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Obeidat M, Algargaz W, Barukba M, Bodoor K, Mohamad I, Barakat F, Al Bashir S. Clinical and molecular characteristics of Jordanian oropharyngeal cancer patients according to P16 expression: a retrospective study and a report of a novel biomarker. Med Mol Morphol 2024; 57:136-146. [PMID: 38459388 DOI: 10.1007/s00795-024-00383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/29/2024] [Indexed: 03/10/2024]
Abstract
The purpose of this study was to assess the clinicopathological features of oropharyngeal cancer patients in Jordan based on their HPV status. Sixty-nine biopsies from two hospitals were included. Tissue microarrays were prepared from formalin-fixed paraffin-embedded (FFPE) specimens and stained with antibodies for CDKN2A/P16, EGFR, PI3K, PTEN, AKT, pS473AKT, PS2mTOR, and TIMAP. The cohort was divided according to P16 expression. Chi-square test and survival analyses were employed to evaluate the variations among the study variables and determine the prognostic factors, respectively. P16 expression was found in 55.1% of patients; however, there was no significant association between P16 expression and the patients' clinicopathological features. The Kaplan-Meier test revealed that smoking in P16-positive group and younger age (< 58 years) negatively impacted disease-free survival (DFS) (P = 0.04 and P = 0.003, respectively). Multivariate Cox regression test indicated that smoking, age, PI3K, and AKT were negative predictors of DFS (P = 0.021, P = 0.002, P = 0.021, and P = 0.009, respectively), while TIMAP was a positive predictor (P = 0.045). Elevated P16 expression is found in more than half of the patients' specimens. DFS is negatively affected by younger age and the combined effect of smoking and P16 overexpression. TIMAP is overexpressed in P16-positive oropharyngeal cancer, and it is a favorable predictor of DFS.
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Affiliation(s)
- Marya Obeidat
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan.
| | - Wisam Algargaz
- Department of Special Surgery, King Hussein Cancer Center, Amman, 11941, Jordan
- Department of Special Surgery, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Marwa Barukba
- Department of Pathology, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Khaldon Bodoor
- Department of Applied Biology, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, 11941, Jordan
| | - Farid Barakat
- Department of Pathology & Laboratory Medicine, King Hussein Cancer Center, Amman, 11941, Jordan
| | - Samir Al Bashir
- Department of Pathology, Jordan University of Science and Technology, Irbid, 22110, Jordan
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2
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Cleere EF, Murphy J, Crotty TJ, Hintze JM, Timon CVI, Kinsella J, Fitzgerald CWR, Lennon P. HPV overtakes smoking as the leading cause of oropharyngeal cancer in Ireland: experience of a head and neck surgery tertiary referral centre. Ir J Med Sci 2024:10.1007/s11845-024-03715-4. [PMID: 38802697 DOI: 10.1007/s11845-024-03715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Worldwide, the incidence of oropharyngeal squamous cell carcinoma (OPSCC) caused by human papillomavirus (HPV), a sexually transmitted virus, is increasing. This increase has yet to be demonstrated in an Irish cohort. AIMS To evaluate the number of OPSCC presentations locally, to stratify cases by HPV status and to estimate if any changes in the patient population had occurred over a 10-year period. METHODS A STROBE-compliant, retrospective evaluation of patients with OPSCC at St James's Hospital between 2012 and 2022 was performed. Patients with non-SCC histology, undocumented HPV status and residual or recurrent tumours were excluded. RESULTS We included 294 patients with a mean age of 60.4 years (95% CI 59.2-61.5 years) and 175 (59.5%) patients had HPV+ OPSCC. The number of new OPSCC diagnoses increased from 115 patients (39.1%) between 2012 and 2016 to 179 patients (60.9%) between 2017 and 2021. This was associated with an increased proportion of HPV-linked OPSCC (50.4% 2012-2016 vs. 65.4% 2017-2021, p = 0.011). Over time, more patients had a functionally limiting comorbidity (p = 0.011). The mean age of HPV+ OPSCC cases increased by 3.6 years (p = 0.019). Patients with HPV+ OPSCC had greater 2-year OS (83.9% vs. 54.9%; p < 0.001) and 2-year DFS (73.5% vs. 45.6%; p < 0.001). The 2-year OS and DFS did not change over time for HPV+ or HPV- patients. CONCLUSIONS In our institution, the number of patients with OPSCC is increasing due to an escalation in cases associated with HPV. Population-level interventions such as vaccination programs may alter the current increase in the incidence of these tumours.
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Affiliation(s)
- Eoin F Cleere
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland.
| | - Josh Murphy
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Thomas J Crotty
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Justin M Hintze
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Conrad V I Timon
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - John Kinsella
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Conall W R Fitzgerald
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
| | - Paul Lennon
- Department of Otolaryngology Head and Neck Surgery, St James's Hospital, Dublin, Ireland
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Hardman JC, Constable J, Dobbs S, Hogan C, Hulse K, Khosla S, Milinis K, Tudor-Green B, Williamson A, Paleri V. Survival outcomes in head and neck squamous cell carcinoma of unknown primary: A national cohort study. Clin Otolaryngol 2024. [PMID: 38766691 DOI: 10.1111/coa.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 03/14/2024] [Accepted: 04/07/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION To investigate factors influencing survival in head and neck squamous cell carcinoma of unknown primary (HNSCCUP). METHODS A retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres, of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT within 3 months of diagnosis with metastatic cervical squamous cell carcinoma. Patients treated as HNSCCUP underwent survival analysis, stratified by neck dissection and/or radiotherapy to the ipsilateral neck, and by HPV status. RESULTS Data were received from 57 centres for 965 patients, of whom 482 started treatment for HNSCCUP (65.7% HPV-positive, n = 282/429). Five-year overall survival (OS) for HPV-positive patients was 85.0% (95% CI 78.4-92.3) and 43.5% (95% CI 32.9-57.5) for HPV-negative. HPV-negative status was associated with worse OS, disease-free (DFS), and disease-specific (DSS) survival (all p < .0001 on log-rank test) but not local control (LC) (p = .16). Unilateral HPV-positive disease treated with surgery alone was associated with significantly worse DFS (p < .0001) and LC (p < .0001) compared to radiotherapy alone or combined modalities (5-year DFS: 24.9%, 82.3% and 94.3%; 5-year LC: 41.8%, 98.8% and 98.6%). OS was not significantly different (p = .16). Unilateral HPV-negative disease treated with surgery alone was associated with significantly worse LC (p = .017) (5-year LC: estimate unavailable, 93.3% and 96.6%, respectively). Small numbers with bilateral disease precluded meaningful sub-group analysis. CONCLUSIONS HPV status is associated with variable management and outcomes in HNSCCUP. Unilateral neck disease is treated variably and associated with poorer outcomes when managed with surgery alone. The impact of diagnostic oropharyngeal surgery on primary site emergence, survival and functional outcomes is unestablished.
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Affiliation(s)
- John C Hardman
- Head and Neck Unit, The Royal Marsden Hospital, London, UK
| | - James Constable
- Department of Otolaryngology, Head and Neck Surgery, Gloucestershire Royal Hospital, Gloucester, UK
| | - Sian Dobbs
- Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK
| | - Christopher Hogan
- Department of Otolaryngology, Head and Neck Surgery, Basildon University Hospital, Basildon, UK
| | - Kate Hulse
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Shivun Khosla
- Department of Otolaryngology, Head and Neck Surgery, Royal Surrey County Hospital, Guildford, UK
| | - Kristijonas Milinis
- Liverpool Head and Neck Centre, Liverpool University Foundation Trust, Liverpool, UK
| | - Ben Tudor-Green
- Department of Otorhinolaryngology-Head & Neck Surgery, Derriford Hospital, Plymouth, UK
| | - Andrew Williamson
- Department of Otolaryngology, Head and Neck Surgery, Monklands University Hospital, Glasgow, UK
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospital, London, UK
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Molteni G, Bassani S, Arsie AE, Zampieri E, Mannelli G, Orlandi E, Bossi P, De Virgilio A. Role of TORS as De-Escalation Strategy in HPV-Related Oropharyngeal Cancer, What We Need to Know. Healthcare (Basel) 2024; 12:1014. [PMID: 38786424 PMCID: PMC11121063 DOI: 10.3390/healthcare12101014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/04/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) presents unique challenges and opportunities for treatment, particularly regarding de-escalation strategies to reduce treatment morbidity without compromising oncological outcomes. This paper examines the role of Transoral Robotic Surgery (TORS) as a de-escalation strategy in managing HPV-related OPSCC. We conducted a comprehensive literature review from January 2010 to June 2023, focusing on studies exploring TORS outcomes in patients with HPV-positive OPSCC. These findings highlight TORS's potential to reduce the need for adjuvant therapy, thereby minimizing treatment-related side effects while maintaining high rates of oncological control. TORS offers advantages such as precise tumor resection and the ability to obtain accurate pathological staging, which can guide the tailoring of adjuvant treatments. Some clinical trials provide evidence supporting the use of TORS in specific patient populations. The MC1273 trial demonstrated promising outcomes with lower doses of adjuvant radiotherapy (RT) following TORS, showing high locoregional tumor control rates and favorable survival outcomes with minimal side effects. ECOG 3311 evaluated upfront TORS followed by histopathologically directed adjuvant therapy, revealing good oncological and functional outcomes, particularly in intermediate-risk patients. The SIRS trial emphasized the benefits of upfront surgery with neck dissection followed by de-escalated RT in patients with favorable survival and excellent functional outcomes. At the same time, the PATHOS trial examined the impact of risk-adapted adjuvant treatment on functional outcomes and survival. The ongoing ADEPT trial investigates reduced-dose adjuvant RT, and the DART-HPV study aims to compare standard adjuvant chemoradiotherapy (CRT) with a reduced dose of adjuvant RT in HPV-positive OPSCC patients. These trials collectively underscore the potential of TORS in facilitating treatment de-escalation while maintaining favorable oncological and functional outcomes in selected patients with HPV-related OPSCC. The aim of this scoping review is to discuss the challenges of risk stratification, the importance of HPV status determination, and the implications of smoking on treatment outcomes. It also explores the evolving criteria for adjuvant therapy following TORS, focusing on reducing radiation dosage and volume without compromising treatment efficacy. In conclusion, TORS emerges as a viable upfront treatment option for carefully selected patients with HPV-positive OPSCC, offering a pathway toward treatment de-escalation. However, selecting the optimal candidate for TORS-based de-escalation strategies is crucial to fully leverage the benefits of treatment de-intensification.
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Affiliation(s)
- Gabriele Molteni
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy
| | - Sara Bassani
- Otolaryngology-Head and Neck Surgery Department, University of Verona, 37129 Verona, Italy; (A.E.A.)
| | - Athena Eliana Arsie
- Otolaryngology-Head and Neck Surgery Department, University of Verona, 37129 Verona, Italy; (A.E.A.)
| | - Erica Zampieri
- Otolaryngology-Head and Neck Surgery Department, University of Verona, 37129 Verona, Italy; (A.E.A.)
| | - Giuditta Mannelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Firenze, Italy
| | - Ester Orlandi
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Clinical Department, National Center for Oncological Hadrontherapy (Fondazione CNAO), 27100 Pavia, Italy
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy;
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
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5
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Harbor SN, Schneider JW, Solomons N, Sanderson M, Afrogheh AH. An Evaluation of High-Risk HPV in Squamous Cell Carcinomas of the Lip in a South African Cohort. Head Neck Pathol 2024; 18:36. [PMID: 38709462 DOI: 10.1007/s12105-024-01639-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/18/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND To determine the prevalence of HR-HPV in a series of lip SCC from South African patients, using currently accepted HPV-testing methodologies and to define the clinical and histomorphologic features of HPV-associated lip SCC. METHODS Fifty SCC of lip and 50 control cases were tested for HR-HPV using p16 and HR-HPV DNA PCR. p16-equivocal/positive and HPV DNA PCR-positive SCC were further evaluated for the expression of HPV-16 and HPV-18 mRNA transcripts using reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) to confirm transcriptionally active HPV. RESULTS p16 was positive in 22% (n = 11) and equivocal in 4% (n = 2) of the SCC. One p16-positive case showed positivity for both HPV-16 DNA and HPV-16 E6/E7 mRNA transcripts (HPV prevalence rate of 2%). The HPV-positive case was non-keratinizing and occurred in an 80-year-old female. The two p16-equivocal cases were HR-HPV DNA positive and mRNA PCR negative. p16 was found to have a positive predictive value of 9%. CONCLUSION Findings from our cohort of lip SCC suggest that HR-HPV may have an insignificant role in the pathogenesis of SCC at this site. Due to its low ppv, p16 is insufficient to establish HR-HPV infection in SCC of the lip. The combination of p16 and DNA PCR appears to correlate with the presence of transcriptionally active virus. HPV E6/E7 mRNA detection is the gold standard for identifying HR-HPV. mRNA testing is not widely available in sub-Saharan Africa due to technical and financial constraints; however, the test appears to be of great value in p16-equivocal lip SCC.
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Affiliation(s)
- Sharon N Harbor
- Division of Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Johann W Schneider
- Division of Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Nadine Solomons
- Division of Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
| | - Micheline Sanderson
- Division of Anatomical Pathology, Stellenbosch University, Cape Town, South Africa
| | - Amir H Afrogheh
- Division of Anatomical Pathology, Stellenbosch University, Cape Town, South Africa.
- Department of Oral and Maxillofacial Pathology, National Health Laboratory Service, University of the Western Cape, Cape Town, South Africa.
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa.
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6
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Baliga S, Abou-Foul AK, Parente P, Szturz P, Thariat J, Shreenivas A, Nankivell P, Bertolini F, Biau J, Blakaj D, Brennan S, Brunet A, De Oliveira TB, Burtness B, Maseda AC, Chow VLY, Chua ML, de Ridder M, Garikipati S, Hanai N, Ho FCH, Huang SH, Kiyota N, Klinghammer K, Kowalski LP, Kwong DL, McDowell LJ, Merlano MC, Nair S, Economopoulou P, Overgaard J, Psyrri A, Tribius S, Waldron J, Yom SS, Mehanna H. Essential data variables for a minimum dataset for head and neck cancer trials and clinical research: HNCIG consensus recommendations and database. Eur J Cancer 2024; 203:114038. [PMID: 38579517 DOI: 10.1016/j.ejca.2024.114038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/17/2024] [Indexed: 04/07/2024]
Abstract
The Head and Neck Cancer International Group (HNCIG) has undertaken an international modified Delphi process to reach consensus on the essential data variables to be included in a minimum database for HNC research. Endorsed by 19 research organisations representing 34 countries, these recommendations provide the framework to facilitate and harmonise data collection and sharing for HNC research. These variables have also been incorporated into a ready to use downloadable HNCIG minimum database, available from the HNCIG website.
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Affiliation(s)
- Sujith Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Ahmad K Abou-Foul
- Institute for Head and neck studies and education, University of Birmingham, UK.
| | - Pablo Parente
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Petr Szturz
- Medical Oncology, Department of Oncology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland.
| | - Juliette Thariat
- Department of Radiation Oncology, Comprehensive Cancer Centre François Baclesse, Caen, France.
| | - Aditya Shreenivas
- Department of Hematology and Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Paul Nankivell
- Institute for Head and Neck Studies and Education, University of Birmingham, UK.
| | | | - Julian Biau
- INSERM U1240 IMoST, University of Clermont Auvergne, Clermont-Ferrand, France; Department of radiation therapy, Centre Jean Perrin, Clermont-Ferrand, France, University of Clermont Auvergne, Clermont-Ferrand, France.
| | | | | | - Aina Brunet
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Universitari Bellvitge, Institut d'Investigacio Biomedica (IDIBELL), Barcelona, Spain.
| | | | - Barbara Burtness
- Department of Internal Medicine and Yale Cancer Center, Yale School of Medicine, CT, USA.
| | | | - Velda Ling-Yu Chow
- Department of Surgery, The University of Hong Kong, Hong Kong, SAR China.
| | - Melvin Lk Chua
- Oncology Academic Programme, Duke-NUS Medical School, Singapore; Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore.
| | - Mischa de Ridder
- Department of radiotherapy, University Medical Center Utrecht, the Netherlands.
| | | | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Aichi, Japan.
| | | | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Tornoto, Canada.
| | - Naomi Kiyota
- Cancer Center, Kobe Univesity Hospital, Kobe, Japan.
| | - Konrad Klinghammer
- Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin Hindenburgdamm, Berlin, Germany.
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil.
| | - Dora L Kwong
- Department of Clinical Oncology, Centre of Cancer Medicine, School of Clinical Medicine, LSK Faculty of Medicine, the University of Hong Kong, Hong Kong, SAR China.
| | - Lachlan J McDowell
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Woollongabba, Australia, University of Queensland, Brisbane, Australia.
| | | | - Sudhir Nair
- Department of Surgical Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Mumbai, India.
| | - Panagiota Economopoulou
- Medical Oncology Unit, 2nd Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
| | - Amanda Psyrri
- Medical Oncology Unit, 2nd Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Silke Tribius
- Hermann, Holthusen Institute of Radiation Oncology Asklepios Klinik St. Georg Asklepios Tumorzentrum, Hamburg, Germany.
| | - John Waldron
- Princess Margaret Cancer Center University of Toronto, Canada.
| | - Sue S Yom
- University of California San Francisco, San Francisco, CA, USA.
| | - Hisham Mehanna
- Institute for Head and neck studies and education, University of Birmingham, Birmingham, UK.
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Malone LC, Twaddell WS, Drachenberg CB, Hatten KM, Papadimitriou JC. Two Head and Neck Carcinomas With Squamous and Mucinous Components and Human Papillomavirus Associations: Maxillary Mucoepidermoid Carcinoma ex Sinonasal Schneiderian Papilloma and Tonsillar Invasive Stratified Mucin Producing Carcinoma (ISMC). Int J Surg Pathol 2024; 32:607-614. [PMID: 37431192 DOI: 10.1177/10668969231185149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Carcinomas of the head-and-neck region with squamous and glandular/mucinous features constitute a heterogeneous group, with a significant minority of tumors showing an human papillomavirus (HPV) association. The differential diagnosis is usually between mucoepidermoid carcinoma (MEC) and adenosquamous carcinoma. We present here two tumors that exemplify both the challenges of diagnostic classification, as well as the complex relationship to HPV: (a) a low risk HPV positive/p16 negative carcinoma that is most consistent with a relatively typical intermediate grade mucoepidermoid type carcinoma with complete MEC phenotype (three cell types), originating from intranasal sinonasal papillomas with exophytic and inverted patterns, and invading surrounding maxillary compartments, and (b) a p16 and keratin 7 (KRT7) positive carcinoma of the right tonsil, characterized by stratified squamous and mucinous cell (mucocyte) features. Whereas the first tumor represents a typical MEC ex-Schneiderian papilloma, the second is morphologically most consistent with the, novel for this anatomic location, diagnosis of "invasive stratified mucin producing carcinoma" (ISMC), pointing to an analogy to similar, high-risk HPV-driven malignancies recently described in the gynecologic (GYN) and genitourinary (GU) areas. Both tumors, despite their mucoepidermoid-like features had no connection to salivary glands and lacked the MAML2 translocation typical of salivary gland MEC, pointing to a mucosal/non-salivary gland origin. Using these two carcinomas as examples, we attempt to address questions related to: (a) the histological distinction between MEC, adenosquamous carcinoma, and ISMC, (b) similarities and differences between these histological entities in mucosal sites versus morphologically similar salivary gland tumors, and (c) the role of HPV in these tumors.
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Affiliation(s)
- Laura C Malone
- Department of Pathology, University of Maryland School of Medicine, Baltimore, USA
| | - William S Twaddell
- Department of Pathology, University of Maryland School of Medicine, Baltimore, USA
| | | | - Kyle M Hatten
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, USA
| | - John C Papadimitriou
- Department of Pathology, University of Maryland School of Medicine, Baltimore, USA
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8
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Barlow J, Gilja S, Ferrandino RM, Berger MH, Posner MR, Bakst RL, Khan MN, Teng MS, Genden EM, Chai RL, Roof SA. Evaluating human papillomavirus testing, prevalence, and association with prognosis in head and neck squamous cell carcinoma by subsite: A national cancer database study. Am J Otolaryngol 2024; 45:104243. [PMID: 38442460 DOI: 10.1016/j.amjoto.2024.104243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To compare human papillomavirus (HPV) testing, prevalence, and association with prognosis between head and neck squamous cell carcinoma (HNSCC) subsites. MATERIALS AND METHODS This study utilized the National Cancer Database (NCDB) to identify patients diagnosed with HNSCC between 2010 and 2017. Rates of HPV testing, HPV-positivity, and changes in these rates over time were measured by subsite. The impact of HPV-positivity on overall survival across six head and neck subsites was assessed using multivariable-adjusted Cox proportional hazards analysis. RESULTS A total of 121,550 patients were included. Of this cohort, 87,575 (72.1%) were tested for HPV, with the oropharynx (55,049/64,158; 85.8%) displaying the highest rates of testing and the sinonasal tract (1519/2853; 53.2%) displaying the lowest testing rates. Of the 86,136 with a definitive result, 46,878 (54.4%) were HPV-positive, with the oropharynx (40,313/54,205; 74.4%) displaying the highest rates of HPV-positivity and the oral cavity (1818/11,505; 15.8%) displaying the lowest. HPV-positive malignancy was associated with significantly improved adjusted overall survival in the oropharynx (HR = 0.42 [95% CI: 0.43-0.47]), oral cavity (HR = 0.86 [95% CI: 0.79-0.95]), sinonasal tract (HR = 0.63 [95% CI: 0.48-0.83]), larynx (HR = 0.78 [95% CI: 0.71-0.87]), and hypopharynx (HR = 0.56 [95% CI: 0.48-0.66]), but not the nasopharynx (HR = 0.93 [95% CI: 0.77-1.14]). CONCLUSION HPV testing rates were significantly lower in non-oropharyngeal subsites. This is relevant as HPV-associated disease displayed significantly improved overall survival in both the oropharynx and four of five non-oropharyngeal subsites. While validation with prospective studies is necessary, these findings may warrant HPV testing in all HNSCC subsites.
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Affiliation(s)
- Joshua Barlow
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
| | - Shivee Gilja
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Rocco M Ferrandino
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Michael H Berger
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Marshall R Posner
- Department of Hematology/Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Mohemmed N Khan
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Marita S Teng
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Eric M Genden
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Raymond L Chai
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Scott A Roof
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
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9
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Meldgaard Justesen M, Kronberg Jakobsen K, Fenger Carlander AL, Hjordt Holm Larsen M, Wessel I, Kiss K, Friborg J, Ibrahim Channir H, Rubek N, Grønhøj C, von Buchwald C. Outcomes of transoral robotic surgery for early-stage oropharyngeal squamous cell carcinoma with low rates of adjuvant therapy: A consecutive single-institution study from 2013 to 2020. Oral Oncol 2024; 152:106783. [PMID: 38569317 DOI: 10.1016/j.oraloncology.2024.106783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 03/03/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased in recent decades, driven by infection with human papillomavirus (HPV). Transoral robotic surgery (TORS) and neck dissection (ND) has been employed as an alternative to radiotherapy/chemoradiotherapy. The current literature is lacking studies providing an exhaustive overview of recurrence characteristics and long-term outcomes in TORS-treated OPSCC-patients. METHODS All patients treated for OPSCC with primary TORS + ND in Eastern Denmark between 2013 and 2020 were included in the study. The aim was to explore overall survival (OS), recurrence-free survival (RFS), recurrence patterns, and ultimate failure rate (UFR). OS and RFS were examined using the Kaplan-Meier method. Cox proportional regression analyses were employed to examine effect of different variables on risk of death and recurrence. RESULTS The study included 153 patients of which 88.9 % (n = 136) were treated with TORS alone while 11.1 % (n = 17) received adjuvant therapy. The 1-, 3-, and 5-year OS were 97.4 %, 94.1 %, and 87.6 % while 1-, 3-, and 5-year RFS were 96.6 %, 87.8 %, and 84.9 %. The UFR was 6.5 % in the cohort. Patients with HPV+/p16 + OPSCC had a significantly better 5-year OS of 92.3 % than patients with discordant or double-negative HPV/p16 status (OS = 73.3 %). No differences in outcomes between patients treated with or without adjuvant therapy were found in regression analysis. CONCLUSION Excellent survival and disease control was obtained with TORS + ND in this cohort, despite lesser application of adjuvant therapy than other TORS-centers, implying that TORS without adjuvant therapy can be successfully applied in treatment of early-stage OPSCC.
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Affiliation(s)
- Marius Meldgaard Justesen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark.
| | - Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - Amanda-Louise Fenger Carlander
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - Mikkel Hjordt Holm Larsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - Katalin Kiss
- Department of Pathology, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - Jeppe Friborg
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - Hani Ibrahim Channir
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - Niclas Rubek
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark
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10
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Lammert A, Abo-Madyan Y, Huber L, Ludwig S, Scherl C, Rotter N. [Cervical CUP Syndrome: Diagnosis and Therapy]. Laryngorhinootologie 2024; 103:371-382. [PMID: 38697084 DOI: 10.1055/a-2150-4834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
In CUP syndrome (CUP = cancer of unknown primary) there are 1 or more metastases of a primary tumor that cannot be localized despite extensive diagnostics. CUP syndrome accounts for 5% of all human malignancies, making it one of the 10 most common forms of cancer. In addition to inflammatory lymph node enlargement and benign changes such as cervical cysts, lymph node metastases are among the most common cervical masses. Cervical CUP syndrome is a histologically confirmed cervical lymph node metastasis with an unknown primary tumor. In addition to anamnesis, clinical examination and histological confirmation, diagnostics include radiological imaging using PET-CT and panendoscopy with histological primary tumor search. Treatment options include surgical therapy with neck dissection and chemoradiotherapy.
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11
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Weiland T, Zgubic J, Brcic L, Thurnher D. Detection of antibody subclasses IgA, IgM and IgG against HPV L1 in HPV-positive oropharyngeal squamous cell carcinoma patients: a pilot study. Eur Arch Otorhinolaryngol 2024; 281:2637-2644. [PMID: 38441604 PMCID: PMC11023979 DOI: 10.1007/s00405-024-08537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/06/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Despite prognostic superiority of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC), up to 25% of patients will suffer from recurrence within the first 5 years. Therefore, it is of great scientific interest to find relevant biomarkers to identify patients at risk. In this prospective observational study, we aimed to investigate the dynamics of HPV-L1 capsid protein specific antibody (AB) subclasses IgA, IgM, and IgG in HPV-positive OPSCC patients under therapy. METHODS Serum samples from HPV-positive OPSCC patients, identified by positive p16-immunohistochemistry, were collected before and during tumor-specific therapy and 3-6 months during follow-up. They were analyzed for the presence of HPV-L1 AB subclasses IgA, IgM, and IgG using an HPV-L1-specific immuno-assay. Additionally, a PCR-based HPV-DNA detection from the tumor tissue was performed. RESULTS Altogether, 33 patients with a mean follow-up of 55 months were included. Analysis of a total of 226 serum samples revealed that the most common L1-AB-subclass pattern was characterized by IgG > > IgA > IgM without significant fluctuation during the course of disease. Patients with excessive IgG levels tended to higher tumor stages and three out of three patients with disease recurrence showed increasing IgG AB titers beforehand. Seven patients showed an IgA dominance at diagnosis, which was associated with a better disease-free survival. CONCLUSION Despite limited cases, our prospective pilot study revealed promising trends in HPV L1 AB subclasses and may contribute useful information for future risk stratification and post-treatment monitoring in HPV-positive OPSCC patients.
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Affiliation(s)
- Thomas Weiland
- Department of Otorhinolaryngology-Head & Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria.
| | - Jakob Zgubic
- Department of Otorhinolaryngology-Head & Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Dietmar Thurnher
- Department of Otorhinolaryngology-Head & Neck Surgery, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
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12
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Mehanna H, Alemany L, von Buchwald C. Advances in testing for human papillomavirus -mediated head and neck cancer. Curr Opin Oncol 2024; 36:143-146. [PMID: 38506408 PMCID: PMC10990024 DOI: 10.1097/cco.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
PURPOSE OF REVIEW New evidence has recently emerged regarding the utility and benefits of dual p16 INKa (p16) and Human papillomavirus (HPV) status testing when determining the diagnosis and prognosis of patients with oropharyngeal cancer. RECENT FINDINGS HPV RNA polymerase chain reaction (PCR) is the most accurate diagnostic test. The other assays (HPV DNA PCR, HPV DNA/RNA in-situ hybridization (ISH) and p16) applied to formalin fixed tumour tissue have varying but high sensitivities and specificities. Dual p16 and HPV testing identifies discordant (p16+/HPV- or p16-/HPV+) results in 9.2% of cases, who have significantly poorer prognoses than p16+/HPV+, particularly in smokers. The proportion of discordant cases varies by region, and appears to be highest in regions with lowest attributable (p16+/HPV+) fractions. Dual testing improves prognostication for oropharyngeal cancer cases by identifying discordant cases and improving the prognostic power of the Tumour Node Metastasis (TNM) classification, especially in regions with high discordant rates. SUMMARY Dual testing is essential when considering patients for clinical trials of treatment de-escalation, and may be important when counselling patients on prognosis, especially in regions with high discordant rates and in smokers.
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Affiliation(s)
- Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Laia Alemany
- Consortium for Biomedical Research in Epidemiology and Public Health—CIBERESP, Carlos III Institute of Health, Av. De Monforte de Lemos 5, 28029 Madrid, Spain
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Institut d’Investigació Biomedica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Christian von Buchwald
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
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13
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Bhardwaj S, Gitman M, Ramirez JD, Paniz-Mondolfi A, Westra WH. Reappraisal of p16 for Determining HPV Status of Head and Neck Carcinomas Arising in HPV Hotspots. Am J Surg Pathol 2024; 48:581-587. [PMID: 38482860 DOI: 10.1097/pas.0000000000002204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
In an era of head and neck oncology where HPV status will soon dictate patient management, reliable HPV detection is critical. P16 immunohistochemistry (IHC) is currently recommended as the test of choice for oropharyngeal squamous cell carcinomas (OPSCCs). The purpose of this study was to determine the performance characteristics of p16 IHC based on a large clinical experience of squamous cell carcinomas (SCC) arising from HPV hot-spot regions of the head and neck. Consecutive OPSCCs, sinonasal SCCs, and metastatic SCCs of unknown primary sites were evaluated for the presence of HPV by p16 IHC and PCR-based HPV DNA testing as part of clinical care. For discrepant cases, high-risk HPV E6/E7 mRNA in situ hybridization (ISH) and, when possible, matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (MassArray) genotyping were performed. 746 cancers underwent HPV testing by p16 IHC and DNA PCR genotyping. There was a 95.6% concordance between the 2 assays. Of the 33 discrepant cases, 32 cases (4.3%) were p16 positive but HPV DNA negative. In these cases, 68% were positive for mRNA ISH, invariably related to a non-16 HPV genotype. P16 IHC had an overall accuracy of 98.8%, a sensitivity of 99.8%, and a specificity of 92.1%. P16 IHC is a sensitive and specific assay for determining HPV status. HPV DNA PCR appears vulnerable to HPV genotype diversity and is prone to missing rare non-16 genotypes. HPV mRNA ISH is a practical and reliable direct measure of HPV that may help eliminate the small number of false-positive p16 cases and avoid potential patient harm related to erroneous HPV classification.
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Affiliation(s)
- Swati Bhardwaj
- Department of Pathology, The Icahn School of Medicine at Mount Sinai Hospital, New York, NY
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14
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Carlander ALF, Bendtsen SK, Rasmussen JH, Jakobsen KK, Garset-Zamani M, Grønhøj C, Friborg J, Hutcheson K, Johnson FM, Fuller CD, Moreno AC, Babarinde T, Gross ND, Myers JN, von Buchwald C. Clinical and prognostic differences in oropharyngeal squamous cell carcinoma in USA and Denmark, two HPV high-prevalence areas. Eur J Cancer 2024; 202:113983. [PMID: 38452723 DOI: 10.1016/j.ejca.2024.113983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/15/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Uncertainty persists regarding clinical and treatment variations crucial to consider when comparing high human papillomavirus (HPV)-prevalence oropharyngeal squamous cell carcinoma (OPSCC) cohorts for accurate patient stratification and replicability of clinical trials across different geographical areas. METHODS OPSCC patients were included from The University of Texas MD Anderson Cancer Center (UTMDACC), USA and from The University Hospital of Copenhagen, Denmark from 2015-2020, (n = 2484). Outcomes were 3-year overall survival (OS) and recurrence-free interval (RFI). Subgroup analyses were made for low-risk OPSCC patients (T1-2N0M0) and high-risk patients (UICC8 III-IV). RESULTS There were significantly more HPV-positive (88.2 % vs. 63.1 %), males (89.4 % vs. 74.1 %), never-smokers (52.1 % vs. 23.7 %), lower UICC8-stage (I/II: 79.3 % vs. 68 %), and fewer patients treated with radiotherapy (RT) alone (14.8 % vs. 30.3 %) in the UTMDACC cohort. No difference in the adjusted OS was observed (hazard ratio [HR] 1.21, p = 0.23), but a significantly increased RFI HR was observed for the Copenhagen cohort (HR: 1.74, p = 0.003). Subgroup analyses of low- and high-risk patients revealed significant clinical and treatment differences. No difference in prognosis was observed for low-risk patients, but the prognosis for high-risk patients in the Copenhagen cohort was worse (OS HR 2.20, p = 0.004, RFI HR 2.80, p = 0.002). CONCLUSIONS We identified significant differences in clinical characteristics, treatment modalities, and prognosis between a Northern European and Northern American OPSCC population. These differences are important to consider when comparing outcomes and for patient stratification in clinical trials, as reproducibility might be challenging.
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Affiliation(s)
- Amanda-Louise Fenger Carlander
- Department of Otolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Simone Kloch Bendtsen
- Department of Otolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jacob H Rasmussen
- Department of Otolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kathrine Kronberg Jakobsen
- Department of Otolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Garset-Zamani
- Department of Otolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jeppe Friborg
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Katherine Hutcheson
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas M.D. Anderson Cancer Center, UTMDACC, TX, USA
| | - Faye M Johnson
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas M.D. Anderson Cancer Center, UTMDACC, TX, USA; The University of Texas Graduate School of Biomedical Sciences; UTMDACC, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, UTMDACC, TX, USA
| | - Amy C Moreno
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, UTMDACC, TX, USA
| | - Toyin Babarinde
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, UTMDACC, TX, USA
| | - Neil D Gross
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas M.D. Anderson Cancer Center, UTMDACC, TX, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, UTMDACC, TX, USA; The University of Texas Graduate School of Biomedical Sciences; UTMDACC, TX, USA
| | - Christian von Buchwald
- Department of Otolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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15
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Qiu E, Vejdani-Jahromi M, Kaliaev A, Fazelpour S, Goodman D, Ryoo I, Andreu-Arasa VC, Fujima N, Buch K, Sakai O. Fully automated 3D machine learning model for HPV status characterization in oropharyngeal squamous cell carcinomas based on CT images. Am J Otolaryngol 2024; 45:104357. [PMID: 38703612 DOI: 10.1016/j.amjoto.2024.104357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Human papillomavirus (HPV) status plays a major role in predicting oropharyngeal squamous cell carcinoma (OPSCC) survival. This study assesses the accuracy of a fully automated 3D convolutional neural network (CNN) in predicting HPV status using CT images. METHODS Pretreatment CT images from OPSCC patients were used to train a 3D DenseNet-121 model to predict HPV-p16 status. Performance was evaluated by the ROC Curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score. RESULTS The network achieved a mean AUC of 0.80 ± 0.06. The best-preforming fold had a sensitivity of 0.86 and specificity of 0.92 at the Youden's index. The PPV, NPV, and F1 scores are 0.97, 0.71, and 0.82, respectively. CONCLUSIONS A fully automated CNN can characterize the HPV status of OPSCC patients with high sensitivity and specificity. Further refinement of this algorithm has the potential to provide a non-invasive tool to guide clinical management.
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Affiliation(s)
- Edwin Qiu
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Maryam Vejdani-Jahromi
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Artem Kaliaev
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Sherwin Fazelpour
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Deniz Goodman
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Inseon Ryoo
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - V Carlota Andreu-Arasa
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America; Department of Radiology, VA Boston Healthcare System, MA, United States of America
| | - Noriyuki Fujima
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America; Hokkaido University Hospital, Department of Diagnostic and Interventional Radiology, Sapporo, Japan
| | - Karen Buch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Osamu Sakai
- Department of Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America; Department of Radiation Oncology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, United States of America; Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States of America.
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16
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Zilla ML, Lajara S. A case of fine-needle aspiration of a neck mass with atypical squamous cells and macrophages. Diagn Cytopathol 2024. [PMID: 38676304 DOI: 10.1002/dc.25326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
Head and neck lesions often undergo fine-needle aspiration to determine the appropriate management and therapeutic decisions. However, there are numerous diagnostic challenges encountered with these specimens, particularly, if atypical squamous cells are identified. Here, we present a case of an enlarging right neck mass in a 38-year-old female and discuss the diagnostic difficulties and potential pitfalls. Additionally, we review the approach to diagnosis, including differential diagnostic considerations as well as available ancillary testing.
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Affiliation(s)
- Megan L Zilla
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sigfred Lajara
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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17
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Weiss M, Ferré VM, Deschamps L, Evrard D, Gonthier C, Charpentier C, Brunet-Possenti F. Detection of α-papillomaviruses in extragenital cutaneous squamous cell carcinomas. Br J Dermatol 2024; 190:762-764. [PMID: 38305419 DOI: 10.1093/bjd/ljae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 02/03/2024]
Abstract
Previous studies have demonstrated that human papillomaviruses (HPVs) of the beta genus can contribute to the onset of cutaneous carcinomas in organ transplant recipients. In contrast, there are limited data related to the oncogenicity of alpha (α)-HPVs in the skin. Herein, we explore the characteristics of three cutaneous squamous cell carcinomas presenting α-HPV infection occurring in patients with HIV, in order to determine the role of α-HPV in these skin cancers.
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Affiliation(s)
| | - Valentine M Ferré
- Department of Virology, Hôpital Bichat-Claude Bernard, AP-HP, Université Paris Cité, INSERM, IAME, UMR 1137, Paris, France
| | | | | | | | - Charlotte Charpentier
- Department of Virology, Hôpital Bichat-Claude Bernard, AP-HP, Université Paris Cité, INSERM, IAME, UMR 1137, Paris, France
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18
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Du M, Lin Q, Yan S, Gao X, Yang C, Li Z, Liao W, Yang A, Chen S. Clinicopathologic characteristics of HPV-associated head and neck squamous cell carcinoma in Southern China: long-term retrospective study of 400 cases. Ther Adv Med Oncol 2024; 16:17588359241242962. [PMID: 38617023 PMCID: PMC11010741 DOI: 10.1177/17588359241242962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
Background Human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) is an evolving and growing disease, especially in developing countries. However, the clinical characteristics of HPV-associated HNSCC in regard to HPV infection rates, patient features, and prognosis are under-reported in the Asian population. Methods In this study, we retrospectively enrolled a 400-case cohort of HNSCC with p16 immunochemistry and analyzed with long-term follow-up. We investigate the current HPV prevalence of HNSCC, unique HPV-associated patient clinical characteristics, and patient prognosis in the southern China population. Results HPV infection exhibited a 15% prevalence in all HNSCC cases, notably higher in oropharyngeal cases (30.7%), followed by oral cavity (11.8%), laryngeal (10.1%), and hypopharyngeal (2.5%). HPV status, gender, old age, and location of tumor were significantly associated with the patient's survival. Tonsil invasion was found more frequent in HPV-positive oropharyngeal HNSCC than in HPV-negative cases. HPV-associated HNSCC patients tend to possess stronger tobacco and alcohol habits, which were correlated to poor survival. HPV status's correlation with gender, age, and anatomical location is associated intricately with patient survival. The secondary primary tumor rate was found higher within the HPV-negative group, compared to the HPV-positive group (9.12% versus 1.67%). Conclusion Our study provided a current picture of HPV-associated HNSCC in the southern China population and elaborated the understanding of key factors that correlate to HNSCC prognosis. Our findings indicated a strong susceptibility of HPV-associated oropharyngeal HNSCC in the tonsil and the difference in secondary primary tumor rates associated with HPV status.
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Affiliation(s)
- Mingyuan Du
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Qiaohong Lin
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Shida Yan
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Xianlu Gao
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Chulin Yang
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Zhaoyang Li
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Wei Liao
- Department of Intensive Care Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Ankui Yang
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Shuwei Chen
- Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
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19
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Deutsch F, Sais D, Keatinge N, Hill M, Tran NH, Elliott M, Tran N. Biplex quantitative PCR to detect transcriptionally active human papillomavirus 16 from patient saliva. BMC Cancer 2024; 24:442. [PMID: 38600473 PMCID: PMC11005208 DOI: 10.1186/s12885-024-12125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Head and neck cancers, particularly oropharyngeal cancers (OPC), have been increasingly associated with human papillomavirus (HPV) infections, specifically HPV16. The current methods for HPV16 detection primarily rely on p16 staining or PCR techniques. However, it is important to note the limitations of conventional PCR, as the presence of viral DNA does not always indicate an ongoing viral infection. Moreover, these tests heavily rely on the availability of tissue samples, which can present challenges in certain situations. In this study, we developed a RT-qPCR biplex approach to detect HPV16 oncogenes E6 and E7 RNA in saliva samples from OPC patients. Salivary supernatant was used as the liquid biopsy source. We successfully obtained RNA from salivary supernatant, preserving its integrity as indicated by the detection of several housekeeping genes. Our biplex approach accurately detected E6 and E7 RNA in HPV16-positive cell lines, tissues, and finally in OPC salivary samples. Importantly, the assay specifically targeted HPV16 and not HPV18. This biplexing technique allowed for reduced sample input without compromising specificity. In summary, our approach demonstrates the potential to detect viable HPV16 in saliva from OPC patients. Since the assay measures HPV16 RNA, it provides insights into the transcriptional activity of the virus. This could guide clinical decision-making and treatment planning for individuals with HPV-related OPC.
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Affiliation(s)
- Fiona Deutsch
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Dayna Sais
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Ni Keatinge
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Meredith Hill
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Ngoc Ha Tran
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Michael Elliott
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Nham Tran
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia.
- Chris O'Brien Lifehouse, Sydney, NSW, Australia.
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20
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Lorini L, Bossi P, Psyrri A, Bonomo P. Human Papilloma Virus (HPV) driven oropharyngeal cancer in current or previous heavy smokers: should we look for a different treatment paradigm? Front Oncol 2024; 14:1383019. [PMID: 38651143 PMCID: PMC11033308 DOI: 10.3389/fonc.2024.1383019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Human papillomavirus Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OSCC) has increased in incidence in recent decades and represents a heterogeneous disease entity in the context of Head and Neck Squamous Cell Carcinoma (HNSCC), in terms of disease prognosis. Treatment of locoregionally advanced OSCC is mainly based on concurrent chemoradiotherapy. Given the younger age of patients, if compared with HPV-negative counterparts, and the high cure rates, the acute- and long-term toxicity in survivors represents a field of interest. However, patient selection for de-escalation trials remains a major challenge due to the lack of robust validated prognostic indicators within the HPV-associated OSCC. Discussion The impact of smoking status on HPV-associated OSCC prognosis has been demonstrated in the majority of studies. However, the magnitude of the association is unclear due to variability in smoking metrics and study outcomes. Smoking status has been identified as a potential confounding factor in HPV-positive de-escalation trials. Smokers with HPV-positive OSCC have a worse prognosis in most studies than non-smokers and may require different and more aggressive therapeutic strategies.
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Affiliation(s)
- Luigi Lorini
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Paolo Bossi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Amanda Psyrri
- Section of Medical Oncology, 2(nd) Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Haidari, Athens, Greece
| | - Pierluigi Bonomo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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21
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Zupancic M, Kostopoulou ON, Holzhauser S, Lukoseviciute M, Jylhä C, Marklund L, Näsman A, Sivars L, Dalianis T. Human papillomavirus (HPV) load is higher in HPVDNA/p16 positive than in HPVDNA positive/p16 negative oropharyngeal squamous cell carcinoma but does not differ significantly between various subsites or correlate to survival. Oral Oncol 2024; 151:106749. [PMID: 38461771 DOI: 10.1016/j.oraloncology.2024.106749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Patients with human papillomavirus DNA positive (HPVDNA+) and p16ink4a overexpressing (p16+) oropharyngeal squamous cell carcinoma (OPSCC), especially those with cancer in the tonsillar and base of tongue subsites as compared to other OPSCC subsites have a better outcome than those with only HPVDNA+ or only p16+ cancer. Likewise having a high viral load has been suggested to be a positive prognostic factor. We therefore hypothesized, that HPV viral load could vary depending on OPSCC subsite, as well as with regard to whether the cancer was HPVDNA+ and p16+, or only HPVDNA+, or only p16+ and that this affected outcome. MATERIAL AND METHODS To address these issues HPV viral load was determined by HPV digital droplet (dd) PCR in tumor biopsies with previously known HPVDNA/p16 status from 270 OPSCC patients diagnosed 2000-2016 in Stockholm, Sweden. More specifically, of these patients 235 had HPVDNA+/p16+, 10 had HPVDNA+/p16-, 13 had HPVDNA-/p16+ and 12 had HPVDNA-/p16- cancer. RESULTS We found that HPVDNA+/p16+ OPSCC had a significantly higher viral load than HPVDNA+/p16- OPSCC. Moreover, there was a tendency for a higher viral load in the tonsillar and base of tongue OPSCC subsites compared to the other subsites and for a low viral load to correlate to a better clinical outcome but none of these tendencies reached statistical significance. CONCLUSION To conclude, the mean viral load in HPVDNA+/p16+ OPSCC was higher than in HPVDNA+/p16- OPSCC, but there was no statistically significant difference in viral load depending on OPSCC subsite or on clinical outcome.
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Affiliation(s)
- Mark Zupancic
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | | | - Stefan Holzhauser
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Cecilia Jylhä
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Dept of Clinical Genetics, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Linda Marklund
- Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Intervention and Technology, Division of ENT Diseases, Karolinska Institutet, Sweden; Department of Surgical Sciences, Section of Otolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Anders Näsman
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Dept of Clinical Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Sivars
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - Tina Dalianis
- Dept. of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Medical Unit Head, Neck, Lung, and Skin Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
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22
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Dietz A, Wichmann G, Wiegand S, Waterboer T, Budach W, Klußmann JP. [Update: Epidemiology and Prevention of Oropharyngeal Cancer]. Laryngorhinootologie 2024; 103:296-313. [PMID: 38565110 DOI: 10.1055/a-2133-2348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Due to the association with the causal HPV-16 infection, the oropharyngeal carcinoma spreads into two separate entities depending on HPV-16 positivity. More recent data show a diversified picture of the importance and prevalence of the surrogate parameter p16 (discordance) for a definitive HPV-16 association, which varies worldwide. In the context of prevention options, vaccination is of major and HPV screening of healthy people only of little importance.
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23
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Matos LL, Kowalski LP, Chaves ALF, de Oliveira TB, Marta GN, Curado MP, de Castro Junior G, Farias TP, Bardales GS, Cabrera MA, Capuzzo RDC, de Carvalho GB, Cernea CR, Dedivitis RA, Dias FL, Estefan AM, Falco AH, Ferraris GA, Gonzalez-Motta A, Gouveia AG, Jacinto AA, Kulcsar MAV, Leite AK, Lira RB, Mak MP, De Marchi P, de Mello ES, de Matos FCM, Montero PH, de Moraes ED, de Moraes FY, Morais DCR, Poenitz FM, Poitevin A, Riveros HO, Sanabria Á, Ticona-Castro M, Vartanian JG, Viani G, Vines EF, William Junior WN, Conway D, Virani S, Brennan P. Latin American Consensus on the Treatment of Head and Neck Cancer. JCO Glob Oncol 2024; 10:e2300343. [PMID: 38603656 DOI: 10.1200/go.23.00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 04/13/2024] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.
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Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Gilberto de Castro Junior
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Andrés Munyo Estefan
- Profesor Adjunto Catedra de Otorrinolaringologia del Hospital de Clínicas, Montevidéu, Uruguay
| | | | | | | | - Andre Guimarães Gouveia
- Juravinski Cancer Centre, Department of Oncology, Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Marco Aurelio Vamondes Kulcsar
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Ana Kober Leite
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Renan Bezerra Lira
- AC Camargo Cancer Center and Hospital Albert Einstein, São Paulo, Brazil
| | - Milena Perez Mak
- 3Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | | | | | | | - Pablo H Montero
- Department of Surgical Oncology and Head and Neck Surgery, Division of Surgery, P. Universidad Católica de Chile, Santiago, Chile
| | | | | | | | | | | | | | - Álvaro Sanabria
- 4Department of Surgery, Universidad de Antioquia, Hospital Alma Mater, Medellin, Colombia
| | - Miguel Ticona-Castro
- 5ESMO Member, Peruvian Society of Medical Oncology (S.P.O.M.) Member, La Molina, Peru
| | - José Guilherme Vartanian
- 6Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Gustavo Viani
- 7Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Eugenio F Vines
- Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | - Shama Virani
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
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24
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Bommakanti KK, St John MA. Is p16 Testing Sufficient as a Surrogate for HPV-Related Squamous Cell Carcinoma? Laryngoscope 2024. [PMID: 38494594 DOI: 10.1002/lary.31392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/04/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Krishna K Bommakanti
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A
- UCLA Head and Neck Cancer Program, UCLA Health, University of California, Los Angeles, California, U.S.A
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A
- UCLA Head and Neck Cancer Program, UCLA Health, University of California, Los Angeles, California, U.S.A
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25
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Thigpen BT, Johnston RB, Giubellino A, Mogrovejo DO, Jethwa AR, Patino WD. Metastatic Tonsil Squamous Cell Carcinoma: An Important Consideration in the Differential Diagnosis of Malignant Basaloid Neoplasms in the Skin: Case Report and Review of the Literature. Am J Dermatopathol 2024:00000372-990000000-00298. [PMID: 38457690 DOI: 10.1097/dad.0000000000002656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT Malignant basaloid neoplasms of the skin are frequent, and their accurate diagnosis holds paramount importance for treatment and prognosis. However, these neoplasms can present diagnostic challenges because of their extensive differential diagnosis, which encompasses cutaneous metastasis among many other possibilities. We present a case of a 74-year-old man with a history of p16-positive palatine tonsil squamous cell carcinoma (SCC) treated with surgery and adjuvant radiation with no prior evidence of recurrence who presented to the dermatologist with 2 chin papules. The initial histopathologic evaluation of these lesions showed poorly differentiated malignant basaloid neoplasms. Subsequently, these biopsies were compared with the previous biopsies from his tonsil and lymph node, which showed similar findings including positive p16 staining and positive molecular testing for human papillomavirus-16, confirming the diagnosis of cutaneous metastasis from his previously diagnosed human papillomavirus-related tonsil SCC. Additional imaging studies found metastases to internal organs including the brain, and he was started on chemotherapy, immunotherapy, and radiation therapy. Cutaneous metastases from tonsil SCC are exceedingly rare, and only 5 cases have been described. Furthermore, this is the first case confirming the presence of high-risk human papillomavirus by molecular studies within the cutaneous metastases. The presented case underscores the importance of recognizing this unusual manifestation of tonsil SCC metastatic to the skin along with a good clinical patient history, ensuring accurate and prompt diagnosis and treatment of this condition.
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Affiliation(s)
- Bradley T Thigpen
- University of Alabama Marnix E. Heersink School of Medicine, Birmingham, AL
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26
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Gharzai LA, Morris E, Suresh K, Nguyen-Tân PF, Rosenthal DI, Gillison ML, Harari PM, Garden AS, Koyfman S, Caudell JJ, Jones CU, Mitchell DL, Krempl G, Ridge JA, Gensheimer MF, Bonner JA, Filion E, Dunlap NE, Stokes WA, Le QT, Torres-Saavedra P, Mierzwa M, Schipper MJ. Surrogate endpoints in clinical trials of p16-positive squamous cell carcinoma of the oropharynx: an individual patient data meta-analysis. Lancet Oncol 2024; 25:366-375. [PMID: 38423050 PMCID: PMC10962533 DOI: 10.1016/s1470-2045(24)00016-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The increased incidence of human papillomavirus (HPV)-related cancers has motivated efforts to optimise treatment for these patients with excellent prognosis. Validation of surrogates for overall survival could expedite the investigation of new therapies. We sought to evaluate candidate intermediate clinical endpoints in trials assessing definitive treatment of p16-positive oropharyngeal cancer with chemotherapy or radiotherapy. METHODS We did a retrospective review of five multicentre, randomised trials (NRG/RTOG 9003, 0129, 0234, 0522, and 1016) that tested radiotherapy with or without chemotherapy in patients (aged ≥18 years) with p16-positive localised head or neck squamous-cell carcinomas. Eight intermediate clinical endpoints were considered as potential surrogates for overall survival: freedom from local progression, freedom from regional progression, freedom from distant metastasis, freedom from locoregional progression, freedom from any progression, locoregional progression-free survival, progression-free survival, and distant metastasis-free survival. We used a two-stage meta-analytical framework, which requires high correlation between the intermediate clinical endpoint and overall survival at the patient level (condition 1), and high correlation between the treatment effect on the intermediate clinical endpoint and the treatment effect on overall survival (condition 2). For both, an r2 greater than 0·7 was used as criteria for clinically relevant surrogacy. FINDINGS We analysed 1373 patients with oropharyngeal cancer from May 9, 2020, to Nov 22, 2023. 1231 (90%) of patients were men, 142 (10%) were women, and 1207 (88%) were White, with a median age of 57 years (IQR 51-62). Median follow-up was 4·2 years (3·1-5·1). For the first condition, correlating the intermediate clinical endpoints with overall survival at the individual and trial level, the three composite endpoints of locoregional progression-free survival (Kendall's τ 0·91 and r2 0·72), distant metastasis-free survival (Kendall's τ 0·93 and r2 0·83), and progression-free survival (Kendall's τ 0·88 and r2 0·70) were highly correlated with overall survival at the patient level and at the trial-group level. For the second condition, correlating treatment effects of the intermediate clinical endpoints and overall survival, the composite endpoints of locoregional progression-free survival (r2 0·88), distant metastasis-free survival (r2 0·96), and progression-free survival (r2 0·92) remained strong surrogates. Treatment effects on the remaining intermediate clinical endpoints were less strongly correlated with overall survival. INTERPRETATION We identified locoregional progression-free survival, distant metastasis-free survival, and progression-free survival as surrogates for overall survival in p16-positive oropharyngeal cancers treated with chemotherapy or radiotherapy, which could serve as clinical trial endpoints. FUNDING NRG Oncology Operations, NRG Oncology SDMC, the National Cancer Institute, Eli Lilly, Aventis, and the University of Michigan.
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Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, Northwestern University, Chicago, IL, USA
| | - Emily Morris
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Krithika Suresh
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Phuc Felix Nguyen-Tân
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - David I Rosenthal
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maura L Gillison
- Department of Thoracic and Head/Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul M Harari
- Department of Radiation Oncology, University of Wisconsin, Madison, WI, USA
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shlomo Koyfman
- Department of Radiation Oncology, University of Cleveland Medical Center, Cleveland, OH, USA
| | - Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Christopher U Jones
- Department of Radiation Oncology, Sutter Cancer Research Consortium, Novato, CA, USA
| | - Darrion L Mitchell
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Greg Krempl
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - John A Ridge
- Department of Otolaryngology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - James A Bonner
- Department of Radiation Oncology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Neal E Dunlap
- Department of Radiation Oncology, The James Graham Brown Cancer Center at University of Louisville, Louisville, KY, USA
| | - William A Stokes
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | | | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
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27
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Yuvnik T, Chia L, Laura OC, Tieu TT, Mahesh K, Bradley B, Daron C, Chris W. Differences in geometric patterns of failure in human papillomavirus (HPV)-associated and HPV-non-associated oropharyngeal cancer after definitive radiotherapy. Head Neck 2024; 46:552-560. [PMID: 38108534 DOI: 10.1002/hed.27606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate and compare the spatial pattern of locoregional recurrences in patients diagnosed with HPV-associated and HPV-non-associated oropharyngeal SCC (OPSCC) treated with definitive radiotherapy. METHODS AND MATERIALS Patients who had locoregional recurrence following definitive intensity-modulated radiation therapy were identified at a single tertiary institution. Target volumes were delineated according to the latest consensus international guidelines. Recurrences were classified into five categories based on radiotherapy dose distribution and target volume, using a previously validated methodology; type A (central high dose), type B (peripheral high dose), type C (central elective dose), type D (peripheral elective dose), and type E (extraneous dose). The types of failure were compared between p16-positive and p16-negative tumors using the Pearson chi-square test. RESULTS Fifty-eight locoregional recurrences were observed in 36 patients. The majority of recurrences were in nodal locations (66%, 38/58). Among these, 34 (59%) were classified as type A, 6 (10%) as type B, 9 (15%) as type C, 5 (9%) as type D, and 4 (7%) as type E failure. A significant difference was found in the types of failure between p16-positive and p16-negative tumors (X2 9.52, p = 0.044). p16-negative tumors were more likely to have recurrences in a peripheral location compared to p16-positive tumors (32% vs. 7%). p16-positive tumor were more likely to have extraneous recurrences (17% vs. 0%). CONCLUSION Our study results identified a significant difference in patterns of locoregional failure among patients diagnosed with oropharyngeal cancer following consensus-based tumor delineation and modern radiotherapy. Further confirmatory pattern of failure studies are required to enable greater individualization of radiotherapy for patients diagnosed with oropharyngeal malignancy in the future.
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Affiliation(s)
- Trada Yuvnik
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
| | - Low Chia
- Canberra Region Cancer Centre, Garran, Australian Capital Territory, Australia
| | - O' Connor Laura
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Tieu Thi Tieu
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Kumar Mahesh
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Beeksma Bradley
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Cope Daron
- University of Newcastle, Newcastle, New South Wales, Australia
- John Hunter Hospital - Surgical Services, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Wratten Chris
- Calvary Mater Newcastle - Radiation Oncology, Waratah, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
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28
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Eberly HW, Sciscent BY, Lorenz FJ, Rettig EM, Goyal N. Current and Emerging Diagnostic, Prognostic, and Predictive Biomarkers in Head and Neck Cancer. Biomedicines 2024; 12:415. [PMID: 38398017 PMCID: PMC10886579 DOI: 10.3390/biomedicines12020415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
Head and neck cancers (HNC) are a biologically diverse set of cancers that are responsible for over 660,000 new diagnoses each year. Current therapies for HNC require a comprehensive, multimodal approach encompassing resection, radiation therapy, and systemic therapy. With an increased understanding of the mechanisms behind HNC, there has been growing interest in more accurate prognostic indicators of disease, effective post-treatment surveillance, and individualized treatments. This chapter will highlight the commonly used and studied biomarkers in head and neck squamous cell carcinoma.
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Affiliation(s)
- Hänel W. Eberly
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
| | - Bao Y. Sciscent
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
| | - F. Jeffrey Lorenz
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
| | - Eleni M. Rettig
- Department of Otolaryngology Head and Neck Surgery, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02108, USA
| | - Neerav Goyal
- Department of Otolaryngology Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA 17033, USA; (H.W.E.); (F.J.L.)
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Lim YX, D'Silva NJ. HPV-associated oropharyngeal cancer: in search of surrogate biomarkers for early lesions. Oncogene 2024; 43:543-554. [PMID: 38191674 PMCID: PMC10873204 DOI: 10.1038/s41388-023-02927-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Abstract
The incidence of oropharyngeal cancer (OPSCC) has escalated in the past few decades; this has largely been triggered by high-risk human papillomavirus (HPV). Early cancer screening is needed for timely clinical intervention and may reduce mortality and morbidity, but the lack of knowledge about premalignant lesions for OPSCC poses a significant challenge to early detection. Biomarkers that identify individuals at high risk for OPSCC may act as surrogate markers for precancer but these are limited as only a few studies decipher the multistep progression from HPV infection to OPSCC development. Here, we summarize the current literature describing the multistep progression from oral HPV infection, persistence, and tumor development in the oropharynx. We also examine key challenges that hinder the identification of premalignant lesions in the oropharynx and discuss potential biomarkers for oropharyngeal precancer. Finally, we evaluate novel strategies to improve investigations of the biological process that drives oral HPV persistence and OPSCC, highlighting new developments in the establishment of a genetic progression model for HPV + OPSCC and in vivo models that mimic HPV + OPSCC pathogenesis.
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Affiliation(s)
- Yvonne X Lim
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 N. University Ave, Ann Arbor, MI, USA
| | - Nisha J D'Silva
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 N. University Ave, Ann Arbor, MI, USA.
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, USA.
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30
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Lyu SI, Johannsen J, Simon AG, Knipper K, Wuerdemann N, Sharma SJ, Thelen M, Hansen KK, Fretter C, Klasen C, Esser J, Suchan MC, Abing H, Zimmermann PH, Schultheis AM, Schloesser HA, Klussmann JP, Quaas A, Eckel HNC. Co-expression patterns of cancer associated fibroblast markers reveal distinct subgroups related to patient survival in oropharyngeal squamous cell carcinoma. Front Cell Dev Biol 2024; 12:1337361. [PMID: 38328551 PMCID: PMC10847231 DOI: 10.3389/fcell.2024.1337361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024] Open
Abstract
Background: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rapidly increasing in high income countries due to its association with persistent high-risk human papilloma virus (HPV) infection. Recent scientific advances have highlighted the importance of the tumor microenvironment in OPSCC. In this study, including 216 OPSCC patients, we analyze the composition of four established markers of cancer associated fibroblasts (CAFs) in the context of intratumoral CD8 T-cell infiltration. Methods: Immunohistochemical staining for fibroblast activation protein (FAP), platelet-derived growth factor receptor beta (PDGFRb), periostin, alpha smooth muscle actin (α-SMA) and CD8 were analyzed digitally and their association with survival, tumor- and patient characteristics was assessed. Results: Co-expression of CAF markers was frequent but not associated with HPV status. FAPhigh and PDGFRbhigh expression were associated with increased CD8 T-cell infiltration. Low expression of PDGFRb improved patient survival in female patients but not in male patients. We identified PDGFRblow periostinlow α-SMAlow status as an independent predictor of improved survival (hazard ratio 0.377, p = 0.006). Conclusion: These findings elucidate the co-expression of four established CAF markers in OPSCC and underscore their association with T-cell infiltration and patient survival. Future analyses of CAF subgroups in OPSCC may enable the development of individualized therapies.
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Affiliation(s)
- Su Ir Lyu
- Faculty of Medicine and University Hospital of Cologne, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Jannik Johannsen
- Faculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Adrian Georg Simon
- Faculty of Medicine and University Hospital of Cologne, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Karl Knipper
- Faculty of Medicine and University Hospital of Cologne, Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Nora Wuerdemann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Shachi Jenny Sharma
- Faculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Martin Thelen
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Kevin Karl Hansen
- Faculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Caroline Fretter
- Faculty of Medicine and University Hospital of Cologne, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Charlotte Klasen
- Faculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Julia Esser
- Faculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Malte Christian Suchan
- Faculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Helen Abing
- Faculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Philipp Heinrich Zimmermann
- Faculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Anne Maria Schultheis
- Faculty of Medicine and University Hospital of Cologne, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Hans Anton Schloesser
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital of Cologne, Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Jens Peter Klussmann
- Faculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Alexander Quaas
- Faculty of Medicine and University Hospital of Cologne, Institute of Pathology, University of Cologne, Cologne, Germany
| | - Hans Nikolaus Caspar Eckel
- Faculty of Medicine and University Hospital of Cologne, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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Mehanna H, Rapozo D, von Zeidler SV, Harrington KJ, Winter SC, Hartley A, Nankivell P, Schache AG, Sloan P, Odell EW, Thavaraj S, Hunter KD, Shah KA, Thomas GJ, Long A, Amel-Kashipaz R, Brown RM, Conn B, Hall GL, Matthews P, Weir J, Yeo Y, Pring M, West CM, McCaul J, Golusinski P, Sitch A, Spruce R, Batis N, Bryant JL, Brooks JM, Jones TM, Buffa F, Haider S, Robinson M. Developing and Validating a Multivariable Prognostic-Predictive Classifier for Treatment Escalation of Oropharyngeal Squamous Cell Carcinoma: The PREDICTR-OPC Study. Clin Cancer Res 2024; 30:356-367. [PMID: 37870417 PMCID: PMC10792360 DOI: 10.1158/1078-0432.ccr-23-1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/09/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE While there are several prognostic classifiers, to date, there are no validated predictive models that inform treatment selection for oropharyngeal squamous cell carcinoma (OPSCC).Our aim was to develop clinical and/or biomarker predictive models for patient outcome and treatment escalation for OPSCC. EXPERIMENTAL DESIGN We retrospectively collated clinical data and samples from a consecutive cohort of OPSCC cases treated with curative intent at ten secondary care centers in United Kingdom and Poland between 1999 and 2012. We constructed tissue microarrays, which were stained and scored for 10 biomarkers. We then undertook multivariable regression of eight clinical parameters and 10 biomarkers on a development cohort of 600 patients. Models were validated on an independent, retrospectively collected, 385-patient cohort. RESULTS A total of 985 subjects (median follow-up 5.03 years, range: 4.73-5.21 years) were included. The final biomarker classifier, comprising p16 and survivin immunohistochemistry, high-risk human papillomavirus (HPV) DNA in situ hybridization, and tumor-infiltrating lymphocytes, predicted benefit from combined surgery + adjuvant chemo/radiotherapy over primary chemoradiotherapy in the high-risk group [3-year overall survival (OS) 63.1% vs. 41.1%, respectively, HR = 0.32; 95% confidence interval (CI), 0.16-0.65; P = 0.002], but not in the low-risk group (HR = 0.4; 95% CI, 0.14-1.24; P = 0.114). On further adjustment by propensity scores, the adjusted HR in the high-risk group was 0.34, 95% CI = 0.17-0.67, P = 0.002, and in the low-risk group HR was 0.5, 95% CI = 0.1-2.38, P = 0.384. The concordance index was 0.73. CONCLUSIONS We have developed a prognostic classifier, which also appears to demonstrate moderate predictive ability. External validation in a prospective setting is now underway to confirm this and prepare for clinical adoption.
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Affiliation(s)
- Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
| | - Davy Rapozo
- National Cancer Institute of Brazil, Rio de Janeiro, Brazil
| | - Sandra V. von Zeidler
- Pathology Department and Biotechnology Post-graduation Program, Federal University of Espírito Santo, Vitória, Brazil
| | - Kevin J. Harrington
- The Royal Marsden/The Institute of Cancer Research National Institute of Health Research Biomedical Research Centre, London, United Kingdom
| | - Stuart C. Winter
- Department of ENT-Head and Neck Surgery, Churchill Hospital, Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
| | - Andrew Hartley
- Hall-Edwards Radiotherapy Research Group, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
| | - Andrew G. Schache
- Northwest Cancer Research Centre, Department of Molecular & Clinical Cancer Medicine, University of Liverpool Head & Neck Unit, University Hospital Aintree, Liverpool, United Kingdom
| | - Philip Sloan
- Center for Oral Health Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Edward W. Odell
- Head and Neck Pathology, King's College London, Guy's Hospital, London, United Kingdom
| | - Selvam Thavaraj
- Faculty of Dental, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
- Head and Neck Pathology at Guy's & St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Keith D. Hunter
- Liverpool Head and Neck Centre, Molecular and Clinical Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Ketan A. Shah
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Gareth J. Thomas
- Cancer Sciences Unit, University of Southampton, University Road, Southampton, United Kingdom
| | - Anna Long
- Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Rachel M. Brown
- University Hospitals Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Brendan Conn
- Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | | | - Paul Matthews
- Department of Pathology, University Hospitals Coventry and Warwickshire, United Kingdom
| | - Justin Weir
- Department of Cellular Pathology, Charing Cross Hospital, Imperial College Healthcare Trust, London, United Kingdom
| | - Yen Yeo
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Miranda Pring
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Catharine M.L. West
- Division of Cancer Studies, University of Manchester, Christie Hospital NHS Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - James McCaul
- Department of Maxillofacial and Head and Neck Surgery, Queen Elizabeth II Hospital, Glasgow, Scotland
| | - Pawel Golusinski
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora, Zielona Gora, Poland
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Nikolaos Batis
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
| | - Jennifer L. Bryant
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
| | - Jill M. Brooks
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
| | - Terence M. Jones
- Northwest Cancer Research Centre, Department of Molecular & Clinical Cancer Medicine, University of Liverpool Head & Neck Unit, University Hospital Aintree, Liverpool, United Kingdom
| | - Francesca Buffa
- Department of Oncology, University of Oxford, Oxford, United Kingdom
- Department of Computing Sciences, Bocconi University, Milano, Italy
| | - Syed Haider
- Department of Oncology, University of Oxford, Oxford, United Kingdom
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Max Robinson
- Center for Oral Health Research, Newcastle University, Newcastle upon Tyne, United Kingdom
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32
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Mehanna H, Gaunt P, Kong A, Hartley A, Sanghera P, Forster M, Sen M, Paleri V, Fong C, Geropantas D, Srinivasan D, Garikipati S, Moleron R, Casswell G, Aynsley E, Ward A, O'Toole L, Mirza A, Firth C, Humphreys I, Fulton-Lieuw T, Roques T, Nankivell P. CompARE: study protocol for a phase III randomised controlled platform trial comparing alternative regimens for escalating treatment of intermediate and high-risk oropharyngeal cancer. Trials 2024; 25:50. [PMID: 38221636 PMCID: PMC10788973 DOI: 10.1186/s13063-023-07881-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Patients with intermediate and high-risk oropharyngeal cancer (OPC) have poorer response to standard treatment and poorer overall survival compared to low-risk OPC. CompARE is designed to test alternative approaches to intensified treatment for these patients to improve survival. METHODS CompARE is a pragmatic phase III, open-label, multicenter randomised controlled trial with an adaptive multi-arm, multi-stage design and an integrated QuinteT Recruitment Intervention. Eligible OPC patients include those with human papillomavirus (HPV) negative, T1-T4, N1-N3 or T3-4, N0, or HPV positive N3, T4, or current smokers (or ≥ 10 pack years previous smoking history) with T1-T4, N2b-N3. CompARE was originally designed with four arms (one control [arm 1] and three experimental: arm 2-induction chemotherapy followed by arm 1; arm 3-dose-escalated radiotherapy plus concomitant cisplatin; and arm 4-resection of primary followed by arm 1). The three original experimental arms have been closed to recruitment and a further experimental arm opened (arm 5-induction durvalumab followed by arm 1 and then adjuvant durvalumab). Currently recruiting are arm 1 (control): standard treatment of 3-weekly cisplatin 100 mg/m2 or weekly 40 mg/m2 with intensity-modulated radiotherapy using 70 Gy in 35 fractions ± neck dissection determined by clinical and radiological assessment 3 months post-treatment, and arm 5 (intervention): one cycle of induction durvalumab 1500 mg followed by standard treatment then durvalumab 1500 mg every 4 weeks for a total of 6 months. The definitive and interim primary outcome measures are overall survival time and event-free survival (EFS) time, respectively. Secondary outcome measures include quality of life, toxicity, swallowing outcomes, feeding tube incidence, surgical complication rates, and cost-effectiveness. The design anticipates that after approximately 7 years, 84 required events will have occurred to enable analysis of the definitive primary outcome measure for this comparison. Planned interim futility analyses using EFS will also be performed. DISCUSSION CompARE is designed to be efficient and cost-effective in response to new data, emerging new treatments or difficulties, with the aim of bringing new treatment options for these patients. TRIAL REGISTRATION ISRCTN ISRCTN41478539 . Registered on 29 April 2015.
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Affiliation(s)
- Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, University of Birmingham, B15 2TT, Birmingham, UK.
| | - Piers Gaunt
- Cancer Research UK Clinical Trials Unit, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | | | - Mehmet Sen
- St James's University Hospital, Leeds, UK
| | | | | | - Dinos Geropantas
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | | | | | | | - Amy Ward
- Queen's Hospital Romford, London, UK
| | | | | | - Charlotte Firth
- Cancer Research UK Clinical Trials Unit, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Isla Humphreys
- Cancer Research UK Clinical Trials Unit, Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Tessa Fulton-Lieuw
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, University of Birmingham, B15 2TT, Birmingham, UK
| | - Tom Roques
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, University of Birmingham, B15 2TT, Birmingham, UK
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Dongre HN, Elnour R, Tornaas S, Fromreide S, Thomsen LCV, Kolseth IBM, Nginamau ES, Johannessen AC, Vintermyr OK, Costea DE, Bjørge L. TP53 mutation and human papilloma virus status as independent prognostic factors in a Norwegian cohort of vulva squamous cell carcinoma. Acta Obstet Gynecol Scand 2024; 103:165-175. [PMID: 37840151 PMCID: PMC10755123 DOI: 10.1111/aogs.14689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Vulva squamous cell carcinoma (VSCC) develops through two separate molecular pathways-one involving high-risk human papilloma virus infection (HPV-associated), and the other without HPV infection (HPV-independent) often involving TP53 mutation. HPV-associated VSCC generally has a better progression-free survival than HPV-independent VSCC. The aim of this study was to determine TP53 mutation status using immunohistochemistry, compare different methods of HPV detection and correlate both with survival in a retrospective cohort of 123 patients with VSCC. MATERIAL AND METHODS Immunohistochemistry for p53, Ki67 and p16INK4A (a surrogate marker for HPV infection) was performed on formalin-fixed paraffin-embedded tissues from a cohort of surgically treated VSCC patients to identify molecular subtypes of VSCC. Presence of HPV infection was detected by HPV DNA PCR and HPV mRNA in situ hybridization (ISH). The Pearson chi-square test and multivariable Cox regression model were used to investigate the association of different parameters with progression-free survival and disease-specific survival (DSS), and Kaplan-Meier curves were used to show the association of different parameters with survival. RESULTS The results of p53 and p16INK4A immunohistochemistry confirmed three VSCC subtypes associated with different prognosis. The TP53 mutation status was identified as an independent prognostic factor of worse progression-free survival (p = 0.024) after adjustment for FIGO stage. p16INK4A immunohistochemistry, mRNA ISH, and DNA PCR had excellent concordance in terms of HPV detection. According to the multivariable Cox regression model, the presence of hrHPV mRNA correlated significantly with increased progression-free survival (p = 0.040) and DSS (p = 0.045), after adjustment for other confounders. CONCLUSIONS p53 and p16INK4A immunohistochemistry stratify VSCC cohort into three subtypes with TP53mutated patients having the worst prognosis. The detection of hrHPV mRNA by ISH was an independent predictor of increased survival. Thus, the combined detection of p53 and HPV mRNA might improve risk stratification in VSCC.
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Affiliation(s)
- Harsh Nitin Dongre
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Rammah Elnour
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Stian Tornaas
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Siren Fromreide
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Liv Cecilie Vestrheim Thomsen
- Center for Cancer Biomarkers CCBIO, Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
| | | | | | - Anne Christine Johannessen
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of Pathology, Laboratory ClinicHaukeland University HospitalBergenNorway
| | - Olav Karsten Vintermyr
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of Pathology, Laboratory ClinicHaukeland University HospitalBergenNorway
| | - Daniela Elena Costea
- Center for Cancer Biomarkers CCBIO and Gade Laboratory of Pathology, Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of Pathology, Laboratory ClinicHaukeland University HospitalBergenNorway
| | - Line Bjørge
- Center for Cancer Biomarkers CCBIO, Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
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Gaffney J, Ramzan A, Dinizulu T, Maley C, Onamusi O, Motamedi-Ghahfarokhi G, Price G, Metcalf R, Garcez K, Hughes C, Lee L, Thomson D, Price J, Jain Y, McPartlin A. Association of follow-up imaging frequency with temporal incidence and patterns of distant failure following (chemo) radiotherapy for HPV related oropharyngeal cancer. Oral Oncol 2024; 148:106645. [PMID: 37992488 DOI: 10.1016/j.oraloncology.2023.106645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Emerging data supports radical intent therapy for oligometastatic (OM) relapsed human papilloma virus (HPV+) related oropharyngeal cancer (OPC). We assess the association of follow-up imaging frequency amongst HPV + OPC, with temporal and spatial patterns of distant relapse, to inform rationalisation of routine post-treatment imaging. MATERIALS AND METHODS A retrospective single centre cohort study was carried out of consecutive HPV + OPC patients treated with radical intent (chemo)radiotherapy ((CT)RT) between 2011 and 2019. OM state was defined as ≤ 5 metastasis, none larger than 3 cm (OMs) or, if interval from last negative surveillance imaging > 6-months, then ≤ 10 metastasis, none larger than 5 cm, (OMp). Patients not meeting OMs / OMp criteria were deemed to have incurable diffuse metastatic disease (DMdiffuse). RESULTS 793 HPV-OPC patients were identified with median follow-up 3.15years (range 0.2-8.9). 52 (6.6 %) patients had radiologically identified DM at first failure and were considered for analysis. The median time to recurrence was 15.1 months (range: 2.6-63 months). 87 % of distant metastasis (DM) occurred in the first two years after treatment. Twenty-seven (52 %) patients had OM (OMs or OMp) at time of failure, with 31 % having OMs. The median time from completion of treatment to diagnosis of DMdiffuse vs OM was 22.2 months (range: 2.6-63.1 months) vs 11.6 months (range: 3.5-32.5 months). The probability of being diagnosed with OM vs DMdiffuse increased with reducing interval from last negative surveillance scan to imaging identifying DM (≤6 months 88.9 %, 7-12 months 71.4 %, 13-24 months 35 %, > 24 months 22.2 %). CONCLUSION We demonstrate that a reduced interval between last negative imaging and subsequent radiological diagnosis of DM is associated with increased likelihood of identification of OM disease. Consideration of increased frequency of surveillance imaging during the first two years of follow up is supported, particularly for patients at high risk of distant failure.
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Affiliation(s)
- John Gaffney
- The Christie NHS Foundation Trust, Manchester, UK.
| | | | | | | | | | | | - Gareth Price
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | | | - Kate Garcez
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - Lip Lee
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - James Price
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - Yatin Jain
- The Christie NHS Foundation Trust, Manchester, UK
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35
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Shenker RF, Razavian NB, D'Agostino RB, Mowery YM, Brizel DM, Hughes RT. Clinical outcomes of oropharyngeal squamous cell carcinoma stratified by human papillomavirus subtype: A systematic review and meta-analysis. Oral Oncol 2024; 148:106644. [PMID: 38006690 PMCID: PMC10843598 DOI: 10.1016/j.oraloncology.2023.106644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/17/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE We aim to determine if there is a survival difference between patients with oropharyngeal squamous cell carcinoma (OPSCC) associated with human papillomavirus (HPV) 16 versus HPV-non16 subtypes. PATIENT AND METHODS Databases were queried for full length, peer-reviewed, English language, articles published between 01/01/1980 and 06/08/2022. Studies reporting clinical outcomes of OPSCC associated with HPV16 and HPV-non16 subtypes with at least 10 patients were included. Primary outcome was the overall survival (OS) of patients with HPV16- versus HPV-non16-associated OPSCC. Secondary outcomes were recurrence-free survival (RFS) and pooled rate of p16 positivity by immunohistochemistry (IHC). RESULTS A total of 9 studies met inclusion criteria and included 1,310 patients with HPV16 and 219 with HPV-non16 subtypes of OPSCC. The prevalence of HPV-non16 was 14.3 %. The pooled 5-year OS rates for patients with HPV16 and HPV-non16 were 83.4 %(95 % CI 77.8-89.0 %) and 69.3 %(95 % CI 58.5-80.1 %), respectively. OS at 5 years was significantly worse for HPV-non16 subtype, compared to HPV16 (log odds ratio [OR] -0.54, p = 0.008). There was a trend towards worse 5-year RFS with HPV-non16 compared to HPV16 (log OR -0.55, p = 0.063). Patients with HPV-non16 disease were less likely to be p16 positive by IHC (log OR -0.91, p = 0.02). CONCLUSION Patients with HPV-non16OPSCC may experience worse OS and were less likely to be p16 positive compared to patients with HPV16 disease. While future prospective validation is warranted, routine assessment of both p16 IHC and HPV subtype could be considered prior to pursuing treatment de-escalation for HPV-associated OPSCC.
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Affiliation(s)
- Rachel F Shenker
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, United States
| | - Niema B Razavian
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Ralph B D'Agostino
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Yvonne M Mowery
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, United States
| | - David M Brizel
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, United States
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC, United States.
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Constantin M, Chifiriuc MC, Mihaescu G, Vrancianu CO, Dobre EG, Cristian RE, Bleotu C, Bertesteanu SV, Grigore R, Serban B, Cirstoiu C. Implications of oral dysbiosis and HPV infection in head and neck cancer: from molecular and cellular mechanisms to early diagnosis and therapy. Front Oncol 2023; 13:1273516. [PMID: 38179168 PMCID: PMC10765588 DOI: 10.3389/fonc.2023.1273516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Head and neck cancer (HNC) is the sixth most common type of cancer, with more than half a million new cases annually. This review focuses on the role of oral dysbiosis and HPV infection in HNCs, presenting the involved taxons, molecular effectors and pathways, as well as the HPV-associated particularities of genetic and epigenetic changes and of the tumor microenvironment occurred in different stages of tumor development. Oral dysbiosis is associated with the evolution of HNCs, through multiple mechanisms such as inflammation, genotoxins release, modulation of the innate and acquired immune response, carcinogens and anticarcinogens production, generation of oxidative stress, induction of mutations. Thus, novel microbiome-derived biomarkers and interventions could significantly contribute to achieving the desideratum of personalized management of oncologic patients, regarding both early diagnosis and treatment. The results reported by different studies are not always congruent regarding the variations in the abundance of different taxons in HNCs. However, there is a consistent reporting of a higher abundance of Gram-negative species such as Fusobacterium, Leptotrichia, Treponema, Porphyromonas gingivalis, Prevotella, Bacteroidetes, Haemophilus, Veillonella, Pseudomonas, Enterobacterales, which are probably responsible of chronic inflammation and modulation of tumor microenvironment. Candida albicans is the dominant fungi found in oral carcinoma being also associated with shorter survival rate. Specific microbial signatures (e.g., F. nucleatum, Bacteroidetes and Peptostreptococcus) have been associated with later stages and larger tumor, suggesting their potential to be used as biomarkers for tumor stratification and prognosis. On the other hand, increased abundance of Corynebacterium, Kingella, Abiotrophia is associated with a reduced risk of HNC. Microbiome could also provide biomarkers for differentiating between oropharyngeal and hypopharyngeal cancers as well as between HPV-positive and HPV-negative tumors. Ongoing clinical trials aim to validate non-invasive tests for microbiome-derived biomarkers detection in oral and throat cancers, especially within high-risk populations. Oro-pharyngeal dysbiosis could also impact the HNCs therapy and associated side-effects of radiotherapy, chemotherapy, and immunotherapy. HPV-positive tumors harbor fewer mutations, as well as different DNA methylation pattern and tumor microenvironment. Therefore, elucidation of the molecular mechanisms by which oral microbiota and HPV infection influence the HNC initiation and progression, screening for HPV infection and vaccination against HPV, adopting a good oral hygiene, and preventing oral dysbiosis are important tools for advancing in the battle with this public health global challenge.
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Affiliation(s)
- Marian Constantin
- Department of Microbiology, Institute of Biology of Romanian Academy, Bucharest, Romania
- The Research Institute of the University of Bucharest, ICUB, Bucharest, Romania
| | - Mariana Carmen Chifiriuc
- The Research Institute of the University of Bucharest, ICUB, Bucharest, Romania
- Microbiology Immunology Department, Faculty of Biology, University of Bucharest, Bucharest, Romania
- Department of Life, Medical and Agricultural Sciences, Biological Sciences Section, Romanian Academy, Bucharest, Romania
| | - Grigore Mihaescu
- Microbiology Immunology Department, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Corneliu Ovidiu Vrancianu
- The Research Institute of the University of Bucharest, ICUB, Bucharest, Romania
- Microbiology Immunology Department, Faculty of Biology, University of Bucharest, Bucharest, Romania
- DANUBIUS Department, National Institute of Research and Development for Biological Sciences, Bucharest, Romania
| | - Elena-Georgiana Dobre
- The Research Institute of the University of Bucharest, ICUB, Bucharest, Romania
- Immunology Department, “Victor Babes” National Institute of Pathology, Bucharest, Romania
| | - Roxana-Elena Cristian
- The Research Institute of the University of Bucharest, ICUB, Bucharest, Romania
- DANUBIUS Department, National Institute of Research and Development for Biological Sciences, Bucharest, Romania
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Coralia Bleotu
- The Research Institute of the University of Bucharest, ICUB, Bucharest, Romania
- Cellular and Molecular Pathology Department, Ştefan S. Nicolau Institute of Virology, Bucharest, Romania
| | - Serban Vifor Bertesteanu
- Coltea Clinical Hospital, ENT, Head & Neck Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Raluca Grigore
- Coltea Clinical Hospital, ENT, Head & Neck Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Serban
- University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Catalin Cirstoiu
- University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Kansy BA, Wehrs TP, Bruderek K, Si Y, Ludwig S, Droege F, Hasskamp P, Henkel U, Dominas N, Hoffmann TK, Horn PA, Schuler M, Gauler TC, Lindemann M, Lang S, Bankfalvi A, Brandau S. HPV-associated head and neck cancer is characterized by distinct profiles of CD8 + T cells and myeloid-derived suppressor cells. Cancer Immunol Immunother 2023; 72:4367-4383. [PMID: 38019346 DOI: 10.1007/s00262-023-03571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/23/2023] [Indexed: 11/30/2023]
Abstract
Patients with HPV--localized head and neck cancer (HNC) show inferior outcomes after surgery and radiochemotherapy compared to HPV-associated cancers. The underlying mechanisms remain elusive, but differences in immune status and immune activity may be implicated. In this study, we analyzed immune profiles of CD8+ T cells and myeloid-derived suppressor cells (MDSC) in HPV+ versus HPV- disease.The overall frequency of CD8+ T cells was reduced in HNC versus healthy donors but substantially increased after curative therapy (surgery and/or radiochemotherapy). In HPV+ patients, this increase was associated with significant induction of peripheral blood CD8+/CD45RA-/CD62L- effector memory cells. The frequency of HPV-antigen-specific CD8+ cells was low even in patients with virally associated tumors and dropped to background levels after curative therapy. Pre-therapeutic counts of circulating monocytic MDSC, but not PMN-MDSC, were increased in patients with HPV- disease. This increase was accompanied by reduced fractions of terminally differentiated CD8+ effector cells. HPV- tumors showed reduced infiltrates of CD8+ and CD45RO+ immune cells compared with HPV+ tumors. Importantly, frequencies of tumor tissue-infiltrating PMN-MDSC were increased, while percentages of Granzyme B+ and Ki-67+ CD8 T cells were reduced in patients with HPV- disease.We report differences in frequencies and relative ratios of MDSC and effector T cells in HPV- HNC compared with more immunogenic HPV-associated disease. Our data provide new insight into the immunological profiles of these two tumor entities and may be utilized for more tailored immunotherapeutic approaches in the future.
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Affiliation(s)
- Benjamin A Kansy
- Research Division, Department of Otorhinolaryngology, West German Cancer Center, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Tim P Wehrs
- Research Division, Department of Otorhinolaryngology, West German Cancer Center, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Kirsten Bruderek
- Research Division, Department of Otorhinolaryngology, West German Cancer Center, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Yu Si
- Research Division, Department of Otorhinolaryngology, West German Cancer Center, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany
- Department of Otolaryngology, Head and Neck Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Sonja Ludwig
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany
| | - Freya Droege
- Research Division, Department of Otorhinolaryngology, West German Cancer Center, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Pia Hasskamp
- Research Division, Department of Otorhinolaryngology, West German Cancer Center, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Uta Henkel
- Research Division, Department of Otorhinolaryngology, West German Cancer Center, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Nina Dominas
- Research Division, Department of Otorhinolaryngology, West German Cancer Center, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, University Hospital Ulm, Ulm, Germany
| | - Peter A Horn
- Institute for Transfusion Medicine, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Thomas C Gauler
- Department of Medical Oncology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
- Department of Radiation Oncology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Monika Lindemann
- Institute for Transfusion Medicine, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Stephan Lang
- Research Division, Department of Otorhinolaryngology, West German Cancer Center, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Agnes Bankfalvi
- Institute of Pathology, University Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Sven Brandau
- Research Division, Department of Otorhinolaryngology, West German Cancer Center, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany.
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.
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Chen AM. Management of unknown primary head and neck cancer with radiation therapy in the era of human papillomavirus (HPV): No longer cutting down the tree to get an apple. Radiother Oncol 2023; 189:109952. [PMID: 37844736 DOI: 10.1016/j.radonc.2023.109952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE Given the central role that radiation has in the management of head and neck squamous cell carcinoma of unknown primary origin, it is imperative to review how treatment paradigms have been refined and continue to evolve in the modern era. METHODS AND MATERIALS This study was designed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. A literature search of peer-reviewed publications was undertaken to identify works pertaining to the use of radiation for squamous cell carcinoma of unknown primary origin presenting as cervical lymph node metastases. Articles published from January 2002 to January 2023 with full text available on PubMed and restricted to the English language and human subjects were included. The full bibliographies of identified articles were reviewed and irrelevant studies were removed. RESULTS While such breakthroughs as intensity-modulated radiotherapy, positron emission tomography, biomarker testing with immune-histochemistry, and minimally invasive surgical techniques such as transoral robotic surgery have fundamentally changed the approach to this disease in recent decades, controversies still exist with respect to the manner in which radiation is delivered. Although the incidence of head and neck unknown primary cancer is relatively low, questions regarding the necessity of comprehensive radiation using the age-old standard method of targeting the bilateral necks and entire pharyngeal axis to encompass all putative sites of mucosal disease persist. CONCLUSIONS Prospective evidence is lacking, and the available studies have been complicated by such factors as the relatively limited sample sizes, as well as the variability in work-up, treatment, inclusion criteria, and follow-up. Regardless, advances in science and technology have ushered in more precise approaches with a high degree of customization, particularly given the increased proportion of patients presenting with human papillomavirus-related disease.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California, Irvine, Chao Family Comprehensive Cancer Center, Orange, CA 92868, USA.
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Klasen C, Wuerdemann N, Rothbart P, Prinz J, Eckel HNC, Suchan M, Kopp C, Johannsen J, Ziogas M, Charpentier A, Huebbers CU, Sharma SJ, Langer C, Arens C, Wagner S, Quaas A, Klußmann JP. Sex-specific aspects in patients with oropharyngeal squamous cell carcinoma: a bicentric cohort study. BMC Cancer 2023; 23:1054. [PMID: 37919644 PMCID: PMC10621233 DOI: 10.1186/s12885-023-11526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Oropharyngeal squamous cell carcinoma (OPSCC) is the only subgroup of head neck cancer that presents with an increased incidence. Gender-specific studies in other cancer entities have revealed differences in treatment response and prognosis. However, only limited data in OPSCC according to gender and human papillomavirus (HPV) status exist. Therefore, we aimed to investigate sex-specific differences in OPSCC and how these may be distributed in relation to HPV and other risk factors. METHODS This retrospective, bicentric study included 1629 patients with OPSCC diagnosed between 1992 and 2020. We formed subgroups based on TNM status, American Joint Cancer Committee 8th edition (AJCC8), HPV status, treatment modality (surgery (± radio(chemo)therapy (RCT) vs. definitive RCT) and patient-related risk factors and investigated gender differences and their impact on patients survival via descriptive-,uni- and multivariate analysis. RESULTS With the exception of alcohol abuse, no significant differences were found in risk factors between men and women. Females presented with better OS than males in the subgroup T1-2, N + , independent of risk factors (p = 0.008). Males demonstrated significant stratification through all AJCC8 stages (all p < 0.050). In contrast, women were lacking significance between stage II and III (p = 0.992). With regard to therapy (surgery (± R(C)T) - vs. definitive RCT) women treated with surgery had better OS than men in the whole cohort (p = 0.008). Similar results were detected in the HPV-negative OPSCC sub-cohort (p = 0.042) and in high-risk groups (AJCC8 stage III and IV with M0, p = 0.003). CONCLUSION Sex-specific differences in OPSCC represent a health disparity, particularly according to staging and treatment, which need to be addressed in future studies.
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Affiliation(s)
- Charlotte Klasen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany.
| | - Nora Wuerdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Pauline Rothbart
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
| | - Johanna Prinz
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Hans Nicholaus Casper Eckel
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
| | - Malte Suchan
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
| | - Christopher Kopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
| | - Jannik Johannsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
| | - Maria Ziogas
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
| | - Arthur Charpentier
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
| | - Christian Ulrich Huebbers
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Jean-Uhrmacher-Institute for Otorhinolaryngological Research, University of Cologne, Geibelstrasse 29-31, 50931, Cologne, Germany
| | - Shachi Jenny Sharma
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
| | - Christine Langer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, Klinikstrasse 33, Giessen, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, Klinikstrasse 33, Giessen, Germany
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, Klinikstrasse 33, Giessen, Germany
| | - Alexander Quaas
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
- Institute of Pathology, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Jens Peter Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne University of Cologne, Robert-Koch-Str. 21, 50931, Cologne, Germany
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Stöth M, Meyer T, Gehrke T, Hagen R, Scheich M, Hackenberg S, Scherzad A. Discontinuation of anti‑programmed cell death protein 1 immune checkpoint inhibition after complete remission in head and neck squamous cell carcinoma: A case report and literature review. Oncol Lett 2023; 26:489. [PMID: 37818135 PMCID: PMC10561138 DOI: 10.3892/ol.2023.14076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/07/2023] [Indexed: 10/12/2023] Open
Abstract
Programmed cell death protein 1 (PD-1) inhibition plays a central role in the current treatment of recurrent or metastatic head and neck squamous cell carcinoma (R/M-HNSCC). Some patients achieve a durable response, and even complete remission (CR) is possible, though it occurs rarely. In cases of durable CR, there are no guidelines regarding a possible discontinuation of immunotherapy. Since clinical experience on this issue is limited, the present study reported on a case of a durable CR following discontinuation of PD-1 inhibition in R/M-HNSCC and additionally presented an overview on the current literature. The present study reported on a case of CR of recurrent oropharyngeal cancer after four cycles of PD-1 monotherapy with Nivolumab. The therapy was discontinued after overall 46 cycles. Even after 3 more years of follow-up, there was no sign of tumor recurrence. Overall, according to reports from the literature, CR seems to be an indicator for durable disease control after therapy discontinuation. Since data on therapy termination is rare, decisions about when to stop successful immunotherapy in R/M-HNSCC have to be made individually for each patient.
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Affiliation(s)
- Manuel Stöth
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, D-97080 Würzburg, Germany
| | - Till Meyer
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, D-97080 Würzburg, Germany
| | - Thomas Gehrke
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, D-97080 Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, D-97080 Würzburg, Germany
| | - Matthias Scheich
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, D-97080 Würzburg, Germany
| | - Stephan Hackenberg
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Rhine-Westphalia Technical University of Aachen, D-52074 Aachen, Germany
| | - Agmal Scherzad
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, D-97080 Würzburg, Germany
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Lilja-Fischer JK, Kristensen MH, Lassen P, Steiniche T, Tramm T, Stougaard M, Maare C, Johansen J, Primdahl H, Kristensen CA, Andersen M, Eriksen JG, Overgaard J. HPV testing versus p16 immunohistochemistry in oropharyngeal squamous cell carcinoma: results from the DAHANCA 19 study. Acta Oncol 2023; 62:1384-1388. [PMID: 37837201 DOI: 10.1080/0284186x.2023.2266127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION The prognosis after primary (chemo-)radiotherapy for oropharyngeal squamous cell carcinoma (OPSCC) is affected by Human Papillomavirus (HPV) status, with a better prognosis in HPV-positive OPSCC. HPV-status is routinely assessed by p16 immunohistochemistry (IHC), but additional HPV DNA testing is debated. Also, there are numerous HPV genotypes, which prognostic role may need clarification. The purpose of this study was: (1) to test a custom-made targeted HPV next generation sequencing (NGS) panel in OPSCC, (2) to determine correlation with p16 IHC, and (3) to assess the impact of HPV DNA testing on outcome in the prospectively randomized clinical trial DAHANCA 19. MATERIALS AND METHODS We included 271 patients with OPSCC treated with primary (chemo-)radiotherapy in the DAHANCA 19 trial. Of these, 199 (73%) were p16-positive. HPV-status was determined by targeted HPV next generation sequencing (NGS), using a custom-made HPV genotyping panel. RESULTS HPV was detected in 194 tumor samples. p16 IHC and NGS HPV status were concordant in 265 (98%) of 271 patients, whereas we did not detect HPV DNA in 5 p16-positive tumors. HPV16 accounted for 169 of 194 HPV-positive cases (87%). HPV genotypes 18, 31, 33, 35, and 59 were also detected.Loco-regional failure and overall survival were similar whether patients were separated by p16 IHC, or HPV DNA status (p < 0.0001 for all) and did not depend on HPV genotype (p = 0.9 and p = 0.7). CONCLUSION In the present study, HPV DNA testing or typing in a Danish OPSCC cohort did not add additional information to p16 IHC, the most widely used and accepted prognostic indicator.
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Affiliation(s)
- Jacob Kinggaard Lilja-Fischer
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Otolaryngology - Head & Neck surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Pernille Lassen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Steiniche
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Tramm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Magnus Stougaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Ferrandino RM, Chen S, Kappauf C, Barlow J, Gold BS, Berger MH, Westra WH, Teng MS, Khan MN, Posner MR, Misiukiewicz KJ, Bakst RL, Sindhu KK, Genden EM, Chai RL, Roof SA. Performance of Liquid Biopsy for Diagnosis and Surveillance of Human Papillomavirus-Associated Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:971-977. [PMID: 37422913 PMCID: PMC10331620 DOI: 10.1001/jamaoto.2023.1937] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Importance There is growing interest in the use of circulating plasma tumor human papillomavirus (HPV) DNA for diagnosis and surveillance of patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). Recent advances in the assays, combining the identification of circulating HPV tumor DNA and tumor DNA fragment analysis (tumor tissue-modified viral [TTMV]-HPV DNA), have been shown to be highly accurate. However, use of these newer techniques has been limited to small cohort studies and clinical trials. Objective To establish the clinical efficacy of plasma TTMV-HPV DNA testing in the diagnosis and surveillance of HPV-associated OPSCC in a contemporary clinical setting. Design, Setting, and Participants This retrospective observational cohort study included patients with OPSCC who underwent TTMV-HPV DNA testing between April 2020 and September 2022 during the course of routine clinical care. For the diagnosis cohort, patients with at least 1 TTMV-HPV DNA measurement prior to initiation of primary therapy were included. Patients were included in the surveillance cohort if they had at least 1 TTMV-HPV DNA test performed after completion of definitive or salvage therapy. Main Outcomes and Measures Per-test performance metrics, including sensitivity, specificity, positive predictive value, and negative predictive value, for TTMV-HPV DNA testing. Results Of 399 patients included in the analysis, 163 were in the diagnostic cohort (median [IQR] age, 63 [56-68.5] years; 142 [87.1%] male), and 290 were in the surveillance cohort (median [IQR] age, 63 [57-70] years; 237 [81.7%] male). Of the 163 patients in the diagnostic cohort, 152 (93.3%) had HPV-associated OPSCC while 11 (6.7%) had HPV-negative OPSCC. The TTMV-HPV DNA sensitivity in pretreatment diagnosis was 91.5% (95% CI, 85.8%-95.4% [139 of 152 tests]), and the specificity was 100% (95% CI, 71.5%-100% [11 of 11 tests]). In the surveillance cohort, 591 tests conducted in 290 patients were evaluated. A total of 23 patients had molecularly confirmed pathologic recurrences. The TTMV-HPV DNA test demonstrated sensitivity of 88.4% (95% CI, 74.9%-96.1% [38 of 43 tests]) and specificity of 100% (95% CI, 99.3%-100% [548 of 548 tests]) in detecting the recurrences. Positive predictive value was 100% (95% CI, 90.7%-100% [38 of 38 tests]), and negative predictive value was 99.1% (95% CI, 97.9%-99.7% [548 of 553 tests]). The median (range) lead time from positive TTMV-HPV DNA test to pathologic confirmation was 47 (0-507) days. Conclusions and Relevance This cohort study demonstrated that when evaluated in a clinical setting, the TTMV-HPV DNA assay demonstrated 100% specificity in both diagnosis and surveillance. However, the sensitivity was 91.5% for the diagnosis cohort and 88.4% for the surveillance cohort, signifying that nearly 1 in 10 negative tests among patients with HPV-associated OPSCC was a false negative. Additional research is required to validate the assay's performance and, if validated, then further research into the implementation of this assay into standard clinical practice guidelines will be required.
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Affiliation(s)
- Rocco M. Ferrandino
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sida Chen
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catharine Kappauf
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua Barlow
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brandon S. Gold
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael H. Berger
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - William H. Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marita S. Teng
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohemmed N. Khan
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall R. Posner
- Department of Hematology/Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Krzysztof J. Misiukiewicz
- Department of Hematology/Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard L. Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kunal K. Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric M. Genden
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raymond L. Chai
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott A. Roof
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Chen AM, Harris JP, Gan M, Nabar R, Tjoa T, Haidar YM, Truong A, Chow DS, Armstrong WB. Posttreatment Surveillance Imaging After Radiation for Head and Neck Cancer. JAMA Netw Open 2023; 6:e2342825. [PMID: 37948074 PMCID: PMC10638654 DOI: 10.1001/jamanetworkopen.2023.42825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/19/2023] [Indexed: 11/12/2023] Open
Abstract
Importance The role of surveillance imaging after treatment for head and neck cancer is controversial and evidence to support decision-making is limited. Objective To determine the use of surveillance imaging in asymptomatic patients with head and neck cancer in remission after completion of chemoradiation. Design, Setting, and Participants This was a retrospective, comparative effectiveness research review of adult patients who had achieved a complete metabolic response to initial treatment for head and neck cancer as defined by having an unequivocally negative positron emission tomography (PET) scan using the PET response criteria in solid tumors (PERCIST) scale within the first 6 months of completing therapy. The medical records of 501 consecutive patients who completed definitive radiation therapy (with or without chemotherapy) for newly diagnosed squamous cell carcinoma of the head and neck between January 2014 and June 2022 were reviewed. Exposure Surveillance imaging was defined as the acquisition of a PET with computed tomography (CT), magnetic resonance imaging (MRI), or CT of the head and neck region in the absence of any clinically suspicious symptoms and/or examination findings. For remaining patients, subsequent surveillance after the achievement of a complete metabolic response to initial therapy was performed on an observational basis in the setting of routine follow-up using history-taking and physical examination, including endoscopy. This expectant approach led to imaging only in the presence of clinically suspicious symptoms and/or physical examination findings. Main Outcome and Measures Local-regional control, overall survival, and progression-free survival based on assignment to either the surveillance imaging or expectant management cohort. Results This study included 340 patients (mean [SD] age, 59 [10] years; 201 males [59%]; 88 Latino patients [26%]; 145 White patients [43%]) who achieved a complete metabolic response during this period. There was no difference in 3-year local-regional control, overall survival, progression-free survival, or freedom from distant metastasis between patients treated with surveillance imaging vs those treated expectantly. Conclusions and Relevance In this comparative effectiveness research, imaging-based surveillance failed to improve outcomes compared with expectant management for patients who were seemingly in remission after completion of primary radiation therapy for head and neck cancer.
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Affiliation(s)
- Allen M. Chen
- Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Jeremy P. Harris
- Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Meng Gan
- Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Rupali Nabar
- Department of Internal Medicine, Division of Hematology-Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Tjoson Tjoa
- Department of Otolaryngology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Yarah M. Haidar
- Department of Otolaryngology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Annie Truong
- Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - Daniel S. Chow
- Department of Diagnostic Radiology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
| | - William B. Armstrong
- Department of Otolaryngology, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange
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Hirakawa H, Ikegami T, Touyama M, Ooshiro Y, Higa T, Higa T, Agena S, Kinjyo H, Kondo S, Kise N, Tanaka K, Maeda H, Tamaki T, Wada N, Suzuki M. p16 Overexpression in Sinonasal Squamous Cell Carcinoma: Association with Human Papillomavirus and Prediction of Survival Outcomes. J Clin Med 2023; 12:6861. [PMID: 37959327 PMCID: PMC10650892 DOI: 10.3390/jcm12216861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
p16 overexpression is often used as a surrogate marker for human papillomavirus (HPV) infection in oropharyngeal squamous cell carcinoma but remains an uncertain diagnostic tool for HPV-related sinonasal squamous cell carcinoma (SNSCC). Our study involved 79 consecutive SNSCC patients who were treated at a tertiary referral university hospital during 2006-2021. We retrospectively examined their clinical characteristics and conducted p16 immunohistochemistry and HPV detection. We found that 12.7% of the patients exhibited p16 overexpression, which was significantly more common in the nasal cavity and increased from 2015 onward. The HPV was a high-risk type and viral loads ranged from 4.2 to 1.6 × 106 copies/ng DNA with genome integration. Five-year overall survival (OS) and five-year relapse-free survival (RFS) rates were 74.6% and 69.9%, respectively. Our multivariate analysis showed that T category (T1-4a) and hemoglobin levels (≥13.7) were significant favorable prognostic factors for OS, while T category, performance status, and p16 overexpression were significantly associated with RFS. In patients with p16 overexpression, OS was 100% and RFS was 90%. Our findings suggest that p16 overexpression is a reliable surrogate marker for transcriptionally active HPV infection and predicts a favorable prognosis.
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Affiliation(s)
- Hitoshi Hirakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Taro Ikegami
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Masatomo Touyama
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Yurika Ooshiro
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Tomoyo Higa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Teruyuki Higa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Shinya Agena
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Hidetoshi Kinjyo
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Shunsuke Kondo
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Norimoto Kise
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Katsunori Tanaka
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Hiroyuki Maeda
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
| | - Tomoko Tamaki
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan (N.W.)
| | - Naoki Wada
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan (N.W.)
| | - Mikio Suzuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan; (H.H.); (T.I.); (M.T.); (T.H.)
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Jakobsen KK, Bendtsen SK, Pallisgaard N, Friborg J, Lelkaitis G, Grønhøj C, von Buchwald C. Liquid Biopsies with Circulating Plasma HPV-DNA Measurements-A Clinically Applicable Surveillance Tool for Patients with HPV-Positive Oropharyngeal Cancer. Clin Cancer Res 2023; 29:3914-3923. [PMID: 37477909 DOI: 10.1158/1078-0432.ccr-23-1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/25/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To evaluate the accuracy of cell-free human papillomavirus-DNA (cfHPV-DNA) measurements in liquid biopsies in predicting disease in patients with HPV-positive/p16-positive (HPV+/p16+) oropharyngeal squamous cell carcinoma (OPSCC). EXPERIMENTAL DESIGN This was a prospective cohort study. Plasma samples were collected before treatment, serially after curative intended therapy at follow-up visits 2 weeks, and 6, 9, 12, 18, 24, and 30 months after treatment. A droplet digital PCR assay comprising eight HPV genotypes was used. HPV genotypes found in plasma and tumor tissue were compared. We correlated biopsy- or imaging-verified tumor progression to cfHPV-DNA in follow-up samples. RESULTS We enrolled 72 patients with HPV+/p16+ OPSCC. Baseline sensitivity for cfHPV-DNA detection was 97.2% (95% confidence interval, 90.3%-99.6%). CfHPV-DNA copy number/milliliter plasma correlated with tumor stage. We found a 100% concordance between HPV genotype in tumor tissue and plasma. Fifty-four patients were followed with serial blood samples for a median of 19.7 months (interquartile range, 13.5-25.5 months). Forty-one patients had undetectable plasma cfHPV-DNA in all follow-up samples, and none developed recurrences. Thirteen patients were classified as cfHPV-DNA-positive in a follow-up plasma sample. Of these, five patients developed a recurrence, and three had residual cancer. It was possible to detect cfHPV-DNA in plasma 97 to 166 days prior to the proven recurrence. CONCLUSIONS To our knowledge, to date, our study, comprising the largest study of patients with HPV+/p16+ OPSCC, using an ultrasensitive multiplex HPV gene panel, revealed a high sensitivity of cfHPV-DNA detection in the liquid biopsies. We recommend serial plasma HPV samples for clinical monitoring of patients with HPV+/p16+ OPSCC.
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Affiliation(s)
- Kathrine K Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Simone K Bendtsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jeppe Friborg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Giedrius Lelkaitis
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Wuerdemann N, Joosse S, Klasen C, Prinz J, Demers I, George J, Speel EJM, Wagner S, Klußmann JP. [ctHPV-DNA based precision oncology for patients with oropharyngeal cancer - Where are we?]. Laryngorhinootologie 2023; 102:728-734. [PMID: 37364603 DOI: 10.1055/a-2092-3837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Human papillomavirus (HPV) is an established etiologic factor for cancers in the head and neck region, specifically for Oropharyngeal Squamous Cell Carcinoma (OPSCC). The comparatively good overall survival justifies the current discussion regarding therapy de-escalation for patients with a low-risk profile. In addition to the immunohistochemistry-based biomarker p16INK4a, there is still a need for diagnostic and prognostic biomarkers that allow risk stratification and monitoring during therapy and follow-up of these patients. In recent years, liquid biopsy, especially in the form of plasma samples, has gained importance and is already used to monitor viral DNA in patients with Epstein-Barr virus-associated nasopharyngeal carcinoma. Circulating DNA (ctDNA) released by the tumor into the bloodstream is particularly suitable for a high specificity in detecting virus-associated tumors. Detection of viral E6 and E7 oncogenes in HPV-positive OPSCC is predominantly performed by droplet digital/quantitative PCR as well as next generation sequencing. Detection of circulating HPV-DNA derived from tumor cells (ctHPV-DNA) at diagnosis is associated with advanced tumor stage, locoregional and distant metastases. Longitudinal studies have further demonstrated that detectable and/or increasing ctHPV-DNA levels are associated with treatment failure and disease relapse. However, a standardization of the diagnostic procedure is necessary before introducing liquid biopsy into the clinical routine. In the future, this might allow a valid reflection of disease progression in HPV-positive OPSCC.
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Affiliation(s)
- Nora Wuerdemann
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Köln, Deutschland
- Klinik für Innere Medizin I, Uniklinik Köln, Köln, Deutschland
| | - Simon Joosse
- Abteilung für Tumorbiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Charlotte Klasen
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Köln, Deutschland
| | - Johanna Prinz
- Klinik für Innere Medizin I, Uniklinik Köln, Köln, Deutschland
| | - Imke Demers
- Institut für Pathologie, Maastricht Universität, GROW-School für Onkologie und Entwicklungsbiologie, Maastricht, Niederlande
| | - Julie George
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Köln, Deutschland
| | - Ernst-Jan Maria Speel
- Institut für Pathologie, Maastricht Universität, GROW-School für Onkologie und Entwicklungsbiologie, Maastricht, Niederlande
- GROW-School für Onkologie und Entwicklungsbiologie, Institut für Pathologie, Maastricht Universität, Maastricht, Niederlande
| | - Steffen Wagner
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Jens Peter Klußmann
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Köln, Deutschland
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47
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Lim YX, Mierzwa ML, Sartor MA, D'Silva NJ. Clinical, morphologic and molecular heterogeneity of HPV-associated oropharyngeal cancer. Oncogene 2023; 42:2939-2955. [PMID: 37666939 PMCID: PMC10541327 DOI: 10.1038/s41388-023-02819-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
The incidence of human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is rising rapidly and has exceeded cervical cancer to become the most common HPV-induced cancer in developed countries. Since patients with HPV + OPSCC respond very favorably to standard aggressive treatment, the emphasis has changed to reducing treatment intensity. However, recent multi-center clinical trials failed to show non-inferiority of de-escalation strategies on a population basis, highlighting the need to select low-risk patients likely to respond to de-intensified treatments. In contrast, there is a substantial proportion of patients who develop recurrent disease despite aggressive therapy. This supports that HPV + OPSCC is not a homogeneous disease, but comprises distinct subtypes with clinical and biological variations. The overall goal for this review is to identify biomarkers for HPV + OPSCC that may be relevant for patient stratification for personalized treatment. We discuss HPV + OPSCC as a heterogeneous disease from multifaceted perspectives including clinical behavior, tumor morphology, and molecular phenotype. Molecular profiling from bulk tumors as well as single-cell sequencing data are discussed as potential driving factors of heterogeneity between tumor subgroups. Finally, we evaluate key challenges that may impede in-depth investigations of HPV + OPSCC heterogeneity and outline potential future directions, including a section on racial and ethnic differences.
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Affiliation(s)
- Yvonne X Lim
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011N. University Ave, Ann Arbor, MI, USA
| | - Michelle L Mierzwa
- Rogel Cancer Center, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, USA
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maureen A Sartor
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Biostatistics, School of Public Health, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nisha J D'Silva
- Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011N. University Ave, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, USA.
- Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.
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48
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Poljak M, Cuschieri K, Alemany L, Vorsters A. Testing for Human Papillomaviruses in Urine, Blood, and Oral Specimens: an Update for the Laboratory. J Clin Microbiol 2023; 61:e0140322. [PMID: 37439692 PMCID: PMC10446865 DOI: 10.1128/jcm.01403-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
Twelve high-risk alpha human papillomavirus (HPV) genotypes cause approximately 690,000 cancer cases annually, with cervical and oropharyngeal cancer being the two most prominent types. HPV testing is performed in laboratory settings for various applications of a clinical, epidemiological, and research nature using a range of clinical specimens collected by clinicians or by individuals (self-collected specimens). Here, we reflect on the importance and justification of using the right test for the right application and provide practical updates for laboratories either participating in or anticipating involvement in HPV testing in three specimen types, namely, urine, blood, and oral specimens, which are considered "alternative" specimens by many. In addition to clinician-collected cervical samples and self-collected cervicovaginal samples, first-void urine is emerging as a credible specimen for HPV-based cervical cancer screening, triage of HPV screen-positive women, monitoring HPV vaccine impact, and HPV testing in groups for which a less invasive sample is preferred. Detection of cell-free DNA (including HPV DNA) in blood has great promise for the early detection of HPV-attributable oropharyngeal cancer (HPV-AOC) and potentially other HPV-driven cancers and as an adjunct prognostic marker in long-term tumor surveillance, including treatment response. The moderate sensitivity of HPV testing in oral rinses or swabs at HPV-AOC diagnosis prevents its use in HPV-AOC secondary prevention but represents a promising prognostic tool in HPV-AOC tertiary prevention, where the HPV persistence in oral rinses throughout treatment may predict early HPV-AOC recurrences and/or the development of secondary HPV-AOC. The increasing sophistication of specific collection devices designed for alternative samples and the enhanced precision of novel molecular technologies are likely to support the evolution of this field and catalyze potential translation into routine practice.
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Affiliation(s)
- Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Alex Vorsters
- Centre for Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Klein S, Wuerdemann N, Demers I, Kopp C, Quantius J, Charpentier A, Tolkach Y, Brinker K, Sharma SJ, George J, Hess J, Stögbauer F, Lacko M, Struijlaart M, van den Hout MFCM, Wagner S, Wittekindt C, Langer C, Arens C, Buettner R, Quaas A, Reinhardt HC, Speel EJ, Klussmann JP. Predicting HPV association using deep learning and regular H&E stains allows granular stratification of oropharyngeal cancer patients. NPJ Digit Med 2023; 6:152. [PMID: 37598255 PMCID: PMC10439941 DOI: 10.1038/s41746-023-00901-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
Human Papilloma Virus (HPV)-associated oropharyngeal squamous cell cancer (OPSCC) represents an OPSCC subgroup with an overall good prognosis with a rising incidence in Western countries. Multiple lines of evidence suggest that HPV-associated tumors are not a homogeneous tumor entity, underlining the need for accurate prognostic biomarkers. In this retrospective, multi-institutional study involving 906 patients from four centers and one database, we developed a deep learning algorithm (OPSCCnet), to analyze standard H&E stains for the calculation of a patient-level score associated with prognosis, comparing it to combined HPV-DNA and p16-status. When comparing OPSCCnet to HPV-status, the algorithm showed a good overall performance with a mean area under the receiver operator curve (AUROC) = 0.83 (95% CI = 0.77-0.9) for the test cohort (n = 639), which could be increased to AUROC = 0.88 by filtering cases using a fixed threshold on the variance of the probability of the HPV-positive class - a potential surrogate marker of HPV-heterogeneity. OPSCCnet could be used as a screening tool, outperforming gold standard HPV testing (OPSCCnet: five-year survival rate: 96% [95% CI = 90-100%]; HPV testing: five-year survival rate: 80% [95% CI = 71-90%]). This could be confirmed using a multivariate analysis of a three-tier threshold (OPSCCnet: high HR = 0.15 [95% CI = 0.05-0.44], intermediate HR = 0.58 [95% CI = 0.34-0.98] p = 0.043, Cox proportional hazards model, n = 211; HPV testing: HR = 0.29 [95% CI = 0.15-0.54] p < 0.001, Cox proportional hazards model, n = 211). Collectively, our findings indicate that by analyzing standard gigapixel hematoxylin and eosin (H&E) histological whole-slide images, OPSCCnet demonstrated superior performance over p16/HPV-DNA testing in various clinical scenarios, particularly in accurately stratifying these patients.
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Affiliation(s)
- Sebastian Klein
- Department of Hematology and Stem Cell Transplantation, University Duisburg-Essen, University Hospital Essen, Essen, Germany.
- Institute of Pathology, Medical Faculty, University Hospital Cologne, Cologne, Germany.
| | - Nora Wuerdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Medical Faculty, Cologne, Germany
| | - Imke Demers
- Department of Pathology, GROW - School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christopher Kopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Jennifer Quantius
- Institute of Pathology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Arthur Charpentier
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Medical Faculty, Cologne, Germany
| | - Yuri Tolkach
- Institute of Pathology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Klaus Brinker
- Hamm-Lippstadt University of Applied Sciences, Hamm, Germany
| | - Shachi Jenny Sharma
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Medical Faculty, Cologne, Germany
| | - Julie George
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, Cologne, Germany
- Department of Translational Genomics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jochen Hess
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Heidelberg, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fabian Stögbauer
- Tissue Bank of the National Center for Tumor Diseases (NCT) Heidelberg, Germany, and Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Institute of Pathology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Martin Lacko
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marijn Struijlaart
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mari F C M van den Hout
- Department of Pathology, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
- Clinic of Otorhinolaryngology, Head and Neck Surgery, Klinikum Dortmund, University of Witten/Herdecke, Faculty for Health, Department of Human Medicine, Witten, Germany
| | - Christine Langer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
| | - Reinhard Buettner
- Institute of Pathology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Hans Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, University Duisburg-Essen, University Hospital Essen, Essen, Germany
- West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Ernst-Jan Speel
- Department of Pathology, GROW - School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University Hospital Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Medical Faculty, Cologne, Germany
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Chen AM. De-escalated radiation for human papillomavirus virus-related oropharyngeal cancer: evolving paradigms and future strategies. Front Oncol 2023; 13:1175578. [PMID: 37576899 PMCID: PMC10413127 DOI: 10.3389/fonc.2023.1175578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/25/2023] [Indexed: 08/15/2023] Open
Abstract
The incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma has increased dramatically in recent years reaching epidemic-like proportions. Data has emerged not only showing that these cancers are a unique entity with distinct molecular characteristics but that they also have a significantly improved prognosis as a result of their exquisite radiosensitivity compared to their HPV-negative counterparts. This, it has been increasingly suggested that these tumors can be targeted with de-escalated approaches using reduced doses of radiation. The overriding goal of de-escalation is to maintain the high cure and survival rates associated with traditional approaches while reducing the incidence of both short- and long-term toxicity. Although the exact reason for the improved radiosensitivity of HPV-positive oropharyngeal carcinoma is unclear, prospective studies have now been published demonstrating that de-escalated radiation can successfully maintain the high rates of cure and preserve quality of life for appropriately selected patients with this disease. However, these studies have been complicated by such factors as the relatively limited sample sizes, as well as the variability in treatment, inclusion criteria, and follow-up. As the data continues to mature on de-escalation, it is unquestionable that treatment paradigms for this disease will evolve. The ongoing quest to define a standard regimen comprises the subject of this review.
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Affiliation(s)
- Allen M. Chen
- Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, School of Medicine, University of California- Irvine, Irvine, CA, United States
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