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Nordanger IM, Beisland C, Thorkelsen TK, Honoré A, Juliebø-Jones P, Bostad L, Berget E, Costea DE, Moen CA. The Prognostic Value of Human Papillomavirus Status in Penile Cancer: Outcomes From a Norwegian Cohort Study. Clin Genitourin Cancer 2024; 22:102127. [PMID: 38918085 DOI: 10.1016/j.clgc.2024.102127] [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: 04/09/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Penile squamous cell carcinoma (PSCC) can develop from human papillomavirus (HPV) infection. This study investigates if the prognostic value of the TNM stage groups or the components tumor stage (pT), grade of differentiation (Grade), lymphovascular invasion (LVI), and nodular stage (pN) depend on HPV status. Also, whether the value of tumor parameters (pT, Grade, and LVI) for predicting node-positive disease depends on HPV status was investigated. PATIENTS AND METHODS Stored tumor tissue from 226 patients treated for PSCC in Western Norway between 1973 and 2023 was investigated for HPV DNA. Histopathological variables were reevaluated according to the current TNM classification. Disease course was registered from hospital records. Inclusion of an interaction term between HPV and TNM stage groups in Cox regression enabled analysis of whether cancer-specific survival (CSS) of the stage groups depended on HPV status. This was also done separately for pT, Grade, LVI, and pN. Logistic regression with interaction terms between HPV and the tumor parameters were used to investigate if their predictive value depended on HPV status. RESULTS HPV DNA was detected in 43% of the tumors. Stratified by HPV status, there was no significant interaction term in the Cox regression between HPV status and TNM stage groups (P = .74). Similar results were found for pT (P = .94), Grade (P = .08), LVI (P = .91) and pN (P = .77). Moreover, there were no significant interaction terms in the logistic regression between HPV status and the tumor parameters pT, Grade, and LVI (all P > .2). CONCLUSIONS This study found that prognosis of the TNM stage groups and the components pT, Grade, LVI, and pN were not modified by HPV in PSCC. The value of pT, Grade, and LVI for predicting lymph node-positive disease was not affected by HPV status.
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Affiliation(s)
- Ida M Nordanger
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Alfred Honoré
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Leif Bostad
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Ellen Berget
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Daniela E Costea
- Department of Pathology, Haukeland University Hospital, Bergen, Norway; The Gade Laboratory for Pathology and Centre for Cancer Biomarkers (CCBIO), Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian A Moen
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Rosing F, Meier M, Schroeder L, Laban S, Hoffmann T, Kaufmann A, Siefer O, Wuerdemann N, Klußmann JP, Rieckmann T, Alt Y, Faden DL, Waterboer T, Höfler D. Quantification of human papillomavirus cell-free DNA from low-volume blood plasma samples by digital PCR. Microbiol Spectr 2024; 12:e0002424. [PMID: 38829114 PMCID: PMC11218464 DOI: 10.1128/spectrum.00024-24] [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: 01/23/2024] [Accepted: 04/23/2024] [Indexed: 06/05/2024] Open
Abstract
The incidence rate of human papillomavirus-driven oropharyngeal cancer (HPV-OPC) is increasing in countries with high human development index. HPV cell-free DNA (cfDNA) isolated from 3 to 4 mL blood plasma has been successfully used for therapy surveillance. A highly discussed application of HPV-cfDNA is early detection of HPV-OPC. This requires sensitive and specific cfDNA detection as cfDNA levels can be very low. To study the predictive power of pre-diagnostic HPV-cfDNA, archived samples from epidemiological cohorts with limited plasma volume are an important source. To establish a cfDNA detection workflow for low plasma volumes, we compared cfDNA purification methods [MagNA Pure 96 (MP96) and QIAamp ccfDNA/RNA] and digital PCR systems (Biorad QX200 and QIAGEN QIAcuity One). Final assay validation included 65 low-volume plasma samples from oropharyngeal cancer (OPC) patients with defined HPV status stored for 2-9 years. MP96 yielded a 28% higher cfDNA isolation efficiency in comparison to QIAamp. Both digital PCR systems showed comparable analytical sensitivity (6-17 copies for HPV16 and HPV33), but QIAcuity detected both types in the same assay. In the validation set, the assay had 80% sensitivity (n = 28/35) for HPV16 and HPV33 and a specificity of 97% (n = 29/30). In samples with ≥750 µL plasma, the sensitivity was 85% (n = 17/20), while in samples with <750 µL plasma, it was 73% (n = 11/15). Despite the expected drop in sensitivity with decreased plasma volume, the assay is sensitive and highly specific even in low-volume samples and thus suited for studies exploring HPV-cfDNA as an early HPV-OPC detection marker in low-volume archival material.IMPORTANCEHPV-OPC has a favorable prognosis compared to HPV-negative OPC. However, the majority of tumors is diagnosed after regional spread, thus making intensive treatment necessary. This can cause lasting morbidity with a large impact on quality of life. One potential method to decrease treatment-related morbidity is early detection of the cancer. HPV cfDNA has been successfully used for therapy surveillance and has also been detected in pre-diagnostic samples of HPV-OPC patients. These pre-diagnostic samples are only commonly available from biobanks, which usually only have small volumes of blood plasma available. Hence, we have developed a workflow optimized for small-volume archival samples. With this method, a high sensitivity can be achieved despite sample limitations, making it suitable to conduct further large-scale biobank studies of HPV-cfDNA as a prognostic biomarker for HPV-OPC.
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Affiliation(s)
- Fabian Rosing
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Meier
- Department of Otorhinolaryngology and Head and Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center Ulm, University Medical Center Ulm, Ulm, Germany
| | - Lea Schroeder
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Simon Laban
- Department of Otorhinolaryngology and Head and Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center Ulm, University Medical Center Ulm, Ulm, Germany
| | - Thomas Hoffmann
- Department of Otorhinolaryngology and Head and Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center Ulm, University Medical Center Ulm, Ulm, Germany
| | - Andreas Kaufmann
- Department of Gynecology, HPV Research Laboratory, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Oliver Siefer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Nora Wuerdemann
- Department of Internal Medicine, Faculty of Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jens Peter Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Thorsten Rieckmann
- Department of Radiobiology and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Otolaryngology and Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yvonne Alt
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel L. Faden
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Mass Eye and Ear, Boston, Massachusetts, USA
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniela Höfler
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Ji M, Ma G, Liu C, Gu B, Du X, Ou X, Xu X, Song S, Yang Z. Head-to-head comparison of [ 68Ga]Ga-DOTA-FAPI-04 and [ 18F]FDG PET/CT for the evaluation of tonsil cancer and lymph node metastases: a single-centre retrospective study. Cancer Imaging 2024; 24:56. [PMID: 38702821 PMCID: PMC11069139 DOI: 10.1186/s40644-024-00699-3] [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: 01/14/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND This study aimed to compare the diagnostic value of [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT imaging for primary lesions and metastatic lymph nodes in patients with tonsil cancer. METHOD Twenty-one tonsil cancer patients who underwent [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT scans within two weeks in our centre were retrospectively enrolled. The maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR) of the two tracers were compared by using the Mann‒Whitney U test. In addition, the sensitivity, specificity, and accuracy of the two methods for diagnosing metastatic lymph nodes were analysed. RESULTS In detecting primary lesions, the efficiency was higher for [68 Ga]Ga-DOTA-FAPI-04 PET/CT (20/22) than for [18F]FDG PET/CT (9/22). Although [68 Ga]Ga-DOTA-FAPI-04 uptake (SUVmax, 5.03 ± 4.06) was lower than [18F]FDG uptake (SUVmax, 7.90 ± 4.84, P = 0.006), [68 Ga]Ga-DOTA-FAPI-04 improved the distinction between the primary tumor and contralateral normal tonsillar tissue. The TBR was significantly higher for [68 Ga]Ga-DOTA-FAPI-04 PET/CT (3.19 ± 2.06) than for [18F]FDG PET/CT (1.89 ± 1.80) (p < 0.001). In lymph node analysis, SUVmax and TBR were not significantly different between [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT (7.67 ± 5.88 vs. 8.36 ± 6.15, P = 0.498 and 5.56 ± 4.02 vs. 4.26 ± 3.16, P = 0.123, respectively). The specificity and accuracy of [68 Ga]Ga-DOTA-FAPI-04 PET/CT were higher than those of [18F]FDG PET/CT in diagnosing metastatic cervical lymph nodes (all P < 0.05). CONCLUSION The availability of [68 Ga]Ga-DOTA-FAPI-04 complements the diagnostic results of [18F]FDG by improving the detection rate of primary lesions and the diagnostic accuracy of cervical metastatic lymph nodes in tonsil cancer compared to [18F]FDG.
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Affiliation(s)
- Mengjing Ji
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, 200032, China
| | - Guang Ma
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, 200032, China
| | - Cheng Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, 200032, China
| | - Bingxin Gu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, 200032, China
| | - Xinyue Du
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, 200032, China
| | - Xiaomin Ou
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Xiaoping Xu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032, China
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, 200032, China
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032, China.
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, 200032, China.
| | - Zhongyi Yang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Center for Biomedical Imaging, Fudan University, Shanghai, 200032, China.
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, 200032, China.
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Hurel C, Carsuzaa F, Salleron J, Gorphe P, Righini C, Rogé M, de Mones E, Morinière S, Vergez S, Thariat J, Dufour X. Impact of HPV status in T1-2 oropharyngeal squamous cell carcinoma with bulky N3 nodes: a multicenter GETTEC study. Eur Arch Otorhinolaryngol 2023; 280:847-853. [PMID: 36068323 DOI: 10.1007/s00405-022-07637-8] [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: 06/13/2022] [Accepted: 08/30/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The purpose of our study was to investigate the impact of HPV status in oncologic outcomes in patients with T1-2 oropharyngeal SCC associated with bulky N3 nodes, and to determine progression prognosis factors aiming to define the best therapeutic strategies for these patients. METHODS This multicenter retrospective study included patients with T1-2 oropharyngeal SCC with N3 nodes treated between 2010 and 2015 in 8 French comprehensive cancer centers. HPV status was determined with P16 hyperexpression in immunohistochemistry. HPV-positive patients were separated into 2 groups according to the associated smoking history (HPV + T +) or not (HPV + T-). We compared the oncological outcomes of patients according to HPV-status and smoking history. RESULTS Of 67 patients with T1-2 N3 oropharyngeal SCC, 36 patients (53.7%) were HPV negative and 31 patients (46.3%) HPV positive. 2-year PFS was significantly better in HPV + T- group (p = 0.036). The risk of death or progression was significantly reduced in HPV + T- comparatively to HPV- (HR 0.25 95%CI [0.07; 0.89]). 2-year OS was significantly better in HPV + T- group than in the other two groups (p = 0.017). CONCLUSION In patients with T1-2 oropharyngeal SCC associated with bulky N3 nodes, HPV positive patients without smoking history had better OS and PFS than HPV positive patients with smoking history and HPV negative patients. Thus, HPV status is a significant prognostic factor for survival but this benefit is altered when smoking history is associated. N3 HPV positive patients with smoking history have to be classified as high-risk.
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Affiliation(s)
- Charles Hurel
- Head and Neck Surgery, Service ORL, chirurgie cervico-maxillo-faciale et audiophonologie, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
| | - Florent Carsuzaa
- Head and Neck Surgery, Service ORL, chirurgie cervico-maxillo-faciale et audiophonologie, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France.
| | - Julia Salleron
- Cellule Data Biostatistique, Institut de Cancérologie de Lorraine, Université de Lorraine, 54519, Vandœuvre-lès-Nancy, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Christian Righini
- Head and Neck Surgery, University Hospital of Grenoble, La Tronche, France
| | | | - Erwan de Mones
- Head and Neck Surgery, University Hospital of Tours, Tours, France
| | - Sylvain Morinière
- Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux cedex, France
| | - Sébastien Vergez
- Institut Universitaire du Cancer de Toulouse Oncopole-CHU de Toulouse, Toulouse, France
| | | | - Xavier Dufour
- Head and Neck Surgery, Service ORL, chirurgie cervico-maxillo-faciale et audiophonologie, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021, Poitiers Cedex, France
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5
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Hewavisenti R, Ferguson A, Wang K, Jones D, Gebhardt T, Edwards J, Zhang M, Britton W, Yang J, Hong A, Palendira U. CD103+ tumor-resident CD8+ T cell numbers underlie improved patient survival in oropharyngeal squamous cell carcinoma. J Immunother Cancer 2021; 8:jitc-2019-000452. [PMID: 32527931 PMCID: PMC7292045 DOI: 10.1136/jitc-2019-000452] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) is one of the fastest growing cancers in the Western world. When compared to OPSCCs induced by smoking or alcohol, patients with HPV+ OPSCC, have better survival and the mechanisms remain unclear. METHODS The Cancer Genome Atlas (TCGA) database was examined for genes associated with tissue-resident CD8+ T cells. Multiplex immunohistochemistry (IHC) staining was performed on tumor specimen taken from 35 HPV+ and 27 HPV- OPSCC patients. RESULTS TCGA database revealed that the expression of genes encoding CD103 and CD69 were significantly higher in HPV+ head and neck SCCs (HNSCC) than in HPV- HNSCC. Higher expression levels of these two genes were also associated with better overall survival. IHC staining showed that the proportion of CD103+ tumor-resident CD8+ T cells were significantly higher in HPV+ OPSCCs when compared to HPV- OPSCC. This higher level was also associated with both lower risk of loco-regional failure, and better overall survival. Importantly, patients with HPV- OPSCC who had comparable levels of CD103+ tumor-resident CD8+ T cells to those with HPV+ OPSCC demonstrated similar survival as those with HPV+OPSCC. CONCLUSION Our results show that CD103+ tumor-resident CD8+ T cells are critical for protective immunity in both types of OPSCCs. Our data further suggest that the enhanced local protective immunity provided by tumor-resident T cell responses is the underlying factor driving favorable clinical outcomes in HPV+ OPSCCs over HPV- OPSCCs.
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Affiliation(s)
| | - Angela Ferguson
- Centenary Institute, Newtown, New South Wales, Australia.,Infectious Diseases and Immunology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Wang
- School of Mathematics and Statistics, The University of Sydney, Sydney, New South Wales, Australia
| | - Deanna Jones
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Gebhardt
- Department of Immunology and Microbiology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jarem Edwards
- Centenary Institute, Newtown, New South Wales, Australia
| | - Mei Zhang
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | | | - Jean Yang
- School of Mathematics and Statistics, The University of Sydney, Sydney, New South Wales, Australia
| | - Angela Hong
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia .,Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Umaimainthan Palendira
- Centenary Institute, Newtown, New South Wales, Australia .,Infectious Diseases and Immunology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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6
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Boeker R, Stromberger C, Heiland M, Beck-Broichsitter B, Hofmann VM, Neumann K, Ochsenreither S, Olze H, Dommerich S, Piwonski I, Coordes A. Carcinoma of Unknown Primary and the 8th Edition TNM Classification for Head and Neck Cancer. Laryngoscope 2021; 131:E2534-E2542. [PMID: 33734438 DOI: 10.1002/lary.29499] [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: 09/30/2020] [Revised: 02/06/2021] [Accepted: 02/20/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE In the 8th Edition TNM Classification for Head and Neck Cancer, the classification for carcinoma of unknown primary (CUP) changed in addition to oropharyngeal carcinomas. The current classification considers extranodal extension (ENE), determination of p16 (surrogate marker for human papillomavirus), and detection of Epstein-Barr virus (EBV). The aim of this study was to investigate the influence of the new classification on the prognosis of p16-positive and p16-negative CUP and the impact of EBV proof. METHODS Clinical and pathological data from patients with CUP of the head and neck between 2009 and 2018 were evaluated. The 7th (UICC7) and 8th (UICC8) edition of the Union for International Cancer Control staging system were applied and compared. RESULTS There were 97 patients treated, 26.8% women and 73.2% men. The average age at initial diagnosis was 64.6 years. Of which, 58.8% had a documented history of smoking, 37.1% were positive for p16, 4.1% were positive for EBV, and 66% had ENE. Most of the patients were at stage III/IVa (78.4% according to UICC7). According to UICC8, p16+ patients were mainly at stage I (86.1%), and p16- at stage IVb (56.1%). P16 status (P = .002), ENE (P = .001), nodal category (TNM7, P < .001), UICC stage (TNM7, P < .001) and UICC stage (TNM8, P < .001) had a significant impact on survival in the univariate analysis. The 8th TNM classification resulted in a downstaging of p16-positive CUP syndromes and an upstaging of p16-negative syndromes. CONCLUSION The 8th TNM classification shows the lower UICC stage in p16-positive CUP syndromes. The prognostic significance for survival has improved from the 7th to the 8th TNM classification. LEVEL OF EVIDENCE USING THE 2011 OCEBM: Level 3. Laryngoscope, 131:E2534-E2542, 2021.
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Affiliation(s)
- Robert Boeker
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Carmen Stromberger
- Department of Radiooncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Benjamin Franklin, Berlin, Germany
| | - Benedicta Beck-Broichsitter
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Benjamin Franklin, Berlin, Germany
| | - Veit M Hofmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Konrad Neumann
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Biometrics and Clinical Epidemiology, Campus Charité Mitte, Berlin, Germany
| | - Sebastian Ochsenreither
- Department of Hematology and Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany.,Charité Comprehensive Cancer Center, Berlin, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Steffen Dommerich
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Iris Piwonski
- Department of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Annekatrin Coordes
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow Klinikum and Campus Charité Mitte, Berlin, Germany
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7
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Costa JM, Sumarroca A, Rodríguez C, Gutiérrez A, García J, López M, Quer M, León X. Prognostic Value of Nodal Involvement in Patients With Oropharyngeal Carcinoma According to the HPV Status. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Costa JM, Sumarroca A, Rodríguez C, Gutiérrez A, García J, López M, Quer M, León X. Prognostic value of nodal involvement in patients with oropharyngeal carcinoma according to the HPV status. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:212-218. [PMID: 31924300 DOI: 10.1016/j.otorri.2019.08.002] [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: 06/02/2019] [Revised: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Different studies performed in populations with a high incidence of HPV infection have found no prognostic capacity of clinical nodal involvement (cN+) in patients with HPV-positive oropharyngeal carcinomas. The objective of this study was to assess the prognostic ability of nodal involvement in patients with oropharyngeal carcinomas according to HPV status in a cancer population with a low incidence of HPV infection. MATERIAL AND METHODS Retrospective study of a cohort of 420 patients with oropharyngeal carcinomas treated during the period 1990-2016 for whom information on HPV status was available. RESULTS 14.8% of the patients included in the study had HPV-positive tumours. In relation to patients without nodal involvement (cN0), nodal involvement at diagnosis (cN+) significantly decreased the specific survival of patients with HPV-negative oropharyngeal carcinomas. Conversely, no differences in survival were found for patients with HPV-positive tumours according to the presence of nodal involvement. A history of toxic consumption did not change the absence of prognostic significance of nodal involvement for patients with HPV-positive tumours. CONCLUSIONS Regional involvement at the time of diagnosis is not a prognostic variable for patients with HPV-positive oropharyngeal carcinomas.
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Affiliation(s)
- Jose-Miguel Costa
- Servicio de ORL y Cirugía de Cabeza y Cuello, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España.
| | - Anna Sumarroca
- Servicio de ORL y Cirugía de Cabeza y Cuello, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - Camilo Rodríguez
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Alfons Gutiérrez
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
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9
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Jimenez Jimenez AM, Moulick A, Bhowmick S, Strmiska V, Gagic M, Horakova Z, Kostrica R, Masarik M, Heger Z, Adam V. One-step detection of human papilloma viral infection using quantum dot-nucleotide interaction specificity. Talanta 2019; 205:120111. [PMID: 31450441 DOI: 10.1016/j.talanta.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 12/12/2022]
Abstract
Due to the close relationship between carcinogenesis and human papillomavirus (HPV), and since they are transmitted via huge number of asymptomatic carriers, the detection of HPV is really needed to reduce the risk of developing cancer. According to the best of our knowledge, our study provides the very first method for one-step detection of viral infection and if it has initiated the subsequent cancer proliferation. The proposed novel nanosystem consists of magnetic glass particles (MGPs), which were attached with DNA probe on their surface to hybridize with target DNAs. The MGP-probe-DNA hybrid was finally conjugated with CdTe/ZnSe core/shell quantum dots (QDs). The proposed detection system is based on a novel mechanism in which the MGPs separate out the target DNAs from different biological samples using external magnetic field for better and clear detection and the QDs give different fluorescent maxima for different target DNAs due to their ability to interact differently with different nucleotides. Firstly, the method was optimized using HPV genes cloned into synthetic plasmids. Then it was applied directly on the samples from normal and cancerous cells. After that, the real hospital samples of head and neck squamous cell carcinoma (HNSCC) with or without the infection of HPV were also analyzed. Our novel nano-system is proved successful in detecting and distinguishing between the patients suffering by HPV infection with or without subsequent cancer having detection limit estimated as 1.0 x 109 (GEq/mL). The proposed methodology is faster and cost-effective, which can be applied at the clinical level to help the doctors to decide the strategy of medication that may save the life of the patients with an early treatment.
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Affiliation(s)
- Ana Maria Jimenez Jimenez
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00, Brno, Czech Republic; Central European Institute of Technology, Brno University of Technology, Technicka 3058/10, CZ-616 00, Brno, Czech Republic
| | - Amitava Moulick
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00, Brno, Czech Republic; Central European Institute of Technology, Brno University of Technology, Technicka 3058/10, CZ-616 00, Brno, Czech Republic
| | - Sukanya Bhowmick
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00, Brno, Czech Republic; Central European Institute of Technology, Brno University of Technology, Technicka 3058/10, CZ-616 00, Brno, Czech Republic
| | - Vladislav Strmiska
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00, Brno, Czech Republic; Central European Institute of Technology, Brno University of Technology, Technicka 3058/10, CZ-616 00, Brno, Czech Republic
| | - Milica Gagic
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00, Brno, Czech Republic; Central European Institute of Technology, Brno University of Technology, Technicka 3058/10, CZ-616 00, Brno, Czech Republic
| | - Zuzana Horakova
- Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne's Faculty Hospital, CZ-65691, Brno, Czech Republic
| | - Rom Kostrica
- Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne's Faculty Hospital, CZ-65691, Brno, Czech Republic
| | - Michal Masarik
- Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Kamenice 5, CZ-625 00, Brno, Czech Republic
| | - Zbynek Heger
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00, Brno, Czech Republic; Central European Institute of Technology, Brno University of Technology, Technicka 3058/10, CZ-616 00, Brno, Czech Republic
| | - Vojtech Adam
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00, Brno, Czech Republic; Central European Institute of Technology, Brno University of Technology, Technicka 3058/10, CZ-616 00, Brno, Czech Republic.
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10
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Gorphe P, Chekkoury Idrissi Y, Tao Y, Moya-Plana A, Casiraghi O, Janot F, Blanchard P, Mirghani H, Temam S. Smoking and papillomavirus DNA in patients with p16-positive N3 oropharyngeal squamous cell carcinoma. Head Neck 2018; 41:1039-1045. [PMID: 30552841 DOI: 10.1002/hed.25523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 08/20/2018] [Accepted: 10/05/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We investigated the survival of patients with a p16-positive N3 oropharyngeal squamous cell carcinoma (OPSCC) and the prognostic significance of patient, tumor, and treatment characteristics. METHODS We retrospectively reviewed the data of patients treated at our Cancer Center for a p16-positive N3 OPSCC between 2003 and 2016. End points were overall survival (OS) and progression-free survival (PFS). RESULTS A total of 29 patients were included. The 5-year OS and PFS were 67.5% and 59.1%, respectively. Smoking history above 10 pack-years and the absence of human papillomavirus DNA were associated with worse OS (P = .02 and P = .03, respectively) and PFS (P = .02 and P = .02, respectively). Induction chemotherapy or radical neck dissection were not associated with different treatment outcomes. CONCLUSION Patients with an N3 p16-positive oropharyngeal cancer in our series had a 5-year OS rate of 67.5%. Smoking history and viral DNA were prognostic factors associated with survival.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
| | - Younes Chekkoury Idrissi
- Department of Head and Neck Oncology, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
| | - Yungan Tao
- Department of Radiotherapy, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
| | - Odile Casiraghi
- Department of Pathology, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
| | - François Janot
- Department of Head and Neck Oncology, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
| | - Pierre Blanchard
- Department of Radiotherapy, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
| | - Haïtham Mirghani
- Department of Head and Neck Oncology, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Oncology, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
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11
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Beniwal A, Karwasra I, Parmar A, Beniwal HK, Sakhrani JK. Human Papillomavirus in Head and Neck Squamous Cell Carcinoma. Indian J Surg 2018. [DOI: 10.1007/s12262-016-1585-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Lewis JS, Beadle B, Bishop JA, Chernock RD, Colasacco C, Lacchetti C, Moncur JT, Rocco JW, Schwartz MR, Seethala RR, Thomas NE, Westra WH, Faquin WC. Human Papillomavirus Testing in Head and Neck Carcinomas: Guideline From the College of American Pathologists. Arch Pathol Lab Med 2018; 142:559-597. [PMID: 29251996 DOI: 10.5858/arpa.2017-0286-cp] [Citation(s) in RCA: 351] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context Human papillomavirus (HPV) is a major cause of oropharyngeal squamous cell carcinomas, and HPV (and/or surrogate marker p16) status has emerged as a prognostic marker that significantly impacts clinical management. There is no current consensus on when to test oropharyngeal squamous cell carcinomas for HPV/p16 or on which tests to choose. Objective To develop evidence-based recommendations for the testing, application, interpretation, and reporting of HPV and surrogate marker tests in head and neck carcinomas. Design The College of American Pathologists convened a panel of experts in head and neck and molecular pathology, as well as surgical, medical, and radiation oncology, to develop recommendations. A systematic review of the literature was conducted to address 6 key questions. Final recommendations were derived from strength of evidence, open comment period feedback, and expert panel consensus. Results The major recommendations include (1) testing newly diagnosed oropharyngeal squamous cell carcinoma patients for high-risk HPV, either from the primary tumor or from cervical nodal metastases, using p16 immunohistochemistry with a 70% nuclear and cytoplasmic staining cutoff, and (2) not routinely testing nonsquamous oropharyngeal carcinomas or nonoropharyngeal carcinomas for HPV. Pathologists are to report tumors as HPV positive or p16 positive. Guidelines are provided for testing cytologic samples and handling of locoregional and distant recurrence specimens. Conclusions Based on the systematic review and on expert panel consensus, high-risk HPV testing is recommended for all new oropharyngeal squamous cell carcinoma patients, but not routinely recommended for other head and neck carcinomas.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - William C Faquin
- From the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Lewis); the Department of Radiation Oncology, Stanford University Medical Center, Palo Alto, California (Dr Beadle); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Drs Bishop and Westra); the Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri (Dr Chernock); Surveys, the College of American Pathologists, Northfield, Illinois (Mss Colasacco and Thomas); Policy and Advocacy, American Society of Clinical Oncology, Alexandria, Virginia (Ms Lacchetti); the Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Moncur); the Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexler Medical Center, Columbus (Dr Rocco); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Schwartz); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Seethala); and the Department of Pathology, Massachusetts General Hospital, Boston (Dr Faquin)
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13
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Yin LX, D'Souza G, Westra WH, Wang SJ, van Zante A, Zhang Y, Rettig EM, Ryan WR, Ha PK, Wentz A, Koch W, Eisele DW, Fakhry C. Prognostic factors for human papillomavirus-positive and negative oropharyngeal carcinomas. Laryngoscope 2018. [PMID: 29536542 DOI: 10.1002/lary.27130] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC) are distinct disease entities. Prognostic factors specific to each entity have not been adequately explored. Goals for this study were: 1) to determine whether HPV-positive and HPV-negative OPSCCs have distinct prognostic factors, and 2) to explore the prognostic significance of sex and race in OPSCC after HPV stratification STUDY DESIGN: Retrospective case series. METHODS A retrospective review of 239 incident OPSCC patients from 1995 to 2012, treated at Johns Hopkins and University of California-San Francisco was conducted. Women and nonwhite races were oversampled. All analyses were stratified by tumor HPV in situ hybridization status. The effects of sex and race on survival were considered in Kaplan-Meier and unadjusted and adjusted Cox regression models. RESULTS One hundred thirty-four (56.1%) OPSCC patients were HPV positive. On univariate analysis, women had better overall survival than men among HPV-positive (hazard ratio [HR]: 0.47, 95% confidence interval [CI]: 0.20-1.07; P = .06) but not HPV-negative (HR: 0.73, 95% CI: 0.43-1.24; P = .24) OPSCCs. On multivariate analysis, women with HPV-positive OPSCCs remained at lower risk of death (adjusted hazard ratio [aHR]: 0.34, 95% CI: 0.12-0.96; P = .04). Survival did not vary significantly by race among HPV-positive patients. Among HPV-negative patients, Hispanic patients had significantly better survival in unadjusted (HR: 0.27, 95% CI: 0.08-0.91; P = .04) but not adjusted (aHR: 0.93, 95% CI: 0.11-7.36; P = .94) analysis. CONCLUSIONS Women with HPV-positive OPSCC may have improved overall survival compared to men. Sex does not play a prognostic role in HPV-negative OPSCC. There are no differences in prognosis by race among HPV-positive or HPV-negative patients. LEVEL OF EVIDENCE 4 Laryngoscope, E287-E295, 2018.
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Affiliation(s)
- Linda X Yin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - William H Westra
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Steven J Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona
| | - Annemieke van Zante
- Department of Pathology, University of California-San Francisco, San Francisco, California, U.S.A
| | - Yuehan Zhang
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Eleni M Rettig
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Alicia Wentz
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Wayne Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
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14
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Is p16 an adequate surrogate for human papillomavirus status determination? Curr Opin Otolaryngol Head Neck Surg 2018; 25:108-112. [PMID: 28141601 DOI: 10.1097/moo.0000000000000341] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW In head and neck cancer management, immunoexpression of protein p16 is widely used as a surrogate marker for human papillomavirus (HPV) positivity due to challenges of direct HPV testing. Previously p16 has been reported to have good sensitivity but only moderate specificity in HPV-status determination. The aim of this review is to evaluate the existing information on sensitivity and specificity of p16 immunohistochemistry (IHC) in HPV-status determination among the recent studies. RECENT FINDINGS We searched the time period from October 2014 to April 2016 and included 28 studies (a total of 31 analyses), which reported both p16 and HPV status in their series. The sensitivity of p16 in HPV determination ranged between 28.2 and 100.0%. The mean and median sensitivities were 90.5 and 95.4%, respectively. The specificity ranged between 31.1 and 100.0%. The mean and median specificities were 83.3 and 87.3%, respectively. SUMMARY Our review presents current information on the feasibility of p16 IHC in HPV status determination, which is in line with previous studies. Patients with HPV-positive tumors can be identified with p16 IHC, but a risk for misclassification of HPV-negative tumors as HPV positive exists. This fact has to be taken into consideration if HPV status will influence treatment planning.
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15
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Jacobi C, Rauch J, Hagemann J, Lautz T, Reiter M, Baumeister P. Prognostic value of the lymph node ratio in oropharyngeal carcinoma stratified for HPV-status. Eur Arch Otorhinolaryngol 2017; 275:515-524. [PMID: 29204919 DOI: 10.1007/s00405-017-4833-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/29/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Lymph node ratio (LNR) was shown to be a prognostic factor in laryngeal and oral cavity primaries. The purpose of this study was to investigate the impact of the lymph node ratio in oropharyngeal squamous cell carcinoma (OPSCC) with a high incidence of HPV-related disease. Therefore, the role of LNR was evaluated as an additional predictive parameter to the 8th edition of AJCC TNM staging system. METHODS From December 2009 to August 2015, patients diagnosed with primary oropharyngeal squamous cell carcinoma were prospectively enrolled. After tumor resection with uni- or bilateral neck dissection, patients with ≥ 1 nodal metastasis (pN+) were eligible for a retrospective LNR analysis. RESULTS 137 patients underwent tumor resection with uni- or bilateral neck dissection. The proportion of HPV-associated disease was 42%. Most patients (n = 96; 70%) presented with involved neck nodes. In p16-positive OPSCC, the rate of pN + cases was significantly increased compared to p16-negative OPSCC (86% vs. 58%, p = 0.007). Patients with LNR ≤ 10% had a significant better overall survival (OS) and disease-specific survival (DSS). However, when stratified for p16-status, LNR ≤ 10% had a significant impact on OS only for HPV-associated tumors (p = 0.027), whereas LNR of ≤ 10% was not a significant predictor for better OS in p16-negative OPSCC (p = 0.143). CONCLUSION The LNR with a cut-off value of 10% serves as an additional prognostic parameter in HPV-related OPSCC and may help to improve risk stratification in combination with the revised AJCC 8th edition TNM classification.
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Affiliation(s)
- Christian Jacobi
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany.
| | - Josepha Rauch
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Jan Hagemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Johannes-Gutenberg-University Medical Center, Langenbeckstraße 1, Mainz, 55131, Germany
| | - Thomas Lautz
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian Reiter
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Philipp Baumeister
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany.,Clinical Cooperation Group Personalized Radiotherapy in Head and Neck Cancer, Helmholtz Center, Munich, Germany
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16
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Detection of HPV related oropharyngeal cancer in oral rinse specimens. Oncotarget 2017; 8:109393-109401. [PMID: 29312616 PMCID: PMC5752529 DOI: 10.18632/oncotarget.22682] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background The majority of patients diagnosed with oropharyngeal squamous cell cancer (OPSCC) are due to HPV infection. At present, there are no reliable tests for screening HPV in patients with OPSCC. The objective of this study was to assess the Cobas® HPV Test on oral rinse specimens as an early, non-invasive tool for HPV-related OPSCC. Methods Oral rinse specimens were collected from 187 patients (45 with OPSCC, 61 with oral cavity SCC (OCSCC) and 81 control patients who had benign or malignant thyroid nodules) treated at MSKCC. The Cobas® HPV Test was used to detect 14 high-risk HPV types in these samples. Performance of the HPV Test was correlated with p16 tumor immunohistochemistry as gold standard. Results 91.1% of the oropharynx cancer patients had p16 positive tumors compared to 3.3% of oral cavity cancer. Of the 81 control patients, 79 (97.5%) had no HPV in their oral rinse giving a specificity of the HPV test of 98%. For the combined oral cavity oropharynx cancer cohort, the sensitivity, specificity, positive predictive value and negative predictive value of the HPV Test were 79.1%, 90.5%, 85.0% and 86.4% respectively when p16 immunohistochemistry was used as the reference. Conclusion The Cobas® HPV Test on oral rinse is a highly specific and potentially sensitive test for oropharyngeal cancer and may be a potentially useful screening test for early oropharyngeal cancer. Impact We describe an oral rinse test for the detection of HPV related oropharyngeal cancer.
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17
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p16 immunohistochemistry in oropharyngeal squamous cell carcinoma: a comparison of antibody clones using patient outcomes and high-risk human papillomavirus RNA status. Mod Pathol 2017; 30:1194-1203. [PMID: 28621317 DOI: 10.1038/modpathol.2017.31] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/02/2017] [Accepted: 03/12/2017] [Indexed: 01/23/2023]
Abstract
High-risk human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas have a more favorable prognosis than HPV-negative ones. p16 immunohistochemistry has been recommended as a prognostic test in clinical practice. Several p16 antibodies are available, and their performance has not been directly compared. We evaluated three commercially available p16 antibody clones (E6H4, JC8 and G175-405) utilizing 199 cases of oropharyngeal squamous cell carcinoma from a tissue microarray, read by three pathologists with three different cutoffs for positivity: any staining, >50% and >75%. Positive predictive values for high-risk HPV status by RNA in situ hybridization for the E6H4, JC8 and G175-405 clones were 98%, 100% and 99% at the 75% cutoff, but negative predictive values were much more variable at 86%, 69% and 56%, respectively. These improved using the 50% cutoff, becoming similar for all three antibodies. Intensity varied substantially, with 85% of E6H4, 72% of JC8 and 67% of G175-405 showing strong (3+) intensity. With Kaplan-Meier survival plots at the 75% cutoff, the E6H4 clone showed the largest differential in disease specific and overall survival between p16-positive and -negative results. Decreasing the cutoff to 50% increased correlation with HPV in situ hybridization and improved the survival differential for the JC8 and G175-405 clones without worsening of performance for the E6H4 clone. Interobserver agreement was also assessed by kappa scores and was highest for the E6H4 clone. Overall, these study results show modest but important performance differences between the three different p16 antibody clones, suggesting that the E6H4 clone performs best because of strongest staining intensity, greatest differential in outcomes between positive and negative results, lowest interobserver variability, and lowest background, nonspecific staining. The results also suggest that a 75% cutoff is very functional but that, in this patient population with high HPV incidence, 50% and any staining cutoffs may be more effective, particularly for the non-E6H4 clones.
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18
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Jouhi L, Atula T, Saarilahti K, Hagström J, Haglund C, Mohamed H, Mäkitie A, Keski-Säntti H. Changing trends in the management of the neck in oropharyngeal squamous cell carcinoma. Head Neck 2017; 39:1412-1420. [DOI: 10.1002/hed.24781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 10/26/2016] [Accepted: 02/10/2017] [Indexed: 11/07/2022] Open
Affiliation(s)
- Lauri Jouhi
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Helsinki and Helsinki University Hospital; P.O. Box 263, FI-00029 HUS Helsinki Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Helsinki and Helsinki University Hospital; P.O. Box 263, FI-00029 HUS Helsinki Finland
| | - Kauko Saarilahti
- Department of Oncology; University of Helsinki and Helsinki University Hospital; P.O. Box 180, FI-00029 HUS Helsinki Finland
| | - Jaana Hagström
- Department of Pathology; University of Helsinki, HUSLAB, and Helsinki University Hospital; P.O. Box 21, FI-00014 Helsinki Finland
- Research Programs Unit; Translational Cancer Biology, University of Helsinki; P.O. Box 63, FI-00014 Helsinki Finland
| | - Caj Haglund
- Research Programs Unit; Translational Cancer Biology, University of Helsinki; P.O. Box 63, FI-00014 Helsinki Finland
- Department of Surgery; University of Helsinki and Helsinki University Hospital, University of Helsinki; P.O. Box 22, FI-00014 Helsinki Finland
| | - Hesham Mohamed
- Department of Pathology; University of Helsinki and Helsinki University Hospital, University of Helsinki; P.O. Box 21, FI-00014 Helsinki Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Helsinki and Helsinki University Hospital; P.O. Box 263, FI-00029 HUS Helsinki Finland
| | - Harri Keski-Säntti
- Department of Otorhinolaryngology - Head and Neck Surgery; University of Helsinki and Helsinki University Hospital; P.O. Box 263, FI-00029 HUS Helsinki Finland
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19
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Hosseini SZ, Makvandi M, Samarbafzade A, Timori A, Ranjbar N, Saki N, Nisi N, Shahani T, Varnaseri M, Angali Ahmadi K. Frequency of Human Papillomavirus (HPV) 16 and 18 Detection
in Paraffin- Embedded Laryngeal Carcinoma Tissue. Asian Pac J Cancer Prev 2017; 18:889-893. [PMID: 28545184 PMCID: PMC5494237 DOI: 10.22034/apjcp.2017.18.4.889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and Objective: Human papilloma virus (HPV) 16 and HPV18 have been detected in head and neck squamous cell carcinomas (HNSCC) and there is evidence that detection of HPVs would have better prognostic value than patients with HNSCC negative for HPVs. Thus, this study was conducted to evaluate frequency of HPV 16 and HPV 18 genotypes in patients with laryngeal carcinoma. Materials and methods: Fifty formalin-fixed, paraffin-embedded (FFPE) tissue blocks of laryngeal cancers were collected. Sections were prepared at 5 μm and DNA was extracted from each sample and subjected to the polymerase chain reaction (PCR) to detect HPV-16/18 DNA s. Results: All samples were squamous cell carcinomas (SCCs). Overall 14/50 (28%) were positive for HPVs, 8 (18%) with HPV-16 and 6 (12%) with HPV-18. Additionally, 2 (4%) mixed infections of HPV 16 and 18 genotypes were observed among these cases. Conclusions: Overall, 28% of HNSCC samples proved positive for HPV16 and HPV18 genotypes, two high-risk HPV types. It is important to further assess whether such viral infection, could be a risk factor in HNSCC progression.
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Affiliation(s)
- Seyed Zinab Hosseini
- Health Research Institute; Infectious and Tropical Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Porceddu SV, Milne R, Brown E, Bernard A, Rahbari R, Cartmill B, Foote M, McGrath M, Coward J, Panizza B. Validation of the ICON-S staging for HPV-associated oropharyngeal carcinoma using a pre-defined treatment policy. Oral Oncol 2017; 66:81-86. [DOI: 10.1016/j.oraloncology.2017.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/17/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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21
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Tassone P, Crawley M, Bovenzi C, Zhan T, Keane W, Cognetti D, Luginbuhl A, Curry J. Pathologic Markers in Surgically Treated HPV-Associated Oropharyngeal Cancer: Retrospective Study, Systematic Review, and Meta-analysis. Ann Otol Rhinol Laryngol 2017; 126:365-374. [PMID: 28397563 DOI: 10.1177/0003489417693014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Human papillomavirus-associated (HPV) oropharyngeal cancer is a unique clinical entity whose incidence is increasing. It is controversial whether traditional pathologic markers of aggressive head and neck cancer also apply in surgically treated HPV-associated disease. STUDY DESIGN Retrospective study, systematic review, and meta-analysis Data Sources: PubMed and Cochrane review. REVIEW METHODS PubMed and Cochrane review were searched for published articles on surgically treated HPV-associated oropharyngeal cancer. Eligible studies were included in a meta-analysis of survival using several clinicopathologic markers as predictors. Surgically treated HPV-positive oropharyngeal cancer patients at our institution were studied retrospectively and added to the meta-analysis. RESULTS Eight published reports, plus our retrospective series, were included in the meta-analysis. This showed significant impact on event-free survival for T stage, nodal number, perineural invasion, and lymphovascular invasion (all P < .05) but not for N stage extracapsular extension ( P = ns). CONCLUSIONS While many traditional clinico-pathologic markers of aggressive disease in head and neck cancer also impact survival in surgically treated HPV-associated oropharyngeal cancer, extracapsular extension may be less important.
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Affiliation(s)
- Patrick Tassone
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Meghan Crawley
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Cory Bovenzi
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- 2 Department of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - William Keane
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Cognetti
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam Luginbuhl
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph Curry
- 1 Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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22
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Morphologic diversity in human papillomavirus-related oropharyngeal squamous cell carcinoma: Catch Me If You Can! Mod Pathol 2017; 30:S44-S53. [PMID: 28060372 DOI: 10.1038/modpathol.2016.152] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 01/19/2023]
Abstract
As the human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma epidemic has developed in the past several decades, it has become clear that these tumors have a wide variety of morphologic tumor types and features. For the practicing pathologist, it is critical to have a working knowledge about these in order to make the correct diagnosis, not to confuse them with other lesions, and to counsel clinicians and patients on their significance (or lack of significance) for treatment and outcomes. In particular, there are a number of pitfalls and peculiarities regarding HPV-related tumors and their nodal metastases that can easily result in misclassification and confusion. This article will discuss the various morphologic types and features of HPV-related oropharyngeal carcinomas, specific differential diagnoses when challenging, and, if established, the clinical significance of each finding.
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Liskamp CP, Janssens GO, Bussink J, Melchers WJ, Kaanders JH, Verhoef CG. Adverse effect of smoking on prognosis in human papillomavirus-associated oropharyngeal carcinoma. Head Neck 2016; 38:1780-1787. [PMID: 27248701 DOI: 10.1002/hed.24516] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/02/2016] [Accepted: 05/05/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this retrospective study was to identify prognostic factors in a cohort of patients with oropharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT). METHODS Medical records of 142 patients treated with (chemo)radiotherapy between September 2005 and September 2011 were reviewed and the human papillomavirus (HPV) status was determined by polymerase chain reaction (PCR) analysis. Potential prognostic factors for 3-year locoregional control and overall survival (OS) were evaluated. RESULTS HPV-positive patients (n = 82) had locoregional control and OS of 78% and 79%, respectively. Significant prognostic factors on multivariate analysis were smoking (p = .03) for locoregional control and OS, and comorbidity (p = .04) for OS. Further stratification was done according to smoking behavior in HPV-positive patients. Locoregional control in current smokers was 67% compared to 86% in never smokers and former smokers, respectively (p = .02). CONCLUSION Smoking was the only modifiable prognostic factor in HPV-positive patients. Therefore, active stop-smoking programs must be integrated in the routine management of patients to maximize treatment results. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1780-1787, 2016.
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Affiliation(s)
- Carmen P Liskamp
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert O Janssens
- Department of Radiation Oncology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Johan Bussink
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem J Melchers
- Department of Medical Microbiology, Radboud University Medical Center Nijmegen, The Netherlands
| | - Johannes H Kaanders
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelia G Verhoef
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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Keane FK, Chen YH, Tishler RB, Schoenfeld JD, Haddad RI, Goguen LA, Catalano P, Neville BA, Margalit DN. Population-based validation of the recursive partitioning analysis-based staging system for oropharyngeal cancer. Head Neck 2016; 38:1530-8. [DOI: 10.1002/hed.24470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/01/2015] [Accepted: 03/14/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Florence K. Keane
- Harvard Radiation Oncology Program; Harvard Medical School; Boston Massachusetts
| | - Yu-Hui Chen
- Dana-Farber/Harvard Cancer Center; Boston Massachusetts
| | - Roy B. Tishler
- Department of Radiation Oncology; Dana-Farber Cancer Institute/Brigham and Women's Hospital; Boston Massachusetts
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology; Dana-Farber Cancer Institute/Brigham and Women's Hospital; Boston Massachusetts
| | - Robert I. Haddad
- Department of Medical Oncology; Dana-Farber Cancer Institute; Harvard Medical School and Department of Medicine; Brigham and Women's Hospital; Boston Massachusetts
| | - Laura A. Goguen
- Division of Otolaryngology; Department of Surgery; Brigham and Women's Hospital; Boston Massachusetts
| | - Paul Catalano
- Dana-Farber/Harvard Cancer Center; Boston Massachusetts
| | | | - Danielle N. Margalit
- Department of Radiation Oncology; Dana-Farber Cancer Institute/Brigham and Women's Hospital; Boston Massachusetts
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25
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Porceddu SV. A TNM classification for HPV+ oropharyngeal cancer. Lancet Oncol 2016; 17:403-404. [PMID: 26936026 DOI: 10.1016/s1470-2045(15)00611-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Sandro V Porceddu
- University of Queensland, Princess Alexandra Hospital, Radiation Oncology, Brisbane, QLD 4102, Australia.
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26
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O'Sullivan B, Huang SH, Su J, Garden AS, Sturgis EM, Dahlstrom K, Lee N, Riaz N, Pei X, Koyfman SA, Adelstein D, Burkey BB, Friborg J, Kristensen CA, Gothelf AB, Hoebers F, Kremer B, Speel EJ, Bowles DW, Raben D, Karam SD, Yu E, Xu W. Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study. Lancet Oncol 2016; 17:440-451. [PMID: 26936027 DOI: 10.1016/s1470-2045(15)00560-4] [Citation(s) in RCA: 499] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/27/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Human papillomavirus-related (HPV+) oropharyngeal cancer is a rapidly emerging disease with generally good prognosis. Many prognostic algorithms for oropharyngeal cancer incorporate HPV status as a stratification factor, rather than recognising the uniqueness of HPV+ disease. The International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S) aimed to develop a TNM classification specific to HPV+ oropharyngeal cancer. METHODS The ICON-S study included patients with non-metastatic oropharyngeal cancer from seven cancer centres located across Europe and North America; one centre comprised the training cohort and six formed the validation cohorts. We ascertained patients' HPV status with p16 staining or in-situ hybridisation. We compared overall survival at 5 years between training and validation cohorts according to 7th edition TNM classifications and HPV status. We used recursive partitioning analysis (RPA) and adjusted hazard ratio (AHR) modelling methods to derive new staging classifications for HPV+ oropharyngeal cancer. Recent hypotheses concerning the effect of lower neck lymph nodes and number of lymph nodes were also investigated in an exploratory training cohort to assess relevance within the ICON-S classification. FINDINGS Of 1907 patients with HPV+ oropharyngeal cancer, 661 (35%) were recruited at the training centre and 1246 (65%) were enrolled at the validation centres. 5-year overall survival was similar for 7th edition TNM stage I, II, III, and IVA (respectively; 88% [95% CI 74-100]; 82% [71-95]; 84% [79-89]; and 81% [79-83]; global p=0·25) but was lower for stage IVB (60% [53-68]; p<0·0001). 5-year overall survival did not differ among N0 (80% [95% CI 73-87]), N1-N2a (87% [83-90]), and N2b (83% [80-86]) subsets, but was significantly lower for those with N3 disease (59% [51-69]; p<0·0001). Stage classifications derived by RPA and AHR models were ranked according to survival performance, and AHR-New was ranked first, followed by AHR-Orig, RPA, and 7th edition TNM. AHR-New was selected as the proposed ICON-S stage classification. Because 5-year overall survival was similar for patients classed as T4a and T4b, T4 is no longer subdivided in the re-termed ICON-S T categories. Since 5-year overall survival was similar among N1, N2a, and N2b, we re-termed the 7th edition N categories as follows: ICON-S N0, no lymph nodes; ICON-S N1, ipsilateral lymph nodes; ICON-S N2, bilateral or contralateral lymph nodes; and ICON-S N3, lymph nodes larger than 6 cm. This resembles the N classification of nasopharyngeal carcinoma but without a lower neck lymph node variable. The proposed ICON-S classification is stage I (T1-T2N0-N1), stage II (T1-T2N2 or T3N0-N2), and stage III (T4 or N3). Metastatic disease (M1) is classified as ICON-S stage IV. In an exploratory training cohort (n=702), lower lymph node neck involvement had a significant effect on survival in ICON-S stage III but had no effect in ICON-S stage I and II and was not significant as an independent factor. Overall survival was similar for patients with fewer than five lymph nodes and those with five or more lymph nodes, within all ICON-S stages. INTERPRETATION Our proposed ICON-S staging system for HPV+ oropharyngeal cancer is suitable for the 8th edition of the Union for International Cancer Control/American Joint Committee on Cancer TNM classification. Future work is needed to ascertain whether T and N categories should be further refined and whether non-anatomical factors might augment the full classification. FUNDING None.
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Affiliation(s)
- Brian O'Sullivan
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
| | - Shao Hui Huang
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jie Su
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Nancy Lee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem Riaz
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xin Pei
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - David Adelstein
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Brian B Burkey
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Jeppe Friborg
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anita B Gothelf
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Frank Hoebers
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bernd Kremer
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ernst-Jan Speel
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - David Raben
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Sana D Karam
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Eugene Yu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Dahlstrom KR, Garden AS, William WN, Lim MY, Sturgis EM. Proposed Staging System for Patients With HPV-Related Oropharyngeal Cancer Based on Nasopharyngeal Cancer N Categories. J Clin Oncol 2016; 34:1848-54. [PMID: 26884553 DOI: 10.1200/jco.2015.64.6448] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Patients with human papillomavirus (HPV)-related oropharyngeal cancer (OPC) generally present with more advanced disease but have better survival than patients with HPV-unrelated OPC. The current American Joint Commission on Cancer (AJCC)/Union for International Cancer Control (UICC) TNM staging system for OPC was developed for HPV-unrelated OPC. A new staging system is needed to adequately predict outcomes of patients with HPV-related OPC. PATIENTS AND METHODS Patients with newly diagnosed HPV-positive OPC (by p16 immunohistochemistry or in situ hybridization) treated at our institution from January 2003 through December 2012 were included. By using recursive partitioning analysis (RPA), we developed new stage groupings with both traditional OPC regional lymph node (N) categories and nasopharyngeal carcinoma (NPC) N categories. Survival was estimated by the Kaplan-Meier method, and the relationship between stage and survival was examined by using Cox proportional hazards regression analysis. RESULTS A total of 661 patients with HPV-positive OPC met the inclusion criteria. With the traditional TNM staging system, there was no difference in survival between stages (P = .141). RPA with NPC N categories resulted in more balanced stage groups and better separation between groups for 5-year survival than RPA with traditional OPC N categories. With the stage groupings that were based in part on NPC N categories, the risk of death increased with increasing stage (P for trend < .001), and patients with stage III disease had five times the risk of death versus patients with stage IA disease. CONCLUSION New stage groupings that are based on primary tumor (T) categories and NPC N categories better separate patients with HPV-positive OPC with respect to survival than does the current AJCC/UICC TNM staging system. Although confirmation of our findings in other patient populations is needed, we propose consideration of NPC N categories as an alternative to the traditional OPC N categories in the new AJCC/UICC TNM staging system that is currently being developed.
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Affiliation(s)
| | - Adam S Garden
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William N William
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ming Yann Lim
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erich M Sturgis
- All authors: The University of Texas MD Anderson Cancer Center, Houston, TX
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Sedghizadeh PP, Billington WD, Paxton D, Ebeed R, Mahabady S, Clark GT, Enciso R. Is p16-positive oropharyngeal squamous cell carcinoma associated with favorable prognosis? A systematic review and meta-analysis. Oral Oncol 2016; 54:15-27. [PMID: 26794879 DOI: 10.1016/j.oraloncology.2016.01.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/30/2015] [Accepted: 01/01/2016] [Indexed: 12/29/2022]
Abstract
The purpose of this systematic review and meta-analysis was to compare the prognosis of patients with p16 expressing oropharyngeal squamous cell cancers to patients with p16 non-expressing cancers. Clinical outcomes that were evaluated included overall survival, local recurrence, disease-free survival, disease-specific survival, and event-free survival. The following electronic databases were searched: Cochrane Library, MEDLINE (via Pubmed), and Web of Science. Publications were restricted to English language. Studies were limited to controlled clinical trials on the survival rates of patients with oropharyngeal tumors that were p16 expressing, compared to patients with p16 non-expressing tumors, and at least one clinical endpoint reported by trial authors (hazard ratios). Specific ascertainment criteria were applied for inclusion and exclusion of eligible studies. Data was independently extracted in duplicate. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis PRISMA checklist. Risk of bias was assessed for all included studies, and disagreements between review authors were discussed until an agreement was reached. Eighteen studies were included for final review and meta-analysis. The subgroup meta-analyses, which included survival and recurrence data, showed significantly favorable outcomes for patients with p16 expressing tumors. There is strong evidence to support that patients with p16 expressing oropharyngeal squamous cell cancers have favorable clinical outcomes and prognosis.
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Affiliation(s)
- Parish P Sedghizadeh
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States.
| | - William D Billington
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
| | - Dain Paxton
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
| | - Rabeh Ebeed
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
| | - Susan Mahabady
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
| | - Glenn T Clark
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
| | - Reyes Enciso
- University of Southern California, Ostrow School of Dentistry, 925 West 34th Street, Los Angeles, CA 90089, United States
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29
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Buckley L, Gupta R, Ashford B, Jabbour J, Clark JR. Oropharyngeal cancer and human papilloma virus: evolving diagnostic and management paradigms. ANZ J Surg 2015; 86:442-7. [DOI: 10.1111/ans.13417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Lisa Buckley
- Graduate School of Medicine; University of Wollongong; Wollongong New South Wales Australia
| | - Ruta Gupta
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Bruce Ashford
- Illawarra Health and Medical Research Institute; Wollongong New South Wales Australia
| | - Joe Jabbour
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
| | - Jonathan R. Clark
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse; Sydney New South Wales Australia
- South Western Sydney Clinical School; University of New South Wales; Sydney New South Wales Australia
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30
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Liu JT, Kann BH, De B, Buckstein M, Bakst RL, Genden EM, Posner MR, Som PM, Gupta V. Prognostic value of radiographic extracapsular extension in locally advanced head and neck squamous cell cancers. Oral Oncol 2015; 52:52-7. [PMID: 26728104 DOI: 10.1016/j.oraloncology.2015.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We investigated associations between radiographic evidence of nodal extracapsular extension (rECE) and outcomes for locally advanced head and neck squamous cell cancers (LAHNC). MATERIALS AND METHODS We conducted a single-institution retrospective study of 258 consecutive LAHNC patients with accessible pretreatment contrast-enhanced neck CT scans, who completed definitive or adjuvant radiation therapy. All scans were reviewed by an expert head and neck radiologist for evidence of rECE. Kaplan-Meier and Cox regression multivariate analyses (MVA) were performed to evaluate the impact of rECE on overall survival (OS), progression free survival (PFS), distant control (DC), and locoregional control (LRC). RESULTS One-hundred forty patients were rECE-positive and 118 were rECE-negative. The rECE-positive cohort had more cN3 disease (11.6% vs. 0.8%) and heavier smoking histories (60.0% vs. 44.9% with ⩾10-pack-years). The rECE-positive cohort had significantly worse 3-year OS (64.3% vs. 82.8%, p=0.002), PFS (58.9% vs. 76.0%, p=0.001), DC (72.3% vs. 90.6%, p<0.001), and LRC (75.9% vs. 89.8%, p=0.002). On MVA, rECE independently predicted for worse OS, PFS, DC, and LRC for LAHNC overall. On subset analysis of HPV-positive oropharyngeal cancers, rECE was not a significant prognosticator. CONCLUSION For all sites of LAHNC, except HPV-positive oropharyngeal cancers, presence of rECE independently predicts for worse disease control and survival. Further studies are needed to validate these findings and demonstrate whether rECE may be considered for risk-stratifying patients for clinical trial design and treatment decisions.
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Affiliation(s)
- Jerry T Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States.
| | - Benjamin H Kann
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States
| | - Brian De
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States
| | - Eric M Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States
| | - Marshall R Posner
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States
| | - Peter M Som
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York City, NY 10029, United States
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31
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Hong A, Zhang X, Jones D, Zhang M, Lee CS, Lyons JG, Veillard AS, Rose B. E6 viral protein ratio correlates with outcomes in human papillomavirus related oropharyngeal cancer. Cancer Biol Ther 2015; 17:181-7. [PMID: 26575468 DOI: 10.1080/15384047.2015.1108489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The study aimed to identify prognostic markers to improve the management of patients with HPV positive OSCC Methods: We determined the ratio of HPV E6*I and E6*II splice variants by quantitative RT-PCR in 177 HPV positive OSCC and correlated the findings with other clinicopathological data Results: There was no significant difference in locoregional recurrence (HR 1.72 p = 0.24) and death (HR 1.65, p = 0.13) among patients whose tumors had an E6*I/*II ratio ≥1 compared with an E6*I/*II ratio of <1. Univariate analysis showed that patients with E6*I/*II ≥1 OSCC were more likely to have an event. In the multivariable analysis, there was a trend for more events in patients with E6*I/*II ratio ≥1 (HR 1.70, 95% CI 0.95-3.03, p = 0.07) CONCLUSION: Our data suggest that the use of HPV 16 spliced transcripts may help to predict for poorer outcomes in patients with HPV positive OSCC.
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Affiliation(s)
- Angela Hong
- a Central Clinical School, Sydney Medical School, The University of Sydney , NSW , Australia.,b Department of Radiation Oncology , Lifehouse , NSW , Australia
| | - Xiaoying Zhang
- c Department of Infectious Diseases and Immunology , Sydney Medical School, The University of Sydney , NSW , Australia
| | - Deanna Jones
- c Department of Infectious Diseases and Immunology , Sydney Medical School, The University of Sydney , NSW , Australia
| | - Mei Zhang
- a Central Clinical School, Sydney Medical School, The University of Sydney , NSW , Australia.,b Department of Radiation Oncology , Lifehouse , NSW , Australia
| | - C Soon Lee
- d Department of Anatomical Pathology , Royal Prince Alfred Hospital , Camperdown , NSW , Australia
| | - J Guy Lyons
- a Central Clinical School, Sydney Medical School, The University of Sydney , NSW , Australia
| | | | - Barbara Rose
- c Department of Infectious Diseases and Immunology , Sydney Medical School, The University of Sydney , NSW , Australia
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32
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Huang SH, Xu W, Waldron J, Hope AJ, O'Sullivan B. Reply to J.J. Beitler et al. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.62.5715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shao Hui Huang
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J. Hope
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Franceschini D, Paiar F, Saieva C, Bonomo P, Agresti B, Meattini I, Greto D, Mangoni M, Meacci F, Loi M, Zei G, Livi L, Biti G. Prognostic factors in patients with locally advanced head and neck cancer treated with concurrent radiochemotherapy. Radiol Med 2015; 121:229-37. [PMID: 26403512 DOI: 10.1007/s11547-015-0586-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/19/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE This study was undertaken to evaluate the association of individual parameters and outcome in patients with unresectable locally advanced head and neck cancer treated with radiochemotherapy. MATERIALS AND METHODS We retrospectively reviewed data from 126 patients treated in our Institution between 1998 and 2010 for a locally advanced head and neck cancer. Sixteen individual parameters were evaluated for association with specific outcomes such as overall survival, persistence of disease, disease-specific survival and disease-free survival. RESULTS Six factors influenced overall survival on Kaplan-Meier survival analysis and on univariate Cox regression analysis: smoking, body mass index, site, haemoglobin (Hb) nadir, total dose of radiotherapy and comorbidities. On a multivariate logistic model with stepwise selection, comorbidities, body mass index, total dose and site maintained significance. A significant association for persistence of disease was found with smoking, Hb nadir and site of cancer on univariate and multivariate analysis. Disease-free survival was correlated with performance status, Hb nadir and comorbidities using Kaplan-Meier survival analysis and on univariate Cox regression analysis. Only performance status maintained the significance on multivariate analysis. Disease-specific survival was correlated with five parameters: body mass index, site, Hb nadir, therapy interruption and total dose; on multivariate analysis, Hb nadir, therapy interruption and site maintained a statistically significant association. CONCLUSIONS Hb nadir during treatment, body mass index, smoking, stage, comorbidities and performance status are prognostic factors of outcome and response to radical treatment with radiochemotherapy.
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Affiliation(s)
- Davide Franceschini
- Department of Radiation-Oncology, University of Florence, Florence, Italy.
- Department of Radiotherapy, University of Florence, Largo G.A. Brambilla 3, 50134, Florence, Italy.
| | - Fabiola Paiar
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Calogero Saieva
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Center (ISPO), Florence, Italy
| | - Pierluigi Bonomo
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Benedetta Agresti
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Daniela Greto
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Monica Mangoni
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Fiammetta Meacci
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Mauro Loi
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Giacomo Zei
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Radiation-Oncology, University of Florence, Florence, Italy
| | - Giampaolo Biti
- Department of Radiation-Oncology, University of Florence, Florence, Italy
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Murray S, Ha MN, Thompson K, Hart RD, Rajaraman M, Snow SL. A different entity: a population based study of characteristics and recurrence patterns in oropharyngeal squamous cell carcinomas. J Otolaryngol Head Neck Surg 2015; 44:30. [PMID: 26310237 PMCID: PMC4551366 DOI: 10.1186/s40463-015-0082-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/09/2015] [Indexed: 02/02/2023] Open
Abstract
Background Cases of squamous cell carcinoma (SCC) of the oropharynx were compared with other head and neck cancer (HNC) anatomic subsites in patients treated at the provincial referral centre for HNC, the Nova Scotia Cancer Centre (NSCC). Methods A retrospective chart review was performed on HNC patients assessed at the NSCC between 2010 and 2011. Patient demographics, disease characteristics, treatment details and outcomes, including recurrence rates and survival were collected. Data was collected on new and recurrent cases of HNC. This data was compared between the two types of HNC using chi-square tests for dichotomous categorical variables or Fishers exact test where appropriate. Wald test was used to compare categorical variables with 3 categories. Continuous variables were compared using the non-parametric Wilcoxon test. Results 318 charts were included in the analysis. 122 (38 %) were oropharyngeal squamous cell carcinomas (OPSCCs). In terms of disease characteristics, OPSCCs were more likely to be poorly differentiated/undifferentiated (n = 267, 49(40 %) vs 42(21 %), p < 0.001), non-keratinizing (n = 169, 25(20 %) vs 17(9 %), p < 0.001), greater than 2 cm (n = 253, 72(59 %) vs 78(40 %), p = 0.0061), stage 4 (n = 313, 55(45 %) vs 64(33 %), p = 0.0315) and have had locoregional nodal spread (n = 315, 103(84 %) vs 55(28 %), p < 0.001). In the subset of 57 patients that had p16 testing, OPSCCs were more likely to be p16(+) (37(30 %) vs 1(1 %), p < .001). There were no significant differences in terms of Charlson probability of 10 year survival, smoking or alcohol consumption although OPSCC patients were significantly less likely to have COPD as a co-morbidity (n = 318, 19(16 %) vs 53(27 %), p = 0.0175). Finally, OPSCCs had less chance for relapse than non-OPSCCs in both univariate (2.119 times less, p=0.0034) and multivariate (1.899 times less, p=0.0505) analyses along with a 1.822 times less overall mortality in a multivariae analysis (p=0.0408). Conclusions This analysis suggests that Nova Scotian OPSCCs should be considered distinct from other HNC lesions, most notably in terms of disease characteristics and prognosis. Specifically, despite a higher association with disease factors traditionally considered to be linked to poor prognosis, outcomes were actually superior in terms of relapse and overall mortality.
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Affiliation(s)
- Scott Murray
- Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada.
| | - Michael N Ha
- Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada.
| | - Kara Thompson
- Dalhousie University, Research Methods Unit, Halifax, Nova Scotia, Canada.
| | - Robert D Hart
- Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada. .,Department of Surgery, Division of Otolaryngology, Capital District Health Authority, Halifax, Nova Scotia, Canada.
| | - Murali Rajaraman
- Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada. .,Department of Radiation Oncology, Capital District Health Authority, Halifax, Nova Scotia, Canada.
| | - Stephanie L Snow
- Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, Canada. .,Department of Internal Medicine, Division of Medical Oncology, Capital District Health Authority, Halifax, Nova Scotia, Canada.
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35
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Parshad S, Nandi S, Marwah N, Mehta P, Tripathi M, Netrapal, Gogna S, Karwasra RK. Human papillomavirus 16 and 18 in squamous cell carcinoma of oral cavity and sexual practices: A pilot study at a Tertiary Care Hospital of North India. Natl J Maxillofac Surg 2015; 6:185-9. [PMID: 27390494 PMCID: PMC4922230 DOI: 10.4103/0975-5950.183857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Oral squamous cell carcinoma (OSCC) is the most common malignancy in India and tobacco and betel nut chewing are well established risk factors. Despite successful campaigns to help people shun this habit in developing countries the incidence has rather gone up and HPV and sexual practices are now definitely implicated for this. AIM An attempt was made to generate Indian data on role of HPV and sexual practices in relation to OSCC. SETTINGS AND DESIGN A prospective observational study was conducted on 50 patients with oral squamous cell carcinoma. MATERIALS AND METHODS Tissue biopsies from fifty patients of oral squamous cell carcinoma (OSCC) were subjected to PCR analysis to look for presence of HPV 16 and 18. Fifty patients with benign lesions were taken as control. STATISTICAL METHODS USED The data was statistically analysed using SPSS version 22 and chi square test. RESULTS 42% of OSCC patients were found to harbour HPV 16 and 18 whereas only 8% of patients with benign lesions had HPV 16 and 18. A significant number of HPV positive patients i.e. 9 out of 21 gave history of multiple sexual partners and oral sex. CONCLUSIONS This high percentage of HPV in OSCC in an Indian population from a tertiary care centre in north India and its association with prevailing sexual practices is quite significant.
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Affiliation(s)
- Sanjeev Parshad
- Department of Surgery, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Sourabh Nandi
- Department of Surgery, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nisha Marwah
- Department of Pathology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Promod Mehta
- Department of Biotechnology, Maharshi Dayanand University, Rohtak, Haryana, India
| | - Mayank Tripathi
- Department of Surgical Oncology, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Netrapal
- Department of Biotechnology, Maharshi Dayanand University, Rohtak, Haryana, India
| | - Shekhar Gogna
- Department of Surgery, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - R. K. Karwasra
- Department of Surgery, Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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36
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Hong A, Lee CS, Jones D, Veillard AS, Zhang M, Zhang X, Smee R, Corry J, Porceddu S, Milross C, Elliott M, Clark J, Rose B. Rising prevalence of human papillomavirus-related oropharyngeal cancer in Australia over the last 2 decades. Head Neck 2015; 38:743-50. [PMID: 25521312 DOI: 10.1002/hed.23942] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND This study provides Australian data on the characteristics of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC) over the last 2 decades. METHODS The HPV status of 515 patients with oropharyngeal SCC diagnosed between 1987 and 2010 was determined by HPV E6-targeted multiplex real time polymerase chain reaction assay (PCR) and p16 immunohistochemistry. RESULTS The HPV positivity rate increased from 20.2% (1987-1995) to 63.5% (2006-2010). Among HPV-positive oropharyngeal SCC over the study period, the median age increased from 55.4 years to 59.8 years (p = .004) and there was a trend of an increasing proportion of never smokers (19.2% to 34.0%). The use of radiation therapy (RT) in patients with HPV-positive oropharyngeal cancer increased from 26.9% to 68.1% (p = .007) and we also observed a trend of improved outcomes. CONCLUSION Our data show a rising prevalence of HPV-positive oropharyngeal SCC in Australia over the last 2 decades. These patients with HPV-positive oropharyngeal SCC are now presenting at an older age and about one third have never smoked.
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Affiliation(s)
- Angela Hong
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Radiation Oncology, Lifehouse, Sydney, New South Wales, Australia
| | - C Soon Lee
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Deanna Jones
- Department of Infectious Diseases and Immunology, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne-Sophie Veillard
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mei Zhang
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Radiation Oncology, Lifehouse, Sydney, New South Wales, Australia
| | - Xiaoying Zhang
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Robert Smee
- Department of Radiation Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - June Corry
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Sandro Porceddu
- Cancer Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Christopher Milross
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Radiation Oncology, Lifehouse, Sydney, New South Wales, Australia
| | - Michael Elliott
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Barbara Rose
- Department of Infectious Diseases and Immunology, The University of Sydney, Sydney, New South Wales, Australia
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37
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Zhang M, Rose B, Lee CS, Hong AM. In vitro 3-dimensional tumor model for radiosensitivity of HPV positive OSCC cell lines. Cancer Biol Ther 2015; 16:1231-40. [PMID: 26046692 DOI: 10.1080/15384047.2015.1056410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The incidence of oropharyngeal squamous cell carcinoma (OSCC) is increasing due to the rising prevalence of human papillomavirus (HPV) positive OSCC. HPV positive OSCC is associated with better outcomes than HPV negative OSCC. Our aim was to explore the possibility that this favorable prognosis is due to the enhanced radiosensitivity of HPV positive OSCC. HPV positive OSCC cell lines were generated from the primary OSCCs of 2 patients, and corresponding HPV positive cell lines generated from nodal metastases following xenografting in nude mice. Monolayer and 3 dimensional (3D) culture techniques were used to compare the radiosensitivity of HPV positive lines with that of 2 HPV negative OSCC lines. Clonogenic and protein assays were used to measure survival post radiation. Radiation induced cell cycle changes were studied using flow cytometry. In both monolayer and 3D culture, HPV positive cells exhibited a heterogeneous appearance whereas HPV negative cells tended to be homogeneous. After irradiation, HPV positive cells had a lower survival in clonogenic assays and lower total protein levels in 3D cultures than HPV negative cells. Irradiated HPV positive cells showed a high proportion of cells in G1/S phase, increased apoptosis, an increased proliferation rate, and an inability to form 3D tumor clumps. In conclusion, HPV positive OSCC cells are more radiosensitive than HPV negative OSCC cells in vitro, supporting a more radiosensitive nature of HPV positive OSCC.
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Key Words
- 3 dimensional, 3D
- 3D scaffold
- 5-bromo-2 485 0 -deoxy-uridine, BrdU
- DNA damage
- Gray, Gy
- Human papillomavirus, HPV
- Immunohistochemistry, IHC
- In situ ybridization, ISH
- Oropharyngeal cancer
- Oropharyngeal squamous cell carcinoma, OSCC
- P16INK4, p16
- Propodium iodide, PI
- Ribonuclease A, RNAse
- apoptosis
- cell cycle
- epithelial-mesenchymal transition, EMT
- human papillomavirus
- polymerase chain reaction, PCR
- radiosensitivity
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Affiliation(s)
- Mei Zhang
- a Sydney Medical School; Central Clinical School ; The University of Sydney ; Sydney , NSW , Australia
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38
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Keane FK, Chen YH, Neville BA, Tishler RB, Schoenfeld JD, Catalano PJ, Margalit DN. Changing prognostic significance of tumor stage and nodal stage in patients with squamous cell carcinoma of the oropharynx in the human papillomavirus era. Cancer 2015; 121:2594-602. [PMID: 25873094 DOI: 10.1002/cncr.29402] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/10/2015] [Accepted: 03/11/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) tends to present at an advanced nodal stage (N stage), the prognosis is generally better than that for HPV-negative OPSCC. Prior work has demonstrated the increasing incidence of HPV-related OPSCC in the United States. This study was designed to determine whether the changing epidemiology of OPSCC is reflected in changes in the prognostic significance of the tumor stage (T stage) and the N stage in a population-based cohort. METHODS The Surveillance, Epidemiology, and End Results program was used to identify 13,328 patients who were 18 years old or older and were diagnosed with OPSCC from 1997 to 2008. The Kaplan-Meier method was used to estimate head and neck cancer-specific survival. Cox proportional hazards models were used to evaluate the associations between head and neck cancer-specific mortality (HNCSM) and T and N stages and the interaction of variables with the year of diagnosis. RESULTS With a median follow-up of 67 months, there were 4099 head and neck cancer deaths. There was a significant interaction between the T stage and time (P for interaction = .01), with the effect of the T stage on HNCSM increasing from 1997 to 2008. The T stage retained a linear relationship with HNCSM. The effect of the N stage on HNCSM declined over time (P for interaction = .0004). The current American Joint Committee on Cancer (AJCC) staging system did not subdivide distinct prognostic subgroups for HNCSM by overall stage. CONCLUSIONS In this population-based study of OPSCC, the effect of the N stage on cancer-specific mortality decreased over time as the impact of the T stage increased. The current AJCC staging system did not distinguish prognostic subgroups. These changes may reflect the increasing prevalence of HPV-related OPSCC. Further study in HPV-defined cohorts is needed to tailor the AJCC staging system to better reflect HNCSM risk. Cancer 2015;121:2594-2602. © 2015 American Cancer Society.
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Affiliation(s)
| | - Yui-Hui Chen
- Department of Biostatistics and Computational Biology, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | | | - Roy B Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul J Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Danielle N Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
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39
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Kaczmar JM, Tan KS, Heitjan DF, Lin A, Ahn PH, Newman JG, Rassekh CH, Chalian AA, O'Malley BW, Cohen RB, Weinstein GS. HPV-related oropharyngeal cancer: Risk factors for treatment failure in patients managed with primary transoral robotic surgery. Head Neck 2015; 38:59-65. [PMID: 25197014 DOI: 10.1002/hed.23850] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine clinical factors that predict locoregional recurrence or distant metastasis in patients with human papillomavirus (HPV)-positive oropharyngeal cancer treated with surgery and guideline-indicated adjuvant therapy. METHODS We identified all presumed HPV-positive patients with oropharyngeal cancer in our health system from January 2010 to August 2012 treated with surgery and guideline-indicated adjuvant therapy. Statistical analysis was performed to identify clinical predictors associated with treatment failure. RESULTS One hundred fourteen p16+ oropharyngeal cancers managed with initial surgical resection were identified. Median follow-up was 17 months. Two-year locoregional failure was 3.3% and distant failure was 8.4%. Statistical analysis found that conventional poor prognostic features did not predict treatment failure. CONCLUSION Locoregional recurrence and development of distant metastatic disease are uncommon in patients who are appropriately selected for surgical management of p16+ oropharyngeal cancer regardless of the presence or absence of conventional poor prognostic features.
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Affiliation(s)
- John M Kaczmar
- Department of Medical Oncology, Fox Chase Cancer Center/Temple University, Philadelphia, Pennsylvania
| | - Kay See Tan
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel F Heitjan
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter H Ahn
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason G Newman
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher H Rassekh
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ara A Chalian
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bert W O'Malley
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roger B Cohen
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory S Weinstein
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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40
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Huang SH, Xu W, Waldron J, Siu L, Shen X, Tong L, Ringash J, Bayley A, Kim J, Hope A, Cho J, Giuliani M, Hansen A, Irish J, Gilbert R, Gullane P, Perez-Ordonez B, Weinreb I, Liu FF, O'Sullivan B. Refining American Joint Committee on Cancer/Union for International Cancer Control TNM stage and prognostic groups for human papillomavirus-related oropharyngeal carcinomas. J Clin Oncol 2015; 33:836-45. [PMID: 25667292 DOI: 10.1200/jco.2014.58.6412] [Citation(s) in RCA: 306] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To refine stage and prognostic group for human papillomavirus (HPV) -related nonmetastatic (M0) oropharyngeal cancer (OPC). METHODS All patients with nonmetastatic (M0) p16-confirmed OPC treated with radiotherapy with or without chemotherapy from 2000 to 2010 were included. Overall survival (OS) was compared among TNM stages for patients with HPV-related and HPV-unrelated OPC separately. For HPV-related OPC, recursive partitioning analysis (RPA) derived new RPA stages objectively. Cox regression was used to calculate adjusted hazard ratios (AHRs) to derive AHR stages. The performance of survival prediction of RPA stage and AHR stage was assessed against the current seventh edition TNM stages. Prognostic groups were derived by RPA, combining RPA stage and nonanatomic factors. RESULTS The cohort comprised 573 patients with HPV-related OPC and 237 patients with HPV-unrelated OPC, with a median follow-up of 5.1 years. Lower 5-year OS with higher TNM stage was evident for patients with HPV-unrelated OPC (stage I, II, III, and IV 5-year OS: 70%, 58%, 50%, and 30%, respectively; P = .004) but not for patients with HPV-related OPC (stage I, II, III, and IV 5-year OS: 88%, 78%, 71%, and 74%, respectively; P = .56). RPA divided HPV-related OPC into RPA-I (T1-3N0-2b), RPA-II (T1-3N2c), and RPA-III (T4 or N3; 5-year OS: 82%, 76%, and 54%, respectively; P < .001). AHR also yielded a valid classification, but RPA stage demonstrated better survival prediction. A further RPA (including RPA stage, age, and smoking pack-years [PYs]) derived the following four valid prognostic groups for survival: group I (T1-3N0-N2c_≤ 20 PY), group II (T1-3N0-N2c_> 20 PY), group III (T4 or N3_age ≤ 70), and group IVA (T4 or N3_age > 70; 5-year OS: 89%, 64%, 57%, and 40%, respectively; P < .001). CONCLUSION An RPA-based TNM stage grouping (stage I/II/III: T1-3N0-N2b/T1-3N2c/T4 or N3, with M1 as stage IV) is proposed for HPV-related OPC as a result of significantly improved survival prediction compared with the seventh edition TNM, and prognostication is further improved by an RPA-based prognostic grouping within the American Joint Committee on Cancer/Union for International Cancer Control TNM framework for HPV-related OPC.
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Affiliation(s)
- Shao Hui Huang
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - John Waldron
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Lillian Siu
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Xiaowei Shen
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Li Tong
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Jolie Ringash
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew Bayley
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - John Kim
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew Hope
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - John Cho
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Aaron Hansen
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Irish
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Patrick Gullane
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Bayardo Perez-Ordonez
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Ilan Weinreb
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Shao Hui Huang, Wei Xu, John Waldron, Lillian Siu, Xiaowei Shen, Li Tong, Jolie Ringash, Andrew Bayley, John Kim, Andrew Hope, John Cho, Meredith Giuliani, Aaron Hansen, Jonathan Irish, Ralph Gilbert, Patrick Gullane, Bayardo Perez-Ordonez, Ilan Weinreb, Fei-Fei Liu, and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto; and Fei-Fei Liu and Brian O'Sullivan, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada.
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41
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Mackenzie P, Pryor D, Burmeister E, Foote M, Panizza B, Burmeister B, Porceddu S. T-category Remains an Important Prognostic Factor for Oropharyngeal Carcinoma in the Era of Human Papillomavirus. Clin Oncol (R Coll Radiol) 2014; 26:643-7. [DOI: 10.1016/j.clon.2014.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/31/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
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42
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Ward MJ, Mellows T, Harris S, Webb A, Patel NN, Cox HJ, Piper K, Ottensmeier CH, Thomas GJ, King EV. Staging and treatment of oropharyngeal cancer in the human papillomavirus era. Head Neck 2014; 37:1002-13. [PMID: 24753272 DOI: 10.1002/hed.23697] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/28/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Oropharyngeal squamous cell carcinoma (SCC) is staged using the TNM system. Human papillomavirus (HPV)-positive tumors have improved prognosis, despite presenting at advanced stage. Optimal treatment and stratification of HPV-positive patients are not clearly defined. METHODS We retrospectively analyzed 266 patients with oropharyngeal SCC for mortality and feeding tube dependency related to TNM stage, HPV status, and treatment. RESULTS TNM staging was prognostic in HPV-negative patients (stage III/IV hazard ratio [HR], 2.00; p = .05; N(+) HR, 2.19; p = .02). Only T classification was prognostic in HPV-positive tumors (T3/T4 HR 3.31; p = .006). HPV-positive tumors showed improved survival regardless of treatment. Patients receiving chemotherapy had a significantly increased risk of feeding tube dependency (odds ratio [OR], 1.72; p = .03). CONCLUSION These data suggest that the current TNM system has little prognostic value in HPV-positive oropharyngeal SCC. Patients with HPV-positive tumors show improved survival independent of treatment. The addition of chemotherapy increases the risk of feeding tube dependency and could potentially be avoided in T1/T2 HPV-positive tumors without compromising survival.
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Affiliation(s)
- Matthew J Ward
- Cancer Sciences Unit, University of Southampton, United Kingdom
| | - Toby Mellows
- Cancer Sciences Unit, University of Southampton, United Kingdom
| | - Scott Harris
- Department of Medical Statistics, University of Southampton, United Kingdom
| | - Andrew Webb
- Department of Oral and Maxillofacial Surgery, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Nimesh N Patel
- Department of Otolaryngology - Head and Neck Surgery, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Hugh J Cox
- Department of Otolaryngology - Head and Neck Surgery, Poole NHS Foundation Trust, United Kingdom
| | - Kim Piper
- Department of Cellular Pathology, Bart's and The London School of Medicine and Dentistry, United Kingdom
| | - Christian H Ottensmeier
- Cancer Sciences Unit, University of Southampton, United Kingdom.,NIHR Experimental Cancer Medicine Centre Southampton, United Kingdom
| | - Gareth J Thomas
- Cancer Sciences Unit, University of Southampton, United Kingdom.,NIHR Experimental Cancer Medicine Centre Southampton, United Kingdom
| | - Emma V King
- Cancer Sciences Unit, University of Southampton, United Kingdom.,Department of Otolaryngology - Head and Neck Surgery, Poole NHS Foundation Trust, United Kingdom.,NIHR Experimental Cancer Medicine Centre Southampton, United Kingdom
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43
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Saito Y, Ebihara Y, Ushiku T, Omura G, Kobayashi K, Ando M, Sakamoto T, Fukayama M, Yamasoba T, Asakage T. Negative Human Papillomavirus Status and Excessive Alcohol Consumption are Significant Risk Factors for Second Primary Malignancies in Japanese Patients with Oropharyngeal Carcinoma†. Jpn J Clin Oncol 2014; 44:564-9. [DOI: 10.1093/jjco/hyu042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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44
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Kann BH, Buckstein M, Carpenter TJ, Bakst R, Misiukiewicz K, Genden E, Posner M, Kostakoglu L, Som P, Gupta V. Radiographic extracapsular extension and treatment outcomes in locally advanced oropharyngeal carcinoma. Head Neck 2014; 36:1689-94. [DOI: 10.1002/hed.23512] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
- Benjamin H. Kann
- Department of Radiation Oncology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Michael Buckstein
- Department of Radiation Oncology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Todd J. Carpenter
- Department of Radiation Oncology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Richard Bakst
- Department of Radiation Oncology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Krzysztof Misiukiewicz
- Department of Hematology and Oncology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Eric Genden
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine at Mount Sinai; New York New York
| | - Marshall Posner
- Department of Hematology and Oncology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Lale Kostakoglu
- Department of Radiology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Peter Som
- Department of Radiology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Vishal Gupta
- Department of Radiation Oncology; Icahn School of Medicine at Mount Sinai; New York New York
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45
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Cooper T, Biron V, Adam B, Klimowicz AC, Puttagunta L, Seikaly H. Prognostic utility of basaloid differentiation in oropharyngeal cancer. J Otolaryngol Head Neck Surg 2013; 42:57. [PMID: 24350944 PMCID: PMC3892036 DOI: 10.1186/1916-0216-42-57] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 11/21/2013] [Indexed: 12/24/2022] Open
Abstract
Background Human papillomavirus (HPV) is recognized as the key risk factor for a distinct subset of oropharyngeal squamous cell carcinoma. P16 is a reliable, sensitive surrogate marker for HPV and confers a positive prognostic advantage. Basaloid differentiation on hematoxylin and eosin (H&E) staining is anecdotally noted by some pathologists to be associated with p16 positivity. This association, however, has not been adequately quantified in the literature, nor has the prognostic implications of basaloid differentiation been described. Objectives 1) To correlate the H&E staining feature of basaloid differentiation with p16 positivity in oropharyngeal cancer. 2) To investigate the prognostic utility of basaloid differentiation in oropharyngeal cancer survival. Methods Retrospective cross-sectional study of all patients diagnosed with and treated for oropharyngeal cancer at a single tertiary cancer center from 2002 to 2009. Tissue microarrays (TMAs) were generated from 208 oropharyngeal tumor specimens stained with H&E and immunohistochemical markers. These oropharyngeal TMAs were utilized in several previous publications. Samples were scored for basaloid differentiation by a pathologist blinded to the p16 result. A multivariate survival analysis with Cox-regression and Kaplan-Meier survival analysis was performed. Results In the 208 samples, basaloid differentiation correlated with p16 positivity (Spearman’s rho 0.435). Basaloid differentiation and p16 positivity were both independent predictors of improved survival. The 5 year disease specific survival (DSS) was 73% for p16 positive tumors and 35% for p16 negative tumors (p < 0.001). Similarly, the 5 year DSS of basaloid differentiated tumors was 74% compared to 41% for non-basaloid tumors (p = 0.001). Patients with p16 positive and basaloid differentiated tumors had the best survival outcomes with a 5 year DSS of 80%. Conclusions Basaloid differentiation is a feature on H&E which correlates with p16 positivity and is a simple, inexpensive, independent, positive prognostic indicator of comparable magnitude to p16 status. Due to the added prognostic value of basaloid differentiation, this feature should be routinely reported by qualified pathologists.
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Affiliation(s)
| | | | | | | | | | - Hadi Seikaly
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB T6G 2B7, Canada.
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46
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Petrelli F, Sarti E, Barni S. Predictive value of human papillomavirus in oropharyngeal carcinoma treated with radiotherapy: An updated systematic review and meta-analysis of 30 trials. Head Neck 2013; 36:750-9. [DOI: 10.1002/hed.23351] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/27/2013] [Accepted: 04/09/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Fausto Petrelli
- Medical Oncology Unit; Oncology Department; Azienda Ospedaliera Treviglio, Piazzale Ospedale 1 24047 Treviglio (BG) Italy
| | - Enrico Sarti
- Radiotherapy Unit; Oncology Department; Azienda Ospedaliera Treviglio, Piazzale Ospedale 1 24047 Treviglio (BG) Italy
| | - Sandro Barni
- Medical Oncology Unit; Oncology Department; Azienda Ospedaliera Treviglio, Piazzale Ospedale 1 24047 Treviglio (BG) Italy
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47
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Ruttkay-Nedecky B, Jimenez Jimenez AM, Nejdl L, Chudobova D, Gumulec J, Masarik M, Adam V, Kizek R. Relevance of infection with human papillomavirus: the role of the p53 tumor suppressor protein and E6/E7 zinc finger proteins (Review). Int J Oncol 2013; 43:1754-62. [PMID: 24045364 DOI: 10.3892/ijo.2013.2105] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/12/2013] [Indexed: 12/13/2022] Open
Abstract
Human papillomaviruses (HPV) are small circular, double-stranded DNA viruses infecting epithelial tissues. HPV types can be classified both as high-risk or low-risk. Of the more than 120 different identified types of HPV, the majority are involved in infections of the genital tract, cancer of the cervix, vulva, vagina and penis, and of non-anogenital localizations, such as the head and neck areas. From the point of view of the infection, human papillomaviruses have developed several molecular mechanisms to enable infected cells to suppress apoptosis. This review provides a comprehensive and critical summary of the current literature that focuses on cervical carcinoma and cancer of the head and neck caused by HPV. In particular, we discuss HPV virology, the molecular mechanisms of carcinogenesis, the role of the tumor suppressor protein p53 and the E6/E7 zinc finger proteins. Classification of HPV according to diagnosis is also described.
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Affiliation(s)
- Branislav Ruttkay-Nedecky
- Department of Chemistry and Biochemistry, Faculty of Agronomy, Mendel University in Brno, CZ-613 00 Brno, Czech Republic
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48
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Habbous S, Harland LTG, La Delfa A, Fadhel E, Xu W, Liu FF, Goldstein D, Waldron J, Huang SH, O'Sullivan B, Liu G. Comorbidity and prognosis in head and neck cancers: Differences by subsite, stage, and human papillomavirus status. Head Neck 2013; 36:802-10. [DOI: 10.1002/hed.23360] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/01/2013] [Accepted: 04/11/2013] [Indexed: 01/16/2023] Open
Affiliation(s)
- Steven Habbous
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Biostatistics; Princess Margaret Hospital; Toronto Ontario Canada
| | - Luke T. G. Harland
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
| | - Anthony La Delfa
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
| | - Ehab Fadhel
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
| | - Wei Xu
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Biostatistics; Princess Margaret Hospital; Toronto Ontario Canada
| | - Fei-Fei Liu
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Radiation Oncology; University of Toronto; Toronto Ontario Canada
| | - David Goldstein
- Department of Otolaryngology - Head and Neck Surgery; Princess Margaret Cancer Centre; University Health Network, University of Toronto; Toronto Ontario Canada
| | - John Waldron
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Radiation Oncology; University of Toronto; Toronto Ontario Canada
| | - Shao-Hui Huang
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Radiation Oncology; University of Toronto; Toronto Ontario Canada
| | - Brian O'Sullivan
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Radiation Oncology; University of Toronto; Toronto Ontario Canada
| | - Geoffrey Liu
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Medical Biophysics and Epidemiology; Division of Epidemiology; Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
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49
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Betiol J, Villa LL, Sichero L. Impact of HPV infection on the development of head and neck cancer. Braz J Med Biol Res 2013; 46:217-26. [PMID: 23532264 PMCID: PMC3854371 DOI: 10.1590/1414-431x20132703] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/03/2013] [Indexed: 01/20/2023] Open
Abstract
Human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC)
is considered to be a distinct clinical entity with better prognosis than the
classical tobacco- and alcohol-associated tumors. The increasing incidence of
this neoplasia during the last decades highlights the need to better understand
the role of HPV in the development of these cancers. Although the proportion of
HNSCC attributed to HPV varies considerably according to anatomical site,
overall approximately 25% of all HNSCC are HPV-DNA positive, and HPV-16 is by
far the most prevalent type. In this review we discuss the existing evidence for
a causal association between HPV infection and HNSCC at diverse anatomical head
and neck subsites.
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Affiliation(s)
- J Betiol
- Laboratório de Biologia Molecular, Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo,São Paulo, SP, Brasil
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50
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Hong A, Jones D, Chatfield M, Lee CS, Zhang M, Clark J, Elliott M, Harnett G, Milross C, Rose B. HPV status of oropharyngeal cancer by combination HPV DNA/p16 testing: biological relevance of discordant results. Ann Surg Oncol 2012. [PMID: 23208131 DOI: 10.1245/s10434-012-2778-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Human papillomavirus (HPV) causes up to 70 % of oropharyngeal cancers (OSCC). HPV positive OSCC has a more favorable outcome, thus HPV status is being used to guide treatment and predict outcome. Combination HPV DNA/p16(ink4) (p16) testing is commonly used for HPV status, but there are no standardized methods, scoring or interpretative criteria. The significance of discordant (HPV DNA positive/p16 negative and HPV DNA negative/p16 positive) cancers is controversial. In this study, 647 OSCCs from 10 Australian centers were tested for HPV DNA/p16 expression. Our aims are to determine p16 distribution by HPV DNA status to inform decisions on p16 scoring and to assess clinical significance of discordant cancers. METHODS HPV DNA was identified using a multiplex tandem HPV E6 polymerase chain reaction (PCR) assay and p16 expression by semiquantitative immunohistochemistry. RESULTS p16 distribution was essentially bimodal (42 % of cancers had ≥ 70 % positive staining, 52 % <5 % positive, 6 % between 5 and 70 %). Cancers with 5 to <50 % staining had similar characteristics to the p16 negative group, and cancers with 50 to <70 % staining were consistent with the ≥ 70 % group. Using a p16 cut-point of 50 %, there were 25 % HPV DNA positive/p16 negative cancers and 1 % HPV DNA negative/p16 positive cancers. HPV DNA positive/p16 negative cancers had outcomes similar to HPV DNA negative/p16 negative cancers. CONCLUSIONS 50 % is a reasonable cut-point for p16; HPV DNA positive/p16 negative OSCCs may be treated as HPV negative for clinical purposes; HPV DNA/p16 testing may add no prognostic information over p16 alone.
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Affiliation(s)
- Angela Hong
- Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia,
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