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Liao S, Zhang B, Su Y, Pan Y, Zhang J, Ye Z, Zhang R, Kong X, Qin G, Mo Y, Ruan X, Liu J, Gan C, Dai J, Zhang R, Luo G, Liao X, Jiang W. Intensity-modulated radiotherapy alone compared with intensity-modulated radiotherapy plus concurrent chemotherapy in intermediate-risk nasopharyngeal carcinoma : A prospective multicenter phase II trial. Strahlenther Onkol 2024:10.1007/s00066-024-02201-1. [PMID: 38324078 DOI: 10.1007/s00066-024-02201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/07/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND This study aimed to investigate the clinical benefit of adding concurrent chemotherapy to intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) patients with an intermediate risk (stage II and T3N0M0). METHODS A multicenter phase II randomized trial was conducted in intermediate-risk NPC patients. Enrolled patients were previously untreated and aged ranged from 18 to 70 years without severe coexisting diseases. Patients were randomly assigned to receive IMRT alone or IMRT+concurrent chemotherapy (CC; three cycles of 80 mg/m2 cisplatin every 3 weeks). Primary endpoint was defined as 3‑year progression-free survival (PFS). The secondary endpoints were distant metastasis-free survival (DMFS), locoregional relapse-free survival (LRRFS), overall survival (OS), and treatment-associated toxicity. We registered this study with Chinese Clinical Trial Registry (CliCTR1800017132; registered July 13, 2018, study start July 13, 2018). RESULTS From November 2015 to July 2019, 42 patients with stage II and T3N0M0 NPC were enrolled; 20 patients received IMRT alone while 22 patients received IMRT+CC. After a median of 58 months of follow-up, we estimated the 3‑year PFS rates as 90% (IMRT group) and 86.4% (IMRT+CC group; hazard ratio 1.387, 95% confidence interval 0.240-8.014; P = 0.719). The 3‑year PFS, OS, and cumulative DMFS and LRRFS showed no significant differences between the two groups (P > 0.05). However, the IMRT group displayed a lower incidence of nausea/vomiting, leucopenia, and dry mouth than the IMRT+CC group. CONCLUSION Adding CC to IMRT provided no survival benefit but increased treatment-associated toxicities in patients with intermediate-risk NPC.
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Affiliation(s)
- Shufang Liao
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Key Laboratory of Oncology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, 15 Lequn Road, 541001, Guilin, China
| | - Bin Zhang
- Department of Radiation Oncology, Wuzhou Red Cross Hospital, 543002, Wuzhou, China
| | - Yixin Su
- Department of Radiation Oncology, Lingshan People's Hospital, Zhongxiu Road, 535400, Lingshan, China
| | - Yufei Pan
- Department of Oncology, Nan Xishan Hospital, 46 Chongxin Road, 541001, Guilin, China
| | - Jian Zhang
- Department of Oncology, the People's Hospital of Laibin, 546100, Laibin, China
| | - Zhenkai Ye
- Department of Radiation Oncology, the People's Hospital of Guangxi Zhuang Autonomous Region, 530001, Nanning, China
| | - Rongjun Zhang
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Key Laboratory of Oncology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, 15 Lequn Road, 541001, Guilin, China
| | - Xiangyun Kong
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Key Laboratory of Oncology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, 15 Lequn Road, 541001, Guilin, China
| | - Guanjie Qin
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Key Laboratory of Oncology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, 15 Lequn Road, 541001, Guilin, China
| | - Yunyan Mo
- Department of Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, China
| | - Xiaolan Ruan
- Department of Oncology, Nan Xishan Hospital, 46 Chongxin Road, 541001, Guilin, China
| | - Jian Liu
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Key Laboratory of Oncology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, 15 Lequn Road, 541001, Guilin, China
| | - Chunqiao Gan
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Key Laboratory of Oncology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, 15 Lequn Road, 541001, Guilin, China
| | - Jinxuan Dai
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Key Laboratory of Oncology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, 15 Lequn Road, 541001, Guilin, China
| | - Ruyun Zhang
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Key Laboratory of Oncology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, 15 Lequn Road, 541001, Guilin, China
| | - Guanhong Luo
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Key Laboratory of Oncology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, 15 Lequn Road, 541001, Guilin, China
| | - Xiaofei Liao
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Key Laboratory of Oncology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, 15 Lequn Road, 541001, Guilin, China
| | - Wei Jiang
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Key Laboratory of Oncology (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, 15 Lequn Road, 541001, Guilin, China.
- Department of Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, China.
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Midorikawa S, Mizukami H, Kudoh K, Takeuchi Y, Sasaki T, Kushibiki H, Wang Z, Itakura Y, Murakami K, Kudo N, Nagaki T, Wakasa T, Nakamura Y, Matsubara A. Diabetes can increase the prevalence of EBV infection and worsen the prognosis of nasopharyngeal carcinoma. Pathology 2024; 56:65-74. [PMID: 38071160 DOI: 10.1016/j.pathol.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 01/24/2024]
Abstract
Epstein‒Barr virus (EBV) infection is a primary oncogenic factor of nasopharyngeal carcinoma (NPC) that elicits epithelial-mesenchymal transition (EMT). Although diabetic patients are more susceptible to various infectious diseases, the pathological association with virus-related NPC has not yet been clarified. Herein, we evaluated the influence of diabetes on the clinicopathological changes of 70 patients with NPC. Disease-specific survival (DSS) modified by viral infection was also analysed. The proportion of NPC patients with diabetes was 32.9% (23/70 cases), and 91.3% (21/23 cases) were infected with EBV detected by EBER-I in situ hybridisation. NPC with diabetes showed an effect on EMT evaluated by immunostaining for E-cadherin and vimentin, which was correlated with HbA1c levels. Receiver operating characteristic (ROC) curve analysis determined a HbA1c level of 6.5% as the cut-off value for primary disease death at 2 years [area under the curve (AUC) 0.76; sensitivity 0.64; and specificity 0.81]. High HbA1c levels (≥6.5%) significantly increased the number of lymph node metastases in NPC compared to low HbA1c levels (<6.5%, p<0.01). Diabetic NPC patients had a significantly poorer prognosis than all non-diabetic patients (DSS, 72 months vs not reached, p<0.05). Diabetic EBV-positive NPC patients had a significantly poorer prognosis than non-diabetic EBV-positive patients (DSS, 35 months vs not reached, p<0.01). Multivariate analysis using the Cox proportional hazards model also suggested that HbA1c ≥6.5% was a significant factor in poor prognosis, with a hazard ratio of 6.84 (p<0.05). Collectively, our results revealed for the first time a high prevalence of EBV infection, poor prognosis and the importance of proper glycaemic control in diabetic NPC patients.
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Affiliation(s)
- Shin Midorikawa
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan; Department of Otolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Hiroki Mizukami
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
| | - Kazuhiro Kudoh
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yuki Takeuchi
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Takanori Sasaki
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Hanae Kushibiki
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Zhenchao Wang
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yuko Itakura
- Department of Pathology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Miyagi, Japan
| | - Kotaro Murakami
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Naomi Kudo
- Department of Otolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Takahiko Nagaki
- Department of Otolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Tomoko Wakasa
- Department of Diagnostic Pathology, Kindai University Nara Hospital, Nara, Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Atsushi Matsubara
- Department of Otolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Koide Y, Kodaira T, Kitayama M, Kawakita D, Kirita T, Yoshimoto S, Nakamizo M, Nibu KI. Definitive radiotherapy for nasopharyngeal carcinoma in Japan: analysis of cases in the National Head and Neck Cancer Registry from 2011 to 2014. Jpn J Clin Oncol 2024; 54:54-61. [PMID: 37781753 DOI: 10.1093/jjco/hyad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/09/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE This study aimed to analyze the nationwide prognosis of patients with nasopharyngeal carcinoma who underwent definitive radiotherapy in Japan, utilizing the National Head and Neck Cancer Registry data. METHODS A total of 741 patients diagnosed with primary nasopharyngeal carcinoma were screened from 2011 to 2014. The inclusion criteria were histologically proven nasopharyngeal squamous cell carcinoma, receiving definitive radiotherapy, and no distant metastases. Patients with unclear prognoses or unknown staging were excluded. The primary endpoint was 5-year overall survival, and secondary endpoints were 5-year progression-free survival and survival by stage. RESULTS A total of 457 patients met the inclusion criteria. The median age was 60 years, and 80% were male. The proportions of patients with performance status 0, 1, 2 and 3 were 69, 10, 1 and 1%, respectively. Chemoradiotherapy was administered to 84.7%. Radiotherapy modalities were recorded only for 29 patients (three received intensity-modulated radiotherapy and 26 received two/three-dimensional radiotherapy). Of those included, 7.4, 24.7, 35.7, 24.5 and 7.7% had Stage I, II, III, IVA and IVB disease, respectively. The 5-year overall survival was 72.5% for all patients: 82.6, 86.6, 76.0, 51.4 and 66.5% for Stage I, II, III, IVA and IVB disease, respectively. The 5-year progression-free survival was 58.6%: 75.6, 66.8, 61.5, 43.7 and 46.5% for Stage I, II, III, IVA and IVB disease, respectively. CONCLUSIONS This nationwide survey demonstrated favorable prognoses and provided valuable foundational data for similar future surveys to monitor the penetration of appropriate treatment and changes in clinical structures based on new evidence.
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Affiliation(s)
- Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
| | - Megumi Kitayama
- Clinical Study Support Center, Data Center Department, Wakayama Medical University Hospital, Wakayama, Japan
| | - Daisuke Kawakita
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tadaaki Kirita
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, Kashihara, Japan
| | - Seiichi Yoshimoto
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Munenaga Nakamizo
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Otorhinolaryngology-Head and Neck Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken-Ichi Nibu
- Japan Society for Head and Neck Cancer, Fukagawa, Koto-ku, Tokyo, Japan
- Department of Otolaryngology, Kobe University School of Medicine, Kobe, Hyogo, Japan
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Kobayashi E, Kondo S, Dochi H, Moriyama-Kita M, Hirai N, Komori T, Ueno T, Nakanishi Y, Hatano M, Endo K, Sugimoto H, Wakisaka N, Yoshizaki T. Protein Farnesylation on Nasopharyngeal Carcinoma, Molecular Background and Its Potential as a Therapeutic Target. Cancers (Basel) 2022; 14:cancers14122826. [PMID: 35740492 PMCID: PMC9220992 DOI: 10.3390/cancers14122826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Nasopharyngeal carcinoma is distinguished from other head and neck carcinomas by the association of its carcinogenesis with the Epstein–Barr virus. It is highly metastatic, and a novel therapeutic modality for metastatic nasopharyngeal carcinoma is keenly awaited. Protein farnesylation is a C-terminal lipid modification of proteins and was initially investigated as a key process in activating the RAS oncoprotein through its association with the cellular membrane structure. Since then, more and more evidence has accumulated to indicate that proteins other than RAS are also farnesylated and have significant roles in carcinogenesis. This review delineates molecular pathogenesis through protein farnesylation in the context of nasopharyngeal carcinoma and discusses the potential of farnesylation as a therapeutic target. Abstract Nasopharyngeal carcinoma (NPC) is one of the Epstein–Barr virus (EBV)-associated malignancies. NPC is highly metastatic compared to other head and neck carcinomas, and evidence has shown that the metastatic features of NPC are involved in EBV infection. The prognosis of advanced cases, especially those with distant metastasis, is still poor despite advancements in molecular research and its application to clinical settings. Thus, further advancement in basic and clinical research that may lead to novel therapeutic modalities is needed. Farnesylation is a lipid modification in the C-terminus of proteins. It enables proteins to attach to the lipid bilayer structure of cellular membranes. Farnesylation was initially identified as a key process of membrane association and activation of the RAS oncoprotein. Farnesylation is thus expected to be an ideal therapeutic target in anti-RAS therapy. Additionally, more and more molecular evidence has been reported, showing that proteins other than RAS are also farnesylated and have significant roles in cancer progression. However, although several clinical trials have been conducted in cancers with high rates of ras gene mutation, such as pancreatic carcinomas, the results were less favorable than anticipated. In contrast, favorable outcomes were reported in the results of a phase II trial on head and neck carcinoma. In this review, we provide an overview of the molecular pathogenesis of NPC in terms of the process of farnesylation and discuss the potential of anti-farnesylation therapy in the treatment of NPC.
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5
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Kondo S, Okuno Y, Murata T, Dochi H, Wakisaka N, Mizokami H, Moriyama-Kita M, Kobayashi E, Kano M, Komori T, Hirai N, Ueno T, Nakanishi Y, Endo K, Sugimoto H, Kimura H, Yoshizaki T. EBV genome variations enhance clinicopathological features of nasopharyngeal carcinoma in a non-endemic region. Cancer Sci 2022; 113:2446-2456. [PMID: 35485636 PMCID: PMC9277247 DOI: 10.1111/cas.15381] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/17/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is caused by infection with Epstein–Barr virus (EBV) and endemic in certain geographic regions. EBV lytic gene, BALF2, closely associates with viral reactivation and BALF2 gene variation, the H‐H‐H strain, causes NPC in endemic region, southern China. Here, we investigate whether such EBV variations also affect NPC in a non‐endemic region, Japan. Viral genome sequencing with 47 EBV isolates of Japanese NPC were performed and compared with those of other EBV‐associated diseases from Japan or NPC in Southern China. EBV genomes of Japanese NPC are different from those of other diseases in Japan or endemic NPC; Japanese NPC was not affected by the endemic strain (the BALF2 H‐H‐H) but frequently carried the type 2 EBV or the strain with intermediate risk of endemic NPC (the BALF2 H‐H‐L). Seven single nucleotide variations were specifically associated with Japanese NPC, of which six were present in both type 1 and 2 EBV genomes, suggesting the contribution of the type 2 EBV‐derived haplotype. This observation was supported by a higher viral titer and stronger viral reactivation in NPC with either type 2 or H‐H‐L strains. Our results highlight the importance of viral strains and viral reactivation in the pathogenesis of non‐endemic NPC.
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Affiliation(s)
- Satoru Kondo
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan.,These authors contributed equally to this work
| | - Yusuke Okuno
- Department of Virology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.,Pediatric Cancer Treatment Center, Nagoya University Hospital, Nagoya, Aichi, Japan.,These authors contributed equally to this work
| | - Takayuki Murata
- Department of Virology and Parasitology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hirotomo Dochi
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Naohiro Wakisaka
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Harue Mizokami
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Makiko Moriyama-Kita
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Eiji Kobayashi
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Makoto Kano
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Takeshi Komori
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Nobuyuki Hirai
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Takayoshi Ueno
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Yosuke Nakanishi
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Kazuhira Endo
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Hisashi Sugimoto
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
| | - Hiroshi Kimura
- Department of Virology, Nagoya University, Graduate school of Medicine, Nagoya, Aichi, Japan
| | - Tomokazu Yoshizaki
- Division of Otolaryngology and Head and Neck Surgery, Graduate School of Medical science, Kanazawa University. Kanazawa, Ishikawa, Japan
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Song Y, Cheng W, Li H, Liu X. The global, regional, national burden of nasopharyngeal cancer and its attributable risk factors (1990-2019) and predictions to 2035. Cancer Med 2022; 11:4310-4320. [PMID: 35475595 DOI: 10.1002/cam4.4783] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/10/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022] Open
Abstract
We aim to report the latest incidence, mortality, and disability-adjusted life-years (DALYs) between 1990 and 2019, by age, sex, sociodemographic index (SDI), and provide predictions to 2035. We use estimates from Global Burden of Disease, Injuries, and Risk Factors Study 2019 to analyze the incidence, mortality, and DALYs. All the estimates were shown as counts and age-standardized rates (ASR). In 2019, there were more than 176,501 (156,046 to 199,917) incidence cases, with ASRs of 2.1 (1.9 to 2.4). Nasopharyngeal cancer (NPC) accounted for 71,610 (65,442 to 77,625) deaths, with ASRs of 0.9 (0.8 to 0.9). NPC was also responsible for 2.34 million (2,139,753 to 2,536,657) DALYs, with ASRs of 28.0 (25.7 to 30.4). The count of all the new cases increased from 1990 to 2019. At the regional level, the highest age-standardized incidence rates were found in East Asia, the highest age-standardized death and DALY rates were shown in Southeast Asia. At the national level, the age-standardized incidence rates were highest in Singapore, and the age-standardized death and DALY rates were highest in Malaysia. The total numbers and rates of all the estimates were significantly higher among males than females across most of the age groups. The considerable burden of NPC was attributable to alcohol use, smoking, and occupational exposure to formaldehyde. A total of six GBD regions and 88 countries are projected to experience an increase in NPC ASRs between 2019 and 2035, respectively. Despite the current decline in age-standardized mortality and DALY rates globally, the age-standardized incidence rate has increased from 1990 to 2019, and continues to increase between 2020 and 2035, indicating that nasopharyngeal cancer remains a major health challenge worldwide. Prevention strategies should focus on modifiable risk factors, especially among males in East Asia.
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Affiliation(s)
- Yexun Song
- Department of Otolaryngology-Head Neck Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Wenwei Cheng
- The Third Xiangya Hospital of Central South University, Changsha, China.,Xiangya School of Public Health, Central South University, Changsha, China
| | - Heqing Li
- Department of Otolaryngology-Head Neck Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiajing Liu
- Graduate School of Guilin Medical University, Guilin, China
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7
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Tamin S, Adham M, Noer A, Supriana N, Bardosono S. Upright epiglottis prevents aspiration in patients with nasopharyngeal carcinoma post-chemoradiation. PLoS One 2021; 16:e0261110. [PMID: 34882745 PMCID: PMC8659317 DOI: 10.1371/journal.pone.0261110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022] Open
Abstract
NPC is the most widely found malignant tumor in the head and neck region in Indonesia. Chemoradiation therapy for NPC can induce swallowing disorders (dysphagia) that adversely affects a patients quality of life. This study aimed to assess the swallowing process by flexible endoscopic evaluation of swallowing in patients with nasopharyngeal carcinoma after chemoradiation. Thirty-nine patients with NPC who had chemoradiation therapy more than one month previously underwent flexible endoscopic evaluation of swallowing and were assessed for oral transport time, sensation, standing-secretion, pre-swallowing leakage, residue, penetration, aspiration, and silent aspiration. The most common structural abnormalities were an upright and swollen epiglottis (89.4%), poor oral hygiene, and velopharyngeal closure defects (56.4%). This examination also revealed a mild degree of standing secretion (38.5%) and aspiration (10.3%). No penetration was observed in 64.1% of the patients, and no silent aspiration was observed in any of the patients. A severe degree of residue (45.7%) was observed when administering oatmeal, while the residue was mild to moderate when administering gastric rice, crackers, and milk. The residue changed to a mild degree (32.3%-51.4%) in all food administrations after the watering maneuver. The highest penetration was noted after oatmeal administration (42.8%), and the highest aspiration was found after milk administration (8.6%). Standing secretion in almost all patients was caused by hyposensitivity of the hypopharynx. Persistent residue and hyposensitivity of the hypopharynx led to aspiration. The low percentage of aspiration and silent aspiration might have been caused by the upright and swollen epiglottis that prevented aspiration. Poor oral hygiene and a dry mouth led to prolonged oral transport. Therefore, most patients had hypopharyngeal abnormalities in the form of a swollen and upright epiglottis. Secretion and food residue were also detected. Drinking helps to expedite the swallowing process by facilitating oral phase transport and reducing residues.
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Affiliation(s)
- Susyana Tamin
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- * E-mail:
| | - Marlinda Adham
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Arfan Noer
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nana Supriana
- Department of Radio Oncology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Saptawati Bardosono
- Department of Nutrition Science, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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8
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Vatte C, Al-Amri AM, Cyrus C, Chathoth S, Ahmad A, Alsayyah A, Al-Ali A. Epstein-Barr virus infection mediated TP53 and Bcl-2 expression in nasopharyngeal carcinoma pathogenesis. Mol Clin Oncol 2021; 15:260. [PMID: 34754447 PMCID: PMC8569298 DOI: 10.3892/mco.2021.2422] [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: 06/22/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023] Open
Abstract
Epstein Barr virus (EBV) stimulates neoplastic transformation of nasopharyngeal epithelial cells through various molecular mechanisms, predominantly affecting inactivation of tumor-suppressor genes and activation of oncogenes. EBV infection is a major risk factor for nasopharyngeal carcinoma (NPC), yet its role in the carcinogenesis is not clear. EBV infection alters the expression of antiapoptotic proteins and tumor suppressor proteins. Therefore, this study investigated the correlation between EBV infection status with B cell lymphoma-2 (Bcl-2) and TP53 protein expression amongst laryngeal and nasopharyngeal cancer cases. This study was performed using 22 nasopharyngeal and 11 laryngeal cancer cases. EBV infection status, TP53 and Bcl-2 protein expression was studied using immunohistochemistry. The majority of the laryngeal cancer cases exhibited a poor prognosis and presented low Bcl-2 expression. A total of 22.7% cases were infected with EBV in the NPC cases. Upregulated TP53 expression was associated with EBV infection in the NPC cohort, and EBV infection was correlated with TP53 upregulation in the patients with NPC, suggesting mutual regulation between TP53 and EBV.
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Affiliation(s)
- Chittibabu Vatte
- Department of Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Kingdom of Saudi Arabia
| | - Ali M Al-Amri
- Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar 31952, Kingdom of Saudi Arabia
| | - Cyril Cyrus
- Department of Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Kingdom of Saudi Arabia
| | - Shahanas Chathoth
- Department of Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Kingdom of Saudi Arabia
| | - Arafat Ahmad
- Department of Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Kingdom of Saudi Arabia
| | - Ahmed Alsayyah
- Department of Pathology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar 31952, Kingdom of Saudi Arabia
| | - Amein Al-Ali
- Department of Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Kingdom of Saudi Arabia
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Liao KC, Chuang HC, Chien CY, Lin YT, Tsai MH, Su YY, Yang CH, Lai CC, Huang TL, Li SH, Lee TF, Lin WT, Lee CH, Fang FM. Quality of Life as a Mediator between Cancer Stage and Long-Term Mortality in Nasopharyngeal Cancer Patients Treated with Intensity-Modulated Radiotherapy. Cancers (Basel) 2021; 13:cancers13205063. [PMID: 34680211 PMCID: PMC8533735 DOI: 10.3390/cancers13205063] [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: 08/03/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Even after the implementation of intensity-modulated radiotherapy (IMRT), nasopharyngeal cancer (NPC) survivors may continue to exhibit several physical symptoms that negatively affect long-term quality of life (QoL). An NPC patient cohort study (n = 682) was conducted to examine the potential mediating effect of QoL (evaluated at multiple treatment-related time points) on the cancer stage–mortality association. Patients with advanced NPC exhibited low global health QoL and high QoL-HN35 symptom pre-IMRT, 3 months post-IMRT, and 2 years post-IMRT. Global health QoL and QoL-HN35 symptom scores 2 years after IMRT explained 49.4% and 39.4% of the excessive effect of advanced NPC on mortality risk. Our findings indicate that global health QoL and QoL-HN35 symptom 2 years after IMRT are key mediators of the relationship between advanced NPC and high mortality. These findings emphasize the significance of QoL-HN35 symptom and global health QoL-associated medical support and care for patients with NPC who received IMRT. Abstract Background: Quality of life (QoL) attained before, during, or after treatments is recognized as a vital factor associated with therapeutic benefits in cancer patients. This nasopharyngeal cancer (NPC) patient longitudinal study assessed the relationship among QoL, cancer stage, and long-term mortality in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). Patients and Methods: The European Organization for Research and Treatment of Cancer (EORTC) core QoL questionnaire (QLQ-C30) and the head and neck cancer-specific QoL questionnaire module (QLQ-HN35) were employed to evaluate four-dimensional QoL outcomes at five time points: pre- (n = 682), during (around 40 Gy) (n = 675), 3 months (n = 640), 1 year (n = 578) and 2 years post-IMRT (n = 505), respectively, for 682 newly diagnosed NPC patients treated between 2003 and 2017 at a single institute. The median followed-up time was 7.5 years, ranging from 0.3 to 16.1 years. Generalized estimating equations, multivariable proportional hazards models, and Baron and Kenny’s method were used to assess the investigated effects. Results: Advanced AJCC stage (III–IV) patients revealed a 2.26-fold (95% CI—1.56 to 3.27) higher covariate-adjusted mortality risk than early-stage (I–II) patients. Compared with during IMRT, advanced-stage patients had a significantly low global health QoL and a significantly high QoL-HN35 symptom by a large magnitude at pre-, 3 months, and 2 years post-IMRT. QoL scales at pre-IMRT, 1 year, and 2 years post-IMRT were significantly associated with mortality. The effect changes of mortality risk explained by global health QoL, QoL-C30, and QoL-HN35 symptom were 5.8–9.8% at pre-IMRT but at 2 years post-IMRT were 39.4–49.4% by global health QoL and QoL-HN35 symptoms. Conclusions: We concluded advanced cancer stage correlates with a long-term high mortality in NPC patients treated with IMRT and the association is partially intermediated by QoL at pre-IMRT and 2 years post-IMRT. Therefore, QoL-HN35 symptom and global health QoL-dependent medical support and care should be focused and tailored at 2 years post-IMRT.
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Affiliation(s)
- Kuan-Cho Liao
- Department of Radiation Oncology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan;
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Hui-Ching Chuang
- Department of Otolaryngologist, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan; (H.-C.C.); (C.-Y.C.); (Y.-T.L.); (M.-H.T.); (Y.-Y.S.); (C.-H.Y.); (C.-C.L.)
| | - Chih-Yen Chien
- Department of Otolaryngologist, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan; (H.-C.C.); (C.-Y.C.); (Y.-T.L.); (M.-H.T.); (Y.-Y.S.); (C.-H.Y.); (C.-C.L.)
| | - Yu-Tsai Lin
- Department of Otolaryngologist, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan; (H.-C.C.); (C.-Y.C.); (Y.-T.L.); (M.-H.T.); (Y.-Y.S.); (C.-H.Y.); (C.-C.L.)
| | - Ming-Hsien Tsai
- Department of Otolaryngologist, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan; (H.-C.C.); (C.-Y.C.); (Y.-T.L.); (M.-H.T.); (Y.-Y.S.); (C.-H.Y.); (C.-C.L.)
| | - Yan-Ye Su
- Department of Otolaryngologist, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan; (H.-C.C.); (C.-Y.C.); (Y.-T.L.); (M.-H.T.); (Y.-Y.S.); (C.-H.Y.); (C.-C.L.)
| | - Chao-Hui Yang
- Department of Otolaryngologist, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan; (H.-C.C.); (C.-Y.C.); (Y.-T.L.); (M.-H.T.); (Y.-Y.S.); (C.-H.Y.); (C.-C.L.)
| | - Chi-Chih Lai
- Department of Otolaryngologist, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan; (H.-C.C.); (C.-Y.C.); (Y.-T.L.); (M.-H.T.); (Y.-Y.S.); (C.-H.Y.); (C.-C.L.)
| | - Tai-Lin Huang
- Department of Hematology and Oncology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan; (T.-L.H.); (S.-H.L.)
| | - Shau-Hsuan Li
- Department of Hematology and Oncology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan; (T.-L.H.); (S.-H.L.)
| | - Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung 80778, Taiwan;
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Wei-Ting Lin
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA;
| | - Chien-Hung Lee
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Office of Institutional Research & Planning, Secretariat, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Correspondence: (C.-H.L.); (F.-M.F.); Tel.: +886-7-312-1101 (ext. 2314) (C.-H.L.); +886-7-731-7123 (ext. 7000) (F.-M.F.); Fax: +886-7-311-0811 (C.-H.L.); +886-7-398-6179 (F.-M.F.)
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan;
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 333323, Taiwan
- Correspondence: (C.-H.L.); (F.-M.F.); Tel.: +886-7-312-1101 (ext. 2314) (C.-H.L.); +886-7-731-7123 (ext. 7000) (F.-M.F.); Fax: +886-7-311-0811 (C.-H.L.); +886-7-398-6179 (F.-M.F.)
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Yu H, Yin X, Mao Y, Chen M, Tang Q, Yan S. The global burden of nasopharyngeal carcinoma from 2009 to 2019: an observational study based on the Global Burden of Disease Study 2019. Eur Arch Otorhinolaryngol 2021; 279:1519-1533. [PMID: 34146150 PMCID: PMC8897385 DOI: 10.1007/s00405-021-06922-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/29/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE The incidence and mortality rate of nasopharyngeal carcinoma (NPC) has changed in recent years. Our goal is to determine the epidemiological pattern of NPC to help policymakers allocate limited medical resources. METHODS Detailed information about NPC from 2009 to 2019 was collected from the Global Burden of Disease 2019 database. Age-standardized rates (ASRs) and corresponding estimated annual percentage changes (EAPCs) were calculated to assess NPC's incidence and mortality trends. RESULTS Globally, there was a consistent increase in the NPC incidence cases from 2009 to 2019 (from 121.65 × 103 cases in 2009 to 176.50 × 103 cases in 2019, increasing by 45.09%). The age-standardized incidence rate (ASIR) of NPC increased from 1.81 in 2009 to 2.12 in 2019 (EAPC = 1.59, 95% CI 1.36-1.81). On the contrary, the mortality of NPC showed a downward trend (ASDR: 0.93 in 2009 and 0.86 in 2019; EAPC = - 0.63, 95% CI - 0.78 to - 0.48), and it was negatively correlated with the social demographic index (SDI) in most regions. Both incidence and mortality rates of high-incidence territories tended to be stable or decline. Males had significantly higher incidence and mortality of NPC than females. The number of patients with onset age greater than 50 years old accounted for the highest proportion. We found that smoking, occupational exposure to formaldehyde, and alcohol use were the main risk factors for NPC-related mortality. CONCLUSION Globally, the incidence rate of NPC has been slightly increasing, while the mortality and disability-adjusted life years (DALYs) have been decreasing. NPC burden in high-middle and middle SDI areas was the heaviest. The current prevention strategy should be repositioned, and some countries should formulate more targeted approaches to reduce the current burden of NPC.
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Affiliation(s)
- Hao Yu
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Xin Yin
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Yiran Mao
- School of Life Sciences, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing, 100084, People's Republic of China
| | - Meiqin Chen
- Department of Radiation Oncology, Affiliated Jinhua Hospital, College of Medicine, Zhejiang University, Jinhua, 321000, Zhejiang, People's Republic of China
| | - Qiuying Tang
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Senxiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China.
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