Clinical impact of human papillomavirus in laryngeal squamous cell carcinoma: a retrospective study

P53 and pRB induction improves response to radiation therapy in HPV-positive laryngeal squamous cell carcinoma

INTRODUCTION

Patients with Human Papillomavirus (HPV+)-associated Laryngeal Squamous Cell Carcinoma (LSCC) exhibit dramatically improved survival relative to those with HPV-Negative (HPV-) tumors. In this study, the authors aimed to investigate the radiosensitivity of all available confirmed HPV+ and HPV-LSCC cells in vitro and in vivo.

METHODS

Primary LSCC cells were generated from tumor specimens obtained from patients. Real-time PCR was performed to confirm HPV infection and the expression of HPV-related genes (E6 and E7), p53, and pRB. Clonogenic survival assays, western blotting, and flow cytometry were used to assess radiation sensitivity, apoptosis, and the expression of p53 and pRB. p53 and pRB knockout cells were generated using CRISPR/Cas9 technology.

RESULTS

HPV+ LSCC cells displayed enhanced radiation sensitivity compared to HPV- cells. Radiation-induced apoptosis in HPV+ LSCC cells, accompanied by increased levels of p53 and pRB. Knockout of p53 or pRB led to radiation resistance and attenuated radiation-induced apoptosis in HPV+ LSCC cells. In vivo experiments showed similar results, where knockout of p53 or pRB decreased radiosensitivity in tumor-bearing mice.

CONCLUSION

The present findings demonstrated that HPV+ LSCC cells displayed obvious inherent radiation sensitivity, corresponding to increased apoptosis following radiation exposure. Mechanism study showed that the expression of p53 and pRB in HPV+ cells are required for radiation sensitivity. These findings highlight a novel mechanism by which p53 and pRB play key roles in the radiation sensitivity of HPV+ LSCC compared to HPV-LSCC.

p16 Expression in Laryngeal Squamous Cell Carcinoma: A Surrogate or Independent Prognostic Marker?

Laryngeal squamous cell carcinoma (LSCC) is a common malignancy that, despite scientific advancements, has not seen an improvement in its prognosis in the last decades. Few promising predictive markers have been found and none are relevant in clinical practice. p16ink4a, an oncosuppressor protein involved in cell cycle arrest, with a prognostic impact on other cancers, has been widely used in the head and neck region as a surrogate marker of HPV infection. Published papers and recent meta-analyses seem to minimize the biological role of HPV in the context of LSCC's cancerogenesis, and to disprove the reliability of p16ink4a as a surrogate prognostic marker in this context, while still highlighting its potential role as an independent predictor of survival. Unfortunately, the available literature, in particular during the last two decades, is often not focused on its potential role as an independent biomarker and few relevant data are found in papers mainly focused on HPV. The available data suggest that future research should focus specifically on p16ink4a, taking into account both its potential inactivation and overexpression, different patterns of staining, and immunohistochemistry cutoffs, and should focus not on its potential role as a surrogate marker but on its independent role as a predictor of survival.

Clinical Value of Endoscopic Esophageal Screening in Head and Neck Squamous Cell Carcinoma Patients

OBJECTIVE

To investigate the clinical benefit of routine esophageal screening in newly diagnosed head and neck squamous cell carcinoma (HNSCC) patients.

STUDY DESIGN

Retrospective cohort study.

SETTING

Tertiary medical center.

METHODS

This retrospective study selected newly diagnosed HNSCC patients from the Chang Gung Research Database between January 2007 and December 2019. Patients who underwent endoscopic esophageal examinations within 2 months of the initial diagnosis of HNSCC were included in the screening group. The clinical outcomes of the screening and nonscreening groups were analyzed.

RESULTS

In total, 13,627 HNSCC patients were included, comprising 1032 females and 12,640 males (mean age 55.0 years), and the esophageal screening group included 7033 (51.4%) patients. The prevalence rate of esophageal tumors was 4.5%. Hypopharyngeal cancer patients were the most likely to have (13.4%) second primary esophageal tumors. The American Joint Committee on Cancer stage of the esophageal tumor was lower in the esophageal screening group than in the nonesophageal screening group. The oral, oropharyngeal, and hypopharyngeal cancer patients in the esophageal screening group had better survival outcomes than their counterparts in the nonesophageal screening group.

CONCLUSION

Endoscopic esophageal screening of newly diagnosed HNSCC patients can detect esophageal tumors at an early stage and improve overall survival. Esophageal screening could be a routine survey in HNSCC patients, particularly those with lifestyle risk factors and in countries with a high prevalence of esophageal cancer.

Laryngeal Cancer: Epidemiology, Etiology, and Prevention: A Narrative Review

Laryngeal cancer comprises 30%-40% of head and neck malignancies, and it is the most common malignancy in otolaryngology. The main risk factors for laryngeal cancer are tobacco use, excessive alcohol consumption, gastroesophageal reflex, Plummer-Vinson syndrome, exposure to heat, chemicals, and some viral infections. This literature review summarizes all known data over the past decade with an assessment of the main etiological factors related to cancer incidence, general measurement issues in the cancer epidemiology and the current state of science in relation to laryngeal cancer. The geographical distribution of laryngeal cancer also reveals some important aspects. Europe remains the most prevalent continent for this type of malignancy, whilst the epidemiologic burden in Africa remains low. Overall, there are clear differences in morbidity and mortality from laryngeal cancer between urban and rural areas, with gender inequalities. In some countries, the incidence rates are high in rural areas, and in some, such as in China, the urban population is more affected. High rates of laryngeal cancer are closely associated with both low average income and a high percentage of the population with lower-than-average education countries with higher Socio-demographic Index (SDI) have made greater improvements in the treatment of LC than countries with lower SDI. Epidemiological data on risk factors can provide valuable information for developing cancer prevention strategies.

Role of P16 Expression in the Prognosis of Patients With Laryngeal Cancer: A Single Retrospective Analysis

BACKGROUND

A possible oncogenic role of human papillomavirus (HPV) in head and neck cancers (mainly oropharynx tumors) has been suggested. This significant association has been considered true for oropharynx tumors; however, the association between HPV infection and laryngeal carcinomas is yet to be established. The aim of this study was to evaluate the relationship between p16 expression and long-term overall, disease-free, and disease-specific survival (OS, DF, and DSS, respectively) in patients surgically treated for laryngeal carcinoma.

MATERIALS AND METHODS

Seventy-four previously untreated laryngeal carcinoma patients who underwent surgical treatment were considered for this retrospective study. The tissue specimens were processed for immunohistochemical p16 protein (surrogate HPV marker) detection.

RESULTS

Survival analysis of the p16 expression of the primary tumor showed that the 5-year OS rates were 90% and 29.7% for the p16-positive and negative groups, respectively (P = .003). The 5-year DFS and DSS also differed between both groups (P < .001), whereas the 5-year DSS seemed to be related to tumor/lymph node classification and p16 expression. However, only p16 expression was identified as an independent prognostic factor associated with OS and DSS.

CONCLUSIONS

Surgically treated p16-positive laryngeal cancer patients may represent a subset of patients with a better prognosis than their p16-negative counterparts.

Evidence for different molecular parameters in head and neck squamous cell carcinoma of nonsmokers and nondrinkers: Systematic review and meta-analysis on HPV, p16, and TP53

BACKGROUND

The goal of this review was to present an overview of the currently identified molecular parameters in head and neck squamous cell carcinoma (HNSCC) of nonsmokers and nondrinkers (NSND).

METHODS

Following the PRISMA guidelines, a systematic search was performed using the electronic databases PubMed, Embase, and Google Scholar.

RESULTS

Of the 902 analyzed unique studies, 74 were included in a quantitative synthesis and 24 in a meta-analysis. Human papillomavirus (HPV) was reported as a molecular parameter in 38 studies, followed by p16 and TP53 (23 and 14 studies, respectively). The variety of other molecular parameters concerned sporadic findings in small numbers of NSND.

CONCLUSIONS

HNSCC in NSND is more often related to HPV and p16 overexpression compared to tumors of smokers-drinkers. In a third of virus-negative tumors, TP53 mutations were detected with a mutational profile associated with aging and ultraviolet light exposure rather than to tobacco consumption.

Lymphoscintigraphy for Sentinel Node Mapping in Head and Neck Cancer

The aim of this comprehensive review is to describe and analyze the role of the sentinel node mapping in head and neck cancers. For this purpose, head and neck neoplasms have been categorized in cutaneous malignancies and neoplasms of the upper aerodigestive tract. A concise description of lymphatic drainage will be the "prelude" for each section, as well as the description of the injection techniques, when specific. Concisely, the attention has been focused on detection rate of the sentinel node by lymphoscintigraphy for each cancer, and for those patients in which the sentinel lymph node has been identified, true-positives rates, false-negative rates, and overall accuracy has been pointed out. Overall, in cutaneous neoplasms of the head and neck, the detection rate is higher than 90%, however the false-negative rate is still an issue, in particular in melanoma, inducing the need for newer developments. In fact, new tracers and techniques are already available, while prospective multicenter trials exploring the outcome impact are needed in the near future. For the upper aerodigestive tract and in particular oral cavity and oropharynx, sentinel lymph node identification by lymphoscintigraphy allows avoiding unnecessary neck dissection and/or node irradiation. Even in this case, the main limit remains the risk of false-negative rates. While, for patients affected by laryngeal and hypopharyngeal cancers the data seem very limited and, although the feasibility has been demonstrated, performances of this lymphoscintigraphy still need to be confirmed by multicenter studies.

Prevalence and Detection of Sexually Transmitted Cases of Laryngeal Carcinoma

INTRODUCTION

Human papillomavirus (HPV) is among the reported etiologies of laryngeal squamous cell carcinoma (LSCC). Understanding the impact of HPV on LSCC may help reduce its incidence. This study investigates the association between HPV and LSCC as well as the roles for different immunohistochemical stains in HPV detection.

METHODS

A total of fifty-two formalin-fixed, paraffin-embedded tissue samples of LSCC, diagnosed between 2005 and 2015, were obtained from the archives of the Pathology Department. The samples were stained and processed to evaluate the relationship of HPV to LSCC.

RESULTS

Patients had a mean age of 65.02 ± 14.341 years. By polymerase chain reaction (PCR), high-risk strains of HPV were detected in 15.4% of tissue samples. HPV-16 was found in 75% of the positive samples for an overall prevalence of 13.5%. P16 immunostaining was positive in 15.4% of cases while cyclin B and cyclin E were positive in 65.4% and 76.9%, respectively. Over half of the cases were histologically graded as moderately-differentiated, 28.8% as well-differentiated, and 15.4% as poorly-differentiated.

DISCUSSION

The prevalence of HPV-positive LSCC was lower than previously stated in the literature. HPV-16 was the most commonly detected subtype, in concordance with the findings of multiple other studies. HPV-positive LSCC trended with higher histologic grade. P16 and cyclin E immunohistochemical stains were of limited use in identifying HPV in LSCC. In contrast, cyclin B had a high sensitivity which could be used to rule out HPV in LSCC.

Combined Effect of HPV and Several Gene SNPs in Laryngeal Cancer

Background and objectives: Laryngeal squamous cell carcinoma (LSCC) is one of the most common head and neck tumors. The molecular mechanism of LSCC remains unclear. The aim of this study was to evaluate the prevalence of Human papillomavirus (HPV) and single nucleotide polymorphisms (SNPs) of TP53, MDM2, MDM4, MTHFR, CASP8, and CCR5 genes in LSCC, and to assess their correlations with patient survival. Materials and Methods: 49 LSCC patients were enrolled in this study. PCR and qRT-PCR were used to detect, identify, and quantify HPV. SNPs were genotyped using PCR and PCR-RFLP. Results: By analyzing the interactions of the SNPs of the genes with clinical parameters, the majority of patients with lymph node status (N1,2) were identified as carriers of MDM2T/G, CASP8ins/del, CCR5wt/wt SNP. Cluster analysis showed that patients with MDM2T/T SNP survive longer than patients identified as CASP8ins/ins, MTHFRC/C, and MDM4A/A variant carriers; meanwhile, LSCC patients with MDM2T/T polymorphic variant had the best survival. Multivariate analysis showed that HPV-positive patients without metastasis in regional lymph nodes (N0) and harboring CASP8ins/del variant had the best survival. Meanwhile, HPV-negative patients with identified metastasis in lymph nodes (N1 and N2) and CASP8ins/del variant had poor survival. Conclusions: This finding suggests patients survival prognosis and tumor behavior are different according HPV status, SNP variants, and clinical characteristics of the LSCC.

Updates on larynx cancer epidemiology

Objective

Laryngeal cancer is an important oncologic entity, whose prognosis depends on establishing appropriate preventive and diagnostic measures, especially in populations at higher risk.

Methods

Epidemiologic information including worldwide incidence, prevalence, burden of health loss (disability-adjusted life year; DALYs) and mortality of larynx cancer was obtained from the Global Health Data Exchange (GHDx) database.

Results

The current incidence, prevalence and mortality of laryngeal cancer are estimated at 2.76 cases/year per 100,000 inhabitants, 14.33 cases/year per 100,000 inhabitants and 1.66 deaths/year per 100,000 inhabitants, respectively, averaging 3.28 million DALYs each year. Incidence and prevalence have increased by 12% and 24%, respectively during the past 3 decades, whilst mortality has declined by around 5%. The epidemiologic burden of this malignancy is approximately 5-fold higher in males and increases in parallel with ageing, peaking after 65 years of age. Both incidence and mortality rates are higher in Europe and lower in Africa, but the ratio between deaths and incidence is the highest in Africa. Incidence has gradually declined in Europe during the past 3 decades, whilst it has increased in South-East Asia and Western Pacific. Cigarette smoking and alcohol abuse contribute for about 90% of overall worldwide mortality for laryngeal cancer.

Conclusions

Laryngeal cancer still poses a high clinical and societal burden, with an escalating temporal trend not expected to reverse soon.

Role of human papillomavirus in laryngeal squamous cell carcinoma: A meta-analysis of cohort study

Objective

To evaluate the association of human papilloma virus (HPV) infection with prognosis, specifically overall survival (OS) and disease‐free survival (DFS), in laryngeal squamous cell carcinoma (LSCC) patients.

Method

A systematic review and meta‐analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. LSCC was confirmed on the basis of histopathology, whereas HPV status was confirmed by polymerase chain reaction.

Results

A total of 6539 articles were initially searched from 8 databases, of which 11 studies were eligible for our review. A total of 1442 LSCC cases were included in this analysis. Eight studies examined 3‐year OS for LSCC. The pooled hazard ratio (HR) from the 8 studies was 0.29 (95% CI: 0.25‐0.33). There was a statistically significant difference in 3‐year OS between the HPV‐negative and ‐positive groups, with the latter having a better survival. There was no statistically significant differences in 5‐ and 10‐year OS. Five studies examined 3‐ and 5‐year DFS for LSCC, whereas only 3 studies examined 10‐year DFS. There was no statistically significant difference in 3‐, 5‐, and 10‐year DFS between the HPV groups.

Conclusion

This study evaluated the survival impact of HPV infection in LSCC patients. The OS of the HPV‐positive group was better than that of the HPV‐negative group in terms of short‐term survival. Compared with the HPV‐negative group, the HPV‐positive group had a better trend of DFS, suggesting that a larger sample size and further exploration of the pathology and local control of HPV‐positive tumors are needed.

Supraglottic p16+ squamous cell carcinoma during pregnancy: a case report and review of the literature

BACKGROUND

Head and neck cancer during pregnancy is uncommon. Specifically, laryngeal cancer in pregnancy has only been previously reported 10 times. HPV p16+ supraglottic cancer during pregnancy has never been described in the literature prior to this case report. This case is important to report to understand the most effective and safe diagnostic, treatment and follow-up options available for pregnant patients with laryngeal cancer.

CASE PRESENTATION

This report describes a case of a 33-year-old patient who was 24 weeks pregnant presenting with dysphonia and odynophagia. After laryngeal biopsy and MRI she was diagnosed with T3N1M0, stage three p16+ squamous cell carcinoma of the supraglottis. After inter-disciplinary consultation as well as extensive patient discussion, an awake tracheostomy, PEG tube placement and then elective C-section at 28 weeks' gestation was completed. This was followed by chemoradiotherapy. The patient has remained free from disease with a healthy child at four years post-treatment.

CONCLUSION

Supraglottic cancer during pregnancy is rare with only four previous cases reported in the literature. This case report elucidates the importance of including multiple specialities as well as patient preference in the decision-making process regarding treatment for patients with supraglottic cancer during pregnancy. Furthermore, diagnostic and treatment guidelines for pregnant patients with head and neck cancers should be established to promote the best possible oncological, obstetrical and neonatal care.

Human papillomavirus-associated squamous cell carcinoma of the larynx or hypopharynx: Clinical outcomes and implications for laryngeal preservation

OBJECTIVES

Human papillomavirus (HPV) can be detected in approximately 25% of squamous cell carcinomas (SCC) of the larynx and hypopharynx. Though HPV is associated with improved survival and disease control in patients with oropharyngeal SCC, the role of HPV as a marker of favorable treatment outcomes in laryngeal and hypopharyngeal cancer is unclear.

MATERIALS AND METHODS

Patients treated for laryngeal or hypopharyngeal SCC were reviewed. HPV status detected by p16 and/or HPV DNA PCR were abstracted from the medical record. A subset of samples (stage III-IV treated with primary radiotherapy) was retrospectively tested for p16 and HPV DNA. Overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were determined and compared between HPV-positive (p16+, PCR+ or both) and HPV-negative (p16- or PCR-) patients.

RESULTS

In total, 279 patients were identified, 94 of which were tested for HPV. Eighty-two (87%) were negative and 12 (13%) were positive for HPV. At 3 years, there were no significant differences in OS (72% v. 83%), DFS (60% v. 71%) and LRC (80% v. 89%). Performance status, smoking history and stage predicted for OS, while performance status and stage predicted for DFS. Analysis of patients treated with primary radiotherapy revealed non-significantly higher rates of laryngeal preservation at 3 years (75% v. 100%).

CONCLUSION

HPV was detected in 13% of tested laryngeal/hypopharyngeal cancers. HPV does not appear to significantly impact survival or disease control in patients with SCC of the larynx or hypopharynx. Non-significant improvements in laryngeal preservation were observed in HPV-positive patients.

Diagnostic Tumor Markers in Head and Neck Squamous Cell Carcinoma (HNSCC) in the Clinical Setting

Head and neck squamous cell carcinoma (HNSCC) represents a group of tumors arising in the oral cavity, oropharynx, and larynx. Although HNSCC is traditionally associated with tobacco and alcohol consumption, a growing proportion of head and neck tumors, mainly of the oropharynx, are associated with Human Papilloma Virus (HPV). Recurrent/metastatic disease is characterized by dismal prognosis and there is an unmet need for the development of biomarkers for detection of early disease, accurate prediction of prognosis, and appropriate selection of therapy. Based on the REMARK guidelines, a variety of diagnostic and prognostic biomarkers are being evaluated in clinical trials but their clinical significance is doubtful. Herein, we will focus on biomarkers in HNSCC used in the clinical setting and we will illustrate their clinical relevance.

Association study of cell cycle proteins and human papillomavirus in laryngeal cancer in Chinese population

OBJECTIVE

To investigate the role of human papillomavirus (HPV) in laryngeal squamous cell carcinoma (LSCC) and analyse the relationship between HPV and the expression of cell cycle-related proteins.

DESIGN

The study consisted of LSCC between 2005 and 2011 in Tongren Hospital. Clinical data such as age, sex, smoking/alcohol consumption, and TNM stage were collected. HPV DNA and cell cycle-related proteins were assessed in terms of clinical features.

SETTING

Single-centre study.

PARTICIPANTS

A total of 332 LSCC patients were included in the study.

MAIN OUTCOME MEASURES

The presence of genotype-specific HPV DNA was evaluated using PCR-RDB in formalin-fixed paraffin-embedded tissues. All samples were also evaluated for p16^INK4A , p21^WAF1/CIP1 , P53, Cyclin D1, and Ki67 immunohistochemical staining by tissue microarray.

RESULTS

HPV DNA was detected in 45 of 332 (13.55%) patients with LSCC, with HPV-16 being the predominant genotype. The presence of HPV-16 DNA was significantly associated with basaloid squamous cell carcinoma and cystic lymph node metastasis (P < 0.05). Of the 332 patients, 36 (10.84%) were scored as p16^INK4A positivity and they were more likely to be female (P < 0.05). Cyclin D1-positivity and p21^WAF1/CIP1 -positivity were observed in 60.24% (200/332) and 40.66% (135/332), respectively. In 114 cases (34.33%), LSCCs had moderate- to -strong p53 accumulation, which was correlated with TNM stage (P < 0.05). HPV-16 DNA was correlated with p16^INK4A and manifested a higher Ki-67 labelling index and p21^WAF1/CIP1 expression than HPV-16-negative tumours (P < 0.05). No relationship was observed between Cyclin D1or P53 expression and HPV-16 infection (P > 0.05).

CONCLUSION

HPV DNA was detected in 13.55% patients with LSCC, with HPV-16 being the predominant genotype and it was correlated with p16^INK4A and manifested a higher Ki-67 labelling index and p21^WAF1/CIP1 expression than HPV-16-negative tumours.

Clinical, Histological and Immunohistochemical Evaluation of Larynx Cancer

ABSTRACT: Laryngeal cancer represents the malignant degeneration, of epithelial nature or from the connective tissue, which starts in the constitutive elements of the larynx. Cancer localization in the larynx represents between 1% and 3% of all malignant tumors and approximately 50% of ear, nose and throat (ENT) tumors. Squamous cell carcinoma is the most common form (around 95%) of laryngeal cancer, with high incidence in human males from southern and central Europe, Romania occupying one of the top places. Material and Methods. Our study consisted of 490 patients diagnosed with laryngeal cancer from 2010 to 2016. They have been clinically, histologically, immunohistochemically, genetically, therapeutically and prognostically analyzed. Suspended microlaringoscopy has been the standard, allowing tumor extension evaluation and biopsy. All specimens were microscopically analyzed in standard or special histology stainings. For unclear histology specimens, immunohistochemical stainings were performed. Results and discussions. Histological types have been represented as follows: 31 carcinomas in situ, 17 microinvasive carcinoma, 205 poorly differentiated carcinomas, 138 moderately differentiated carcinomas, 63 well differentiated carcinomas, 8 papillary carcinomas, 1 leiomyosarcoma, 1 chondrosarcoma, 6 basaloid squamous cell carcinomas, 4 verrucous carcinoma, 1 malignant melanoma. Conclusions. The study brings to light the importance of integrated clinical, morphological and genetic evaluation of laryngeal cancer, regarding tumoral invasion grading and establishing an adequate surgical and oncologic treatment. The importance of immunohistochemistry in laryngeal cancer concerns prognosis factors which correlate with the evolution and histopathological degree of the lesion. The analysis of tumor invasion can lead to the development of therapeutic conduct and the establishment of prognostic markers.