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Mrosk F, Doll C, Scheer J, Neumann F, Hofmann E, Kreutzer K, Voss J, Rubarth K, Beck M, Heiland M, Koerdt S. Oncologic Outcome in Advanced Oral Squamous Cell Carcinoma After Refusal of Recommended Adjuvant Therapy. JAMA Otolaryngol Head Neck Surg 2023; 149:1027-1033. [PMID: 37824130 PMCID: PMC10570914 DOI: 10.1001/jamaoto.2023.3111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/28/2023] [Indexed: 10/13/2023]
Abstract
Importance Clinicians may be confronted with patients refusing recommended adjuvant therapy (AT) after the primary resection of an advanced oral squamous cell carcinoma (OSCC). However, for this tumor entity, data are lacking regarding the oncological outcomes and associated factors after refusal of AT. Objective To evaluate the difference in survival and disease recurrence for patients with and without recommended AT after resection of advanced OSCC. Design, Setting, and Participants In this single-center retrospective matched cohort study, patients with advanced OSCC who refused recommended AT between January 2010 and December 2021 were matched 1:1 according to Union for International Cancer Control tumor staging with patients who completed AT. Exposures Patients with advanced OSCC who refused or completed recommended AT between 2010 and 2021. Main Outcomes and Measures The primary outcome of this study was the comparison of overall survival (OS) and recurrence-free survival (RFS) between the 2 study groups. Results A total of 82 patients (mean [SD] age at time of surgery, 68.0 [11.3] years; 38 [46.3%] female, 44 [53.7%] male) with and without AT (41 per study group) were included in the analysis. Patients refusing AT developed more frequent disease recurrence than patients who completed AT (61.0% vs 26.8%; difference, 34.2%; odds ratio, 4.26; 95% CI, 1.68-10.84). In addition, patients who refused AT presented with lower 2-year OS (72.7% vs 88.6%; difference, 15.9%; 95% CI, 8.6%-40.6%) and much lower 2-year RFS (39.1% vs 74.2%; difference, 35.1%; 95% CI, 0.2%-70.5%). In the patient cohort who rejected AT, a worse OS was associated with female sex (48.6% vs 90.5%; difference, 41.9%; 95% CI, 0.6%-84.4%), pT1-2 category (57.1% vs 92.3%; difference, 35.2%; 95% CI, 3.3%-73.6%), and pN1 or higher category (61.2% vs 82.6%; difference, 21.4%; 95% CI, 14.1%-56.8%). Lower RFS was associated with female sex (37.9% vs 90.9%; difference, 53.0%; 95% CI, 8.0%-97.9%), advanced T category (pT3-4, 35.3% vs 80.0%; difference, 44.7%; 95% CI, 6.4%-95.3%), lymph node yield of 20 or greater (31.4% vs 80.6%; difference, 49.2%; 95% CI, 4.9%-93.4%), and lymph node ratio of less than 4.6% (36.6% vs 84.4%; difference, 47.8%; 95% CI, 1.8%-93.1%). Conclusions and Relevance In this cohort study of patients with advanced OSCC, refusal of AT was associated with worse oncological outcomes. The prevalence of disease recurrence during follow-up was 34% higher in patients who refused AT than in patients who completed AT. The results from this study may assist clinicians in guiding patients who are considering refusal of or withdrawal from AT.
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Affiliation(s)
- Friedrich Mrosk
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany
| | - Christian Doll
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany
| | - Julia Scheer
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany
| | - Felix Neumann
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany
| | - Elena Hofmann
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Kilian Kreutzer
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany
| | - Jan Voss
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Rubarth
- Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, Berlin, Germany
| | - Marcus Beck
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiation Oncology, Berlin, Germany
| | - Max Heiland
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany
| | - Steffen Koerdt
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany
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Tao H, Wei Y, Shen Z, Liu Z. Matched-pair analysis of the impact of low-dose postoperative radiotherapy on prognosis in patients with advanced hypopharyngeal squamous cell carcinoma without positive surgical margins and extracapsular extension. Front Oncol 2023; 13:1089275. [PMID: 37746267 PMCID: PMC10513504 DOI: 10.3389/fonc.2023.1089275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Background We conducted a comparative analysis between low and high-dose postoperative radiotherapy in patients with hypopharyngeal squamous cell carcinoma (HPSCC) in stage III or IV without positive surgical margins and extracapsular extension (ECE). Propensity score matching (PSM) was used to eliminate confounding factors and reduce bias. Methods The matched-pair analysis included 156 patients divided into two groups: the low-dose radiotherapy group (LD-RT 50 Gy, 78 cases) and the high-dose radiotherapy group (HD-RT 60 Gy, 78 cases). Both cohorts were statistically comparable in terms of age, gender, subsite, and TNM classification. Results The median follow-up time was 49 months (ranging from 5 to 100 months). The overall survival (OS) rate, progression-free survival (PFS) rate, locoregional control rate (87% vs. 85.7%; p = 0.754), distant metastases-free survival (79.2% vs. 76.6%; p = 0.506), and the occurrence of second primary tumors (96.1% vs. 93.5%; p = 0.347) showed no significant differences between the LD-RT group and the HD-RT group. The 3-year OS was 64.9% and 61% in the low-dose and high-dose group, respectively, and 63% in the entire group (p = 0.547). The 3-year PFS was 63.6% and 54.5% (p = 0.250), respectively, and the 3-year PFS of the entire group was 59.1%. Multivariate analyses revealed that pathological T and N classification, and pathological differentiation were associated with 3-year OS, PFS, and LRFS and were independent prognostic factors (p < 0.05). LD-RT was not associated with an increased risk of death and disease progression compared to HD-RT. Conclusion The results of postoperative low-dose radiotherapy did not show inferiority to those of high-dose radiation for patients with advanced hypopharyngeal cancer without positive surgical margins and ECE in terms of OS, PFS, locoregional control, and metastases-free survival.
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Affiliation(s)
| | - Yumei Wei
- Department of Head and Neck Radiotherapy, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
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Gaeta A, Tagliabue M, D'Ecclesiis O, Ghiani L, Maugeri P, De Berardinis R, Veneri C, Gaiaschi C, Cacace M, D'Andrea L, Ansarin M, Gandini S, Chiocca S. Are sex and gender considered in head and neck cancer clinical studies? NPJ Precis Oncol 2023; 7:84. [PMID: 37679495 PMCID: PMC10484986 DOI: 10.1038/s41698-023-00439-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023] Open
Abstract
We analyzed the inclusion of sex and/or gender (S/G) in Head and Neck Cancer (HNC) clinical studies, through inspecting ClinicalTrials.gov (AACT) and the mention of Human Papilloma Virus (HPV) on a specific subgroup, namely oral cavity, larynx and oropharynx. Only 5% of HNC studies mention S/G as a planned analytical variable. Proportionally more observational studies treated S/G as an analytical variable than interventional studies (10% vs 5%, P-value ≤ 0.001), 8% of studies that mentioned S/G involved more than 100 subjects while 4% less than 100 (P-value ≤ 0.001). In randomized protocols, S/G was mentioned more in studies with a planned sample of more than 100 patients and including HPV status (P-value < 0.05). Small controlled studies have lower mention of S/G as an analytical variable than uncontrolled studies (4% and 10%, respectively among studies with less than 100 subjects). Significantly greater mention of S/G as an analytical variable is observed in controlled and randomized studies with a sample size greater than 100 subjects. HPV was mentioned in only 18% of oral cavity-larynx-oropharynx studies. Interventional studies do not regularly account for S/G during HNC study design. Thus, although fundamental, in studies concerning HNC the S/G variable is often not considered. In trials published in scientific journals (P-value = 0.01) and in more recent clinical trials (P-value = 0.002), S/G is taken more into account suggesting an increasing awareness on its importance. However, the need to systematically include S/G in study design clearly emerges, to better highlight sex-related differences in disease incidence and prognosis and best imbue science and medicine with the proper biological and cultural differences.
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Affiliation(s)
- Aurora Gaeta
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Adamello 16, 20139, Milan, Italy
| | - Marta Tagliabue
- Department of Otolaryngology Head & Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Oriana D'Ecclesiis
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Adamello 16, 20139, Milan, Italy
| | - Lavinia Ghiani
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Adamello 16, 20139, Milan, Italy
| | - Paolo Maugeri
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Adamello 16, 20139, Milan, Italy
| | - Rita De Berardinis
- Department of Otolaryngology Head & Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Camilla Veneri
- GENDERS (Gender & Equality in Research and Science) - University of Milan, Milan, Italy
| | - Camilla Gaiaschi
- GENDERS (Gender & Equality in Research and Science) - University of Milan, Milan, Italy
- Department of Human and Social Sciences, University of Salento, Lecce, Italy
| | - Marina Cacace
- Knowledge & Innovation, Via Guido Reni 56, Rome, 00196, Italy
| | | | - Mohssen Ansarin
- Department of Otolaryngology Head & Neck Surgery, IEO, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Adamello 16, 20139, Milan, Italy
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Via Adamello 16, 20139, Milan, Italy.
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Tagliabue M, D'Ecclesiis O, De Berardinis R, Gaeta A, Martinoli C, Piana AF, Maffini F, Gandini S, Ansarin M, Chiocca S. The prognostic role of sex and hemoglobin levels in patients with oral tongue squamous cell carcinoma. Front Oncol 2022; 12:1018886. [PMID: 36457509 PMCID: PMC9706199 DOI: 10.3389/fonc.2022.1018886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/27/2022] [Indexed: 10/31/2023] Open
Abstract
Background Women and men differ genetically, biologically (sex) and by social construct (gender), possibly impacting on prognostic factors in predicting cancer survival. Hemoglobin levels and immune system activation are players acting in this scenario which could play a role in partly determining prognosis between patients of different sex/gender (S/G). Here, we investigate these factors in patients affected by tongue squamous cell carcinoma. Methods This is an observational retrospective cohort study. We collected tongue cancer patients' clinical data, including hemoglobin levels and neutrophil lymphocyte ratio (NLR). Overall survival (OS) and disease-free survival (DFS) were compared between women and men considering confounding and prognostic factors in multivariate Cox proportional hazard models. Stratified analyses were also conducted by sex and tumor stage. Result 576 patients, 39.9% women and 60.1% men, were found eligible for the analysis. Men were more often smokers (p<0.001), alcohol consumers (p<0.001), overweight or obese (p<0.001) and undergoing radiotherapy (p=0.002). In multivariate models for stage I-II, men showed half risk of death and relapse compared to women (HR=0.44; 95%CI 0.24-0.81, p=0.009; HR=0.55; 95%CI 0.34-0.87, p=0.01, for OS and DFS respectively). Moreover, low hemoglobin levels appeared to be an independent prognostic factor for women but not for men in terms of both OS and DFS. Specifically, women with low hemoglobin levels showed a worse tumor outcome (HR=2.66; 95%CI 1.50-4.70; HR=2.09; 95%CI 1.24-3.53, for OS and DFS respectively). Low hemoglobin levels appeared to be a poor OS prognostic factor for women at stage I-II (p<0.004) but not for men (p=0.10). Women with advanced stage tumors, NLR>2.37, who did not performed Radiotherapy and with depth of invasion (DOI)> 10 were associated with a significant increase in relapse and death (all p<0.05). Conclusion In our cohort of patients with oral tongue squamous cell carcinoma, men present better OS and DFS than women with early stages tumors. Low hemoglobin level was an independent prognostic factor for women, especially at early-stage tumors. For advanced stages (III-IV), sex is not a significant factor related to patients' prognosis.
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Affiliation(s)
- Marta Tagliabue
- Department of Otolaryngology Head and Neck Surgery, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Oriana D'Ecclesiis
- Department of Experimental Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Rita De Berardinis
- Department of Otolaryngology Head and Neck Surgery, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Aurora Gaeta
- Department of Experimental Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Chiara Martinoli
- Department of Experimental Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Andrea Fausto Piana
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Fausto Maffini
- Division of Pathology, European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Mohssen Ansarin
- Department of Otolaryngology Head and Neck Surgery, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Susanna Chiocca
- Department of Experimental Oncology, European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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Nguyen NP, Kim L, Thariat J, Baumert BG, Mazibuko T, Gorobets O, Vinh-Hung V, Giap H, Mehmood T, Vincent F, Chi A, Basu T, Loganadane G, Mohammadianpanah M, Karlsson U, Oboite E, Oboite J, Ali A, Page BR. Immunotherapy and Modern Radiotherapy Technique for Older Patients with Locally Advanced Head and Neck Cancer: A Proposed Paradigm by the International Geriatric Radiotherapy Group. Cancers (Basel) 2022; 14:5285. [PMID: 36358703 PMCID: PMC9654379 DOI: 10.3390/cancers14215285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 10/29/2023] Open
Abstract
The standard of care for locally advanced head and neck cancer is concurrent chemoradiation or postoperative irradiation with or without chemotherapy. Surgery may not be an option for older patients (70 years old or above) due to multiple co-morbidities and frailty. Additionally, the standard chemotherapy of cisplatin may not be ideal for those patients due to oto- and nephrotoxicity. Though carboplatin is a reasonable alternative for cisplatin in patients with a pre-existing hearing deficit or renal dysfunction, its efficacy may be inferior to cisplatin for head and neck cancer. In addition, concurrent chemoradiation is frequently associated with grade 3-4 mucositis and hematologic toxicity leading to poor tolerance among older cancer patients. Thus, a new algorithm needs to be developed to provide optimal local control while minimizing toxicity for this vulnerable group of patients. Recently, immunotherapy with check point inhibitors (CPI) has attracted much attention due to the high prevalence of program death-ligand 1 (PD-L1) in head and neck cancer. In patients with recurrent or metastatic head and neck cancer refractory to cisplatin-based chemotherapy, CPI has proven to be superior to conventional chemotherapy for salvage. Those with a high PD-L1 expression defined as 50% or above or a high tumor proportion score (TPS) may have an excellent response to CPI. This selected group of patients may be candidates for CPI combined with modern radiotherapy techniques, such as intensity-modulated image-guided radiotherapy (IM-IGRT), volumetric arc therapy (VMAT) or proton therapy if available, which allow for the sparing of critical structures, such as the salivary glands, oral cavity, cochlea, larynx and pharyngeal muscles, to improve the patients' quality of life. In addition, normal organs that are frequently sensitive to immunotherapy, such as the thyroid and lungs, are spared with modern radiotherapy techniques. In fit or carefully selected frail patients, a hypofractionated schedule may be considered to reduce the need for daily transportation. We propose a protocol combining CPI and modern radiotherapy techniques for older patients with locally advanced head and neck cancer who are not eligible for cisplatin-based chemotherapy and have a high TPS. Prospective studies should be performed to verify this hypothesis.
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Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Lyndon Kim
- Department of Neurology, Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY 10029, USA
| | | | - Brigitta G. Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, 7000 Chur, Switzerland
| | - Thandeka Mazibuko
- International Geriatric Radiotherapy Group, Department of Radiation Oncology, Washington, DC 20001, USA
| | - Olena Gorobets
- Department of Maxillofacial Surgery, Centre Hospitalier Universitaire de Martinique, 97213 Le Lamentin Martinique, France
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Centre Hospitalier de la Polynesie Francaise, 98716 Pirae, Tahiti, French Polynesia
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Tahir Mehmood
- Department of Radiation Oncology, Northampton General Hospital, Northampton NN1 5BD, UK
| | - Felix Vincent
- Department of Surgery, Southern Regional Health System-Lawrenceburg, Lawrenceburg, TN 38464, USA
| | - Alexander Chi
- Department of Radiation Oncology, Beijing Chest Hospital, Beijing 101149, China
| | - Trinanjan Basu
- Department of Radiation Oncology, HCG Cancer Center Borivali, and HCG ICS, Mumbai, Maharashtra 400092, India
| | | | | | - Ulf Karlsson
- International Geriatric Radiotherapy Group, Department of Radiation Oncology, Washington, DC 20001, USA
| | - Eromosele Oboite
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Joan Oboite
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Ahmed Ali
- Department of Hematology Oncology, Howard University, Washington, DC 20059, USA
| | - Brandi R. Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD 21093, USA
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Sex-Related Differences in Outcomes for Oropharyngeal Squamous Cell Carcinoma by HPV Status. Int J Otolaryngol 2022; 2022:4220434. [PMID: 35546963 PMCID: PMC9085342 DOI: 10.1155/2022/4220434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/19/2022] [Accepted: 02/25/2022] [Indexed: 12/20/2022] Open
Abstract
Background Overall survival for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) has differed by sex, but little is known regarding cancer-specific outcomes. We assessed the independent association of sex with cancer-specific survival in patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). Methods We identified 14,183 patients from the Surveillance, Epidemiology, and End Results (SEER) program with OPSCC and tumor HPV status. We used Kaplan–Meier methods to compare overall survival (OS) and OPSCC-specific survival (HNCSS) by patient sex and by tumor HPV status. We then separately fit multivariable survival and competing risk models evaluating the association of sex on these outcomes by tumor HPV status and stratified by the use of guideline-concordant OPSCC treatment. Results A total of 10,210 persons with HPV-positive tumors (72.0%) and 3,973 with HPV-negative tumors (28.0%) were identified. A larger proportion of women had HPV-negative tumors (24.0%) versus HPV-positive tumors (13.2%; p < 0.001). Women with HPV-positive tumors were less likely to receive guideline-concordant treatment compared to men. In unadjusted survival analyses, women did not differ in OS or HNCSS compared to men for HPV-positive tumors but had worse OS and HNCSS for HPV-negative tumors. After adjustment, men and women with HPV-positive OPSCC did not differ in OS or HNCSS. However, women with HPV-negative tumors faced worse overall survival (hazard ratio (HR) 1.15, 95% CI 1.02–1.29) that persisted even after stratifying for stage-appropriate treatment (HR 1.28, 95% CI 1.11–1.47). Conclusions Women with HPV-positive OPSCC had similar survival outcomes compared to men, but those with HPV-negative tumors have worse overall and cancer-specific survival.
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Phase II study of dichloroacetate, an inhibitor of pyruvate dehydrogenase, in combination with chemoradiotherapy for unresected, locally advanced head and neck squamous cell carcinoma. Invest New Drugs 2022; 40:622-633. [DOI: 10.1007/s10637-022-01235-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/11/2022] [Indexed: 12/14/2022]
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Jehn P, Linsen SS, Zeller AN, Eckstein FM, Neuhaus MT, Gellrich NC, Krüskemper G, Lentge F, Spalthoff S, Korn P. Gender-specific differences concerning psychosocial aspects and functional impairments that influence quality of life in oral cancer treatment. Support Care Cancer 2022; 30:4905-4915. [PMID: 35171323 DOI: 10.1007/s00520-022-06907-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Patients with oral cancer have gender-specific differences with respect to health-related quality of life (HRQoL) and psychosocial variables (PV). The aim of the present study was to evaluate HRQoL and PV outcomes in patients treated for oral squamous cell carcinoma. METHODS Data of 1234 patients were collected from a multicenter rehabilitation study of the German-Austrian-Swiss Cooperative Group on Tumours of the Maxillofacial Region (DÖSAK). Patient characteristics, oncological variables, post-treatment impairments, general quality of life (QoL), and PV (coping strategies, control beliefs, personal traits, perceived social support, depression, anxiety, and fear of tumor recurrence) were recorded. RESULTS After treatment, HRQoL was similar between genders concerning general QoL, but men experienced significantly more treatment-related functional impairments influencing HRQoL. PV revealed gender-specific coping strategies, with women reporting significantly more "depressive coping," "religiosity," "fatalistic externality," and higher "social burden." Owing to their religious coping strategies, fatalistic attitude, and perceived higher social integration, women demonstrated superior disease acceptance, despite higher depression, anxiety, and lower psychosocial resilience. Conversely, men reported more introverted personal traits and lower social integration. CONCLUSION Interventions during oral cancer treatment should address PV and have gender-specific elements to improve HRQoL after therapy.
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Affiliation(s)
- Philipp Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany.
| | - Sabine Swantje Linsen
- Department of Prosthodontics; Preclinical Education and Dental Material Science, University Hospital Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - Alexander-Nicolai Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | - Fabian Matthias Eckstein
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | - Michael-Tobias Neuhaus
- Department of Oral, Craniomaxillofacial and Facial Plastic Surgery, University Hospital of Leipzig, Liebigstr. 12, Leipzig, 04103, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | - Gertrud Krüskemper
- Department of Medical Psychology, Ruhr University of Bochum, Universitätsstr. 150, Building MA 0/145, 44780, Bochum, Germany
| | - Fritjof Lentge
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | - Simon Spalthoff
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | - Philippe Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
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Differential Characteristics of Patients With Squamous Cell Carcinoma of the Head and Neck According to Gender. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:359-369. [PMID: 34844674 DOI: 10.1016/j.otoeng.2020.08.007] [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: 04/06/2020] [Accepted: 08/18/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To analyse the trend in the percentage of patients with squamous cell carcinoma of the head and neck (SCCHN) of female gender over the last decades, and differences in survival according to gender. MATERIAL AND METHODS Retrospective study of 5828 SCCHN diagnosed during the period 1985-2019. In the survival analysis we only included only patients with more than two years of follow-up. RESULTS The proportion of tumours in female patients increased significantly over the study period. There was greater increase of tumours located in the oral cavity, oropharynx and larynx in the percentage of female patients. When considering the total number of patients, there were no significant differences in disease-specific survival according to gender. We observed a variable behaviour of disease-specific survival according to gender depending on the primary location of the tumour. For tumours of the larynx and oropharynx the female patients had a disease-specific survival significantly higher than that of men, while for tumours of the oral cavity, the female patients had a significant reduction of disease-specific survival. CONCLUSIONS In our setting, the percentage of female patients with HNSCC has been increasing steadily over recent decades. There were differences in disease-specific survival according to gender depending on the location of the primary tumour.
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Shinn JR, Carey RM, Mady LJ, Shimunov D, Parhar HS, Cannady SB, Rajasekaran K, Lukens JN, Lin A, Swisher-McClure S, Cohen RB, Bauml JM, Rassekh CH, Newman JG, Chalian AA, Basu D, Weinstein GS, Brody RM. Sex-based differences in outcomes among surgically treated patients with HPV-related oropharyngeal squamous cell carcinoma. Oral Oncol 2021; 123:105570. [PMID: 34742005 DOI: 10.1016/j.oraloncology.2021.105570] [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: 07/29/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Sex differences in surgically treated HPV-associated oropharyngeal squamous cell carcinoma are not defined due to the low number of affected women. We explored the oncologic outcomes of men and women with p16-positive oropharyngeal squamous cell carinoma treated with primary surgery. MATERIALS AND METHODS Retrospective analysis of patients with HPV-related oropharyngeal cancer treated with surgery and pathology guided adjuvant therapy from 2007 to 2017. Primary end point was recurrence-free and overall survival. RESULTS Of 468 men (86.7%) and 72 women (13.3%), women presented more often with clinical N0 nodal disease (25% vs 12.2%). There were no differences in adverse pathologic features or T stage, although women were more likely to present with N0 disease (16.7% vs 10%), less N2 disease (6.9% vs 17.7%, p = 0.03), and more stage I disease (88.9% vs 75%). As a result, women were more likely to undergo surgery alone (30.6% vs 14.1%) while men were more likely to require adjuvant radiation therapy (47.2% vs 36.1%). Four women (5.6%) and 30 men (6.4%, p = 0.8) died during follow-up. Multivariate analysis controlling for age, sex, treatment, and pathologic stage demonstrated no differences in overall survival between men and women. There were no differences in recurrence-free or overall survival between men and women at two and five years. CONCLUSIONS Although women undergoing transoral robotic surgery for HPV+ oropharyngeal squamous cell carcinoma may have less advanced disease, upfront surgery with pathology-guided adjuvant therapy produces similar oncologic results in men and women while accounting for disease burden.
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Affiliation(s)
- Justin R Shinn
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Ryan M Carey
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Leila J Mady
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - David Shimunov
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Harman S Parhar
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Steven B Cannady
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Samuel Swisher-McClure
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Roger B Cohen
- Division of Hematology and Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Joshua M Bauml
- Division of Hematology and Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Christopher H Rassekh
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Jason G Newman
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Ara A Chalian
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Devraj Basu
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Gregory S Weinstein
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
| | - Robert M Brody
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States.
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García-Cabo P, López F, Sánchez-Canteli M, Fernández-Vañes L, Álvarez-Marcos C, Llorente JL, de la Rúa MÁ, Blay P, Rodrigo JP. Matched-Pair Analysis of Survival in the Patients with Advanced Laryngeal and Hypopharyngeal Squamous Cell Carcinoma Treated with Induction Chemotherapy Plus Chemo-Radiation or Total Laryngectomy. Cancers (Basel) 2021; 13:cancers13071735. [PMID: 33917434 PMCID: PMC8038732 DOI: 10.3390/cancers13071735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary There are no randomized studies comparing organ-preservation protocols with chemo-selection to the classical total laryngectomy plus (chemo)radiotherapy. Thus, we performed a matched-pair analysis to compare these two treatments with respect to locoregional control, disease-specific survival (DSS), and overall survival (OS) in patients with locally advanced squamous cell carcinoma of the larynx and hypopharynx. The results did not show differences between the two treatments for patients with T3/T4a larynx and T2–T4a hypopharynx cancer with respect to OS and DSS, locoregional control, and metastasis-free survival. Abstract Background: We performed a comparative analysis between an organ-preservation protocol and surgery followed by radiotherapy in patients with locally advanced squamous cell carcinoma of the larynx and hypopharynx; Methods: 60 previously untreated patients who were treated with induction chemotherapy followed by chemoradiotherapy in responders were compared with a control group of 60 patients treated with up-front surgery. Both groups were statistically comparable, according to the subsite, TNM (tumor-node-metastasis) stage, age, and sex; Results: Mean age was 58 years and 92% were male. No significant statistical difference was observed for overall survival (OS) (HR 0.75; 95% CI 0.48–1.18; P = 0.22) and disease-specific survival (DSS) (HR 0.98; 95% CI 0.52–1.83, P = 0.96). Also, there was no significant difference for recurrence-free survival (HR 0.931; 95% CI 0.57–1.71; P = 0.81), metastases-free survival (HR 2.23; 95% CI 0.67–7.41; P = 0.19), and the appearance of second primary tumors (HR 1.22; 95% CI 0.51–2.88; P = 0.64); Conclusions: The results of the organ-preservation approach did not appear inferior to those of surgery plus (chemo)radiotherapy for patients with T3/T4a larynx and T2–T4a hypopharynx cancer with respect to OS and DSS, locoregional control and metastases-free survival.
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Affiliation(s)
- Patricia García-Cabo
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (P.G.-C.); (M.S.-C.); (L.F.-V.); (C.Á.-M.); (J.L.L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto Universitario de Oncología del Principado de Asturias (IUOPA), University of Oviedo, IUOPA, CIBERONC-ISCIII, 33011 Oviedo, Spain
| | - Fernando López
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (P.G.-C.); (M.S.-C.); (L.F.-V.); (C.Á.-M.); (J.L.L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto Universitario de Oncología del Principado de Asturias (IUOPA), University of Oviedo, IUOPA, CIBERONC-ISCIII, 33011 Oviedo, Spain
- Correspondence: (F.L.); (J.P.R.)
| | - Mario Sánchez-Canteli
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (P.G.-C.); (M.S.-C.); (L.F.-V.); (C.Á.-M.); (J.L.L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto Universitario de Oncología del Principado de Asturias (IUOPA), University of Oviedo, IUOPA, CIBERONC-ISCIII, 33011 Oviedo, Spain
| | - Laura Fernández-Vañes
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (P.G.-C.); (M.S.-C.); (L.F.-V.); (C.Á.-M.); (J.L.L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto Universitario de Oncología del Principado de Asturias (IUOPA), University of Oviedo, IUOPA, CIBERONC-ISCIII, 33011 Oviedo, Spain
| | - César Álvarez-Marcos
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (P.G.-C.); (M.S.-C.); (L.F.-V.); (C.Á.-M.); (J.L.L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto Universitario de Oncología del Principado de Asturias (IUOPA), University of Oviedo, IUOPA, CIBERONC-ISCIII, 33011 Oviedo, Spain
| | - José Luis Llorente
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (P.G.-C.); (M.S.-C.); (L.F.-V.); (C.Á.-M.); (J.L.L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto Universitario de Oncología del Principado de Asturias (IUOPA), University of Oviedo, IUOPA, CIBERONC-ISCIII, 33011 Oviedo, Spain
| | - Maria Ángeles de la Rúa
- Department of Radiation Oncology, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain;
| | - Pilar Blay
- Department of Medical Oncology, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain;
| | - Juan P. Rodrigo
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain; (P.G.-C.); (M.S.-C.); (L.F.-V.); (C.Á.-M.); (J.L.L.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto Universitario de Oncología del Principado de Asturias (IUOPA), University of Oviedo, IUOPA, CIBERONC-ISCIII, 33011 Oviedo, Spain
- Correspondence: (F.L.); (J.P.R.)
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León X, García J, López M, Holgado A, Llansana A, Quer M. Differential characteristics of patients with squamous cell carcinoma of the head and neck according to gender. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:S0001-6519(20)30173-4. [PMID: 33618830 DOI: 10.1016/j.otorri.2020.08.009] [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: 04/06/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the trend in the percentage of patients with squamous cell carcinoma of the head and neck of female gender over the last decades, and differences in survival according to gender. MATERIAL AND METHODS Retrospective study of 5,828 squamous cell carcinoma of the head and neck diagnosed during the period 1985-2019. In the survival analysis we only included only patients with more than two years of follow-up. RESULTS The proportion of tumours in female patients increased significantly over the study period. There was greater increase of tumours located in the oral cavity, oropharynx and larynx in the percentage of female patients. When considering the total number of patients, there were no significant differences in disease-specific survival according to gender. We observed a variable behaviour of disease-specific survival according to gender depending on the primary location of the tumour. For tumours of the larynx and oropharynx the female patients had a disease-specific survival significantly higher than that of men, while for tumours of the oral cavity, the female patients had a significant reduction of disease-specific survival. CONCLUSIONS In our setting, the percentage of female patients with squamous cell carcinoma of the head and neck has been increasing steadily over recent decades. There were differences in disease-specific survival according to gender depending on the location of the primary tumour.
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Affiliation(s)
- 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.
| | - 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
| | - Anna Holgado
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Albert Llansana
- 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; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
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13
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Gender and race interact to influence survival disparities in head and neck cancer. Oral Oncol 2020; 112:105093. [PMID: 33232879 DOI: 10.1016/j.oraloncology.2020.105093] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 12/23/2022]
Abstract
Gender and race disparities in head and neck squamous cell carcinoma (HSNCC) survival are independently well documented, but no prior studies have examined the joint effect of these factors on HSNCC outcomes. We aim to comprehensively estimate the effect of gender and race on overall survival in HNSCC. We constructed a retrospective cohort from the National Cancer Database for primary HNSCC of the larynx, hypopharynx, oral cavity, and oropharynx from 2010 to 2015. We used Kaplan-Meier curves and Cox proportional hazards regressions to calculate hazard ratios adjusting for treatment type, age, insurance, staging classifications, and comorbidities. Oral cavity cancer was significantly more common among Hispanic and White females compared to other sites. Female non-oropharyngeal HNSCC cases had better five-year overall survival than males (56.3% versus 54.4%, respectively), though Black females (52.8%) had poorer survival than both White (56.2%) and Hispanic (57.9%) males. There were significant differences in oropharyngeal cancer by HPV status. Notably, Black females with HPV-positive oropharyngeal OPSCC had far worse survival than any other race and gender group. These results persisted even when adjusting for potential mediating factors. Clearly gender is a significant prognosticator for HNSCC and has meaningful interactions with race. The distinct site distributions across gender and race reveal important insights into HNSCC among females. Taking into account these gender disparities while considering race is essential to providing appropriate care to head and neck patients and accurately counselling these individuals on prognosis and outcomes.
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Mundi N, Ghasemi F, Zeng PY, Prokopec SD, Patel K, Kim HAJ, Di Gravio E, MacNeil D, Khan MI, Han MW, Shaikh M, Mendez A, Yoo J, Fung K, Gameiro SF, Palma DA, Mymryk JS, Barrett JW, Boutros PC, Nichols AC. Sex disparities in head & neck cancer driver genes: An analysis of the TCGA dataset. Oral Oncol 2020; 104:104614. [DOI: 10.1016/j.oraloncology.2020.104614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/26/2019] [Accepted: 02/22/2020] [Indexed: 12/20/2022]
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15
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Ding D, Stokes W, Eguchi M, Hararah M, Sumner W, Amini A, Goddard J, Somerset H, Bradley C, McDermott J, Raben D, Karam SD. Association Between Lymph Node Ratio and Recurrence and Survival Outcomes in Patients With Oral Cavity Cancer. JAMA Otolaryngol Head Neck Surg 2019; 145:53-61. [PMID: 30452499 DOI: 10.1001/jamaoto.2018.2974] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Oral cavity squamous cell carcinoma (OCSCC) is associated with often-delayed clinical diagnosis, poor prognosis, and expensive therapeutic approaches. Prognostic accuracy is important in improving treatment outcomes of patients with this disease. Objectives To assess lymph node ratio (LNR) and other factors in estimating response to treatment and provide prognostic information helpful for clinical decision making. Design, Setting, and Participants A retrospective cohort study was conducted from January 1, 2000, to December 31, 2015, at an academic hospital in Denver, Colorado. Participants included 149 patients with primary OCSCC who received curative-intent surgery and/or postoperative adjuvant therapies. Analysis was performed from December 8, 2017, to August 15, 2018. Main Outcomes and Measures Overall survival (OS), disease-free survival (DFS), locoregional disease-free survival (LRDFS), and distant metastasis-free survival (DMDFS) adjusted for known prognostic risk factors, as well as correlation of LNR with other histopathologic prognostic factors. Results Of the 149 patients included in analysis, 105 were men (70.5%); the median age at diagnosis was 59 years (range, 28-88 years). Using the Kaplan-Meier method, the 5-year survival estimates for OS rate was 40.4% (95% CI, 31.3%-49.3%); DFS, 48.6% (95% CI, 38.6%-58.0%); LRDFS, 57.7% (95% CI, 46.6%-67.2%); and DMDFS, 74.7% (95% CI, 65.1%-82.0%). The median follow-up was 20 months for all patients and 34.5 months (range, 0-137 months) for surviving patients. Nonwhite race (hazard ratio [HR], 2.15; 95% CI, 1.22-3.81), T3-T4 category (HR, 1.99; 95% CI, 1.18-3.35), and LNR greater than 10% (HR, 2.71; 95% CI, 1.39-5.27) were associated with poorer OS. Nonwhite patients also had higher risk of locoregional failures (HR, 2.47; 95% CI, 1.28-4.79), whereas women were more likely to have distant metastasis (HR, 2.55; 95% CI, 1.14-5.71). Floor-of-mouth subsite had fewer locoregional recurrences than did other subsites (HR, 0.45, 95% CI, 0.21-0.99). An LNR greater than 10% independently was associated with worse OS (HR, 2.71; 95% CI, 1.39-5.27), DFS (HR, 2.48; 95% CI, 1.18-5.22), and DMDFS (HR, 6.05; 95% CI, 1.54-23.71). The LNR was associated with N-stage (Cramer V, 0.69; 95% CI, 0.58-0.78), extracapsular extension (Cramer V, 0.55; 95% CI, 0.44-0.66), lymphovascular invasion (Cramer V, 0.46; 95% CI, 0.27-0.61); number of excised lymph nodes (Cramer V, 0.24; 95% CI, 0.06-0.37), margin (Cramer V, 0.22; 95% CI, 0.05-0.38), and tumor thickness combined with depth of invasion (Cramer V, 0.25; 95% CI, 0.05-0.38). Conclusions and Relevance Locoregional treatment failure remained the predominant pattern of failure. An advanced pathologic stage and nonwhite race were found to be associated with worse outcomes. The findings from this study suggest that LNR is the most robust prognostic factor and appears to have implications for risk stratification in this disease.
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Affiliation(s)
- Ding Ding
- Department of Radiation Oncology, University of Colorado Denver, Aurora
| | - William Stokes
- Department of Radiation Oncology, University of Colorado Denver, Aurora
| | - Megan Eguchi
- Department of Health Systems, Management and Policy, University of Colorado Cancer Center, Aurora
| | - Mohammad Hararah
- Department of Otolaryngology and Head and Neck Surgery, University of Colorado Denver, Aurora
| | - Whitney Sumner
- Department of Radiation Oncology, University of Colorado Denver, Aurora
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Julie Goddard
- Department of Otolaryngology and Head and Neck Surgery, University of Colorado Denver, Aurora
| | - Hilary Somerset
- Department of Pathology, University of Colorado Denver, Aurora
| | - Cathy Bradley
- Department of Health Systems, Management and Policy, University of Colorado Cancer Center, Aurora
| | | | - David Raben
- Department of Radiation Oncology, University of Colorado Denver, Aurora
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Denver, Aurora
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Shin JY, Jung HJ, Moon A. Molecular Markers in Sex Differences in Cancer. Toxicol Res 2019; 35:331-341. [PMID: 31636844 PMCID: PMC6791665 DOI: 10.5487/tr.2019.35.4.331] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 12/24/2022] Open
Abstract
Cancer is one of the common causes of death with a high degree of mortality, worldwide. In many types of cancers, if not all, sex-biased disparities have been observed. In these cancers, an individual's sex has been shown to be one of the crucial factors underlying the incidence and mortality of cancer. Accumulating evidence suggests that differentially expressed genes and proteins may contribute to sex-biased differences in male and female cancers. Therefore, identification of these molecular differences is important for early diagnosis of cancer, prediction of cancer prognosis, and determination of response to specific therapies. In the present review, we summarize the differentially expressed genes and proteins in several cancers including bladder, colorectal, liver, lung, and non-small cell lung cancers as well as renal clear cell carcinoma, and head and neck squamous cell carcinoma. The sex-biased molecular differences were identified via proteomics, genomics, and big data analysis. The identified molecules represent potential candidates as sex-specific cancer biomarkers. Our study provides molecular insights into the impact of sex on cancers, suggesting strategies for sex-biased therapy against certain types of cancers.
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Affiliation(s)
- Ji Yoon Shin
- Duksung Innovative Drug Center, College of Pharmacy, Duksung Women's University, Seoul, Korea
| | - Hee Jin Jung
- Duksung Innovative Drug Center, College of Pharmacy, Duksung Women's University, Seoul, Korea
| | - Aree Moon
- Duksung Innovative Drug Center, College of Pharmacy, Duksung Women's University, Seoul, Korea
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Morgan RL, Eguchi MM, Mueller AC, Daugherty SL, Amini A, Karam SD. Imaging at diagnosis impacts cancer-specific survival among patients with cancer of the oropharynx. Cancer 2019; 125:2794-2802. [PMID: 31042320 DOI: 10.1002/cncr.32148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/18/2019] [Accepted: 03/27/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The optimal imaging for the staging of oropharyngeal cancer is not well defined. METHODS The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database for 2006 through 2011 was used to compare patient characteristics and hospital region by the initial imaging modality used for patients with oropharyngeal cancer. The primary outcome was 3-year cancer-specific survival (CSS). Cox proportional hazards models were adjusted for imaging, age, sex, region, education, race, American Joint Committee on Cancer stage of disease, and treatment, which were examined using backward elimination. The authors also explored how initial imaging use varied by patient characteristics and hospital region. RESULTS A total of 1765 patients underwent initial diagnostic imaging. Of those, approximately 11.4% (202 patients) received computed tomography (CT) alone as their initial imaging modality, 5.2% (91 patients) underwent magnetic resonance imaging (MRI) without positron emission tomography (PET), and 83.3% (1472 patients) had initial imaging that included PET. The overall 3-year CSS rate for the entire population was 63.7%. In the adjusted survival models compared by initial imaging modality, patients who underwent a PET examination were found to have higher survival than those who underwent CT alone or MRI, respectively (hazard ratio, 1.337 [95% CI, 1.001-1.785; P = .0491]; and hazard ratio, 1.748 [95% CI, 1.2-2.545; P = .0036]). CONCLUSIONS Among patients with oropharyngeal cancer, initial staging with PET imaging was associated with improved 3-year CSS compared with initial staging with MRI or CT.
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Affiliation(s)
- Rustain L Morgan
- Department of Radiology, University of Colorado Denver, Aurora, Colorado
| | - Megan M Eguchi
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Adam C Mueller
- Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado
| | - Stacie L Daugherty
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado
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Dauzier E, Lacas B, Blanchard P, Le QT, Simon C, Wolf G, Janot F, Horiuchi M, Tobias JS, Moon J, Simes J, Deshmane V, Mazeron JJ, Mehta S, Zaktonik B, Tamura M, Moyal E, Licitra L, Fortpied C, Haffty BG, Ghi MG, Gregoire V, Harris J, Bourhis J, Aupérin A, Pignon JP. Role of chemotherapy in 5000 patients with head and neck cancer treated by curative surgery: A subgroup analysis of the meta-analysis of chemotherapy in head and neck cancer. Oral Oncol 2019; 95:106-114. [PMID: 31345376 DOI: 10.1016/j.oraloncology.2019.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the effect of chemotherapy added to a surgical locoregional treatment (LRT) for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS We studied the sub-group of trials with surgical LRT included in the meta-analysis on chemotherapy in head and neck cancer (MACH-NC). Data from published and unpublished randomized trials comparing the addition of chemotherapy to LRT in HNSCC patients were sought using electronic database searching for the period 1965-2000, hand searching and by contacting experts in the field. Trials with less than 60 patients, or preoperative radiotherapy or where the type of LRT could not be individually determined were excluded. All individual patient data were checked for internal consistency, compared with published reports, and validated with trialists. Data were pooled using a fixed-effect model. Heterogeneity was assessed using Cochrane test and I2 statistic. RESULTS Twenty-four trials were eligible (5000 patients). Chemotherapy improved overall survival (HR = 0.92 [95%CI: 0.85-0.99] p = 0.02). There was a significant interaction between treatment effect and timing of chemotherapy (p = 0.08 at pre-specified threshold of 0.10) with a greater effect for concomitant chemotherapy (HR = 0.79, 95%CI: 0.69-0.92). The benefit of chemotherapy was greater in women (HRwomen = 0.63, 95%CI: 0.50-0.80) compared to men (HRmen = 0.96, 95%CI: 0.89-1.04; p for interaction = 0.001). CONCLUSIONS This analysis confirmed the benefit of concomitant chemotherapy added to surgical LRT. The role of induction therapy as yet to be determined as it did not improve OS. Women may benefit more than men from chemotherapy.
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Affiliation(s)
- Etienne Dauzier
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Benjamin Lacas
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Pierre Blanchard
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France; Department of Radiation Therapy, Gustave Roussy Cancer Campus, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Christian Simon
- Department of Otolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Gregory Wolf
- Department of Otolaryngology, University of Michigan, Ann Arbor, USA
| | - François Janot
- Département de Cancérologie Cervico-faciale, Gustave Roussy Cancer Campus, Université Paris Sud, Villejuif, France
| | - Masatoshi Horiuchi
- Department of Otolaryngology, Tokai University School of Medicine, Kanagawa, Japan
| | - Jeffrey S Tobias
- Department of Radiotherapy, University College London Hospital, London, UK
| | - James Moon
- SWOG Statistical Center, Seattle, WA, USA
| | - John Simes
- NHMRC Clinical Trials Center, Camperdown, Australia
| | - Vinay Deshmane
- Surgical Oncology & Breast Diseases, P.D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | | | - Samir Mehta
- Department of Surgery, Sarla Hospital, Mumbai, India
| | - Branko Zaktonik
- Department of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Minoru Tamura
- Dept. of Dentistry and Oral Surgery, Shinshu University School of Medicine, Japan
| | - Elizabeth Moyal
- Département de radiothérapie, IUCT Oncopole - CLCC Institut Claudius Regaud, Toulouse, France
| | - Lisa Licitra
- Department of Medical Oncology 3, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milano and University of Milan, Italy
| | | | - Bruce G Haffty
- Dept. of Therapeutic Radiology, Rutgers Robert Wood Johnson and NJ Medical School, NJ, USA
| | | | | | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, USA
| | - Jean Bourhis
- Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anne Aupérin
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
| | - Jean-Pierre Pignon
- Meta-Analysis Unit, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
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19
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Park A, Alabaster A, Shen H, Mell LK, Katzel JA. Undertreatment of women with locoregionally advanced head and neck cancer. Cancer 2019; 125:3033-3039. [DOI: 10.1002/cncr.32187] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Annie Park
- Department of Internal Medicine Scripps Mercy San Diego California
| | - Amy Alabaster
- Division of Research Kaiser Permanente Oakland California
| | - Hanjie Shen
- Center for Precision Radiation Medicine La Jolla California
| | - Loren K. Mell
- Center for Precision Radiation Medicine La Jolla California
- Department of Radiation Medicine and Applied Sciences University of California San Diego San Diego California
| | - Jed A. Katzel
- Department of Oncology Kaiser Permanente Santa Clara California
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20
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Martin E, Radomski S, Harley E. Sarcomas of the paranasal sinuses: An analysis of the SEER database. Laryngoscope Investig Otolaryngol 2019; 4:70-75. [PMID: 30828621 PMCID: PMC6383302 DOI: 10.1002/lio2.245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 11/06/2018] [Accepted: 12/12/2018] [Indexed: 02/03/2023] Open
Abstract
Objective To determine the demographics, treatment modalities, and overall survival of patients with sinonasal sarcoma. Methods All cases of primary sinonasal sarcomas diagnosed between the years of 2009 and 2014 were extracted from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Additional variables collected included age, gender, ethnicity, tumor histological subtype, tumor size, treatment modality, vitality status, and follow-up time. Kaplan-Meier survival curves were generated and overall survival was calculated. Results One hundred and four cases of sinonasal sarcoma were identified. The majority of patients were female (55%), white (76%), and non-Hispanic (84%), and the mean age was 47 ± 22 years. The most common tumor sites were the maxillary sinus, followed by the ethmoid, sphenoid, and frontal sinus. Forty six percent of tumors were rhabdomyosarcoma type. Most patients (66%) had some type of surgery, 64% received radiation, and 58% received chemotherapy as part of their treatment. Overall 1- and 5-year survival was 79% and 31%, respectively. There was no significant difference in survival based on patient gender, age, ethnicity, radiation, or chemotherapy treatment. Conclusions This study adds to the current literature of sinonasal sarcomas and is the first to report in detail the surgical interventions performed as well as characteristics about lymph node spread, tumor histology, and treatment outcomes since the advent of radiation and chemotherapy. As these tumors are so rare, continued study of the demographics, tumor characteristics, and long-term outcomes of this population is necessary to guide treatment modalities and strategies for otolaryngologists. Level of Evidence 2b.
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Affiliation(s)
- Elaine Martin
- Georgetown University School of Medicine Washington DC
| | | | - Earl Harley
- Georgetown University School of Medicine Washington DC.,Department of Otolaryngology-Head & Neck Surgery Georgetown University Hospital Washington DC
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21
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Petersen JF, Timmermans AJ, van Dijk BAC, Overbeek LIH, Smit LA, Hilgers FJM, Stuiver MM, van den Brekel MWM. Trends in treatment, incidence and survival of hypopharynx cancer: a 20-year population-based study in the Netherlands. Eur Arch Otorhinolaryngol 2017; 275:181-189. [PMID: 29080963 PMCID: PMC5754418 DOI: 10.1007/s00405-017-4766-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/04/2017] [Indexed: 11/30/2022]
Abstract
Hypopharynx cancer has the worst prognosis of all head and neck squamous cell cancers. Since the 1990s, a treatment shift has appeared from a total laryngectomy towards organ preservation therapies. Large randomized trials evaluating treatment strategies for hypopharynx cancer, however, remain scarce, and frequently this malignancy is evaluated together with larynx cancer. Therefore, our aim was to determine trends in incidence, treatment and survival of hypopharynx cancer. We performed a population-based cohort study including all patients diagnosed with T1–T4 hypopharynx cancer between 1991 and 2010 in the Netherlands. Patients were recorded by the national cancer registry database and verified by a national pathology database. 2999 patients were identified. The incidence increased significantly with 4.1% per year until 1997 and decreased non-significantly afterwards. For women, the incidence increased with 1.7% per year during the entire study period. Total laryngectomy as primary treatment significantly decreased, whereas radiotherapy and chemoradiation increased. The 5-year overall survival significantly increased from 28% in 1991–2000 to 34% in 2001–2010. Overall survival for T3 was equal for total laryngectomy and (chemo)radiotherapy, but for T4-patients the survival was significantly better after primary total laryngectomy (± adjuvant radiotherapy). This large population-based study demonstrates a shift in treatment preference towards organ preservation therapies. The 5-year overall survival increased significantly in the second decade. The assumed equivalence of organ preservation and laryngectomy may require reconsideration for T4 disease.
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Affiliation(s)
- Japke F Petersen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Adriana J Timmermans
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Boukje A C van Dijk
- Department of Research, Comprehensive Cancer Organization The Netherlands (IKNL), Utrecht, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lucy I H Overbeek
- PALGA (The Dutch Nationwide Network and Registry of Histopathology and Cytopathology), Houten, The Netherlands
| | - Laura A Smit
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frans J M Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Institute of Phonetic Sciences-Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Clinical Epidemiology Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Institute of Phonetic Sciences-Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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22
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Matched-pair analysis of patients with advanced hypopharyngeal cancer: surgery versus concomitant chemoradiotherapy. Int J Clin Oncol 2017. [PMID: 28624863 DOI: 10.1007/s10147-017-1151-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to compare the therapeutic outcomes of total pharyngolaryngectomy with those of concomitant chemoradiotherapy in advanced hypopharyngeal cancer. METHODS This is a retrospective multi-institutional study. The medical records of 979 patients with hypopharyngeal cancer, who were initially treated between 2006 and 2008, were reviewed. In this study, we matched a group of total pharyngolaryngectomy patients with a second group of chemoradiotherapy patients, according to age, gender, subsite, arytenoid fixation, cartilage invasion, and N classification, and analyzed overall survival, disease-specific survival, and locoregional control rates. RESULTS The matched-pair analysis included 254 patients. The 5-year overall survival, disease-specific survival, and locoregional control rates were 58.5% and 53.5% (P = 0.30), 68.9% and 68.0% (P = 0.80), and 82.2% and 63.6% (P < 0.01), respectively, for patients in the total pharyngolaryngectomy and chemoradiotherapy groups. For T4a patients with cartilage invasion, the matched-pair analysis included 46 patients. The 5-year overall survival, disease-specific, and locoregional control rates were 56.5% and 26.0% (P = 0.092), 56.5% and 41.3% (P = 0.629), and 43.0% and 42.5% (P = 0.779), respectively, for patients in the total pharyngolaryngectomy and chemoradiotherapy groups. CONCLUSIONS The data from this large-scale multi-institutional joint research program of hypopharyngeal cancer in Japan suggest that chemoradiotherapy may provide adequate survival benefit for hypopharyngeal cancer patients with the distinct advantage of larynx preservation. Our data also suggest that chemoradiotherapy is as beneficial as total pharyngolaryngectomy for the local control of locally advanced hypopharyngeal cancer.
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23
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Zevallos JP, Mazul AL. The complex relation between race, sex, and human papillomavirus status in head and neck cancer. Cancer 2017; 123:1486-1487. [PMID: 28241091 DOI: 10.1002/cncr.30619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/16/2017] [Accepted: 01/18/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Jose P Zevallos
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Angela L Mazul
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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24
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Choi SH, Terrell JE, Fowler KE, McLean SA, Ghanem T, Wolf GT, Bradford CR, Taylor J, Duffy SA. Socioeconomic and Other Demographic Disparities Predicting Survival among Head and Neck Cancer Patients. PLoS One 2016; 11:e0149886. [PMID: 26930647 PMCID: PMC4773190 DOI: 10.1371/journal.pone.0149886] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/06/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Institute of Medicine (IOM) report, "Unequal Treatment," which defines disparities as racially based, indicates that disparities in cancer diagnosis and treatment are less clear. While a number of studies have acknowledged cancer disparities, they have limitations of retrospective nature, small sample sizes, inability to control for covariates, and measurement errors. OBJECTIVE The purpose of this study was to examine disparities as predictors of survival among newly diagnosed head and neck cancer patients recruited from 3 hospitals in Michigan, USA, while controlling for a number of covariates (health behaviors, medical comorbidities, and treatment modality). METHODS Longitudinal data were collected from newly diagnosed head and neck cancer patients (N = 634). The independent variables were median household income, education, race, age, sex, and marital status. The outcome variables were overall, cancer-specific, and disease-free survival censored at 5 years. Kaplan-Meier curves and univariate and multivariate Cox proportional hazards models were performed to examine demographic disparities in relation to survival. RESULTS Five-year overall, cancer-specific, and disease-free survival were 65.4% (407/622), 76.4% (487/622), and 67.0% (427/622), respectively. Lower income (HR, 1.5; 95% CI, 1.1-2.0 for overall survival; HR, 1.4; 95% CI, 1.0-1.9 for cancer-specific survival), high school education or less (HR, 1.4; 95% CI, 1.1-1.9 for overall survival; HR, 1.4; 95% CI, 1.1-1.9 for cancer-specific survival), and older age in decades (HR, 1.4; 95% CI, 1.2-1.7 for overall survival; HR, 1.2; 95% CI, 1.1-1.4 for cancer-specific survival) decreased both overall and disease-free survival rates. A high school education or less (HR, 1.4; 95% CI, 1.0-2.1) and advanced age (HR, 1.3; 95% CI, 1.1-1.6) were significant independent predictors of poor cancer-specific survival. CONCLUSION Low income, low education, and advanced age predicted poor survival while controlling for a number of covariates (health behaviors, medical comorbidities, and treatment modality). Recommendations from the Institute of Medicine's Report to reduce disparities need to be implemented in treating head and neck cancer patients.
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Affiliation(s)
- Seung Hee Choi
- College of Nursing, Michigan State University, East Lansing, MI, United States of America
| | - Jeffrey E. Terrell
- University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Karen E. Fowler
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America
| | - Scott A. McLean
- University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Tamer Ghanem
- Henry Ford Hospital, Detroit, MI, United States of America
| | - Gregory T. Wolf
- University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Carol R. Bradford
- University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Jeremy Taylor
- Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI, United States of America
| | - Sonia A. Duffy
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America
- College of Nursing, Ohio State University, Columbus, OH, United States of America
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25
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Tsai WC, Kung PT, Wang ST, Huang KH, Liu SA. Beneficial impact of multidisciplinary team management on the survival in different stages of oral cavity cancer patients: results of a nationwide cohort study in Taiwan. Oral Oncol 2014; 51:105-11. [PMID: 25484134 DOI: 10.1016/j.oraloncology.2014.11.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/23/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between multidisciplinary team (MDT) management and survival of oral cavity cancer patients using a nationwide database in Taiwan. MATERIALS AND METHODS A nationwide cohort study was conducted between 2005 and 2008. The follow-up end point was 2010. Claims data of oral cavity cancer patients were retrieved from the Taiwan Cancer Registry Database. Secondary data were obtained from the Taiwan's National Health Insurance Research Database. Among 19,766 newly diagnosed oral cavity cancer patients, we identified 16,991 patients who underwent treatment between 2004 and 2008 for further analyses. RESULTS Overall survival was compared between patients who received MDT management (n=3324) and those who did not (n=13,367). Hazard ratios (HR) of death in patients with MDT management were also analyzed. Patients with MDT management had a lower risk of death when compared with that of patients without MDT management (HR: 0.94, 95% confidence intervals (CI): 0.89-1.00; P=0.032). The effect of MDT management on survival was stronger for male patients than for female patients (HR: 0.94, 95% CI: 0.89-1.00; P=0.040 versus HR: 0.98, 95% CI: 0.75-1.27; P=0.866). In addition, the effect of MDT management was strong among patients with a Charlson Comorbidity Index between 4 and 6, in those without coexisting catastrophic illness/injury, and in patients with stage IV diseases. CONCLUSION Survival rates in oral cavity cancer patients with MDT management appeared to be marginally better than those of patients without MDT management.
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Affiliation(s)
- Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Shih-Ting Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Shih-An Liu
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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26
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Montero-Miranda PH, Ganly I. Survivorship--competing mortalities, morbidities, and second malignancies. Otolaryngol Clin North Am 2013; 46:681-710. [PMID: 23910478 DOI: 10.1016/j.otc.2013.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mortality of head and neck cancer has declined in the United States over the past 20 years. This improvement has been linked to use of multimodality treatment of advanced disease. Despite this improvement, disease-specific survival remains low. Patients who survive head and neck cancer are exposed to morbidity and mortality secondary to the same factors as the general population. Factors related to cancer and cancer treatment predispose them to increased risk of mortality. Improvements in head and neck cancer treatment have led to a scenario where an increasing proportion of patients die from causes other than the primary cancer, called competing mortalities.
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Affiliation(s)
- Pablo H Montero-Miranda
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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27
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Kano S, Homma A, Hayashi R, Kawabata K, Yoshino K, Iwae S, Hasegawa Y, Nibu K, Kato T, Shiga K, Matsuura K, Monden N, Fujii M. Matched-Pair Analysis in Patients with Advanced Oropharyngeal Cancer: Surgery versus Concurrent Chemoradiotherapy. Oncology 2013; 84:290-8. [DOI: 10.1159/000346908] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
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28
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Effects of multidisciplinary care on the survival of patients with oral cavity cancer in Taiwan. Oral Oncol 2012; 48:803-10. [DOI: 10.1016/j.oraloncology.2012.03.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 03/17/2012] [Accepted: 03/26/2012] [Indexed: 12/27/2022]
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29
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Wu AW, Suh JD, Metson R, Wang MB. Prognostic factors in sinonasal sarcomas: analysis of the surveillance, epidemiology and end result database. Laryngoscope 2012; 122:2137-42. [PMID: 22777866 DOI: 10.1002/lary.23442] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 04/16/2012] [Accepted: 04/26/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Sinonasal sarcomas are rare and often aggressive malignant tumors. Although tumor histology and location are the only reported prognostic indicators for this disease, we sought to determine if additional clinical factors might influence patient survival. STUDY DESIGN Retrospective cohort study using a national cancer database. METHODS Cases of sinonasal sarcomas from 1973 to 2008 were extracted from the Surveillance, Epidemiology and End Result (SEER) database. The influence of patient age, gender, race, and prior irradiation, as well as tumor histology and subsite, was calculated using the Kaplan-Meier method. RESULTS A total of 352 patients with sinonasal sarcomas were identified. Histologic subtype, tumor location, gender, and patient age were found to influence patient survival. Specifically, increased age, male sex, frontal and maxillary sinus subsites, and rhabdomyosarcoma and Kaposi sarcoma histologies were associated with a significant increase in mortality rate (P < .05). CONCLUSIONS This study comprises the largest analysis of patients with sinonasal sarcoma in the literature and demonstrates the impact of patient age, tumor histology, and tumor location on the overall survival of individuals with these rare malignancies.
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Affiliation(s)
- Arthur W Wu
- Division of Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA.
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30
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Ward MC, Lan L, Chen AY, Beitler JJ. The value of tumor diameter in predicting prognosis of oropharynx cancer treated with chemoradiation. Oral Oncol 2012; 48:876-80. [PMID: 22503697 DOI: 10.1016/j.oraloncology.2012.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/03/2012] [Accepted: 03/06/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The tumor node metastasis (TNM) system is the most widely used staging system for cancers of the oropharynx, yet is known to omit key prognostic indicators. Tumor volume has been shown in other head and neck sites to add predictive power but is not as useful in the oropharynx. This study investigates the value of other methods in quantifying tumor burden. METHODS Treatment plans of oropharyngeal cancer patients treated non-operatively were retrospectively reviewed. Potential prognostic factors including TNM, demographics, smoking history, and various tumor dimensions were analyzed. RESULTS Records identified 93 patients treated with definitive concurrent chemoradiation who had at least one year of follow-up and a clear GTV contour on the original treatment plan. On univariate analysis, tumor diameter and tumor volume showed a significant relationship to overall and disease-free survival. Tumor stage, age and smoking history showed significance in regard to overall survival. On multivariate analysis tumor diameter showed independent significance but not TNM or tumor volume. CONCLUSION Our method of measuring tumor diameter has independent prognostic significance in the oropharynx where GTV has shown questionable value.
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Affiliation(s)
- Matthew C Ward
- Medical College of Georgia, Georgia Health Sciences University, Augusta, GA, USA
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