1
|
Cleere EF, Murphy J, Crotty TJ, Hintze JM, Timon CVI, Kinsella J, Fitzgerald CWR, Lennon P. HPV overtakes smoking as the leading cause of oropharyngeal cancer in Ireland: experience of a head and neck surgery tertiary referral centre. Ir J Med Sci 2024:10.1007/s11845-024-03715-4. [PMID: 38802697 DOI: 10.1007/s11845-024-03715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Worldwide, the incidence of oropharyngeal squamous cell carcinoma (OPSCC) caused by human papillomavirus (HPV), a sexually transmitted virus, is increasing. This increase has yet to be demonstrated in an Irish cohort. AIMS To evaluate the number of OPSCC presentations locally, to stratify cases by HPV status and to estimate if any changes in the patient population had occurred over a 10-year period. METHODS A STROBE-compliant, retrospective evaluation of patients with OPSCC at St James's Hospital between 2012 and 2022 was performed. Patients with non-SCC histology, undocumented HPV status and residual or recurrent tumours were excluded. RESULTS We included 294 patients with a mean age of 60.4 years (95% CI 59.2-61.5 years) and 175 (59.5%) patients had HPV+ OPSCC. The number of new OPSCC diagnoses increased from 115 patients (39.1%) between 2012 and 2016 to 179 patients (60.9%) between 2017 and 2021. This was associated with an increased proportion of HPV-linked OPSCC (50.4% 2012-2016 vs. 65.4% 2017-2021, p = 0.011). Over time, more patients had a functionally limiting comorbidity (p = 0.011). The mean age of HPV+ OPSCC cases increased by 3.6 years (p = 0.019). Patients with HPV+ OPSCC had greater 2-year OS (83.9% vs. 54.9%; p < 0.001) and 2-year DFS (73.5% vs. 45.6%; p < 0.001). The 2-year OS and DFS did not change over time for HPV+ or HPV- patients. CONCLUSIONS In our institution, the number of patients with OPSCC is increasing due to an escalation in cases associated with HPV. Population-level interventions such as vaccination programs may alter the current increase in the incidence of these tumours.
Collapse
Affiliation(s)
- Eoin F Cleere
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland.
| | - Josh Murphy
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Thomas J Crotty
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Justin M Hintze
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Conrad V I Timon
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - John Kinsella
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Conall W R Fitzgerald
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Paul Lennon
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| |
Collapse
|
2
|
Rizzo A, Salari F, Eplite A, Giacomelli A, Moschese D, Dalu D, Cossu MV, Lorusso R, Pozza G, Morelli L, Fasola C, Tonielli C, Fusetti C, De Cristofaro V, Gori A, Lombardi A, Rizzardini G, Gismondo MR, Antinori S. Detection and typization of HPV genotypes in subjects with oral and upper respiratory tract lesions, Milan, Italy. Infect Dis (Lond) 2024; 56:293-298. [PMID: 38217420 DOI: 10.1080/23744235.2024.2303020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Oral human papillomavirus (HPV) is common among healthy individuals but causes and implications of persistent infections are under evaluation in the pathogenesis of head and neck neoplasms. METHODS This was a retrospective study evaluating the prevalence of high-risk (HR), probable HR and low-risk (LR) HPV types in patients reporting signs/symptoms of oral and upper respiratory tract lesions. Individuals attending between 2019 and 2022 a University Hospital in Milan, Italy, with risk factors for HPV (unprotected oral sex and/or previous documentation of HPV infection in oral and upper respiratory tract and/or another anatomical site) were included. RESULTS Fourteen out of 110 (12.7%) individuals tested positive for HPV DNA. The prevalence of HR-HPV and LR-HPV was 3.6% (4/110) and 9.1% (10/110), respectively. No probable/possible HR-HPV was detected. Specifically, 10/110 (9.1%) were diagnosed with 1 LR-HPV genotype, 3/110 (2.7%) were infected with 1 HR-HPV and 1/110 had 3 concomitant HR-HPV types. HPV 16 (2.7%, 3/110) and 6 (4.5%, 5/110) were the most common HR and LR types, respectively. One patient positive for HPV 16, 33 and 35 was diagnosed with cancer at the base of the tongue. Two individuals among those who tested positive for HPV DNA reported previous HPV vaccination. CONCLUSIONS Our data, in line with observations from previous prevalence studies, support the potential role of HPV in head and neck neoplasms. HPV DNA testing should be performed in patients presenting lesions in oral/respiratory tracts and risk factors for HPV. Improvement in HPV vaccination coverage is warranted.
Collapse
Affiliation(s)
- Alberto Rizzo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Federica Salari
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Angelo Eplite
- Otolaryngology Unit - ASST Fatebenefratelli Sacco, "Luigi Sacco" University Hospital, Milano, Italy
| | - Andrea Giacomelli
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Davide Moschese
- I Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Davide Dalu
- Department of Oncology - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Maria Vittoria Cossu
- I Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Rosaria Lorusso
- Otolaryngology Unit - ASST Fatebenefratelli Sacco, "Luigi Sacco" University Hospital, Milano, Italy
| | - Giacomo Pozza
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Loriana Morelli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Cinzia Fasola
- Department of Oncology - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Claudia Tonielli
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Chiara Fusetti
- II Infectious Disease Unit - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Valeria De Cristofaro
- Otolaryngology Unit - ASST Fatebenefratelli Sacco, "Luigi Sacco" University Hospital, Milano, Italy
| | - Andrea Gori
- II Infectious Disease Unit - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milano, Italy
- Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Milano, Italy
| | - Alessandra Lombardi
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Giuliano Rizzardini
- I Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
| | - Maria Rita Gismondo
- Laboratory of Clinical Microbiology, Virology and Bioemergencies - ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
- Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Milano, Italy
| | - Spinello Antinori
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milano, Italy
- Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
3
|
Dodhia VH, Penny F, Shanmugasundaram R, Patel N. De-escalating radiotherapy in HPV-positive oropharyngeal squamous cell carcinoma: how much is too little? BMJ Case Rep 2024; 17:e257078. [PMID: 38262720 PMCID: PMC10826500 DOI: 10.1136/bcr-2023-257078] [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] [Indexed: 01/25/2024] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) had a rapidly increasing incidence rate in high-income countries, with a significant increase in cases related to human papilloma virus (HPV). HPV-positive (HPV+) OPSCC has shown better survival rates compared with HPV-negative (HPV-) cases, prompting investigations into de-escalation strategies to reduce or change chemoradiotherapy protocols. We present a case of a patient with HPV+ OPSCC who discontinued chemoradiotherapy after 2 weeks, effectively receiving a de-escalated dose of 18 Gy over nine fractions and only one cycle of cisplatin, subsequently undergoing curative surgical resection with no residual disease in the radiotherapy field 14 years later. This case challenges the concept of standard radiotherapy dosing in HPV+ OPSCC and discusses the implications on future de-escalation trials.
Collapse
Affiliation(s)
| | - Fiona Penny
- Department of ENT, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Ramkumar Shanmugasundaram
- Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Nimesh Patel
- Department of ENT, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
- University of Southampton, Southampton, Hampshire, UK
| |
Collapse
|
4
|
Cui M, Cheng J, Cheng H, Zhao M, Zhou D, Zhang M, Jia J, Luo L. Characteristics of human papillomavirus infection among oropharyngeal cancer patients: A systematic review and meta-analysis. Arch Oral Biol 2024; 157:105830. [PMID: 37924712 DOI: 10.1016/j.archoralbio.2023.105830] [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: 09/06/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This study aimed to explore the characteristics of human papillomavirus (HPV) in oropharyngeal carcinoma (OPC), in order to provide a new theoretical basis for the prevention, treatment, and management of OPC. METHODS The electronic databases were searched available publications relevant to HPV infection and OPC. Studies were collected until July, 2023. The effect sizes were combined using R 4.2.2 software. Subgroup and sensitivity analyses were performed to explore the sources of heterogeneity. Funnel plot and Egger's test were used to assess the publication bias. RESULTS Seventy-one studies were included with 10,908 OPC patients. The pooled prevalence of HPV and HR-HPV infection was 44.22% and 43.94%, respectively. The genotypes of HR-HPV were HPV16 (37.24%), HPV33 (2.44%), HPV18 (1.64%), HPV35 (1.53%), and HPV58 (0.89%). The highest HPV infection was in North America (66.87%), Oceania (43.09%), and Europe (41.49%), lowest in Africa (4.89%). Females exhibited higher HPV infection (43.18% vs 34.59% in males). Top subsites of HPV infection was tonsil (45.78%), followed by base of tongue (36.66%). Infection was higher in OPC patients aged > 60 (38.15%) than < 60 (34.73%). The prevalence of HPV infection in stage I-II of OPC patients is higher than that in stage III-IV. CONCLUSIONS HPV genotyping (16, 18, 33, 35, 58) is a key factor in the prevention and treatment of OPC. Identifying tonsils, base of tongue, and soft palate as common subsites to improve early detection. Elderly women with high HPV infection require attention to risk management and health education for prevention.
Collapse
Affiliation(s)
- Meimei Cui
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China; Department of Pathology, Weifang Medical University, Weifang, China
| | - Jinling Cheng
- Digestive Department, Shandong Second Provincial General Hospital, Jinan, China
| | - Huijuan Cheng
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China
| | - Ming Zhao
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China; School of Public Health, Jiamusi University, Jiamusi, China
| | - Dan Zhou
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China; School of Public Health, Jiamusi University, Jiamusi, China
| | - Min Zhang
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China; School of Public Health, Jiamusi University, Jiamusi, China
| | - Jingjing Jia
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China; Department of Basic medicine, Jiamusi University, China
| | - Limei Luo
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China.
| |
Collapse
|
5
|
Tan H, Huang H, Yang H, Qian J, Wei L, Liu W. Construction and validation of a prognostic model for tongue cancer based on three genes signature. Medicine (Baltimore) 2023; 102:e36097. [PMID: 37986320 PMCID: PMC10659661 DOI: 10.1097/md.0000000000036097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/20/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023] Open
Abstract
Tongue squamous cell carcinoma (TSCC) has a poor prognosis and destructive characteristics. Reliable biomarkers are urgently required to predict disease outcomes and to guide TSCC treatment. This study aimed to develop a multigene signature and prognostic nomogram that can accurately predict the prognosis of patients with TSCC. We screened differentially expressed genes associated with TSCC using The Cancer Genome Atlas dataset. Based on this, we developed a new multi-mRNA gene signature using univariate Cox regression, Least Absolute Shrinkage and Selection Operator regression, and multivariate Cox regression. We used the concordance index to evaluate the accuracy of this new multigene model. Moreover, we performed receiver operating characteristic and Kaplan-Meier survival analyses to assess the predictive ability of the new multigene model. In addition, we created a prognostic nomogram incorporating clinical and pathological characteristics, with the aim of enhancing the adaptability of this model in practical clinical settings. We successfully developed a new prognostic model based on the expression levels of these 3 mRNAs that can be used to predict the prognosis of patients with TSCC. This prediction model includes 3 genes: KRT33B, CDKN2A, and CA9. In the validation set, the concordance index of this model was 0.851, and the area under the curve was 0.778 and 0.821 in the training and validation sets, respectively. Kaplan-Meier survival analysis showed that regardless of whether it was in the training or validation set, the prognosis of high-risk patients was significantly worse than that of low-risk patients (P < .001). Multivariate Cox regression analysis revealed that this model was an independent prognostic factor for patients with TSCC (P < .001). Our study suggests that this 3-gene signature model has a high level of accuracy and predictive ability, is closely related to the overall survival rate of patients with TSCC, and can independently predict the prognosis of TSCC patients with high accuracy and predictive ability.
Collapse
Affiliation(s)
- Haosheng Tan
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Huang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huaiyu Yang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxin Qian
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyuan Wei
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wensheng Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|