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Abdelhakam DA, Huenerberg KA, Nassar A. Utility of p16 and HPV testing in oropharyngeal squamous cell carcinoma: An institutional review. Diagn Cytopathol 2020; 49:54-59. [PMID: 32845095 DOI: 10.1002/dc.24593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/07/2020] [Indexed: 12/30/2022]
Abstract
In the US, 60% to 80% of oropharyngeal squamous cell carcinomas (OPSCCs) are associated with human papillomavirus (HPV). However, until recently, no consensus existed about when and how to test for HPV in patients with head and neck cancers. We aimed to evaluate the use of p16 and HPV testing at our institution because p16 immunohistochemistry is reportedly a reliable surrogate marker for HPV detection in OPSCCs. METHODS We identified all cases at our institution of primary or metastatic squamous cell carcinoma (SCC) of the head and neck with a concurrent p16 immunostain analysis from January 1, 2013, through August 31, 2018. Patient demographic data, tumor characteristics, p16 result, and any HPV result (in situ hybridization and E6 and E7 RNA test) were captured. RESULTS We identified 104 patients. Most primary tumors (53/57 [93.0%]) and metastases (40/47 [85.1%]) were positive for p16. Thirty-seven cases (35.6%) had reflex high-risk HPV (HR HPV) testing performed. Of the 35 p16-positive cases, 6 had discrepant HR HPV results (p16+ /HPV- ). We identified 47 p16 immunostains that were performed on lymph nodes with primary tumors of unknown origin. Most were cytology cases (34/47 [72.3%]), and most were p16 positive (40/47 [85.1%]). Neither tumor differentiation nor tumor keratinization was predictive of p16 positivity. Tumors with basaloid differentiation were universally p16 positive. CONCLUSION p16 immunohistochemistry accurately identifies HPV-positive OPSCC. Cytology specimens have an important role in characterizing SCC of unknown origin. HR HPV testing is not routinely required, and results may be discrepant with p16 findings.
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Affiliation(s)
- Dina A Abdelhakam
- Department of Clinical Pathology, Ain shams University, Cairo, Egypt.,Department of Cancer Biology, Mayo Clinic, Jacksonville, Florida, USA
| | - Katherine A Huenerberg
- Department of Pathology, George Washington University, Washington, District of Columbia, USA
| | - Aziza Nassar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
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2
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Devaraja K, Aggarwal S, Verma SS, Gupta SC. Clinico-pathological peculiarities of human papilloma virus driven head and neck squamous cell carcinoma: A comprehensive update. Life Sci 2020; 245:117383. [PMID: 32007572 DOI: 10.1016/j.lfs.2020.117383] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/17/2020] [Accepted: 01/28/2020] [Indexed: 01/11/2023]
Abstract
AIMS The current article provides a detailed account of the current understanding of molecular and clinico-pathological aspects of Human papilloma virus (HPV) driven head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS The literature review included most of the landmark trials and clinical studies related to the HPV driven HNSCC. KEY FINDINGS HPV positive HNSCC differ distinctly from HPV negative tobacco-related HNSCC, especially in oropharyngeal region. Therefore, the American joint committee on cancer`s latest manual for classification and staging of cancer suggests a separate staging system for HPV positive oropharyngeal cancers. Despite the younger patients being affected and the high propensity for cervical metastasis, the HPV positive oropharyngeal cancers respond much better to the treatment. The association with wild type TP53 and low EGFR expression confers the favorable prognosis in HPV driven HNSCC. Since the association is not universal, we suggest checking for p53 and EGFR expression status before considering de-intensification of therapy. In addition, the presence of matted lymph nodes and five or more nodes could mean relatively poorer prognosis, and are not suitable for de-intensification of therapy. The same is also true probably with higher T stage and co-existing tobacco use. The methods for the detection of p16, HPV DNA, HPV E6/E7 mRNA, anti-E6/E7 antibodies, in tissue, in serum and in saliva of patients, along with their clinical implications are also discussed. SIGNIFICANCE This article provides latest developments on the HPV driven HNSCC. 'Diagnosis of transcriptionally active HPV infection,' 'Modalities for surveillance,' 'Implication of de-escalation of therapy' are some of the critical issues that could serve the medical, the research as well as the patient communities.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India.
| | - Sadhna Aggarwal
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sumit Singh Verma
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, 221 005, India
| | - Subash Chandra Gupta
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, 221 005, India.
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3
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Kimura E, Araki K, Tomifuji M, Tanaka Y, Uno K, Yamashita T, Shiotani A. Value of transoral surgery for human papillomavirus-mediated oropharyngeal cancer: validation of a new staging system in Japanese patients. J Int Med Res 2019; 47:5048-5059. [PMID: 31516052 PMCID: PMC6833394 DOI: 10.1177/0300060519866594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to validate new staging of Japanese patients with human papillomavirus-mediated oropharyngeal cancer (HPV+-OPC) and the effectiveness of transoral surgery. Methods Fifty-three patients with HPV+-OPC were classified according to the seventh and eighth editions of the American Joint Committee on Cancer (AJCC) staging, along with assessment of prognosis, smoking and alcohol status, and treatment outcome. Transoral videolaryngoscopic surgery (TOVS) was performed as transoral surgery. Results The 5-year overall survival (OS) rate was 77.3% in all patients. Five-year OS rates of seventh edition staging were as follows: II, 100%; III, 100%; IVa, 75.9%; and IVb and IVc, 0%. Five-year OS rates of the eighth edition clinical staging were as follows: I, 89.3%; II, 88.9%; III, 46.3%; and IV, 0%. In non-smoking and smoking patients with HPV+-OPC, the 5-year OS rates were 90.9% and 70.7%, respectively. TOVS was used for treating 20 smokers with HPV+-OPC (5-year OS: 85.7%), while 12 were treated with chemoradiotherapy (5-year OS: 75.0%). Conclusions The eighth edition of the AJCC determines the prognosis of HPV+-OPC more accurately than the seventh edition in clinical staging. Smokers with HPV+-OPC have a poor prognosis, but TOVS might improve the prognosis.
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Affiliation(s)
- Eiko Kimura
- Department of Otolaryngology - Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Koji Araki
- Department of Otolaryngology - Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Masayuki Tomifuji
- Department of Otolaryngology - Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yuya Tanaka
- Department of Otolaryngology - Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Kosuke Uno
- Department of Otolaryngology - Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Taku Yamashita
- Department of Otolaryngology - Head and Neck Surgery, Kitasato University, Sagamihara, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology - Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan
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4
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Ziai H, Alenazi A, Hearn M, O'Connell DA, Puttagunta L, Barber B, Harris JR, Seikaly H, Biron VL. The association of Bcl-xL and p53 expression with survival outcomes in oropharyngeal cancer. Cancer Biomark 2019; 24:141-151. [PMID: 30614804 DOI: 10.3233/cbm-182106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The role of molecular biomarkers in oropharyngeal squamous cell carcinoma (OPSCC) has recently been increasingly recognized. There is conflicting evidence in the literature with regards to the prognostic value of p53 and Bcl-xL. OBJECTIVE The purpose of this study was to investigate the association between p53 and Bcl-xL expression profiles and survival outcomes in OPSCC. METHODS Patients diagnosed with OPSCC and treated with curative intent between 1998 and 2009 were included in the study. Patient demographics, disease, treatment, and oncologic outcomes were collected prospectively. A tissue microarray (TMA) from patients' biopsies or surgical specimens was retrospectively constructed. The expression levels of p53, Bcl-xL, and p16 were digitally quantified and correlated to patient survival outcomes. RESULTS One hundred and sixty-six patients were included (mean age 56.7 years; standard deviation (SD) ± 10.0; 78% male). High expression of Bcl-xL (p= 0.04) was significantly associated with nodal disease at presentation, and decreased overall survival (OS) (p= 0.04). Combined expression of low Bcl-xL and low p53 conferred a survival advantage in non-smokers (p= 0.04). Multivariate analysis supported smoking and p16 status as independent prognosticators for OS. CONCLUSIONS This study suggests that biomarker profiling using Bcl-xL and p53 levels may be of prognostic value in select patients with OPSCC.
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Affiliation(s)
- Hedyeh Ziai
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Abdulrahman Alenazi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Matthew Hearn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Daniel A O'Connell
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Lakshmi Puttagunta
- Department of Laboratory Medicine and Pathology, University of Alberta, University of Alberta Hospital, Edmonton, AB, Canada
| | - Brittany Barber
- Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Jeffrey R Harris
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Vincent L Biron
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Götz C, Bischof C, Wolff KD, Kolk A. Detection of HPV infection in head and neck cancers: Promise and pitfalls in the last ten years: A meta-analysis. Mol Clin Oncol 2019; 10:17-28. [PMID: 30655973 PMCID: PMC6313947 DOI: 10.3892/mco.2018.1749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 08/09/2018] [Indexed: 12/16/2022] Open
Abstract
The current controversial discussion on the disease-specific survival of patients with human papillomavirus (HPV)-positive (+) and -negative (-) squamous cell carcinoma (SCC) of the head neck region was the motivation for the present meta-analysis. Different detection methods for HPV are available, though these often lack sensitivity. As a consequence, there may be false interpretation of HPV positivity. A bias concerning HPV status and therefore also survival rates is serving a non-durable relevance in the discussion of tailored therapies. A literature search was performed via the online database PubMed/NCBI, and data extraction and statistical analysis were conducted. A total of 139 studies published between 2004 and 2014 were evaluated in the present meta-analysis. The HPV detection methods, patient characteristics, tumor localizations and stages, as well as (neo-) adjuvant therapies and survival times were analyzed. The average incidence rates of HPV+ patients with oropharyngeal tumors were higher than those of patients with cancers of other regions of the head and neck. Upon evaluating the results of different detection methods no significant differences were identified. We have compared the HPV incidence rates of each detection method, when studies have used more than one. Regarding overall survival, the pooled adjusted hazard ratio (HR) for oropharyngeal SCC was 0.31 [95% confidence interval (CI)=0.27-0.36]. Unfortunately, only 3 equivalent studies were available on nonoropharyngeal tumors, for which the pooled adjusted HR was 1 (95% CI=0.73-1.36). Overall, the evaluation demonstrated that the survival rates reported in numerous studies were not evaluated multifactorially and important confounders were excluded from the statistics. The HPV detection methods used were often not sufficient in representing HPV positivity. In addition, oropharyngeal and oral SCCs were assessed together in the localization. The widely differing number of HPV+ patients in each of the various studies may be explained by insufficient detection methods and by a lack of localization distinction. The considerations of a tailored therapy according to HPV status should be rejected based on the present information. The previously published studies should be read critically and do not represent a basis for therapeutic decisions.
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Affiliation(s)
- Carolin Götz
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, D-81675 Munich, Germany
| | - Clara Bischof
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, D-81675 Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, D-81675 Munich, Germany
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Klinikum Rechts der Isar, D-81675 Munich, Germany
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Lewis JS, Beadle B, Bishop JA, Chernock RD, Colasacco C, Lacchetti C, Moncur JT, Rocco JW, Schwartz MR, Seethala RR, Thomas NE, Westra WH, Faquin WC. Human Papillomavirus Testing in Head and Neck Carcinomas: Guideline From the College of American Pathologists. Arch Pathol Lab Med 2018; 142:559-597. [PMID: 29251996 DOI: 10.5858/arpa.2017-0286-cp] [Citation(s) in RCA: 329] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context Human papillomavirus (HPV) is a major cause of oropharyngeal squamous cell carcinomas, and HPV (and/or surrogate marker p16) status has emerged as a prognostic marker that significantly impacts clinical management. There is no current consensus on when to test oropharyngeal squamous cell carcinomas for HPV/p16 or on which tests to choose. Objective To develop evidence-based recommendations for the testing, application, interpretation, and reporting of HPV and surrogate marker tests in head and neck carcinomas. Design The College of American Pathologists convened a panel of experts in head and neck and molecular pathology, as well as surgical, medical, and radiation oncology, to develop recommendations. A systematic review of the literature was conducted to address 6 key questions. Final recommendations were derived from strength of evidence, open comment period feedback, and expert panel consensus. Results The major recommendations include (1) testing newly diagnosed oropharyngeal squamous cell carcinoma patients for high-risk HPV, either from the primary tumor or from cervical nodal metastases, using p16 immunohistochemistry with a 70% nuclear and cytoplasmic staining cutoff, and (2) not routinely testing nonsquamous oropharyngeal carcinomas or nonoropharyngeal carcinomas for HPV. Pathologists are to report tumors as HPV positive or p16 positive. Guidelines are provided for testing cytologic samples and handling of locoregional and distant recurrence specimens. Conclusions Based on the systematic review and on expert panel consensus, high-risk HPV testing is recommended for all new oropharyngeal squamous cell carcinoma patients, but not routinely recommended for other head and neck carcinomas.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - William C Faquin
- From the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Lewis); the Department of Radiation Oncology, Stanford University Medical Center, Palo Alto, California (Dr Beadle); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Drs Bishop and Westra); the Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri (Dr Chernock); Surveys, the College of American Pathologists, Northfield, Illinois (Mss Colasacco and Thomas); Policy and Advocacy, American Society of Clinical Oncology, Alexandria, Virginia (Ms Lacchetti); the Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Moncur); the Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexler Medical Center, Columbus (Dr Rocco); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Schwartz); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Seethala); and the Department of Pathology, Massachusetts General Hospital, Boston (Dr Faquin)
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7
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Habbous S, Chu KP, Lau H, Schorr M, Belayneh M, Ha MN, Murray S, O'Sullivan B, Huang SH, Snow S, Parliament M, Hao D, Cheung WY, Xu W, Liu G. Human papillomavirus in oropharyngeal cancer in Canada: analysis of 5 comprehensive cancer centres using multiple imputation. CMAJ 2017; 189:E1030-E1040. [PMID: 28808115 DOI: 10.1503/cmaj.161379] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The incidence of oropharyngeal cancer has risen over the past 2 decades. This rise has been attributed to human papillomavirus (HPV), but information on temporal trends in incidence of HPV-associated cancers across Canada is limited. METHODS We collected social, clinical and demographic characteristics and p16 protein status (p16-positive or p16-negative, using this immunohistochemistry variable as a surrogate marker of HPV status) for 3643 patients with oropharyngeal cancer diagnosed between 2000 and 2012 at comprehensive cancer centres in British Columbia (6 centres), Edmonton, Calgary, Toronto and Halifax. We used receiver operating characteristic curves and multiple imputation to estimate the p16 status for missing values. We chose a best-imputation probability cut point on the basis of accuracy in samples with known p16 status and through an independent relation between p16 status and overall survival. We used logistic and Cox proportional hazard regression. RESULTS We found no temporal changes in p16-positive status initially, but there was significant selection bias, with p16 testing significantly more likely to be performed in males, lifetime never-smokers, patients with tonsillar or base-of-tongue tumours and those with nodal involvement (p < 0.05 for each variable). We used the following variables associated with p16-positive status for multiple imputation: male sex, tonsillar or base-of-tongue tumours, smaller tumours, nodal involvement, less smoking and lower alcohol consumption (p < 0.05 for each variable). Using sensitivity analyses, we showed that different imputation probability cut points for p16-positive status each identified a rise from 2000 to 2012, with the best-probability cut point identifying an increase from 47.3% in 2000 to 73.7% in 2012 (p < 0.001). INTERPRETATION Across multiple centres in Canada, there was a steady rise in the proportion of oropharyngeal cancers attributable to HPV from 2000 to 2012.
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Affiliation(s)
- Steven Habbous
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Karen P Chu
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Harold Lau
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Melissa Schorr
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Mathieos Belayneh
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Michael N Ha
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Scott Murray
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Brian O'Sullivan
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Shao Hui Huang
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Stephanie Snow
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Matthew Parliament
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Desiree Hao
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Winson Y Cheung
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Wei Xu
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
| | - Geoffrey Liu
- Ontario Cancer Institute (Habbous, O'Sullivan, Huang, Liu) and Department of Biostatistics (Xu), Princess Margaret Cancer Centre, Toronto, Ont.; Radiation Oncology (Chu, Belayneh, Parliament), Cross Cancer Institute, Edmonton, Alta.; Department of Oncology (Lau, Hao), University of Calgary, Alberta Health Services, Calgary, Alta.; Department of Oncology (Schorr, Hao), Division of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alta.; Division of Medical Oncology (Ha, Murray, Snow), Nova Scotia Cancer Centre, Dalhousie University, Halifax, NS; Department of Radiation Oncology (O'Sullivan, Huang), Department of Medicine (Liu) and Department of Epidemiology, Dalla Lana School of Public Health (Liu), University of Toronto, Toronto, Ont.; Medical Oncology (Cheung), BC Cancer Agency, Vancouver, BC
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8
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Karpathiou G, Monaya A, Forest F, Froudarakis M, Casteillo F, Marc Dumollard J, Prades JM, Peoc'h M. p16 and p53 expression status in head and neck squamous cell carcinoma: a correlation with histological, histoprognostic and clinical parameters. Pathology 2016; 48:341-8. [DOI: 10.1016/j.pathol.2016.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/22/2015] [Accepted: 01/27/2016] [Indexed: 01/08/2023]
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9
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Rosko AJ, Birkeland AC, Wilson KF, Muenz DG, Bellile E, Bradford CR, McHugh JB, Spector ME. Tumor Biomarkers in Spindle Cell Variant Squamous Cell Carcinoma of the Head and Neck. Otolaryngol Head Neck Surg 2016; 155:106-12. [PMID: 26980915 DOI: 10.1177/0194599816636612] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/10/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine biomarkers of recurrence and survival in patients with spindle cell variant squamous cell carcinoma (SpSCC) of the head and neck. STUDY DESIGN Retrospective case control study. SETTING Tertiary academic center. SUBJECTS AND METHODS Thirty-two SpSCC patients (mean age, 68.8) between 1987 and 2009 were identified and reviewed. A tissue microarray (TMA) was constructed from tumor specimens. Tumor biomarkers under study included p16, epidermal growth factor receptor (EGFR), p53, EZH2, cyclin D1, CD104, HGFa, p21, and cMET. An additional TMA was constructed from patients with non-SpSCC oral cavity squamous cell carcinoma for comparative purposes. The main outcomes were overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). RESULTS In the SpSCC cohort, tumors positive for cMet had worse OS (P < .001). Patients positive for cMet (P = .007), cyclin D1 (P = .019), and p16 (P = .004) had worse DSS. Recurrence-free survival was also worse in patients with tumors positive for cMet (P = .037), cyclin D1 (P = .012), and p16 (P < .001). Compared with the oral cavity cohort, there was a significantly larger proportion of patients in the SpSCC group with tumors staining positive for cMet and a lower proportion of tumors positive for cyclin D1. CONCLUSION cMet, cyclin D1, and p16 are predictive tumor biomarkers for risk of recurrence and worse DSS in patients with SpSCC.
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Affiliation(s)
- Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew C Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin F Wilson
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Daniel G Muenz
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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10
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Eriksen JG, Lassen P. Human Papilloma Virus as a Biomarker for Personalized Head and Neck Cancer Radiotherapy. Recent Results Cancer Res 2016; 198:143-61. [PMID: 27318685 DOI: 10.1007/978-3-662-49651-0_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A dramatic increase in the incidence of HPV-related oropharyngeal cancer has been reported in some parts of the western world over the past 30 years. They constitute a clinically distinct subgroup of cancers in terms of molecular biology, patient characteristics, and treatment outcome. This chapter describes the molecular characteristics, epidemiology, and demographics of the HPV-related head and neck cancers and discuss available methods to detect HPV-related tumours. The impact of HPV-related biomarkers in clinical studies on radiotherapy only, altered fractionation, modulation of hypoxia, and concurrent chemo- or bio-radiotherapy are reviewed as well as the perspectives of de-escalation and immune-modulation are discussed.
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Affiliation(s)
| | - Pernille Lassen
- Department of Oncology, Department of Clinical Experimental Oncology, Aarhus University Hospital, 8000, Aarhus C, Denmark
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11
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Clark J, Jeffery CC, Zhang H, Cooper T, O'Connell DA, Harris J, Seikaly H, Biron VL. Correlation of PET-CT nodal SUVmax with p16 positivity in oropharyngeal squamous cell carcinoma. J Otolaryngol Head Neck Surg 2015; 44:37. [PMID: 26374294 PMCID: PMC4570692 DOI: 10.1186/s40463-015-0091-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/02/2015] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) has been rising in recent years. Given the clinical impact of HPV/p16 positivity in OPSCC, identifying surrogate markers of this disease early in the diagnostic work-up of these patients could improve patient care. Methods Demographic, pathologic, staging and PET-CT data from patients diagnosed with OPSCC from 2009–2014 were obtained from a prospectively collected provincial cancer registry. Tumor HPV/p16 status was correlated to the maximum standard uptake value (SUVmax) of the primary tumor and cervical nodes. Comparisons of means and multinomial regression models were used to determine associations between p16 status and SUVmax. A diagnostic odds ratio was calculated using a cut off value for predicting HPV/p16 positivity based on nodal SUVmax. Results PET-CT and HPV/p16 data was obtained for 65 patients treated surgically for OPSCC. Significantly higher nodal SUVmax was associated with HPV/p16 positive nodes (SUVmax 10.8 vs 7.9). No significant differences were seen between HPV/p16 positive vs negative primary tumor SUVmax (10.3 vs 13.7). In combination with other clinical parameters, higher nodal SUVmax was highly correlated with HPV/p16 positivity. Conclusion Elevated nodal SUVmax is a significant predictor of HPV/p16 positive disease.
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Affiliation(s)
- Jessica Clark
- Faculty of Medicine and Dentistry, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Caroline C Jeffery
- Faculty of Medicine and Dentistry, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Han Zhang
- Faculty of Medicine and Dentistry, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Tim Cooper
- Faculty of Medicine and Dentistry, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Daniel A O'Connell
- Faculty of Medicine and Dentistry, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada. dan.o'
| | - Jeffrey Harris
- Faculty of Medicine and Dentistry, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Hadi Seikaly
- Faculty of Medicine and Dentistry, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Vincent L Biron
- Faculty of Medicine and Dentistry, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada. .,University of Alberta, Otolaryngology-Head and Neck Surgery, 1E4, Walter Mackenzie Centre, University of Alberta Hospital, 8440-112St, Edmonton, Alberta, T6G 2B7, Canada.
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12
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Seikaly H, Biron VL, Zhang H, O'Connell DA, Côté DWJ, Ansari K, Williams DC, Puttagunta L, Harris JR. Role of primary surgery in the treatment of advanced oropharyngeal cancer. Head Neck 2015; 38 Suppl 1:E571-9. [DOI: 10.1002/hed.24042] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 12/30/2014] [Accepted: 03/06/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Hadi Seikaly
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | - Vincent L. Biron
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | - Han Zhang
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | - Daniel A. O'Connell
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | - David W. J. Côté
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | - Khalid Ansari
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | - David C. Williams
- Division of General Surgery; Department of Surgery; University of Alberta; Edmonton Alberta Canada
| | - Lakshmi Puttagunta
- Department of Laboratory Medicine and Pathology; University of Alberta, University of Alberta Hospital; Edmonton Alberta Canada
| | - Jeffrey R. Harris
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; University of Alberta; Edmonton Alberta Canada
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13
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Isayeva T, Xu J, Ragin C, Dai Q, Cooper T, Carroll W, Dayan D, Vered M, Wenig B, Rosenthal E, Grizzle W, Anderson J, Willey CD, Yang ES, Brandwein-Gensler M. The protective effect of p16(INK4a) in oral cavity carcinomas: p16(Ink4A) dampens tumor invasion-integrated analysis of expression and kinomics pathways. Mod Pathol 2015; 28:631-53. [PMID: 25523612 DOI: 10.1038/modpathol.2014.149] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/08/2014] [Accepted: 09/11/2014] [Indexed: 11/09/2022]
Abstract
A large body of evidence shows that p16(INK4a) overexpression predicts improved survival and increased radiosensitivity in HPV-mediated oropharyngeal squamous cell carcinomas.(OPSCC). Here we demonstrate that the presence of transcriptionally active HPV16 in oral cavity squamous cell carcinomas does not correlate with p16(INK4a) overexpression, enhanced local tumor immunity, or improved outcome. It is interesting that HPV-mediated oropharyngeal squamous cell carcinomas can be categorized as having a 'nonaggressive' invasion phenotype, whereas aggressive invasion phenotypes are more common in HPV-negative squamous cell carcinomas. We have developed primary cancer cell lines from resections with known pattern of invasion as determined by our validated risk model. Given that cell lines derived from HPV-mediated oropharyngeal squamous cell carcinomas are less invasive than their HPV-negative counterparts, we tested the hypothesis that viral oncoproteins E6, E7, and p16(INK4a) can affect tumor invasion. Here we demonstrate that p16(INK4a) overexpression in two cancer cell lines (UAB-3 and UAB-4), derived from oral cavity squamous cell carcinomas with the most aggressive invasive phenotype (worst pattern of invasion type 5 (WPOI-5)), dramatically decreases tumor invasiveness by altering expression of extracellular matrix remodeling genes. Pathway analysis integrating changes in RNA expression and kinase activities reveals different potential p16(INK4a)-sensitive pathways. Overexpressing p16(INK4a) in UAB-3 increases EGFR activity and increases MMP1 and MMP3 expression, possibly through STAT3 activation. Overexpressing p16(INK4a) in UAB-4 decreases PDGFR gene expression and reduces MMP1 and MMP3, possibly through STAT3 inactivation. Alternatively, ZAP70/Syk might increase MUC1 phosphorylation, leading to the observed decreased MMP1 expression.
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Affiliation(s)
- Tatyana Isayeva
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jie Xu
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health, Philadelphia, PA, USA
| | - Qian Dai
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffiny Cooper
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William Carroll
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dan Dayan
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Marilena Vered
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Bruce Wenig
- Department of Pathology, Beth Israel Medical Center, Continuum Health Partners, New York, NY, USA
| | - Eben Rosenthal
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William Grizzle
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joshua Anderson
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher D Willey
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eddy S Yang
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Margaret Brandwein-Gensler
- Departments of Pathology, Surgery, Medicine, Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Cooper T, Biron VL, Fast D, Tam R, Carey T, Shmulevitz M, Seikaly H. Oncolytic activity of reovirus in HPV positive and negative head and neck squamous cell carcinoma. J Otolaryngol Head Neck Surg 2015; 44:8. [PMID: 25890191 PMCID: PMC4348167 DOI: 10.1186/s40463-015-0062-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/09/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The management of patients with advanced stages of head and neck cancer requires a multidisciplinary and multimodality treatment approach which includes a combination of surgery, radiation, and chemotherapy. These toxic treatment protocols have significantly improved survival outcomes in a distinct population of human papillomavirus (HPV) associated oropharyngeal cancer. HPV negative head and neck squamous cell carcinoma (HNSCC) remains a challenge to treat because there is only a modest improvement in survival with the present treatment regimens, requiring innovative and new treatment approaches. Oncolytic viruses used as low toxicity adjunct cancer therapies are novel, potentially effective treatments for HNSCC. One such oncolytic virus is Respiratory Orphan Enteric virus or reovirus. Susceptibility of HNSCC cells towards reovirus infection and reovirus-induced cell death has been previously demonstrated but has not been compared in HPV positive and negative HNSCC cell lines. OBJECTIVES To compare the infectivity and oncolytic activity of reovirus in HPV positive and negative HNSCC cell lines. METHODS Seven HNSCC cell lines were infected with serial dilutions of reovirus. Two cell lines (UM-SCC-47 and UM-SCC-104) were positive for type 16 HPV. Infectivity was measured using a cell-based ELISA assay 18 h after infection. Oncolytic activity was determined using an alamar blue viability assay 96 h after infection. Non-linear regression models were used to calculate the amounts of virus required to infect and to cause cell death in 50% of a given cell line (EC50). EC50 values were compared. RESULTS HPV negative cells were more susceptible to viral infection and oncolysis compared to HPV positive cell lines. EC50 for infectivity at 18 h ranged from multiplicity of infection (MOI) values (PFU/cell) of 18.6 (SCC-9) to 3133 (UM-SCC 104). EC50 for cell death at 96 h ranged from a MOI (PFU/cell) of 1.02×10(2) (UM-SCC-14A) to 3.19×10(8) (UM-SCC-47). There was a 3×10(6) fold difference between the least susceptible cell line (UM-SCC-47) and the most susceptible line (UM-SCC 14A) EC50 for cell death at 96 h. CONCLUSIONS HPV negative HNSCC cell lines appear to demonstrate greater reovirus infectivity and virus-mediated oncolysis compared to HPV positive HNSCC. Reovirus shows promise as a novel therapy in HNSCC, and may be of particular benefit in HPV negative patients.
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Affiliation(s)
- Timothy Cooper
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, 1E4 Walter Mackenzie Center, 8440 112 St., Edmonton, AB, T6G 2B7, Canada.
| | - Vincent L Biron
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, 1E4 Walter Mackenzie Center, 8440 112 St., Edmonton, AB, T6G 2B7, Canada.
| | - David Fast
- Faculty of Science 1-001 CCIS, University of Alberta, Edmonton, AB, T6G 2E9, Canada.
| | - Raymond Tam
- Faculty of Medicine and Dentistry, University of Alberta, 2J2 WC Mackenzie Health Sciences Centre, Edmonton, AB, T6G 2R7, Canada.
| | - Thomas Carey
- Department of Head and Neck Surgery, University of Michigan, 5311B Med Sci I, Ann Arbor, MI, 48109-5616, USA.
| | - Maya Shmulevitz
- Department of Medical Microbiology and Immunology, University of Alberta, 6-142 J Katz Group Centre for Pharmacy & Health Research, Edmonton, AB, T6G 2E1, Canada.
| | - Hadi Seikaly
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, 1E4 Walter Mackenzie Center, 8440 112 St., Edmonton, AB, T6G 2B7, Canada.
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15
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Shapiro LQ, Sherman EJ, Riaz N, Setton J, Koutcher L, Zhang Z, Shi W, Fury MG, Wolden SL, Pfister DG, Morris L, Lee N. Efficacy of concurrent cetuximab vs. 5-fluorouracil/carboplatin or high-dose cisplatin with intensity-modulated radiation therapy (IMRT) for locally-advanced head and neck cancer (LAHNSCC). Oral Oncol 2014; 50:947-55. [PMID: 25132089 PMCID: PMC5125726 DOI: 10.1016/j.oraloncology.2014.07.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/09/2014] [Accepted: 07/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We previously reported inferior outcomes for locally-advanced head and neck squamous cell carcinoma (LAHNSCC) patients treated with concurrent cetuximab vs. high-dose cisplatin with intensity-modulated radiation therapy (IMRT). Prior to FDA approval of cetuximab for LAHNSCC, non-cisplatin eligible patients at our institution received 5-fluorouracil (5FU)/carboplatin. We sought to compare concurrent cetuximab vs. 5FU/carboplatin vs. high-dose cisplatin with IMRT for LAHNSCC. MATERIALS AND METHODS Retrospective review was performed for LAHNSCC patients treated at Memorial Sloan-Kettering Cancer Center from 11/02 to 04/08 with concurrent cetuximab (n=49), 5FU/carboplatin (n=52), or cisplatin (n=259) and IMRT. Overall survival (OS), locoregional failure (LRF), distant metastasis-free survival, and late toxicity were analyzed using univariate and multivariate analyses. OS analysis was confirmed by propensity score adjustment. RESULTS Treatment groups were similar with regard to primary tumor site, overall stage, and alcohol and tobacco history. Cetuximab and 5FU/carboplatin patients were older, with lower performance status, more comorbidities, higher T classification, and worse renal function. On multivariate analysis, compared with cisplatin and 5FU/carboplatin, cetuximab was associated with inferior 4-year OS (86.9% vs. 70.2% vs. 40.9%; P<.0001) and 4-year LRF (6.3% vs. 9.7% vs. 40.2%; P<.0001). Late toxicity was highest with 5FU/carboplatin (25.0%) vs. cisplatin (8.0%) vs. cetuximab (7.7%). CONCLUSIONS Although 5FU/carboplatin patients were sicker and experienced greater toxicity than cisplatin patients, no significant difference was found in all endpoints. In contrast, despite similar pretreatment characteristics, outcomes for cetuximab vs. 5FU/carboplatin were significantly worse. We feel that caution should be used with routine use of cetuximab in the management of LAHNSCC.
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Affiliation(s)
- Lauren Q Shapiro
- Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY, United States
| | - Eric J Sherman
- Memorial Sloan-Kettering Cancer Center, Department of Medicine, New York, NY, United States
| | - Nadeem Riaz
- Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY, United States
| | - Jeremy Setton
- Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY, United States
| | - Lawrence Koutcher
- Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY, United States
| | - Zhigang Zhang
- Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY, United States
| | - Weiji Shi
- Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY, United States
| | - Matthew G Fury
- Memorial Sloan-Kettering Cancer Center, Department of Medicine, New York, NY, United States
| | - Suzanne L Wolden
- Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY, United States
| | - David G Pfister
- Memorial Sloan-Kettering Cancer Center, Department of Medicine, New York, NY, United States
| | - Luc Morris
- Memorial Sloan-Kettering Cancer Center, Department of Surgery, New York, NY, United States
| | - Nancy Lee
- Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY, United States.
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16
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Saba NF, Wilson M, Doho G, DaSilva J, Benjamin Isett R, Newman S, Chen ZG, Magliocca K, Rossi MR. Mutation and Transcriptional Profiling of Formalin-Fixed Paraffin Embedded Specimens as Companion Methods to Immunohistochemistry for Determining Therapeutic Targets in Oropharyngeal Squamous Cell Carcinoma (OPSCC): A Pilot of Proof of Principle. Head Neck Pathol 2014; 9:223-35. [PMID: 25236499 PMCID: PMC4424213 DOI: 10.1007/s12105-014-0566-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 08/17/2014] [Indexed: 11/24/2022]
Abstract
The role of molecular methods in the diagnosis of head and neck cancer is rapidly evolving and holds great potential for improving outcomes for all patients who suffer from this diverse group of malignancies . However, there is considerable debate as to the best clinical approaches, particularly for Next Generation Sequencing (NGS). The choices of NGS methods such as whole exome, whole genome, whole transcriptomes (RNA-Seq) or multiple gene resequencing panels, each have strengths and weakness based on data quality, the size of the data, the turnaround time for data analysis, and clinical actionability. There have also been a variety of gene expression signatures established from microarray studies that correlate with relapse and response to treatment, but none of these methods have been implemented as standard of care for oropharyngeal squamous cell carcinoma (OPSCC). Because many genomic methodologies are still far from the capabilities of most clinical laboratories, we chose to explore the use of a combination of off the shelf targeted mutation analysis and gene expression analysis methods to complement standard anatomical pathology methods. Specifically, we have used the Ion Torrent AmpliSeq cancer panel in combination with the NanoString nCounter Human Cancer Reference Kit on 8 formalin-fixed paraffin embedded (FFPE) OPSCC tumor specimens, (4) HPV-positive and (4) HPV-negative. Differential expression analysis between HPV-positive and negative groups showed that expression of several genes was highly likely to correlate with HPV status. For example, WNT1, PDGFA and OGG1 were all over-expressed in the positive group. Our results show the utility of these methods with routine FFPE clinical specimens to identify potential therapeutic targets which could be readily applied in a clinical trial setting for clinical laboratories lacking the instrumentation or bioinformatics infrastructure to support comprehensive genomics workflows. To the best of our knowledge, these preliminary experiments are among the earliest to combine both mutational and gene expression profiles using Ion Torrent and NanoString technologies. This reports serves as a proof of principle methodology in OPSCC.
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Affiliation(s)
- Nabil F. Saba
- />Department of Otolaryngology and Head and Neck Oncology Program, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA USA , />Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA USA
| | - Malania Wilson
- />Emory Integrated Genomics Core, Emory University School of Medicine, Atlanta, GA USA
| | - Gregory Doho
- />Emory Integrated Genomics Core, Emory University School of Medicine, Atlanta, GA USA
| | - Juliana DaSilva
- />Emory Integrated Genomics Core, Emory University School of Medicine, Atlanta, GA USA
| | - R. Benjamin Isett
- />Emory Integrated Genomics Core, Emory University School of Medicine, Atlanta, GA USA
| | - Scott Newman
- />Biostatistics and Bioinformatics, Emory University School of Medicine, Atlanta, GA USA
| | - Zhuo Georgia Chen
- />Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA USA
| | - Kelly Magliocca
- />Department of Otolaryngology and Head and Neck Oncology Program, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA USA , />Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - Michael R. Rossi
- />Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA USA , />Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA USA
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17
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Choby GW, Albergotti WG, Byrd JK, Egloff AM, Johnson JT. Factors contributing to recurrence of oral cavity and laryngeal tumors and estimation of tumor age. Laryngoscope 2014; 124:2297-304. [DOI: 10.1002/lary.24745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/08/2014] [Accepted: 04/29/2014] [Indexed: 01/18/2023]
Affiliation(s)
- Garret W. Choby
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania U.S.A
| | - William G. Albergotti
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania U.S.A
| | - James K. Byrd
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania U.S.A
| | - Ann Marie Egloff
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania U.S.A
| | - Jonas T. Johnson
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania U.S.A
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Cooper T, Biron V, Adam B, Klimowicz AC, Puttagunta L, Seikaly H. Prognostic utility of basaloid differentiation in oropharyngeal cancer. J Otolaryngol Head Neck Surg 2013; 42:57. [PMID: 24350944 PMCID: PMC3892036 DOI: 10.1186/1916-0216-42-57] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 11/21/2013] [Indexed: 12/24/2022] Open
Abstract
Background Human papillomavirus (HPV) is recognized as the key risk factor for a distinct subset of oropharyngeal squamous cell carcinoma. P16 is a reliable, sensitive surrogate marker for HPV and confers a positive prognostic advantage. Basaloid differentiation on hematoxylin and eosin (H&E) staining is anecdotally noted by some pathologists to be associated with p16 positivity. This association, however, has not been adequately quantified in the literature, nor has the prognostic implications of basaloid differentiation been described. Objectives 1) To correlate the H&E staining feature of basaloid differentiation with p16 positivity in oropharyngeal cancer. 2) To investigate the prognostic utility of basaloid differentiation in oropharyngeal cancer survival. Methods Retrospective cross-sectional study of all patients diagnosed with and treated for oropharyngeal cancer at a single tertiary cancer center from 2002 to 2009. Tissue microarrays (TMAs) were generated from 208 oropharyngeal tumor specimens stained with H&E and immunohistochemical markers. These oropharyngeal TMAs were utilized in several previous publications. Samples were scored for basaloid differentiation by a pathologist blinded to the p16 result. A multivariate survival analysis with Cox-regression and Kaplan-Meier survival analysis was performed. Results In the 208 samples, basaloid differentiation correlated with p16 positivity (Spearman’s rho 0.435). Basaloid differentiation and p16 positivity were both independent predictors of improved survival. The 5 year disease specific survival (DSS) was 73% for p16 positive tumors and 35% for p16 negative tumors (p < 0.001). Similarly, the 5 year DSS of basaloid differentiated tumors was 74% compared to 41% for non-basaloid tumors (p = 0.001). Patients with p16 positive and basaloid differentiated tumors had the best survival outcomes with a 5 year DSS of 80%. Conclusions Basaloid differentiation is a feature on H&E which correlates with p16 positivity and is a simple, inexpensive, independent, positive prognostic indicator of comparable magnitude to p16 status. Due to the added prognostic value of basaloid differentiation, this feature should be routinely reported by qualified pathologists.
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Affiliation(s)
| | | | | | | | | | - Hadi Seikaly
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, 1E4 University of Alberta Hospital, Edmonton, AB T6G 2B7, Canada.
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Barber BR, Biron VL, Klimowicz AC, Puttagunta L, Côté DWJ, Seikaly H. Molecular predictors of locoregional and distant metastases in oropharyngeal squamous cell carcinoma. J Otolaryngol Head Neck Surg 2013; 42:53. [PMID: 24401183 PMCID: PMC3819019 DOI: 10.1186/1916-0216-42-53] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/19/2013] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing due to fundamental changes in oncogenesis related to effects of the human papilomavirus (HPV). Virally-mediated tumours behave and respond to treatment differently than their classic, carcinogenically-mediated counterparts despite similar stage and grade of disease. This difference in behaviour has lead to investigation of etiologies of OPSCC at the molecular level. Molecular biomarkers offer potential insight into the behaviour of OPSCC. Identifying a subset of patients that are more likely to have recurrence and distant metastasis is valuable for prognostication and treatment planning. There is limited information regarding the profiles of these biomarkers in locoregional and distant metastases in OPSCC. Objective This study was designed to identify biomarker profiles predictive of locoregional and distant metastases and recurrence in OPSCC. Methods Cross-sectional study of a prospectively-collected oropharyngeal tumour database was undertaken. All patients with OPSCC presenting to the University of Alberta Hospital from 2002-2009 were included in the study. Data collection from the Alberta Cancer Registry, including demographics, nodal status, distant metastases, treatment, recurrence, and survival, was undertaken. Tissue micro-arrays (TMAs) were constructed for each tumour specimen using triplicate cores (0.6mm) of formalin-fixed, paraffin-embedded (FFPE) pre-treatment tumour tissue. TMAs were processed using immunohistochemistry for p16, EGFR, Ki67, p53, and Bcl-XL. Positivity for each biomarker was determined using quantified AQUAnalysis ® scores on histoplots. Multivariate statistics were utilized to assess the relationship between each biomarker and locoregional and distant metastases, as well as recurrence-free survival (RFS). Results High expression of p16 (p=0.000) and Bcl-XL (p=0.039) independently demonstrated a significant association with nodal disease at presentation. Kaplan-Meier analysis demonstrated improved RFS in patients with high p16 and decreased RFS in patients with high p53 expression. Cox regression analysis supported p16 as an independent prognosticator for improved RFS. p53 demonstrated an association with recurrence, but when compared to p16 status, nodal status, and staging, was not an independent predictor of recurrence. Conclusions Biomarker profiling using p16, Bcl-xL, and p53 may be useful in prognostication and treatment planning in patients with OPSCC.
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Hunt JL, Barnes L, Lewis JS, Mahfouz ME, Slootweg PJ, Thompson LDR, Cardesa A, Devaney KO, Gnepp DR, Westra WH, Rodrigo JP, Woolgar JA, Rinaldo A, Triantafyllou A, Takes RP, Ferlito A. Molecular diagnostic alterations in squamous cell carcinoma of the head and neck and potential diagnostic applications. Eur Arch Otorhinolaryngol 2013; 271:211-23. [PMID: 23467835 DOI: 10.1007/s00405-013-2400-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 02/07/2013] [Indexed: 12/12/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a common malignancy that continues to be difficult to treat and cure. In many organ systems and tumor types, there have been significant advances in the understanding of the molecular basis for tumorigenesis, disease progression and genetic implications for therapeutics. Although tumorigenesis pathways and the molecular etiologies of HNSCC have been extensively studied, there are still very few diagnostic clinical applications used in practice today. This review discusses current clinically applicable molecular markers, including viral detection of Epstein-Barr virus and human papillomavirus, and molecular targets that are used in diagnosis and management of HNSCC. The common oncogenes EGFR, RAS, CCND1, BRAF, and PIK3CA and tumor suppressor genes p53, CDKN2A and NOTCH are discussed for their associations with HNSCC. Discussion of markers with potential future applications is also included, with a focus on molecular alterations associated with targeted therapy resistance.
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Affiliation(s)
- Jennifer L Hunt
- Department of Pathology and Laboratory Services, College of Medicine, University of Arkansas for Medical Sciences, Arkansas, USA
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21
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O'Rorke MA, Ellison MV, Murray LJ, Moran M, James J, Anderson LA. Human papillomavirus related head and neck cancer survival: a systematic review and meta-analysis. Oral Oncol 2012; 48:1191-201. [PMID: 22841677 DOI: 10.1016/j.oraloncology.2012.06.019] [Citation(s) in RCA: 294] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 06/18/2012] [Accepted: 06/29/2012] [Indexed: 01/22/2023]
Abstract
Human Papillomavirus (HPV) related oropharyngeal squamous cell carcinomas (OPSCCs) are reported to have improved prognosis and survival in comparison to other head and neck squamous cell cancers (HNSCCs). This systematic review and meta-analysis examines survival differences in HPV-positive HNSCC and OPSCC subtypes including tonsillar carcinoma in studies not previously investigated. Four electronic databases were searched from their inception till April 2011. A random effects meta-analysis was used to pool study estimates evaluating disease-specific (death from HNSCC), overall (all-cause mortality), progression-free and disease-free (recurrence free) survival outcomes in HPV-positive vs. HPV-negative HNSCCs. All statistical tests were two-sided. Forty-two studies were included. Patients with HPV-positive HNSCC had a 54% better overall survival compared to HPV-negative patients HR 0.46 (95% CI 0.37-0.57); the pooled HR for tonsillar cancer and OPSCC was 0.50 (95% CI 0.33-0.77) and HR 0.47 (95% CI 0.35-0.62) respectively. The pooled HR for disease specific survival was 0.28 (95% CI 0.19-0.40); similar effect sizes were found irrespective of the adjustment for confounders, HPV detection methods or study location. Both progression-free survival and disease-free survival were significantly improved in HPV-positive HNSCCs. HPV-positive HNSCCs and OPSCCs patients have a significantly lower disease specific mortality and are less likely to experience progression or recurrence of their cancer than HPV-negative patients; findings which have connotations for treatment selection in these patients.
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Affiliation(s)
- M A O'Rorke
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queens University Belfast, Belfast, UK.
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22
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Chen ZW, Weinreb I, Kamel-Reid S, Perez-Ordoñez B. Equivocal p16 immunostaining in squamous cell carcinoma of the head and neck: staining patterns are suggestive of HPV status. Head Neck Pathol 2012; 6:422-9. [PMID: 22801997 PMCID: PMC3500888 DOI: 10.1007/s12105-012-0382-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 06/27/2012] [Indexed: 01/03/2023]
Abstract
p16 immunohistochemistry (IHC) is commonly used as a surrogate marker for human papillomavirus (HPV) detection in squamous cell carcinomas of the head and neck (SCCHN). However, the HPV status of tumors not staining strongly for p16 is difficult to interpret and may require the use of PCR, not available in all laboratories, as a final arbiter. We aim to determine if staining pattern in equivocal p16 staining and correlation to the percentage of positively stained tumor cells is predictive of HPV status. A retrospective review was performed on all SCCHN that underwent p16 IHC and PCR in our institution from 2007 to 2010. Descriptors of staining pattern in the original IHC report were retrieved. All available IHC slides were reviewed and reclassified using consensus staining pattern descriptors. Original and reclassified descriptors were compared to the final PCR HPV status for statistical significance using the χ(2) test. An estimate of the percentage of tumor cells that showed any form of staining was performed. Thirty-two SCCHN cases that underwent PCR HPV testing had equivocal p16 IHC results. Twenty-six cases available for review were reclassified into four staining patterns. Comparing age, sex, tumor site and diagnosis to HPV PCR status showed no statistically significant findings. However, comparing original descriptors to HPV status was statistically significant with isolated staining associated with negative HPV status (p = 0.0002). Analysis using reclassified descriptors showed strong association of membranous/cytoplasmic staining of isolated cells with negative HPV status and faint, diffuse nuclear and cytoplasmic staining with positive HPV status (p = 0.00006). HPV-negative cases with the former pattern had no more than 30 % positively-stained tumor cells and HPV-positive cases with the latter pattern had 50-90 % positively-stained cells. Our results suggest that pattern of staining in p16 IHC is associated with HPV status. For instance, a diffuse nuclear and cytoplasmic staining pattern, regardless of intensity, is associated with HPV positivity. The HPV-positive cases determined by staining pattern were also associated with a higher percentage of stained tumor cells.
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Affiliation(s)
- Zhongchuan Will Chen
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, ON Canada
| | - Ilan Weinreb
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, ON Canada
| | - Suzanne Kamel-Reid
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, ON Canada
| | - Bayardo Perez-Ordoñez
- Department of Laboratory Medicine and Pathobiology, University Health Network, University of Toronto, Toronto, ON Canada
- Department of Pathology, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
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Granata R, Miceli R, Orlandi E, Perrone F, Cortelazzi B, Franceschini M, Locati L, Bossi P, Bergamini C, Mirabile A, Mariani L, Olmi P, Scaramellini G, Potepan P, Quattrone P, Ang K, Licitra L. Tumor stage, human papillomavirus and smoking status affect the survival of patients with oropharyngeal cancer: an Italian validation study. Ann Oncol 2012; 23:1832-7. [DOI: 10.1093/annonc/mdr544] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Müller S, Khuri FR, Kono SA, Beitler JJ, Shin DM, Saba NF. HPV positive squamous cell carcinoma of the oropharynx. Are we observing an unusual pattern of metastases? Head Neck Pathol 2012; 6:336-44. [PMID: 22528827 PMCID: PMC3422578 DOI: 10.1007/s12105-012-0355-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 04/01/2012] [Indexed: 11/29/2022]
Abstract
UNLABELLED To describe the clinical, histopathologic, immunohistochemical and molecular features of human papilloma virus (HPV)+ squamous cell carcinomas of the oropharynx that had an atypical clinical course. METHODS AND RESULTS Four patients with HPV+ oropharyngeal squamous cell carcinoma (OPSCC) were identified retrospectively based on unanticipated clinical behavior. The histopathology, immunohistochemistry and molecular studies of both the primary tumor and the metastases were analyzed to look for any predictors to explain the clinical course. The four patients were all male (average age 55) who presented initially with a neck mass and had stage IVA disease. Three of the primary tumors were nonkeratinizing squamous cell carcinoma and one case was a hybrid tumor of both high-grade squamous cell carcinoma and nonkeratinizing type, and all were p16 and HPV 16/18 positive. All patients received concurrent chemoradiation as primary therapy and had a complete response. Disease-free survival ranged from 7 to 15 months and metastases in 3 patients occurred only in bone, including the sternum, humerus, clavicle, and vertebrae. In one patient, distant metastases were identified in the pancreas, liver, lung and skull base. All metastatic lesions were nonkeratinizing morphology and were p16 and/or HPV positive. Two patients died of their disease, one patient is alive with disease and one patient is disease-free. Although infrequent, unanticipated clinical outcomes can occur in HPV-related OPSCC including distant metastases and bone-only metastases. The tumor morphology of the metastases was comparable to the primary and retained p16 and HPV expression.
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Affiliation(s)
- Susan Müller
- Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Road NE, Atlanta, GA 30322 USA ,Department of Otolaryngology Head and Neck Surgery, Emory University, Atlanta, GA USA ,Department of Winship Cancer Institute, Emory University, Atlanta, GA USA
| | - Fadlo R. Khuri
- Department of Winship Cancer Institute, Emory University, Atlanta, GA USA ,Department of Hematology and Medical Oncology, Emory University, Atlanta, GA USA
| | - Scott A. Kono
- Department of Winship Cancer Institute, Emory University, Atlanta, GA USA ,Department of Hematology and Medical Oncology, Emory University, Atlanta, GA USA
| | - Jonathan J. Beitler
- Department of Otolaryngology Head and Neck Surgery, Emory University, Atlanta, GA USA ,Department of Winship Cancer Institute, Emory University, Atlanta, GA USA ,Department of Hematology and Medical Oncology, Emory University, Atlanta, GA USA ,Department of Radiation Oncology, Emory University, Atlanta, GA USA
| | - Dong M. Shin
- Department of Winship Cancer Institute, Emory University, Atlanta, GA USA ,Department of Hematology and Medical Oncology, Emory University, Atlanta, GA USA
| | - Nabil F. Saba
- Department of Winship Cancer Institute, Emory University, Atlanta, GA USA ,Department of Hematology and Medical Oncology, Emory University, Atlanta, GA USA
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25
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Rades D, Seibold ND, Gebhard MP, Noack F, Schild SE, Thorns C. Prognostic factors (including HPV status) for irradiation of locally advanced squamous cell carcinoma of the head and neck (SCCHN). Strahlenther Onkol 2011; 187:626-32. [DOI: 10.1007/s00066-011-1139-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 06/14/2011] [Indexed: 10/17/2022]
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26
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van Monsjou H, van Velthuysen M, van den Brekel M, Jordanova E, Melief C, Balm A. Human papillomavirus status in young patients with head and neck squamous cell carcinoma. Int J Cancer 2011; 130:1806-12. [DOI: 10.1002/ijc.26195] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 05/02/2011] [Indexed: 01/11/2023]
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27
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Hunt JL. An update on molecular diagnostics of squamous and salivary gland tumors of the head and neck. Arch Pathol Lab Med 2011; 135:602-9. [PMID: 21526958 DOI: 10.5858/2010-0655-rair.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Molecular testing in anatomic pathology is becoming standardized and can contribute valuable diagnostic, therapeutic, and prognostic information for the clinical management of patients. In head and neck pathology, recent advances in molecular testing have provided important targets in several different diagnostic areas, with particular emerging clinical applications in squamous and salivary gland pathology. In squamous mucosal-derived lesions, human papilloma virus has emerged as an important pathogenic etiology in a subset of oropharyngeal squamous cell carcinomas. Within the category of salivary gland tumors, 3 tumors have recently been recognized that contain oncogenic translocations. OBJECTIVE To describe the current state of information about the molecular alterations in squamous lesions and in salivary gland tumors of the head and neck. DATA SOURCES Published literature on squamous and salivary gland tumors of the head and neck. CONCLUSIONS The different approaches to identification of viral-associated tumors include assays using polymerase chain reaction, in situ hybridization, and immunohistochemistry. Most mucoepidermoid carcinomas harbor MECT1-MAML2 gene rearrangement. The MYB-NFIB translocations have recently been identified in adenoid cystic carcinomas. Finally, a newly described tumor of salivary gland, mammary analogue secretory carcinoma, harbors the ETV6-NTRK3 translocation. Although these translocations are just emerging as diagnostic targets, future roles may evolve as potential therapeutic targets.
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Affiliation(s)
- Jennifer L Hunt
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
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Brockton N, Dort J, Lau H, Hao D, Brar S, Klimowicz A, Petrillo S, Diaz R, Doll C, Magliocco A. High Stromal Carbonic Anhydrase IX Expression Is Associated With Decreased Survival in p16-Negative Head-and-Neck Tumors. Int J Radiat Oncol Biol Phys 2011; 80:249-57. [DOI: 10.1016/j.ijrobp.2010.11.059] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 11/02/2010] [Accepted: 11/12/2010] [Indexed: 12/30/2022]
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Kader HA, Wick DA, Webb JR. Research Highlights: Do conventional treatments for HPV-positive head and neck cancers elicit immunotherapeutic type responses? Immunotherapy 2011; 3:469-73. [DOI: 10.2217/imt.11.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Hosam A Kader
- Radiation Therapy Program, British Columbia Cancer Agency, Victoria, British Columbia, V8R 6V5, Canada
| | - Darin A Wick
- Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, V8R 6V5, Canada
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