retrospective study including consecutive patients with OPSCC treated with curative intent. RESULTS A total of 82 consecutive patients with OPSCC met inclusion criteria. At multivariate analysis, patients with SPCM infiltration were at significantly higher risk of death (HR: 3.37, CI: 1.21-9.38) and progression (HR: 3.39, CI: 1.38-8.32). In a multivariate model conditioned on HPV status, a significantly higher risk of death and progression was observed by combining both SPCM and HPV status with patients harboring an HPV-negative OPSCC with SPCM infiltration showing the poorest outcome. CONCLUSION MRI evidence of SPCM involvement significantly and independently increases the risk of death and progression in subjects with OPSCC. Considering both MRI-assessed SPCM infiltration and HPV status significantly improved risk stratification in these malignancies.
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Affiliation(s)
- Giancarlo Tirelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Nicoletta Gardenal
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Margherita Tofanelli
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Ferruccio Degrassi
- Department of Medical, Surgical and Health Sciences, Section of Radiology, University of Trieste, Trieste, Italy
| | - Maria Assunta Cova
- Department of Medical, Surgical and Health Sciences, Section of Radiology, University of Trieste, Trieste, Italy
| | - Erika Sacchet
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Fabiola Giudici
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
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Jakobsen KK, Bendtsen SK, Pallisgaard N, Friborg J, Lelkaitis G, Grønhøj C, von Buchwald C. Liquid Biopsies with Circulating Plasma HPV-DNA Measurements-A Clinically Applicable Surveillance Tool for Patients with HPV-Positive Oropharyngeal Cancer. Clin Cancer Res 2023; 29:3914-3923. [PMID: 37477909 DOI: 10.1158/1078-0432.ccr-23-1064] [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: 04/11/2023] [Revised: 05/25/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To evaluate the accuracy of cell-free human papillomavirus-DNA (cfHPV-DNA) measurements in liquid biopsies in predicting disease in patients with HPV-positive/p16-positive (HPV+/p16+) oropharyngeal squamous cell carcinoma (OPSCC). EXPERIMENTAL DESIGN This was a prospective cohort study. Plasma samples were collected before treatment, serially after curative intended therapy at follow-up visits 2 weeks, and 6, 9, 12, 18, 24, and 30 months after treatment. A droplet digital PCR assay comprising eight HPV genotypes was used. HPV genotypes found in plasma and tumor tissue were compared. We correlated biopsy- or imaging-verified tumor progression to cfHPV-DNA in follow-up samples. RESULTS We enrolled 72 patients with HPV+/p16+ OPSCC. Baseline sensitivity for cfHPV-DNA detection was 97.2% (95% confidence interval, 90.3%-99.6%). CfHPV-DNA copy number/milliliter plasma correlated with tumor stage. We found a 100% concordance between HPV genotype in tumor tissue and plasma. Fifty-four patients were followed with serial blood samples for a median of 19.7 months (interquartile range, 13.5-25.5 months). Forty-one patients had undetectable plasma cfHPV-DNA in all follow-up samples, and none developed recurrences. Thirteen patients were classified as cfHPV-DNA-positive in a follow-up plasma sample. Of these, five patients developed a recurrence, and three had residual cancer. It was possible to detect cfHPV-DNA in plasma 97 to 166 days prior to the proven recurrence. CONCLUSIONS To our knowledge, to date, our study, comprising the largest study of patients with HPV+/p16+ OPSCC, using an ultrasensitive multiplex HPV gene panel, revealed a high sensitivity of cfHPV-DNA detection in the liquid biopsies. We recommend serial plasma HPV samples for clinical monitoring of patients with HPV+/p16+ OPSCC.
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Affiliation(s)
- Kathrine K Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Simone K Bendtsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jeppe Friborg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Giedrius Lelkaitis
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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López-Ansio M, Ramos-García P, González-Moles MÁ. Prognostic and Clinicopathological Significance of the Loss of Expression of Retinoblastoma Protein (pRb) in Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:3132. [PMID: 37370742 DOI: 10.3390/cancers15123132] [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: 05/10/2023] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
This systematic review and meta-analysis aims to evaluate the scientific evidence on the implications of retinoblastoma protein (pRb) alterations in oral cancer, in order to determine its prognostic and clinicopathological significance. PubMed, Embase, Web of Science, and Scopus were searched for studies published before February 2022, with no restrictions by publication date or language. The quality of the studies using the Quality in Prognosis Studies tool (QUIPS tool). Meta-analysis was conducted to achieve the proposed objectives, as well as heterogeneity, subgroup, meta-regression, and small study-effects analyses. Twenty studies that met the inclusion criteria (2451 patients) were systematically reviewed and meta-analyzed. Our results were significant for the association between the loss of pRb expression and a better overall survival (HR = 0.79, 95%CI = 0.64-0.98, p = 0.03), whereas no significant results were found for disease-free survival or clinico-pathological parameters (T/N status, clinical stage, histological grade). In conclusion, our evidence-based results demonstrate that loss of pRb function is a factor associated with improved survival in patients with OSCC. Research lines that should be developed in the future are highlighted.
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Affiliation(s)
- María López-Ansio
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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Li Z, Liu P, Wang Z, Zhang Z, Chen Z, Chu R, Li G, Han Q, Zhao Y, Li L, Miao J, Kong B, Song K. Prevalence of human papillomavirus DNA and p16 INK4a positivity in vulvar cancer and vulvar intraepithelial neoplasia: a systematic review and meta-analysis. Lancet Oncol 2023; 24:403-414. [PMID: 36933562 DOI: 10.1016/s1470-2045(23)00066-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) DNA and p16INK4a positivity have crucial roles in the pathogenesis of vulvar cancer and vulvar intraepithelial neoplasia. We aimed to examine the pooled prevalence of HPV DNA and p16INK4a positivity in vulvar cancer and vulvar intraepithelial neoplasia worldwide. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, and the Cochrane Library databases for studies published between Jan 1, 1986, and May 6, 2022, that reported the prevalence of HPV DNA, or p16INK4a positivity, or both, in histologically verified vulvar cancer or vulvar intraepithelial neoplasia. Studies on a minimum of five cases were included. Study-level data were extracted from the published studies. Random effect models were used to examine the pooled prevalence of HPV DNA and p16INK4a positivity in both vulvar cancer and vulvar intraepithelial neoplasia, which were further investigated using stratified analyses by histological subtype, geographical region, HPV DNA or p16INK4a detection method, tissue sample type, HPV genotype, publication year, and age at diagnosis. Additionally, meta-regression was applied to explore sources of heterogeneity. FINDINGS We retrieved 6393 search results, of which 6233 were excluded for being duplicates or after application of our inclusion and exclusion criteria. We also identified two studies from manual searches of references lists. 162 studies were eligible for inclusion in the systematic review and meta-analysis. The prevalence of HPV in vulvar cancer (91 studies; n=8200) was 39·1% (95% CI 35·3-42·9) and in vulvar intraepithelial neoplasia (60 studies; n=3140) was 76·1% (70·7-81·1). The most predominant HPV genotype in vulvar cancer was HPV16 (78·1% [95% CI 73·5-82·3]), followed by HPV33 (7·5% [4·9-10·7]). Similarly, HPV16 (80·8% [95% CI 75·9-85·2]) and HPV33 (6·3% [3·9-9·2]) were also the most two predominant HPV genotypes in vulvar intraepithelial neoplasia. The distribution of type-specific HPV genotypes in vulvar cancer among geographical regions was different, with HPV16 varying between regions, showing a high prevalence in Oceania (89·0% [95% CI 67·6-99·5]) and a low prevalence in South America (54·3% [30·2-77·4]). The prevalence of p16INK4a positivity in patients with vulvar cancer was 34·1% (95% CI 30·9-37·4; 52 studies; n=6352), and it was 65·7% (52·5-77·7; 23 studies; n=896) in patients with vulvar intraepithelial neoplasia. Furthermore, among patients with HPV-positive vulvar cancer, p16INK4a positivity prevalence was 73·3% (95% CI 64·7-81·2), compared with 13·8% (10·0-18·1) in HPV-negative vulvar cancer. The prevalence of double positivity for HPV and p16INK4a was 19·6% (95% CI 16·3-23·0) in vulvar cancer and 44·2% (26·3-62·8) in vulvar intraepithelial neoplasia. Most analyses had large heterogeneity (I2>75%). INTERPRETATION The high prevalence of HPV16 and HPV33 in vulvar cancer and vulvar intraepithelial neoplasia emphasised the importance of nine-valent HPV vaccination in preventing vulvar neoplasm. Additionally, this study highlighted the potential clinical significance of double positivity for HPV DNA and p16INK4a in vulvar neoplasm. FUNDING Taishan Scholar Youth Project of Shandong Province, China.
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Affiliation(s)
- Zhuang Li
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Penglin Liu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Ziying Wang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zhaoyang Zhang
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zhongshao Chen
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Ran Chu
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Guiju Li
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Qiuyue Han
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yong Zhao
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Li Li
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jinwei Miao
- Department of Gynecological Oncology, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Beihua Kong
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Kun Song
- Department of Obstetrics and Gynaecology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
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Mehanna H, Taberna M, von Buchwald C, Tous S, Brooks J, Mena M, Morey F, Grønhøj C, Rasmussen JH, Garset-Zamani M, Bruni L, Batis N, Brakenhoff RH, Leemans CR, Baatenburg de Jong RJ, Klussmann JP, Wuerdemann N, Wagner S, Dalianis T, Marklund L, Mirghani H, Schache A, James JA, Huang SH, O'Sullivan B, Nankivell P, Broglie MA, Hoffmann M, Quabius ES, Alemany L, Taberna M, von Buchwald C, Tous S, Huang SH, O'Sullivan B, Garset-Zamani M, Brooks J, Batis N, Fulton-Lieuw T, Nankivell P, Schache A, James JA, Brakenhoff RH, Leemans CR, Heideman DAM, Bloemena E, Nauta I, de Jong RB, Dalianis T, Marklund L, Mirghani H, Wagner S, Wittekindt C, Klussmann JP, Wuerdemann N, Quaas A, Sharma SJ, Maltseva M, Zimmermann P, Hoffmann M, Quabius ES, Däppen MB, Ärztin L, Bruni L, Mena M, Morey F, Alemany L. Prognostic implications of p16 and HPV discordance in oropharyngeal cancer (HNCIG-EPIC-OPC): a multicentre, multinational, individual patient data analysis. Lancet Oncol 2023; 24:239-251. [PMID: 36796393 DOI: 10.1016/s1470-2045(23)00013-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND p16INK4a (p16) immunohistochemistry is the most widely used biomarker assay for inferring HPV causation in oropharyngeal cancer in clinical and trial settings. However, discordance exists between p16 and HPV DNA or RNA status in some patients with oropharyngeal cancer. We aimed to clearly quantify the extent of discordance, and its prognostic implications. METHODS In this multicentre, multinational individual patient data analysis, we did a literature search in PubMed and Cochrane database for systematic reviews and original studies published in English between Jan 1, 1970, and Sept 30, 2022. We included retrospective series and prospective cohorts of consecutively recruited patients previously analysed in individual studies with minimum cohort size of 100 patients with primary squamous cell carcinoma of the oropharynx. Patient inclusion criteria were diagnosis with a primary squamous cell carcinoma of oropharyngeal cancer; data on p16 immunohistochemistry and on HPV testing; information on age, sex, tobacco, and alcohol use; staging by TNM 7th edition; information on treatments received; and data on clinical outcomes and follow-up (date of last follow-up if alive, date of recurrence or metastasis, and date and cause of death). There were no limits on age or performance status. The primary outcomes were the proportion of patients of the overall cohort who showed the different p16 and HPV result combinations, as well as 5-year overall survival and 5-year disease-free survival. Patients with recurrent or metastatic disease or who were treated palliatively were excluded from overall survival and disease-free survival analyses. Multivariable analysis models were used to calculate adjusted hazard ratios (aHR) for different p16 and HPV testing methods for overall survival, adjusted for prespecified confounding factors. FINDINGS Our search returned 13 eligible studies that provided individual data for 13 cohorts of patients with oropharyngeal cancer from the UK, Canada, Denmark, Sweden, France, Germany, the Netherlands, Switzerland, and Spain. 7895 patients with oropharyngeal cancer were assessed for eligibility. 241 were excluded before analysis, and 7654 were eligible for p16 and HPV analysis. 5714 (74·7%) of 7654 patients were male and 1940 (25·3%) were female. Ethnicity data were not reported. 3805 patients were p16-positive, 415 (10·9%) of whom were HPV-negative. This proportion differed significantly by geographical region and was highest in the areas with lowest HPV-attributable fractions (r=-0·744, p=0·0035). The proportion of patients with p16+/HPV- oropharyngeal cancer was highest in subsites outside the tonsil and base of tongue (29·7% vs 9·0%, p<0·0001). 5-year overall survival was 81·1% (95% CI 79·5-82·7) for p16+/HPV+, 40·4% (38·6-42·4) for p16-/HPV-, 53·2% (46·6-60·8) for p16-/HPV+, and 54·7% (49·2-60·9) for p16+/HPV-. 5-year disease-free survival was 84·3% (95% CI 82·9-85·7) for p16+/HPV+, 60·8% (58·8-62·9) for p16-/HPV-; 71·1% (64·7-78·2) for p16-/HPV+, and 67·9% (62·5-73·7) for p16+/HPV-. Results were similar across all European sub-regions, but there were insufficient numbers of discordant patients from North America to draw conclusions in this cohort. INTERPRETATION Patients with discordant oropharyngeal cancer (p16-/HPV+ or p16+/HPV-) had a significantly worse prognosis than patients with p16+/HPV+ oropharyngeal cancer, and a significantly better prognosis than patients with p16-/HPV- oropharyngeal cancer. Along with routine p16 immunohistochemistry, HPV testing should be mandated for clinical trials for all patients (or at least following a positive p16 test), and is recommended where HPV status might influence patient care, especially in areas with low HPV-attributable fractions. FUNDING European Regional Development Fund, Generalitat de Catalunya, National Institute for Health Research (NIHR) UK, Cancer Research UK, Medical Research Council UK, and The Swedish Cancer Foundation and the Stockholm Cancer Society.
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Affiliation(s)
- Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, UK.
| | - Miren Taberna
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Christian von Buchwald
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Sara Tous
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomèdica de Bellvitge (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
| | - Jill Brooks
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, UK
| | - Marisa Mena
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomèdica de Bellvitge (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
| | - Francisca Morey
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christian Grønhøj
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Jacob Høygaard Rasmussen
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Martin Garset-Zamani
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Laia Bruni
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomèdica de Bellvitge (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
| | - Nikolaos Batis
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ruud H Brakenhoff
- Otolaryngology-head and neck surgery, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands
| | - C René Leemans
- Otolaryngology-head and neck surgery, Cancer Centre Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands
| | | | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Nora Wuerdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Linda Marklund
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden; Medical Unit Head and Neck, Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Surgical Sciences, Section of Otolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Haïtham Mirghani
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Andrew Schache
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jaqueline A James
- Precision Medicine Centre of Excellence, Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, UK; Regional Molecular Diagnostic Service, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Shao Hui Huang
- Department of Radiation Oncology/Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology/Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomics Sciences, University of Birmingham, Birmingham, UK
| | - Martina A Broglie
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Markus Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Elgar Susanne Quabius
- Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomèdica de Bellvitge (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
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8
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Vani NV, Madhanagopal R, Swaminathan R, Ganesan TS. Dynamics of oral human papillomavirus infection in healthy population and head and neck cancer. Cancer Med 2023. [PMID: 36846921 DOI: 10.1002/cam4.5686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 03/01/2023] Open
Abstract
The recent increase in high-risk human papillomavirus (HR-HPV)-associated oral and oropharyngeal cancers has gained considerable importance due to their distinct clinical and molecular characteristics. However, the natural history of oral HPV from acquisition to persistence and malignant transformation is still unclear. The global prevalence of oral HPV infection in healthy individuals ranges from 0.67% to 35%, while 31%-38.5% in head and neck cancer (HNC). The persistence rate of oral HR-HPV infection is 5.5% -12.8% globally. India has the highest HNC burden due to apparent differences in predisposing factors compared with the West. The prevalence of oral HPV in healthy individuals and its contribution to HNC is less evident in Indian studies. HR-HPV-associated HNC in this region accounts for 26%, with an active infection in 8%-15% of these tumors. There is a lack of concordance in the expression of p16 as a surrogate marker for HPV detection in HNC because of differences in behavioral risk factors. Due to a lack of evidence, treatment de-escalation cannot be implemented despite the improved outcome of HPV-associated oropharyngeal cancers. This review critically analyzes the existing literature on the dynamics of oral HPV infection and HPV-associated HNC, identifying potential avenues for future research. A better understanding of the oncogenic role of HR-HPV in HNC will help to formulate novel therapeutic approaches and is expected to have a significant public health impact as preventive strategies can be implemented.
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Affiliation(s)
- N V Vani
- Epidemiology, Biostatistics, and Tumour Registry, Cancer Institute (WIA), Chennai, India
| | - R Madhanagopal
- Epidemiology, Biostatistics, and Tumour Registry, Cancer Institute (WIA), Chennai, India
| | - R Swaminathan
- Epidemiology, Biostatistics, and Tumour Registry, Cancer Institute (WIA), Chennai, India
| | - T S Ganesan
- Medical Oncology, Cancer Institute (WIA), Chennai, India
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9
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刘 雅, 陈 怀. [New progress in diagnosis and treatment of HPV-positive oropharyngeal carcinoma]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:802-806. [PMID: 36217663 PMCID: PMC10128556 DOI: 10.13201/j.issn.2096-7993.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Indexed: 06/16/2023]
Abstract
In recent years, the incidence of oropharyngeal carcinoma (OPC) is increasing, while the better prognosis of patients with Human papillomavirus (HPV) positive oropharyngeal carcinoma has been confirmed in a number of studies. There are a variety of detection methods for HPV-associated oropharyngeal carcinoma. Including P16 immunohistochemistry, Polymerase Chain Reaction (PCR) or In situ hybridization (ISH) detection of HPV DNA, HPV RNA, Revers transcriptase Polymerase Chain Reaction (RT PCR) was used to detect HPV RNA. The better prognosis of patients with HPV-positive oropharyngeal carcinoma has led to the emergence of a large number of degraded treatment trials. The traditional P16 test has certain limitations in the diagnosis of patients with HPV-positive oropharyngeal carcinoma. It is necessary to combine with other detection methods to accurately screen out patients with HPV-positive oropharyngeal carcinoma and better apply to degraded therapy. In this article, we will briefly introduce the trend of HPV-associated oropharyngeal carcinoma, the detection methods and the new progress of degraded treatment trials.
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Affiliation(s)
- 雅岷 刘
- 南方医科大学南方医院耳鼻咽喉头颈外科(广州,510515)Department of Otolaryngology Head and Neck Surgery, Southern Hospital, Southern Medical University, Guangzhou, 510515, China
| | - 怀宏 陈
- 南方医科大学南方医院耳鼻咽喉头颈外科(广州,510515)Department of Otolaryngology Head and Neck Surgery, Southern Hospital, Southern Medical University, Guangzhou, 510515, China
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10
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Tosi A, Parisatto B, Menegaldo A, Spinato G, Guido M, Del Mistro A, Bussani R, Zanconati F, Tofanelli M, Tirelli G, Boscolo-Rizzo P, Rosato A. The immune microenvironment of HPV-positive and HPV-negative oropharyngeal squamous cell carcinoma: a multiparametric quantitative and spatial analysis unveils a rationale to target treatment-naïve tumors with immune checkpoint inhibitors. J Exp Clin Cancer Res 2022; 41:279. [PMID: 36123711 PMCID: PMC9487049 DOI: 10.1186/s13046-022-02481-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICI) are approved for treatment of recurrent or metastatic oropharyngeal head and neck squamous cell carcinoma in the first- and second-line settings. However, only 15–20% of patients benefit from this treatment, a feature increasingly ascribed to the peculiar characteristics of the tumor immune microenvironment (TIME). Methods Immune-related gene expression profiling (GEP) and multiplex immunofluorescence (mIF) including spatial proximity analysis, were used to characterize the TIME of 39 treatment-naïve oropharyngeal squamous cell carcinomas (OPSCC) and the corresponding lymph node metastases. GEP and mIF results were correlated with disease-free survival (DFS). HPV-positive tumors disclosed a stronger activation of several immune signalling pathways, as well as a higher expression of genes related to total tumor-infiltrating lymphocytes, CD8 T cells, cytotoxic cells and exhausted CD8 cells, than HPV-negative patients. Accordingly, mIF revealed that HPV-positive lesions were heavily infiltrated as compared to HPV-negative counterparts, with a higher density of T cells and checkpoint molecules. CD8+ T cells appeared in closer proximity to tumor cells, CD163+ macrophages and FoxP3+ cells in HPV-positive primary tumors, and related metastases. In HPV-positive lesions, PD-L1 expression was increased as compared to HPV-negative samples, and PD-L1+ tumor cells and macrophages were closer to PD-1+ cytotoxic T lymphocytes. Considering the whole cohort, a positive correlation was observed between DFS and higher levels of activating immune signatures and T cell responses, higher density of PD-1+ T cells and their closer proximity to tumor cells or PD-L1+ macrophages. HPV-positive patients with higher infiltration of T cells and macrophages had a longer DFS, while CD163+ macrophages had a negative role in prognosis of HPV-negative patients. Conclusions Our results suggest that checkpoint expression may reflect an ongoing antitumor immune response. Thus, these observations provide the rationale for the incorporation of ICI in the loco-regional therapy strategies for patients with heavily infiltrated treatment-naïve OPSCC, and for the combination of ICI with tumor-specific T cell response inducers or TAM modulators for the “cold” OPSCC counterparts. Supplementary Information The online version contains supplementary material available at 10.1186/s13046-022-02481-4.
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11
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Loermann G, Kolb M, Prascevic D, Siemert J, Wiegand S, Zebralla V, Pirlich M, Stöhr M, Dietz A, Wald T, Wichmann G. High-Risk Human Papillomavirus (HR-HPV) DNA Detection in Mouthwashes for Diagnosis of HPV-Driven Oropharynx Cancer and Its Curative Therapy—A Feasibility Study. J Clin Med 2022; 11:jcm11195509. [PMID: 36233378 PMCID: PMC9570661 DOI: 10.3390/jcm11195509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/02/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
Detection of p16 through immunohistochemistry (IHC) is the standard for determining the HPV status of the tumor according the TNM eighth edition released in 2017 and has become crucial for determining the HPV status of oropharyngeal squamous cell carcinomas (OPSCC) with direct impact on staging and prognostication. In recent years, detection of HPV DNA in mouthwashes has been proposed as a noninvasive alternative, both for OPSCCs and for other head and neck squamous cell carcinomas (HNSCCs). However, the prospect of using the mouthwashes to monitor the response to therapy is unclear. To evaluate the effect of curative therapy on the detection of HPV DNA, we performed a prospective study comparing the detection frequency of high-risk HPV DNA (HR-HPV-DNA) in pre- and post-therapy mouthwashes. We collected 137 mouthwashes from 88 pathologically confirmed HNSCC patients for DNA isolation and HPV genotyping with the Inno-LiPA assay. We show that HPV DNA in pretherapeutic mouthwashes can detect HPV-driven HNSCCs with a sensitivity of 50.0% and specificity of 85.4%, alongside a high negative predictive value of 79.5% and an accuracy of 74.5%. Furthermore, we observed a notable decrease in the detection frequency of HR-HPV-DNA after successful treatment (pre-therapy 50.0% (9/18) versus post-therapy 9.7% (3/28)). However, the comparatively low sensitivity regarding detection of HPV-driven OPSCC argues against its use in clinical routine.
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Affiliation(s)
- Gera Loermann
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany
| | - Marlen Kolb
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany
| | - Dusan Prascevic
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany
- Peter Debye Institute for Soft Matter Physics, Leipzig University, Linnéstraße 5, 04103 Leipzig, Germany
| | - Julia Siemert
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany
| | - Susanne Wiegand
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany
| | - Veit Zebralla
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany
| | - Markus Pirlich
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany
| | - Matthäus Stöhr
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany
| | - Andreas Dietz
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany
| | - Theresa Wald
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany
| | - Gunnar Wichmann
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Liebigstr. 10-14, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-972-1926; Fax: +49-341-972-1909
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12
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Mena M, Wang X, Tous S, Quiros B, Clavero O, Alejo M, Morey F, Taberna M, Leon Vintro X, Lloveras Rubio B, Alos L, Mehanna H, Quint W, Pawlita M, Tommasino M, Pavón MA, Muñoz N, De Sanjose S, Bosch FX, Alemany L. Concordance of p16 INK4a and E6*I mRNA among HPV-DNA-Positive Oropharyngeal, Laryngeal, and Oral Cavity Carcinomas from the ICO International Study. Cancers (Basel) 2022; 14:3787. [PMID: 35954451 PMCID: PMC9367257 DOI: 10.3390/cancers14153787] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Tests or test algorithms for diagnosing HPV-driven oral cavity and laryngeal head and neck carcinomas (HNC) have not been yet validated, and the differences among oral cavity and laryngeal sites have not been comprehensively evaluated. We aimed to assess the utility of a diagnostic algorithm for the detection of HPV-driven oral cavity (OCC), oropharyngeal (OPC) and laryngeal (LC) carcinomas using HPV-DNA testing followed by p16INK4a immunohistochemistry, taking E6*I mRNA detection as the reference standard. Methods: Formalin-fixed paraffin-embedded OCC, OPC, and LC carcinomas were collected from pathology archives in 29 countries. All samples were subjected to histopathological evaluation, DNA quality control, and HPV-DNA detection. All HPV-DNA-positive samples (including 78 OCC, 257 OPC, and 51 LC out of 3680 HNC with valid HPV-DNA results) were also tested for p16INK4a immunohistochemistry and E6*I mRNA. Three different cutoffs of nuclear and cytoplasmic staining were evaluated for p16INK4a: (a) >25%, (b) >50%, and (c) ≥70%. The concordance of p16INK4a and E6*I mRNA among HPV-DNA-positive OCC, OPC, and LC cases was assessed. Results: A total of 78 OCC, 257 OPC, and 51 LC were HPV-DNA-positive and further tested for p16INK4a and E6*I mRNA. The percentage of concordance between p16INK4a (cutoff ≥ 70%) and E6*I mRNA among HPV-DNA-positive OCC, OPC, and LC cases was 79.5% (95% CI 69.9−89.1%), 82.1% (95% CI 77.2−87.0%), and 56.9% (95% CI 42.3−71.4%), respectively. A p16INK4a cutoff of >50% improved the concordance although the improvement was not statistically significant. For most anatomical locations and p16INK4a cutoffs, the percentage of discordant cases was higher for HPV16- than HPV-non16-positive cases. Conclusions: The diagnostic algorithm of HPV-DNA testing followed by p16INK4a immunohistochemistry might be helpful in the diagnosis of HPV-driven OCC and OPC, but not LC. A different p16INK4a expression pattern was observed in those cases HPV-DNA-positive for types other than HPV16, as compared to HPV16-positive cases. Our study provides new insights into the use HPV-DNA, p16INK4a, and HPV-E6*I mRNA for diagnosing an HPV-driven HNC, including the optimal HPV test or p16INK4a cutoffs to be used. More studies are warranted to clarify the role of p16INK4a and HPV status in both OPC and non-OPC HNC.
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Affiliation(s)
- Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Xin Wang
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Sara Tous
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Beatriz Quiros
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Omar Clavero
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maria Alejo
- Pathology Department, Hospital de Vic, 08500 Vic, Spain
- Pathology Department, Hospital General de l’Hopitalet, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Francisca Morey
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Miren Taberna
- Oncology Department, Catalan Institute of Oncology (ICO)-IDIBELL, ONCOBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Xavier Leon Vintro
- Otorhinolaryngology Department, Hospital Sant Pau, 08026 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | - Llúcia Alos
- Pathology Department, Hospital Clinic, 08036 Barcelona, Spain
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham B15 2TT, UK
| | - Wim Quint
- DDL Diagnostic Laboratory, 2288 ER Rijswijk, The Netherlands
| | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - Miguel Angel Pavón
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Nubia Muñoz
- National Cancer Institute, Bogotá 111511, Colombia
| | - Silvia De Sanjose
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- ISGlobal, 08036 Barcelona, Spain
| | - Francesc Xavier Bosch
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Universitat Oberta de Catalunya, 08035 Barcelona, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Multifactorial Model Based on DWI-Radiomics to Determine HPV Status in Oropharyngeal Squamous Cell Carcinoma. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background: Oropharyngeal squamous cell carcinoma (OPSCC) associated with human papillomavirus (HPV) has higher rates of locoregional control and a better prognosis than HPV-negative OPSCC. These differences are due to some unique biological characteristics that are also visible through advanced imaging modalities. We investigated the ability of a multifactorial model based on both clinical factors and diffusion-weighted imaging (DWI) to determine the HPV status in OPSCC. Methods: The apparent diffusion coefficient (ADC) and the perfusion-free tissue diffusion coefficient D were derived from DWI, both in the primary tumor (PT) and lymph node (LN). First- and second-order radiomic features were extracted from ADC and D maps. Different families of machine learning (ML) algorithms were trained on our dataset using five-fold cross-validation. Results: A cohort of 144 patients was evaluated retrospectively, which was divided into a training set (n = 95) and a validation set (n = 49). The 50th percentile of DPT, the inverse difference moment of ADCLN, smoke habits, and tumor subsite (tonsil versus base of the tongue) were the most relevant predictors. Conclusions: DWI-based radiomics, together with patient-related parameters, allowed us to obtain good diagnostic accuracies in differentiating HPV-positive from HPV-negative patients. A substantial decrease in predictive power was observed in the validation cohort, underscoring the need for further analyses on a larger sample size.
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14
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Galati L, Combes JD, Le Calvez-Kelm F, McKay-Chopin S, Forey N, Ratel M, McKay J, Waterboer T, Schroeder L, Clifford G, Tommasino M, Gheit T. Detection of Circulating HPV16 DNA as a Biomarker for Cervical Cancer by a Bead-Based HPV Genotyping Assay. Microbiol Spectr 2022; 10:e0148021. [PMID: 35225653 PMCID: PMC9045285 DOI: 10.1128/spectrum.01480-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
Human papillomavirus (HPV) circulating tumor DNA (HPV ctDNA) was proposed as a biomarker for the detection and disease monitoring of HPV-related cancers. One hundred eighty plasma samples obtained from women diagnosed with HPV16-positive cervical cancer (CC) (n = 100), HPV16-positive premalignant lesions (cervical intraepithelial neoplasia grade 3 [CIN3]) (n = 20), and HPV DNA-negative controls (n = 60) were randomly selected from the archives for evaluating the performance of a bead-based HPV genotyping assay (E7 type-specific multiplex genotyping assay [E7-MPG]) in detecting HPV16 ctDNA. The performance of the E7-MPG was compared with those of DNA detection by droplet digital PCR (ddPCR) and detection of HPV16 E6 antibodies evaluated in an independent study. Internal controls to assess DNA quality were included in the molecular assays, i.e., beta-globin and ESR1, respectively. The sensitivity and specificity of E7-MPG and/or E6 antibodies to detect HPV16-positive CCs were evaluated. HPV16 ctDNA was detected using the E7-MPG in 42.3% of all plasma samples and in 74.7% of plasma samples from HPV16-positive CC cases. The validation of E7-MPG data by ddPCR showed that the sensitivity of the E7-MPG test for HPV16-positive CC detection was higher than that of ddPCR (74.7% versus 63.1%; P < 0.001). When both HPV16 ctDNA and E6 antibodies were considered, the sensitivity for HPV16-positive CC detection increased from 74.7% to 86.1%, while the specificity was unchanged at 97.8%. The performance of E7-MPG for the detection of HPV16 ctDNA appears to be at least as sensitive as that of ddPCR, offering an additional tool for ctDNA detection of HPV16-positive CC. The use of an additional blood marker of HPV infection, such as E6 antibodies, further improved the detection of CC. IMPORTANCE The validity of HPV ctDNA as a marker of HPV-driven cancers has been previously reported. Herein we validated an alternative to ddPCR for HPV16 ctDNA detection, using a bead-based HPV genotyping assay that offers the potential advantage of reducing the cost of clinical management due to the multiplex capability of the test, thus facilitating its use in clinical settings. In addition, we analyzed HPV ctDNA in the context of E6 antibodies as an additional HPV marker. The HPV16 ctDNA biomarker appeared to be highly specific and, to a lesser extent, sensitive for the detection of CC, mainly indicated for those at an advanced tumor stage. In this proof-of-principle study, E6 antibodies were mainly detected in early tumor stages of CC, while HPV ctDNA was mainly positive at advanced tumor stages.
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Affiliation(s)
- Luisa Galati
- International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Nathalie Forey
- International Agency for Research on Cancer, Lyon, France
| | - Mathis Ratel
- International Agency for Research on Cancer, Lyon, France
| | - James McKay
- International Agency for Research on Cancer, Lyon, France
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lea Schroeder
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Gary Clifford
- International Agency for Research on Cancer, Lyon, France
| | | | - Tarik Gheit
- International Agency for Research on Cancer, Lyon, France
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15
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Azzimonti B, Raimondo L, Squarzanti DF, Rosso T, Zanetta P, Aluffi Valletti P, Chiusa L, Masini L, Pecorari G, Airoldi M, Krengli M, Giovarelli M, Valente G. Macrophages expressing TREM-1 are involved in the progression of HPV16-related oropharyngeal squamous cell carcinoma. Ann Med 2021; 53:541-550. [PMID: 33769181 PMCID: PMC8008925 DOI: 10.1080/07853890.2021.1905872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/25/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Many types of research have been performed to improve the diagnosis, therapy, and prognosis of oropharyngeal carcinomas (OP-SCCs). Since they arise in lymphoid-rich areas and intense lymphocytic infiltration has been related to a better prognosis, a TREM-1 putative function in tumour progression and survival has been hypothesized. MATERIALS AND METHODS Twenty-seven human papillomavirus (HPV) 16+ OP-SCC specimens have been analyzed to relate TREM-1 expression with histiocytic and lymphocytic markers, HPV presence and patients' outcome. RESULTS No differences have been shown between intratumoral and stromal CD4+ cells, while intratumoral CD8+ lymphocytes are higher with respect to the tumour stroma (p = .0005). CD68+ cells are more than CD35+ and TREM-1+; their presence is related to CD35± and TREM-1± histiocytes (p = .005 and .026, respectively). Intratumoral CD4+ lymphocytes are higher in p16+ cases (11/27) than in p16- (p = .042); moreover, p16 positivity correlates to a better survival (p = .034). CD4+, CD8+ and CD35+ cells have no impact on survival, while CD68 expression heavily influences progression and bad outcome (p = .037). TREM-1 positivity also leads to worst overall survival (p = .001): peritumoral expression and death-cause relationship are always significant, particularly when the cause is OP-SCC (p = .000). CONCLUSION While p16 shows to better stratify HPV16+ patients' outcome, TREM-1+ macrophages suggest their key importance in HPV-related OP-SCCs progression.KEY MESSAGESTREM-1 positivity correlates to the worst overall survival of HPV16-positive OPSCCs-affected patients.p16-positive HPV16 related OPSCCs patients have a better prognosis with respect to p16-negative ones.
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Affiliation(s)
- Barbara Azzimonti
- Center for Translational Research on Autoimmune and Allergic Diseases (CAAD), Department of Health Sciences (DiSS), University of Piemonte Orientale (UPO), Novara, Italy
| | - Luca Raimondo
- Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Diletta Francesca Squarzanti
- Center for Translational Research on Autoimmune and Allergic Diseases (CAAD), Department of Health Sciences (DiSS), University of Piemonte Orientale (UPO), Novara, Italy
| | - Tiziana Rosso
- Clinical Epidemiology Unit, “Città della Salute e della Scienza” Hospital – CPO Piemonte, Torino, Italy
| | - Paola Zanetta
- Center for Translational Research on Autoimmune and Allergic Diseases (CAAD), Department of Health Sciences (DiSS), University of Piemonte Orientale (UPO), Novara, Italy
| | - Paolo Aluffi Valletti
- Division of Ear Nose and Throat Department-Head and Neck Surgery, DiSS, University of Piemonte Orientale (UPO), Novara, Italy
| | - Luigi Chiusa
- Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy
| | - Laura Masini
- Radiotherapy Unit, Department of Translational Medicine (DiMeT), University of Piemonte Orientale (UPO), Novara, Italy
| | - Giancarlo Pecorari
- Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mario Airoldi
- Department of Oncology, Azienda Ospedaliera Universitaria Citta’ della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Krengli
- Radiotherapy Unit, Department of Translational Medicine (DiMeT), University of Piemonte Orientale (UPO), Novara, Italy
| | - Mirella Giovarelli
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
- Center for Experimental Research and Medical Studies (CERMS), AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Guido Valente
- Pathology Unit, Ospedale “Sant’Andrea”, DiMeT, University of Piemonte Orientale (UPO), Vercelli, Italy
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16
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Accuracy of liquid-based brush cytology and HPV detection for the diagnosis and management of patients with oropharyngeal and oral cancer. Clin Oral Investig 2021; 26:2587-2595. [PMID: 34839418 PMCID: PMC8898233 DOI: 10.1007/s00784-021-04228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/13/2021] [Indexed: 12/03/2022]
Abstract
Objectives This study aims to evaluate the usefulness of liquid-based brush cytology for malignancy diagnosis and HPV detection in patients with suspected oropharyngeal and oral carcinomas, as well as for the diagnosis of tumoral persistence after treatment. Material and methods Seventy-five patients with suspicion of squamous cell carcinoma of the oropharynx or oral cavity were included. Two different study groups were analyzed according to the date of the sample collection: (1) during the first endoscopy exploration and (2) in the first control endoscopy after treatment for squamous cell carcinoma. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy diagnosis as well as for HPV-DNA detection on brush cytologies were assessed. Results Before treatment, the brush cytology showed a sensitivity of 88%, specificity of 100%, and accuracy of 88%. After treatment, it showed a sensitivity of 71%, specificity of 77%, and accuracy of 75%. HPV-DNA detection in cytology samples showed a sensitivity of 85%, specificity of 100%, and accuracy of 91% before treatment and an accuracy of 100% after treatment. Conclusions Liquid-based brush cytology showed good accuracy for diagnosis of oropharyngeal and oral squamous cell carcinoma before treatment, but its value decreases after treatment. Nevertheless, it is useful for HPV-DNA detection, as well as to monitor the patients after treatment. Clinical relevance Brush cytology samples are reliable for the detection of HPV-DNA before and after treatment and may be a useful method to incorporate in the HPV testing guidelines.
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17
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Paytubi S, Taberna M, Mena M, Quirós B, Gomà M, Alemany L, Bosch FX, Pavón MÁ. The Isothermal Amplification AmpFire Assay for Human Papillomavirus (HPV) Detection and Genotyping in Formalin-Fixed, Paraffin-Embedded Oropharyngeal Cancer Samples. J Mol Diagn 2021; 24:79-87. [PMID: 34801703 DOI: 10.1016/j.jmoldx.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/12/2021] [Accepted: 10/13/2021] [Indexed: 12/01/2022] Open
Abstract
Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCCs) represent a distinct clinical entity compared with HPV-negative tumors with particular regard to treatment response and survival outcome. The aim of this study was to assess the AmpFire Multiplex HR-HPV tests, for the detection and genotyping of 15 high-risk (HR) HPV types in formalin-fixed, paraffin-embedded (FFPE) samples and identify HPV-driven OPSCC. DNA from 160 OPSCC FFPE specimens plus 23 samples from other head and neck primary sites was tested. Results were compared with those obtained using Linear Array HPV-DNA Genotyping Test. Linear Array and AmpFire Multiplex HR-HPV tests showed, for all samples and specifically for OPSCCs, an overall concordance agreement of 98.9% and 99.4% and a Cohen κ coefficient of 0.972 and 0.984, respectively. A concordance of 100% for HPV16 and HPV18 was observed. The overall agreement between p16INK4a overexpression and HPV detection by the AmpFire Multiplex HR-HPV assay in 145 OPSCC samples was 93.8%, with a Cohen κ coefficient of 0.848. The AmpFire HPV Tests are simple assays for detection and genotyping of HPV-DNA in OPSCC FFPE samples and can be easily implemented in the clinical practice setting for HPV-DNA detection.
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Affiliation(s)
- Sonia Paytubi
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL, Barcelona, Spain.
| | - Miren Taberna
- Medical Oncology Department, Catalan Institute of Oncology, IDIBELL, ONCOBELL, Barcelona, Spain
| | - Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Quirós
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Gomà
- Department of Pathology, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Francesc X Bosch
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain; Universitat Oberta de Catalunya, Barcelona, Spain
| | - Miguel Á Pavón
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, IDIBELL, ONCOBELL, Barcelona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
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18
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Piludu F, Marzi S, Gangemi E, Farneti A, Marucci L, Venuti A, Benevolo M, Pichi B, Pellini R, Sperati F, Covello R, Sanguineti G, Vidiri A. Multiparametric MRI Evaluation of Oropharyngeal Squamous Cell Carcinoma. A Mono-Institutional Study. J Clin Med 2021; 10:jcm10173865. [PMID: 34501313 PMCID: PMC8432241 DOI: 10.3390/jcm10173865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 12/30/2022] Open
Abstract
The aim of this paper is to define the pre-treatment radiological characteristics of oropharyngeal squamous cell carcinoma (OPSCC) using morphological and non-morphological magnetic resonance imaging (MRI), based on HPV status, in a single-institution cohort. In total, 100 patients affected by OPSCC were prospectively enrolled in the present study. All patients underwent 1.5T MR with standard sequences, including diffusion-weighted imaging with and intravoxel incoherent motion (IVIM-DWI) technique and a dynamic contrast-enhanced (DCE) MRI. For all patients, human papillomavirus (HPV) status was available. No statistically significant differences in the volume of primary tumors (PTs) and lymph nodes (LNs) were observed based on HPV status. When comparing the two patient groups, no significant differences were found for the PT radiologic characteristics (presence of well-defined borders, exophytic growth, ulceration, and necrosis) and LN morphology (solid/cystic/necrotic). Tumor subsite, smoking status, and alcohol intake significantly differed based on HPV status, as well as ADC and Dt values of both PTs and LNs. We detected no significant difference in DCE-MRI parameters by HPV status. Based on a multivariate logistic regression model, the combination of clinical factors, such as tumor subsite and alcohol habits, with the perfusion-free diffusion coefficient Dt of LNs, may help to accurately discriminate OPSCC by HPV status.
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Affiliation(s)
- Francesca Piludu
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.P.); (E.G.)
| | - Simona Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy;
| | - Emma Gangemi
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.P.); (E.G.)
- Center for Integrated Research, Departmental Faculty of Medicine and Surgery, University Campus Bio-Medico of Rome, Via Álvaro del Portillo, 33, 00128 Rome, Italy
| | - Alessia Farneti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
| | - Laura Marucci
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
| | - Aldo Venuti
- HPV Unit (UOSD), Department of Tumor Immunology and Immunotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy;
| | - Maria Benevolo
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (M.B.); (R.C.)
| | - Barbara Pichi
- Department of Otolaryngology and Head and Neck Surgery, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (B.P.); (R.P.)
| | - Raul Pellini
- Department of Otolaryngology and Head and Neck Surgery, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (B.P.); (R.P.)
| | - Francesca Sperati
- Biostatistics-Scientific Direction, IRCCS San Gallicano Dermatological Institute, Via Elio Chianesi 53, 00144 Rome, Italy;
| | - Renato Covello
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (M.B.); (R.C.)
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
| | - Antonello Vidiri
- Department of Radiology and Diagnostic Imaging, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; (F.P.); (E.G.)
- Correspondence: ; Tel.: +39-335-547-6057
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19
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Jakobsen KK, Carlander ALF, Bendtsen SK, Garset-Zamani M, Lynggaard CD, Grønhøj C, von Buchwald C. Diagnostic Accuracy of HPV Detection in Patients with Oropharyngeal Squamous Cell Carcinomas: A Systematic Review and Meta-Analysis. Viruses 2021; 13:1692. [PMID: 34578274 PMCID: PMC8473001 DOI: 10.3390/v13091692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/02/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022] Open
Abstract
The aim of the study was to evaluate the diagnostic accuracy of Human Papillomavirus (HPV) techniques in oropharyngeal cancer. PubMed, EMBASE, the Cochrane Library and clinicaltrials.org were systematically searched for studies reporting methods of HPV detection. Primary outcomes were sensitivity and specificity of HPV detection. In this case, 27 studies were included (n = 5488, 41.6% HPV+). In this case, 13 studies evaluated HPV detection in tumour tissue, nine studies examined HPV detection in blood samples and five studies evaluated HPV detection in oral samples. Accuracy of HPV detection in tumour tissue was high for all detection methods, with pooled sensitivity ranging from 81.1% (95% CI 71.9-87.8) to 93.1% (95% CI 87.4-96.4) and specificity ranging from 81.1% (95% CI 71.9-87.8) to 94.9% (95% CI 79.1-98.9) depending on detection methods. Overall accuracy of HPV detection in blood samples revealed a sensitivity of 81.4% (95% CI 62.9-91.9) and a specificity of 94.8% (95% CI 91.4-96.9). In oral samples pooled sensitivity and specificity were lower (77.0% (95% CI 68.8-83.6) and 74.0% (95% CI 58.0-85.4)). In conclusion, we found an overall high accuracy for HPV detection in tumour tissue regardless of the HPV detection method used. HPV detection in blood samples may provide a promising new way of HPV detection.
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Affiliation(s)
- Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, 2100 København, Denmark; (A.-L.F.C.); (S.K.B.); (M.G.-Z.); (C.D.L.); (C.G.); (C.v.B.)
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20
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Hashida Y, Higuchi T, Matsumoto S, Iguchi M, Murakami I, Hyodo M, Daibata M. Prognostic significance of human papillomavirus 16 viral load level in patients with oropharyngeal cancer. Cancer Sci 2021; 112:4404-4417. [PMID: 34382311 PMCID: PMC8486212 DOI: 10.1111/cas.15105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
Human papillomavirus (HPV) infection in patients with oropharyngeal squamous cell carcinoma (OPSCC) is a major determinant for better prognosis. However, there remain HPV‐positive patients who have poor outcomes. The stratification strategy for detecting high‐risk patients among those with HPV‐positive OPSCC has not been well delineated, especially for Asian patients. We undertook a retrospective cohort study on the survival rate of 89 Japanese patients diagnosed with primary OPSCC. The tumors were concurrently analyzed for the presence of HPV E6 DNA/mRNA, viral DNA load, p16 expression, viral physical status, and viral variant lineage. Human papillomavirus 16 viral DNA was found in 45 (51%) OPSCCs. Human papillomavirus 16 DNA‐positive OPSCCs with higher viral load (classified as HPV16 DNA‐medium/high OPSCCs) showed significantly favorable overall survival and progression‐free survival compared with HPV16 DNA‐positive OPSCCs with lower viral load (<10 copies/cell; HPV16 DNA‐low OPSCCs) and HPV16 DNA‐negative OPSCCs. E6 mRNA expression was observed in all HPV16 DNA‐medium/high OPSCCs but not in HPV16 DNA‐low OPSCCs. Notably, p16‐positive and HPV16 DNA‐negative/low OPSCCs showed significantly worse survival than p16‐positive and HPV16 DNA‐medium/high OPSCCs and resembled HPV‐unrelated OPSCCs with regard to survival and risk factor profile. Although not significant, a trend toward shorter survival was observed for HPV16‐integrated OPSCCs. Phylogenetic analysis revealed two major types of HPV16 variants termed Asian (A4) and European (A1/A2/A3) variants, but no difference in survival between these variants was observed. Altogether, these findings suggest that HPV viral load is a potentially informative factor for more accurate risk stratification of patients with OPSCC.
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Affiliation(s)
- Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Shuichi Matsumoto
- Department of Otolaryngology, Head and Neck Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Mitsuko Iguchi
- Department of Pathology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Ichiro Murakami
- Department of Pathology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masamitsu Hyodo
- Department of Otolaryngology, Head and Neck Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Japan
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21
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Molimard C, L’Huillier V, Overs A, Soret C, Algros MP, Mougin C, Guenat D, Mauvais O, Prétet JL. Human papillomavirus DNA and p16 expression in head and neck squamous cell carcinoma in young French patients. J Int Med Res 2021; 49:3000605211022534. [PMID: 34232797 PMCID: PMC8267044 DOI: 10.1177/03000605211022534] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/13/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Human papillomavirus (HPV) is a risk factor for head and neck squamous cell carcinoma (HNSCC), which is currently increasing worldwide. We evaluated the prevalence of HPV DNA and p16 expression in HNSCC patients age <45 years compared with patients aged ≥45 years. METHODS Thirty-nine patients aged <45 years who presented at Besançon University Hospital with HNSCC since 2005 were included in this retrospective study. HPV DNA was detected by HPV genotyping and p16 expression was determined by immunohistochemistry using paraffin-embedded tissues. A matched-group of 38 patients aged ≥45 years from Besançon University Hospital was included. RESULTS The overall prevalence of HPV infection was 11.7%. HPV16 was the only genotype detected in 4/39 and 5/38 patients, and p16 was expressed in 6/39 and 4/38 patients aged <45 years and ≥45 years, respectively. CONCLUSIONS HPV-positivity and p16 expression were similar in both age groups. The results suggest that p16 immunohistochemistry may provide a prognosis biomarker for all HNSCCs, not only oropharyngeal cancers, and this should be addressed in large clinical trials.
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Affiliation(s)
- Chloé Molimard
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
- Service d'Anatomie et Cytologie Pathologiques, CHU Besançon, Besançon, France
| | | | - Alexis Overs
- Laboratoire de Biochimie, CHU Besançon, Besançon, France
| | - Christine Soret
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
| | - Marie-Paule Algros
- Service d'Anatomie et Cytologie Pathologiques, CHU Besançon, Besançon, France
| | - Christiane Mougin
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
| | - David Guenat
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
- EA3181, UFC, Université Bourgogne-Franche-Comté, LabEx LipSTIC ANR-11-LABEX-0021, Besançon, France
| | - Olivier Mauvais
- Service d'Oto-Rhino-Laryngologie, CHU Besançon, Besançon, France
| | - Jean-Luc Prétet
- Centre National de Référence Papillomavirus, CHU Besançon, Besançon, France
- EA3181, UFC, Université Bourgogne-Franche-Comté, LabEx LipSTIC ANR-11-LABEX-0021, Besançon, France
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22
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Näsman A, Holzhauser S, Kostopoulou ON, Zupancic M, Ährlund-Richter A, Du J, Dalianis T. Prognostic Markers and Driver Genes and Options for Targeted Therapy in Human-Papillomavirus-Positive Tonsillar and Base-of-Tongue Squamous Cell Carcinoma. Viruses 2021; 13:v13050910. [PMID: 34069114 PMCID: PMC8156012 DOI: 10.3390/v13050910] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022] Open
Abstract
The incidence of Human-papillomavirus-positive (HPV+) tonsillar and base-of-tongue squamous cell carcinoma (TSCC and BOTSCC, respectively) is increasing epidemically, but they have better prognosis than equivalent HPV-negative (HPV−) cancers, with roughly 80% vs. 50% 3-year disease-free survival, respectively. The majority of HPV+ TSCC and BOTSCC patients therefore most likely do not require the intensified chemoradiotherapy given today to head and neck cancer patients and would with de-escalated therapy avoid several severe side effects. Moreover, for those with poor prognosis, survival has not improved, so better-tailored alternatives are urgently needed. In line with refined personalized medicine, recent studies have focused on identifying predictive markers and driver cancer genes useful for better stratifying patient treatment as well as for targeted therapy. This review presents some of these endeavors and briefly describes some recent experimental progress and some clinical trials with targeted therapy.
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Affiliation(s)
- Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet, Bioclinicum J6:20, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.N.); (S.H.); (O.N.K.); (M.Z.); (A.Ä.-R.)
| | - Stefan Holzhauser
- Department of Oncology-Pathology, Karolinska Institutet, Bioclinicum J6:20, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.N.); (S.H.); (O.N.K.); (M.Z.); (A.Ä.-R.)
| | - Ourania N. Kostopoulou
- Department of Oncology-Pathology, Karolinska Institutet, Bioclinicum J6:20, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.N.); (S.H.); (O.N.K.); (M.Z.); (A.Ä.-R.)
| | - Mark Zupancic
- Department of Oncology-Pathology, Karolinska Institutet, Bioclinicum J6:20, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.N.); (S.H.); (O.N.K.); (M.Z.); (A.Ä.-R.)
| | - Andreas Ährlund-Richter
- Department of Oncology-Pathology, Karolinska Institutet, Bioclinicum J6:20, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.N.); (S.H.); (O.N.K.); (M.Z.); (A.Ä.-R.)
| | - Juan Du
- Department of Microbiology, Tumor Biology and Cellular Biology, Karolinska Institutet, Biomedicum, 171 77 Stockholm, Sweden;
| | - Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Bioclinicum J6:20, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.N.); (S.H.); (O.N.K.); (M.Z.); (A.Ä.-R.)
- Correspondence:
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23
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Benzerdjeb N, Tantot J, Blanchet C, Philouze P, Mekki Y, Lopez J, Devouassoux-Shisheboran M. Oropharyngeal squamous cell carcinoma: p16/p53 immunohistochemistry as a strong predictor of HPV tumour status. Histopathology 2021; 79:381-390. [PMID: 33560536 DOI: 10.1111/his.14350] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 12/13/2022]
Abstract
AIMS Oropharyngeal squamous cell carcinomas (OPSCC) related to human papillomavirus (HPV) infection have a better prognosis than those without HPV infection. Although p16INK4a overexpression is used as a surrogate marker for HPV infection, 5-20% of p16-positive OPSCC are described as being unrelated to HPV infection, with worse overall survival compared to OPSCC-related HPV. There is therefore a risk of undertreating a proportion of OPSCC patients falsely considered to be HPV-driven because of p16 positivity. TP53 mutations are highly prevalent in OPSCC driven by mutagens in tobacco and alcohol. We describe herein a combined p16/p53 algorithm to predict HPV tumour status in OPSCC. METHODS AND RESULTS A total of 110 OPSCC were identified in the database of the pathology department and were studied using p16 and p53 immunohistochemistry. For p16-positive or p16-negative/wild-type patterns-p53 (WT-p53) cases (n = 63), DNA in-situ hybridisation for high-risk HPV was performed, and if negative the HPV status was controlled by HPV DNA polymerase chain reaction (PCR) (n = 19). A significant association between TP53 mutation and pattern of p53 expression was found (WT-p53, seven of 16, P < 0.001). The p16-positive/WT-p53 was significantly associated with HPV+ tumour status (p16-positive/WT-p53, 50 of 110, P < 0.001). Interestingly, a subset of p16-positive OPSCC was unrelated to HPV (13.5%, eight of 59), and showed mutant-type staining of p53 expression. CONCLUSIONS The p16 protein immunopositivity in conjunction with the mutant-type pattern of p53 staining helped to reclassify a subset of p16-positive OPSCC as OPSCC-unrelated HPV. This approach could be routinely applied by pathologists involved in the management of OPSCC, because of their potential therapeutic implications.
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Affiliation(s)
- Nazim Benzerdjeb
- Department of Pathology, Institut de Pathologie Multisite, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Université Lyon 1, Villeurbanne, Hôpital La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Juliet Tantot
- Department of Pathology, Institut de Pathologie Multisite, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Christophe Blanchet
- Department of Pathology, Institut de Pathologie Multisite, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Université Lyon 1, Villeurbanne, Hôpital La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Pierre Philouze
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital La Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yahia Mekki
- Laboratoire de Virologie, Institut des Agents Infectieux, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, Lyon, France
| | - Jonathan Lopez
- Biochemistry and Molecular Biology Department, Hospital Lyon-Sud, Université Lyon I, Lyon, Pierre-Bénite, France
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Institut de Pathologie Multisite, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Université Lyon 1, Villeurbanne, Hôpital La Croix Rousse, Hospices Civils de Lyon, Lyon, France
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24
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Mulder FJ, Klufah F, Janssen FME, Farshadpour F, Willems SM, de Bree R, zur Hausen A, van den Hout MFCM, Kremer B, Speel EJM. Presence of Human Papillomavirus and Epstein-Barr Virus, but Absence of Merkel Cell Polyomavirus, in Head and Neck Cancer of Non-Smokers and Non-Drinkers. Front Oncol 2021; 10:560434. [PMID: 33552950 PMCID: PMC7855709 DOI: 10.3389/fonc.2020.560434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Determine the presence and prognostic value of human papillomavirus (HPV), Epstein-Barr virus (EBV), Merkel cell polyomavirus (MCPyV), and cell cycle proteins in head and neck squamous cell carcinoma (HNSCC) of non-smokers and non-drinkers (NSND). METHODS Clinical characteristics and tumors of 119 NSND with HNSCC were retrospectively collected and analyzed on tissue microarrays. RNAscope in situ hybridization (ISH) was used to screen for the presence of HPV and MCPyV mRNA. Immunohistochemistry was performed for expression of p16 as surrogate marker for HPV, Large T-antigen for MCPyV, and cell cycle proteins p53 and pRb. Positive virus results were confirmed with polymerase chain reaction. For EBV, EBV encoded RNA ISH was performed. Differences in 5-year survival between virus positive and negative tumors were determined by log rank analysis. RESULTS All oropharyngeal tumors (OPSCC) (n = 10) were HPV-positive, in addition to one oral (OSCC) and one nasopharyngeal tumor (NPSCC). The other three NPSCC were EBV-positive. MCPyV was not detected. Patients with HPV or EBV positive tumors did not have a significantly better 5-year disease free or overall survival. Over 70% of virus negative OSCC showed mutant-type p53 expression. CONCLUSION In this cohort, all OPSCC and NPSCC showed HPV or EBV presence. Besides one OSCC, all other oral (n = 94), hypopharyngeal (n = 1), and laryngeal (n = 9) tumors were HPV, EBV, and MCPyV negative. This argues against a central role of these viruses in the ethiopathogenesis of tumors outside the oro- and nasopharynx in NSND. So, for the majority of NSND with virus negative OSCC, more research is needed to understand the carcinogenic mechanisms in order to consider targeted therapeutic options.
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Affiliation(s)
- Frans J. Mulder
- Department of Otorhinolaryngology and Head & Neck Surgery, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Faisal Klufah
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Albaha University, Albaha, Saudi Arabia
| | - Famke M. E. Janssen
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Stefan M. Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Pathology, University Medical Center Groningen, Groningen, Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Axel zur Hausen
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Mari F. C. M. van den Hout
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology and Head & Neck Surgery, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Ernst-Jan M. Speel
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
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25
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Culié D, Schiappa R, Modesto A, Viotti J, Chamorey E, Dassonville O, Poissonnet G, Bizeau A, Vergez S, Dupret-Bories A, Fakhry N, Santini L, Lallemant B, Chambon G, Sudaka A, Peyrade F, Saada-Bouzid E, Benezery K, Jourdan-Soulier F, Chapel F, Ramay AS, Roger P, Galissier T, Coste V, Ben Lakdar A, Guerlain J, Mirghani H, Gorphe P, Guelfucci B, Garrel R, Temam S, Bozec A. Upfront surgery or definitive radiotherapy for p16+ oropharyngeal cancer. A GETTEC multicentric study. Eur J Surg Oncol 2021; 47:1389-1397. [PMID: 33390333 DOI: 10.1016/j.ejso.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the impact of the initial therapeutic strategy on oncologic outcomes in patients with HPV-positive OPSCC. METHODS All p16-positive OPSCCs treated from 2009 to 2014 in 7 centers were retrospectively included and classified according to the therapeutic strategy: surgical strategy (surgery ± adjuvant radiotherapy and chemotherapy) vs. non-surgical strategy (definitive radiotherapy ± chemotherapy). Univariate, multivariate propensity score matching analyses were performed to compare overall (OS), disease-specific (DSS) and recurrence-free survival (RFS). RESULTS 382 patients were included (surgical group: 144; non-surgical group: 238). Five-year OS, DSS and RFS were 89.2, 96.8 and 83.9% in the surgical group and 84.2, 87.1 and 70.4% in the non-surgical group, respectively. These differences were statistically significant for DSS and RFS after multivariate analysis, but only for RFS after propensity score matching analysis. CONCLUSION In p16+ OPSCC patients, upfront surgery results in higher RFS than definitive radiotherapy ± chemotherapy but does not impact OS.
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Affiliation(s)
- Dorian Culié
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France.
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Anouchka Modesto
- Department of Radiotherapy, Cancer University Institute of Toulouse, Toulouse, France
| | - Julien Viotti
- Department of Statistics, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Emmanuel Chamorey
- Department of Statistics, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Olivier Dassonville
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Gilles Poissonnet
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Alain Bizeau
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Agnes Dupret-Bories
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Laure Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Guillaume Chambon
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Anne Sudaka
- Department of Pathology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Frederic Peyrade
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
| | | | | | - Anne Sophie Ramay
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Pascal Roger
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Thibault Galissier
- Department of Pathology, Cancer University Institute of Toulouse, Toulouse, France
| | - Valérie Coste
- Department of Pathology, University Hospital of Montpellier, Montpellier, France
| | - Aicha Ben Lakdar
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - Joanne Guerlain
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Haitham Mirghani
- Department of Otorhinolaryngology and Head and Neck Surgery, European Hospital Georges Pompidou, Paris, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Alexandre Bozec
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte D'Azur University, Nice, France
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26
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Tagliabue M, Mena M, Maffini F, Gheit T, Quirós Blasco B, Holzinger D, Tous S, Scelsi D, Riva D, Grosso E, Chu F, Lucas E, Ridder R, Rrehm S, Bogers JP, Lepanto D, Lloveras Rubio B, Vijay Kumar R, Gangane N, Clavero O, Pawlita M, Anantharaman D, Radhakrishna Pillai M, Brennan P, Sankaranarayanan R, Arbyn M, Lombardi F, Taberna M, Gandini S, Chiesa F, Ansarin M, Alemany L, Tommasino M, Chiocca S. Role of Human Papillomavirus Infection in Head and Neck Cancer in Italy: The HPV-AHEAD Study. Cancers (Basel) 2020; 12:E3567. [PMID: 33260360 PMCID: PMC7760748 DOI: 10.3390/cancers12123567] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023] Open
Abstract
Literature on the role of human papillomavirus (HPV) in head and neck cancer (HNC) in Italy is limited, especially for non-oropharyngeal tumours. Within the context of the HPV-AHEAD study, we aimed to assess the prognostic value of different tests or test algorithms judging HPV carcinogenicity in HNC and factors related to HPV positivity at the European Institute of Oncology. We conducted a retrospective cohort study (2000-2010) on a total of 696 primary HNC patients. Formalin-fixed, paraffin-embedded cancer tissues were studied. All HPV-DNA-positive and a random sample of HPV-DNA-negative cases were subjected to HPV-E6*I mRNA detection and p16INK4a staining. Multivariate models were used to assess for factors associated with HPV positivity and proportional hazards for survival and recurrence. The percentage of HPV-driven cases (considering HPV-E6*I mRNA positivity) was 1.8, 2.2, and 40.4% for oral cavity (OC), laryngeal (LC), and oropharyngeal (OPC) cases, respectively. The estimates were similar for HPV-DNA/p16INK4a double positivity. Being a non-smoker or former smoker or diagnosed at more recent calendar periods were associated with HPV-E6*I mRNA positivity only in OPC. Being younger was associated with HPV-E6*I mRNA positivity in LC. HPV-driven OPC, but not HPV-driven OC and LC, showed better 5 year overall and disease-free survival. Our data show that HPV prevalence in OPC was much higher than in OC and LC and observed to increase in most recent years. Moreover, HPV positivity conferred better prognosis only in OPC. Novel insights on the role of HPV in HNC in Italy are provided, with possible implications in the clinical management of these patients.
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Affiliation(s)
- Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.T.); (D.S.); (D.R.); (E.G.); (F.C.); (F.C.); (M.A.)
| | - Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology-Bellvitge Biomedical Research Institute (ICO-IDIBELL), L’Hospitalet de Llobregat, 08908 Barcenola, Spain; (M.M.); (B.Q.B.); (S.T.); (O.C.); (L.A.)
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Fausto Maffini
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (F.M.); (D.L.)
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer (IARC), 69372 Lyon, France; (T.G.); (E.L.)
| | - Beatriz Quirós Blasco
- Cancer Epidemiology Research Program, Catalan Institute of Oncology-Bellvitge Biomedical Research Institute (ICO-IDIBELL), L’Hospitalet de Llobregat, 08908 Barcenola, Spain; (M.M.); (B.Q.B.); (S.T.); (O.C.); (L.A.)
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Dana Holzinger
- Deutsches Krebsforschungszentrum (DKFZ), 69120 Heidelberg, Germany; (D.H.); (M.P.)
| | - Sara Tous
- Cancer Epidemiology Research Program, Catalan Institute of Oncology-Bellvitge Biomedical Research Institute (ICO-IDIBELL), L’Hospitalet de Llobregat, 08908 Barcenola, Spain; (M.M.); (B.Q.B.); (S.T.); (O.C.); (L.A.)
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Daniele Scelsi
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.T.); (D.S.); (D.R.); (E.G.); (F.C.); (F.C.); (M.A.)
| | - Debora Riva
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.T.); (D.S.); (D.R.); (E.G.); (F.C.); (F.C.); (M.A.)
| | - Enrica Grosso
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.T.); (D.S.); (D.R.); (E.G.); (F.C.); (F.C.); (M.A.)
| | - Francesco Chu
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.T.); (D.S.); (D.R.); (E.G.); (F.C.); (F.C.); (M.A.)
| | - Eric Lucas
- Infections and Cancer Biology Group, International Agency for Research on Cancer (IARC), 69372 Lyon, France; (T.G.); (E.L.)
| | - Ruediger Ridder
- Roche mtm laboratories, 69117 Mannheim, Germany; (R.R.); (S.R.)
- Ventana Medical Systems Inc./Roche Tissue Diagnostics, Tucson, AZ 85755, USA
| | - Susanne Rrehm
- Roche mtm laboratories, 69117 Mannheim, Germany; (R.R.); (S.R.)
| | - Johannes Paul Bogers
- Laboratory for Cell Biology and Histology, University of Antwerp, 2610 Antwerp, Belgium;
| | - Daniela Lepanto
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (F.M.); (D.L.)
| | | | - Rekha Vijay Kumar
- Kidwai Memorial Institute of Oncology, Bangalore, Karnataka 560029, India;
| | - Nitin Gangane
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra State 442102, India;
| | - Omar Clavero
- Cancer Epidemiology Research Program, Catalan Institute of Oncology-Bellvitge Biomedical Research Institute (ICO-IDIBELL), L’Hospitalet de Llobregat, 08908 Barcenola, Spain; (M.M.); (B.Q.B.); (S.T.); (O.C.); (L.A.)
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Michael Pawlita
- Deutsches Krebsforschungszentrum (DKFZ), 69120 Heidelberg, Germany; (D.H.); (M.P.)
| | - Devasena Anantharaman
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram, Kerala 695012, India; (D.A.); (M.R.P.)
| | | | - Paul Brennan
- Section of Genetics, International Agency for Research on Cancer (IARC), 69372 Lyon, France;
| | | | - Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Sciensano, 1050 Brussels, Belgium;
| | - Francesca Lombardi
- Data Management, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Miren Taberna
- Medical Oncology Department, Catalan Institute of Oncology (ICO), ONCOBELL, IDIBELL, L’Hospitalet de Llobregat, 08035 Barcelona, Spain;
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Fausto Chiesa
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.T.); (D.S.); (D.R.); (E.G.); (F.C.); (F.C.); (M.A.)
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (M.T.); (D.S.); (D.R.); (E.G.); (F.C.); (F.C.); (M.A.)
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology-Bellvitge Biomedical Research Institute (ICO-IDIBELL), L’Hospitalet de Llobregat, 08908 Barcenola, Spain; (M.M.); (B.Q.B.); (S.T.); (O.C.); (L.A.)
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer (IARC), 69372 Lyon, France; (T.G.); (E.L.)
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy;
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27
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Menegaldo A, Schroeder L, Holzinger D, Tirelli G, Dal Cin E, Tofanelli M, Rigo S, Mantovani M, Stellin M, Del Mistro A, Dei Tos AP, Guerriero A, Niero M, Borsetto D, Da Mosto MC, Polesel J, Pawlita M, Waterboer T, Boscolo-Rizzo P. Detection of HPV16/18 E6 Oncoproteins in Head and Neck Squamous Cell Carcinoma Using a Protein Immunochromatographic Assay. Laryngoscope 2020; 131:1042-1048. [PMID: 33103777 DOI: 10.1002/lary.29184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/24/2020] [Accepted: 09/25/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES/HYPOTHESIS The accurate diagnostic assessment of clinically relevant human papillomavirus (HPV) infections in patients with head and neck squamous cell carcinoma represents an urgent unmet medical need. The aim of this study was to determine feasibility, accuracy, and clinical significance of HPV16/18 E6 oncoprotein detection on cytological specimens from oropharyngeal squamous cell carcinoma (OPSCC) and neck lymph node metastasis of SCC from unknown primary tumor (CUP) via a protein immunochromatographic assay. STUDY DESIGN Cross-sectional study. METHODS Cytological specimens from primary tumor and neck metastases were collected from 34 patients with OPSCC or CUP and applied to a lateral flow format test that detects HPV16 and HPV18 E6 oncoproteins. E6 oncoprotein positivity or negativity in these specimens was compared to the specimens' "HPV-driven" reference status, defined by presence of HPV-DNA in combination with p16INK4a overexpression and/or HPV E6 seropositivity. RESULTS Eighteen of 29 OPSCC (62%) and three of five CUP (60%) were HPV-driven according to our reference method. The E6 oncoprotein lateral flow test had a sensitivity of 94% (95% CI: 70%-100%) and a specificity of 100% (95% CI: 66%-100%) on primary tumor, and a sensitivity of 88% (95% CI: 64%-99%) and a specificity of 100% (95% CI: 74%-100%) on neck metastases. Test agreement between the E6 lateral flow test and the clinical reference method, HPV-DNA plus p16INK4a was excellent, both for primary lesion and neck metastases. CONCLUSIONS We found the detection of HPV16/18 E6 oncoproteins to be a feasible, highly reliable, and low-invasive method to assess "HPV-driven" status in OPSCC and CUP. LEVEL OF EVIDENCE II Laryngoscope, 131:1042-1048, 2021.
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Affiliation(s)
- Anna Menegaldo
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Lea Schroeder
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dana Holzinger
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Elisa Dal Cin
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Margherita Tofanelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Stefania Rigo
- Department of Otorhinolaryngology and Head and Neck Surgery, Azienda Sanitaria Universitaria Integrata di Trieste-ASUITS, Trieste, Italy
| | - Monica Mantovani
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Marco Stellin
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Annarosa Del Mistro
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | | | | | - Monia Niero
- Department of Pathology, University of Padova, Treviso, Italy
| | | | - Maria C Da Mosto
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Michael Pawlita
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padova, Treviso, Italy
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Mariz BALA, Kowalski LP, William WN, de Castro G, Chaves ALF, Santos M, de Oliveira TB, Araújo ALD, Normando AGC, Ribeiro ACP, Brandão TB, Vargas PA, Lopes MA, Santos-Silva AR. Global prevalence of human papillomavirus-driven oropharyngeal squamous cell carcinoma following the ASCO guidelines: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2020; 156:103116. [PMID: 33115701 DOI: 10.1016/j.critrevonc.2020.103116] [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: 02/19/2020] [Revised: 06/24/2020] [Accepted: 09/25/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES to provide accurate information about the global prevalence of human papillomavirus (HPV) in oropharyngeal squamous cell carcinomas (OPSCC). MATERIAL AND METHODS a systematic review was performed using three main electronic databases. Studies were independently assessed by two reviewers based on established eligibility criteria, to identify the prevalence of HPV-driven OPSCC following criteria defined by the American Society of Clinical Oncology. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Statistical software MedCalc was used to perform meta-analyses. RESULTS from 2215 records found, 15 were included, reporting data from 6009 patients (time period range: 1980-2016), distributed in 11 countries. Eleven studies were considered as presenting low risk, and four as moderate risk of bias. Using proportion meta-analysis, pooled prevalence of HPV-driven OPSCC was 44.8 % (95 %CI: 36.4-53.5 %; i2 = 97.6 %), with the highest rates in New Zealand (74.5 %; 95 %CI: 60.9-85.3 %), and the lowest in Brazil (11.1 %; 95 %CI: 4.5-21.5 %). HPV prevalence was similar between males (45.7 %; 95 %CI: 36.5-55.0 %; i2 = 96.4 %) and females (42.2 %; 95 %CI: 34.3-50.5 %; i2 = 85.4 %). Mean/median age ranged from 59.1-67.1 years in the HPV-negative group, and from 55.7-63.5 years in the HPV-positive group. There was an overall discordance between testing by p16 (49.4 %; 95 %CI, 38.2-60.5 %; i2 = 96.2 %) and p16+ISH/PCR (44.7 %; 95 %CI, 33.5-56.2 %; i2 = 96.4 %). CONCLUSION Overall pooled prevalence of HPV-driven OPSCC was approximately 45 %, with similar distribution among males and females. Double p16/HPV-DNA/RNA testing may be considered to increase specificity and prognostic accuracy.
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Affiliation(s)
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, AC Camargo Cancer Center and Department of Head and Neck Surgery, University of Sao Paulo Medical School, São Paulo, Brazil
| | | | - Gilberto de Castro
- Department of Clinical Oncology, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil
| | | | - Marcos Santos
- UNESCO Chair of Bioethics, Brasília University, Brasília, DF, Brazil
| | | | - Anna Luiza Damaceno Araújo
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | | | - Ana Carolina Prado Ribeiro
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil; Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil
| | - Thaís Bianca Brandão
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), São Paulo, Brazil; Oral Medicine Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
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Mulder FJ, Pierssens DDCG, Baijens LWJ, Kremer B, Speel EJM. Evidence for different molecular parameters in head and neck squamous cell carcinoma of nonsmokers and nondrinkers: Systematic review and meta-analysis on HPV, p16, and TP53. Head Neck 2020; 43:303-322. [PMID: 33098216 PMCID: PMC7756438 DOI: 10.1002/hed.26513] [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: 07/21/2020] [Revised: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The goal of this review was to present an overview of the currently identified molecular parameters in head and neck squamous cell carcinoma (HNSCC) of nonsmokers and nondrinkers (NSND). METHODS Following the PRISMA guidelines, a systematic search was performed using the electronic databases PubMed, Embase, and Google Scholar. RESULTS Of the 902 analyzed unique studies, 74 were included in a quantitative synthesis and 24 in a meta-analysis. Human papillomavirus (HPV) was reported as a molecular parameter in 38 studies, followed by p16 and TP53 (23 and 14 studies, respectively). The variety of other molecular parameters concerned sporadic findings in small numbers of NSND. CONCLUSIONS HNSCC in NSND is more often related to HPV and p16 overexpression compared to tumors of smokers-drinkers. In a third of virus-negative tumors, TP53 mutations were detected with a mutational profile associated with aging and ultraviolet light exposure rather than to tobacco consumption.
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Affiliation(s)
- Frans J Mulder
- Department of Otorhinolaryngology and Head & Neck Surgery, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Damiana D C G Pierssens
- Department of Oral and Cranio-Maxillofacial Surgery, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Laura W J Baijens
- Department of Otorhinolaryngology and Head & Neck Surgery, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology and Head & Neck Surgery, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Ernst-Jan M Speel
- Department of Pathology, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
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Evolving Profile of HPV-Driven Oropharyngeal Squamous Cell Carcinoma in a National Cancer Institute in Italy: A 10-Year Retrospective Study. Microorganisms 2020; 8:microorganisms8101498. [PMID: 33003378 PMCID: PMC7599861 DOI: 10.3390/microorganisms8101498] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 11/17/2022] Open
Abstract
Globally, 30% of oropharyngeal carcinomas (OPSCC) are caused by Human Papillomavirus (HPV). Recently, increasing incidence trends for HPV-driven OPSCC have been reported in many countries and changes in the typical HPV-positive OPSCC patient have been recorded, with an increase in the median age and diagnoses in women. We investigated the characteristics of the OPSCC patients attending an Italian Cancer Institute from 2010 to 2019 and assessed possible changes overtime of demographic, behavioral, and clinico-pathologic variables of HPV-driven OPSCC. Overall, 339 OPSCCs were evaluated. HPV-DNA and p16 positivity were 48.7% and 55.2%, respectively, with an HPV-driven fraction (i.e., HPV-DNA+/p16+) of 48.3%. We observed a significant increase overtime in the rate of HPV-associated cases (53.7% in 2015–2019 vs. 40.3% in 2010–2014, p = 0.019). The rate of HPV-driven cases was significantly higher among women, never smokers, patients with T1–T2 tumors, and with nodal involvement. A trend was also observed toward an increase in HPV-driven OPSCCs among patients >61 years, women, former smokers, and patients with no nodal involvement in 2015–2019. Our findings consolidate the observation that HPV-associated OPSCCs are also increasing in Italy. Moreover, they suggest that the profile of the HPV-driven OPSCC patient might be changing.
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Culié D, Viotti J, Modesto A, Schiappa R, Chamorey E, Dassonville O, Poissonnet G, Guelfucci B, Bizeau A, Vergez S, Dupret-Bories A, Garrel R, Fakhry N, Santini L, Lallemant B, Chambon G, Sudaka A, Peyrade F, Saada-Bouzid E, Benezery K, Jourdan-Soulier F, Chapel F, Ramay AS, Roger P, Galissier T, Coste V, Ben Lakdar A, Guerlain J, Temam S, Mirghani H, Gorphe P, Bozec A. Upfront surgery or definitive radiotherapy for patients with p16-negative oropharyngeal squamous cell carcinoma. A GETTEC multicentric study. Eur J Surg Oncol 2020; 47:367-374. [PMID: 33004271 DOI: 10.1016/j.ejso.2020.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Therapeutic management of oropharyngeal squamous cell carcinomas (OPSCC) is still debated. Since the role of HPV was demonstrated, few studies have focused on HPV-negative OPSCC. The aim of our study was to assess the impact of therapeutic strategy (surgical vs. non-surgical) on oncologic outcomes in patients with HPV-negative OPSCC. MATERIAL AND METHOD All p16-negative OPSCCs treated from 2009 to 2014 in 7 tertiary-care centers were included in this retrospective study and were classified according to the therapeutic strategy: surgical strategy (surgery ± adjuvant radiotherapy and chemotherapy) vs. non-surgical strategy (definitive radiotherapy ± chemotherapy). Patients not eligible for surgery (unresectable tumor, poor general-health status) were excluded. Univariate, multivariate and propensity score matching analyses were performed to compare overall (OS), disease-specific (DSS) and recurrence-free survival (RFS). RESULTS Four hundred seventy-four (474) patients were included in the study (surgical group: 196; non-surgical group: 278). Five-year OS, DSS and RFS were 76.5, 81.3 and 61.3%, respectively, in the surgical group and 49.9, 61.8 and 43.4%, respectively, in the non-surgical group. The favorable impact of primary surgical treatment on oncologic outcomes was statistically significant after multivariate analysis. This effect was more marked for locally-advanced than for early-stage tumors. Propensity score matching analysis confirmed the prognostic impact of primary surgical treatment for RFS. CONCLUSION Therapeutic strategy is an independent prognostic factor in patients with p16-negative OPSCC and primary surgical treatment is associated with improved OS, DSS and RFS. These results suggest that surgical strategy is a reliable option for advanced stage OPSCC.
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Affiliation(s)
- Dorian Culié
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France.
| | - Julien Viotti
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Anouchka Modesto
- Department of Radiotherapy, Cancer University Institute of Toulouse, Toulouse, France
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Emmanuel Chamorey
- Department of Statistics, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Olivier Dassonville
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Gilles Poissonnet
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Alain Bizeau
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Agnes Dupret-Bories
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, Toulouse, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Laure Santini
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance - Hospitals of Marseille, Marseille, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Guillaume Chambon
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, Nîmes, France
| | - Anne Sudaka
- Department of Pathology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Frederic Peyrade
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
| | | | | | - Anne Sophie Ramay
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Pascal Roger
- Department of Pathology, University Hospital of Nîmes, Nîmes, France
| | - Thibault Galissier
- Department of Pathology, Cancer University Institute of Toulouse, Toulouse, France
| | - Valérie Coste
- Department of Pathology, University Hospital of Montpellier, Montpellier, France
| | - Aicha Ben Lakdar
- Department of Pathology, Gustave Roussy Institute, Villejuif, France
| | - Joanne Guerlain
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Haitham Mirghani
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, Villejuif, France
| | - Alexandre Bozec
- University Institute of the Face and Neck, Antoine Lacassagne Centre, Côte d'Azur University, Nice, France
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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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HPV-Induced Oropharyngeal Cancer and the Role of the E7 Oncoprotein Detection via Brush Test. Cancers (Basel) 2020; 12:cancers12092388. [PMID: 32842554 PMCID: PMC7563171 DOI: 10.3390/cancers12092388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/08/2020] [Accepted: 08/21/2020] [Indexed: 12/27/2022] Open
Abstract
Background: High risk human papillomavirus (hr-HPV)-associated oropharyngeal cancers (OPCs) are characterized by significantly better therapy responses. In order to implement a de-escalated treatment strategy for this tumor entity, it is highly crucial to accurately distinguish HPV-associated OPCs from non-HPV-associated ones. Methods: In this prospective study, 56 patients with histologically confirmed OPC were evaluated. A commercially available sandwich ELISA test system was used for the detection of hr-HPV E7 oncoprotein targeting the genotypes 16, 18 and 45. Results were presented as optical density. Positivity for HPV DNA and p16 immunohistochemistry (IHC) was taken as the reference method. Results: E7 positivity was significantly associated with the reference method (p = 0.048). The sensitivity, specificity, positive predictive value and negative predictive value for the E7 oncoptotein was 60.9% (95% CI 38.5 to 80.3%), 66.7% (95% CI 46% to 83.5%), 64.2% (95% CI 49.4 to 77.4%) and 63.01% (95% CI 48.9–75.2%), respectively, for the cutoff provided by the manufacturer. Conclusions: We found a significant association between E7 oncoprotein detection and the currently used combination. We believe that the use of the ELISA based E7 antigen test could be a valuable addition in cases of ambiguous findings and may be used in combination with other techniques to distinguish between HPV-driven and non-HPV-driven OPCs. However, the low sensitivity of the assay coupled with the small sample size in our study may represent a limitation. We recommend that future larger studies elucidate the diagnostic value of the E7 brush test.
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Epidemiology of human papillomavirus-related oropharyngeal cancer in a classically low-burden region of southern Europe. Sci Rep 2020; 10:13219. [PMID: 32764593 PMCID: PMC7411067 DOI: 10.1038/s41598-020-70118-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/21/2020] [Indexed: 01/22/2023] Open
Abstract
The incidence of human papillomavirus (HPV)-related oropharyngeal cancer is increasing in some regions. Nevertheless, the epidemiology of this disease has not been extensively investigated in southern Europe. We conducted a retrospective cohort study of patients diagnosed with primary oropharyngeal cancer from 1991 to 2016. Cancer tissues underwent histopathological evaluation, DNA quality control, HPV-DNA detection and p16INK4a immunohistochemistry. Data were collected from medical records. Factors associated with HPV positivity and time trends were evaluated with multivariable Bayesian models. The adjusted prevalence of HPV-related cases in 864 patients with a valid HPV-DNA result was 9.7%, with HPV-DNA/p16INK4a double positivity being considered. HPV-related oropharyngeal cancer was likely to occur in non-smokers and non-drinkers, to be located in the tonsil or diagnosed at advanced stages. Time-trend analysis showed an increasing risk of HPV-related oropharyngeal cancer in the most recent periods (5-year period increase of 30%). This increase was highest and with a clear increasing trend only in the most recent years (2012–2016). The prevalence of HPV-related oropharyngeal cancer started to sharply increase in the most recent years in our setting, as occurred two decades ago in areas where most oropharyngeal cancer cases are currently HPV-related. Our results provide a comprehensive assessment of the epidemiological landscape of HPV-related oropharyngeal cancer in a region of southern Europe.
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Dickinson A, Saraswat M, Syrjänen S, Tohmola T, Silén R, Randén-Brady R, Carpén T, Hagström J, Haglund C, Mattila P, Mäkitie A, Joenväärä S, Silén S. Comparing serum protein levels can aid in differentiating HPV-negative and -positive oropharyngeal squamous cell carcinoma patients. PLoS One 2020; 15:e0233974. [PMID: 32542012 PMCID: PMC7295232 DOI: 10.1371/journal.pone.0233974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The surrogate immunohistochemical marker, p16INK4a, is used in clinical practice to determine the high-risk human papillomavirus (HPV) status of oropharyngeal squamous cell carcinomas (OPSCC). With a specificity of 83%, this will misclassify some patients compared with direct HPV testing. Patients who are p16INK4a-positive but HPV DNA-negative, or RNA-negative, may be unsuitable for treatment de-escalation aimed at reducing treatment-related side effects. We aimed to identify cost-effective serum markers to improve decision making for patients at risk of misclassification by p16INK4a alone. METHODS Serum proteins from pre-treatment samples of 36 patients with OPSCC were identified and quantified using label-free mass spectrometry-based proteomics. HPV-status was determined using p16INK4a/HPV DNA and E6/E7 mRNA. Serum protein expressions were compared between groups of patients according to HPV status, using the unpaired t-test with a Benjamini-Hochberg correction. ROC curves (AUC) were calculated with SPSS (v25). RESULTS Of 174 serum proteins identified, complement component C7 (C7), apolipoprotein F (ApoF) and galectin-3-Binding Protein (LGALS3BP) significantly differed between HPV-positive and -negative tumors (AUC ranging from 0.84-0.87). ApoF levels were more than twice as high in the E6/E7 mRNA HPV-positive group than HPV-negative. CONCLUSIONS Serum C7, ApoF and LGALS3BP levels discriminate between HPV-positive and HPV-negative OPSCC. Further studies are needed to validate these host immunity-related proteins as markers for HPV-associated OPSCC.
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Affiliation(s)
- Amy Dickinson
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Mayank Saraswat
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
- HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Stina Syrjänen
- Department of Oral Pathology and Oral Radiology, University of Turku, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Tiialotta Tohmola
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Robert Silén
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Reija Randén-Brady
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Carpén
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagström
- Department of Oral Pathology and Oral Radiology, University of Turku, Turku, Finland
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Surgery, University of Helsinki and Helsinki, University Hospital Helsinki, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki and Helsinki, University Hospital Helsinki, Helsinki, Finland
- Research Programs Unit, Translational Cancer Medicine, University of Helsinki, Helsinki, Finland
| | - Petri Mattila
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Sakari Joenväärä
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
- HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Suvi Silén
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
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Del Mistro A, Frayle H, Menegaldo A, Favaretto N, Gori S, Nicolai P, Spinato G, Romeo S, Tirelli G, da Mosto MC, Polesel J, Boscolo Rizzo P. Age-independent increasing prevalence of Human Papillomavirus-driven oropharyngeal carcinomas in North-East Italy. Sci Rep 2020; 10:9320. [PMID: 32518378 PMCID: PMC7283341 DOI: 10.1038/s41598-020-66323-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/13/2020] [Indexed: 01/16/2023] Open
Abstract
HPV-driven oropharyngeal carcinomas (OPCs) show geographical variations with increasing temporal trends in several areas. We investigated their frequency and clinical outcomes within a prospective multicenter cohort study in North-East Italy. A tumor was defined as HPV-driven by using at least two different biomarkers, usually HPV-DNA positivity and p16INK4A overexpression. Different survival outcomes were compared among patients with HPV-driven and non-HPV-driven tumors. Overall, 42/130 (32.3%) patients with newly diagnosed OPC during the period 2000–2018 resulted HPV-driven; HPV16 was involved in 37 cases (88%), HPV33 in 3 cases (7%), HPV58 and HPV18 in 1 case each. Over time, HPV-driven cases raised from 16.7% (6/36) during 2000–2006 to 46.1% (24/52) during 2013–2018 (p < 0.001). The increase in HPV-driven OPCs was more marked in females than males (p = 0.010), and the frequency of HPV-driven cases was similar in the different age groups. In comparison to cases with non-HPV-driven tumors, a significantly (p < 0.001) better progression-free and overall survival were recorded among patients affected by HPV-driven OPC. The prevalence of HPV-driven OPC cases has been significantly increasing during the last two decades also in North-East Italy and was associated with favorable outcome. OPCs driven by non-HPV16 oncogenic types were restricted to patients older than 68-yrs.
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Affiliation(s)
- Annarosa Del Mistro
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Via Gattamelata, 64, 35128, Padova, Italy.
| | - Helena Frayle
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Via Gattamelata, 64, 35128, Padova, Italy
| | - Anna Menegaldo
- Department of Neurosciences DNS, Section of Otolaryngology, University of Padova, P.le Ospedale 1, 31100, Treviso, Italy
| | - Niccolò Favaretto
- Department of Neurosciences DNS, Section of Otolaryngology, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Silvia Gori
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Via Gattamelata, 64, 35128, Padova, Italy
| | - Piero Nicolai
- Department of Neurosciences DNS, Section of Otolaryngology, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Giacomo Spinato
- Department of Neurosciences DNS, Section of Otolaryngology, University of Padova, P.le Ospedale 1, 31100, Treviso, Italy.,Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, University of Padova, Via Gattamelata, 64, 35128, Padova, Italy
| | - Salvatore Romeo
- Anatomical Pathology Unit, San Donà di Piave Hospital, Azienda ULSS 4 Veneto Orientale, Via Nazario Sauro 25, 30027, San Donà di Piave, VE, Italy
| | - Giancarlo Tirelli
- Head and Neck Department, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Maria Cristina da Mosto
- Department of Neurosciences DNS, Section of Otolaryngology, University of Padova, P.le Ospedale 1, 31100, Treviso, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Aviano National Cancer Institute, IRCCS, Via Franco Gallini, 2, 33081, Aviano, PN, Italy
| | - Paolo Boscolo Rizzo
- Department of Neurosciences DNS, Section of Otolaryngology, University of Padova, P.le Ospedale 1, 31100, Treviso, Italy
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The emergence of long-term survivors in recurrent and metastatic squamous cell head and neck cancer. Curr Opin Oncol 2020; 31:160-168. [PMID: 30844888 DOI: 10.1097/cco.0000000000000530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW The systemic therapies available in recurrent and metastatic head and neck squamous cell carcinoma to date are palliative-intent treatments in most cases. However, a small subgroup of patients derives unconventional benefit and become long-term survivors, achieving cure in some cases. This review focusses on this group of patients, discusses recent literature and suggests plausible molecular hypothesis. RECENT FINDINGS Human papillomavirus-related disease is known to confer a better prognosis in metastatic patients, probably because of its greater sensitivity to systemic therapies. This group of patients seems to have a greater immune activation, which could partly explain this fact. Moreover, the use of antiepidermal growth factor receptor therapies in the metastatic setting has doubled the prevalence of long-term survivors. One of the most plausible explanations is the immune-modulatory effect of cetuximab mediated by antibody-dependent cell-mediated cytotoxicity.These facts, along with the recent encouraging results of checkpoint inhibitors in this disease, give hope that these therapies will not only improve survival but also increase the prevalence of long-term survivors. SUMMARY Long-term survivors merit our utmost attention as an in-depth study of these patients could help us to better understand the tumour biology and allow us to develop robust biomarkers and effective targeted therapies, which could in turn lead to a true paradigm shift.
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Vidiri A, Gangemi E, Ruberto E, Pasqualoni R, Sciuto R, Sanguineti G, Farneti A, Benevolo M, Rollo F, Sperati F, Spasiano F, Pellini R, Marzi S. Correlation between histogram-based DCE-MRI parameters and 18F-FDG PET values in oropharyngeal squamous cell carcinoma: Evaluation in primary tumors and metastatic nodes. PLoS One 2020; 15:e0229611. [PMID: 32119697 PMCID: PMC7051076 DOI: 10.1371/journal.pone.0229611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/10/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate the correlation between histogram-based Dynamic Contrast-Enhanced magnetic resonance imaging (DCE-MRI) parameters and positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG-PET) values in oropharyngeal squamous cell carcinoma (OPSCC), both in primary tumors (PTs) and in metastatic lymph nodes (LNs). METHODS 52 patients with a new pathologically-confirmed OPSCC were included in the present retrospective cohort study. Imaging including DCE-MRI and 18F-FDG PET/CT scans were acquired in all patients. Both PTs and the largest LN, if present, were volumetrically contoured. Quantitative parameters, including the transfer constants, Ktrans and Kep, and the volume of extravascular extracellular space, ve, were calculated from DCE-MRI. The percentiles (P), P10, P25, P50, P75, P90, and skewness, kurtosis and entropy were obtained from the histogram-based analysis of each perfusion parameter. Standardized uptake values (SUV), SUVmax, SUVpeak, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were calculated applying a SUV threshold of 40%. The correlations between all variables were investigated with the Spearman-rank correlation test. To exclude false positive results under multiple testing, the Benjamini-Hockberg procedure was applied. RESULTS No significant correlations were found between any parameters in PTs, while significant associations emerged between Ktrans and 18F-FDG PET parameters in LNs. CONCLUSIONS Evident relationships emerged between DCE-MRI and 18F-FDG PET parameters in OPSCC LNs, while no association was found in PTs. The complex relationships between perfusion and metabolic biomarkers should be interpreted separately for primary tumors and lymph-nodes. A multiparametric approach to analyze PTs and LNs before treatment is advisable in head and neck squamous cell carcinoma (HNSCC).
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Affiliation(s)
- Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Emma Gangemi
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Departmental Faculty of Medicine and Surgery, Center for Integrated Research, University Campus Bio-Medico of Rome, Rome, Italy
- * E-mail:
| | - Emanuela Ruberto
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rosella Pasqualoni
- Department of Nuclear Medicine, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Rosa Sciuto
- Department of Nuclear Medicine, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Farneti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Benevolo
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Rollo
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Filomena Spasiano
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Raul Pellini
- Department of Otolaryngology & Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simona Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Chen TC, Wu CT, Ko JY, Yang TL, Lou PJ, Wang CP, Chang YL. Clinical characteristics and treatment outcome of oropharyngeal squamous cell carcinoma in an endemic betel quid region. Sci Rep 2020; 10:526. [PMID: 31949181 PMCID: PMC6965138 DOI: 10.1038/s41598-019-57177-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022] Open
Abstract
The clinical characteristics of oropharyngeal squamous cell carcinoma (OPSCC) may be different between endemic and non-endemic regions of betel nut chewing. The impact of combined alcohol drinking/betel quid chewing/cigarette smoking (ABC) exposure on the survival of OPSCC remains unclear. We reviewed the medical records of OPSCC patients between 1999 and 2013. Immunohistochemical staining of p16 and HPV genotype detection by DNA Polymerase chain reaction were both performed for each tumor. A total of 300 eligible patients including 74 HPV+ OPSCC patients and 226 HPV− OPSCC patients were enrolled. The 5-year disease-free survival rates for the HPV−, HPV+ OPSCC with and without ABC patients were 49.8%, 58.4% and 94%, respectively. The 5-year overall survival rates for the patients with HPV−, HPV+ OPSCC with and without ABC patients were 46%, 57.4% and 86%, respectively. Advanced locoregionally disease (T3/T4, N2/N3), HPV- OPSCC, combined 2 or all ABC exposure were the independent adverse prognostic factors for disease-free and overall survival. Therefore, our data suggest that in an endemic region of betel quid chewing, HPV− OPSCC comprises the majority of OPSCC and has a worse survival. Combined 2 or all ABC exposure had a significant negative impact on disease-free and overall survival.
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Affiliation(s)
- Tseng-Cheng Chen
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan.,Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, 10002, Taiwan
| | - Chen-Tu Wu
- Department of Pathology, National Taiwan University Hospital, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei, 10002, Taiwan.,Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, 10002, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan
| | - Cheng-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan.,Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, 10002, Taiwan
| | - Yih-Leong Chang
- Department of Pathology, National Taiwan University Hospital, National Taiwan University Cancer Center and National Taiwan University College of Medicine, Taipei, 10002, Taiwan. .,Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, 10002, Taiwan.
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40
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Viros Porcuna D, Pollan Guisasola C, Viña Soria C, Cirauqui Cirauqui B, Pardo Muñoz L, Collurá F, Mesia Nin R. Transoral robotic surgery for squamous cell carcinoma of the oropharynx in a primarily human papillomavirus-negative patient population. Clin Transl Oncol 2019; 22:1303-1311. [PMID: 31858433 DOI: 10.1007/s12094-019-02256-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/02/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Transoral robotic surgery (TORS) is one of the main treatment options for non-locally advanced primary oropharyngeal cancer in the United States. However, its use is more limited in countries with a low incidence of human papillomavirus (HPV), such as Spain, in patients with advanced disease, and as salvage surgery. To shed light on the use and potential benefit of TORS in Spanish patients, we analyzed the functional and oncologic outcomes of TORS as both primary and salvage surgery in a primarily HPV-negative population which is representative of oropharyngeal squamous cell carcinoma (OPSCC) patients in Spain. MATERIAL AND METHODS This is a retrospective analysis of prospectively collected data on OPSCC patients treated with TORS at our center between February 2017 and February 2019. RESULTS Fifty-four OPSCC patients were included; 79.6% were males and 80.5% were HPV negative. Median age was 62 years. Primary surgery was performed on 73.7% (48.1% stage I-II; 51.9% stage III-IV) and salvage surgery on 25.9% of patients. Positive margin rates were 4.3% for T1-2 and 25.8% for T3-4. None of the stage I-II patients and 27.7% of stage III-IV patients required adjuvant treatment. Reconstructive surgery was performed in 19.2% of all patients. Normal swallowing was achieved in 92.7% of patients at 6 months after surgery. 1- and 2-year survival rates for all patients were 94.5% and 89%, respectively. The overall complication rate was 16.1%. Bleeding occurred in 11.5% of patients. Longer hospitalization time was associated with surgical complications (P = 0.03) and reconstructive surgery (P = 0.03) but not with salvage surgery. CONCLUSION TORS is a safe and effective treatment for HPV-negative T1-2 OPSCC patients. The positive margin rate was worse in T3-4 patients, indicating the need for careful patient selection in this subgroup.
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Affiliation(s)
- D Viros Porcuna
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain.
| | - C Pollan Guisasola
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
| | - C Viña Soria
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
| | - B Cirauqui Cirauqui
- Medical Oncology Department, Institut Català d'Oncologia, Badalona Applied Research Group in Oncology (B-ARGO), Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
| | - L Pardo Muñoz
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
| | - F Collurá
- Otolaryngology Section, Head and Neck Surgery, Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
| | - R Mesia Nin
- Medical Oncology Department, Institut Català d'Oncologia, Badalona Applied Research Group in Oncology (B-ARGO), Hospital Germans Trias i Pujol, Ctra Canyet s/n, 08916, Badalona, Spain
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Vidiri A, Marzi S, Gangemi E, Benevolo M, Rollo F, Farneti A, Marucci L, Spasiano F, Sperati F, Di Giuliano F, Pellini R, Sanguineti G. Intravoxel incoherent motion diffusion-weighted imaging for oropharyngeal squamous cell carcinoma: Correlation with human papillomavirus Status. Eur J Radiol 2019; 119:108640. [DOI: 10.1016/j.ejrad.2019.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/17/2019] [Accepted: 08/11/2019] [Indexed: 01/04/2023]
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Rollo F, Donà MG, Pichi B, Pellini R, Covello R, Benevolo M. Evaluation of the Anyplex II HPV28 Assay in the Detection of Human Papillomavirus in Archival Samples of Oropharyngeal Carcinomas. Arch Pathol Lab Med 2019; 144:620-625. [PMID: 31509455 DOI: 10.5858/arpa.2019-0199-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The improved survival and better response to treatments of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) highlight the need for effective tools in evaluating HPV status on formalin-fixed, paraffin-embedded (FFPE) cancer tissues. To date, there is no agreement regarding the most appropriate method for HPV testing on FFPE materials. OBJECTIVE.— We aimed to investigate the performance of the Anyplex II HPV28 (Anyplex) on FFPE OPSCC tissues and to compare it with 2 other methods for HPV-DNA detection and p16 overexpression. DESIGN.— One hundred sixty FFPE OPSCCs were evaluated, which had already been analyzed with the INNO-LiPA HPV assay, Xpert HPV assay, and p16 immunostaining. RESULTS.— All the samples but 1 provided valid results with the Anyplex, which showed the highest HPV detection rate and a good concordance with all the other methods (κ = 0.75, 95% CI, 0.65-0.85 versus INNO-LiPA; κ = 0.80, 95% CI, 0.70-0.89 versus Xpert; κ = 0.76, 95% CI, 0.65-0.86 versus p16). Moreover, the HPV-driven fraction, based on HPV-DNA and p16 double positivity, was higher with Anyplex (83 of 159, 52.2%) than with the other 2 assays, that is, 78 of 156 (50.0%) for INNO-LiPA and 80 of 160 (50.0%) for Xpert. CONCLUSIONS.— Anyplex II HPV28 showed a higher HPV detection rate and HPV-associated fraction than the other methods used. This assay is suitable for HPV detection in archival OPSCC tissues.
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Affiliation(s)
- Francesca Rollo
- From the Departments of Pathology (Drs Rollo, Covello, and Benevolo) and Otolaryngology Head Neck Surgery (Drs Pichi and Pellini), Regina Elena National Cancer Institute IRCCS, Rome, Italy; and STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Rome, Italy (Dr Donà)
| | - Maria Gabriella Donà
- From the Departments of Pathology (Drs Rollo, Covello, and Benevolo) and Otolaryngology Head Neck Surgery (Drs Pichi and Pellini), Regina Elena National Cancer Institute IRCCS, Rome, Italy; and STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Rome, Italy (Dr Donà)
| | - Barbara Pichi
- From the Departments of Pathology (Drs Rollo, Covello, and Benevolo) and Otolaryngology Head Neck Surgery (Drs Pichi and Pellini), Regina Elena National Cancer Institute IRCCS, Rome, Italy; and STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Rome, Italy (Dr Donà)
| | - Raul Pellini
- From the Departments of Pathology (Drs Rollo, Covello, and Benevolo) and Otolaryngology Head Neck Surgery (Drs Pichi and Pellini), Regina Elena National Cancer Institute IRCCS, Rome, Italy; and STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Rome, Italy (Dr Donà)
| | - Renato Covello
- From the Departments of Pathology (Drs Rollo, Covello, and Benevolo) and Otolaryngology Head Neck Surgery (Drs Pichi and Pellini), Regina Elena National Cancer Institute IRCCS, Rome, Italy; and STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Rome, Italy (Dr Donà)
| | - Maria Benevolo
- From the Departments of Pathology (Drs Rollo, Covello, and Benevolo) and Otolaryngology Head Neck Surgery (Drs Pichi and Pellini), Regina Elena National Cancer Institute IRCCS, Rome, Italy; and STI/HIV Unit, San Gallicano Dermatologic Institute IRCCS, Rome, Italy (Dr Donà)
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Prevalence of Human Papillomavirus (HPV) Infection and the Association with Survival in Saudi Patients with Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2019; 11:cancers11060820. [PMID: 31200489 PMCID: PMC6627701 DOI: 10.3390/cancers11060820] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 12/11/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) shows wide disparities, association with human papillomavirus (HPV) infection, and prognosis. We aimed at determining HPV prevalence, and its prognostic association with overall survival (OS) in Saudi HNSCC patients. The study included 285 oropharyngeal and oral-cavity HNSCC patients. HPV was detected using HPV Linear-Array and RealLine HPV-HCR. In addition, p16INK4a (p16) protein overexpression was evaluated in 50 representative cases. Oropharyngeal cancers were infrequent (10%) compared to oral-cavity cancers (90%) with no gender differences. Overall, HPV-DNA was positive in 10 HNSCC cases (3.5%), mostly oropharyngeal (21%). However, p16 expression was positive in 21 cases of the 50 studied (42%) and showed significantly higher OS (p = 0.02). Kaplan–Meier univariate analysis showed significant associations between patients’ OS and age (p < 0.001), smoking (p = 0.02), and tumor stage (p < 0.001). A Cox proportional hazard multivariate analysis confirmed the significant associations with age, tumor stage, and also treatment (p < 0.01). In conclusion, HPV-DNA prevalence was significantly lower in our HNSCC patients than worldwide 32–36% estimates (p ≤ 0.001). Although infrequent, oropharyngeal cancer increased over years and showed 21% HPV-DNA positivity, which is close to the worldwide 36–46% estimates (p = 0.16). Besides age, smoking, tumor stage, and treatment, HPV/p16 status was an important determinant of patients’ survival. The HPV and/or p16 positivity patients had a better OS than HPV/p16 double-negative patients (p = 0.05). Thus, HPV/p16 status helps improve prognosis by distinguishing between the more favorable p16/HPV positive and the less favorable double-negative tumors.
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44
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Geng Y, Liu L. Human papillomavirus genotypes and infection among women in Changzhou, China. Hum Vaccin Immunother 2019; 15:1884-1888. [PMID: 31116690 DOI: 10.1080/21645515.2019.1611159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Human papillomavirus (HPV) infection is a major cause of cervical cancer. HPV vaccine has been shown to be highly effective in preventing HPV infection, and understanding the genotypes of HPV infection can guide the utilization of HPV vaccine. This epidemiological study aimed to investigate the genotype distribution of HPV in HPV-positive female patients in Changzhou. This study enrolled HPV-positive female patients admitted at the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University were enrolled in this study. HPV genotypes were identified via standard HPV DNA testing. The cohort comprised 5738 patients, that the predominant genotypes were HPV52 (13.4%), HPV16 (9.6%), HPV58 (8.8%), HPV81 (8.6%), and HPV53 (7.7%). HPV infection prevalence was the highest among those aged 41-45 y (16.6%), followed by those aged 31-35 y (15.1%) and 36-40 y (15.1%). In total, 46.8% of infections were found in women aged 31-45 y. The main genotypes of HPV infection upon physical examination or diagnosis of cervicitis and cervical cancer were HPV52, 16, 58, 81, and 53. HPV52, 16, 58, 81, and 53 are the most predominant genotypes of HPV infection. Further, HPV infection is most prevalent among women aged 31-45 y. Our findings provide experimental evidence for guiding HPV vaccination policy.
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Affiliation(s)
- Yan Geng
- a Department of Blood Transfusion, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University , Changzhou , China
| | - Liyan Liu
- a Department of Blood Transfusion, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University , Changzhou , China
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45
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Taberna M, Oliva M, Mesía R. Cetuximab-Containing Combinations in Locally Advanced and Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma. Front Oncol 2019; 9:383. [PMID: 31165040 PMCID: PMC6536039 DOI: 10.3389/fonc.2019.00383] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/24/2019] [Indexed: 12/29/2022] Open
Abstract
Cetuximab remains to date the only targeted therapy approved for the treatment of head and neck squamous cell carcinoma (HNSCC). The EGFR pathway plays a key role in the tumorigenesis and progression of this disease as well as in the resistance to radiotherapy (RT). While several anti-EGFR agents have been tested in HNSCC, cetuximab, an IgG1 subclass monoclonal antibody against EGFR, is the only drug with proven efficacy for the treatment of both locoregionally-advanced (LA) and recurrent/metastatic (R/M) disease. The addition of cetuximab to radiotherapy is a validated treatment option in LA-HNSCC. However, its use has been limited to patients who are considered unfit for standard of care chemoradiotherapy (CRT) with single agent cisplatin given the lack of direct comparison of these two regimens in randomized phase III trials and the inferiority suggested by metanalysis and phase II studies. The current use of cetuximab in HNSCC is about to change given the recent results from randomized prospective clinical trials in both the LA and R/M setting. Two phase III studies evaluating RT-cetuximab vs. CRT in Human Papillomavirus (HPV)-positive LA oropharyngeal squamous cell carcinoma (De-ESCALaTE and RTOG 1016) showed inferior overall survival and progression-free survival for RT-cetuximab combination, and therefore CRT with cisplatin remains the standard of care in this disease. In the R/M HNSCC, the EXTREME regimen has been the standard of care as first-line treatment for the past 10 years. However, the results from the KEYNOTE-048 study will likely position the anti-PD-1 agent pembrolizumab as the new first line treatment either alone or in combination with chemotherapy in this setting based on PD-L1 status. Interestingly, cetuximab-mediated immunogenicity through antibody dependent cell cytotoxicity (ADCC) has encouraged the evaluation of combined approaches with immune-checkpoint inhibitors in both LA and R/M-HNSCC settings. This article reviews the accumulated evidence on the role of cetuximab in HNSCC in the past decade, offering an overview of its current impact in the treatment of LA and R/M-HNSCC disease and its potential use in the era of immunotherapy.
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Affiliation(s)
- Miren Taberna
- Medical Oncology Department, Catalan Institute of Oncology, ONCOBELL, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Medicine Department, Barcelona University, Barcelona, Spain
| | - Marc Oliva
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Ricard Mesía
- B-ARGO Group, Medical Oncology Department, Catalan Institute of Oncology, Badalona, Spain
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Rasmussen JH, Grønhøj C, Håkansson K, Friborg J, Andersen E, Lelkaitis G, Klussmann JP, Wittekindt C, Wagner S, Vogelius IR, von Buchwald C. Risk profiling based on p16 and HPV DNA more accurately predicts location of disease relapse in patients with oropharyngeal squamous cell carcinoma. Ann Oncol 2019; 30:629-636. [PMID: 30657857 DOI: 10.1093/annonc/mdz010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the era of precision medicine and HPV-related oropharyngeal squamous cell carcinoma (OPSCC), it is relevant to assess the risk of not only survival, but also the risk of local, regional, or distant treatment failure. The UICC 8th edition uses the surrogate marker p16 to stratify for HPV association but discordance between p16 status and HPV association has been shown. The purpose of this study was to develop a prognostic model to predict the risk of local, regional, and distant metastases and non-cancer-related death for patients with OPSCC, test the prognostic relevance of adding HPV DNA and p16 status, and validate the findings in an independent external dataset. PATIENTS AND METHODS Consecutive patients diagnosed with OPSCC and treated with curative radiotherapy with or without cisplatin in eastern Denmark from 2000 to 2014 were included. Characteristics included age, gender, TNM stage, smoking habits, performance status, and HPV status assessed with p16 and HPV DNA. The information was used to develop a prognostic model for first site of failure with four competing events: recurrence in T-, N-, and M-site, and death with no evidence of disease. RESULTS Overall 1243 patients were eligible for the analysis. A prognostic model with the four events was developed and externally validated in an independent dataset with a heterogeneously treated patient population from another institution. The individual prognostication from the competing risk analysis is displayed in a user friendly online tool (https://rasmussen.shinyapps.io/OPSCCmodelHPV_p16/). Replacing p16 status with the combined variable HPV/p16 status influenced the HR and patients with HPV-/p16+ had significantly higher HR of M-site recurrence than HPV+/p16+ with a HR = 2.56; CI [1.30; 5.02]; P = 0.006 (P = 0.013 in the validation cohort). CONCLUSION Patients with HPV-/p16+ have significantly higher risk of M-site recurrence and could potentially be relevant candidates for clinical trials testing systemic treatments in combination with conventional treatments.
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Affiliation(s)
- J H Rasmussen
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology.
| | - C Grønhøj
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology
| | - K Håkansson
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - J Friborg
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - E Andersen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Copenhagen
| | - G Lelkaitis
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J P Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne
| | - C Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - S Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - I R Vogelius
- Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen
| | - C von Buchwald
- Departments of Otorhinolaryngology, Head and Neck Surgery and Audiology
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47
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Kiyuna A, Ikegami T, Uehara T, Hirakawa H, Agena S, Uezato J, Kondo S, Yamashita Y, Deng Z, Maeda H, Suzuki M, Ganaha A. High-risk type human papillomavirus infection and p16 expression in laryngeal cancer. Infect Agent Cancer 2019; 14:8. [PMID: 30873218 PMCID: PMC6402092 DOI: 10.1186/s13027-019-0224-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/28/2019] [Indexed: 11/27/2022] Open
Abstract
Background Oropharyngeal cancers associated with high-risk type human papillomavirus (HR-HPV) infection have better prognosis than virus negative cancers. Similarly, the HPV status in laryngeal cancer (LC) may be associated with better outcome. Methods Samples from 88 patients with LC were investigated using the polymerase chain reaction (PCR) and p16 immunohistochemistry for HR-HPV analysis. The cut-off point for p16 overexpression was diffuse (≥75%) tumor expression with at least moderate (+ 2/3) staining intensity. Results The 5-year cumulative survival (CS) rate was 80.7% in all patients with LC. According to a combination of HR-HPV DNA status and p16 overexpression, subjects with LC were divided into four groups: HR-HPV DNA-positive/p16 overexpression-positive (n = 5, 5.7%; CS = 100%), HR-HPV DNA-positive/p16 overexpression-negative (n = 11, 12.5%; CS =81.8%), HR-HPV DNA-negative/p16 overexpression-positive (n = 0), and HR-HPV DNA-negative/p16 overexpression-negative (n = 72, 81.8%; CS = 79.5%). HR-HPV DNA-positive/p16-positive cases tended to have integrated HPV infection and high viral load, compared with HR-HPV DNA-positive/p16 overexpression-negative cases. Conclusions LC patients with HPV infection and high levels of p16 expression might have an improved survival outcome; however, it is necessary to recruit additional LC cases with HPV infection to determine the definitive characteristics of HPV-mediated LC and estimate survival outcome. These results may contribute to the development of a useful method for selecting patients with a potentially fair response to treatment and ensure laryngeal preservation.
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Affiliation(s)
- Asanori Kiyuna
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan
| | - Taro Ikegami
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan
| | - Takayuki Uehara
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan
| | - Hitoshi Hirakawa
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan
| | - Shinya Agena
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan
| | - Jin Uezato
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan
| | - Shunsuke Kondo
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan
| | - Yukashi Yamashita
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan
| | - Zeyi Deng
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan.,2Department of Otorhinolaryngology, Head and Neck Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hiroyuki Maeda
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan
| | - Mikio Suzuki
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan
| | - Akira Ganaha
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan.,Department of Otolaryngology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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48
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Ren J, Yang W, Su J, Ren X, Fazelzad R, Albert T, Habbous S, Goldstein DP, de Almeida JR, Hansen A, Jang R, Bratman SV, Hope A, Chen R, Wang J, Xu Y, Cheng D, Zhao Y, Xu W, Liu G. Human papillomavirus and p16 immunostaining, prevalence and prognosis of squamous carcinoma of unknown primary in the head and neck region. Int J Cancer 2019; 145:1465-1474. [PMID: 30698281 DOI: 10.1002/ijc.32164] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/19/2018] [Accepted: 12/21/2018] [Indexed: 02/05/2023]
Abstract
The prevalence of human papillomavirus (HPV) in squamous cell carcinoma of unknown primary in the head and neck (SCCUPHN), and prognosis by HPV status of SCCUPHN patients has been difficult to estimate because of the rarity of this subtype. In MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, EMBASE, Cochrane library and Web of Science searches, observational studies and clinical trials that reported survival rates of patients with SCCUPHN by HPV status were identified. Meta-analysis estimated the prevalence and prognosis (overall survival, OS; progression-free survival, PFS) of SCCUPHN by HPV status, and compared them to studies of oropharyngeal squamous cell carcinoma (OPSCC) from the same institutions and across continents. In 17 SCCUPHN studies (n = 1,149) and 17 institution-matched OPSCC studies (n = 6,522), the pooled HPV prevalence of SCCUPHN was 49%, which was only 10% (95%CI: 1-19%) lower than OPSCC prevalence in the underlying population. Estimated 5-year OS for HPV-negative SCCUPHN was 44% (95%CI: 36-51%) vs. HPV-positive SCCUPHN of 91% (95%CI: 86-96%); hazard ratio (HR) for OS was 3.25 (95%CI: 2.45-4.31) and PFS was 4.49 (95%CI: 2.88-7.02). HRs by HPV status for OPSCC were similar to that in SCCUPHN. While North American SCCUPHNs had higher HPV prevalence than European SCCUPHNs (OR = 2.68 (95%CI: 1.3-5.6)), HR of OS for HPV-negative vs. HPV-positive patients were similar in both continents (HRs of 3.78-4.09). Prevalence of HPV among SCCUPHN patients were lower than in OPSCC. The survival benefit conferred by being HPV-positive was similar in SCCUPHN as in OPSCCs, independent of continent.
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Affiliation(s)
- Jianjun Ren
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China.,Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Wen Yang
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Xue Ren
- Department of Economic Statistics, School of Statistics and Management, Shanghai University of Finance and Economics, Shanghai, China
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Tiong Albert
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Steven Habbous
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology- Head and Neck Surgery, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology- Head and Neck Surgery, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aaron Hansen
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Raymond Jang
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, University of Toronto, and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ruiqi Chen
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jing Wang
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yang Xu
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Danni Cheng
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Liu
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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49
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Staging and prognosis of oropharyngeal carcinoma according to the 8th Edition of the American Joint Committee on Cancer Staging Manual in human papillomavirus infection. Eur Arch Otorhinolaryngol 2018; 276:827-836. [PMID: 30594962 PMCID: PMC6411679 DOI: 10.1007/s00405-018-05263-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/20/2018] [Indexed: 11/01/2022]
Abstract
PURPOSE The aim of this study was to evaluate the 8th edition of the American Joint Committee on Cancer Staging Manual: Head and Neck Section on oropharyngeal squamous cell cancer (OPSCC) and to clarify the relationship between p16 overexpression and the presence of human papillomavirus (HPV) DNA using fresh frozen samples. METHODS Samples from 100 OPSCC patients were analyzed using polymerase chain reaction (PCR) and p16 immunohistochemistry. RESULTS Five-year overall survival (OS) was 73.0%, 93.9%, and 62.2% in all, p16-positive (n = 34), and p16-negative (n = 66) cases, respectively. OS tended to be better aligned with stage in the 8th edition than in the 7th edition. The 5-year OS was 96.0% in never or light smokers (< 40 pack-years), and 87.5% in heavy smokers (≥ 40 pack-years) in the p16-positive group, respectively (p = 0.027). HPV infection was found in 100% of p16-positive and 21.2% of p16-negative cases. The p16-positive cases had higher viral load and integrated physical status than the p16-negative cases. Although 1 case with p16 overexpression showed no PCR amplification using consensus primers, PCR amplification was detected using HPV 16 E6-specific primers. CONCLUSIONS The 8th edition predicts OPSCC prognosis more accurately than the 7th edition and p16-overexpression is an excellent surrogate marker for detecting HPV infection. Although high-risk-type HPV infection was observed in p16-negative cases, it showed no significant effect in survival outcome.
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50
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Taberna M, Torres M, Alejo M, Mena M, Tous S, Marquez S, Pavón MA, León X, García J, Guix M, Hijano R, Bonfill T, Aguilà A, Lozano A, Mesía R, Alemany L, Bravo IG. The Use of HPV16-E5, EGFR, and pEGFR as Prognostic Biomarkers for Oropharyngeal Cancer Patients. Front Oncol 2018; 8:589. [PMID: 30619735 PMCID: PMC6297752 DOI: 10.3389/fonc.2018.00589] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/22/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Anti-epidermal-growth-factor-receptor (EGFR) therapies in combination with radiotherapy are being studied on de-escalation clinical trials for HPV-related oropharyngeal cancer (OPC) patients. The HPV16-E5 oncoprotein increases recycling of activated EGFR to the cell surface, enhancing factor signal transduction. Our aim was to evaluate viral HPV16-E5 oncogene expression as well as EGFR and phosphorylated-EGFR (pEGFR), protein levels as biomarkers for clinical outcome in a retrospective cohort of OPC patients. Methods: Formalin-fixed-paraffin-embedded OPCs were collected from 1990 to 2013. OPC samples containing HPV-DNA were subject to viral E6*I mRNA detection and p16INK4a immunohistochemistry (IHC). HPV16-positive cases were evaluated for HPV16-E5 (RT-PCR) and EGFR/pEGFR (IHC). A stratified and matched random sample of HPV-negative samples was used as control and evaluated for EGFR/pEGFR. Overall survival (OS) and disease free survival (DFS) estimates were assessed for locally advanced OPC patients (stage III, IVa,b 7th edition). Results: Among 788 OPC patient samples, 53 were double positive for HPV16-DNA/p16INK4a. HPV16-E5 expression was found in 41 of 53 samples (77.4%). EGFR expression was observed in 37.7 vs 70.8% of HPV16-positive vs HPV-negative samples, respectively; (adjusted OR = 0.15) 5% CI = 0.04–0.56]). Expression of pEGFR followed an inverse pattern with 39.6 and 24.9% detection in HPV16-positive and HPV-negative samples; (adjusted OR = 1.58 [95% CI = 0.48–5.17]). Within HPV16-positive cases, no association between HPV16-E5/EGFR nor pEGFR was observed. With a median follow-up of 39.36 months (min = 0.03 – max = 272.07), the combination of HPV status and EGFR or pEGFR expression were predictors of better OS (p < 0.001, for both) and DFS (p < 0.001 for EGFR and p = 0.003 for pEGFR). Conclusions: HPV16-E5 is highly expressed on HPV16-positive OPCs. Interestingly, HPV16-positive cases expressed significantly more pEGFR while HPV-negative cases expressed more EGFR. The combinations of HPV status and EGFR or pEGFR may be useful biomarkers for evaluating prognosis outcome in OPC patients.
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Affiliation(s)
- Miren Taberna
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), IDIBELL, ONCOBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Montserrat Torres
- Cancer Epidemiology Research Program, Infections and Cancer Laboratory, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María Alejo
- Department of Pathology, Hospital General de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Sara Tous
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Sandra Marquez
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miquel A Pavón
- Cancer Epidemiology Research Program, Infections and Cancer Laboratory, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier León
- Otorhinolaryngology Department, Hospital de Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Jacinto García
- Otorhinolaryngology Department, Hospital de Sant Pau, Barcelona, Spain
| | - Marta Guix
- Cancer Research Program, IMIM, Hospital del Mar, Barcelona, Spain.,Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Rafael Hijano
- Department of Otorhinolaryngology, Hospital del Mar, Barcelona, Spain
| | - Teresa Bonfill
- Department of Medical Oncology, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Antón Aguilà
- Department of Otorhinolaryngology, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Alicia Lozano
- Department of Radiation Oncology, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ricard Mesía
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), IDIBELL, ONCOBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Department of Medical Oncology, Catalan Institute of Oncology (ICO), Hospital Can Ruti, Badalona, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio G Bravo
- French National Center for Scientific Research (CNRS), Laboratory MIVEGEC (CNRS IRD Uni Montp), Montpellier, France
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