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Okolo O, Honzel E, Britton WR, Yu VX, Flashner S, Martin C, Nakagawa H, Parikh AS. Experimental Modeling of Host-Bacterial Interactions in Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:5810. [PMID: 38136355 PMCID: PMC10742111 DOI: 10.3390/cancers15245810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
The microscopic species colonizing the human body, collectively referred to as the microbiome, play a crucial role in the maintenance of tissue homeostasis, immunity, and the development of disease. There is evidence to suggest associations between alterations in the microbiome and the development of head and neck squamous cell carcinomas (HNSCC). The use of two-dimensional (2D) modeling systems has made significant strides in uncovering the role of microbes in carcinogenesis; however, direct mechanistic links remain in their infancy. Patient-derived three-dimensional (3D) HNSCC organoid and organotypic models have recently been described. Compared to 2D models, 3D organoid culture systems effectively capture the genetic and epigenetic features of parent tissue in a patient-specific manner and may offer a more nuanced understanding of the role of host-microbe responses in carcinogenesis. This review provides a topical literature review assessing the current state of the field investigating the role of the microbiome in HNSCC; including in vivo and in vitro modeling methods that may be used to characterize microbiome-epithelial interactions.
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Affiliation(s)
- Ogoegbunam Okolo
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10027, USA; (O.O.); (W.R.B.); (V.X.Y.); (S.F.); (C.M.); (H.N.)
- Columbia Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10027, USA;
| | - Emily Honzel
- Columbia Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10027, USA;
| | - William R. Britton
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10027, USA; (O.O.); (W.R.B.); (V.X.Y.); (S.F.); (C.M.); (H.N.)
- Columbia Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10027, USA;
| | - Victoria X. Yu
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10027, USA; (O.O.); (W.R.B.); (V.X.Y.); (S.F.); (C.M.); (H.N.)
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, NY 10027, USA
| | - Samuel Flashner
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10027, USA; (O.O.); (W.R.B.); (V.X.Y.); (S.F.); (C.M.); (H.N.)
| | - Cecilia Martin
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10027, USA; (O.O.); (W.R.B.); (V.X.Y.); (S.F.); (C.M.); (H.N.)
- Organoid and Cell Culture Core, Columbia University Digestive and Liver Diseases Research Center, Columbia University, New York, NY 10027, USA
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, NY 10027, USA
| | - Hiroshi Nakagawa
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10027, USA; (O.O.); (W.R.B.); (V.X.Y.); (S.F.); (C.M.); (H.N.)
- Organoid and Cell Culture Core, Columbia University Digestive and Liver Diseases Research Center, Columbia University, New York, NY 10027, USA
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, NY 10027, USA
| | - Anuraag S. Parikh
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10027, USA; (O.O.); (W.R.B.); (V.X.Y.); (S.F.); (C.M.); (H.N.)
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, NY 10027, USA
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Lee KC, Waring NA, Yu VX, Okolo O, Caruana SM, Troob SH, Parikh AS. Prolonged operative time predicts postoperative deep venous thrombosis in head and neck cancer patients who undergo free flap reconstruction. Laryngoscope Investig Otolaryngol 2023; 8:1584-1588. [PMID: 38130246 PMCID: PMC10731485 DOI: 10.1002/lio2.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Objective This study sought to quantify the deep venous thrombosis (DVT) incidence in head and neck cancer (HNC) patients undergoing free tissue transfer and to identify independent predictors of postoperative DVT. Materials and Methods This is a cross-sectional study of the National Surgical Quality Improvement Program database from 2010 through 2020. The sample included all HNC surgical patients treated with free flap reconstruction. The study outcome was the presence of a DVT requiring treatment within 30 days of surgery. Univariate analyses were performed using chi-squared and independent t-tests. A multiple logistic regression model was created using all significant univariate predictors. Results A total of 3954 patients were identified, of whom 53 (1.3%) experienced a postoperative DVT. The only medical comorbidity associated with DVT was COPD (RR = 2.7 [1.3, 5.4]; p < .01). Operative time longer than 9 hours (RR = 1.9 [1.0, 3.2]; p = .04) and length of stay longer than 10 days (RR = 1.9 [1.1, 3.2]; p = .02) were associated with greater DVT rates. In the multivariate analysis, only COPD (p < .01) and operative time (p = .02) were independently associated with DVT risk. The presence of a DVT was found to increase the relative risk of readmission (RR = 2.1 [1.2, 3.6]; p < .01) and non-home disposition (RR = 2.4 [1.7, 3.5]; p < .01). Conclusions The incidence of DVT in HNC free flap patients was comparable to what has been reported in the general population of HNC surgery patients. Operative time >9 h and COPD history were independent risk factors for DVT in this subset of patients. Symptomatic DVTs necessitating treatment were accompanied by poorer post-hospitalization outcomes. Level of Evidence Level 3.
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Affiliation(s)
- Kevin C. Lee
- Division of Oral and Maxillofacial SurgeryColumbia University Irving Medical Center, NewYork‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Nicholas A. Waring
- Department of Otolaryngology – Head and Neck SurgeryColumbia University Irving Medical Center, NewYork‐Presbyterian HospitalNew YorkNew YorkUSA
- Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Victoria X. Yu
- Department of Otolaryngology – Head and Neck SurgeryColumbia University Irving Medical Center, NewYork‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Ogoegbunam Okolo
- Department of Otolaryngology – Head and Neck SurgeryColumbia University Irving Medical Center, NewYork‐Presbyterian HospitalNew YorkNew YorkUSA
- Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Salvatore M. Caruana
- Department of Otolaryngology – Head and Neck SurgeryColumbia University Irving Medical Center, NewYork‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Scott H. Troob
- Department of Otolaryngology – Head and Neck SurgeryColumbia University Irving Medical Center, NewYork‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Anuraag S. Parikh
- Department of Otolaryngology – Head and Neck SurgeryColumbia University Irving Medical Center, NewYork‐Presbyterian HospitalNew YorkNew YorkUSA
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Parikh AS, Li Y, Mazul A, Yu VX, Thorstad W, Rich J, Paniello RC, Caruana SM, Troob SH, Jackson RS, Pipkorn P, Zolkind P, Qi Z, Adkins D, Ding L, Puram SV. Immune Cell Deconvolution Reveals Possible Association of γδ T Cells with Poor Survival in Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:4855. [PMID: 37835549 PMCID: PMC10571517 DOI: 10.3390/cancers15194855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: The role of rare immune cell subtypes in many solid tumors, chief among them head and neck squamous cell carcinoma (HNSCC), has not been well defined. The objective of this study was to assess the association between proportions of common and rare immune cell subtypes and survival outcomes in HNSCC. (2) Methods: In this cohort study, we utilized a deconvolution approach based on the CIBERSORT algorithm and the LM22 signature matrix to infer proportions of immune cell subtypes from 517 patients with untreated HPV-negative HNSCC from The Cancer Genome Atlas. We performed univariate and multivariable survival analysis, integrating immune cell proportions with clinical, pathologic, and genomic data. (3) Results: We reliably deconvolved 22 immune cell subtypes in most patients and found that the most common immune cell types were M0 macrophages, M2 macrophages, and memory resting CD4 T cells. In the multivariable analysis, we identified advanced N stage and the presence of γδ T cells as independently predictive of poorer survival. (4) Conclusions: We uncovered that γδ T cells in the tumor microenvironment were a negative predictor of survival among patients with untreated HNSCC. Our findings underscore the need to better understand the role of γδ T cells in HNSCC, including potential pro-tumorigenic mechanisms, and whether their presence may predict the need for alternative therapy approaches.
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Affiliation(s)
- Anuraag S. Parikh
- Department of Otolaryngology—Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA; (V.X.Y.); (S.M.C.); (S.H.T.)
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Yize Li
- Department of Medicine, Division of Oncology, Washington University in St. Louis, St. Louis, MO 63110, USA (D.A.); (L.D.)
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Angela Mazul
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63108, USA; (A.M.); (J.R.); (R.C.P.); (R.S.J.); (P.P.); (P.Z.); (Z.Q.)
| | - Victoria X. Yu
- Department of Otolaryngology—Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA; (V.X.Y.); (S.M.C.); (S.H.T.)
| | - Wade Thorstad
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO 63110, USA;
| | - Jason Rich
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63108, USA; (A.M.); (J.R.); (R.C.P.); (R.S.J.); (P.P.); (P.Z.); (Z.Q.)
| | - Randal C. Paniello
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63108, USA; (A.M.); (J.R.); (R.C.P.); (R.S.J.); (P.P.); (P.Z.); (Z.Q.)
| | - Salvatore M. Caruana
- Department of Otolaryngology—Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA; (V.X.Y.); (S.M.C.); (S.H.T.)
| | - Scott H. Troob
- Department of Otolaryngology—Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA; (V.X.Y.); (S.M.C.); (S.H.T.)
| | - Ryan S. Jackson
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63108, USA; (A.M.); (J.R.); (R.C.P.); (R.S.J.); (P.P.); (P.Z.); (Z.Q.)
| | - Patrik Pipkorn
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63108, USA; (A.M.); (J.R.); (R.C.P.); (R.S.J.); (P.P.); (P.Z.); (Z.Q.)
| | - Paul Zolkind
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63108, USA; (A.M.); (J.R.); (R.C.P.); (R.S.J.); (P.P.); (P.Z.); (Z.Q.)
| | - Zongtai Qi
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63108, USA; (A.M.); (J.R.); (R.C.P.); (R.S.J.); (P.P.); (P.Z.); (Z.Q.)
| | - Douglas Adkins
- Department of Medicine, Division of Oncology, Washington University in St. Louis, St. Louis, MO 63110, USA (D.A.); (L.D.)
| | - Li Ding
- Department of Medicine, Division of Oncology, Washington University in St. Louis, St. Louis, MO 63110, USA (D.A.); (L.D.)
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO 63108, USA
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63108, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Sidharth V. Puram
- Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63108, USA; (A.M.); (J.R.); (R.C.P.); (R.S.J.); (P.P.); (P.Z.); (Z.Q.)
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63108, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63108, USA
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Okolo O, Yu V, Flashner S, Martin C, Nakagawa H, Lin DT, Puram SV, Parikh AS. Protocol for tumor dissociation and fluorescence-activated cell sorting of human head and neck cancers. STAR Protoc 2023; 4:102294. [PMID: 37149858 PMCID: PMC10189548 DOI: 10.1016/j.xpro.2023.102294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/16/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Tumors originating from the head and neck represent diverse histologies and are comprised of several cell types, including malignant cells, cancer-associated fibroblasts, endothelial cells, and immune cells. In this protocol, we describe a step-by-step approach for the dissociation of fresh human head and neck tumor specimens, followed by isolation of viable single cells using fluorescence-activated cell sorting. Our protocol facilitates the effective downstream use of techniques, including single-cell RNA sequencing and generation of three-dimensional patient-derived organoids. For complete details on the use and execution of this protocol, please refer to Puram et al. (2017)1 and Parikh et al. (2022).2.
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Affiliation(s)
- Ogoegbunam Okolo
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA; Columbia Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Victoria Yu
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA; Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, NY 10032, USA
| | - Samuel Flashner
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA
| | - Cecilia Martin
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA; Organoid and Cell Culture Core, Columbia University Digestive and Liver Diseases Research Center, Columbia University, New York, NY 10032, USA
| | - Hiroshi Nakagawa
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA; Organoid and Cell Culture Core, Columbia University Digestive and Liver Diseases Research Center, Columbia University, New York, NY 10032, USA; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard University, Boston, MA 02114, USA; Department of Otolaryngology, Harvard Medical School, Harvard University, Boston, MA 02114, USA
| | - Sidharth V Puram
- Department of Otolaryngology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; Department of Genetics, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA.
| | - Anuraag S Parikh
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA; Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, NY 10032, USA.
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5
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Puram SV, Mints M, Pal A, Qi Z, Reeb A, Gelev K, Barrett TF, Gerndt S, Liu P, Parikh AS, Ramadan S, Law T, Mroz EA, Rocco JW, Adkins D, Thorstad WL, Gay HA, Ding L, Paniello RC, Pipkorn P, Jackson RS, Wang X, Mazul A, Chernock R, Zevallos JP, Silva-Fisher J, Tirosh I. Cellular states are coupled to genomic and viral heterogeneity in HPV-related oropharyngeal carcinoma. Nat Genet 2023; 55:640-650. [PMID: 37012457 PMCID: PMC10191634 DOI: 10.1038/s41588-023-01357-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/27/2023] [Indexed: 04/05/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) includes a subset of cancers driven by human papillomavirus (HPV). Here we use single-cell RNA-seq to profile both HPV-positive and HPV-negative oropharyngeal tumors, uncovering a high level of cellular diversity within and between tumors. First, we detect diverse chromosomal aberrations within individual tumors, suggesting genomic instability and enabling the identification of malignant cells even at pathologically negative margins. Second, we uncover diversity with respect to HNSCC subtypes and other cellular states such as the cell cycle, senescence and epithelial-mesenchymal transitions. Third, we find heterogeneity in viral gene expression within HPV-positive tumors. HPV expression is lost or repressed in a subset of cells, which are associated with a decrease in HPV-associated cell cycle phenotypes, decreased response to treatment, increased invasion and poor prognosis. These findings suggest that HPV expression diversity must be considered during diagnosis and treatment of HPV-positive tumors, with important prognostic ramifications.
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Affiliation(s)
- Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA.
| | - Michael Mints
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Ananya Pal
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Zongtai Qi
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashley Reeb
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Kyla Gelev
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Thomas F Barrett
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Sophie Gerndt
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ping Liu
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Anuraag S Parikh
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Salma Ramadan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Travis Law
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Edmund A Mroz
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, OH, USA
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, OH, USA
| | - Doug Adkins
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Wade L Thorstad
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hiram A Gay
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Li Ding
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO, USA
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Xiaowei Wang
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Department of Pharmacology and Regenerative Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Angela Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Rebecca Chernock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Jessica Silva-Fisher
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Itay Tirosh
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
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6
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Parikh AS, Yu VX, Flashner S, Okolo OB, Lu C, Henick BS, Momen-Heravi F, Puram SV, Teknos T, Pan Q, Nakagawa H. Patient-derived three-dimensional culture techniques model tumor heterogeneity in head and neck cancer. Oral Oncol 2023; 138:106330. [PMID: 36773387 PMCID: PMC10126876 DOI: 10.1016/j.oraloncology.2023.106330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/08/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) outcomes remain stagnant, in part due to a poor understanding of HNSCC biology. The importance of tumor heterogeneity as an independent predictor of outcomes and treatment failure in HNSCC has recently come to light. With this understanding, 3D culture systems, including patient derived organoids (PDO) and organotypic culture (OTC), that capture this heterogeneity may allow for modeling and manipulation of critical subpopulations, such as p-EMT, as well as interactions between cancer cells and immune and stromal cells in the microenvironment. Here, we review work that has been done using PDO and OTC models of HNSCC, which demonstrates that these 3D culture models capture in vivo tumor heterogeneity and can be used to model tumor biology and treatment response in a way that faithfully recapitulates in vivo characteristics. As such, in vitro 3D culture models represent an important bridge between 2D monolayer culture and in vivo models such as patient derived xenografts.
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Affiliation(s)
- Anuraag S Parikh
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, NY, United States; Columbia University Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Victoria X Yu
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, NY, United States
| | - Samuel Flashner
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, NY, United States
| | - Ogoegbunam B Okolo
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Chao Lu
- Department of Genetics and Development, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, United States
| | - Brian S Henick
- Division of Hematology/Oncology, Department of Medicine, Columbia Unversity, New York, NY, United States
| | - Fatemeh Momen-Heravi
- Columbia University College of Dental Medicine, Columbia University, New York, NY, United States
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States; Department of Genetics, Washington University School of Medicine, St. Louis, MO, United States
| | - Theodoros Teknos
- Department of Otolaryngology, Case Western Reserve University, Cleveland, OH, United States
| | - Quintin Pan
- Department of Otolaryngology, Case Western Reserve University, Cleveland, OH, United States
| | - Hiroshi Nakagawa
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, NY, United States.
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7
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Flashner S, Martin C, Matsuura N, Shimonosono M, Tomita Y, Morimoto M, Okolo O, Yu VX, Parikh AS, Klein-Szanto AJP, Yan K, Gabre JT, Lu C, Momen-Heravi F, Rustgi AK, Nakagawa H. Modeling Oral-Esophageal Squamous Cell Carcinoma in 3D Organoids. J Vis Exp 2022:10.3791/64676. [PMID: 36622034 PMCID: PMC10037110 DOI: 10.3791/64676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) is prevalent worldwide, accounting for 90% of all esophageal cancer cases each year, and is the deadliest of all human squamous cell carcinomas. Despite recent progress in defining the molecular changes accompanying ESCC initiation and development, patient prognosis remains poor. The functional annotation of these molecular changes is the necessary next step and requires models that both capture the molecular features of ESCC and can be readily and inexpensively manipulated for functional annotation. Mice treated with the tobacco smoke mimetic 4-nitroquinoline 1-oxide (4NQO) predictably form ESCC and esophageal preneoplasia. Of note, 4NQO lesions also arise in the oral cavity, most commonly in the tongue, as well as the forestomach, which all share the stratified squamous epithelium. However, these mice cannot be simply manipulated for functional hypothesis testing, as generating isogenic mouse models is time- and resource-intensive. Herein, we overcome this limitation by generating single cell-derived three-dimensional (3D) organoids from mice treated with 4NQO to characterize murine ESCC or preneoplastic cells ex vivo. These organoids capture the salient features of ESCC and esophageal preneoplasia, can be cheaply and quickly leveraged to form isogenic models, and can be utilized for syngeneic transplantation experiments. We demonstrate how to generate 3D organoids from normal, preneoplastic, and SCC murine esophageal tissue and maintain and cryopreserve these organoids. The applications of these versatile organoids are broad and include the utilization of genetically engineered mice and further characterization by flow cytometry or immunohistochemistry, the generation of isogeneic organoid lines using CRISPR technologies, and drug screening or syngeneic transplantation. We believe that the widespread adoption of the techniques demonstrated in this protocol will accelerate progress in this field to combat the severe burden of ESCC.
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Affiliation(s)
- Samuel Flashner
- Herbert Irving Comprehensive Cancer Center, Columbia University
| | - Cecilia Martin
- Herbert Irving Comprehensive Cancer Center, Columbia University; Organoid and Cell Culture Core, Columbia University Digestive and Liver Diseases Research Center, Columbia University
| | | | | | - Yasuto Tomita
- Herbert Irving Comprehensive Cancer Center, Columbia University
| | - Masaki Morimoto
- Herbert Irving Comprehensive Cancer Center, Columbia University
| | | | - Victoria X Yu
- Herbert Irving Comprehensive Cancer Center, Columbia University; Department of Otolaryngology, Head and Neck Surgery, Columbia University
| | - Anuraag S Parikh
- Herbert Irving Comprehensive Cancer Center, Columbia University; Department of Otolaryngology, Head and Neck Surgery, Columbia University
| | | | - Kelley Yan
- Herbert Irving Comprehensive Cancer Center, Columbia University; Organoid and Cell Culture Core, Columbia University Digestive and Liver Diseases Research Center, Columbia University
| | - Joel T Gabre
- Herbert Irving Comprehensive Cancer Center, Columbia University; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University
| | - Chao Lu
- Herbert Irving Comprehensive Cancer Center, Columbia University; Department of Genetics and Development, Columbia University
| | - Fatemeh Momen-Heravi
- Herbert Irving Comprehensive Cancer Center, Columbia University; Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University
| | - Anil K Rustgi
- Herbert Irving Comprehensive Cancer Center, Columbia University; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University
| | - Hiroshi Nakagawa
- Herbert Irving Comprehensive Cancer Center, Columbia University; Organoid and Cell Culture Core, Columbia University Digestive and Liver Diseases Research Center, Columbia University; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University;
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8
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Parikh AS, Wizel A, Davis D, Lefranc-Torres A, Rodarte-Rascon AI, Miller LE, Emerick KS, Varvares MA, Deschler DG, Faquin WC, Aster JC, Lin DT, Bernstein BE, Drier Y, Puram SV. Single-cell RNA sequencing identifies a paracrine interaction that may drive oncogenic notch signaling in human adenoid cystic carcinoma. Cell Rep 2022; 41:111743. [PMID: 36450256 PMCID: PMC9760094 DOI: 10.1016/j.celrep.2022.111743] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 08/11/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
Salivary adenoid cystic carcinoma (ACC) is a rare, biologically unique biphasic tumor that consists of malignant myoepithelial and luminal cells. MYB and Notch signaling have been implicated in ACC pathophysiology, but in vivo descriptions of these two programs in human tumors and investigation into their active coordination remain incomplete. We utilize single-cell RNA sequencing to profile human head and neck ACC, including a comparison of primary ACC with a matched local recurrence. We define expression heterogeneity in these rare tumors, uncovering diversity in myoepithelial and luminal cell expression. We find differential expression of Notch ligands DLL1, JAG1, and JAG2 in myoepithelial cells, suggesting a paracrine interaction that may support oncogenic Notch signaling. We validate this selective expression in three published cohorts of patients with ACC. Our data provide a potential explanation for the biphasic nature of low- and intermediate-grade ACC and may help direct new therapeutic strategies against these tumors.
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Affiliation(s)
- Anuraag S. Parikh
- Department of Otolaryngology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA,These authors contributed equally
| | - Avishai Wizel
- The Lautenberg Center for Immunology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel,These authors contributed equally
| | - Daniel Davis
- The Lautenberg Center for Immunology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | | | | | - Lauren E. Miller
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, USA,Department of Otolaryngology, Harvard Medical School, Boston, MA 02115, USA
| | - Kevin S. Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, USA,Department of Otolaryngology, Harvard Medical School, Boston, MA 02115, USA
| | - Mark A. Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, USA,Department of Otolaryngology, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel G. Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, USA,Department of Otolaryngology, Harvard Medical School, Boston, MA 02115, USA
| | - William C. Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA,Department of Pathology, Harvard Medical School, Boston, MA 02115, USA
| | - Jon C. Aster
- Department of Pathology, Harvard Medical School, Boston, MA 02115, USA,Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Derrick T. Lin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, USA,Department of Otolaryngology, Harvard Medical School, Boston, MA 02115, USA
| | - Bradley E. Bernstein
- Department of Pathology, Harvard Medical School, Boston, MA 02115, USA,Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA,Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA,Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Yotam Drier
- The Lautenberg Center for Immunology and Cancer Research, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel,These authors contributed equally,Correspondence: (Y.D.), (S.V.P.)
| | - Sidharth V. Puram
- Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO 63110, USA,Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA,These authors contributed equally,Lead contact,Correspondence: (Y.D.), (S.V.P.)
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9
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Parikh AS, Puram SV. RNA sequencing and expression heterogeneity in head and neck cancer. Cancer Cytopathol 2022; 130:842-843. [PMID: 35838629 DOI: 10.1002/cncy.22622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/11/2022]
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10
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Bulbul MG, Tarabichi O, Parikh AS, Yoon BC, Juliano A, Sadow PM, Faquin W, Gropler M, Walker R, Puram SV, Varvares MA. The utility of intra-oral ultrasound in improving deep margin clearance of oral tongue cancer resections. Oral Oncol 2021; 122:105512. [PMID: 34564016 DOI: 10.1016/j.oraloncology.2021.105512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the potential utility of intra-oral ultrasound (IOUS) in guiding deep margin clearance and measuring depth of invasion (DOI) of oral tongue carcinomas (OTC). MATERIALS AND METHODS Retrospective chart review of consecutive patients with T1-T3 OTC who underwent intraoperative ultrasound-guided resection and a comparator group that had undergone resection without the use of IOUS both by a single surgeon. Data was extracted from operative, pathology and radiology reports. Deep margins and DOI were reviewed by a dedicated head and neck pathologist. Correlation between histologic and ultrasound DOI was assessed using Pearson correlation. RESULTS A total of 23 patients were included in the study cohort with a comparator group of 21 patients in the control group. None of the patients in the study cohort had a positive (cut-through) deep margin and the mean deep margin clearance was 8.5 ± 4.9 and 6.7 ± 3.8 for the IOUS and non-IOUS groups respectively (p-value 0.18) showing a non-significant improvement in the IOUS group. As a secondary outcome, there was a strong correlation between histologic and ultrasound DOI (0.9449). CONCLUSION Ultrasound appears to be a potentially effective tool in guiding OTC resections. In this small series, IOUS facilitated deep margin clearance and resulted in a non-statistically significant increase in deep margin clearance. Intraoral ultrasound can accurately measure lesional DOI.
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Affiliation(s)
- Mustafa G Bulbul
- Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Osama Tarabichi
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Anuraag S Parikh
- Department of Otolaryngology, Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Byung C Yoon
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy Juliano
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew Gropler
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - Ronald Walker
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Sidharth V Puram
- Department of Otolaryngology - Head and Neck Surgery and Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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11
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Li MM, Zhao S, Eskander A, Rygalski C, Brock G, Parikh AS, Haring CT, Swendseid B, Zhan KY, Bradford CR, Teknos TN, Carrau RL, VanKoevering KK, Seim NB, Old MO, Rocco JW, Puram SV, Kang SY. ASO Visual Abstract: Stage Migration and Survival Trends in Laryngeal Cancer. Ann Surg Oncol 2021. [PMID: 34346018 DOI: 10.1245/s10434-021-10342-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Michael M Li
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | | | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Anuraag S Parikh
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian Swendseid
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kevin Y Zhan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, USA.,Department of Genetics, Washington University School of Medicine, St. Louis, USA
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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12
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Li MM, Zhao S, Eskander A, Rygalski C, Brock G, Parikh AS, Haring CT, Swendseid B, Zhan KY, Bradford CR, Teknos TN, Carrau RL, VanKoevering KK, Seim NB, Old MO, Rocco JW, Puram SV, Kang SY. Stage Migration and Survival Trends in Laryngeal Cancer. Ann Surg Oncol 2021; 28:7300-7309. [PMID: 34263369 DOI: 10.1245/s10434-021-10318-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND During the last two decades, significant advancements in the treatment of laryngeal cancer have occurred. Although survival of head and neck cancer patients has improved over time, the temporal trend of laryngeal cancer survival is an area of controversy. METHODS From 2004 to 2016, 77,527 patients who had laryngeal cancer treated with curative intent in the United States were identified in the National Cancer Database. Relative and observed survival rates were assessed for temporal trends. Multinomial logistic regression investigated the relationship between American Joint Committee on Cancer (AJCC) stage and increasing calendar year. RESULTS No significant improvement in 2- or 5-year observed survival (OS) or relative survival (RS) was observed. The 5-year RS ranged from 61.72 to 63.97%, and the 5-year OS ranged from 54.26 to 56.52%. With each increasing year, the proportion of stage 4 disease increased, with risk for stage 4 disease at the time of diagnosis increasing 2.2% annually (adjusted odds ratio [aOR], 1.022; 95% confidence interval [CI], 1.017-1.028; p < 0.001). This increase was driven by a 4.7% yearly increase in N2 disease (aOR, 1.047; 95% CI, 1.041-1.053; p < 0.001), with an annual 1.2% increase in T3 disease (aOR, 1.012; 95% CI, 1.007-1.018; p < 0.001) and a 1.2% increase in T4 disease (aOR, 1.012; 95% CI, 1.005-1.018; p < 0.001). CONCLUSION Despite advances in the field, laryngeal cancer survival in the United States is not improving over time. This may be due to an increase in the proportion of stage 4 disease, driven primarily by increasing nodal disease. To achieve survival improvement commensurate with scientific and technologic advances, efforts should be made to diagnose and treat laryngeal cancer at earlier stages to prevent further stage migration.
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Affiliation(s)
- Michael M Li
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | | | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Anuraag S Parikh
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian Swendseid
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kevin Y Zhan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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13
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Miller AL, Holcomb AJ, Parikh AS, Richards JM, Rathi VK, Goldfarb JW, Remenschneider AK, Bergmark RW, Annino DJ, Goguen LA, Rettig EM, Deschler DG, Emerick KS, Lin DT, Richmon JD, Chan CL, Min LC, Uppaluri R, Varvares MA. Assessment of Preoperative Functional Status Prior to Major Head and Neck Surgery: A Pilot Study. Otolaryngol Head Neck Surg 2021; 166:688-695. [PMID: 34154446 DOI: 10.1177/01945998211019306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To demonstrate feasibility of a recently developed preoperative assessment tool, the Vulnerable Elders Surgical Pathways and Outcomes Analysis (VESPA), to characterize the baseline functional status of patients undergoing major head and neck surgery and to examine the relationship between preoperative functional status and postoperative outcomes. STUDY DESIGN Case series with planned data collection. SETTING Two tertiary care academic hospitals. METHODS The VESPA was administered prospectively in the preoperative setting. Data on patient demographics, ablative and reconstructive procedures, and outcomes including total length of stay, discharge disposition, delay in discharge, or complex discharge planning (delay or change in disposition) were collected via retrospective chart review. VESPA scores were calculated and risk categories were used to estimate risk of adverse postoperative outcomes using multivariate logistic regression for categorical outcomes and linear regression for continuous variables. RESULTS Fifty-eight patients met study inclusion criteria. The mean (SD) age was 66.4 (11.9) years, and 58.4% of patients were male. Nearly one-fourth described preoperative difficulty in either a basic or instrumental activity of daily living, and 17% were classified as low functional status (ie, high risk) according to the VESPA. Low functional status did not independently predict length of stay but was associated with delayed discharge (odds ratio [OR], 5.0; 95% CI, 1.2-21.3; P = .030) and complex discharge planning (OR, 5.7; 95% CI, 1.34-24.2; P = .018). CONCLUSION The VESPA can identify major head and neck surgical patients with low preoperative functional status who may be at risk for delayed or complex discharge planning. These patients may benefit from enhanced preoperative counseling and more comprehensive discharge preparation.
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Affiliation(s)
- Ashley L Miller
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew J Holcomb
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Anuraag S Parikh
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julianne M Richards
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Vinay K Rathi
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Business School, Boston, Massachusetts, USA
| | - Jeremy W Goldfarb
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
| | - Regan W Bergmark
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Patient Reported Outcomes, Value and Experience (PROVE) Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Donald J Annino
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Laura A Goguen
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eleni M Rettig
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin S Emerick
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Derrick T Lin
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Chiao-Li Chan
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lillian C Min
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Geriatric Research Education Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Ravindra Uppaluri
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Mark A Varvares
- Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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14
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Feng AL, Holcomb AJ, Abt NB, Mokhtari TE, Suresh K, McHugh CI, Parikh AS, Holman A, Kammer RE, Goldsmith TA, Faden DL, Deschler DG, Varvares MA, Lin DT, Richmon JD. Feeding Tube Placement Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2021; 166:696-703. [PMID: 34154449 DOI: 10.1177/01945998211020302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To identify factors that may predict the need for feeding tubes in patients undergoing transoral robotic surgery (TORS) in the perioperative setting. STUDY DESIGN Retrospective chart review. SETTING Academic tertiary center. METHODS A retrospective series of patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) was identified between October 2016 and November 2019 at a single tertiary academic center. Patient data were gathered, such as frailty information, tumor characteristics, and treatment, including need for adjuvant therapy. Multiple logistic regression was performed to identify factors associated with feeding tube placement following TORS. RESULTS A total of 138 patients were included in the study. The mean age was 60.2 years (range, 37-88 years) and 81.9% were male. Overall 82.9% of patients had human papilloma virus-associated tumors, while 28.3% were current or former smokers with a smoking history ≥10 pack-years. Eleven patients (8.0%) had a nasogastric or gastrostomy tube placed at some point during their treatment. Five patients (3.6%) had feeding tubes placed perioperatively (<4 weeks after TORS), of which 3 were nasogastric tubes. Six patients (4.3%) had feeding tubes placed in the periadjuvant treatment setting for multifactorial reasons; 5 of which were gastrostomy tubes. Only 1 patient (0.7%) was gastrostomy dependent 1 year after surgery. Multiple logistic regression did not demonstrate any significant predictive variables affecting perioperative feeding tube placement following TORS for OPSCC. CONCLUSIONS Feeding tubes are seldom required after TORS for early-stage OPSCC. With appropriate multidisciplinary planning and care, patients may reliably avoid the need for feeding tube placement following TORS for OPSCC.
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Affiliation(s)
- Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew J Holcomb
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas B Abt
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Tara E Mokhtari
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Krish Suresh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher I McHugh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Anuraag S Parikh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Allison Holman
- Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachael E Kammer
- Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tessa A Goldsmith
- Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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15
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Holcomb AJ, Herberg M, Strohl M, Ochoa E, Feng AL, Abt NB, Mokhtari TE, Suresh K, McHugh CI, Parikh AS, Sadow P, Faquin W, Faden D, Deschler DG, Varvares MA, Lin DT, Fakhry C, Ryan WR, Richmon JD. Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma. Head Neck 2021; 43:2434-2444. [PMID: 33856083 DOI: 10.1002/hed.26708] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/17/2021] [Accepted: 04/01/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The impact of close surgical margins on oncologic outcomes in HPV-related oropharyngeal squamous cell carcinoma (HPV + OPSCC) is unclear. METHODS Retrospective case series including patients undergoing single modality transoral robotic surgery (TORS) for HPV + OPSCC at three academic medical centers from 2010 to 2019. Outcomes were compared between patients with close surgical margins (<1 mm or requiring re-resection) and clear margins using the Kaplan-Meier method. RESULTS Ninety-nine patients were included (median follow-up 21 months, range 6-121). Final margins were close in 22 (22.2%) patients, clear in 75 (75.8%), and positive in two (2.0%). Eight patients (8.1%) recurred, including two local recurrences (2.0%). Four patients died during the study period (4.0%). Local control (p = 0.470), disease-free survival (p = 0.513), and overall survival (p = 0.064) did not differ between patients with close and clear margins. CONCLUSIONS Patients with close surgical margins after TORS for HPV + OPSCC without concurrent indications for adjuvant therapy may be considered for observation alone.
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Affiliation(s)
- Andrew J Holcomb
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Herberg
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Madeleine Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Edgar Ochoa
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Allen L Feng
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas B Abt
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Tara E Mokhtari
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Krish Suresh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher I McHugh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Anuraag S Parikh
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Sadow
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - William Faquin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Faden
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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16
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Qi Z, Liu Y, Mints M, Mullins R, Sample R, Law T, Barrett T, Mazul AL, Jackson RS, Kang SY, Pipkorn P, Parikh AS, Tirosh I, Dougherty J, Puram SV. Single-Cell Deconvolution of Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:1230. [PMID: 33799782 PMCID: PMC7999850 DOI: 10.3390/cancers13061230] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 12/24/2022] Open
Abstract
Complexities in cell-type composition have rightfully led to skepticism and caution in the interpretation of bulk transcriptomic analyses. Recent studies have shown that deconvolution algorithms can be utilized to computationally estimate cell-type proportions from the gene expression data of bulk blood samples, but their performance when applied to tumor tissues, including those from head and neck, remains poorly characterized. Here, we use single-cell data (~6000 single cells) collected from 21 head and neck squamous cell carcinoma (HNSCC) samples to generate cell-type-specific gene expression signatures. We leverage bulk RNA-seq data from >500 HNSCC samples profiled by The Cancer Genome Atlas (TCGA), and using single-cell data as a reference, apply two newly developed deconvolution algorithms (CIBERSORTx and MuSiC) to the bulk transcriptome data to quantitatively estimate cell-type proportions for each tumor in TCGA. We show that these two algorithms produce similar estimates of constituent/major cell-type proportions and that a high T-cell fraction correlates with improved survival. By further characterizing T-cell subpopulations, we identify that regulatory T-cells (Tregs) were the major contributor to this improved survival. Lastly, we assessed gene expression, specifically in the Treg population, and found that TNFRSF4 (Tumor Necrosis Factor Receptor Superfamily Member 4) was differentially expressed in the core Treg subpopulation. Moreover, higher TNFRSF4 expression was associated with greater survival, suggesting that TNFRSF4 could play a key role in mechanisms underlying the contribution of Treg in HNSCC outcomes.
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Affiliation(s)
- Zongtai Qi
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (Z.Q.); (R.M.); (R.S.); (T.L.); (T.B.); (A.L.M.); (R.S.J.); (P.P.)
| | - Yating Liu
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Michael Mints
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot 7610001, Israel; (M.M.); (I.T.)
| | - Riley Mullins
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (Z.Q.); (R.M.); (R.S.); (T.L.); (T.B.); (A.L.M.); (R.S.J.); (P.P.)
| | - Reilly Sample
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (Z.Q.); (R.M.); (R.S.); (T.L.); (T.B.); (A.L.M.); (R.S.J.); (P.P.)
- Clinical Research Training Center, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Travis Law
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (Z.Q.); (R.M.); (R.S.); (T.L.); (T.B.); (A.L.M.); (R.S.J.); (P.P.)
| | - Thomas Barrett
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (Z.Q.); (R.M.); (R.S.); (T.L.); (T.B.); (A.L.M.); (R.S.J.); (P.P.)
| | - Angela L. Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (Z.Q.); (R.M.); (R.S.); (T.L.); (T.B.); (A.L.M.); (R.S.J.); (P.P.)
| | - Ryan S. Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (Z.Q.); (R.M.); (R.S.); (T.L.); (T.B.); (A.L.M.); (R.S.J.); (P.P.)
| | - Stephen Y. Kang
- Division of Head and Neck Oncology, Department of Otolaryngology—Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA; (S.Y.K.); (A.S.P.)
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (Z.Q.); (R.M.); (R.S.); (T.L.); (T.B.); (A.L.M.); (R.S.J.); (P.P.)
| | - Anuraag S. Parikh
- Division of Head and Neck Oncology, Department of Otolaryngology—Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA; (S.Y.K.); (A.S.P.)
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Itay Tirosh
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot 7610001, Israel; (M.M.); (I.T.)
| | - Joseph Dougherty
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (Z.Q.); (R.M.); (R.S.); (T.L.); (T.B.); (A.L.M.); (R.S.J.); (P.P.)
- Department of Otolaryngology, Harvard Medical School, Boston, MA 02114, USA
| | - Sidharth V. Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (Z.Q.); (R.M.); (R.S.); (T.L.); (T.B.); (A.L.M.); (R.S.J.); (P.P.)
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA;
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17
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Parikh AS, Kang SY. Variation in elective treatment of the contralateral neck in oropharyngeal cancer. Oral Oncol 2021; 117:105186. [PMID: 33541777 DOI: 10.1016/j.oraloncology.2021.105186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Anuraag S Parikh
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stephen Y Kang
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
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18
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Gadkaree SK, Parikh AS, Barbarite E, Feng AL, McCarty J, Gray ST, Lin DT. Adenoid Cystic Carcinoma of the Nasopharynx with Skull Base Involvement: Retrospective National Cohort Analysis of Treatment Paradigms, Outcomes, and Provider Density. J Neurol Surg B Skull Base 2020; 83:99-104. [DOI: 10.1055/s-0040-1718769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/31/2020] [Indexed: 10/22/2022] Open
Abstract
Abstract
Objectives This article examines a national cohort of patients with nasopharyngeal adenoid cystic carcinoma (ACC) for incidence, skull base invasion, overall survival, and treatment paradigms.
Design, Setting, and Participants Retrospective national population-based study using Surveillance, Epidemiology, and End Results program data of patients with ACC of the nasopharynx (NACC) and skull base between 2004 and 2016.
Main Outcomes and Measures Primary outcomes included 5-year overall survival and odds of radiation treatment. Statistical analysis was performed using STATA 15.0 (STATACorp). p-Values < 0.05 were considered statistically significant.
Results Of the 2,385 cases of ACC, 70 cases were classified as NACC. Twenty-one percent (15) involved invasion of the skull base or posterior pharyngeal wall, and 42% (30) were either stage 3 or stage 4. The 5-year overall survival for patients with NACC without skull base invasion was 67% which dropped to 40% with invasion into the skull base. Radiation was used as the primary form of therapy for 62% of NACC and 73% of NACC invading into skull base. Odds of receiving radiation therapy and 5-year survival were not affected by socioeconomic status or density of providers.
Conclusion NACC is rare in incidence and was most commonly treated with radiation therapy when advanced in stage. Prognosis was dependent on invasion through posterior pharyngeal wall and skull base. Provider density and socioeconomic status did not affect odds of radiation or overall survival for NACC.
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Affiliation(s)
- Shekhar K. Gadkaree
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
- Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Anuraag S. Parikh
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
- Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Eric Barbarite
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
- Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Allen L. Feng
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
- Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Justin McCarty
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Stacey T. Gray
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
- Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Derrick T. Lin
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
- Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
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19
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Abt NB, Holcomb AJ, Feng AL, Suresh K, Mokhtari TE, McHugh CI, Parikh AS, Faden DL, Deschler DG, Varvares MA, Lin DT, Richmon JD. Opioid Usage and Prescribing Predictors Following Transoral Robotic Surgery for Oropharyngeal Cancer. Laryngoscope 2020; 131:E1888-E1894. [PMID: 33210756 DOI: 10.1002/lary.29276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/09/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE/HYPOTHESIS Pain management following transoral robotic surgery (TORS) varies widely. We aim to quantify opioid usage following TORS for oropharyngeal squamous cell carcinoma (OPSCC) and identify prescribing predictors. STUDY DESIGN Retrospective cohort study. METHODS A consecutive series of 138 patients undergoing TORS for OPSCC were reviewed from 2016 to 2019. Opioid usage (standardized to morphine milligram equivalents [MME]) was gathered for 12 months post-surgery via prescribing record cross-check with the Massachusetts Prescription Awareness Tool. RESULTS Of 138 OPSCC TORS patients, 92.8% were human papillomavirus (HPV) positive. Adjuvant therapy included radiation (XRT;67.4%) and chemoradiation (cXRT;6.5%). Total MME usage from start of treatment averaged 1395.7 MMEs with 76.4% receiving three prescriptions or less. Categorical analysis showed age <65, male sex, overweight BMI, lower frailty, former smokers, HPV+, higher T stage, and BOT subsite to be associated with increased MMEs. Adjuvant therapy significantly increased MMEs (TORS+XRT:1646.2; TORS+cXRT:2385.0; TORS alone:554.7 [P < .001]) and 12-month opioid prescription totals (TORS+XRT:3.2; TORS+cXRT:5.5; TORS alone:1.6 [P < .001]). Adjuvant therapy increased time to taper (total MME in TORS alone versus TORS+XRT/cXRT: 0 to 3 months:428.2 versus 845.5, 4 to 6 months:46.8 versus 541.8, 7 to 9 months:12.4 versus 178.6, 10 to 12 months:11.0 versus 4.4,[P < .001]). Positive predictors of opioid prescribing at the 4- to 6-month and 4- to 12-month intervals included adjuvant therapy (odds ratio [OR]:5.56 and 4.51) and mFI-5 score ≥3 (OR:36.67 and 31.94). Following TORS at 6-, 9-, and 12-month, 15.7%, 6.6%, and 4.1% were still using opioids. CONCLUSIONS In OPSCC treated with TORS, opioid use tapers faster for surgery alone versus with adjuvant therapy. Opioid prescribing risks include adjuvant therapy and higher frailty index. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1888-E1894, 2021.
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Affiliation(s)
- Nicholas B Abt
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Andrew J Holcomb
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Allen L Feng
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Krish Suresh
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Tara E Mokhtari
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Christopher I McHugh
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Anuraag S Parikh
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel L Faden
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel G Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeremy D Richmon
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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20
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Gadkaree SK, Parikh AS, Rodarte AI, Lehmann A, Gray ST, Lin DT. Adenoid Cystic Carcinoma of the Skull Base: Response to Radiation Therapy and Outcomes in a Retrospective Case Series. J Neurol Surg B Skull Base 2020; 81:505-510. [PMID: 33134017 DOI: 10.1055/s-0039-1696706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022] Open
Abstract
Objectives The main purpose of this article is to examine a single-center cohort of patients with nasopharyngeal adenoid cystic carcinoma (ACC) for pathologic features, skull base invasion, overall survival, and disease-free survival, with a focus on response to proton beam radiation therapy. Design, Setting, and Participants Single-center institutional cancer registry was used to retrospectively identify and analyze outcomes for 12 patients treated for ACC of the nasopharynx from 2000 to 2016. Main Outcomes and Measures Primary outcomes included 5-year overall survival and locoregional control. Statistical analysis was performed using STATA 12.0 (STATACorp, College Station, Texas, United States). Spearman's rank order correlation was used for ordinal, monotonic variables with p -values <0.05 considered statistically significant. Survival analysis was performed by Kaplan-Meier method; comparison between groups was performed using log-rank test. Results Twelve patients with ACC of the nasopharynx were included. All patients presented with advanced disease and were treated with primary radiation therapy, typically proton beam therapy. Only two underwent a surgical attempt at resection. A majority of cases had a cribriform growth pattern. The 5-year survival was 75% and rate of locoregional control rate at 5 years was 50%, comparable to other ACC cohort studies that included earlier stage tumors in various subsites that were surgically resected. Conclusions Although ACC is traditionally noted to be radioresistant, ACC of the nasopharynx was responsive to radiotherapy in our cohort, despite advanced stage and skull base invasion. Reasons for this improved survival are unclear and suggest the need for further pathologic and genetic characterization of nasopharyngeal ACC.
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Affiliation(s)
- Shekhar K Gadkaree
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
| | - Anuraag S Parikh
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
| | - Alejandro I Rodarte
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
| | - Ashton Lehmann
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States
| | - Stacey T Gray
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States.,Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Derrick T Lin
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, United States.,Division of Head and Neck Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, United States
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21
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Bulbul MG, Zenga J, Tarabichi O, Parikh AS, Sethi RK, Robbins KT, Puram SV, Varvares MA. Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members. Laryngoscope 2020; 131:782-787. [PMID: 32827312 DOI: 10.1002/lary.28976] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/20/2020] [Accepted: 07/10/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the definition of a clear margin and the use of frozen section (FS) among practicing head and neck surgeons in oral cancer management. STUDY DESIGN Cross-sectional survey. METHODS We designed a survey that was sent to American Head and Neck Society (AHNS) members via an email link. RESULTS A total of 185 (13% of 1,392) AHNS members completed our survey. Most surgeons surveyed (96.8%) use FS to supplement oral cavity squamous cell carcinoma resections. Fifty-five percent prefer a specimen-based approach. The majority of respondents believe FS is efficacious in guiding re-resection of positive margins, with 81% considering the new margin to be negative. More than half of respondents defined a distance of >5 mm on microscopic examination as a negative margin. CONCLUSIONS To avoid oral cancer resections that result in positive margins on final analysis, and thus the need for additional therapy, most surgeons surveyed use FS. A majority of surveyed surgeons now prefer a specimen-based approach to margin assessment. Although there is a debate on what constitutes a negative margin, most surgeons surveyed believe it to be >5 mm on microscopic examination. LEVEL OF EVIDENCE 4 Laryngoscope, 131:782-787, 2021.
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Affiliation(s)
- Mustafa G Bulbul
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, U.S.A
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Osama Tarabichi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A
| | - Anuraag S Parikh
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, U.S.A
| | - Rosh K Sethi
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University Medical School, Springfield, Illinois, U.S.A
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery and Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Mark A Varvares
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, U.S.A
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22
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Parikh AS, Fuller JC, Lehmann AE, Goyal N, Gray ST, Lin DT. Prognostic Impact of Adverse Pathologic Features in Sinonasal Squamous Cell Carcinoma. J Neurol Surg B Skull Base 2020; 82:e114-e119. [PMID: 34306926 DOI: 10.1055/s-0040-1710516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/17/2020] [Indexed: 10/24/2022] Open
Abstract
Objective This study aimed to describe the impact of adverse clinical and pathologic features in sinonasal squamous cell carcinoma (SCC). Design This study is designed with retrospective chart review. Setting The present study is conducted at a tertiary care institution. Participants All patients treated surgically for sinonasal SCC at our tertiary care institution between January 2006 and December 2013. Main Outcome Measures Overall survival (OS) and disease free survival (DFS) are the final measurement of this study. Results Forty-eight patients were identified. Mean age at surgery was 65.8 years, and mean follow-up time was 40.7 months. Eighteen patients (38%) had T1-T3 disease, while 30 patients (63%) had T4 disease. Seven patients (8.3%) had nodal disease at presentation. At 2, 5, and 10 years, OS was 71, 54, and 48%, respectively, while DFS was 64, 51, and 45%, respectively. Twelve patients (25%) experienced local recurrences with mean time to recurrence of 15.3 months. Twenty-five patients (52%) had positive margins, 24 (50%) had high-grade tumors, 18 (38%) had perineural invasion (PNI), and 15 (31%) had lymphovascular invasion (LVI). In the univariate analysis, T4 disease (risk ratio [RR] = 2.7) and high grade (RR = 2.4) had a significant association with DFS. In the multivariate analysis, high grade (RR = 4.0 and 4.5) and LVI (RR = 4.1 and 4.7) had a significant association with OS and DFS. Conclusion Our single-institution experience of 48 patients suggests that high grade and LVI are independently associated with survival outcomes in sinonasal SCC, while PNI and microscopically positive margins do not have a significant impact.
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Affiliation(s)
- Anuraag S Parikh
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Jennifer C Fuller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Ashton E Lehmann
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, Penn State University, Hershey, Pennsylvania, United States
| | - Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
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23
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Weitzman RE, Parikh AS, Gadkaree SK, Corrales CE. Skull Base Osteomyelitis Complicated by Petrous Internal Carotid Artery Blowout. Ear Nose Throat J 2020; 100:790S-794S. [PMID: 32133891 DOI: 10.1177/0145561320907164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Skull base osteomyelitis (SBO) is an invasive infection of the external auditory canal, with involvement of the skull base, typically in the elderly diabetic population. Diagnosis may be challenging, as it requires a combination of clinical, laboratory, and radiographical findings. The mainstay of treatment is long-term antibiotic therapy, but surgical debridement of the temporal bone may be necessary in refractory cases. Commonly reported complications include cranial neuropathies, meningitis, temporal lobe abscess, and dural venous sinus thrombosis. A rare and life-threatening complication of SBO is petrous internal carotid artery (ICA) blowout, which has been described as presenting with bleeding from the ear. Here, we describe the case of a 77-year-old woman with SBO complicated by a petrous ICA blowout, which presented with fulminant epistaxis. To our knowledge, this is the second reported case of a massive hemorrhage from a petrous ICA blowout secondary to SBO and the first presentation with massive epistaxis. We present this case to raise awareness of this potential impending complication in patients with SBO and recommend consideration of this etiology when assessing patients with massive epistaxis in the appropriate clinical setting. Level of evidence: III.
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Affiliation(s)
- Rachel E Weitzman
- Division of Otolaryngology, Brigham and Women's Hospital, 1811Harvard Medical School, Boston, MA, USA
| | - Anuraag S Parikh
- Division of Otolaryngology, Brigham and Women's Hospital, 1811Harvard Medical School, Boston, MA, USA
| | - Shekhar K Gadkaree
- Division of Otolaryngology, Brigham and Women's Hospital, 1811Harvard Medical School, Boston, MA, USA
| | - C Eduardo Corrales
- Division of Otolaryngology, Brigham and Women's Hospital, 1811Harvard Medical School, Boston, MA, USA
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Abstract
Head and neck squamous cell carcinoma (HNSCC), like many tumors, is characterized by significant intra-tumoral heterogeneity, namely transcriptional, genetic, and epigenetic differences that define distinct cellular subpopulations. While it has been established that intra-tumoral heterogeneity may have prognostic significance in HNSCC, we are only beginning to describe and define such heterogeneity at a cellular resolution. Recent advances in single-cell sequencing technologies have been critical in this regard, opening new avenues in our understanding of more nuanced tumor biology by identifying distinct cellular subpopulations, dissecting signaling within the tumor microenvironment, and characterizing cellular genomic mutations and copy number aberrations. The combined effect of these insights is likely to be robust and meaningful changes in existing diagnostic and treatment algorithms through the application of novel biomarkers as well as targeted therapeutics. Here, we review single-cell technological and computational advances at the genomic, transcriptomic, and epigenomic levels, and discuss their applications in cancer research and clinical practice, with a specific focus on HNSCC.
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Affiliation(s)
- Zongtai Qi
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, USA; Department of Genetics, Washington University School of Medicine, St. Louis, USA
| | - Thomas Barrett
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, USA; Department of Genetics, Washington University School of Medicine, St. Louis, USA
| | - Anuraag S Parikh
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Itay Tirosh
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, USA; Department of Genetics, Washington University School of Medicine, St. Louis, USA.
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25
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Parikh AS, Khawaja A, Puram SV, Srikanth P, Tjoa T, Lee H, Sethi RKV, Bulbul M, Varvares MA, Rocco JW, Emerick KS, Deschler DG, Lin DT. Outcomes and prognostic factors in parotid gland malignancies: A 10-year single center experience. Laryngoscope Investig Otolaryngol 2019; 4:632-639. [PMID: 31890881 PMCID: PMC6929571 DOI: 10.1002/lio2.326] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/10/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe a 10-year single center experience with parotid gland malignancies and to determine factors affecting outcomes. STUDY DESIGN Retrospective review. METHODS The institutional cancer registry was used to identify patients treated surgically for malignancies of the parotid gland between January 2005 and December 2014. Clinical and pathologic data were collected retrospectively from patient charts and analyzed for their association with overall survival (OS) and disease-free survival (DFS). RESULTS Two hundred patients were identified. Mean age at surgery was 57.8 years, and mean follow-up time was 52 months. One hundred two patients underwent total parotidectomy, while 77 underwent superficial parotidectomy, and 21 underwent deep lobe resection. Seventy patients (35%) required facial nerve (FN) sacrifice. Acinic cell carcinoma was the most common histologic type (22%), followed by mucoepidermoid carcinoma (21.5%) and adenoid cystic carcinoma (12.5%). Twenty-nine patients (14.5%) experienced recurrences, with mean time to recurrence of 23.6 months (range: 1-82 months). Five- and 10-year OS were 81% and 73%, respectively. Five- and 10-year DFS were 80% and 73%, respectively. In univariate analyses, age > 60, histologic type, positive margins, high grade, T-stage, node positivity, perineural invasion, and FN involvement were predictors of OS and DFS. In the multivariate analysis, histology, positive margins, node positivity, and FN involvement were independent predictors of OS and DFS. CONCLUSIONS Our single-center experience of 200 patients suggests that histology, positive margins, node positivity, and FN involvement are independently associated with outcomes in parotid malignancies. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Anuraag S. Parikh
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusetts
- Department of Otology and LaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Ayaz Khawaja
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusetts
| | - Sidharth V. Puram
- Department of Otolaryngology–Head and Neck Surgery and Department of GeneticsWashington University School of MedicineSt. LouisMissouri
| | - Priya Srikanth
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusetts
| | - Tjoson Tjoa
- Department of OtolaryngologyUC IrvineOrangeCalifornia
| | - Hang Lee
- MGH Biostatistics CenterMassachusetts General HospitalBostonMassachusetts
| | - Rosh K. V. Sethi
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusetts
- Department of Otology and LaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Mustafa Bulbul
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusetts
| | - Mark A. Varvares
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusetts
- Department of Otology and LaryngologyHarvard Medical SchoolBostonMassachusetts
| | - James W. Rocco
- Department of OtolaryngologyThe Ohio State UniversityColumbusOhio
| | - Kevin S. Emerick
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusetts
- Department of Otology and LaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Daniel G. Deschler
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusetts
- Department of Otology and LaryngologyHarvard Medical SchoolBostonMassachusetts
| | - Derrick T. Lin
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusetts
- Department of Otology and LaryngologyHarvard Medical SchoolBostonMassachusetts
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26
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Rodarte AI, Parikh AS, Gadkaree SK, Lehmann AE, Faquin WC, Holbrook EH, Lin DT. Human Papillomavirus Related Multiphenotypic Sinonasal Carcinoma: Report of a Case with Early and Progressive Metastatic Disease. J Neurol Surg Rep 2019; 80:e41-e43. [PMID: 31737465 PMCID: PMC6855919 DOI: 10.1055/s-0039-3399571] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/25/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction
Human papillomavirus (HPV) related multiphenotypic sinonasal carcinoma (HMSC) is a newly described entity. The prognosis of this neoplasm is not well understood, but cases often demonstrate high-grade features and paradoxically indolent behavior.
Case Report
We present the case of a 65-year-old man referred with unilateral nasal congestion and epistaxis. Nasal endoscopy and imaging revealed an expansile mass filling the left nasal cavity. The patient underwent endoscopic-assisted medial maxillectomy, with complete resection and negative margins. Pathology revealed a basaloid tumor consisting of solid nests with multiple foci of cribriform architecture, with positivity for high-risk HPV, thus supporting the diagnosis of HMSC. Postoperatively, the patient received 66.6-Gy adjuvant three-dimensional proton therapy. Twenty-three months after surgical resection, he developed enlarging pulmonary nodules with biopsy features consistent with the primary sinonasal tumor. He was treated with three cycles of chemotherapy and eight cycles of immunotherapy, progressing on both therapies. He remains on palliative chemotherapy.
Conclusion
Here, we present a case of HMSC with early and progressive distant metastasis. We aim to add to an understanding of the behavior of this entity. Although this neoplasm may typically be indolent, further classification of high-risk features is necessary to identify rare aggressive cases.
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Affiliation(s)
- Alejandro I Rodarte
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Anuraag S Parikh
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Shekhar K Gadkaree
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Ashton E Lehmann
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - William C Faquin
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Eric H Holbrook
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Derrick T Lin
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
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27
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Parikh AS, Puram SV, Faquin WC, Richmon JD, Emerick KS, Deschler DG, Varvares MA, Tirosh I, Bernstein BE, Lin DT. Immunohistochemical quantification of partial-EMT in oral cavity squamous cell carcinoma primary tumors is associated with nodal metastasis. Oral Oncol 2019; 99:104458. [PMID: 31704557 DOI: 10.1016/j.oraloncology.2019.104458] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/19/2019] [Accepted: 10/21/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Quantify by immunohistochemistry (IHC) a partial epithelial-to-mesenchymal transition (p-EMT) population in oral cavity squamous cell carcinoma (OCSCC) and determine its predictive value for lymph node metastasis. METHODS Tissue microarrays (TMA) were created using 2 mm cores from 99 OCSCC patients (47 with low volume T2 disease, 52 with high volume T4 disease, and ∼50% in each group with nodal metastasis). IHC staining was performed for three validated p-EMT markers (PDPN, LAMB3, LAMC2) and one marker of well-differentiated epithelial cells (SPRR1B). Staining was quantified in a blinded manner by two reviewers. Tumors were classified as malignant basal subtype based on staining for the four markers. In this subset, the p-EMT score was computed as the average of p-EMT markers. RESULTS 84 tumors were classified as malignant basal. There was 87% inter-rater consistency in marker quantification. There were associations of p-EMT scores with higher grade (2.15 vs. 1.92, p = 0.04), PNI (2.13 vs. 1.83, p = 0.003), and node positivity (2.09 vs. 1.87, p = 0.02), including occult node positivity (56% vs. 19%, p = 0.005). P-EMT was independently associated with nodal metastasis in a multivariate analysis (OR 3.12, p = 0.039). Overall and disease free survival showed trends towards being diminished in the p-EMT high group. CONCLUSIONS IHC quantification of p-EMT in OCSCC primary tumors is reliably associated with nodal metastasis, PNI, and high grade. With prospective validation, p-EMT biomarkers may aid in decision-making over whether to perform a neck dissection in the N0 neck and/or for adjuvant therapy planning.
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Affiliation(s)
- Anuraag S Parikh
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery and Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
| | - William C Faquin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Jeremy D Richmon
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Kevin S Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Daniel G Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Itay Tirosh
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Bradley E Bernstein
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
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28
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Bulbul MG, Zenga J, Puram SV, Tarabichi O, Parikh AS, Varvares MA. Understanding approaches to measurement and impact of depth of invasion of oral cavity cancers: A survey of American Head and Neck Society Membership. Oral Oncol 2019; 99:104461. [PMID: 31678765 DOI: 10.1016/j.oraloncology.2019.104461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/30/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate methods used by head and neck surgeons to pre-operatively measure depth of invasion (DOI) in light of the new staging for oral cavity squamous cell carcinoma (OCSCC). MATERIALS AND METHODS A survey was designed and sent to all American Head and Neck Society (AHNS) members via an email link. The last response was recorded on January 16, 2019. RESULTS We received 185 (13.3%) responses from 184 surgeons and 1 radiation oncologist. The majority of surgeons correctly identified DOI (78.9%) and indicated measuring DOI pre-operatively (86%). The most common methods for measuring DOI were manual palpation (32.5%) and full thickness biopsy (25.2%). In addition, most surgeons (84.7%) reported using a DOI threshold (in mm) as their primary criterion in their decision to pursue a neck dissection in the N0 neck. The most common reported threshold was 4 mm (37.4% of those that reported using DOI), however, the range varied from 2 to >10 mm. Two-thirds of surgeons considered DOI an important indicator for adjuvant therapy. CONCLUSION DOI is believed to be an important prognostic indicator guiding neck dissection and the need for adjuvant therapy. While most surgeons currently measure DOI pre-operatively, most use subjective methods. Future studies are needed to establish objective pre-operative DOI measurement techniques and to better inform the decision to perform prophylactic neck dissection, given the current majority practice of prophylactic neck dissection for DOI of 4 mm or greater.
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Affiliation(s)
- Mustafa G Bulbul
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sidharth V Puram
- Department of Otolaryngology - Head and Neck Surgery and Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Osama Tarabichi
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Anuraag S Parikh
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Mark A Varvares
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
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29
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Oliveira-Costa JP, Parikh AS, Neiman LT, Sevenler D, Koo D, Lu C, Faquin WC, Tirosh I, Richmon JD, Emerick KS, Deschler DG, Varvares MA, Lin DT, Puram SV, Bernstein BE, Stott SL. Abstract 1132: Multiplexed immunofluorescence and multispectral imaging-based quantification of tumor and immune cell populations reveals spatial relationships in oral cavity squamous cell carcinoma. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Recent single cell expression profiling of head and neck squamous cell carcinoma (HNSCC) identified a partial epithelial-to-mesenchymal transition (p-EMT) subpopulation of cancer cells. We have previously demonstrated an association of p-EMT subpopulations with adverse clinical and pathologic features, in both TCGA expression data and an independent cohort of single institutional patients. Here, we aim to understand cellular co-expression of EMT markers and spatial relationships with immune infiltrates in oral cavity HNSCC. Paraffin blocks of 10 oral cavity HNSCC patients whose tumors had previously undergone single cell expression profiling were characterized by a 13-marker panel of tumor cell, p-EMT, epithelial differentiation, and immune markers. Multiplexed immunofluorescence was used to perform simultaneous staining within two serial tissue sections. Multispectral imaging was performed using wide field microscopy (Vectra 3), and algorithms were used for spectral unmixing, tissue and cell segmentation, and cell phenotyping. Following user training, tissue and cell segmentation and cell phenotyping were successfully performed in an automated fashion. Whole slides containing entire tissue sections were analyzed, enabling high throughput analysis of hundreds of thousands of individual cells per tumor. p-EMT quantification by tumor, as measured by simultaneous signal for p-EMT markers, showed consistent co-localization, in accordance with prior single cell expression profiling data. We found that individual cells defined as p-EMT positive, based on co-expression of two or more p-EMT markers, co-localized to the leading edge of tumor nests, in close apposition to the stroma. Co-localization of LAMB3 and LAMC2 was the most robust marker combination defining this subpopulation. In addition, helper and cytotoxic T cells were identified across tumors, including activated and exhausted T-cell subsets. The relationships of these cellular subpopulations to other immune cells, which may drive immune cell exhaustion, were explored by radial measurements associated with cell densities and intercellular distances. Tumor and immune cell profiling using 13 markers across serial sections enabled high throughput characterization of individual cells with spatial information in a manner not previously possible. Distinct spatial relationships among p-EMT and epithelial tumor cells were identified, including a potential correlation with immune cells. This technology may have clinical utility in HNSCC, which includes predicting the need for therapy and response to immunotherapy.
Citation Format: Joao Paulo Oliveira-Costa, Anuraag S. Parikh, Linda T. Neiman, Derin Sevenler, Doyeon Koo, Chenyue Lu, William C. Faquin, Itay Tirosh, Jeremy D. Richmon, Kevin S. Emerick, Daniel G. Deschler, Mark A. Varvares, Derrick T. Lin, Sidarth V. Puram, Bradley E. Bernstein, Shannon L. Stott. Multiplexed immunofluorescence and multispectral imaging-based quantification of tumor and immune cell populations reveals spatial relationships in oral cavity squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1132.
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Affiliation(s)
| | | | | | | | | | | | | | - Itay Tirosh
- 2Weizmann Institute of Science, Rehovot, Israel
| | | | | | | | | | | | - Sidarth V. Puram
- 4Washington University School of Medicine in St Louis, St Louis, MO
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30
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Bulbul MG, Tarabichi O, Sethi RK, Parikh AS, Varvares MA. Does Clearance of Positive Margins Improve Local Control in Oral Cavity Cancer? A Meta-analysis. Otolaryngol Head Neck Surg 2019; 161:235-244. [PMID: 30912991 DOI: 10.1177/0194599819839006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare local recurrence-free survival (LRFS) in early oral cavity cancer (OCC) patients with positive/close frozen section (FS) cleared with further resection (R1 to R0) or positive FS not cleared (R1) to those with negative margins on initial FS analysis (R0). DATA SOURCES PubMed, EMBASE, and Cochrane. REVIEW METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for reporting in our study. Only English-language articles that included patients with OCC and local recurrence (LR) comparisons between R0 and initially R1 to final R0 or final R1 groups were included. We requested the raw data from the corresponding authors of eligible studies and performed an individual participant data (IPD) meta-analysis of LRFS outcomes across groups. RESULTS Pooled LRFS data from 8 studies showed that patients in the R1 to R0 group had worse LRFS compared to the R0 group (hazard ratio [HR] = 2.897, P < .001). Patients in the R1 group were also found to have worse LRFS compared to the R0 group (HR = 3.795, P < .001). When compared to final R1 group, the initially R1 to final R0 only showed a trend toward better LRFS. CONCLUSION Margin revision of initially positive margins to "clear" based on FS guidance does not equate to an initially negative margin and does not significantly improve local control. These findings call into question the effectiveness of the current methodology of intraoperative FS in OCC resections and call for a prospective study to determine what system of resected specimen analysis best predicts completeness of resection.
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Affiliation(s)
- Mustafa G Bulbul
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Osama Tarabichi
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosh K Sethi
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Anuraag S Parikh
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,2 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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31
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Puram SV, Parikh AS, Tirosh I. Single cell RNA-seq highlights a role for a partial EMT in head and neck cancer. Mol Cell Oncol 2018; 5:e1448244. [PMID: 30250901 PMCID: PMC6149805 DOI: 10.1080/23723556.2018.1448244] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 02/25/2018] [Accepted: 02/25/2018] [Indexed: 01/03/2023]
Abstract
Studies in single cell transcriptomics have significantly expanded our understanding of tumor biology, including recent analyses in head and neck squamous cell carcinoma. Here, we focus on the role of a partial epithelial-to-mesenchymal (EMT) program in these tumors, with discussion of its dynamics, regulation, and implications for diagnostic and therapeutic approaches.
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Affiliation(s)
- Sidharth V Puram
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology and Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Anuraag S Parikh
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Itay Tirosh
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
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32
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Parikh AS, Bhattacharyya N. Patterns of concurrent cigarette, alcohol, and e-cigarette use: Off-setting or additive behaviors? Laryngoscope 2018; 128:1817-1821. [PMID: 29481701 DOI: 10.1002/lary.27133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/22/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To understand nationwide concurrent use of e-cigarettes (Ecig) with alcohol and conventional cigarettes (Ccig), the major risk factors for head and neck cancer. STUDY DESIGN Cross-sectional analysis of nationally representative survey. METHODS The National Health Interview Surveys for 2014 and 2015 were analyzed for adult responses to specific questions regarding the daily frequency of alcohol, Ccig, and Ecig use. Statistical relationships between these social habits were determined. RESULTS A total of 241.1 million adults (raw N = 162,048) were surveyed (mean age 47.1 years, 51.8% female). Of those, 12.1% (29.2 million) and 3.8% (9.08 million) reported being every day Ccig users and some days Ccig users, respectively. A total of 2.3% (5.63 million) and 1.1% (2.76 million) reported being every day Ecig users and some days Ecig users, respectively. In addition, 58.4% of everyday Ecig users reported also being everyday Ccig users (P < 0.001). Furthermore, 25.6% (61.3 million) and 8.3% (20.0 million) of adults reported light drinking (1-3 drinks/week) and moderate/heavy drinking (4-7 drinks/week), respectively. Of the moderate/heavy drinkers, 17.7% were everyday Ccig users, whereas 12.2% of everyday Ccig users were moderate/heavy drinkers (P < 0.001). Among everyday Ecig users, 34.6% and 11.2% were light drinkers and moderate/heavy drinkers, respectively (P < 0.001). Among non-Ccig users, everyday Ecig users were likely to consume higher levels of alcohol given that 36.5% and 8.9% were light drinkers and moderate/heavy drinkers, respectively (P < 0.01). CONCLUSION We demonstrate a substantial level of Ccig use among moderate/heavy drinkers and Ecig users, as well as a novel independent association between Ecig and moderate/heavy alcohol use. These patterns of concurrent risk factor exposure should be considered when counseling patients who report Ecig use. LEVEL OF EVIDENCE 2b. Laryngoscope, 1817-1821, 2018.
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Affiliation(s)
- Anuraag S Parikh
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Neil Bhattacharyya
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
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Palecek SP, Parikh AS, Kron SJ. Genetic analysis reveals that FLO11 upregulation and cell polarization independently regulate invasive growth in Saccharomyces cerevisiae. Genetics 2000; 156:1005-23. [PMID: 11063681 PMCID: PMC1461303 DOI: 10.1093/genetics/156.3.1005] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Under inducing conditions, haploid Saccharomyces cerevisiae perform a dimorphic transition from yeast-form growth on the agar surface to invasive growth, where chains of cells dig into the solid growth medium. Previous work on signaling cascades that promote agar invasion has demonstrated upregulation of FLO11, a cell-surface flocculin involved in cell-cell adhesion. We find that increasing FLO11 transcription is sufficient to induce both invasive and filamentous growth. A genetic screen for repressors of FLO11 isolated mutant strains that dig into agar (dia) and identified mutations in 35 different genes: ELM1, HSL1, HSL7, BUD3, BUD4, BUD10, AXL1, SIR2, SIR4, BEM2, PGI1, GND1, YDJ1, ARO7, GRR1, CDC53, HSC82, ZUO1, ADH1, CSE2, GCR1, IRA1, MSN5, SRB8, SSN3, SSN8, BPL1, GTR1, MED1, SKN7, TAF25, DIA1, DIA2, DIA3, and DIA4. Indeed, agar invasion in 20 dia mutants requires upregulation of the endogenous FLO11 promoter. However, 13 mutants promote agar invasion even with FLO11 clamped at a constitutive low-expression level. These FLO11 promoter-independent dia mutants establish distinct invasive growth pathways due to polarized bud site selection and/or cell elongation. Epistasis with the STE MAP kinase cascade and cytokinesis/budding checkpoint shows these pathways are targets of DIA genes that repress agar invasion by FLO11 promoter-dependent and -independent mechanisms, respectively.
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Affiliation(s)
- S P Palecek
- Center for Molecular Oncology and Department of Molecular Genetics and Cell Biology, University of Chicago, Chicago, Illinois 60637, USA
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Linehan DC, Peoples GE, Hess DT, Summerhayes IC, Parikh AS, Goedegebuure PS, Eberlein TJ. In vitro stimulation of ovarian tumour-associated lymphocytes with a peptide derived from HER2/neu induces cytotoxicity against autologous tumour. Surg Oncol 1995; 4:41-9. [PMID: 7780612 DOI: 10.1016/s0960-7404(10)80030-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The proto-oncogene HER2/neu encodes for a 185 kDa transmembrane protein with extensive homology to the epidermal growth factor (EGF) receptor. We have previously shown a correlation between HER2/neu expression and the level of in vitro cytotoxicity of tumour-associated lymphocytes (TAL) versus autologous tumour. In addition, we have recently demonstrated that tumour-associated cytotoxic T-lymphocytes (CTL) from ovarian and breast cancer patients can recognize a HER2/neu derived peptide epitope when presented in the context of HLA-A2. Since repeated tumour stimulation of CTL enhances both proliferation and cytotoxicity against autologous tumour, we hypothesized that repeated peptide antigen stimulation would have a similar effect. To be therapeutically useful, the peptide antigen must meet the following conditions: (1) the peptide must be immunogenic and cause a proliferation of CTL to adequate therapeutic numbers, and (2) the peptide-specific CTL which are generated must be cytotoxic against autologous tumour. To test our hypothesis, T-lymphocytes isolated from the ascites of four consecutive HER2/neu+ ovarian cancer patients were initially stimulated with solid phase anti-CD3 antibody and divided into three groups: (1) treatment with recombinant interleukin-2 (IL-2) alone, (2) IL-2 plus weekly stimulation with irradiated autologous tumour cells, and (3) IL-2 plus weekly stimulation with a HER2/neu derived peptide. Peptide-stimulated and tumour-stimulated CTL showed similar increases in proliferation with both groups consistently reaching therapeutic numbers. Peptide-stimulated CTL demonstrated significantly enhanced cytotoxicity against autologous tumour in 4-h chromium release assays as compared to the IL-2 alone group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D C Linehan
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Yoshino I, Goedegebuure PS, Peoples GE, Parikh AS, DiMaio JM, Lyerly HK, Gazdar AF, Eberlein TJ. HER2/neu-derived peptides are shared antigens among human non-small cell lung cancer and ovarian cancer. Cancer Res 1994; 54:3387-90. [PMID: 7912166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Previously, we have reported a correlation between the expression of HER2/neu and sensitivity to HLA-A2-restricted cytotoxic T-cells (CTL) in ovarian cancer. To investigate the role of HER2/neu in human non-small cell lung cancer (NSCLC), we established autologous tumor-specific CTL from tumor-infiltrating lymphocytes of HLA-A2+ HER2/neu+ NSCLC patients. These CTL lines specifically recognized HLA-A2+ HER2/neu+ autologous and allogeneic NSCLC cell lines as well as HLA-A2+ HER2/neu+ heterologous ovarian cancer cell lines. Furthermore, these CTL recognized an overexpressed, HER2/neu-derived peptide. From these results, we conclude that HLA-A2 serves as a restriction element in NSCLC. More importantly, at least one HER2/neu-derived peptide is a tumor-associated antigen in NSCLC and ovarian cancer.
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Affiliation(s)
- I Yoshino
- Division of Surgical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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