Basic consideration of research strategies for head and neck cancer

Symptom Clusters Trajectories and Influencing Factors in Patients With Head and Neck Cancer: A Longitudinal Study

BACKGROUND

While head and neck cancer (HNC) patients often experience many concurrent symptoms, most research has focused on the assessment and management of individual, isolated symptoms.

OBJECTIVE

The aim of this study was to investigate the longitudinal trajectories of symptom clusters in patients with HNC and analyze the predictive factors of each trajectory subgroup.

METHODS

An exploratory factor analysis was conducted to analyze symptom clusters using the M. D. Anderson Symptom Inventory-Head and Neck in 218 HNC patients at 3 time points: during hospitalization, 1 month after discharge, and 3 months after discharge. The latent growth mixture modeling was used to identify the trajectory subgroups, and multinomial logistic regression was used to analyze the predictive factors of trajectory changes.

RESULTS

The 4 symptom clusters were referred to as the mouth and throat symptom cluster, gastrointestinal symptom cluster, psychotherapeutic symptom cluster, and energy deficit symptom cluster. Three to 4 trajectory subgroups were identified in the symptom cluster using the latent growth mixture modeling. High-risk trajectory subgroups were influenced by female patients, low family per-capita monthly income, laryngeal cancer, high clinical staging, and age ( P < .05).

CONCLUSIONS

Mouth and throat symptom cluster is unique to HNC. The high-risk trajectory categories are influenced by gender, family per-capita monthly income, tumor site, TNM clinical staging, and age.

IMPLICATIONS FOR PRACTICE

Identifying high-risk trajectories and influencing factors of symptom clusters can help cancer caregivers in implementing individualized and tailored interventions.

Ten-year (2009-2019) epidemiological study of head and neck, salivary glands and upper aerodigestive tract cancers, and overall survival outcomes in the Northern Territory of Australia

Background

Head and neck, salivary glands and aerodigestive tract cancers (HNACs) rank sixth in cancer incidence in Australia, posing significant public health and economic challenges. However, data on HNACs in the Northern Territory (NT) are lacking, crucial for healthcare planning.

Objective

This study aims to analyse HNACs epidemiology, risk factors and survival outcomes in the NT, focusing on Indigenous and non-Indigenous Australians.

Methods

We conducted a retrospective analysis (2009-2019) of HNACs cases from the NT Cancer Registry. Ethically approved, the study assessed incidence, mortality, risk factors and survival across ethnic populations.

Results

Of 612 potential cases, 524 were analysed, with 35.5% identifying as Aboriginal or Torres Strait Islanders. Predominantly affecting males (median age: 62 years), HNACs showed an age-standardised incidence of 21.9 per 100 000, with stable trends. The 5-year survival rate was 39.6%, notably lower in Indigenous Australians (25%) and remote areas (18%) vs the national average (68%). Oropharyngeal malignancies were common (36% survival). High-risk behaviours such as alcohol use (73%) and smoking (91%) prevailed. Most patients (73%) presented with advanced disease (stages III-IV), with one-third offered palliative care at diagnosis. P16-negative tumours predominated, with increasing P16-positive cases in non-Indigenous patients.

Conclusion

HNACs survival rates in the NT are significantly lower than the national average, especially among Indigenous Australians and remote residents. Targeted interventions are needed to improve service planning and delivery, considering identified risk factors and cultural sensitivities, and promoting Indigenous participation.

Dietary Risk Factors in Upper Aero-Digestive Tract Cancers

The Upper AeroDigestive Tract (UADT) cancers are most common, invasive and have high morbidity. The two leading risk factors, smoking and alcohol, are well known but there is a long list of other risk factors which are not that well talked about. The aim of this study was to ascertain the dietary factors which could be important in their prevention.The PubMed and Google Scholar databases were searched for relevant studies from January 2001 to November 2021. Refined grains were found directly related to the risk of UADT cancer while the whole grain cereals were found protective. Significant inverse associations were observed for the highest compared to the lowest tertile of whole grains and yellow/orange vegetables. Stricter adherence to the Mediterranean diet was seen associated with a substantial and significant decrease in UADT cancer risk. A significant inverse association was also found between yoghurt intake and UADT cancer risk. Consumption of three or more cups of coffee per day was found to have a significant inverse association with UADT cancer. Carcinogenicity of cannabis consumption was observed for regular cannabis smokers (> 1 per day for years). The current study concludes that the protective dietary factors have substantial activity in the prevention of UADT cancer. Nevertheless, basic research is required in investigating the role of these dietary factors and valid biomarkers will be important for chemoprevention studies. The basic research on risk factors on the basis of current knowledge would ultimately lead to the better prevention of UADT cancer.

Clinical Significance of Integrin Subunit Beta 4 in Head and Neck Squamous Cell Carcinoma

Background: The expression level and clinical significance of integrin subunit beta 4 (ITGB4) in head and neck squamous cell carcinoma (HNSCC) remain unclear. Materials and Methods: Expression of ITGB4 in HNSCC tissues were evaluated by calculating standard mean differences (SMDs) based on gene chips, RNA-seq, and immunohistochemistry data (n = 2330) from multiple sources. Receiver operating characteristic (ROC) curves were used to detect the ability of ITGB4 to distinguish HNSCC from non-HNSCC samples. The relationship between the expression level of ITGB4 and clinical parameters was evaluated by calculating SMDs. Results: Identical results of mRNA and protein levels indicated remarkable up-expression of ITGB4 in HNSCC tissues. Further ROC curves showed that ITGB4 could distinguish HNSCC from non-HNSCC samples. Genetic alteration analysis of ITGB4 in HNSCC indicated that overexpression of ITGB4 in HNSCC was likely not owing to genetic alteration of ITGB4. Moreover, ITGB4 overexpression level may be correlated with clinical T stage. Conclusion: ITGB4 likely plays an essential role in HNSCC occurrence based on our study and its potential diagnostic value is worthy of further exploration in the future.

The Association between Metformin and Survival of Head and Neck Cancer: A Systematic Review and Meta-Analysis of 7 Retrospective Cohort Studies

BACKGROUND

Metformin has been associated with improved survival outcomes in various malignancies. However, observational studies in head and neck cancer are inconsistent.

OBJECTIVE

The study aimed to summarize and quantify the relationship between metformin use and the survival of head and neck cancer.

METHODS

A meta-analysis based on cohort studies was systematically conducted (published up to Jan 18, 2020), identified from PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Scopus databases. Summary hazard ratios (HR) and 95% confidence intervals (CI) were calculated using a random-effects model.

RESULTS

Seven retrospective cohort studies including 3,285 head and neck cancer patients were included. The association between the use of metformin and cancer survival was not statistically significant: summarized HR of 0.89 (95% CI 0.66-1.18, P=0.413, I2=64.0%) for overall survival, summarized HR of 0.65 (95% CI 0.31-1.35, P=0.246, I2=60.3%) for disease-free survival, and summarized HR of 0.69 (95% CI 0.40-1.20, P=0.191, I2=73.1%) for disease-specific survival.

CONCLUSION

In this meta-analysis of 7 retrospective cohort studies, there was not a statistically significant association between the use of metformin and better survival for head and neck cancer. However, the analysis may have been underpowered. More studies of prospective designs with larger sample sizes are needed to investigate the effect of metformin on the survival of head and neck cancer.

Diabetes and its Potential Impact on Head and Neck Oncogenesis

In recent years, the incidence of diabetes mellitus and cancer has increased sharply; indeed, these have become the two most important diseases threatening health and survival. Head and neck (HN) tumors are the sixth most common malignancies in humans. Numerous studies have shown that there are many common risk factors for diabetes mellitus and HN squamous cell carcinoma, including advanced age, poor diet and lifestyle, and environmental factors. However, the mechanism linking the two diseases has not been identified. A number of studies have shown that diabetes affects the development, metastasis, and prognosis of HN cancer, potentially through the associated hyperglycemia, hyperinsulinemia and insulin resistance, or chronic inflammation. More recent studies show that metformin, the first-line drug for the treatment of type 2 diabetes, can significantly reduce the risk of HN tumor development and reduce mortality in diabetic patients. Here, we review recent progress in the study of the relationship between diabetes mellitus and HN carcinogenesis, and its potential mechanisms, in order to provide a scientific basis for the early diagnosis and effective treatment of these diseases.

Expression patterns of CD168 correlate with the stage and grade of squamous cell carcinoma of head and neck

The receptor for hyaluronan-mediated motility CD168 is associated with the processes of oncogenesis and metastasis. The objective of the present study was to determine the possible association between the expression and distribution of CD168 and the tumor stage of head-and-neck squamous cell carcinoma (SCC). Formalin-fixed and paraffin-embedded tumor samples obtained from 100 patients during primary resection of SCC from the oral cavity, oropharynx, hypopharynx or larynx were included in the present study. The patients were divided into two risk groups: Low risk, representing the early stage of completely resected SCCs with good-to-moderate differentiation, and the high-risk group, representing the advanced stage SCCs with positive resection margins, vascular invasion or locoregional metastasis. All specimens were stained with a monoclonal antibody against CD168. Percentage and staining intensity of CD168-positive cells were scored, and their spatial distribution within the tumor nests was noted. The results obtained were correlated with the tumor stage. The quantification of CD168 expression revealed significant differences between the two risk groups (t-test, P=0.002), with higher scores in tumors resected from the high-risk SSC group compared with those from the low-risk group. In addition, in the high-risk group, the CD168-positive cells were present predominantly in the periphery (70.4%) of tumor nests, whereas in the low-risk group, only 56.6% were located there; however, this trend did not reach the level of statistical significance. Taken together, the results from the present study suggested that CD168 expression patterns could potentially be used as a predictor of tumor aggressiveness, and therefore they may be a prognostic factor in head-and-neck SCC.

Dendritic cell-based autologous tumor vaccines for head and neck squamous cell carcinoma

BACKGROUND

An autologous vaccine of apoptotic tumor cells (ATCs) and dendritic cells (DCs) was administered to patients with stage III/IV head and neck squamous cell carcinoma (HNSCC) to study safety and feasibility.

METHODS

Autologous DCs were generated from monocytes, loaded with ATCs, and delivered intranodally. Delayed-type hypersensitivity (DTH) and immunological endpoints were measured prevaccination and postvaccination. Clinical follow-up was required.

RESULTS

Tumors obtained from 30 patients yielded 2 × 10(6) to 2 × 10(8) tumor cells. Only 19 of 30 (63%) were sterile. Ten of 30 patients (33%) had ≥1 × 10(7) sterile tumor cells required for vaccine production. Eight of 10 patients had positive recall DTH. Five of 10 patients were leukapheresed to generate DCs. Four of 5 patients were vaccinated. ATC-reactive T cells were detected in 3 of 4 patients. All 4 patients survived >5 years. The trial failed to enroll the projected 12 patients and was terminated.

CONCLUSION

This vaccine was safe and immunogenic but feasible only in patients with HNSCC with positive prevaccine DTH and ≥1 × 10(7) sterile tumor cells. All vaccinated patients were long-term disease-free survivors. © 2015 Wiley Periodicals, Inc. Head Neck 38: E494-E501, 2016.

Demographic, psychosocial, and genetic risk associated with smokeless tobacco use among Mexican heritage youth

BACKGROUND

Despite well-established negative health consequences of smokeless tobacco use (STU), the number and variety of alternative non-combustible tobacco products on the market have increased tremendously over the last 10 years, as has the market share of these products relative to cigarettes. While STU among non-Hispanic white youth has decreased over the last 10 years, the prevalence has remained constant among Hispanic youth. Here we examine demographic, psychosocial, and genetic risk associated with STU among Mexican heritage youth.

METHODS

Participants (50.5 % girls) reported on psychosocial risk factors in 2008-09 (n = 1,087, mean age = 14.3 years), and smokeless tobacco use in 2010-11 (mean age = 16.7 years). Participants provided a saliva sample that was genotyped for genes in the dopamine, serotonin and opioid pathways.

RESULTS

Overall 62 (5.7 %) participants reported lifetime STU. We identified five single nucleotide polymorphisms that increased the risk for lifetime use. Specifically, rs2023902 on SERGEF (OR = 1.93; 95 % CI: 1.05-3.53), rs16941667 on ALDH2 (OR = 3.14; 95 % CI: 1.65-5.94), and rs17721739 on TPH1 (OR = 1.71; 95 % CI: 1.00-2.91) in the dopamine pathway, rs514912 on TRH-DE (OR = 1.84; 95 % CI: 1.25-2.71) in the serotonin pathway, and rs42451417 on the serotonin transporter gene, SLC6A4 (OR = 3.53; 95 % CI: 1.56-7.97). After controlling for genetic risk, being male (OR = 1.86; 95 % CI: 1.02-3.41), obesity status (OR = 2.22; 95 % CI: 1.21-4.09), and both higher levels of anxiety (OR = 1.04; 95 % CI: 1.01-1.08) and social disinhibition (OR = 1.26; 95 % CI: 1.07-1.48) were associated with increased use. High subjective social status (OR = 0.78; 95 % CI: 0.64-0.93) was protective against use, while higher parental education (OR = 2.01; 95 % CI: 1.03-3.93) was associated with increased use.

CONCLUSIONS

These data suggest that use of genetic risk, along with psychosocial, demographic, and behavioral risk factors may increase our ability to identify youth at increased risk for STU, which in turn may improve our ability to effectively target prevention messages to Mexican heritage youth.

Sperm associated antigen 9 (SPAG9) expression and humoral response in benign and malignant salivary gland tumors

Salivary gland cancers are highly aggressive epithelial tumor associated with metastatic potential and high mortality. The tumors are biologically diverse and are of various histotypes. Besides, the detection and diagnosis is a major problem of salivary gland cancer for available treatment modalities. In the present study, we have investigated the association of sperm associated antigen 9 (SPAG9) expression with salivary gland tumor (SGT). Clinical specimens of benign (n = 16) and malignant tumors (n = 86) were examined for the SPAG9 expression. In addition, the sera and adjacent non-cancerous tissues (n = 72) from available patients were obtained. Our in situ RNA hybridization and immunohistochemistry (IHC) analysis revealed significant difference (p = 0.0001) in SPAG9 gene and protein expression in benign (63%) and malignant tumor (84%) specimens. Further, significant association was also observed between SPAG9 expression and malignant tumors (P = 0.05). A cut-off value of >10% cells expressing SPAG9 protein designated as positive in IHC, predicted presence of malignant SGT with 83.72% sensitivity, 100% specificity, 100% PPV and 83.72% NPV. Humoral response against SPAG9 protein was generated in 68% of SGT patients. A cut-off value of 0.212 OD for anti-SPAG9 antibodies in ELISA predicted presence of malignant SGT with 69.23% sensitivity, 100% specificity, 100% PPV and 78.94% NPV. Collectively, our data suggests that the majority of SGT show significant difference and association among benign and malignant tumors for SPAG9 gene and protein expression and also exhibit humoral response against SPAG9 protein. Hence, SPAG9 may be developed as a biomarker for detection and diagnosis of salivary gland tumors.

Hypokalemia during the early phase of refeeding in patients with cancer

OBJECTIVE

Refeeding syndrome occurs in patients with severe malnutrition when refeeding begins after a long period of starvation. This syndrome increases the risk of clinical complications and mortality. Hypophosphatemia is considered the primary characteristic of the syndrome. The aim of our study was to investigate the presence of other electrolyte alterations in patients with cancer during the early stage of refeeding.

METHODS

In this observational study, we enrolled 34 patients with cancer of the upper aerodigestive tract receiving upfront radiotherapy who were also enrolled in a nutrition program. A caloric intake assessment, anthropometric measurements and biochemical laboratory tests were performed.

RESULTS

Significant weight loss (∼20%) was found in these patients. In the patients receiving artificial nutrition, we found lower levels of potassium and total protein compared with those who were fed orally (p = 0.03 for potassium and 0.02 for protein, respectively). Patients on enteral tube feeding had a higher caloric intake compared with those who were fed orally (25±5 kcal/kg/day vs. 10±2 kcal/kg/day).

CONCLUSION

Hypokalemia, like hypophosphatemia, could be a complication associated with refeeding in patients with cancer. Hypokalemia was present in the early stages of high-calorie refeeding.