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Pamulapati S, Abousaud M, Li Y, Ekpenyong A, Rudra S, Remick JS, Bates JE, Stokes WA, McDonald MW, Schmitt NC, El-Deiry MW, Patel MR, Steuer CE, Switchenko JM, Shin DM, Teng Y, Hammond A, Saba NF. Assessing survival outcomes of patients with oral tongue squamous cell carcinoma: Focus on age, sex, and stage. Head Neck 2024; 46:2167-2177. [PMID: 38695445 DOI: 10.1002/hed.27786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 12/24/2023] [Accepted: 04/12/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND The purpose of this study was to provide further insights into whether age and/or sex are associated with prognosis in oral tongue squamous cell carcinoma. METHODS This was a retrospective cohort study utilizing hospital registry data from 2006 to 2016 obtained from the National Cancer Database. Identified patients were divided into various cohorts based on age, sex, and staging. A descriptive analysis was performed using chi-square tests and overall survival rates were estimated using Kaplan-Meier method. RESULTS A total of 17 642 patients were included in the study. The 5-year overall survival rates were 82.0% (95% CI: 79.8%-84.0%) in younger patients versus 67.5% (95% CI: 66.7%-68.3%, p-value <0.0001) older patients. The median overall survival for females was 143.4 months (95% CI: 133.2-NA) versus 129.8 (95% CI: 125.4-138.7, p-value <0.0001) in males. CONCLUSIONS Our analysis suggests that younger age and female sex are both predictors of improved survival in oral tongue squamous cell carcinoma.
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Affiliation(s)
- Saagar Pamulapati
- Internal Medicine Program, Mercyhealth Graduate Medical Education Consortium, Rockford, Illinois, USA
| | - Marin Abousaud
- Astellas Pharma Global Development Inc., Astellas Pharma, Northbrook, Illinois, USA
| | - Yixuan Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Asari Ekpenyong
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Soumon Rudra
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Jill S Remick
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - James E Bates
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - William A Stokes
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Mark W McDonald
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Nicole C Schmitt
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Mark W El-Deiry
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Mihir R Patel
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Conor E Steuer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Yong Teng
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Anthea Hammond
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
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2
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Qi Z, Chen Y, Hu C, Yu Y, Liu K. Clinical characters and survival outcomes in primary squamous cell carcinoma of the retromolar trigone. Curr Probl Surg 2024; 61:101503. [PMID: 39098329 DOI: 10.1016/j.cpsurg.2024.101503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/15/2024] [Accepted: 05/15/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Zhoumiao Qi
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yanling Chen
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Chaoyue Hu
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yanling Yu
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Kai Liu
- School of Medicine, Lishui University, Lishui, Zhejiang, China.
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3
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Wongpattaraworakul W, Choi A, Buchakjian MR, Lanzel EA, Kd AR, Simons AL. Prognostic Role of Tumor-Infiltrating Lymphocytes in Oral Squamous Cell Carcinoma. BMC Cancer 2024; 24:766. [PMID: 38926643 PMCID: PMC11201865 DOI: 10.1186/s12885-024-12539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND In oral squamous cell carcinoma (OSCC), the tumor-node-metastasis (TNM) staging system is a significant factor that influences prognosis and treatment decisions for OSCC patients. Unfortunately, TNM staging does not consistently predict patient prognosis and patients with identical clinicopathological characteristics may have vastly different survival outcomes. Host immunity plays an important role in tumor progression but is not included in the TNM staging system. Tumor-infiltrating lymphocytes (TILs) are part of the host immune response that recognizes tumor cells; and the presence of TILs has emerged as potential candidates for prognostic markers for many types of cancers. The present study aims to determine the association of T cell-specific markers (CD3, CD4, CD8, and FOXP3) with clinicopathological characteristics and survival outcomes in OSCC patients. The prognostic value of CD3, CD4, and CD8 will also be evaluated based on tumor stage. METHODS Tissue microarrays were constructed containing 231 OSCC cases and analyzed by immunohistochemical staining for the expression of CD3, CD4, CD8, and FOXP3. The expression scores for each marker were correlated with clinicopathological parameters and survival outcomes. The prognostic impact of CD3, CD4 and CD8 were further analyzed based on tumor stage (early or advanced). RESULTS CD3, CD4, and CD8 were found to be significantly associated with both overall survival and progression-free survival using univariate analysis. However, none of these markers were found to independently predict the survival outcomes of OSCC using multivariate analysis. Only conventional factors such as nodal status, tumor differentiation and perineural invasion (PNI) were independent predictors of survival outcomes, with nodal status being the strongest independent predictor. Additionally, low CD4 (but not CD3 or CD8) expression was found to identify early-stage OSCC patients with exceptionally poor prognosis which was similar to that of advanced staged OSCC patients. CONCLUSIONS TIL markers such as CD3, CD4, CD8, and FOXP3 can predict the survival outcomes of OSCC patients, but do not serve as independent prognostic markers as found with conventional factors (i.e. nodal status, tumor differentiation and PNI). CD4 expression may assist with risk stratification in early-stage OSCC patients which may influence treatment planning and decision making for early-stage OSCC patients.
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Affiliation(s)
- Wattawan Wongpattaraworakul
- Department of Oral Pathology, Radiology, and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, United States
- Department of Pathology, College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Allen Choi
- Department of Pathology, College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Marisa R Buchakjian
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Emily A Lanzel
- Department of Oral Pathology, Radiology, and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, United States
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Anand Rajan Kd
- Department of Pathology, College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Andrean L Simons
- Department of Oral Pathology, Radiology, and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, United States.
- Department of Pathology, College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, B180K Medical Laboratories Iowa City, IA, 52242, Iowa City, United States.
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4
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Gauss C, Stone LD, Ghafouri M, Quan D, Johnson J, Fribley AM, Amm HM. Overcoming Resistance to Standard-of-Care Therapies for Head and Neck Squamous Cell Carcinomas. Cells 2024; 13:1018. [PMID: 38920648 PMCID: PMC11201455 DOI: 10.3390/cells13121018] [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: 05/29/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
Although there have been some advances during in recent decades, the treatment of head and neck squamous cell carcinoma (HNSCC) remains challenging. Resistance is a major issue for various treatments that are used, including both the conventional standards of care (radiotherapy and platinum-based chemotherapy) and the newer EGFR and checkpoint inhibitors. In fact, all the non-surgical treatments currently used for HNSCC are associated with intrinsic and/or acquired resistance. Herein, we explore the cellular mechanisms of resistance reported in HNSCC, including those related to epigenetic factors, DNA repair defects, and several signaling pathways. This article discusses these mechanisms and possible approaches that can be used to target different pathways to sensitize HNSCC to the existing treatments, obtain better responses to new agents, and ultimately improve the patient outcomes.
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Affiliation(s)
- Chester Gauss
- Carman and Ann Adams Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI 48202, USA; (C.G.); (M.G.)
| | - Logan D. Stone
- Oral & Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Mehrnoosh Ghafouri
- Carman and Ann Adams Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI 48202, USA; (C.G.); (M.G.)
| | - Daniel Quan
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Wayne State University, Detroit, MI 48202, USA; (D.Q.)
| | - Jared Johnson
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Wayne State University, Detroit, MI 48202, USA; (D.Q.)
| | - Andrew M. Fribley
- Carman and Ann Adams Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI 48202, USA; (C.G.); (M.G.)
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Wayne State University, Detroit, MI 48202, USA; (D.Q.)
- Molecular Therapeutics Program, Karmanos Cancer Institute, Wayne State University, Detroit, MI 48202, USA
| | - Hope M. Amm
- Oral & Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
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Mahboubi K, Nakoneshny SC, Sauro K, Roberts S, Hart R, Matthews TW, Dort J, Chandarana SP. The Association of Ethnicity and Oncologic Outcomes for Oral Cavity Squamous Cell Carcinoma (OSCC). Cancers (Basel) 2024; 16:2117. [PMID: 38893235 PMCID: PMC11171403 DOI: 10.3390/cancers16112117] [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: 03/31/2024] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 06/21/2024] Open
Abstract
(1) Background: To compare oncologic outcomes of South Asian (SA) patients treated for oral squamous cell carcinoma (OSCC) to the general population. (2) Methods: Adult patients who underwent surgical resection of OSCC +/- adjuvant treatment between 2009 and 2022 (N = 697) at a regional cancer centre in Canada were included. SA patients, identified using a validated method, were compared to non-SA patients. Kaplan-Meier methods were used to compare the primary outcomes, disease-specific survival (DSS) and recurrence-free survival (RFS) across baseline univariate characteristics, including betel nut consumption. Median follow-up time was 36.4 months. Cox proportional hazard models were used to identify independent predictors of survival with significance set at p < 0.05. (3) Results: SA patients (9% of cohort, N = 64) were significantly younger and had lower rates of smoking and alcohol consumption compared to non-SA patients (p < 0.05). SA patients had a two-fold higher risk of recurrence and significantly worse disease-specific survival, even after adjusting for stage and high-risk features [RFS: HR 2.01 (1.28-3.14), DSS: HR 1.79 (1.12-2.88)]. The consumption of betel nut was not associated with outcomes. (4) Conclusions: SA patients had significantly worse oncologic outcomes, even after controlling for known predictors of poor prognosis. These findings are novel and can inform personalized treatment decisions and influence public health policies when managing patients with different ethnic backgrounds.
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Affiliation(s)
- Kiana Mahboubi
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (S.R.); (R.H.); (T.W.M.); (J.D.); (S.P.C.)
| | - Steven C. Nakoneshny
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Khara Sauro
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (S.R.); (R.H.); (T.W.M.); (J.D.); (S.P.C.)
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Samuel Roberts
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (S.R.); (R.H.); (T.W.M.); (J.D.); (S.P.C.)
- University of Sydney, Camperdown, NSW 2800, Australia
| | - Rob Hart
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (S.R.); (R.H.); (T.W.M.); (J.D.); (S.P.C.)
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - T. Wayne Matthews
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (S.R.); (R.H.); (T.W.M.); (J.D.); (S.P.C.)
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Joseph Dort
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (S.R.); (R.H.); (T.W.M.); (J.D.); (S.P.C.)
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Shamir P. Chandarana
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (K.S.); (S.R.); (R.H.); (T.W.M.); (J.D.); (S.P.C.)
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
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Fei-Zhang DJ, Park AC, Chelius DC, Smith SS, Samant S, Patel UA, Sheyn AM, Rastatter JC. Influence of Social Vulnerability in Treatment and Prognosis of Squamous Cell Carcinoma of the Tongue. Otolaryngol Head Neck Surg 2024; 170:1338-1348. [PMID: 38353303 DOI: 10.1002/ohn.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/20/2023] [Accepted: 12/23/2023] [Indexed: 04/30/2024]
Abstract
OBJECTIVE To investigate the association of social determinants of health (SDoH) in squamous cell carcinoma of the tongue in the United States and to evaluate the real-world contribution of specific disparities. STUDY DESIGN Retrospective cohort study. SETTING United States. METHODS The Centers for Disease Control and Prevention-Social Vulnerability Index (SVI) and National Cancer Institute-Surveillance, Epidemiology, and End Results Program database were used to study 62,103 adult tongue squamous cell carcinoma patients from 1975 to 2017. Regression analysis assessed trends in months of follow-up and survival across social vulnerability and 4 subcategories of social vulnerability. RESULTS As overall SVI score increases (increased social vulnerability), there is a significant decrease in the average length of follow-up (22.95% decrease from 63.99 to 49.31 months; P < .001) across patients from the lowest and highest social vulnerability groups. As overall SVI score increases, there is a significant decrease in the average months of survival (28.00% decrease from 49.20 to 35.43 months; P < .001). There is also a significantly greater odds ratio (OR = 1.05; P < .001) of advanced cancer staging upon presentation at higher SVI scores. Patients with higher SVI scores have a lower OR (0.93; P < .001) of receiving surgery as their primary treatment when compared to patients with lower SVI scores. Patients with higher SVI scores also have a significantly greater OR (OR = 1.05; P < .001) of receiving chemotherapy as their primary treatment when compared to patients with lower SVI scores. CONCLUSION Increased social vulnerability is shown to have a detrimental impact on the treatment and prognosis of patients with squamous cell carcinoma of the tongue.
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Affiliation(s)
- David J Fei-Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Asher C Park
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel C Chelius
- Department of Otolaryngology-Head and Neck Surgery, Pediatric Thyroid Tumor Program and Pediatric Head and Neck Tumor Program, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Stephanie S Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandeep Samant
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Urjeet A Patel
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anthony M Sheyn
- Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Pediatric Otolaryngology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jeffrey C Rastatter
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Huang AE, Shih JJ, Sunwoo JB, Pollom E, Taparra K. Racial Disparities in 30-day Readmissions after Surgery for Head and Neck Cancer. Laryngoscope 2024; 134:1282-1287. [PMID: 37610178 DOI: 10.1002/lary.30997] [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: 05/22/2023] [Revised: 07/21/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Native Hawaiians and other Pacific Islanders (NHPI) patients with head and neck cancer are often aggregated with Asian individuals despite evidence of heterogeneous health outcomes and mortality. The aim of this study was to determine the association of race with unplanned 30-day hospital readmission rate after head and neck surgery across the five federally recognized racial categories. METHODS This retrospective cohort study used a national hospital-based database and included patients ≥18 years old with diagnostically confirmed, nonmetastatic head and neck cancer of any subsite treated surgically between 2004 and 2017. The primary endpoint was unplanned readmission within 30 days of discharge after primary surgery. RESULTS A total of 365,834 patients were included who were predominantly White (87%), treated at academic cancer centers (47%), lower income (63%), with early-stage disease (60%), and with thyroid (47%) or oral cavity (23%) cancers. Median follow-up duration was 47 months. Of the 10,717 (3%) readmissions, 5,845 (1.6%) were unplanned. Adjusted for confounders and compared with White patients, NHPI patients had the highest likelihood of unplanned (aOR 2.07, 95%CI 1.16-3.40, p = 0.008) readmissions. Within the NHPI group, patients with lower income (aOR 4.27, 95%CI 1.28-20.4, p = 0.035) and those residing in an urban or rural area (aOR 7.42, 95%CI 1.14-49.5, p = 0.034) were more likely to be readmitted. CONCLUSIONS NHPI patients with head and neck cancers experience significantly higher 30-day readmissions following definitive surgical treatment. These results highlight the importance of racial disaggregation in clinical studies. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1282-1287, 2024.
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Affiliation(s)
- Alice E Huang
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California, USA
| | - Jonathan J Shih
- University of California-San Francisco School of Medicine, San Francisco, California, USA
| | - John B Sunwoo
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California, USA
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Kekoa Taparra
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
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8
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Semprini J, Reynolds J, Zahnd WE, Wehby G. Eliminating Medicaid dental benefits and early-stage oral cancer diagnoses. Cancer Med 2024; 13:e7061. [PMID: 38457253 PMCID: PMC10923030 DOI: 10.1002/cam4.7061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/25/2023] [Accepted: 02/20/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Despite the importance of regular dental visits for detecting oral cancer, millions of low-income adults lack access to dental services. In July 2009, California eliminated adult Medicaid dental benefits. We tested if this impacted oral cancer detection for Medicaid enrollees. METHODS We analyzed Surveillance, Epidemiology, and End Results-Medicaid data, which contains verified Medicaid enrollment status, to estimate a difference-in-differences model. Our design compares the change in early-stage (Stages 0-II) diagnoses before and after dropping dental benefits in California with the change in early-stage diagnoses among eight states that did not change Medicaid dental benefits. Patients were grouped by oropharyngeal cancer (OPC) and non-OPC (oral cavity cancer), type, and the length of Medicaid enrollment. We also assessed if the effect of dropping dental benefits varied by the number of dentists per capita. RESULTS Dropping Medicaid dental benefits was associated with a 6.5%-point decline in early-stage diagnoses of non-OPC (95% CI = -14.5, -3.2, p = 0.008). This represented a 20% relative reduction from baseline rates. The effect was highest among beneficiaries with 3 months of continuous Medicaid enrollment prior to diagnosis who resided in counties with more dentists per capita. Specifically, dropping dental coverage was associated with a 1.25%-point decline in the probability of early-stage non-OPC diagnoses for every additional dentist per 5000 population (p = 0.006). CONCLUSIONS Eliminating Medicaid dental benefits negatively impacted early detection of cancers of the oral cavity. Continued volatility of Medicaid dental coverage and provider shortages may be further delaying oral cancer diagnoses. Alternative approaches are needed to prevent advanced stage OPC.
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Affiliation(s)
- Jason Semprini
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Julie Reynolds
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Whitney E. Zahnd
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - George Wehby
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
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Lin ME, Castellanos CX, Bagrodia N, West JD, Kokot NC. Differences in presentation, treatment, and outcomes among minority head and neck cancer patient groups in Los Angeles County. Am J Otolaryngol 2024; 45:104031. [PMID: 37639986 DOI: 10.1016/j.amjoto.2023.104031] [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: 06/25/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
IMPORTANCE While minorities represent around 20 % of all HNC patients, these demographics are largely understudied. Furthermore, trends in national studies may not always be fully replicated in locoregional populations, indicating a need for more nuanced study. OBJECTIVE To better understand our patient population, we sought to understand differences in presentation, management, and outcome between Caucasians and minority groups with HNC. DESIGN Retrospective cohort analysis of the Los Angeles County Surveillance Epidemiology and End Results (SEER) database. SETTING Los Angeles County. PARTICIPANTS All patients in Los Angeles County diagnosed with cancer of the head and neck from January 1, 1988 to December 31, 2018. MAIN OUTCOMES AND MEASURES The primary outcome in our study was significant differences between racial and ethnic groups in age of diagnosis, sex, socioeconomic quintile, insurance status, stage at diagnosis, treatment modality, time to first treatment, and cancer-specific cause of death. RESULTS Our 18,510-patient cohort was largely male (64.35 %), white (69.57 %), and were on average 62.84 years old (SD = 20.07). When stratifying patients by race and ethnicity, significant differences were found in average age at diagnosis, sex, socioeconomic quintile, insurance status, and stage at diagnosis, treatment modalities utilized, and time to first treatment (all p < 0.001). Relative to all other head and neck patients, minority groups were significantly younger, had lower proportions of male patients, were less likely to pursue surgery, were more likely to pursue chemotherapy or radiation, and endorsed longer time to first treatment (all p < 0.001). The distribution of socioeconomic quintile (all p < 0.001), insurance status (all p < 0.001), and stage at diagnosis (all p < 0.05) also significantly varied between minority and reference groups. Only African Americans exhibited significantly higher rates of cancer-specific cause of death relative to non-African Americans (p < 0.001). CONCLUSIONS AND RELEVANCE Pervasive socioeconomic disparities between Caucasian HNC patients and those of other minority racial and ethnic groups in Los Angeles County that likely and significantly impact the diagnosis and management of HNC and its resultant outcomes. We encourage others to similarly examine their local populations to tailor the quality of care provided to patients.
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Affiliation(s)
- Matthew Ern Lin
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Carlos X Castellanos
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Department of Head and Neck Surgery, Los Angeles, CA, USA
| | - Neelesh Bagrodia
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jonathan D West
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Niels C Kokot
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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10
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Semprini JT. Late-Stage Oral Cancer Detection After California and Illinois Restored Medicaid Dental Benefits. OTO Open 2024; 8:e111. [PMID: 38229972 PMCID: PMC10790188 DOI: 10.1002/oto2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/31/2023] [Indexed: 01/18/2024] Open
Abstract
Objective Previous research found an association between California's Medicaid dental coverage and oral cancer detection. However, this relationship has yet to be explored in other states or by subgroup populations. Study Design In addition to controlling for sociodemographic and tumor characteristics, this study implemented a traditional difference-in-differences design to compare distant-stage diagnosis trends in states restoring Medicaid dental benefits (California [CA] and Illinois [IL]) with trends in states with constant Medicaid dental benefits. Setting This retrospective, observational study analyzed oral cavity and pharynx cancer case data from The Surveillance, Epidemiology, and End Results program (2004-2017). Methods The outcome was a binary variable indicating whether a patient was diagnosed at a distant stage. Subgroup analyses were conducted by state, race/ethnic group, sex, age, and county-level household income. Results The sample included 109,997 adults diagnosed with cancer of the oral cavity and pharynx. Restoring Medicaid dental benefits was associated with a statistically significant 2.7%-point decline in the probability of a distant-stage oral cancer diagnosis. This estimate represented a 14% relative change from baseline rates. Results were consistent for CA and IL and by county-level median income. Estimates were significantly larger for adults under age 65, males, and adults identifying as Hispanic; non-Hispanic Black; American Indian; or Asian American or Pacific Islander. Conclusion Restoring Medicaid dental coverage improved early detection in both CA and IL, with the greatest reductions in distant-stage diagnoses occurring in younger adults, males, and minoritized racial/ethnic groups. Future research should investigate whether earlier detection reduces oral cancer mortality disparities.
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Affiliation(s)
- Jason T. Semprini
- Department of EpidemologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
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11
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Douse DM, Yin LX, Olawuni FO, Glasgow AE, Habermann EB, Price DL, Tasche KK, Moore EJ, Van Abel KM. Racial disparities in surgical treatment of oropharyngeal cancer: A Surveillance, Epidemiology, and End Results review. Head Neck 2023; 45:2313-2322. [PMID: 37461323 DOI: 10.1002/hed.27467] [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: 01/06/2023] [Revised: 06/03/2023] [Accepted: 07/09/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES Oropharyngeal squamous cell carcinoma (OPSCC) has been rising. This manuscript looks to explore racial disparities in the surgical management of OPSCC. METHODS A cancer database was queried for patients with OPSCC diagnosed from 2004 to 2017. Univariate and multivariable logistic regressions were used to evaluate associations between patient race/ethnicity, surgical treatment, and reasons for lack of surgery. RESULTS 37 306 (74.3%) patients did not undergo surgery, while 12 901 (25.7%) patients did. Non-Hispanic black (NHB) patients were less likely to undergo surgery than other races (17.9% vs. 26.5%; p < 0.0001). In clinical discussions, the Asian, Native American, Hawaiian, Pacific Islander (ANAHPI), and unknown race group was more likely to directly refuse surgery when recommended (2.5% vs. 1.5%; p = 0.015). CONCLUSION Racial differences exist in treatment for OPSCC. NHB patients are less likely to actually undergo surgical management for OPSCC, while other patients are more likely to directly "refuse" surgery outright when offered.
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Affiliation(s)
- Dontre' M Douse
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda X Yin
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Felicia O Olawuni
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy E Glasgow
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Division of Health Care Policy and Research and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Daniel L Price
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kendall K Tasche
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Moore
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn M Van Abel
- Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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12
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Wang W, Zhang Q, Thomson P, Sharma D, Ramamurthy P, Choi SW. Predicting oral cancer survival-Development and validation of an Asia-Pacific nomogram. J Oral Pathol Med 2023. [PMID: 37247328 DOI: 10.1111/jop.13454] [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: 04/13/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Nomograms are graphical calculating devices that predict response to treatment during cancer management. Oral squamous cell carcinoma (OSCC) is a lethal and deforming disease of rising incidence and global significance. The aim of this study was to develop a nomogram to predict individualized OSCC survival using a population-based dataset obtained from Queensland, Australia and externally validated using a cohort of OSCC patients treated in Hong Kong. METHODS Clinico-pathological data for newly diagnosed OSCC patients, including age, sex, tumour site and grading, were accessed retrospectively from the Queensland Cancer Registry (QCR) in Australia and the Clinical Data Analysis and Reporting System (CDARS) in Hong Kong. Multivariate Cox proportional hazard regression was used to construct overall survival (OS) and cancer-specific survival (CSS) prediction models. Nomograms were internally validated using 10-fold cross validation, and externally validated against the Hong Kong dataset. RESULTS Data from 9885 OSCC patients in Queensland and 465 patients from Hong Kong were analysed. All clinico-pathological variables significantly influenced survival outcomes. Nomogram calibration curves demonstrated excellent agreement between predicted and actual probability for Queensland patients. External validation in the Hong Kong population demonstrated slightly poorer nomogram performance, but predictive power remained strong. CONCLUSION Based upon readily available data documenting patient demographic and clinico-pathological variables, predictive nomograms offer pragmatic aid to clinicians in individualized treatment planning and prognosis assessment in contemporary OSCC management.
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Affiliation(s)
- Weilan Wang
- School of Data Science, The City University of Hong Kong, Hong Kong, China
| | - Qingpeng Zhang
- School of Data Science, The City University of Hong Kong, Hong Kong, China
| | - Peter Thomson
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Dileep Sharma
- Oral Health, School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Poornima Ramamurthy
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Siu-Wai Choi
- Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, China
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13
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Cui S, Liu H, Cui G. Nanoparticles as drug delivery systems in the treatment of oral squamous cell carcinoma: current status and recent progression. Front Pharmacol 2023; 14:1176422. [PMID: 37292147 PMCID: PMC10244499 DOI: 10.3389/fphar.2023.1176422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
Oral squamous cell carcinoma (OSCC) is a common human malignancy with an estimated incidence of around 377,713 new cases worldwide in 2020. Despite the advance in clinical management, some of OSCC patients still miss the opportunity of completable resection of tumor, and have to accept medical therapies, e.g., chemotherapy, radiotherapy, or immunotherapy when the disease develops into the advanced stage. However, these therapies have been reported to be far from ideal due to the low efficiency of conventional delivery approaches. To obtain a better therapeutic effect, considerable attempts have been made toward to develop an effective drug delivery system (DDS). Nanoparticles (NPs) including inorganic NPs, polymer NPs, lipid NP, extracellular vesicles and cell membrane-based NPs have been evaluated as the better DDS candidates that can specifically accumulate in the tumor microenvironment along with a large amount of blood vessels. Emerging evidence suggested that NPs formulated with anticancer drugs including chemotherapeutic drugs, radiotherapy and immunotarget antibodies could remarkably improve the release and increase concentration of these drugs at the tumor site and show a better therapeutic efficacy, suggesting that NPs might serve as promising DDSs in the treatment of OSCC. Therefore, we have conducted this review to summarize recent progression and current status of diverse NPs as DDSs in this research field.
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Affiliation(s)
- Shuxia Cui
- Henan Stomatological Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hanzhe Liu
- School of Stomatology, Wuhan University, Wuhan, China
| | - Guanglin Cui
- Faculty of Health Science, Campus Levanger, Nord University, Levanger, Norway
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14
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Tashman K, Noyes EA, Warinner CB, Ogbonna J, Gomez E, Jalisi SM. The relationship between safety-net hospital status and outcomes among elderly head and neck cancer patients. Head Neck 2023. [PMID: 37155322 DOI: 10.1002/hed.27385] [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: 07/09/2022] [Revised: 01/18/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The impact of safety-net status, case volume, and outcomes among geriatric head and neck cancer patients is unknown. METHODS Chi-square tests and Student's t tests to compare head and neck surgery outcomes of elderly patients between safety-net and non-safety-net hospitals. Multivariable linear regressions to determine predictors of outcome variables including mortality index, ICU stays, 30-day readmission, total direct cost, and direct cost index. RESULTS Compared with non-safety-net hospitals, safety-net hospitals had a higher average mortality index (1.04 vs. 0.32, p = 0.001), higher mortality rate (1% vs. 0.5%, p = 0.002), and higher direct cost index (p = 0.001). A multivariable model of mortality index found the interaction between safety-net status and medium case volume was predictive of higher mortality index (p = 0.006). CONCLUSION Safety-net status is correlated with higher mortality index and cost in geriatric head and neck cancer patients. The interaction between medium volume and safety-net status is independently predictive of higher mortality index.
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Affiliation(s)
| | - Elizabeth A Noyes
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Chloe B Warinner
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joseph Ogbonna
- Department of Surgery-Quality Office, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ernest Gomez
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Scharukh M Jalisi
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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15
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Liu Y, Zhong L, Puram SV, Mazul AL. Neighborhood Socioeconomic Status and Racial and Ethnic Survival Disparities in Oral Cavity and Laryngeal Cancer. Cancer Epidemiol Biomarkers Prev 2023; 32:642-652. [PMID: 36827359 PMCID: PMC10650942 DOI: 10.1158/1055-9965.epi-22-0963] [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: 09/10/2022] [Revised: 11/17/2022] [Accepted: 02/17/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Oral cavity cancer (OCC) and laryngeal cancer are among the most common cancers worldwide. This study investigated survival in non-Hispanic (NH) Black, NH White, Asian, and Hispanic patients with OCC and laryngeal cancer of low, intermediate, and high neighborhood socioeconomic status (nSES). METHODS We used data from the SEER 18 Census Tract-level SES and Rurality Database of the National Cancer Institute to create cohorts of OCC and laryngeal cancer patients from 2013 to 2018. Univariate survival analysis was performed with Kaplan-Meier curves and log-rank P values by nSES and then the cross-classification of race, ethnicity, and nSES. We used Cox proportional hazards regression model for multivariable analysis. RESULTS Higher nSES was associated with better OCC survival for NH White, NH Black, and Asian patients, and better laryngeal cancer survival for NH White, NH Black, Hispanic, and Asian patients. In the multivariable analyses of both OCC and laryngeal cancer survival, NH Black patients had worse survival than NH White patients in the high nSES tertile. NH Black patients with OCC were at higher risk of death than NH White patients at all nSES levels. Conversely, Asian patients with laryngeal cancer demonstrated better survival than other races within the high nSES. CONCLUSIONS Overall survival differs between racial and ethnic groups of similar nSESs. These health disparities in patients with OCC and laryngeal cancer reflect broader inequities in the cancer control continuum. IMPACT The cross-classification of race, ethnicity, and nSES revealed disparities in the 5-year overall survival of patients with OCC and laryngeal cancer and highlights the importance of intersectionality in the discussion of health equity.
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Affiliation(s)
- Yupeng Liu
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Lydia Zhong
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sidharth V. Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Angela L. Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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16
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Bommakanti KK, Abiri A, Han AY, Goshtasbi K, Kuan EC, St John MA. Stage-Specific Survival in Young Patients With Oral Tongue Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2023; 168:398-406. [PMID: 35700039 DOI: 10.1177/01945998221101191] [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: 11/02/2021] [Accepted: 04/29/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine demographic factors and clinicopathologic characteristics associated with survival in young patients (age <45 years) with early- (I-II) or late-stage (III-IV) oral tongue squamous cell carcinoma (OTSCC). STUDY DESIGN Retrospective database review. SETTING National Cancer Database. METHODS A retrospective review of 3262 OTSCC cases in young patients between 2005 and 2014 was performed by using data from the National Cancer Database. Factors affecting 2-year survival in patients with early- and late-stage disease were evaluated via univariate and multivariate analyses. RESULTS Overall, 1899 patients with early-stage OTSCC and 1363 with late-stage OTSCC were analyzed. In multivariate analysis of early-stage OTSCC, high tumor grade (hazard ratio, 2.08 [95% CI, 1.45-2.99]), local metastasis (2.85 [1.37-5.95]), and tumor size (1.04 [1.02-1.07]) were predictors of mortality. In late-stage OTSCC, African American race (2.79 [1.40-5.56]), positive surgical margins (1.77 [1.07-2.93]), local metastasis (2.20 [1.03-4.72]), distant metastasis (11.66 [2.10-64.73]), depth of invasion (1.03 [1.01-1.05]), and tumor size (1.01 [1.003-1.01]) were predictors of mortality. Subset analysis of clinical N0-stage tumors revealed that treatment with surgery alone was associated with improved survival (P < .001). CONCLUSION Positive lymph nodes, high tumor grade, and larger tumor size were associated with increased mortality risk in early- and late-stage young OTSCC. More aggressive up-front treatment, including extirpative surgery and elective neck dissection, may be associated with improved outcomes and should be considered in early-stage cases with high-risk features.
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Affiliation(s)
- Krishna K Bommakanti
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
| | - Albert Y Han
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- UCLA Head and Neck Cancer Program, University of California-Los Angeles, Los Angeles, California, USA
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17
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Shruti T, Khanna D, Khan A, Dandpat A, Tiwari M, Singh AG, Mishra A, Shetty A, Birur P, Chaturvedi P. Status and Determinants of Early Detection of Oral Premalignant and Malignant Lesions in India. Cancer Control 2023; 30:10732748231159556. [PMID: 36809192 PMCID: PMC9947682 DOI: 10.1177/10732748231159556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
It has been over four decades since the launch of the National Cancer Control Programme in India, yet the cancer screening rates for oral cancer remain unremarkable. Moreover, India is bracing a large burden of oral cancer with poor survival rates. An effective public health programme implementation relies on a multitude of factors related to cost-effective evidence-based interventions, the healthcare delivery system, public health human resource management, community behaviour, partnership with stakeholders, identifying opportunities and political commitment. In this context, we discuss the various challenges in the early detection of oral premalignant and malignant lesions and potential solutions.
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Affiliation(s)
- Tulika Shruti
- Departmentof Preventive Oncology,
Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha
Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Divya Khanna
- Departmentof Preventive Oncology,
Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha
Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India,Divya Khanna, MD, Department of Preventive
Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi
Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Banaras Hindu University,
Campus, Sundar Bagiya Colony, Sundarpur, Varanasi 221005, India.
| | - Aqusa Khan
- Departmentof Preventive Oncology,
Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha
Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Abhishek Dandpat
- Departmentof Preventive Oncology,
Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha
Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Manish Tiwari
- Department of Head and Neck
Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi
Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Arjun G. Singh
- Department of Head and Neck
Oncology, Tata Memorial Centre, Mumbai, India
| | - Aseem Mishra
- Department of Head and Neck
Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi
Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | | | - Praveen Birur
- Department of Oral Medicine and
Radiology, Consultant Biocon Foundation and Integrated Head and Neck Programme,
Mazumdar Shaw Medical Foundation, KLES Institute of Dental
Sciences, Bengaluru, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Homi Bhabha National
Institute, Anushakti Nagar, India,Centre for Cancer Epidemiology, Tata Memorial Centre, Mumbai, India
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18
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Alabi RO, Elmusrati M, Leivo I, Almangush A, Mäkitie AA. Advanced-stage tongue squamous cell carcinoma: a machine learning model for risk stratification and treatment planning. Acta Otolaryngol 2023; 143:206-214. [PMID: 36794334 DOI: 10.1080/00016489.2023.2172208] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND A significant number of tongue squamous cell carcinoma (TSCC) patients are diagnosed at late stage. OBJECTIVES We primarily aimed to develop a machine learning (ML) model based on ensemble ML paradigm to stratify advanced-stage TSCC patients into the likelihood of overall survival (OS) for evidence-based treatment. We compared the survival outcome of patients who received either surgical treatment only (Sx) or surgery combined with postoperative radiotherapy (Sx + RT) or postoperative chemoradiotherapy (Sx + CRT). MATERIAL AND METHODS A total of 428 patients from Surveillance, Epidemiology, and End Results (SEER) database were reviewed. Kaplan-Meier and Cox proportional hazards models examine OS. In addition, a ML model was developed for OS likelihood stratification. RESULTS Age, marital status, N stage, Sx, and Sx + CRT were considered significant. Patients with Sx + RT showed better OS than Sx + CRT or Sx alone. A similar result was obtained for T3N0 subgroup. For T3N1 subgroup, Sx + CRT appeared more favorable for 5-year OS. In T3N2 and T3N3 subgroups, the numbers of patients were small to make insightful conclusions. The OS predictive ML model showed an accuracy of 86.3% for OS likelihood prediction. CONCLUSIONS AND SIGNIFICANCE Patients stratified as having high likelihood of OS may be managed with Sx + RT. Further external validation studies are needed to confirm these results.
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Affiliation(s)
- Rasheed Omobolaji Alabi
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | - Mohammed Elmusrati
- Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
| | - Alhadi Almangush
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Institute of Biomedicine, Pathology, University of Turku, Turku, Finland.,Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Antti A Mäkitie
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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19
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Li D, Thomas C, Shrivastava N, Gersten A, Gadsden N, Schlecht N, Kawachi N, Schiff BA, Smith RV, Rosenblatt G, Augustine S, Gavathiotis E, Burk R, Prystowsky MB, Guha C, Mehta V, Ow TJ. Establishment of a diverse head and neck squamous cancer cell bank using conditional reprogramming culture methods. J Med Virol 2023; 95:e28388. [PMID: 36477880 PMCID: PMC10168123 DOI: 10.1002/jmv.28388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022]
Abstract
Most laboratory models of head and neck squamous cell cancer (HNSCC) rely on established immortalized cell lines, which carry inherent bias due to selection and clonality. We established a robust panel of HNSCC tumor cultures using a "conditional reprogramming" (CR) method, which utilizes a rho kinase inhibitor (Y-27632) and co-culture with irradiated fibroblast (J2 strain) feeder cells to support indefinite tumor cell survival. Sixteen CR cultures were successfully generated from 19 consecutively enrolled ethnically and racially diverse patients with HNSCC at a tertiary care center in the Bronx, NY. Of the 16 CR cultures, 9/16 were derived from the oral cavity, 4/16 were derived from the oropharynx, and 3/16 were from laryngeal carcinomas. Short tandem repeat (STR) profiling was used to validate culture against patient tumor tissue DNA. All CR cultures expressed ΔNp63 and cytokeratin 5/6, which are markers of squamous identity. Human papillomavirus (HPV) testing was assessed utilizing clinical p16 staining on primary tumors, reverse transcription polymerase chain reaction (RT-PCR) of HPV16/18-specific viral oncogenes E6 and E7 in RNA extracted from tumor samples, and HPV DNA sequencing. Three of four oropharyngeal tumors were p16 and HPV-positive and maintained HPV in culture. CR cultures were able to establish three-dimensional spheroid and murine flank and orthotopic tongue models. CR methods can be readily applied to all HNSCC tumors regardless of patient characteristics, disease site, and molecular background, providing a translational research model that properly includes patient and tumor diversity.
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Affiliation(s)
- Daniel Li
- Department of Pathology, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carlos Thomas
- Department of Pathology, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nitisha Shrivastava
- Department of Pathology, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adam Gersten
- Department of Pathology, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicholas Gadsden
- Department of Anesthesiology, Columbia University, New York, NY, USA
| | - Nicolas Schlecht
- Department of Pathology, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Nicole Kawachi
- Department of Pathology, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bradley A. Schiff
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard V. Smith
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Surgery, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY USA
| | - Gregory Rosenblatt
- Department of Pathology, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
| | - Stelby Augustine
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Robert Burk
- Department of Pediatrics, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, NY USA
| | - Michael B. Prystowsky
- Department of Pathology, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vikas Mehta
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
| | - Thomas J Ow
- Department of Pathology, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center / Albert Einstein College of Medicine, Bronx, NY, USA
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20
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Koyuncu CF, Nag R, Lu C, Corredor G, Viswanathan VS, Sandulache VC, Fu P, Yang K, Pan Q, Zhang Z, Xu J, Chute DJ, Thorstad WL, Faraji F, Bishop JA, Mehrad M, Castro PD, Sikora AG, Thompson LD, Chernock RD, Lang Kuhs KA, Wasman JK, Luo JR, Adelstein DJ, Koyfman SA, Lewis Jr JS, Madabhushi A. Image analysis reveals differences in tumor multinucleations in Black and White patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma. Cancer 2022; 128:3831-3842. [PMID: 36066461 PMCID: PMC9782693 DOI: 10.1002/cncr.34446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/17/2022] [Accepted: 06/28/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Understanding biological differences between different racial groups of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) patients, who have differences in terms of incidence, survival, and tumor morphology, can facilitate accurate prognostic biomarkers, which can help develop personalized treatment strategies. METHODS This study evaluated whether there were morphologic differences between HPV-associated tumors from Black and White patients in terms of multinucleation index (MuNI), an image analysis-derived metric that measures density of multinucleated tumor cells within epithelial regions on hematoxylin-eosin images and previously has been prognostic in HPV-associated OPSCC patients. In this study, the authors specifically evaluated whether the same MuNI cutoff that was prognostic of overall survival (OS) and disease-free survival in their previous study, TTR , is valid for Black and White patients, separately. We also evaluated population-specific cutoffs, TB for Blacks and TW for Whites, for risk stratification. RESULTS MuNI was statistically significantly different between Black (mean, 3.88e-4; median, 3.67e-04) and White patients (mean, 3.36e-04; median, 2.99e-04), with p = .0078. Using TTR , MuNI was prognostic of OS in the entire population with hazard ratio (HR) of 1.71 (p = .002; 95% confidence interval [CI], 1.21-2.43) and in White patients with HR of 1.72 (p = .005; 95% CI, 1.18-2.51). Population-specific cutoff, TW , yielded improved HR of 1.77 (p = .003; 95% CI, 1.21-2.58) for White patients, whereas TB did not improve risk-stratification in Black patients with HR of 0.6 (p = .3; HR, 0.6; 95% CI, 0.2-1.80). CONCLUSIONS Histological difference between White and Black patient tumors in terms of multinucleated tumor cells suggests the need for considering population-specific prognostic biomarkers for personalized risk stratification strategies for HPV-associated OPSCC patients.
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Affiliation(s)
- Can F. Koyuncu
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA,Louis Stokes Cleveland Veterans Affairs Medical CenterClevelandOhioUSA
| | - Reetoja Nag
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA
| | - Cheng Lu
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA
| | - Germán Corredor
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA,Louis Stokes Cleveland Veterans Affairs Medical CenterClevelandOhioUSA
| | - Vidya S. Viswanathan
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA
| | - Vlad C. Sandulache
- Baylor College of MedicineHoustonTexasUSA,Otolaryngology‐Head and Neck SurgeryOperative Care Line, Michael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
| | - Pingfu Fu
- Department of Population and Quantitative Health SciencesCase Western Reserve UniversityClevelandOhioUSA
| | | | - Quintin Pan
- Case Comprehensive Cancer CenterCase Western Reserve UniversityClevelandOhioUSA
| | - Zelin Zhang
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA
| | - Jun Xu
- Nanjing University of Information Science and TechnologyNanjingChina
| | | | | | - Farhoud Faraji
- University of California San DiegoSan DiegoCaliforniaUSA
| | | | - Mitra Mehrad
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | | | | | | | | | - Jay K. Wasman
- School of MedicineCase Western Reserve UniversityClevelandOhioUSA
| | | | | | | | | | - Anant Madabhushi
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA,Atlanta Veterans Administration Medical CenterAtlantaGeorgiaUSA,Louis Stokes Cleveland Veterans Affairs Medical CenterClevelandOhioUSA
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21
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Farhadi K, Rojanaworarit C, Bhurosy T, Olokunlade T, Karaye IM. Trends in Lip, Oral Cavity, and Pharyngeal Cancer Mortality in the United States, 1999-2019. J Oral Pathol Med 2022; 51:763-770. [PMID: 35998115 DOI: 10.1111/jop.13345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/30/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Changes in the epidemiology of lip, oral cavity, and pharyngeal (LOCP) cancers have been reported in the United States. This study aimed to examine the recent trends in LOCP cancer mortality in the United States from 1999 through 2019. METHODS National mortality data were extracted from CDC WONDER, 1999-2019. The International Classification of Diseases Codes, 10th Revision- C00-C14, were used to identify decedents of the malignant neoplasms of the lip, oral cavity, and pharynx. LOCP cancer mortality trends were assessed by fitting a Joinpoint regression model overall and by race/ethnicity, sex, age, and US Census Region. Annual Percentage Changes (APC) were derived to estimate variations in mortality trends over time. RESULTS The age-adjusted mortality rate (AAMR) for LOCP cancers was 2.5 per 100,000 (95% CI: 2.5 - 2.5), equivalent to 180,532 deaths during 1999-2019. Overall mortality trends have stabilized since 2009 (APC= 0.3; 95% CI: -0.1, 0.7), but an examination by subtype revealed rising mortality trends from cancers of the lip and oral cavity (APC= 1.2; 95% CI: 0.7, 1.6) and pharynx (APC=3.2; 95% CI: 1.7, 4.8), and declining trends in malignancies of other and ill-defined areas of the lip, oral cavity, and pharynx (APC= -2.7; 95% CI: -3.4, -2.0). Trend variations were also noted by sex, age, US Census Region, and race/ethnicity. CONCLUSIONS There are differential trends in mortality from LOCP cancers in the US. Investigating the biological, individual, and contextual factors related to LOCP cancers would guide effective public health interventions.
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Affiliation(s)
- Kameron Farhadi
- Department of Population Health, Hofstra University, 131 Hofstra Dome, Hempstead, NY
| | | | - Trishnee Bhurosy
- Department of Population Health, Hofstra University, 126 Hofstra Dome, Hempstead, NY
| | - Temitope Olokunlade
- Department of Environmental and Occupational Health, Texas A&M University, 212 Adriance Lab Rd., College Station, TX
| | - Ibraheem M Karaye
- Department of Population Health, Hofstra University, 106 Hofstra Dome, Hempstead, NY
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22
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Taparra K, Qu V, Pollom E. Disparities in Survival and Comorbidity Burden Between Asian and Native Hawaiian and Other Pacific Islander Patients With Cancer. JAMA Netw Open 2022; 5:e2226327. [PMID: 35960520 PMCID: PMC9375163 DOI: 10.1001/jamanetworkopen.2022.26327] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022] Open
Abstract
Importance Improper aggregation of Native Hawaiian and other Pacific Islander individuals with Asian individuals can mask Native Hawaiian and other Pacific Islander patient outcomes. A comprehensive assessment of cancer disparities comparing Asian with Native Hawaiian and other Pacific Islander populations is lacking. Objective To compare comorbidity burden and survival among East Asian, Native Hawaiian and other Pacific Islander, South Asian, and Southeast Asian individuals with non-Hispanic White individuals with cancer. Design, Setting, and Participants This retrospective cohort study used a national hospital-based oncology database enriched with Native Hawaiian and other Pacific Islander and Asian populations. Asian, Native Hawaiian and other Pacific Islander, and White individuals diagnosed with the most common cancers who received treatment from January 1, 2004, to December 31, 2017, were included. Patients younger than 18 years, without pathologic confirmation of cancer, or with metastatic disease were excluded. Data were analyzed from January to May 2022. Main Outcomes and Measures The primary end points were comorbidity burden by Charlson-Deyo Comorbidity Index and overall survival (OS). Results In total, 5 955 550 patients were assessed, including 60 047 East Asian, 11 512 Native Hawaiian and other Pacific Islander, 25 966 South Asian, 42 815 Southeast Asian, and 5 815 210 White patients. The median (IQR) age was 65 (56-74) years, median (IQR) follow-up was 58 (30-96) months, and 3 384 960 (57%) were women. Patients were predominantly from metropolitan areas (4 834 457 patients [84%]) and the Southern United States (1 987 506 patients [34%]), with above median education (3 576 460 patients [65%]), and without comorbidities (4 603 386 patients [77%]). Cancers included breast (1 895 351 patients [32%]), prostate (948 583 patients [16%]), kidney or bladder (689 187 patients [12%]), lung (665 622 patients [11%]), colorectal (659 165 patients [11%]), melanoma (459 904 patients [8%]), endometrial (307 401 patients [5%]), lymphoma (245 003 patients [4%]), and oral cavity (85 334 patients [1%]) malignant neoplasms. Native Hawaiian and other Pacific Islander patients had the highest comorbidity burden (adjusted odds ratio [aOR], 1.70; 95% CI, 1.47-1.94) compared with Asian and White groups. Asian patients had superior OS compared with White patients for most cancers; only Southeast Asian patients with lymphoma had inferior survival (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.16-1.37). In contrast, Native Hawaiian and other Pacific Islander patients demonstrated inferior OS compared with Asian and White patients for oral cavity cancer (aHR, 1.56; 95% CI, 1.14-2.13), lymphoma (aHR, 1.35; 95% CI, 1.11-1.63), endometrial cancer (aHR, 1.30; 95% CI, 1.12-1.50), prostate cancer (aHR, 1.29; 95% CI, 1.14-1.46), and breast cancer (aHR, 1.09; 95% CI, 1.00-1.18). No cancers among Native Hawaiian and other Pacific Islander patients had superior OS compared with White patients. Conclusions and Relevance In this cohort study, compared with White patients with the most common cancers, Asian patients had superior survival outcomes while Native Hawaiian and other Pacific Islander patients had inferior survival outcomes. Native Hawaiian and other Pacific Islander patients had significantly greater comorbidity burden compared with Asian and White patients, but this alone did not explain the poor survival outcomes. These results support the disaggregation of these groups in cancer studies.
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Affiliation(s)
- Kekoa Taparra
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Vera Qu
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Erqi Pollom
- Department of Radiation Oncology, Stanford University, Palo Alto, California
- Palo Alto Veterans Affairs Hospital, Palo Alto, California
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23
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Moon PK, Ma Y, Megwalu UC. Head and Neck Cancer Stage at Presentation and Survival Outcomes Among Native Hawaiian and Other Pacific Islander Patients Compared With Asian and White Patients. JAMA Otolaryngol Head Neck Surg 2022; 148:636-645. [PMID: 35616952 PMCID: PMC9136676 DOI: 10.1001/jamaoto.2022.1086] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Research studies often group Native Hawaiian and Other Pacific Islander individuals together with Asian individuals despite being consistently identified as having worse health outcomes and higher rates of comorbidities and mortality. Native Hawaiian and Other Pacific Islander individuals also have high incidence rates of oral cavity and pharyngeal cancer compared with the general population; however, disparities in clinical presentation and survival outcomes of head and neck cancer squamous cell carcinoma (HNSCC) among this population have not been investigated nor compared with those of other races. Objective To determine the association of race with cancer stage at diagnosis and survival outcomes among Native Hawaiian and Other Pacific Islander patients with HNSCC compared with Asian and non-Hispanic White patients. Design, Setting, and Participants This was a retrospective population-based cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) 18 database. Asian, Native Hawaiian or Other Pacific Islander, and non-Hispanic White adult patients diagnosed in 1988 through 2015 with HNSCC of the oral cavity, oropharynx, nasopharynx, larynx, and hypopharynx were included; any patient whose record was missing data on disease or demographic information was excluded. Main Outcomes and Measures Cancer stage at presentation was compared among Asian, Native Hawaiian and Other Pacific Islander, and non-Hispanic White patients using a multivariable logistic regression model. Survival outcomes were compared among these racial groups using Cox regression models. Data analyses were performed from July 1, 2021, to March 20, 2022. Results The total study population comprised 76 473 patients: 4894 Asian (mean [SD] age at presentation, 60.7 [14.6] years), 469 Native Hawaiian and Other Pacific Islander (57.8 [12.3] years), and 71 110 non-Hispanic White (62.2 [12.1] years) individuals. Native Hawaiian and Other Pacific Islander patients were more likely to present with advanced-stage HNSCC (odds ratio [OR], 1.38; 95% CI, 1.12 -1.72) compared with non-Hispanic White patients. Asian patients presented with similar stage disease (OR, 1.04; 95% CI, 0.97-1.11) compared with non-Hispanic White patients. Native Hawaiian and Other Pacific Islander patients had worse disease-specific survival (HR, 1.18; 95% CI, 1.02-1.36) compared with non-Hispanic White patients after adjusting for clinical and demographic factors. In contrast, Asian patients had improved disease-specific survival (HR, 0.93; 95% CI, 0.88-0.98) compared with non-Hispanic White patients. Conclusions and Relevance This retrospective population-based cohort study suggests that Native Hawaiian and Other Pacific Islander race was associated with more advanced HNSCC, and worse disease-specific survival compared with non-Hispanic White race, while Asian race was associated with improved survival. This study highlights the importance of disaggregating Asian from Pacific Islander data when assessing health disparities, and the need for culturally sensitive interventions to promote earlier detection of head and neck cancer and improved survival among the Native Hawaiian and Other Pacific Islander population.
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Affiliation(s)
- Peter Kim Moon
- Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Yifei Ma
- Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Uchechukwu C. Megwalu
- Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
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24
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Ahuja NA, Kedia SK, Ward KD, Pichon LC, Chen W, Dillon PJ, Navaparia H. Effectiveness of Interventions to Improve Oral Cancer Knowledge: a Systematic Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:479-498. [PMID: 33506408 DOI: 10.1007/s13187-021-01963-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
Oral cancer is prone to late-stage diagnosis, and subsequent low five-year survival rates. A small number of interventions or campaigns designed to enhance knowledge of risk factors and symptoms associated with oral cancer have been attempted in the UK, US, and some other countries. The purpose of this systematic review is to assess the effectiveness of interventions designed to improve oral cancer knowledge. We searched five databases to identify randomized controlled trials (RCTs) and non-randomized/quasi-experimental (NR/QE) studies targeting the general population or high-risk groups (tobacco users or alcohol consumers), aged ≥15 years, and reporting the outcomes of individual and/or community level interventions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias. Adhering to PRISMA guidelines, 27 (eight RCTs and 19 NR/QE studies) of the 551 studies identified from the five databases met the inclusion criteria. All RCTs and nine NR/QE studies used either printed materials, health education sessions, multimedia aids, or some combinations of these tools. The other ten NR/QE studies were community-based and used mass media campaigns to increase oral cancer awareness. Overall, the majority of studies significantly improved oral cancer knowledge; however, heterogeneity in study design and variation in measurement tools made it difficult to compare outcomes. Findings suggest that individual and/or community level interventions are generally effective in increasing knowledge of oral cancer risk factors, signs and symptoms, and/or its early diagnosis and prevention strategies among the general population or high-risk groups. However, the long-term benefits of these interventions are understudied.
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Affiliation(s)
- Nikhil A Ahuja
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA.
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Weiyu Chen
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Hitesh Navaparia
- Department of Oral and Maxillofacial Surgery, Vaidik Dental College and Research Center, Daman, India
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25
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Zenga J, Awan MJ, Frei A, Petrie E, Sharma GP, Shreenivas A, Shukla M, Himburg HA. Chronic stress promotes an immunologic inflammatory state and head and neck cancer growth in a humanized murine model. Head Neck 2022; 44:1324-1334. [PMID: 35261119 PMCID: PMC9081149 DOI: 10.1002/hed.27028] [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: 11/11/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite the importance of immune response and environmental stress on head and neck cancer (HNC) outcomes, no current pre-clinical stress model includes a humanized immune system. METHODS We investigated the effects of chronic stress induced by social isolation on tumor growth and human immune response in subcutaneous HNC tumors grown in NSG-SGM3 mice engrafted with a human immune system. RESULTS Tumor growth (p < 0.0001) and lung metastases (p = 0.035) were increased in socially isolated versus control animals. Chronic stress increased intra-tumoral CD4+ T-cell infiltrate (p = 0.005), plasma SDF-1 (p < 0.0001) expression, and led to tumor cell dedifferentiation toward a cancer stem cell phenotype (CD44+ /ALDHhigh , p = 0.025). CONCLUSIONS Chronic stress induced immunophenotypic changes, increased tumor growth, and metastasis in HNC in a murine model with a humanized immune system. This model system may provide further insight into the immunologic and oncologic impact of chronic stress on patients with HNC.
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Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI
| | - Musaddiq J. Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Anne Frei
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Ellie Petrie
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Guru Prasad Sharma
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Aditya Shreenivas
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Monica Shukla
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Heather A. Himburg
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
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26
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Duraiswamy S, Rubin SJ, Kim Y, Mur T, Edwards HA. Limited English proficiency and head and neck cancer outcomes. Am J Otolaryngol 2022; 43:103470. [PMID: 35427938 DOI: 10.1016/j.amjoto.2022.103470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Limited English proficiency (LEP) is common among hospitalized patients and may impact clinical care and outcomes. This study aimed to examine the relationship between LEP and clinical oncological outcomes for patients with head and neck cancer (HNC). MATERIALS AND METHODS A single center retrospective review was conducted including adult patients with squamous cell carcinoma of the head and neck who received treatment with curative intent between January 1, 2014 and July 1, 2019. Clinical data collected included patient demographics and clinical variables. Univariate and multivariate analysis was performed to determine whether there was an association between LEP and demographic and clinical factors. RESULTS There were 477 patients included in the study; 426 (81%) were English proficient (EP) while 51 (10.7%) were LEP. The LEP patients were diagnosed with cancer at a later overall stage (p = 0.03) and less frequently treated with surgery alone compared to English speaking patients (p < 0.001). After adjusting for overall stage and primary site, LEP patients were significantly more likely to receive primary surgical management compared to primary non-surgical management [OR = 2.29 95% CI (0.93, 5.58), p = 0.008]. There was also a significant association between LEP and primary site of tumor (p < 0.01). Kaplan-Meyer curves for overall survival and disease specific survival showed no significant differences between the two cohorts (p = 0.8063 and p = 0.4986, respectively). CONCLUSIONS LEP may impact access to care resulting in more advanced overall tumor stage at presentation and treatment with primary surgery compared to non-surgical management after adjusting for tumor stage and primary site. Interventions to provide better access to care, awareness of HNC in the LEP populations, and earlier detection may improve outcomes for LEP patients.
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Affiliation(s)
- Swetha Duraiswamy
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Samuel J Rubin
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Yeahan Kim
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Taha Mur
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
| | - Heather A Edwards
- Department of Otolaryngology, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States of America.
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27
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Emerson MA, Farquhar DR, Lenze NR, Sheth S, Mazul AL, Zanation AM, Hackman TG, Weissler MC, Zevallos JP, Yarbrough WG, Brennan P, Abedi-Ardekani B, Olshan AF. Socioeconomic status, access to care, risk factor patterns, and stage at diagnosis for head and neck cancer among black and white patients. Head Neck 2022; 44:823-834. [PMID: 35044015 PMCID: PMC8904304 DOI: 10.1002/hed.26977] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Little is known about how factors combine to influence progression of squamous cell carcinoma of the head and neck (HNSCC). We aimed to evaluate multidimensional influences of factors associated with HNSCC stage by race. METHODS Using retrospective data, patients with similar socioeconomic status (SES), access to care (travel time/distance), and behavioral risk factors (tobacco/alcohol use and dental care) were grouped by latent class analysis. Relative frequency differences (RFD) were calculated to evaluate latent classes by stage, race, and p16 status. RESULTS We identified three latent classes. Advanced T-stage was higher for black (RFD = +20.2%; 95% CI: -4.6 to 44.9) than white patients (RFD = +10.7%; 95% CI: 2.1-19.3) in the low-SES/high-access/high-behavioral risk class and higher for both black (RFD = +29.6%; 95% CI: 4.7-54.5) and white patients (RFD = +23.9%; 95% CI: 15.2-32.6) in the low-SES/low-access/high-behavioral risk class. CONCLUSION Results suggest that SES, access to care, and behavioral risk factors combine to underly the association with advanced T-stage. Additionally, differences by race warrant further investigation.
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Affiliation(s)
- Marc A. Emerson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Douglas R. Farquhar
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nicholas R. Lenze
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Siddharth Sheth
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Divison of Medical Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Angela L. Mazul
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO
| | - Adam M. Zanation
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Trevor G. Hackman
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark C. Weissler
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jose P. Zevallos
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO
| | - Wendell G. Yarbrough
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Pathology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Paul Brennan
- International Agency for Research on Cancer, WHO, Lyon, France
| | | | - Andrew F. Olshan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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28
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Nicolai A, Taurone S, Carradori S, Artico M, Greco A, Costi R, Scarpa S. The kinesin Eg5 inhibitor K858 exerts antiproliferative and proapoptotic effects and attenuates the invasive potential of head and neck squamous carcinoma cells. Invest New Drugs 2022; 40:556-564. [PMID: 35312942 PMCID: PMC9098576 DOI: 10.1007/s10637-022-01238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/11/2022] [Indexed: 11/18/2022]
Abstract
Our group recently demonstrated that K858, an inhibitor of motor kinesin Eg5, has important antiproliferative and apoptotic effects on breast cancer, prostatic cancer, melanoma and glioblastoma cells. Since high levels of kinesin Eg5 expression have been correlated with a poor prognosis in laryngeal carcinoma, we decided to test the anticancer activity of K858 toward this tumor, which belongs to the group of head and neck squamous cell carcinomas (HNSCCs). These cancers are characterized by low responsiveness to therapy. The effects of K858 on the proliferation and assembly of mitotic spindles of three human HNSCC cell lines were studied using cytotoxicity assays and immunofluorescence for tubulin. The effect of K858 on the cell cycle was analyzed by FACS. The expression levels of cyclin B1 and several markers of apoptosis and invasion were studied by Western blot. Finally, the negative regulation of the malignant phenotype by K858 was evaluated by an invasion assay. K858 inhibited cell replication by rendering cells incapable of developing normal bipolar mitotic spindles. At the same time, K858 blocked the cell cycle in the G2 phase and induced the accumulation of cytoplasmic cyclin B and, eventually, apoptosis. Additionally, K858 inhibited cell migration and attenuated the malignant phenotype. The data described confirm that kinesin Eg5 is an interesting target for new anticancer strategies and suggest that this compound may be a powerful tool for an alternative therapeutic approach to HNSCCs.
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29
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Robinson EM, Lam AS, Solomon I, Brady JS, Pang J, Faraji F, Houlton JJ, Futran ND, Barber BR. Trends in Positive Surgical Margins in cT1-T2 Oral Cavity Squamous Cell Carcinoma. Laryngoscope 2022; 132:1962-1970. [PMID: 35102568 DOI: 10.1002/lary.30033] [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: 10/05/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate trends in contemporary positive surgical margin incidence in cT1-T2 oral cavity squamous cell carcinoma and to evaluate factors associated with surgical margin status. STUDY DESIGN Retrospective analysis of large dataset. METHODS Retrospective analysis of the National Cancer Database. RESULTS Between 2004 and 2016, 39,818 patients with cT1 or cT2 oral cavity squamous cell carcinoma received primary curative-intent surgery. Positive surgical margins were present in 7.95% of patients, and univariable adjusted probability of positive surgical margins over the study period declined by 1% per year (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-1.0; P = .049). Multivariable regression revealed the annual rate of positive surgical margins declined significantly (OR, 0.95 per year; 95% CI, 0.92-0.97; P < .001). Factors associated with increased odds of positive surgical margins included cT2 disease, subsite, understaged disease, lymphovascular invasion, tumor grade, and positive lymph nodes. Race and socioeconomic status were not associated with surgical margin status. Treatment at an academic center was associated with increased time to definitive surgery (median 35 days IQR 22-50 vs. median 27 days IQR 14-42; P < .001) and a 20% reduction in positive surgical margin rate (OR, 0.80; 95% CI, 0.71-0.90; P < .001). Treatment at high-volume centers was less likely to be associated with positive surgical margins (OR, 0.85; 95% CI, 0.74-0.98; P = .02). CONCLUSION Surgical subsite, clinical T and N category, presence of lymphovascular invasion, and histologic grade were independent predictors of positive surgical margins. Patients are increasingly being treated at high-volume and academic centers. Overall, the rate of positive surgical margins in cT1-T2 oral cavity squamous cell carcinoma is decreasing. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Emily M Robinson
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Austin S Lam
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Isaac Solomon
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, La Jolla, California, U.S.A
| | - Jacob S Brady
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - John Pang
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Farhoud Faraji
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego Health, La Jolla, California, U.S.A.,Moores Cancer Center, University of California San Diego Health, La Jolla, California, U.S.A
| | - Jeffrey J Houlton
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Neal D Futran
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Brittany R Barber
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
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Groysman M, Yi SK, Robbins JR, Hsu CC, Julian R, Bauman JE, Baker A, Wang SJ, Bearelly S. The impact of socioeconomic and geographic factors on access to transoral robotic/endoscopic surgery for early stage oropharyngeal malignancy. Am J Otolaryngol 2022; 43:103243. [PMID: 34583290 DOI: 10.1016/j.amjoto.2021.103243] [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: 04/29/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the role of social and geographic factors on the likelihood of receiving transoral robotic surgery (TORS) or non-robotic transoral endoscopic surgery treatment in early stage oropharyngeal squamous cell carcinoma (OPSCC). MATERIALS AND METHODS The National Cancer Database was queried to form a cohort of patients with T1-T2 N0-N1 M0 OPSCC (AJCC v.7) who underwent treatment from 2010 to 2016. Demographics, tumor characteristics, treatment type, social, and geographic factors were all collected. Univariate analysis and multivariate logistic regression were then performed. RESULTS Among 9267 identified patients, 1774 (19.1%) received transoral robotic surgery (TORS), 1191 (12.9%) received transoral endoscopic surgery, and 6302 (68%) received radiation therapy. We found that lower cancer stage, lower comorbidity burden and HPV- positive status predicted a statistically significant increased likelihood of receiving surgery. Patients who reside in suburban or small urban areas (>1 million population), were low-to- middle income, or rely on Medicaid were less likely to receive surgery. Patients that reside in Medicaid-expansion states were more likely to receive TORS (p > .0001). Patients that reside in states that expanded Medicaid January 2014 and after were more likely to receive non-robotic transoral endoscopic surgery (p > .0001). CONCLUSIONS Poorer baseline health, lower socioeconomic status and residence in small urban areas may act as barriers to accessing minimally invasive transoral surgery while residence in a Medicaid-expansion state may improve access. Barriers to accessing robotic surgery may be greater than accessing non-robotic surgery.
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Kaminagakura E, Tango RN, Cruz-Perez D, Bonan R, Yamamoto de Almeida L, de Almeida Lança ML, Bonan P, Martins H, Takahama A, Ito FA, Coutinho-Camillo CM, Lourenço SV, Caneppele T, Sikora AG, Kowalski LP, Young S. Oral squamous cell carcinoma outcome in adolescent/young adult: Systematic review and meta-analysis. Head Neck 2021; 44:548-561. [PMID: 34808012 DOI: 10.1002/hed.26940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 12/24/2022] Open
Abstract
To perform a systematic review focusing on the prognosis of oral cavity squamous cell carcinoma (OSCC) in young patients (≤40 years old) compared to older (>40 years old). Four databases were used in our search strategy. First, all titles were systematically organized using the Covidence platform online. In the second phase, 118 full texts of potentially eligible studies were analyzed by reviewers independently and in pairs. Twelve studies were considered eligible for data extraction. The relapse was higher in the young than in controls (pooled relative risk (RR) = 1.31; 95% CI [1.10-1.56]). The 5-year disease-free survival (DFS) was worse in young group (pooled hazard ratio (HR) = 0.73; 95% CI [0.63-0.85]) but the 5-year overall survival (OS) estimate was similar between the groups (pooled HR = 0.84; 95% CI [0.70-1.00]). While the 5-year OS was similar between groups, the number of relapses and 5-year DFS were worse in patients with OSCC ≤40 years old.
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Affiliation(s)
- Estela Kaminagakura
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil.,Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rubens Nisie Tango
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Danyel Cruz-Perez
- Department of Clinical and Preventive Dentistry, School of Dentistry, Federal University of Pernambuco, Recife, Brazil
| | - Roberta Bonan
- Department of Clinical and Preventive Dentistry, School of Dentistry, Federal University of Pernambuco, Recife, Brazil
| | - Luciana Yamamoto de Almeida
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Araraquara, Brazil
| | - Maria Letícia de Almeida Lança
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Paulo Bonan
- Department of Clinical and Social Dentistry, School of Dentistry, Federal University of Paraíba, João Pessoa, Brazil
| | - Hélder Martins
- Department of Oral Pathology, School of Dentistry, University Federal do Rio Grande do Norte, Natal, Brazil
| | - Ademar Takahama
- Department of Oral Medicine and Pediatric Dentistry, State University of Londrina, Londrina, Brazil
| | - Fábio Augusto Ito
- Department of Oral Medicine and Pediatric Dentistry, State University of Londrina, Londrina, Brazil
| | | | | | - Taciana Caneppele
- Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Andrew G Sikora
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil.,Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Centre, São Paulo, Brazil
| | - Simon Young
- Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Anti-Tumoral Effects of a (1 H-Pyrrol-1-yl)Methyl-1 H-Benzoimidazole Carbamate Ester Derivative on Head and Neck Squamous Carcinoma Cell Lines. Pharmaceuticals (Basel) 2021; 14:ph14060564. [PMID: 34204738 PMCID: PMC8231569 DOI: 10.3390/ph14060564] [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: 05/25/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/25/2022] Open
Abstract
Nocodazole is an antineoplastic agent that exerts its effects by depolymerizing microtubules. Herein we report a structural analog of nocodazole, a (1H-pyrrol-1-yl)methyl-1H-benzoimidazole carbamate ester derivative, named RDS 60. We evaluated the antineoplastic properties of RDS 60 in two human head and neck squamous cell carcinoma (HNSCC) cell lines and we found that this compound significantly inhibited replication of both HNSCC cell lines without inducing any important cytotoxic effect on human dermal fibroblasts and human keratinocytes. The treatment of HNSCC cell lines with 1 μM RDS 60 for 24 h stopped development of normal bipolar mitotic spindles and, at the same time, blocked the cell cycle in G2/M phase together with cytoplasmic accumulation of cyclin B1. Consequently, treatment with 2 μM RDS 60 for 24 h induced the activation of apoptosis in both HNSCC cell lines. Additionally, RDS 60 was able to reverse the epithelial-mesenchymal transition and to inhibit cell migration and extracellular matrix infiltration of both HNSCC cell lines. The reported results demonstrate that this compound has a potent effect in blocking cell cycle, inducing apoptosis and inhibiting cell motility and stromal invasion of HNSCC cell lines. Therefore, the ability of RDS 60 to attenuate the malignancy of tumor cells suggests its potential role as an interesting and powerful tool for new approaches in treating HNSCC.
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Viet CT, Yu G, Asam K, Thomas CM, Yoon AJ, Wongworawat YC, Haghighiabyaneh M, Kilkuts CA, McGue CM, Couey MA, Callahan NF, Doan C, Walker PC, Nguyen K, Kidd SC, Lee SC, Grandhi A, Cheng AC, Patel AA, Philipone E, Ricks OL, Allen CT, Aouizerat BE. The REASON score: an epigenetic and clinicopathologic score to predict risk of poor survival in patients with early stage oral squamous cell carcinoma. Biomark Res 2021; 9:42. [PMID: 34090518 PMCID: PMC8178935 DOI: 10.1186/s40364-021-00292-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is a capricious cancer with poor survival rates, even for early-stage patients. There is a pressing need to develop more precise risk assessment methods to appropriately tailor clinical treatment. Genome-wide association studies have not produced a viable biomarker. However, these studies are limited by using heterogeneous cohorts, not focusing on methylation although OSCC is a heavily epigenetically-regulated cancer, and not combining molecular data with clinicopathologic data for risk prediction. In this study we focused on early-stage (I/II) OSCC and created a risk score called the REASON score, which combines clinicopathologic characteristics with a 12-gene methylation signature, to predict the risk of 5-year mortality. METHODS We combined data from an internal cohort (n = 515) and The Cancer Genome Atlas (TCGA) cohort (n = 58). We collected clinicopathologic data from both cohorts to derive the non-molecular portion of the REASON score. We then analyzed the TCGA cohort DNA methylation data to derive the molecular portion of the risk score. RESULTS 5-year disease specific survival was 63% for the internal cohort and 86% for the TCGA cohort. The clinicopathologic features with the highest predictive ability among the two the cohorts were age, race, sex, tobacco use, alcohol use, histologic grade, stage, perineural invasion (PNI), lymphovascular invasion (LVI), and margin status. This panel of 10 non-molecular features predicted 5-year mortality risk with a concordance (c)-index = 0.67. Our molecular panel consisted of a 12-gene methylation signature (i.e., HORMAD2, MYLK, GPR133, SOX8, TRPA1, ABCA2, HGFAC, MCPH1, WDR86, CACNA1H, RNF216, CCNJL), which had the most significant differential methylation between patients who survived vs. died by 5 years. All 12 genes have already been linked to survival in other cancers. Of the genes, only SOX8 was previously associated with OSCC; our study was the first to link the remaining 11 genes to OSCC survival. The combined molecular and non-molecular panel formed the REASON score, which predicted risk of death with a c-index = 0.915. CONCLUSIONS The REASON score is a promising biomarker to predict risk of mortality in early-stage OSCC patients. Validation of the REASON score in a larger independent cohort is warranted.
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Affiliation(s)
- Chi T Viet
- Department of Oral and Maxillofacial Surgery, Loma Linda University School of Dentistry, 11092 Anderson St., Suite 3304, Loma Linda, CA, 92350, USA.
| | - Gary Yu
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Kesava Asam
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA
- Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY, USA
| | - Carissa M Thomas
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Angela J Yoon
- Division of Oral and Maxillofacial Pathology, Department of Pathology & Cell Biology, Columbia University College of Dental Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Yan Chen Wongworawat
- Department of Pathology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Mina Haghighiabyaneh
- Department of Pathology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Courtney A Kilkuts
- Department of Oral and Maxillofacial Surgery, Loma Linda University School of Dentistry, 11092 Anderson St., Suite 3304, Loma Linda, CA, 92350, USA
| | - Caitlyn M McGue
- Department of Oral and Maxillofacial Surgery, Loma Linda University School of Dentistry, 11092 Anderson St., Suite 3304, Loma Linda, CA, 92350, USA
| | - Marcus A Couey
- Head and Neck Surgery, Providence Cancer Institute, Portland, OR, USA
- Head and Neck Surgery, Legacy Cancer Center, Portland, OR, USA
| | - Nicholas F Callahan
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, College of Dentistry, Chicago, IL, USA
| | - Coleen Doan
- Department of Oral and Maxillofacial Surgery, Loma Linda University School of Dentistry, 11092 Anderson St., Suite 3304, Loma Linda, CA, 92350, USA
| | - Paul C Walker
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Khanh Nguyen
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Stephanie C Kidd
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Steve C Lee
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Anupama Grandhi
- Department of Oral and Maxillofacial Surgery, Loma Linda University School of Dentistry, 11092 Anderson St., Suite 3304, Loma Linda, CA, 92350, USA
| | - Allen C Cheng
- Head and Neck Surgery, Providence Cancer Institute, Portland, OR, USA
- Head and Neck Surgery, Legacy Cancer Center, Portland, OR, USA
| | - Ashish A Patel
- Head and Neck Surgery, Providence Cancer Institute, Portland, OR, USA
- Head and Neck Surgery, Legacy Cancer Center, Portland, OR, USA
| | - Elizabeth Philipone
- Division of Oral and Maxillofacial Pathology, Department of Pathology & Cell Biology, Columbia University College of Dental Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Olivia L Ricks
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Clint T Allen
- Section on Translational Tumor Immunology, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Bradley E Aouizerat
- New York University Rory Meyers College of Nursing, New York, NY, USA
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA
- Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY, USA
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Sung WW, Hsu YC, Dong C, Chen YC, Chao YC, Chen CJ. Favorable Lip and Oral Cancer Mortality-to-Incidence Ratios in Countries with High Human Development Index and Expenditures on Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116012. [PMID: 34205053 PMCID: PMC8199886 DOI: 10.3390/ijerph18116012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The incidence rates of lip and oral cancer have continued to increase, and prognosis is associated with a country's socioeconomic status. The mortality-to-incidence ratio (MIR) is a reasonable indicator of disparities in cancer screening and treatment. In this study, we aimed to understand the association between economic status and cancer prognosis. METHODS Data were obtained from the Global Cancer Observatory (GLOBOCAN) and the World Health Organization (WHO). The MIRs were compared to evaluate the correlation with the human development index (HDI), the current health expenditure (CHE), and the ratio of CHE over gross domestic product (CHE/GDP) disparities via Spearman's rank correlation coefficient. RESULTS The results showed that Asia had the most cases and deaths. In addition, they showed a significant association (p < 0.001, p = 0.005, and p < 0.001, respectively) of the crude rate (CR) of incidence with the HDI, the CHE, and the CHE/GDP. However, their associations with mortality rate (p = 0.303, p = 0.997, and p = 0.101) were not significant. Regarding the correlation of the MIRs, the results revealed a significant association with the HDI, the CHE, and the CHE/GDP (p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSION Countries with higher HDI, CHE per capita, and CHE/GDP tend to have lower MIRs, which indicates favorable clinical outcomes.
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Affiliation(s)
- Wen-Wei Sung
- Department of Urology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.D.); (Y.-C.C.); (Y.-C.C.)
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yong-Chen Hsu
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung 40201, Taiwan;
| | - Chen Dong
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.D.); (Y.-C.C.); (Y.-C.C.)
| | - Ying-Ching Chen
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.D.); (Y.-C.C.); (Y.-C.C.)
| | - Yu-Chi Chao
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.D.); (Y.-C.C.); (Y.-C.C.)
| | - Chih-Jung Chen
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan; (C.D.); (Y.-C.C.); (Y.-C.C.)
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung 40201, Taiwan;
- Correspondence: ; Tel.: +886-4-2359-2525
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Harris JA, Hunter WP, Ji YD, Hanna GJ. Effects of racial residential segregation on oral squamous cell carcinoma prognosis and survival. Oral Oncol 2021; 119:105364. [PMID: 34091188 DOI: 10.1016/j.oraloncology.2021.105364] [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: 03/07/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study is to evaluate the impact of racial residential segregation on disease prognosis and overall survival in Black patients diagnosed with oral squamous cell carcinoma (OSCC), relative to White patients. MATERIALS AND METHODS This retrospective cohort study identified individuals diagnosed with OSCC between 2005 and 2015 using the Surveillance, Epidemiology and End Results Database. Patients were included with cancers diagnosed in the following locations: lip, tongue, gum, floor of mouth, palate, and other/unspecified. Tumors located at the base of tongue, tonsils, and oropharynx were excluded. The primary predictor variable was the degree of residential segregation. The primary outcome was overall survival. A Kaplan Meier survival analysis and univariate/multivariate analyses were performed to account for potential confounders of survival. RESULTS A total of 35,769 patients met inclusion criteria. At the time of initial diagnosis, Black patients presented with OSCC of higher grades and more advanced stages (p < 0.001). A greater number of Black subjects were dead by the time of last follow-up compared to White subjects (p < 0.001). Across the entire spectrum of residential segregation, cumulative survival was worse among Black patients compared to Whites (p < 0.001). Multivariate analysis identified highly segregated counties, advanced age, higher grade/advanced stage at time of diagnosis, lack of surgery, and no chemotherapy treatment as poor prognostic factors for survival among Black individuals. CONCLUSION Racial residential segregation results in poorer long-term cancer survival among Black patients. Understanding the links between residential segregation and inequities in cancer outcomes will allow policymakers to better implement targeted, population-based interventions in treating various cancers.
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Affiliation(s)
- Jack A Harris
- Harvard School of Dental Medicine, Boston, MA, United States.
| | | | - Yisi D Ji
- Harvard Medical School, Boston, MA, United States
| | - Glenn J Hanna
- Harvard Medical School, Boston, MA, United States; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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Lee J, Fernando SJ, Malenke JA, Totten DJ, Kloosterman N, Langerman A, Kim YJ, Mannion K, Sinard R, Netterville J, Rohde SL. Socioeconomic Influences on Short-term Postoperative Outcomes in Patients With Oral Cavity Cancer Undergoing Free Flap Reconstruction. Otolaryngol Head Neck Surg 2021; 166:274-281. [PMID: 34030493 DOI: 10.1177/01945998211012954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the associations between median household income (MHI) and area deprivation index (ADI) on postoperative outcomes in oral cavity cancer. STUDY DESIGN Retrospective review (2000-2019). SETTING Single-institution tertiary medical center. METHODS MHI and ADI were matched from home zip codes. Main postoperative outcomes of interest were length of tracheostomy use, length of hospital stay, return to oral intake, discharge disposition, and 60-day readmissions. Linear and logistic regression controlled for age, sex, race, body mass index, tobacco and alcohol use history, primary tumor location, disease staging at presentation, and length of surgery. A secondary outcome was clinical disease staging (I-IV) at time of presentation. RESULTS The cohort (N = 681) was 91.3% White and 38.0% female, and 51.7% presented with stage IV disease. The median age at the time of surgery was 62 years (interquartile range [IQR], 53-71). The median MHI was $47,659 (IQR, $39,324-$58,917), and the median ADI was 67 (IQR, 48-79). ADI and MHI were independently associated with time to return of oral intake (β = 0.130, P = .022; β = -0.092, P = .045, respectively). Neither was associated with length of tracheostomy, hospital stay, discharge disposition, or readmissions. MHI quartiles were associated with a lower risk of presenting with more advanced disease (Q3 vs Q1: adjusted odds ratio, 0.56 [95% CI, 0.32-0.97]). CONCLUSION MHI is associated with oral cavity cancer staging at the time of presentation. MHI and ADI are independently associated with postoperative return to oral intake following intraoral tumor resection and free flap reconstruction.
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Affiliation(s)
- Jaclyn Lee
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Shanik J Fernando
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan A Malenke
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas J Totten
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Alexander Langerman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Young J Kim
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kyle Mannion
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert Sinard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Change in Age at Diagnosis of Oropharyngeal Cancer in the United States, 1975-2016. Cancers (Basel) 2020; 12:cancers12113191. [PMID: 33143031 PMCID: PMC7693134 DOI: 10.3390/cancers12113191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 12/14/2022] Open
Abstract
Simple Summary While previous studies have suggested that HPV-associated head and neck cancer (HNC) is mostly in the younger population, we found that in the last 40 years, the mean age at diagnosis of oropharyngeal cancer has been 60.3 years. We found that after an initially decrease leading up to the early 2000s, there has been a steady increase in age at diagnosis of oropharyngeal cancer since 2002. For non-oropharyngeal HNC, mean age at diagnosis has steadily increased throughout the last four decades. Finally, we found that age at diagnosis of HNC is higher among females in general, and lowest among blacks. Abstract The emergence of the human papillomavirus (HPV) as the primary etiology of oropharyngeal cancer has changed head and neck cancer (HNC) epidemiology. This study described change in the age at diagnosis of oropharyngeal and non-oropharyngeal HNC in the United States in the last four decades. Using a retrospective cohort analysis, the Surveillance, Epidemiology, and End Results dataset from 1975 to 2016 was queried for eligible adult cases of HNC, grouped as oropharyngeal (n = 31,702) versus non-oropharyngeal (n = 87,108). Age at diagnosis was compared by gender (female, male) using independent t-test, and by race/ethnicity (Hispanic, non-Hispanic black, non-Hispanic white, non-Hispanic other) using analysis of variance. Joinpoint regression estimated yearly increases/decreases in age of diagnosis by sex and race/ethnicity through annual percent changes (APC), which were summarized with average annual percent changes (AAPC). Mean age at diagnosis for oropharyngeal cancer was 60.3 years. While there was initially a decrease in age at diagnosis, a 0.37% annual increase occurred from 2002 to 2016 (APC = 0.37, 95% confidence interval (CI) 0.28, 0.45). For non-oropharyngeal cancer, mean age at diagnosis was 63.2 years, with a continuous increase in age at diagnosis throughout the study period (1975–2016 AAPC = 0.08, 95% CI 0.04, 0.12). Females had higher average age at diagnosis than males for both sites, while blacks (57.4 years for oropharyngeal cancer; 59.0 years for non-oropharyngeal) had the lowest age at diagnosis of all races/ethnicity. Age at diagnosis of oropharyngeal cancer has increased significantly since 2002, while non-oropharyngeal HNC has increased significantly in the last four decades.
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Patel J. Re: Equality, diversity, culture and ethnicity - we cannot stay silent. Br J Oral Maxillofac Surg 2020; 59:137-138. [PMID: 33199043 DOI: 10.1016/j.bjoms.2020.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jay Patel
- School of Dentistry, University of Leeds, Leeds LS2 9JT, UK.
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Kudaravalli S. Regarding “Gaps in Treatment and Surveillance: Head and Neck Cancer Care in a Safety-Net Hospital”. OTO Open 2020; 4:2473974X20938658. [PMID: 32671319 PMCID: PMC7338732 DOI: 10.1177/2473974x20938658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Panth N, Barnes JM, Simpson MC, Adjei Boakye E, Sethi RKV, Varvares MA, Osazuwa-Peters N. Change in stage of presentation of head and neck cancer in the United States before and after the affordable care act. Cancer Epidemiol 2020; 67:101763. [PMID: 32593161 DOI: 10.1016/j.canep.2020.101763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE/HYPOTHESIS Early diagnosis and stage at presentation, two prognostic factors for survival among patients with head and neck cancer (HNC), are significantly impacted by a patient's health insurance status. We aimed to assess the impact of the Patient Protection and Affordable Care Act (ACA) on stage at presentation across socioeconomic and demographic subpopulations of HNC patients in the United States. STUDY DESIGN Retrospective data analysis. METHODS The National Cancer Database, a hospital-based cancer database (2011-2015), was queried for adults aged 18-64 years and diagnosed with a malignant primary HNC. The outcome of interest was change in early-stage diagnoses between 2011-2013 (pre-ACA) and 2014-2015 (post-ACA) using logistic regression models. RESULTS A total of 91,137 HNC cases were identified in the pre-ACA (n = 53,726) and post-ACA (n = 37,411) years. Overall, the odds of early-stage diagnoses did not change significantly post-ACA (aOR = 0.97, 95 % CI 0.94, 1.00; p = 0.081). However, based on health insurance status, HNC patients with Medicaid were significantly more likely to present with early-stage disease post-ACA (aOR = 1.12, 95 % CI 1.03, 1.21; p = 0.007). We did not observe increased odds of early-stage presentation for other insurance types. Males were less likely to present with early-stage disease, pre- or post-ACA. CONCLUSIONS We demonstrate a significant association between ACA implementation and increased early-stage presentation among Medicaid-enrolled HNC patients. This suggests that coverage expansions through the ACA may be associated with increased access to care and may yield greater benefits among low-income HNC patients.
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Affiliation(s)
- Neelima Panth
- Yale School of Medicine, Department of Surgery, Division of Otolaryngology, New Haven, CT, USA
| | - Justin M Barnes
- Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Matthew C Simpson
- Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, USA; Saint Louis University Cancer Center, Saint Louis, MO, USA
| | - Eric Adjei Boakye
- Southern Illinois University School of Medicine, Department of Population Science and Policy, Springfield, IL, USA
| | - Rosh K V Sethi
- University of Michigan Health System, Department of Otolaryngology Head and Neck Surgery, Ann Arbor, MI, USA
| | - Mark A Varvares
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA
| | - Nosayaba Osazuwa-Peters
- Saint Louis University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, USA; Saint Louis University Cancer Center, Saint Louis, MO, USA.
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