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Graessle R, Stromberger C, Beck M, Heiland M, Hofmann VM, Olze H, Dommerich S, Gauger U, Piwonski I, Coordes A. Subgroup Analysis of Overall Survival among Smoking and Non-Smoking Elderly Patients with HNSCC. Cancers (Basel) 2023; 15:cancers15061842. [PMID: 36980728 PMCID: PMC10046679 DOI: 10.3390/cancers15061842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
Smoking is a leading cause of head and neck squamous cell carcinoma (HNSCC). However, non-smokers are also affected by HNSCC, and the prognostic factors applicable to older non-smokers with HNSCC are largely unknown. The aim of this study was to determine predictors of overall survival (OS) in patients both with and without a smoking history aged 70 and over at initial diagnosis. Retrospective data of patients aged ≥70 (initial diagnoses 2004–2018) were examined. Evaluated predictors included tumour stage, biological age, health and therapy. A total of 688 patients (520 smokers, 168 non-smokers) were included with a median age of 74. The 5-year OS was 39.6%. Non-smokers had significantly improved OS compared to smokers (52.0% versus 36.0%, p < 0.001). Disease-free survival (DFS) differed significantly between both groups (hazard ratio = 1.3; 95%CI 1.04–1.626). TNM stage and the recommended therapies (curative versus palliative) were comparable. The proportion of p16-positive oropharyngeal carcinomas was significantly higher in non-smokers (76.7% versus 43.8%, p < 0.001). Smokers were significantly more likely to be men (p < 0.001), drinkers (p < 0.001), and have poorer health status (Karnofsky performance status, KPS, p = 0.023). They were also more likely to have additional tumours (p = 0.012) and lower treatment adherence (p = 0.038). Important predictors of OS identified in both groups, were, among others, alcohol abuse, KPS, Charlson comorbidity index, site of primary tumour, UICC stage and treatment received. Elderly non-smokers are also affected by HNSCC, however, both OS and DFS are increased compared to smokers.
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Affiliation(s)
- Raphaela Graessle
- Department of Otorhinolaryngology, Head and Neck Surgery, Campus Virchow Klinikum and Campus Charité Mitte, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Carmen Stromberger
- Department of Radiooncology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Marcus Beck
- Department of Radiooncology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Campus Virchow Klinikum and Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Veit M. Hofmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Campus Virchow Klinikum and Campus Charité Mitte, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Steffen Dommerich
- Department of Otorhinolaryngology, Head and Neck Surgery, Campus Virchow Klinikum and Campus Charité Mitte, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Ulrich Gauger
- Private Statistical Consultant, 10437 Berlin, Germany
| | - Iris Piwonski
- Department of Pathology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Annekatrin Coordes
- Department of Otorhinolaryngology, Head and Neck Surgery, Campus Virchow Klinikum and Campus Charité Mitte, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Ruppin Brandenburg, Brandenburg Medical School, 16816 Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, 14476 Potsdam, Germany
- Correspondence: or ; Tel.: +49-30-450-555-002
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Shen T, Cai W, Li T, Yu D, Ren C, Yu J. Impact of primary site on survival in patients with nasopharyngeal carcinoma from 2004 to 2015. Front Surg 2022; 9:1001849. [PMID: 36406355 PMCID: PMC9671952 DOI: 10.3389/fsurg.2022.1001849] [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: 08/01/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background Nasopharynx carcinoma (NPC) is the most common malignant tumor of the nasopharynx. Many studies have shown some factors related with the prognosis of NPC patients. Our study aims to evaluate the differences of prognosis between initial and second primary NPC. Material and methods The Surveillance, Epidemiology, and End Results (SEER) program was used to perform the population-based analysis in NPC patients who were newly diagnosed between 2004 and 2015. Kaplan-Meier and Cox regressions were used to evaluate the effects of primary site on the overall survival (OS), as well as the cancer-specific survival (CSS). Results Our study included 5,012 NPC patients: 4,474 initial primary NPC patients and 5,38 s primary NPC patients. Significant differences were observed in sex, age at diagnosis, race, median household income, histological type, American Joint Committee on Cancer (AJCC) stage, N-stage, radiation treatment and chemotherapy between patients with initial and second NPC (P < 0.05). Moreover, the patients with second NPC had longer survival months. In addition, radiation and chemotherapy were recommended both in first and second primary NPC patients. Conclusion Worse prognosis was observed in patients with second primary NPC compared with those with primary NPC in all subgroups of AJCC stage and age at diagnosis.
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Affiliation(s)
- Tianyi Shen
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Wenting Cai
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Tingting Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Donghui Yu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Chengda Ren
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Jing Yu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, China
- Department of Ophthalmology, The Third People’s Hospital of Bengbu, Bengbu, China
- Correspondence: Jing Yu
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Dai X, Gil GF, Reitsma MB, Ahmad NS, Anderson JA, Bisignano C, Carr S, Feldman R, Hay SI, He J, Iannucci V, Lawlor HR, Malloy MJ, Marczak LB, McLaughlin SA, Morikawa L, Mullany EC, Nicholson SI, O'Connell EM, Okereke C, Sorensen RJD, Whisnant J, Aravkin AY, Zheng P, Murray CJL, Gakidou E. Health effects associated with smoking: a Burden of Proof study. Nat Med 2022; 28:2045-2055. [PMID: 36216941 PMCID: PMC9556318 DOI: 10.1038/s41591-022-01978-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/28/2022] [Indexed: 12/17/2022]
Abstract
As a leading behavioral risk factor for numerous health outcomes, smoking is a major ongoing public health challenge. Although evidence on the health effects of smoking has been widely reported, few attempts have evaluated the dose-response relationship between smoking and a diverse range of health outcomes systematically and comprehensively. In the present study, we re-estimated the dose-response relationships between current smoking and 36 health outcomes by conducting systematic reviews up to 31 May 2022, employing a meta-analytic method that incorporates between-study heterogeneity into estimates of uncertainty. Among the 36 selected outcomes, 8 had strong-to-very-strong evidence of an association with smoking, 21 had weak-to-moderate evidence of association and 7 had no evidence of association. By overcoming many of the limitations of traditional meta-analyses, our approach provides comprehensive, up-to-date and easy-to-use estimates of the evidence on the health effects of smoking. These estimates provide important information for tobacco control advocates, policy makers, researchers, physicians, smokers and the public.
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Affiliation(s)
- Xiaochen Dai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Gabriela F Gil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marissa B Reitsma
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Noah S Ahmad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jason A Anderson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Catherine Bisignano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sinclair Carr
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Rachel Feldman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jiawei He
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Vincent Iannucci
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Hilary R Lawlor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Matthew J Malloy
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Laurie B Marczak
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Susan A McLaughlin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Larissa Morikawa
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin C Mullany
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sneha I Nicholson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Erin M O'Connell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chukwuma Okereke
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Joanna Whisnant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aleksandr Y Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Andersen AO, Jensen JS, Jakobsen KK, Stampe H, Nielsen KJ, Wessel I, Christensen A, Andersen E, Friborg J, Grønhøj C, von Buchwald C. The impact of tobacco smoking on survival of patients with oral squamous cell carcinoma: a population-based retrospective study. Acta Oncol 2022; 61:449-458. [PMID: 35114883 DOI: 10.1080/0284186x.2022.2033830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND This article aims to evaluate the impact of smoking status, accumulated tobacco exposure (ATE), and smoking cessation on overall- and disease-free survival (OS and DFS) of patients with oral squamous cell carcinoma (OSCC). MATERIAL AND METHODS Patients with primary OSCC treated with curative intent between 2000 and 2019 in Copenhagen were included (n = 1808). Kaplan-Meier curves and multivariable Cox regression analyses were performed to compare the survival of patients with different smoking history. Interactions between ATE and (A) tumor subsite and (B) excessive alcohol consumption (EAC) on the survival were evaluated using multivariable Cox regression analyses with interaction terms. RESULTS We included 1717 patients with known smoking status (62.8% males, median age: 64 years (IQR: 57-71 years)), who had a 5-year OS of 53.7% (95%CI: 49.8%-57.9%). Based on fully adjusted multivariable Cox regression analyses, significantly elevated hazard ratios (HRs) for OS and DFS were identified for current, but not former smokers, compared to never-smokers. An approximately linear relationship between continuous ATE and survival estimates was identified. ATE analyzed as a categorical variable showed significantly elevated HRs for OS of patients with all categories (0<x ≤ 30, 30<x ≤ 60, and >60 PYs), however only for DFS of patients with >60 PYs, compared to 0 PYs. Furthermore, an unfavorable long-term prognosis was evident after >3.5 (OS) and >2.5 (DFS) years from diagnosis for patients who continued smoking compared to patients with smoking cessation at diagnosis. The survival estimates of patients with different tumor subsite and alcohol consumption differed with increasing ATE. CONCLUSION Tobacco smoking (assessed as smoking status and ATE) was associated with inferior survival (OS and DFS) among patients with OSCC. Unfavorable long-term prognosis was significant for patients who continued smoking compared to patients with smoking cessation at diagnosis. The impact of ATE on survival of patients with OSCC may depend on the tumor subsite and/or alcohol consumption.
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Affiliation(s)
- Amanda Oester Andersen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Schmidt Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Helene Stampe
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Juul Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Christensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Elo Andersen
- Department of Oncology, Herlev-Gentofte University Hospital, Capital Region, Denmark
| | - Jeppe Friborg
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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5
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Yang Z, Du W, Zhang X, Chen D, Fang Q, He Y, Yang Y, Li D, Fan J. Nonsmoking and Nondrinking Oral Squamous Cell Carcinoma Patients: A Different Entity. Front Oncol 2021; 11:558320. [PMID: 34262853 PMCID: PMC8273760 DOI: 10.3389/fonc.2021.558320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Our goal was to analyze the demographic and pathologic characteristics as well as prognosis in nonsmoking and nondrinking (NSND) oral squamous cell carcinoma (SCC) patients compared with typical oral SCC patients. Patients and Methods A total of 353 patients were retrospectively enrolled and divided into two groups: the NSND group and the current smoking/current drinking (CSCD) group. Demographic, pathologic, and molecular data were compared between the two groups. The main research endpoints were locoregional control (LRC) and disease-specific survival (DSS). Results In the NSND group, 16.3%, 41.9%, and 53.5% of patients were aged no more than 40 years, were female, and had an educational background of high school or above compared to 3.7%, 6.0%, and 38.2% of patients in the CSCD group, respectively. A total of 15.1% of the NSND patients had SCC of the lower gingiva and floor of the mouth, which was lower than the 35.6% of patients in the CSCD group. CSCD patients were likely to have an advanced disease stage (48.7% vs 32.5%, p=0.042) and poorly differentiated cancer (26.6% vs 16.3%, p=0.042). The NSND patients had a mean Ki-67 index of 24.5%, which was lower than the mean of 35.7% in the CSCD patients. The two groups had no HPV infection and similar p16 expression (4.7% vs 10.1%, p=0.132), but there was higher expression of p53 (38.6% vs 17.4%, p<0.001) and p63 (59.9% vs 29.1%, p<0.001) in the CSCD group. The 5-year LRC rates for NSND patients and CSCD patients were 48% and 38%, respectively, and the difference was significant (p=0.048). The 5-year DSS rates for NSND patients and CSCD patients were 56% and 39%, respectively, and the difference was significant (p=0.047). Further, a Cox model confirmed the independence of smoking and drinking status for affecting LRC and DSS. Conclusion NSND oral SCC patients are a different entity. HPV infection has a limited role in carcinogenesis in NSND patients, and p16 expression is associated with worse locoregional control.
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Affiliation(s)
- Zhan Yang
- Academy of Military Medical Sciences, Academy of Military Sciences, Beijing, China
| | - Wei Du
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Xu Zhang
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Defeng Chen
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Qigen Fang
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yuezhong He
- Academy of Military Medical Sciences, Academy of Military Sciences, Beijing, China
| | - Yang Yang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ding Li
- Department of Pharmacy, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Jie Fan
- Department of Head Neck and Thyroid Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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Yang X, Han B, Zhang R, Su Y, Hosseini DK, Wu H, Yang M, Sun H. Development and validation of a RNA binding protein-associated prognostic model for head and neck squamous cell carcinoma. Aging (Albany NY) 2021; 13:7975-7997. [PMID: 33758106 PMCID: PMC8034976 DOI: 10.18632/aging.202848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 03/13/2021] [Indexed: 12/13/2022]
Abstract
Evidence shows that defects in RNA-binding proteins (RBPs) are closely related to the occurrence and development of HNSCC. We obtained 502 tumors and 44 normal samples from the TCGA database, among which 190 differentially expressed RBPs were screened. Finally, a prognostic model containing nine RBPs (CELF2, CPEB1, DDX39B, EIF3L, EZH2, KHDRBS3, RNASE10, RNASE3 and SIDT1) was produced. Further analysis showed that the overall survival rate in the high-risk group was lower than that in the low-risk group. The area under the ROC curve (AUC) in the training and testing groups was significant (3-year AUC, 0.735 vs 0.796; 5-year AUC, 0.821 vs 0.804). In addition, a comprehensive analysis of nine identified RBPs showed that most of them were related to the OS of HNSCC patients, and three of them (CELF2, EZH2, and SIDT1) were differentially expressed in HNSCC and control tissues at the protein level. In addition, our data revealed that the identified RBPs are highly interconnected, with high frequency copy number changes in HNSCC samples. GSEA indicated that the abnormal biological processes related to RNA and the activation of some classical tumor signaling pathways were important driving forces for the development of HNSCC. Our results provide novel insights into the pathogenesis of HNSCC, among which nine RBP markers have potential application value in clinical decision-making and individualized treatment of HNSCC.
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Affiliation(s)
- Xiuping Yang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Baoai Han
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Runshi Zhang
- Department of Clinical Laboratory, Xi'an No. 1 Hospital, Xi'an 710000, China
| | - Yuan Su
- Department of Clinical Laboratory, Xi'an Labor Union Hospital, Xi'an 710000, China
| | - Davood K Hosseini
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ 07601, USA
| | - Han Wu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Minlan Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Haiying Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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An Integrated Genomic Strategy to Identify CHRNB4 as a Diagnostic/Prognostic Biomarker for Targeted Therapy in Head and Neck Cancer. Cancers (Basel) 2020; 12:cancers12051324. [PMID: 32455963 PMCID: PMC7281299 DOI: 10.3390/cancers12051324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
Abstract
Although many studies have shown the association between smoking and the increased incidence and adverse prognosis of head and neck squamous cell carcinoma (HNSCC), the mechanisms and pharmaceutical targets involved remain unclear. Here, we integrated gene expression signatures, genetic alterations, and survival analyses to identify prognostic indicators and therapeutic targets for smoking HNSCC patients, and we discovered that the FDA-approved drug varenicline inhibits the target for cancer cell migration/invasion. We first identified 18 smoking-related and prognostic genes for HNSCC by using RNA-Seq and clinical follow-up data. One of these genes, CHRNB4 (neuronal acetylcholine receptor subunit beta-4), increased the risk of death by approximately threefold in CHRNB4-high expression smokers compared to CHRNB4-low expression smokers (log rank, p = 0.00042; hazard ratio, 2.82; 95% CI, 1.55–5.14), former smokers, and non-smokers. Furthermore, we examined the functional enrichment of co-regulated genes of CHRNB4 and its 246 frequently occurring copy number alterations (CNAs). We found that these genes were involved in promoting angiogenesis, resisting cell death, and sustaining proliferation, and contributed to much worse outcomes for CHRNB4-high patients. Finally, we performed CHRNB4 gene editing and drug inhibition assays, and the results validate these observations. In summary, our study suggests that CHRNB4 is a prognostic indicator for smoking HNSCC patients and provides a potential new therapeutic drug to prevent recurrence or distant metastasis.
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8
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Lin TA, Garden AS, Elhalawani H, Elgohari B, Jethanandani A, Ng SP, Mohamed AS, Frank SJ, Glisson BS, Debnam JM, Sturgis EM, Phan J, Reddy JP, Fuller CD, Morrison WH, Skinner HD, Rosenthal DI, Gunn GB. Radiographic retropharyngeal lymph node involvement in HPV-associated oropharyngeal carcinoma: Patterns of involvement and impact on patient outcomes. Cancer 2019; 125:1536-1546. [PMID: 30620385 DOI: 10.1002/cncr.31944] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND The objective of the current study was to characterize the incidence, pattern, and impact on oncologic outcomes of retropharyngeal lymph node (RPLN) involvement in HPV-associated oropharyngeal cancer (OPC). METHODS Data regarding patients with HPV-associated OPC who were treated at The University of Texas MD Anderson Cancer Center with intensity-modulated radiotherapy from 2004 through 2013 were analyzed retrospectively. RPLN status was determined by reviewing pretreatment imaging and/or reports. Outcomes analysis was restricted to patients with lymph node-positive (+) disease. Kaplan-Meier survival estimates were generated and survival curves were compared using the log-rank test. Bayesian information criterion assessed model performance changes with the addition of RPLN status to current American Joint Committee on Cancer staging. Competing risk analysis compared modes of disease recurrence. RESULTS The incidence of radiographic RPLN involvement was 9% (73 of 796 patients) and was found to vary by primary tumor site. The 5-year rates of freedom from distant metastases (FDM) and overall survival were lower in patients with RPLN(+) status compared with those with RPLN-negative (-) status (84% vs 93% [P = .0327] and 74% vs 87% [P = .0078], respectively). RPLN(+) status was not found to be associated with outcomes on multivariate analysis. Bayesian information criterion analysis demonstrated that current American Joint Committee on Cancer staging was not improved with the inclusion of RPLN. Locoregional and distant disease recurrence probabilities for those patients with RPLN(+) status were 8% and 13%, respectively, compared with 10% and 6%, respectively, for those with RPLN(-) status. RPLN(+) status portended worse 5-year FDM in the low-risk subgroup (smoking history of <10 pack-years) and among patients who received concurrent chemotherapy but not induction chemotherapy. CONCLUSIONS RPLN(+) status was associated with worse overall survival and FDM on univariate but not multivariate analysis. In subgroup analyses, RPLN(+) status was associated with poorer FDM in both patients with a smoking history of <10 pack-years and those who received concurrent chemotherapy, suggesting that RPLN(+) status could be considered an exclusion criteria in treatment deintensification efforts seeking to omit chemotherapy.
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Affiliation(s)
- Timothy A Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hesham Elhalawani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Baher Elgohari
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amit Jethanandani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sweet P Ng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abdallah S Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bonnie S Glisson
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Matthew Debnam
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jay P Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heath D Skinner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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9
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Xia X, Zhu YY, Diao WW, Zhu XL, Shi XH, Li WY, Gao ZQ, Li GJ, Chen XM. Matched-pair analysis of survival in the patients with T3 laryngeal squamous cell carcinoma treated with supracricoid partial laryngectomy or total laryngectomy. Onco Targets Ther 2018; 11:7947-7953. [PMID: 30519036 PMCID: PMC6235336 DOI: 10.2147/ott.s175358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The survival outcomes between supracricoid partial laryngectomy (SCPL) and total laryngectomy (TL) were compared in the groups of matched-pair patients with T3 laryngeal squamous cell carcinoma (LSCC). Methods Patients with T3 LSCC were matched based on prognostic factors. The Kaplan–Meier curve and the Cox proportional hazards model were used for analysis on survival. Results A total of 212 patients with T3 LSCC were included after matching (106 underwent SCPL and 106 underwent TL). Multivariable analysis showed no differences in overall survival (hazard risk [HR]=1.15; 95% CI: 0.79–1.67; P=0.47), disease-specific survival (HR=1.11; 95% CI: 0.69–1.80; P=0.66), and recurrence-free survival (HR=1.07; 95% CI: 0.68–1.68; P=0.77) between the SCPL group and TL group. Conclusion SCPL provides reliable therapeutic outcomes and can be used to avoid a TL surgery in some patients with advanced primary laryngeal cancer.
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Affiliation(s)
- Xin Xia
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,
| | - Ying-Ying Zhu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,
| | - Wen-Wen Diao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,
| | - Xiao-Li Zhu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,
| | - Xiao-Hua Shi
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wu-Yi Li
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,
| | - Zhi-Qiang Gao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,
| | - Guo-Jun Li
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,
| | - Xing-Ming Chen
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,
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10
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Nanjappa V, Raja R, Radhakrishnan A, Jain AP, Datta KK, Puttamallesh VN, Solanki HS, Chavan S, Patil A, Renuse S, Jain A, Mathew D, Thakur R, Guerrero-Preston R, Nair B, Routray S, Mohanty N, Gowda KBL, Jadav R, Ghosal S, Kumar RV, Ramesha C, Raghu VC, Mathur PP, Prasad TSK, Califano JA, Sidransky D, Pal A, Ganesh MS, Ray JG, Pandey A, Gowda H, Chatterjee A. Testican 1 (SPOCK1) and protein tyrosine phosphatase, receptor type S (PTPRS) show significant increase in saliva of tobacco users with oral cancer. TRANSLATIONAL RESEARCH IN ORAL ONCOLOGY 2018. [DOI: 10.1177/2057178x18800534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To identify potential candidate proteins which are secretory in nature and present at a higher abundance in oral cancer patients with tobacco habits. Methods: Conditioned media of tobacco-treated and -untreated non-neoplastic oral keratinocytes were analyzed using iTRAQ-based mass spectrometry. Hypersecreted proteins; SPARC (osteonectin), cwcv and kazal like domains proteoglycan 1 (SPOCK1); prosaposin (PSAP); and protein tyrosine phosphatase, receptor type S (PTPRS) were validated by enzyme-linked immunosorbent assay (ELISA) using saliva samples from oral cancer patients who are tobacco users. Results: Proteomic analysis of tobacco-treated and -untreated cells led to the identification of 2873 proteins. Among these, 378 proteins showed high abundance and 253 proteins showed low abundance (2-fold cutoff) in conditioned-media of tobacco-treated cells. ELISA-based validation showed significantly higher levels of SPOCK1, PSAP, and PTPRS in oral cancer patients with tobacco chewing habits compared to healthy controls. However, PSAP showed low specificity compared to SPOCK1 and PTPRS. Conclusions: This study indicates significantly increased levels of SPOCK1, PSAP, and PTPRS in saliva of oral cancer patients with tobacco habits. These protein biomarkers might be useful to identify tobacco users with high risk of developing oral cancers.
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Affiliation(s)
- Vishalakshi Nanjappa
- Institute of Bioinformatics, Bangalore, Karnataka, India
- Amrita School of Biotechnology, Amrita University, Kollam, Kerala, India
| | - Remya Raja
- Institute of Bioinformatics, Bangalore, Karnataka, India
- Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Ankit P Jain
- Institute of Bioinformatics, Bangalore, Karnataka, India
- School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India
| | | | - Vinuth N Puttamallesh
- Institute of Bioinformatics, Bangalore, Karnataka, India
- Amrita School of Biotechnology, Amrita University, Kollam, Kerala, India
| | - Hitendra S Solanki
- Institute of Bioinformatics, Bangalore, Karnataka, India
- School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India
| | - Sandip Chavan
- Institute of Bioinformatics, Bangalore, Karnataka, India
| | - Arun Patil
- Institute of Bioinformatics, Bangalore, Karnataka, India
- School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India
| | - Santosh Renuse
- Institute of Bioinformatics, Bangalore, Karnataka, India
| | - Anu Jain
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Don Mathew
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reetu Thakur
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rafael Guerrero-Preston
- Head and Neck Cancer Research Division, Otolaryngology Department, School of Medicine, The Johns Hopkins University, Baltimore, USA
- Department of Obstetrics and Gynecology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, USA
| | - Bipin Nair
- Amrita School of Biotechnology, Amrita University, Kollam, Kerala, India
| | - Samapika Routray
- Department of Oral Pathology and Microbiology, Institute of Dental Sciences, Siksha’O’Anusandhan University, Bhubaneswar, Odisha, India
- Department of Dental Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Neeta Mohanty
- Department of Oral Pathology and Microbiology, Institute of Dental Sciences, Siksha’O’Anusandhan University, Bhubaneswar, Odisha, India
| | - KB Linge Gowda
- Department of Anesthetic and Pain Relief, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ritesh Jadav
- Deparment of Oral Pathology, Dr. R. Ahmed Dental College & Hospital, Kolkata, West Bengal, India
| | - Sushmita Ghosal
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rekha V Kumar
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Chaluvarayaswamy Ramesha
- Department of Epidemiology and Biostatistics, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Vijay C Raghu
- Department of Epidemiology and Biostatistics, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Premendu Prakash Mathur
- School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India
- Department of Biochemistry and Molecular Biology, Pondicherry University, Pondicherry, India
| | - TS Keshava Prasad
- Institute of Bioinformatics, Bangalore, Karnataka, India
- Amrita School of Biotechnology, Amrita University, Kollam, Kerala, India
- YU-IOB Center for Systems Biology and Molecular Medicine, Yenepoya University, Mangalore, Karnataka, India
| | - Joseph A Califano
- Head and Neck Cancer Research Division, Otolaryngology Department, School of Medicine, The Johns Hopkins University, Baltimore, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Moores Cancer Center, University of California, San Diego, California, USA
| | - David Sidransky
- Head and Neck Cancer Research Division, Otolaryngology Department, School of Medicine, The Johns Hopkins University, Baltimore, USA
| | - Arnab Pal
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandakulutur S Ganesh
- Department of Surgical Oncology, Vydehi Institute of Oncology, Bangalore, Karnataka, India
| | - Jay Gopal Ray
- Deparment of Oral Pathology, Dr. R. Ahmed Dental College & Hospital, Kolkata, West Bengal, India
| | - Akhilesh Pandey
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Departments of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harsha Gowda
- Institute of Bioinformatics, Bangalore, Karnataka, India
- YU-IOB Center for Systems Biology and Molecular Medicine, Yenepoya University, Mangalore, Karnataka, India
| | - Aditi Chatterjee
- Institute of Bioinformatics, Bangalore, Karnataka, India
- YU-IOB Center for Systems Biology and Molecular Medicine, Yenepoya University, Mangalore, Karnataka, India
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11
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Rajagopalan P, Patel K, Jain AP, Nanjappa V, Datta KK, Subbannayya T, Mangalaparthi KK, Kumari A, Manoharan M, Coral K, Murugan S, Nair B, Prasad TSK, Mathur PP, Gupta R, Gupta R, Khanna-Gupta A, Califano J, Sidransky D, Gowda H, Chatterjee A. Molecular alterations associated with chronic exposure to cigarette smoke and chewing tobacco in normal oral keratinocytes. Cancer Biol Ther 2018; 19:773-785. [PMID: 29723088 DOI: 10.1080/15384047.2018.1470724] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tobacco usage is a known risk factor associated with development of oral cancer. It is mainly consumed in two different forms (smoking and chewing) that vary in their composition and methods of intake. Despite being the leading cause of oral cancer, molecular alterations induced by tobacco are poorly understood. We therefore sought to investigate the adverse effects of cigarette smoke/chewing tobacco exposure in oral keratinocytes (OKF6/TERT1). OKF6/TERT1 cells acquired oncogenic phenotype after treating with cigarette smoke/chewing tobacco for a period of 8 months. We employed whole exome sequencing (WES) and quantitative proteomics to investigate the molecular alterations in oral keratinocytes chronically exposed to smoke/ chewing tobacco. Exome sequencing revealed distinct mutational spectrum and copy number alterations in smoke/ chewing tobacco treated cells. We also observed differences in proteomic alterations. Proteins downstream of MAPK1 and EGFR were dysregulated in smoke and chewing tobacco exposed cells, respectively. This study can serve as a reference for fundamental damages on oral cells as a consequence of exposure to different forms of tobacco.
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Affiliation(s)
- Pavithra Rajagopalan
- a Institute of Bioinformatics, International Tech Park , Bangalor , India.,b School of Biotechnology , Kalinga Institute of Industrial Technology , Bhubaneswar , India
| | - Krishna Patel
- a Institute of Bioinformatics, International Tech Park , Bangalor , India.,c School of Biotechnology , Amrita Vishwa Vidyapeetham , Kollam , India
| | - Ankit P Jain
- a Institute of Bioinformatics, International Tech Park , Bangalor , India.,b School of Biotechnology , Kalinga Institute of Industrial Technology , Bhubaneswar , India
| | | | - Keshava K Datta
- a Institute of Bioinformatics, International Tech Park , Bangalor , India
| | | | - Kiran K Mangalaparthi
- a Institute of Bioinformatics, International Tech Park , Bangalor , India.,c School of Biotechnology , Amrita Vishwa Vidyapeetham , Kollam , India
| | | | | | | | | | - Bipin Nair
- c School of Biotechnology , Amrita Vishwa Vidyapeetham , Kollam , India
| | - T S Keshava Prasad
- a Institute of Bioinformatics, International Tech Park , Bangalor , India.,e NIMHANS-IOB Bioinformatics and Proteomics Laboratory , Neurobiology Research Centre, National Institute of Mental Health and Neurosciences , Bangalore , India.,f Center for Systems Biology and Molecular Medicine , Yenepoya , Mangalore , India
| | - Premendu P Mathur
- b School of Biotechnology , Kalinga Institute of Industrial Technology , Bhubaneswar , India.,g Dept. of Biochemistry & Molecular Biology , School of Life Sciences, Pondicherry University , Pondicherry , India
| | - Ravi Gupta
- d Medgenome Labs Pvt. Ltd. , Bangalore , India
| | - Rohit Gupta
- d Medgenome Labs Pvt. Ltd. , Bangalore , India
| | | | - Joseph Califano
- h Department of Surgery , UC San Diego, Moores Cancer Center , La Jolla , CA , USA
| | - David Sidransky
- i Department of Otolaryngology-Head and Neck Surgery , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Harsha Gowda
- a Institute of Bioinformatics, International Tech Park , Bangalor , India
| | - Aditi Chatterjee
- a Institute of Bioinformatics, International Tech Park , Bangalor , India
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12
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Predictors of Smoking Cessation and Relapse in Cancer Patients and Effect on Psychological Variables: an 18-Month Observational Study. Ann Behav Med 2018; 51:117-127. [PMID: 27670773 DOI: 10.1007/s12160-016-9834-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Although cancer patients are generally strongly advised to quit smoking in order to improve treatment efficacy and survival, up to 68 % of patients who were smokers at the time of cancer diagnosis continue smoking. Psychological factors such as depression and anxiety are likely to be associated with smoking behavior following a cancer diagnosis, but the empirical evidence is scarce. PURPOSE This observational study aimed at estimating smoking cessation rates and assessing the effect of smoking cessation on psychological symptoms, as well as the predictive role of the same psychological variables on smoking cessation and smoking relapse following cancer surgery. METHODS As part of a larger prospective, epidemiological study, smokers (n = 175) with a first diagnosis of nonmetastatic cancer completed the Hospital Anxiety and Depression Scale, the Insomnia Severity Index, and the Fear of Cancer Recurrence Inventory. Quitters (n = 55) and pair-matched nonquitters (n = 55) were compared on each symptom at pre-quitting, post-quitting, and at a 4-month follow-up. Predictors of smoking cessation and smoking relapse, including psychological variables, were also investigated. RESULTS Fifty-five patients (31.4 %) stopped smoking at least on one occasion during the study. Of the 55 quitters, 27 (49.1 %) experienced a relapse. At pre-quitting, quitters had significantly higher levels of anxiety (p = .03) and fear of cancer recurrence (p = .01) than nonquitters, symptoms that significantly diminished at post-quitting and 4 months later in this subgroup of patients. Having breast cancer significantly predicted smoking cessation (relative risk [RR] = 3.08), while depressive symptoms were a significant predictor of smoking relapse (RR = 1.07). CONCLUSIONS This study highlights the importance of psychological symptoms in predicting tobacco cessation and relapse among individuals with cancer. Our findings suggest that breast cancer patients are more inclined to stop smoking than patients with other cancers, but future studies should attempt to delineate the effect on smoking cessation of gender and other demographics that characterize this subgroup. This study also suggests that a particular attention should be paid to the early management of depressive symptoms in order to prevent smoking relapse.
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13
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Cariati P, Cabello-Serrano A, Perez-de Perceval-Tara M, Monsalve-Iglesias F, Martínez-Lara I. Oral and oropharyngeal squamous cell carcinoma in young adults: A retrospective study in Granada University Hospital. Med Oral Patol Oral Cir Bucal 2017; 22:e679-e685. [PMID: 29053649 PMCID: PMC5813985 DOI: 10.4317/medoral.21755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/30/2017] [Indexed: 11/26/2022] Open
Abstract
Background This study aims to evaluate and analyze the clinical features and outcomes of oral and oropharyngeal squamous cell carcinoma (SCC) in patients < 45-years old in our center. Material and Methods A retrospective analysis was conducted using the records of patients diagnosed with oral and oropharyngeal SCC between 1998 and 2011 in the University Hospital of Granada (Spain). The analysis identified 33 patients with oral and oropharyngeal SCC with an age of <45 years. Moreover, during the years studied, a further 472 patients were diagnosed with oral and oropharyngeal SCC in our center. Thus, 100 SCC patients with an age of >45 years were randomly selected from the same database. A retrospective analysis was conducted to determine specific features including sites of occurrence, risk factors, sex distribution, socio-economic status, T stage at diagnosis, nodal involvement, degree of tumor differentiation, locoregional failure and overall survival at 5 years was. Further, the results of both groups were compared. Results The male-female ratio was 1.2:1 in the group of young adults and 2.03:1 in the group of patients with an age of >45 years. No significant differences were found in terms of site, nodal involvement, locoregional failure, and overall survival. However, there were statistically significant differences between the two groups in terms of features such as risk factors, socio-economic status, T stage at diagnosis, and degree of tumor differentiation. The overall 5-year survival rate was 62% for patients >45 years old, whilst for the group of young adults this rate was 48.4% (p= 0.17). Conclusions The poor association between the common risk factors and oral and oropharyngeal cancers in young adults suggests that other pathogenic mechanisms should be investigated. For young patients, the data show evidence of poorer outcomes in terms of overall survival (p=0.17), and locoregional failure (p=0.23). Nevertheless, the literature shows that the results in this field are particularly inconsistent, and further research is therefore needed to provide more in-depth knowledge of the disease in this age group. Key words:Oral and oropharyngeal squamous cell carcinoma, young adults, poor prognosis,risk factors.
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Affiliation(s)
- P Cariati
- Hospital Virgen de las Nieves, Carretera de Jaen s/n, Granada 18013 (Spain),
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14
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Choi SH, Terrell JE, Bradford CR, Ghanem T, Spector ME, Wolf GT, Lipkus IM, Duffy SA. Does Quitting Smoking Make a Difference Among Newly Diagnosed Head and Neck Cancer Patients? Nicotine Tob Res 2016; 18:2216-2224. [PMID: 27613928 DOI: 10.1093/ntr/ntw189] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/18/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION To determine if smoking after a cancer diagnosis makes a difference in mortality among newly diagnosed head and neck cancer patients. METHODS Longitudinal data were collected from newly diagnosed head and neck cancer patients with a median follow-up time of 1627 days (N = 590). Mortality was censored at 8 years or September 1, 2011, whichever came first. Based on smoking status, all patients were categorized into four groups: continuing smokers, quitters, former smokers, or never-smokers. A broad range of covariates were included in the analyses. Kaplan-Meier curves, bivariate and multivariate Cox proportional hazards models were constructed. RESULTS Eight-year overall mortality and cancer-specific mortality were 40.5% (239/590) and 25.4% (150/590), respectively. Smoking status after a cancer diagnosis predicted overall mortality and cancer-specific mortality. Compared to never-smokers, continuing smokers had the highest hazard ratio (HR) of dying from all causes (HR = 2.71, 95% confidence interval [CI] = 1.48-4.98). Those who smoked at diagnosis, but quit and did not relapse-quitters-had an improved hazard ratio of dying (HR = 2.38, 95% CI = 1.29-4.36) and former smokers at diagnosis with no relapse after diagnosis-former smokers-had the lowest hazard ratio of dying from all causes (HR = 1.68, 95% CI = 1.12-2.56). Similarly, quitters had a slightly higher hazard ratio of dying from cancer-specific reasons (HR = 2.38, 95% CI = 1.13-5.01) than never-smokers, which was similar to current smokers (HR = 2.07, 95% CI = 0.96-4.47), followed by former smokers (HR = 1.70, 95% CI = 1.00-2.89). CONCLUSIONS Compared to never-smokers, continuing smokers have the highest HR of overall mortality followed by quitters and former smokers, which indicates that smoking cessation, even after a cancer diagnosis, may improve overall mortality among newly diagnosed head and neck cancer patients. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population. IMPLICATIONS Using prospective observational longitudinal data from 590 head and neck cancer patients, this study showed that continuing smokers have the highest overall mortality relative to never-smokers, which indicates that smoking cessation, even after a cancer diagnosis, may have beneficial effects on long-term overall mortality. Health care providers should consider incorporating smoking cessation interventions into standard cancer treatment to improve survival among this population.
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Affiliation(s)
- Seung Hee Choi
- College of Nursing, Michigan State University, East Lansing, MI
| | | | | | | | | | | | | | - Sonia A Duffy
- College of Nursing, Ohio State University, Columbus, OH; .,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
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15
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Cancers de la cavité buccale chez les sujets jeunes : résultats thérapeutiques et analyse de facteurs pronostiques. Cancer Radiother 2016; 20:91-7. [DOI: 10.1016/j.canrad.2015.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 11/15/2022]
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16
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Friemel J, Foraita R, Günther K, Heibeck M, Günther F, Pflueger M, Pohlabeln H, Behrens T, Bullerdiek J, Nimzyk R, Ahrens W. Pretreatment oral hygiene habits and survival of head and neck squamous cell carcinoma (HNSCC) patients. BMC Oral Health 2016; 16:33. [PMID: 26969620 PMCID: PMC4788953 DOI: 10.1186/s12903-016-0185-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background The survival time of patients with head and neck squamous cell carcinoma (HNSCC) is related to health behavior, such as tobacco smoking and alcohol consumption. Poor oral health (OH), dental care (DC) and the frequent use of mouthwash have been shown to represent independent risk factors for head and neck cancerogenesis, but their impact on the survival of HNSCC patients has not been systematically investigated. Methods Two hundred seventy-six incident HNSCC cases recruited for the ARCAGE study were followed through a period of 6–10 years. Interview-based information on wearing of dentures, gum bleeding, teeth brushing, use of floss and dentist visits were grouped into weighted composite scores, i.e. oral health (OH) and dental care (DH). Use of mouthwash was assessed as frequency per day. Also obtained were other types of health behavior, such as smoking, alcohol drinking and diet, appreciated as both confounding and study variables. Endpoints were progression-free survival, overall survival and tumor-specific survival. Prognostic values were estimated using Kaplan-Meier analysis and Cox proportional hazards regression models. Results A good dental care score, summarizing annual dental visits, daily teeth cleaning and use of floss was associated with longer overall survival time (p = .001). The results of the Cox regression models similarly suggested a higher risk of tumor progression and shortened overall survival in patients with poor dental care, but the results lost their statistical significance after other types of health behavior had been controlled for. Frequent use of mouthwash (≥ 2 times/day) significantly increased the risk of tumor-specific death (HR = 2.26; CI = 1.19–4.32). Alcohol consumption and tobacco smoking were dose-dependently associated with tumor progression and shorter overall survival. Conclusion Frequent mouthwash use of ≥ 2 times/day seems to elevate the risk of tumor-specific death in HNSCC patients. Good dental care scores are associated with longer overall survival. Electronic supplementary material The online version of this article (doi:10.1186/s12903-016-0185-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juliane Friemel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany
| | - Ronja Foraita
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany
| | - Kathrin Günther
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany
| | - Mathias Heibeck
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany
| | - Frauke Günther
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany
| | - Maren Pflueger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - Jörn Bullerdiek
- Center for Human Genetics, University of Bremen (ZHG), Bremen, Germany
| | - Rolf Nimzyk
- Center for Human Genetics, University of Bremen (ZHG), Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, D-28359, Bremen, Germany.
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Tay GCA, Iyer NG, Ong WS, Tai D, Ang MK, Ha TC, Soo KC, Tan HK. Outcomes and Prognostic Factors of Radiation-Induced and De Novo Head and Neck Squamous Cell Carcinomas. Otolaryngol Head Neck Surg 2016; 154:880-7. [DOI: 10.1177/0194599816631726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/20/2016] [Indexed: 11/16/2022]
Abstract
Objective We sought to compare clinical outcomes, pathological features, treatment patterns, and survival outcomes between radiation-induced squamous cell carcinoma (RISCC) and de novo SCC (DNSCC) of the head and neck, as well as identify prognostic factors in these patients. Study Design Case-control study. Setting Tertiary medical center. Subjects and Methods Retrospective case-control analysis of 34 RISCCs and 136 DNSCCs matched by age at diagnosis, sex, smoking status, and primary tumor site. Results Median latency of RISCC development was 13 years. Radiation-induced squamous cell carcinomas were more likely to present with node-negative disease than DNSCCs (70.6% vs 42.9%; P = .024). A greater proportion of DNSCCs was treated with curative intent (92.6% vs 79.4%; P = .048) and achieved no residual disease posttreatment (82.2% vs 41.2%; P < .001) compared with RISCCs. Patients with RISCC had poorer overall survival (OS) (median, 1.67 vs 5.03 years; P = .018) and disease-specific survival (DSS) (median, 1.67 vs 8.65 years; P = .001) than those with DNSCC. Among patients who underwent curative treatment with no residual disease after treatment, there were, however, no survival differences between RISCC and DNSCC. Conclusion In our cohort, RISCCs have a poorer prognosis than DNSCCs. However, those able to undergo curative treatment and have no residual disease after treatment have comparable survival outcomes. Locoregional control of these tumors appears paramount in achieving the best outcomes for patients with RISCC.
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Affiliation(s)
- Gerald Ci-An Tay
- Department of General Surgery, Singapore General Hospital, Singapore
| | | | - Whee-Sze Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - David Tai
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Mei-Kim Ang
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Tam Cam Ha
- Medical Education, Research & Evaluation Department (MERE), Duke-NUS Graduate Medical School Singapore, Singapore
| | - Khee-Chee Soo
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Hiang Khoon Tan
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
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Seifart U. [Cancer and life style: What really helps?]. Internist (Berl) 2015; 57:55-62; quiz 63-4. [PMID: 26678284 DOI: 10.1007/s00108-015-3772-2] [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: 11/24/2022]
Abstract
The continuously growing number of patients who survive cancer (long-term survivors) and their special life situations necessitate an increasing need for consultation on the topics of quality of life and recurrence prophylaxis. This consultation is often associated with aspects of complementary medicine and also social medicine, which are becoming increasingly more important in the long-term care of patients. This article presents the scientifically proven knowledge on the aspects of nutrition, sport, nicotine abuse and professional rehabilitation and their importance for the course of cancer diseases.
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Affiliation(s)
- U Seifart
- Klinik Sonnenblick, Akademisches Lehrkrankenhaus der Universität Marburg, Baldinger Str. 1-6, 35043, Marburg, Deutschland.
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Guo Y, Logan HL, Marks JG, Shenkman EA. The relationships among individual and regional smoking, socioeconomic status, and oral and pharyngeal cancer survival: a mediation analysis. Cancer Med 2015; 4:1612-9. [PMID: 26250857 PMCID: PMC4618632 DOI: 10.1002/cam4.509] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 12/13/2022] Open
Abstract
Poorer survival from oral and pharyngeal cancer (OPC) has been reported for populations of lower socioeconomic status (SES), adjusting for risk factors such as patient and clinical characteristics. Beyond these risk factors, higher rates of tobacco use may be a mediator for the observed poorer OPC survival for low SES populations. In this study, we aimed to examine the impact of the relationships among SES, individual smoking status, and living in a region with a higher smoking rate on OPC survival. We obtained Florida Cancer Data System data from 1996 to 2010 and merged the data with US Census data and Behavioral Risk Factor Surveillance System data from 1996 to 2010. We built multivariable survival models to quantify the mediational effect of individual smoking on overall and OPC-specific survival, adjusting for regional smoking, demographics, and clinical characteristics. We found that lower SES, individual smoking, and living in a region with a higher smoking rate were all strongly associated with poorer survival. We estimated that the indirect effect of individual smoking accounted for a large part (ranged from 13.3% to 30.2%) of the total effect of SES on overall and OPC-specific survival. In conclusion, individual and regional smoking are both significant and independent predictors of poor cancer survival. Higher rate of individual smoking is partially responsible for poorer cancer survival in low SES populations. Results of this study provide rationale for considering a multi-level approach that simultaneously targets both individual and contextual factors for future smoking cessation interventions.
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Affiliation(s)
- Yi Guo
- Department of Health Outcomes and Policy, University of FloridaGainesville, Florida
| | - Henrietta L Logan
- Department of Community Dentistry and Behavioral Science, University of FloridaGainesville, Florida
| | - John G Marks
- Department of Community Dentistry and Behavioral Science, University of FloridaGainesville, Florida
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Policy, University of FloridaGainesville, Florida
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20
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Joo YH, Yoo IR, Lee YS, Cho KJ, Park JO, Nam IC, Kim CS, Kim SY, Kim MS. Association between the standardized uptake value and high-risk HPV in hypopharyngeal squamous cell carcinoma. Acta Otolaryngol 2014; 134:1062-70. [PMID: 25220728 DOI: 10.3109/00016489.2014.905701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Median (18)F-FDG PET/CT maximum standardized uptake values (SUV max) cut-off values of 7.9 or greater were associated with high-risk human papillomavirus (HPV) negativity in patients with hypopharyngeal squamous cell carcinoma (HPSCC). Furthermore, median (18)F-FDG PET/CT SUV max cut-off values of 7.9 or greater and high-risk HPV negativity were associated with adverse outcomes. OBJECTIVES We studied the association and the potential prognostic significance of (18)F-FDG PET/CT and high-risk HPV status in HPSCC. METHODS The medical records of 45 patients who underwent (18)F-FDG PET/CT for HPSCC before surgery were reviewed. High-risk HPV in situ hybridization was performed to detect HPV infection. RESULTS The median SUV max was 9.91 ± 4.91 (range 1.9-22.1) and the positive rate of high-risk HPV in situ hybridization was 11% (5 of 45). The SUV max values of negativity for the high-risk HPV subtypes (10.47 ± 4.87) and positivity (5.48 ± 2.45) were found to be significantly different (p = 0.030). The SUV max cut-off value for differentiating negativity for the high-risk HPV subtypes from positivity was 7.9, with a sensitivity of 65% and a specificity of 80%. The 5-year disease-specific survival rate (DSSR) in our cohort was 57%. Patients with an SUV max value higher than 7.9 (p = 0.005) and high-risk HPV negativity (p = 0.047) had decreased 5-year DSSR.
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21
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Lynch J, Lal P, Schick U, Nutting CM, Newbold K, Harrington K, Bhide S. Multiple cervical lymph node involvement and extra-capsular extension predict for contralateral nodal recurrence after ipsilateral radiotherapy for squamous cell carcinoma of the tonsil. Oral Oncol 2014; 50:901-6. [DOI: 10.1016/j.oraloncology.2014.06.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 12/20/2022]
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Karam-Hage M, Cinciripini PM, Gritz ER. Tobacco use and cessation for cancer survivors: an overview for clinicians. CA Cancer J Clin 2014; 64:272-90. [PMID: 24817674 PMCID: PMC4377321 DOI: 10.3322/caac.21231] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/06/2014] [Accepted: 04/07/2014] [Indexed: 01/01/2023] Open
Abstract
Approximately 30% of all cancer deaths in the United States are caused by tobacco use and smoking. Cancers of eighteen sites have been causally linked to smoking, the most common of which are the lung, head and neck, bladder, and esophagus. While quit rates and quit attempt rates are relatively high shortly after a cancer diagnosis, the recidivism rates are also high. Therefore, screening, treating, and preventing relapse to tobacco use is imperative among patients with and survivors of cancer. To date, research has consistently shown that a combination of pharmacologic and behavioral interventions is needed to achieve the highest smoking cessation rates, with a recent emphasis on individualized treatment as a most promising approach. Challenges in health care systems, including the lack of appropriate resources and provider training, have slowed the progress in addition to important clinical considerations relevant to the treatment of tobacco dependence (eg, a high degree of comorbidity with psychiatric disorders and other substance use disorders). However, continued tobacco use has been shown to limit the effectiveness of major cancer treatments and to increase the risk of complications and of developing secondary cancers. The authors recommend that oncology providers screen all patients for tobacco use and refer users to specialized treatment when available. Alternatively, oncology clinicians can provide basic advice on tobacco use cessation and pharmacotherapy and/or referral to outside resources (eg, quitlines). Herein, the authors summarize the current knowledge on tobacco use and its treatment, with a focus on the related available evidence for patients with and survivors of cancer.
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Affiliation(s)
- Maher Karam-Hage
- Associate Professor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul M. Cinciripini
- Professor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ellen R. Gritz
- Professor and Chair, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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Joo YH, Lee YS, Cho KJ, Park JO, Nam IC, Kim CS, Kim SY, Kim MS. Characteristics and prognostic implications of high-risk HPV-associated hypopharyngeal cancers. PLoS One 2013; 8:e78718. [PMID: 24244346 PMCID: PMC3823884 DOI: 10.1371/journal.pone.0078718] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/18/2013] [Indexed: 12/01/2022] Open
Abstract
Background High-risk human papillomavirus (HPV) is an oncogenic virus that causes oropharyngeal cancers, and it has a favorable outcome after the treatment. Unlike in oropharyngeal cancer, the prevalence and role of high-risk HPV in the etiology of hypopharyngeal squamous cell carcinoma (HPSCC) is uncertain. Objective The aim of the present study was to evaluate the effect and prognostic significance of high-risk HPV in patients with HPSCC. Methods The study included 64 subjects with HPSCC who underwent radical surgery with or without radiation-based adjuvant therapy. Primary tumor sites were the pyriform sinus in 42 patients, posterior pharyngeal wall in 19 patients, and postcricoid area in 3 patients. High-risk HPV in situ hybridization was performed to detect HPV infection. Results The positive rate of high-risk HPV in situ hybridization was 10.9% (7/64). There was a significant difference in the fraction of positive high-risk HPV among pyriform sinus cancer (16.7%), posterior pharyngeal wall cancer (0%), and postcricoid area cancer (0%) (p = 0.042). The laryngoscopic examination revealed a granulomatous and exophytic appearance in 85.7% (6/7) of patients with high-risk HPV-positive pyriform sinus cancer, but in only 31.4% (11/35) of patients with high-risk HPV-negative pyriform sinus cancer (p = 0.012). Significant correlations were found between positive high-risk HPV and younger age (p = 0.050) and non-smoking status (p = 0.017). HPV-positive patients had a significantly better disease-free survival (p = 0.026) and disease-specific survival (p = 0.047) than HPV-negative patients. Conclusions High-risk HPV infection is significantly related to pyriform sinus cancer in patients with HPSCC.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn-Soo Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang-Jae Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Ook Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Chul Nam
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chung-Soo Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Sik Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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Yang T, Chang PY, Park SL, Bastani D, Chang SC, Morgenstern H, Tashkin DP, Mao JT, Papp JC, Rao JY, Cozen W, Mack TM, Greenland S, Zhang ZF. Tobacco smoking, NBS1 polymorphisms, and survival in lung and upper aerodigestive tract cancers with semi-Bayes adjustment for hazard ratio variation. Cancer Causes Control 2013; 25:11-23. [PMID: 24166361 DOI: 10.1007/s10552-013-0303-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/01/2013] [Indexed: 01/25/2023]
Abstract
PURPOSE Although single nucleotide polymorphisms (SNPs) of NBS1 have been associated with susceptibility to lung and upper aerodigestive tract (UADT) cancers, their relations to cancer survival and measures of effect are largely unknown. METHODS Using follow-up data from 611 lung cancer cases and 601 UADT cancer cases from a population-based case-control study in Los Angeles, we prospectively evaluated associations of tobacco smoking and 5 NBS1 SNPs with all-cause mortality. Mortality data were obtained from the Social Security Death Index. We used Cox regression to estimate adjusted hazard ratios (HR) for main effects and ratios of hazard ratios (RHR) derived from product terms to assess hazard ratio variations by each SNP. Bayesian methods were used to account for multiple comparisons. RESULTS We observed 406 (66 %) deaths in lung cancer cases and 247 (41 %) deaths in UADT cancer cases with median survival of 1.43 and 1.72 years, respectively. Ever tobacco smoking was positively associated with mortality for both cancers. We observed an upward dose-response association between smoking pack-years and mortality in UADT squamous cell carcinoma. The adjusted HR relating smoking to mortality in non-small cell lung cancer (NSCLC) was greater for cases with the GG genotype of NBS1 rs1061302 than for cases with AA/AG genotypes (semi-Bayes adjusted RHR = 1.97; 95 % limits = 1.14, 3.41). CONCLUSIONS A history of tobacco smoking at cancer diagnosis was associated with mortality among patients with lung cancer or UADT squamous cell carcinoma. The HR relating smoking to mortality appeared to vary with the NBS1 rs1061302 genotype among NSCLC cases.
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Affiliation(s)
- Tingting Yang
- Zhejiang Provincial CDC, Hangzhou, Zhejiang, People's Republic of China
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Chen C, Shen LJ, Li BF, Gao J, Xia YF. Smoking is a poor prognostic factor for male nasopharyngeal carcinoma treated with radiotherapy. Radiother Oncol 2013; 110:409-15. [PMID: 24021341 DOI: 10.1016/j.radonc.2013.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 05/14/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the effect of smoking on prognosis of male nasopharyngeal carcinoma by comparing the treatment outcomes between smokers and non-smokers. MATERIALS AND METHODS A total of 2450 nasopharyngeal carcinoma patients were enrolled, including 1865 male patients. Matching was performed between smokers and non-smokers in male patients according to age, UICC clinical stage, T stage, N stage and treatment. Survival outcomes were compared using Kaplan-Meier analysis and Cox regression. Smoking index was calculated by multiplying cigarette packs per day and smoked time (year). RESULTS In male patients, smokers had significantly lower 5-year overall survival (70.1% vs. 77.5%, P<0.001) and locoregional recurrent free survival (76.8% vs.82.4%, P = 0.002) compared with non-smokers. Matched-pair analysis showed that smokers kept a high risk of death compared with non-smokers (HR = 2.316, P<0.001). High degree of smoking index (>15 pack-years) had a poor effect on overall survival (HR = 1.225, P = 0.016). When smoking index was more than 45 and 60 pack-years, the risk for death increased to 1.498 and 1.899 fold compared with non-smokers (P = 0.040, 0.001), respectively. CONCLUSIONS Smoking was a poor prognostic factor for male nasopharyngeal carcinoma. The heavier the patients smoked, the poorer prognosis they suffered.
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Affiliation(s)
- Chen Chen
- Department of Radiation Oncology, Sun Yat-Sen University, Guangzhou, People's Republic of China; Zhongshan School of Medcine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Lu-Jun Shen
- Department of Radiation Oncology, Sun Yat-Sen University, Guangzhou, People's Republic of China; Zhongshan School of Medcine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Bo-Fei Li
- Department of Radiation Oncology, Sun Yat-Sen University, Guangzhou, People's Republic of China; Zhongshan School of Medcine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jin Gao
- Department of Radiation Oncology, Sun Yat-Sen University, Guangzhou, People's Republic of China; State Key Laboratory of Oncology in Southern China, Cancer Center, , Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yun-Fei Xia
- Department of Radiation Oncology, Sun Yat-Sen University, Guangzhou, People's Republic of China; State Key Laboratory of Oncology in Southern China, Cancer Center, , Sun Yat-Sen University, Guangzhou, People's Republic of China.
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Durr ML, Li D, Wang SJ. Oral cavity squamous cell carcinoma in never smokers: analysis of clinicopathologic characteristics and survival. Am J Otolaryngol 2013; 34:388-93. [PMID: 23540889 DOI: 10.1016/j.amjoto.2013.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 01/12/2013] [Accepted: 01/15/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To examine the relationship between tobacco smoking history and the clinicopathologic and survival characteristics of patients with oral cavity squamous cell carcinoma (OCSCC). MATERIALS AND METHODS This is a retrospective review of 531 patients treated for OCSCC from January 1998 to December 2009 at a tertiary care medical center. RESULTS Thirty-two percent of OCSCC patients were never smokers. There were significant differences in tumor location between ever smokers and never smokers (p<0.001), with never smokers more likely to have oral tongue tumors. Smokers were significantly (p<0.001) more likely than never smokers to present with locally advanced (T3 or T4) disease (57.8% vs. 35.4%). Never smokers demonstrated improved overall survival (78.8 months in never smokers vs. 44.7 months in ever smokers, p=.03). However, there were no survival differences when the two groups were compared separately for locally early (T1/T2) or advanced (T3/T4) disease. For T1/T2 tumors, mean survival was 88.2 months for never smokers and 78.5 months for smokers (p=.10). For T3/T4 tumors, median survival was 29.1 months for never smokers and 23.8 months for smokers (p=.09). CONCLUSIONS Primary tumor location and T-status in OCSCC differed between never smokers and smokers. Compared to smokers, never smokers had fewer locally advanced tumors and better overall survival.
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Montero-Miranda PH, Ganly I. Survivorship--competing mortalities, morbidities, and second malignancies. Otolaryngol Clin North Am 2013; 46:681-710. [PMID: 23910478 DOI: 10.1016/j.otc.2013.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mortality of head and neck cancer has declined in the United States over the past 20 years. This improvement has been linked to use of multimodality treatment of advanced disease. Despite this improvement, disease-specific survival remains low. Patients who survive head and neck cancer are exposed to morbidity and mortality secondary to the same factors as the general population. Factors related to cancer and cancer treatment predispose them to increased risk of mortality. Improvements in head and neck cancer treatment have led to a scenario where an increasing proportion of patients die from causes other than the primary cancer, called competing mortalities.
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Affiliation(s)
- Pablo H Montero-Miranda
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Pytynia KB, Dahlstrom KR, Sturgis EM. Clinical management of squamous cell carcinoma of the oropharynx: how does this differ for HPV-related tumors? Future Oncol 2013; 9:1413-6. [PMID: 23777275 DOI: 10.2217/fon.13.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Kristen B Pytynia
- Department of Head & Neck Surgery, Unit 1445, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Gunn GB, Debnam JM, Fuller CD, Morrison WH, Frank SJ, Beadle BM, Sturgis EM, Glisson BS, Phan J, Rosenthal DI, Garden AS. The impact of radiographic retropharyngeal adenopathy in oropharyngeal cancer. Cancer 2013; 119:3162-9. [PMID: 23733178 DOI: 10.1002/cncr.28195] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/24/2013] [Accepted: 04/26/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND We performed this study to define the incidence of radiographic retropharyngeal lymph node (RPLN) involvement in oropharyngeal cancer (OPC) and its impact on clinical outcomes, neither of which has been well established to date. METHODS Our departmental database was queried for patients irradiated for OPC between 2001 and 2007. Analyzable patients were those with imaging data available for review to determine radiographic RPLN status. Demographic, clinical, and outcome data were retrieved and analyzed. RESULTS The cohort consisted of 981 patients. The median follow-up was 69 months. The base of the tongue (47%) and the tonsil (46%) were the most common primary sites. The majority of patients had stage T1 to T2 primary tumors (64%), and 94% had stage 3 to 4B disease. Intensity-modulated radiation therapy was used in 77% of patients, and systemic therapy was administered in 58% of patients. The incidence of radiographic RPLN involvement was 10% and was highest for the pharyngeal wall (23%) and lowest for the base of the tongue (6%). RPLN adenopathy correlated with several patient and tumor factors. RPLN involvement was associated with poorer 5-year outcomes on univariate analysis (P<.001 for all) for local control (79% vs 92%), nodal control (80% vs 93%), recurrence-free survival (51% vs 81%), distant metastases-free survival (66% vs 89%), and overall survival (52% vs 82%) and maintained significance on multivariate analysis for local control (P = .023), recurrence-free survival (P = .001), distant metastases-free survival (P = .003), and overall survival (P = .001). CONCLUSIONS In this cohort of nearly 1000 patients investigating [corrected] radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends [corrected] a negative influence on disease recurrence, distant relapse, and survival. In this cohort of nearly 1000 patients investigating radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends a negative influence on disease recurrence, distant relapse, and survival.
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Affiliation(s)
- G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Moyses RA, López RVM, Cury PM, Siqueira SAC, Curioni OA, Gois Filho JFD, Figueiredo DLA, Tajara EH, Michaluart P. Significant differences in demographic, clinical, and pathological features in relation to smoking and alcohol consumption among 1,633 head and neck cancer patients. Clinics (Sao Paulo) 2013; 68:738-44. [PMID: 23778492 PMCID: PMC3674275 DOI: 10.6061/clinics/2013(06)03] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 02/01/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE As a lifestyle-related disease, social and cultural disparities may influence the features of squamous cell carcinoma of the head and neck in different geographic regions. We describe demographic, clinical, and pathological aspects of squamous cell carcinoma of the head and neck according to the smoking and alcohol consumption habits of patients in a Brazilian cohort. METHODS We prospectively analyzed the smoking and alcohol consumption habits of 1,633 patients enrolled in five São Paulo hospitals that participated in the Brazilian Head and Neck Genome Project - Gencapo. RESULTS The patients who smoked and drank were younger, and those who smoked were leaner than the other patients, regardless of alcohol consumption. The non-smokers/non-drinkers were typically elderly white females who had more differentiated oral cavity cancers and fewer first-degree relatives who smoked. The patients who drank presented significantly more frequent nodal metastasis, and those who smoked presented less-differentiated tumors. CONCLUSIONS The patients with squamous cell carcinoma of the head and neck demonstrated demographic, clinical, and pathological features that were markedly different according to their smoking and drinking habits. A subset of elderly females who had oral cavity cancer and had never smoked or consumed alcohol was notable. Alcohol consumption seemed to be related to nodal metastasis, whereas smoking correlated with the degree of differentiation.
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Affiliation(s)
- Raquel Ajub Moyses
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Disciplina de Cirurgia de Cabeça e Pescoço (LIM28), São Paulo/SP, Brasil.
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Joo YH, Yoo IR, Cho KJ, Park JO, Nam IC, Kim MS. Preoperative 18F-FDG PET/CT and high-risk HPV in patients with oropharyngeal squamous cell carcinoma. Head Neck 2013; 36:323-7. [PMID: 23729374 DOI: 10.1002/hed.23296] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To evaluate the association of (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG PET/CT) and high-risk human papillomavirus (HPV) status and to establish the histologic correlates in oropharyngeal cancer (OPSCC). METHOD The medical records of 78 patients who underwent (18)F-FDG PET/CT for OPSCC before surgery were reviewed. RESULTS The positive rate of high-risk HPV in situ hybridization was 36% (28 of 78). The maximum standardized uptake values (SUVmax ) of negativity for the high-risk HPV subtypes (10.29 ± 4.30) and positivity (6.69 ± 4.17) were found to be significantly different (p = .001). The SUVmax cutoff value for differentiating negativity for the high-risk HPV subtypes from positivity was 7.10, with the sensitivity of 78% and the specificity of 68%. A median SUVmax (using 7.10 as a cutoff) (p = .041) and high-risk HPV status (p = .040) were found to be associated with 5-year disease-specific survival (DSS). CONCLUSIONS Median (18)F-FDG PET/CT SUVmax cutoff values 7.10 or greater are associated with a high-risk HPV negativity in OPSCC patients.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Gan SJ, Dahlstrom KR, Peck BW, Caywood W, Li G, Wei Q, Zafereo ME, Sturgis EM. Incidence and pattern of second primary malignancies in patients with index oropharyngeal cancers versus index nonoropharyngeal head and neck cancers. Cancer 2013; 119:2593-601. [PMID: 23605777 DOI: 10.1002/cncr.28107] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/08/2013] [Accepted: 03/13/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND A recent review of the Surveillance, Epidemiology, and End Results registry suggested that patients with index squamous cell carcinoma (SCC) of the oropharynx (SCCOP) are less likely to develop second primary malignancies (SPM) than patients with index SCC of nonoropharyngeal sites (oral cavity, larynx, hypopharynx). The objectives of this study were to determine the impact of index primary tumor site on SPM risk and to explore factors that potentially affect this risk within a large, prospectively accrued cohort of patients with index SCC of the head and neck (SCCHN). METHODS A cohort of 2230 patients with incident SCCHN was reviewed for development of SPM. Kaplan-Meier analysis, log-rank testing, and Cox proportional hazards models were used to detect the impact of various factors, including index tumor site, on SPM risk. RESULTS The SPM rate was lower for patients with index SCCOP than for patients with index nonoropharyngeal cancer (P < .001). Among patients with SCCOP, former smokers had a 50% greater risk of SPM, and current smokers had a 100% greater risk of SPM than never-smokers (Ptrend = .008). Also among patients with SCCOP, those with the classic SCCHN phenotype had an SPM risk similar to that of patients with index nonoropharyngeal cancers; those with a typical human papillomavirus phenotype had a very low SPM risk. SPM most commonly occurred at nontobacco-related sites in patients with index SCCOP and at tobacco-related sites in patients with index nonoropharyngeal cancers. CONCLUSIONS In patients with SCCHN, index cancer site and smoking status affect the risk and distribution of SPM.
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Affiliation(s)
- Samuel J Gan
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Li G, Huang Z, Chen X, Wei Q. Role of human papillomavirus and cell cycle-related variants in squamous cell carcinoma of the oropharynx. J Biomed Res 2013; 24:339-46. [PMID: 23554649 PMCID: PMC3596680 DOI: 10.1016/s1674-8301(10)60047-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Indexed: 12/25/2022] Open
Affiliation(s)
- Guojun Li
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4095, USA ; Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4095, USA
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Durr ML, van Zante A, Li D, Kezirian EJ, Wang SJ. Oral Tongue Squamous Cell Carcinoma in Never-Smokers. Otolaryngol Head Neck Surg 2013; 149:89-96. [DOI: 10.1177/0194599813482876] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives (1) To compare clinical characteristics, survival, and recurrence between never-smokers and ever-smokers with oral tongue squamous cell carcinoma (OTSCC). (2) To assess the relationship between clinicopathologic characteristics and survival/recurrence in OTSCC. Study Design Historical cohort study. Setting Academic university medical center. Subjects and Methods This is a study of 120 patients with OTSCC who were treated from January 1999 to February 2010. Clinicopathologic factors were compared between never-smokers and ever-smokers using t tests and χ2 tests. Cox regression analyses examined their association with survival and recurrence. Results Of 120 subjects, 66 (55%) were prior or current smokers. There were no significant differences in clinicopathologic factors between ever-smokers and never-smokers. After adjustment for clinicopathologic factors, multivariate Cox regression analysis demonstrated decreased overall survival for never-smokers, but this difference was not significant (hazard ratio [HR], 2.84; P = .056). Increased depth of tumor invasion (HR per millimter invasion, 1.09; P = .005), nodal metastasis (HR, 7.1; P = .025), and stage III or IV disease (HR, 9.45 and 7.31; P = .026 and .029, respectively) were associated with decreased overall survival. Perineural invasion (HR, 8.56; P = .005) and lymphovascular invasion (HR, 6.01; P = .011) were associated with disease recurrence. Conclusion Overall survival may be decreased in never-smokers with OTSCC. Greater depth of tumor invasion and more advanced stage disease are associated with decreased survival. Perineural invasion and lymphovascular invasion are associated with disease recurrence.
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Affiliation(s)
- Megan L. Durr
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Annemieke van Zante
- Department of Pathology, University of California, San Francisco, California, USA
| | - David Li
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Eric J. Kezirian
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Steven J. Wang
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco, California, USA
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Oral Squamous Cell Carcinoma From Users and Nonusers of Tobacco and Alcohol. Appl Immunohistochem Mol Morphol 2013; 21:148-53. [DOI: 10.1097/pai.0b013e3182558b65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Garden AS, Kies MS, Morrison WH, Weber RS, Frank SJ, Glisson BS, Gunn GB, Beadle BM, Ang KK, Rosenthal DI, Sturgis EM. Outcomes and patterns of care of patients with locally advanced oropharyngeal carcinoma treated in the early 21st century. Radiat Oncol 2013; 8:21. [PMID: 23360540 PMCID: PMC3576243 DOI: 10.1186/1748-717x-8-21] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/20/2013] [Indexed: 12/03/2022] Open
Abstract
Background We performed this study to assess outcomes of patients with oropharyngeal cancer treated with modern therapy approaches. Methods Demographics, treatments and outcomes of patients diagnosed with Stage 3- 4B squamous carcinoma of the oropharynx, between 2000 – 2007 were tabulated and analyzed. Results The cohort consisted of 1046 patients. The 5- year actuarial overall survival, recurrence-free survival and local-regional control rates for the entire cohort were 78%, 77% and 87% respectively. More advanced disease, increasing T-stage and smoking were associated with higher rates of local-regional recurrence and poorer survival. Conclusions Patients with locally advanced oropharyngeal cancer have a relatively high survival rate. Patients’ demographics and primary tumor volume were very influential on these favorable outcomes. In particular, patients with small primary tumors did very well even when treatment was not intensified with the addition of chemotherapy.
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Affiliation(s)
- Adam S Garden
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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O'Sullivan B, Huang SH, Siu LL, Waldron J, Zhao H, Perez-Ordonez B, Weinreb I, Kim J, Ringash J, Bayley A, Dawson LA, Hope A, Cho J, Irish J, Gilbert R, Gullane P, Hui A, Liu FF, Chen E, Xu W. Deintensification candidate subgroups in human papillomavirus-related oropharyngeal cancer according to minimal risk of distant metastasis. J Clin Oncol 2013; 31:543-50. [PMID: 23295795 DOI: 10.1200/jco.2012.44.0164] [Citation(s) in RCA: 463] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To define human papillomavirus (HPV) -positive oropharyngeal cancers (OPC) suitable for treatment deintensification according to low risk of distant metastasis (DM). PATIENTS AND METHODS OPC treated with radiotherapy (RT) or chemoradiotherapy (CRT) from 2001 to 2009 were included. Outcomes were compared for HPV-positive versus HPV-negative patients. Univariate and multivariate analyses identified outcome predictors. Recursive partitioning analysis (RPA) stratified the DM risk. RESULTS HPV status was ascertained in 505 (56%) of 899 consecutive OPCs. Median follow-up was 3.9 years. HPV-positive patients (n = 382), compared with HPV-negative patients (n = 123), had higher local (94% v 80%, respectively, at 3 years; P < .01) and regional control (95% v 82%, respectively; P < .01) but similar distant control (DC; 90% v 86%, respectively; P = .53). Multivariate analysis identified that HPV negativity (hazard ratio [HR], 2.9; 95% CI, 2.0 to 5.0), N2b-N3 (HR, 2.9; 95% CI, 1.8 to 4.9), T4 (HR, 1.8; 95% CI, 1.2 to 2.9), and RT alone (HR, 1.8; 95% CI, 1.1 to 2.5) predicted a lower recurrence-free survival (RFS; all P < .01). Smoking pack-years > 10 reduced overall survival (HR, 1.72; 95% CI, 1.1 to 2.7; P = .03) but did not impact RFS (HR, 1.1; 95% CI, 0.7 to 1.9; P = .65). RPA segregated HPV-positive patients into low (T1-3N0-2c; DC, 93%) and high DM risk (N3 or T4; DC, 76%) groups and HPV-negative patients into different low (T1-2N0-2c; DC, 93%) and high DM risk (T3-4N3; DC, 72%) groups. The DC rates for HPV-positive, low-risk N0-2a or less than 10 pack-year N2b patients were similar for RT alone and CRT, but the rate was lower in the N2c subset managed by RT alone (73% v 92% for CRT; P = .02). CONCLUSION HPV-positive T1-3N0-2c patients have a low DM risk, but N2c patients from this group have a reduced DC when treated with RT alone and seem less suited for deintensification strategies that omit chemotherapy.
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Affiliation(s)
- Brian O'Sullivan
- Room 5-624, Princess Margaret Hospital, 610 University Ave, Toronto, Ontario, Canada M5G 2M9.
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Cucinotta FA, Chappell LJ, Kim MHY, Wang M. Radiation carcinogenesis risk assessments for never-smokers. HEALTH PHYSICS 2012; 103:643-51. [PMID: 23032894 DOI: 10.1097/hp.0b013e318267b3ad] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cigarette smoking, which is presently associated with more than 20% of adult deaths in the United States, is a large confounder to radiation risk estimates derived from epidemiology data. Astronauts and other exposed groups are classified as never-smokers (NS), defined as lifetime use of less than 100 cigarettes. In the past, radiation risk estimates have been made using average U.S. population rates for cancer and all causes of death, which may lead to overestimation of radiation risks for NS. In this report, age- and gender-specific radiation carcinogenesis risk calculations for NS and the average U.S. population are compared. Lung is the major tissue site for smoking and radiation-related cancer. However, other radiogenic cancers where tobacco has been shown to increase population cancer rates are esophagus, oral cavity, salivary gland, bladder, stomach, liver, colorectal, and leukemia. After adjusting U.S. cancer rates to remove smoking effects, radiation risks for lung and other cancers were estimated using the multiplicative risk model and a mixture model, with weighted contributions for additive and multiplicative risk transfer. Radiation mortality risks for NS were reduced compared to the average U.S. population by more than 20% and 50% in the mixture model and multiplicative transfer models, respectively. The authors discuss possible mechanisms of cancer risks from radiation and tobacco that suggest multiplicative effects could occur. These results suggest that improved understanding of possible synergisms between cancer initiators and promoters, such as radiation and tobacco, would greatly improve risk estimates and reduce uncertainties for differentially exposed groups, including NS.
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Affiliation(s)
- Francis A Cucinotta
- NASA, Lyndon B. Johnson Space Center, 2101 NASA Parkway, Houston, TX 77058, USA.
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Garden AS, Dong L, Morrison WH, Stugis EM, Glisson BS, Frank SJ, Beadle BM, Gunn GB, Schwartz DL, Kies MS, Weber RS, Ang KK, Rosenthal DI. Patterns of disease recurrence following treatment of oropharyngeal cancer with intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 2012; 85:941-7. [PMID: 22975604 DOI: 10.1016/j.ijrobp.2012.08.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/02/2012] [Accepted: 08/03/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE To report mature results of a large cohort of patients diagnosed with squamous cell carcinoma of the oropharynx who were treated with intensity modulated radiation therapy (IMRT). METHODS AND MATERIALS The database of patients irradiated at The University of Texas, M.D. Anderson Cancer Center was searched for patients diagnosed with oropharyngeal cancer and treated with IMRT between 2000 and 2007. A retrospective review of outcome data was performed. RESULTS The cohort consisted of 776 patients. One hundred fifty-nine patients (21%) were current smokers, 279 (36%) former smokers, and 337 (43%) never smokers. T and N categories and American Joint Committee on Cancer group stages were distributed as follows: T1/x, 288 (37%); T2, 288 (37%); T3, 113 (15%); T4, 87 (11%); N0, 88(12%); N1/x, 140 (18%); N2a, 101 (13%); N2b, 269 (35%); N2c, 122 (16%); and N3, 56 (7%); stage I, 18(2%); stage II, 40(5%); stage III, 150(19%); and stage IV, 568(74%). Seventy-one patients (10%) presented with nodes in level IV. Median follow-up was 54 months. The 5-year overall survival, locoregional control, and overall recurrence-free survival rates were 84%, 90%, and 82%, respectively. Primary site recurrence developed in 7% of patients, and neck recurrence with primary site control in 3%. We could only identify 12 patients (2%) who had locoregional recurrence outside the high-dose target volumes. Poorer survival rates were observed in current smokers, patients with larger primary (T) tumors and lower neck disease. CONCLUSIONS Patients with oropharyngeal cancer treated with IMRT have excellent disease control. Locoregional recurrence was uncommon, and most often occurred in the high dose volumes. Parotid sparing was accomplished in nearly all patients without compromising tumor coverage.
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Affiliation(s)
- Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Dahlstrom KR, Calzada G, Hanby JD, Garden AS, Glisson BS, Li G, Roberts DB, Weber RS, Sturgis EM. An evolution in demographics, treatment, and outcomes of oropharyngeal cancer at a major cancer center: a staging system in need of repair. Cancer 2012; 119:81-9. [PMID: 22736261 DOI: 10.1002/cncr.27727] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 05/31/2012] [Accepted: 06/01/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND In this retrospective review, the authors examined demographic/clinical characteristics and overall survival in patients with squamous cell carcinoma of the oropharynx at a tertiary cancer center, and they report the characteristics that influenced any observed survival trends over time. METHODS The study included 3891 newly diagnosed, previously untreated patients who presented at the authors' institution between 1955 and 2004. RESULTS Over time, patients presented at younger ages and were more likely to have base of tongue or tonsil tumors and to be never-smokers or former smokers. Patients who were diagnosed between 1995 and 2004 were almost half as likely to die as those who were diagnosed before 1995 (hazard ratio, 0.6; 95% confidence interval, 0.6-0.8). In both multivariable and recursive partitioning survival analyses, the TNM staging system predicted the survival of patients who received treatment before 1995 but did not predict the survival patients treated during the period from 1995 to 2004. CONCLUSIONS Survival among patients with squamous cell carcinoma of the oropharynx improved substantially over the past 50 years. The main contributing factors were changes in clinical characteristics, in particular surrogates for positive human papillomavirus status. The current TNM staging system for squamous cell carcinoma of the oropharynx is inadequate. The incorporation of human papillomavirus status and perhaps smoking status into the TNM system is encouraged.
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Affiliation(s)
- Kristina R Dahlstrom
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, USA
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Warren GW, Kasza KA, Reid ME, Cummings KM, Marshall JR. Smoking at diagnosis and survival in cancer patients. Int J Cancer 2012; 132:401-10. [PMID: 22539012 DOI: 10.1002/ijc.27617] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/13/2012] [Indexed: 12/31/2022]
Abstract
The effect of smoking on survival in cancer patients is limited by the lack of structured prospective assessments of smoking at diagnosis. To assess the effect of smoking at diagnosis on survival, structured smoking assessments were obtained in a cohort of 5,185 cancer patients within 30 days of a cancer diagnosis between 1982 and 1998. Hazard ratios (HRs) or odds ratios were generated to analyze the effects of smoking at diagnosis on overall mortality (OM) and disease-specific mortality (DSM) in a patient cohort from 13 disease sites containing at least 100 patients in each disease site. With a minimum of 12 years of follow-up, current smoking increased OM risk versus recent quit (HR 1.17), former (HR 1.29) and never smokers (HR 1.38) in the overall cohort. Current smoking increased DSM risk versus former (HR 1.23) and never smokers (HR 1.18). In disease sites with proportionately large (>20%) recent quit cohorts (lung and head/neck), current smoking increased OM and DSM risks as compared with recent quit. Current smoking increased mortality risks in lung, head/neck, prostate and leukemia in men and breast, ovary, uterus and melanoma in women. Current smoking was not associated with any survival benefit in any disease site. Data using prospective structured smoking assessments demonstrate that current smoking increased long-term OM and DSM. Standardized smoking assessment at diagnosis is an important variable for evaluating outcomes in cancer patients.
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Affiliation(s)
- Graham W Warren
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Reitzel LR, Nguyen N, Zafereo ME, Li G, Wei Q, Sturgis EM. Neighborhood deprivation and clinical outcomes among head and neck cancer patients. Health Place 2012; 18:861-8. [PMID: 22445028 DOI: 10.1016/j.healthplace.2012.03.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 02/03/2012] [Accepted: 03/04/2012] [Indexed: 11/17/2022]
Abstract
The unique effects of neighborhood-level economic deprivation on survival, recurrence, and second primary malignancy development were examined using adjusted Cox proportional hazards regression models among 1151 incident squamous cell carcinomas of the head and neck patients. Cancer site was examined as a potential moderator. Main analyses yielded null results; however, interaction analyses indicated poorer overall survival [HR=1.59 (1.00-2.53)] and greater second primary malignancy development [HR=2.99 (1.46-6.11)] among oropharyngeal cancer patients from highly deprived neighborhoods relative to less deprived neighborhoods. Results suggest a dual focus on individual and neighborhood risk factors could help improve clinical outcomes among oropharyngeal cancer patients.
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Affiliation(s)
- Lorraine R Reitzel
- Department of Health Disparities Research-Unit 1440, PO Box 301402, University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402, USA.
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Smyth EC, Capanu M, Janjigian YY, Kelsen DK, Coit D, Strong VE, Shah MA. Tobacco use is associated with increased recurrence and death from gastric cancer. Ann Surg Oncol 2012; 19:2088-94. [PMID: 22395977 DOI: 10.1245/s10434-012-2230-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tobacco use increases the risk of developing gastric cancer. We examined the hypothesis that gastric cancer developing in patients with a history of tobacco use may be associated with increased risk of cancer-specific death after curative surgical resection. METHODS From the Memorial Sloan-Kettering Cancer Center Gastric Cancer prospective surgical database, we collected baseline demographic data and tumor characteristics from all patients who had undergone curative resection for gastric cancer between 1995 and 2009 and who had not received pre- or postoperative chemo- or radiotherapy. A smoking history was defined as >100 cigarettes' lifetime use. The primary end point was gastric cancer disease-specific survival (DSS); secondary end points were 5-year disease-free survival (DFS) and overall survival (OS). Gastric cancer-specific hazard was modeled by Cox regression. RESULTS A total of 699 eligible patients were identified with a median age of 70 years (range 25-96 years); 410 (59%) were current or previous smokers. Smoking was associated with gastroesophageal junction/cardia tumors and white non-Hispanic ethnicity. Multivariate analysis included the following variables: tumor stage, age, performance status, diabetes mellitus, gender, and tumor location. In this analysis, the hazard ratio for gastric cancer DSS in smokers was 1.43 (95% confidence interval 1.08-1.91, P=0.01). Smoking was also an independent significant risk factor for worse 5-year DFS (hazard ratio 1.46, P=0.007) and OS (hazard ratio 1.48, P=0.003). Among 516 patients for whom tobacco pack-year usage was available, both heavy (≥20 pack-years) and light (<20 pack-years) tobacco use was significantly associated with DSS, DFS, and OS. CONCLUSIONS Smoking history appears to be an independent risk factor for death from gastric cancer in patients who have undergone curative surgical resection.
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Affiliation(s)
- E C Smyth
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Davis AM, Benson M, Cooney D, Spruell B, Orelian J. A matched-cohort evaluation of a bedside asthma intervention for patients hospitalized at a large urban children's hospital. J Urban Health 2011; 88 Suppl 1:49-60. [PMID: 21337051 PMCID: PMC3042065 DOI: 10.1007/s11524-010-9517-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Emergency care and hospitalizations account for 36% of asthma-related medical expenses for children. National asthma guidelines emphasize the need for asthma self-management education at multiple points of care, including the hospital, to help prevent acute exacerbations. The integration of a bedside asthma education program into discharge planning at a busy urban children's hospital aimed to reduce repeat emergency department (ED) visits and hospitalizations by educating the community's highest-risk children and their families about asthma. A trained respiratory professional provided 45 minutes of individualized bedside education to families at the hospital and one follow-up support phone call within 3 weeks after discharge. Children receiving the intervention were matched to a control group of children not receiving the intervention by age and 2 markers of past utilization using data obtained from hospital records. Repeat ED utilization was analyzed using a Cox proportional hazards model controlling for sex, residence, race or ethnicity, and year. Compared to 698 matched controls, no significant improvement was observed in the 698 intervention participants or any subgroups followed for 12 months after the intervention.
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Affiliation(s)
- Adam M Davis
- Children's Hospital & Research Center Oakland, Oakland, CA, USA.
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Comparison of self-reported smoking status and physician-recorded smoking status among patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Radiother Oncol 2011; 98:143-4. [DOI: 10.1016/j.radonc.2010.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 10/31/2010] [Accepted: 11/06/2010] [Indexed: 11/21/2022]
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Roberts JC, Li G, Reitzel LR, Wei Q, Sturgis EM. No evidence of sex-related survival disparities among head and neck cancer patients receiving similar multidisciplinary care: a matched-pair analysis. Clin Cancer Res 2010; 16:5019-27. [PMID: 20943762 DOI: 10.1158/1078-0432.ccr-10-0755] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE It is unknown whether there are survival disparities between men and women with squamous cell carcinoma of the head and neck (SCCHN), although some data suggest that men have worse outcomes. We conducted a matched-pair study that controlled for several potentially confounding prognostic variables to assess whether a survival advantage exists for female compared with male SCCHN patients receiving similar care. EXPERIMENTAL DESIGN We selected 286 female patients and 286 matched male patients from within a prospective epidemiologic study on 1,654 patients with incident SCCHN evaluated and treated at a single large multidisciplinary cancer center. Matching variables included age (±10 y), race/ethnicity, smoking status (never versus ever), tumor site (oral cavity versus oropharynx versus larynx versus hypopharynx), tumor classification (T(1-2) versus T(3-4)), nodal status (negative versus positive), and treatment (surgery, radiation therapy, surgery and radiation therapy, surgery and chemotherapy, chemoradiotherapy, or surgery and chemoradiotherapy). RESULTS Matched-pair and log-rank analyses showed no significant differences between women and men in recurrence-free, disease-specific, or overall survival. When the analysis was restricted to individual sites (oral cavity, oropharynx, or larynx/hypopharynx), there was also no evidence of a disparity in survival associated with sex. CONCLUSIONS We conclude that there is no evidence to suggest that a survival advantage exists for women as compared with men with SCCHN receiving similar multidisciplinary directed care at a tertiary cancer center.
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Affiliation(s)
- Jess C Roberts
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA
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Farshadpour F, Kranenborg H, Calkoen EVB, Hordijk GJ, Koole R, Slootweg PJ, Terhaard CH. Survival analysis of head and neck squamous cell carcinoma: Influence of smoking and drinking. Head Neck 2010; 33:817-23. [DOI: 10.1002/hed.21549] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2010] [Indexed: 01/02/2023] Open
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A80G polymorphism of reduced folate carrier 1 (RFC1) gene and head and neck squamous cell carcinoma etiology in Brazilian population. Mol Biol Rep 2010; 38:1071-8. [DOI: 10.1007/s11033-010-0204-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 06/11/2010] [Indexed: 11/26/2022]
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Enright KA, Krzyzanowska MK. Control of cardiovascular risk factors among adult cancer survivors: a population-based survey. Cancer Causes Control 2010; 21:1867-74. [PMID: 20645125 DOI: 10.1007/s10552-010-9614-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 07/02/2010] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is a major cause of morbidity and mortality in cancer survivors, with the risk increasing significantly with the presence of multiple cardiac risk factors (RF). The proportion of cancer survivors at elevated risk of CVD on the basis of multiple RF is unknown. METHODS The National Health and Nutrition Examination Survey (NHANES 1999-2006) was used to examine the proportion of cancer survivors with multiple RF (≥2RF) and those at high cardiac risk (≥4 RF) compared with matched controls. RF (hypertension, hypercholesterolemia, weight, exercise, smoking) were defined according to AHA/ACC. RESULTS A total of 1,227 cancer survivors and 4,782 controls were identified. The majority of both cancer survivors and controls had multiple RF (91.5 vs. 89.9%) with a substantial proportion at high cardiac risk (35.2 vs. 32.6%). Compared to controls, survivors were more likely to be smokers (34.5 vs. 25.7%, p = 0.001), but less likely be overweight (67.2 vs. 72.0%, p = 0.02). There was no significant difference in the proportion with hypertension (30.6 vs. 30.8%), hypercholesterolemia (52.4 vs. 54.7%) or low exercise (75.6 vs. 73.0%). Among survivors, only age was associated with RF; with older survivors significantly more likely to have poor control than younger survivors (p = 0.005). CONCLUSION The prevalence of multiple RF was similar but suboptimal among cancer survivors and controls. Cardiac RF control, particularly among older survivors, is an important area of focus for improvement in survivorship care.
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Affiliation(s)
- K A Enright
- Department of Medical Oncology & Hematology, Princess Margaret Hospital, Suite 5-206, 610 University Ave, Toronto, ON M5G 2M9, Canada.
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