Global epidemiologic patterns of oropharyngeal cancer incidence trends

Adaptive radiotherapy for oropharyngeal cancer with daily adapt-to-shape workflow on 1.5 T MRI-linac: Preliminary outcomes and comparison with helical tomotherapy

Introduction

MR-linac could offer several advantages for radical radiochemotherapy (RCHT) in oropharyngeal squamous cell carcinoma (OPSCC) patients. Currently, only a few case series have been published and no comparison with other techniques have been performed.

Methods

Data of 34 consecutive patients treated from September 2022 to May 2024 at a single Institution with RCHT on Unity® MR-linac for OPSCC with daily adaptive radiotherapy (RT) according to the adapt-to-shape (ATS) workflow were prospectively analyzed. A comparative cohort of 34 patients with similar characteristics treated with helical treatment on Radixact® was retrieved.

Results

Characteristics were well balanced across the two groups. Maximal toxicity grade ≥2 rate was borderline higher at RT end in MRI-linac group (p 0.049), but lower one month after RT (76.5 % vs 91.2 %; p = 0.257).Non-significantly lower rates of grade ≥2 xerostomia and dysgeusia were reported in Unity® group one and three months after RT. Higher rates of hospitalizations were reported in Radixact group at 20 fractions and at RT end (64.1 % vs 35.3 %; p = 0.015). Mean Karnofsky performance status (KPS) was higher in Unity group three months after RT (87.67 vs 83.87; p = 0.038).After a median follow up of 361.5 days, local complete response was reported for 93.6 % of patients treated with Unity® and 96.8 % of patients treated with Radixact®.

Conclusions

Results of this analysis support the feasibility of an ATS MR-linac workflow for RCHT in OPSCC. Compared with tomotherapy, treatment with Unity® resulted in significantly lower rates of hospitalization and higher KPS three months after RT. Grade 2 xerostomia and dysgeusia rates were non-significantly lower in Unity group. Optimal results in terms of local control were reported for both techniques.

Health-related quality-of-life assessment in patients with oropharyngeal cancer: A comparison of EQ-5D-5L and EORTC instruments

OBJECTIVE

This study assessed and compared health-related quality of life (HRQoL) in patients with oropharyngeal cancer in Korea using the following instruments: the EuroQol 5-Dimensions 5-Level (EQ-5D-5L); EORTC Quality of Life Questionnaire - Core 30 (QLQ-C30); and the EORTC Quality of Life Questionnaire - Head and Neck 35 (QLQ-H&N35). The principal goal was to evaluate suitability of the EQ-5D-5L for assessing HRQoL in patients with oropharyngeal cancer.

METHODS

A survey was conducted from August 2023 to March 2024 in 297 patients with oropharyngeal cancer across 14 hospitals in Korea. HRQoL data were collected using the EQ-5D-5L, QLQ-C30, and QLQ-H&N35 instruments. Descriptive statistical analyses were performed based on sociodemographic characteristics and correlation analyses between the instruments. A multiple regression analysis was also conducted to identify significant EORTC domains influencing the EQ-5D-5L index.

RESULTS

All EQ-5D-5L items correlated significantly with the QLQ-C30 items but not with the QLQ-H&N35 items. Moderate or strong correlations were observed in 37 % of QLQ-C30 and EQ-5D-5L domain comparisons, while 18 % of QLQ-H&N35 and EQ-5D-5L domain comparisons showed moderate correlations. However, multiple regression analysis revealed that the QLQ-C30 and QLQ-H&N35 scales explained 66.3 % of the EQ-5D-5L index variance, indicating a substantial relationship between these instruments.

CONCLUSIONS

The EORTC domains meaningfully explain the EQ-5D-5L index. These findings support using the EQ-5D-5L to calculate quality-adjusted life years for patients with oropharyngeal cancer and facilitate economic evaluations that inform clinical practice and policymaking.

Oropharyngeal Cancer Incidence and Trends in Brazil

BACKGROUND

Oropharyngeal cancer incidence is rising globally, predominantly in high-income countries, because of human papillomavirus infection. However, further data on oropharyngeal cancer incidence in Brazil is needed. The aim of this study was to estimate the incidence, trends, and predictions of oropharyngeal cancer in Brazilian population-based cancer registries (PBCR) by period, sex, and topography.

METHODS

Data on oropharyngeal cancer were collected from PBCRs (1988-2020). Age-standardized rates were calculated from 2000 onward using the 2010 Brazilian census and world standard population. Annual average percent change was analyzed using the joinpoint regression model. Predictions up to 2034 were made using the Nordpred program and the age-period-cohort model.

RESULTS

A total of 17,980 oropharyngeal cancer cases were recorded across 30 PBCRs (1988-2020). Most cases involved males (81.58%) ages 55 to 59 years (17.06%). The oropharynx not otherwise specified (40.58%), base of the tongue (24.98%), and tonsils (22.52%) were the sites most affected. The highest incidence rates were found in the southeastern and southern regions (3.1-9.4/100,000). Incidence trends increased for 10 PBCR regions in males and 6 regions in females. Predictions up until 2034 indicate decreasing trends for females and increasing trends for males in the north and south of Brazil.

CONCLUSIONS

The incidence of oropharyngeal cancer in Brazil differs among regions, with higher rates observed in the south and southeast. The prevalence of the human papillomavirus-attributable fraction for oropharyngeal cancer is unknown.

IMPACT

Analysis of oropharyngeal cancer incidence rates and regional trends aims to better understand the epidemiology of this malignancy in the Brazilian population.

Shifting HPV-cancer burden: from cervical cancer to oropharyngeal cancer

PURPOSE

This study aims to explore the contrasting trends of decreasing cervical cancer (CC) rates among women and increasing oropharyngeal cancer (OPC) rates among men.

METHODS

The analysis examines public health initiatives, including CC screening programs and HPV vaccination efforts, alongside the changing epidemiology of OPC.

RESULTS

Declines in CC incidence are attributed to improved screening and HPV vaccination. Conversely, OPC rates are rising among men, linked primarily to HPV infection and lack of established screening programs. Data indicate a higher OPC burden in men compared to CC in women in several countries.

CONCLUSION

Addressing the rising OPC trend requires a multifaceted approach, including gender-neutral HPV vaccination, the development of OPC screening methods, and increased public awareness. Sustained efforts in HPV-related cancer prevention are crucial to mitigate these opposing trends.

Oral HPV incidence and risk factors for acquisition

BACKGROUND

We evaluated incidence of oral HPV infection, which precedes HPV-related oropharynx cancer.

METHODS

In this prospective multicenter cohort of participants with HIV and demographically similar participants without HIV, oral rinse and gargle samples were collected every 6-12 months and tested for 35 HPV types (anyHPV), 13 of which were oncogenic (oncHPV). Kaplan Meier and Cox regression were used for incidence curves and clustered risk factor hazard ratios. Logistic regression was used to determine relative odds of same infection at next visit.

RESULTS

The 1587 participants had a median follow-up of 3.67 years, 422 had 708 incident type-specific oral HPV detected. The most common oncHPV was HPV16 [incidence rate = 7.8 per 1000 person-years (95 %CI 5.8-10.6)]. At 5 years, the cumulative incidence of anyHPV, oncHPV and HPV16 was 34.9 % (95 %CI = 31.9 %, 38.3 %), 17.1% (95 %CI = 14.8 %, 19.8 %) and 4.0 % (95 %CI = 2.9, 5.6 %), respectively. Risk of incident oral HPV infection was independently associated with a higher number of oral sex partners, current smoking, younger age, prevalent oral anyHPV, living with HIV and lower CD4 counts. Prevalent oncHPV at baseline had greater odds of being re-detected at subsequent visits than an incident oncHPV detected for the first-time at a later visit. Detection of oral HPV type at one visit was associated with highly elevated odds of detecting that same type-specific infection at the next visit (OR > 100).

CONCLUSION

Cumulative incidence of oral HPV is increased among PLWH and with prevalent oral HPV, represents a mix of new and intermittently detected infections, and is higher among those with repeated detection of oral HPV.

HPV Biomarkers in Oral and Blood-Derived Body Fluids in Head and Neck Cancer Patients

Oral HPV DNA and circulating tumor (ct) HPV DNA in plasma were evaluated as potential biomarkers for HPV-associated head and neck cancer (HNC). Samples from HNC patients (n = 132), including 23 oropharyngeal cancers (OPC), and non-HNC controls (n = 10) were analyzed. HPV status was determined using a multiplex bead-based test (E7-MPG) applied to formalin-fixed paraffin-embedded (FFPE) tissues (n = 90), plasma (n = 141), gargle samples (n = 141), and oral swabs (n = 142). HPV DNA was detected in 25.8% of HNC tissues, 12% of plasma samples, 20.6% of gargles and 7% of oral swabs with HPV16 as the most prevalent genotype. Among OPC cases, HPV16 DNA was found in 71.4% of FFPE samples. High concordance was observed between paired OPC tissues and plasma (91.3%) or gargles (95.2%), with moderate concordance for oral swabs (59.1%). Gargle samples alone demonstrated a 100% detection rate for HPV16-positive OPC, regardless of the cT stage, outperforming plasma (86.7%). Combined oral gargle and plasma analyses detected all HPV-positive OPC cases (7/7) at the early cT1 stage. These findings highlight the limited involvement of HPV in non-oropharyngeal HNC compared to OPC, and support gargle and plasma samples as minimally invasive diagnostic tools for detecting HPV-associated OPC.

Fine needle aspiration cytology including the analysis of human papilloma virus (HPV) DNA enhances the diagnostic workup of solitary cystic neck lesions in a population with a high incidence of HPV positive oropharyngeal cancer

BACKGROUND AND PURPOSE

Distinguishing branchial cleft cysts (BrCCs) from cystic metastases of human papillomavirus (HPV) positive tonsillar or base of tongue squamous cell carcinoma and cancer of unknown primary (CUP) is challenging. Fine needle aspiration cytology (FNAC) from cystic metastasis can be nonrepresentative, while reactive squamous cells from BrCC can be atypical. It is unclear whether benign characteristics and the absence of HPV-DNA in FNAC can enhance distinguishing BrCC from a cystic metastasis; therefore, we investigated here.

PATIENTS/MATERIALS AND METHODS

Morphology and HPV-DNA in FNAC were reevaluated preoperatively and correlated to final diagnosis of 304 BrCC and CUP patients at Karolinska University Hospital during 2016-2023.

RESULTS AND INTERPRETATION

All 176 cases finally diagnosed as BrCC were HPV-DNA negative in the preoperative FNAC. HPV-DNA was present in 100/128 (78.1%) of the FNAC with a solitary cystic neck metastasis and in 3/3 CUPs separately investigated on surgical specimens, which is distributed in 40/58 (69.0%) CUP, 40/41 (97.6%) tonsillar cancer, 21/22 (95.5%) base of tongue cancer, 2/2 uterine cervical cancer, and 0/5 non-HPV-related cancers.

INTERPRETATION

All cases with final BrCC diagnosis were HPV-DNA negative in FNAC. HPV-DNA was only present in FNAC of malignant cystic neck masses of HPV-related tumors or CUP. The data suggest that HPV-DNA analysis in FNAC enhances the diagnostics of cystic masses of the neck. A FNAC with a benign morphology and the absence of HPV-DNA indicated a BrCC, while an HPV-DNA positive aspirate irrespective of morphology suggested an HPV-DNA positive cancer or CUP.

Trends in Human Papillomavirus-Related Health Burden in Greece from 1996 to 2021 with a Focus on Cervical and Lip, Oral Cavity, and Pharyngeal Cancer

This study aimed to evaluate the burden of HPV-related hospitalization and mortality in Greece, with a focus on invasive cervical cancer and lip, oral cavity, and pharyngeal (LOCP) cancers. A retrospective query using data from the Greek Statistical Office and Eurostat was executed. The query included hospital admission and standardized mortality rates (SDRs) on cervical dysplasia and cervical, vulvar, and vaginal; anal; penile; and LOCP cancers. The hospitalization rate for invasive cervical cancer decreased over time, exhibiting a sharp decrease after 2010, while the hospitalization rate for LOCP cancer decreased after 2011, preceded by a sustained increase from 1996. The hospitalization rate of HPV-attributable diseases in total showed a declining tendency between 2013 and 2017. SDR due to cervical cancer showed a slightly decreasing trend in Greece and the European Union, while SDR due to LOCP cancer showed a slightly increasing trend in Greece, but a decrease in the European Union. The decline in hospitalization rates for HPV-related disease in Greece, especially for cervical cancer and dysplasia, and also the declining SDR for invasive cervical cancer in Greece and the EU, are indications of the positive public health impact of screening programs and the implementation of HPV vaccination.

Global, regional and national burdens of cardiovascular disease attributable to secondhand smoke from 1990-2019: an age-period-cohort analysis

BACKGROUND

Over the past three decades, significant disparities in the global burden of cardiovascular disease (CVD) have been observed, particularly CVD attributed to secondhand smoke. However, a comprehensive understanding of global trends and their interaction with secondhand smoke remains inadequate.

METHODS

Using Global Burden of Disease data (1990-2019), an age-period-cohort analysis examined temporal trends in CVD mortality among secondhand smoke-exposed populations, considering age, period and cohort interactions.

RESULTS

Over the 30-year period, the global number of CVD deaths attributed to secondhand smoke increased substantially, from 432.6 thousand in 1990 (95% UI: 357.4-508.3) to 598.5 thousand in 2019 (95% UI: 489.7-713.5), representing a 38.4% increase (95% UI: 26.8%-49.5%). In 2019, CVD accounted for 45.9% of all deaths attributable to secondhand smoke among both sexes globally. Among these CVD deaths, ischaemic heart disease predominated, accounting for 66.4% of cases, compared with stroke. The distribution by sex revealed a slightly lower percentage of males (46.5%) than females (53.5%). Age-period-cohort models show overall global decline in CVD mortality due to secondhand smoke over 30 years, with regional, sex and subtype variations. Notably, a higher Sociodemographic Index (SDI) correlated with a greater reduction in mortality, exhibiting a significant 39.1% decrease in high SDI areas (95% UI: 35.6%-42.3%), in stark contrast to the minimal change observed in low SDI areas (0.1%, 95% UI: -52.4%-62.2%).

CONCLUSIONS

This study highlights the importance of considering secondhand smoke as a modifiable CVD risk. Further research is needed to understand disparities in CVD burden across development levels, sexes and subtypes.

From infection to immortality: The role of HPV and telomerase in head and neck cancer

Head and neck squamous cell carcinomas (HNSCCs) represent a heterogeneous group of malignancies with multifactorial aetiologies. High-risk human papillomavirus (hrHPV) infections, particularly HPV16, and the dysregulation of telomerase activity, specifically through its catalytic subunit, telomerase reverse transcriptase (TERT) are among the key contributors to HNSCC development and progression. HPV promotes oncogenesis via the E6 and E7 oncoproteins, which inactivate tumour suppressors TP53 and RB1, leading to unchecked cellular proliferation. Concurrently, telomerase activation plays a critical role in HNSCC by maintaining telomere length, thus enabling cellular immortality, and facilitating tumour development and progression. The interplay between HPV and telomerase is significant; HPV oncoprotein E6 enhances telomerase activity through multiple regulatory mechanisms, including upregulating TERT expression. Beyond telomere maintenance, TERT influences signalling pathways, cellular metabolism, and the tumour microenvironment, contributing to aggressive tumour behaviour and poor prognosis. This review integrates the roles of HPV and telomerase in HNSCC, focusing on their molecular mechanisms and interactions that drive carcinogenesis and influence disease progression. Understanding the synergistic effects of HPV and TERT in HNSCC may be crucial for risk stratification, prognostic assessment, and the development of novel therapeutic strategies targeting these specific molecular pathways.

Broadening horizons: research on ferroptosis in lung cancer and its potential therapeutic targets

Ferroptosis is a novel form of cell death distinct from traditional mechanisms, characterized by the accumulation of iron ions and the production of lipid peroxides. It not only affects the survival of tumor cells but is also closely linked to changes in the tumor microenvironment. Lung cancer is one of the leading malignancies worldwide in terms of incidence and mortality, and its complex biological mechanisms and resistance make treatment challenging. Recent studies have shown that ferroptosis plays a key role in the onset and progression of lung cancer, with its intricate regulatory mechanisms influencing tumor development and response to therapy. As research into ferroptosis deepens, related molecular pathways, such as glutamate metabolism, iron metabolism, and antioxidant defense, have been gradually revealed. However, in clinical practice, ferroptosis-based therapeutic strategies for lung cancer are still in their early stages. Challenges remain, including the incomplete understanding of the specific mechanisms of ferroptosis, insufficient research on related regulatory factors, and limited insight into the interactions within the tumor microenvironment. Therefore, effective modulation of ferroptosis to enhance lung cancer treatment remains an urgent issue. This review summarizes the biological mechanisms of ferroptosis, analyzes the regulatory factors of ferroptosis in lung cancer cells and their interaction with the tumor microenvironment, and further explores potential therapeutic strategies targeting ferroptosis. By synthesizing the latest research, this paper aims to provide new perspectives and directions for lung cancer treatment, with the goal of advancing clinical applications.

An Assessment of Young Adults' Awareness and Knowledge Related to the Human Papillomavirus (HPV), Oropharyngeal Cancer, and the HPV Vaccine

BACKGROUND/OBJECTIVES

The human papillomavirus (HPV) is a prevalent sexually transmitted infection that is a known cause of morbidities such as genital warts and cancers of the cervix, anus, and oropharynx. Non-cervical HPV-related cancers have been a developing problem in North America, increasing in incidence by up to 225% in some instances over a span of two decades.

METHODS

This study investigated levels of awareness and knowledge of HPV, oropharyngeal cancer (OPC), and the HPV vaccine using a self-administered web-based survey designed specifically for this research. University students (n = 1005) aged 18-30 completed a 42-item questionnaire that included demographic information, awareness questions, and a series of "true/false/I don't know" knowledge questions.

RESULTS

The data gathered revealed that participants had relatively high levels of awareness. However, many respondents had significant gaps in their knowledge of HPV, OPC, and the HPV vaccine. Collectively, the data indicate that awareness and knowledge of HPV and the value of vaccination may place younger individuals at risk for HPV-related infections.

CONCLUSIONS

Although a relatively high level of awareness concerning HPV was observed, the gaps in knowledge suggest that further efforts are necessary to educate young adults. While all risk factors cannot be reduced, the present data may guide future efforts directed toward better education on HPV and related health concerns and associated risks.

Changing Landscape of Head and Neck Squamous Cell Carcinoma and Nasopharyngeal Carcinoma Treatment and Survival Trends in Thailand: A 13-Year Multicenter Retrospective Study of Patients

PURPOSE

The incidence and survival rates of head and neck squamous cell carcinoma (HNSCC) and nasopharyngeal carcinoma (NPC) vary globally, influenced by factors such as ethnicity, lifestyle, and health care systems.

METHODS

A retrospective analysis was conducted on patients with HNSCC treated between 2008 and 2020 in four major Thai academic cancer centers, using a multidisciplinary multicenter database. The study focused on the evolution of patient characteristics, survival changes, and treatment landscape alterations over time.

RESULTS

Among 6,319 patients, the most common primary sites were nasopharynx (33%), oral cavity (23%), oropharynx (17%), larynx (15%), and hypopharynx (8%). An increase in human papillomavirus-related oropharyngeal carcinoma was noted, from 13% in 2008 to 42% in 2019-2020. The majority of patients presented with locally advanced (LA) stages (IVa/b: 50%, III: 26%). Chemoradiotherapy (54%) and surgery (24%) were the main treatments, with cisplatin (79%) being most commonly used in chemoradiation. Overall survival (OS) improved annually across all subsites, correlating with an increase in intensity-modulated radiotherapy (IMRT) use, from 25% in 2008 to 90% in 2019-2020. The median follow-up duration was 4.59 years, with a minimum of 2.75 years. Patients treated with IMRT had significantly longer OS compared with those treated with non-IMRT techniques, in both NPC and non-NPC HNSCC (P < .001).

CONCLUSION

To our knowledge, this is the largest study in Thailand that demonstrates increasing survival outcomes in patients with HNSCC and NPC, despite commonly presenting with LA stages. The increasing use of IMRT may be contributing to improved survival outcomes in both patients with NPC and non-NPC HNSCC patients.

Effects of Lacticaseibacillus paracasei L9 on Oral Microbiota and Cariogenic Factors in Streptococcus mutans-Infected Mice

In the pathogenesis of dental caries, Streptococcus mutans (S. mutans) plays a central role. S. mutans can produce extracellular polysaccharides, which can help the bacteria form biofilms on the tooth surface, create a stable living environment, and hinder the removal of bacteria by natural defense substances in the oral cavity such as saliva. Meanwhile, the oral microbiota and dietary habits exert long-term influences on its development. This study, employing the BALB/c mouse model, explored the effects of L. paracasei L9 on dental caries. In the experiment, mice underwent the S. mutans inoculation and were subsequently treated with L. paracasei L9 or S. salivarius K12 for 28 consecutive days. The results showed that L. paracasei L9 significantly ameliorated early enamel caries, and both L. paracasei L9 and S. salivarius K12 cooperatively downregulated the expressions of critical cariogenic factors, effectively suppressing the initial adhesion of S. mutans and the formation of dental plaques. L. paracasei L9 reshaped the oral microbiota of caries-affected mice, selectively reducing pathogens abundances and augmenting abundances of probiotics such as Lactobacillaceae and Streptococcus salivarius. This study offers a strategic approach for the management of dental caries, highlighting the potential of these probiotics in the field of oral health.

The oncogenic role of the NSD histone methyltransferases in head and neck and cervical cancers

Understanding the role of NSD proteins in virus-induced cancers could reveal new therapeutic strategies. Targeting NSD proteins may not only disrupt the epigenetic changes triggered by viruses but also help restore normal cellular function. For instance, developing NSD inhibitors could counteract abnormal histone modifications caused by viral infections and slow cancer progression. Our review on the NSD protein family emphasizes its critical role in epigenetic regulation and cancer progression, also in virus-induced cancers. As research on the molecular mechanisms of NSD proteins advances, these proteins are emerging as promising candidates for targeted cancer therapies, particularly in cancers driven by histone modifications and transcriptional dysregulation.

In-Office vs Operating Room Time to Treatment of Oropharyngeal Biopsies

This cohort study evaluates whether in-office biopsies significantly improve time to biopsy and time to treatment compared with operating room biopsies.

Impact of Tobacco Use on Oral Cancer Incidence among Women in Urban Slums: A Case-Control Study

Background

Oral cancer represents a significant global health burden, disproportionately affecting vulnerable populations in developing countries like India. Urban slums, characterized by socioeconomic challenges and limited access to healthcare, are particularly susceptible. This study aimed to examine the association between tobacco use, a well-established risk factor, and the incidence of oral cancer among women residing in these underserved communities.

Methods

A case-control study was conducted, involving 300 women from urban slums: 150 cases diagnosed with oral cancer within the past year and 150 controls without a history of the disease. Data were collected through structured interviews, encompassing tobacco use habits (type, frequency, and duration), sociodemographic factors, and oral hygiene practices. Statistical analyses, including Chi-square tests and logistic regression, were employed to assess the association between tobacco use and oral cancer risk.

Results

The study revealed a strong association between tobacco use and oral cancer among women in urban slums. The prevalence of tobacco use, particularly smokeless tobacco, was significantly higher in cases compared to controls. Smokeless tobacco use and smoking emerged as independent risk factors for oral cancer. Lower educational attainment was also identified as an independent risk factor, underscoring the influence of socioeconomic disadvantages on disease susceptibility.

Conclusion

This study provides compelling evidence linking tobacco use to a heightened risk of oral cancer among women in urban slums. The findings underscore the urgent need for targeted interventions, including health education, access to cessation programs, and addressing socioeconomic disparities, to mitigate the burden of oral cancer in this vulnerable population. The study highlights the importance of culturally sensitive and effective preventive measures to combat oral cancer in underserved communities.

Periodontitis and dental quality of life predict long-term survival in head and neck cancer

BACKGROUND

Our aim was to investigate oral health in newly diagnosed head and neck squamous cell carcinoma (HNSCC) patients in relation to long-term survival. We assessed whether the level of alveolar bone loss due to periodontitis at diagnosis, measured from orthopantomogram (OPG), and reported dental health-related quality of life (HRQoL) scores obtained at diagnosis contain prognostic information for HNSCC patients.

METHODS

A total of 79 patients from a consecutive cohort of 106 diagnosed with HNSCC between November 2002 and June 2005 were included. All patients reported dental HRQoL, OPG-determined alveolar bone loss were measured in 79 patients at diagnosis. Reduced alveolar bone loss (≥ 4 mm) from cement-enamel junction on at least two molars or premolars registered both horizontally and vertically served as indicator of periodontal disease.

RESULTS

With alveolar bone loss, we determined increased mortality by univariate analysis (RR = 2.28, CI: 1.22-4.28, p = 0.01) and a strong trend by multivariate analyses adjusted for standard clinical information (RR = 1.95, CI: 0.98-3.87, p = 0.056). Reported lowered dental HRQoL scores predicted long-term survival in both univariate (RR = 3.58, CI: 1.99-6.45, p < 0.001) and multivariate adjusted for standard clinical information (RR = 2.17, CI: 1.17-4.01, p = 0.014). When analyzed with Cox regression, including alveolar bone loss and dental HRQoL, both factors, adjusted by clinical variables, were significant predictors of long-term survival: dental HRQoL (p = 0.007) and present alveolar bone loss (p = 0.034). Non-HNSCC disease-specific long-term survival predicted was also predicted when alveolar bone loss and dental HRQoL were analyzed simultaneously and adjusted for standard clinical information.

CONCLUSIONS

The degree of alveolar bone loss, as determined by OPG, and dental HRQoL both obtained at the time of HNSCC diagnosis, predicted long-term survival. When analyzed simultaneously, both factors remained significant in both univariate and multivariate analyses, adjusted by pertinent clinical variables, highlighting their unique prognostic value.

Transformation zone at the vallate papillae: a significant source of papillomavirus infection at the base of the tongue?

OBJECTIVE

The aim of this study was to investigate whether the base of the tongue harbours a transformation zone (TZ), i.e., an initiation site for papillomavirus infection, analogous to that in the uterine cervix by examining the histological structure of Von Ebner's gland ducts in the vallate papillae.

METHODS

Immunohistochemical staining and immunofluorescence techniques were used to detect markers associated with the uterine cervical TZ in the vallate papillae, and these results were compared with those in uterine cervical tissue. Additionally, tongue samples from mouse papillomavirus (MmuPV1)-infected mice were analysed to test our hypothesis.

RESULTS

The specific expression of CK17 in the squamous epithelium of the vallate papillae indicated the presence of immature squamous epithelium, arising from the transformation of reserve cells in this region. Moreover, a s determined using virus-infected mice, the TZ at the base of the tongue was a significant site for papilloma virus infection.

CONCLUSIONS

This is the first study to reveal the presence of a TZ in the vallate papillae, as determined by the presence of reserve cells and immature squamous epithelium, suggesting that the base of the tongue is a significant site for papillomavirus infection. This finding provides an entry point for the early prevention and diagnosis of HPV-associated lesions in the oropharynx.

Epidemiology of oral cancer in South and South-East Asia: Incidence and mortality

INTRODUCTION

This study provides an epidemiological description of cancer in the lip, oral cavity, and oropharynx in the South and South-East Asia region.

METHODS

The number of new cases and deaths was extracted from the GLOBOCAN 2020 and the CI5 series. We present age-standardized incidence and mortality rates per 100,000 inhabitants. To assess temporal trends, we estimated the annual percent change.

RESULTS

The incidence rates (ASR) for lip and oral cavity cancer in South and South-East Asia were highest in Taiwan (30.2), Sri Lanka (16.5), India (14.8), and Pakistan (13.2) among males. For oropharyngeal cancer, the highest rates were found in Taiwan (4.7), Bangladesh, Sri Lanka, and India (4.3, 2.9, and 2.6, respectively). Incidence rates were consistently higher in males compared to females. Overall, trends in lip and oral cavity cancer incidence were either stable or decreasing in most of the populations evaluated. In India, an increase in rates among males contrasted with a decline among females over the study period.

CONCLUSION

Incidence and mortality rates of oral cavity cancer in South and South-East Asia are among the highest globally. Our results suggest an optimistic trend of reduction in oral cavity rates in the region, despite an increase in rates among Indian males.

Fibroblast Growth Factor Receptor (FGFR) Alterations in HPV Oropharyngeal Cancers

HPV viral E6 and E7 onco-proteins play a well-known role in carcinogenesis. Host genomic alterations also play a key role in the development of HPV-related oropharyngeal cancer and have been under-recognized. We describe a case series of 6 metastatic/locoregionally recurrent HPVOPSCC patients with FGFR alterations. HPVOPSCC presents with distinct pattern of spread both temporally and sites of recurrence compared to  non-HPV-related oropharyngeal cancer. Identification and reporting of genomic alterations in HPV are crucial to the understanding of disease biology and could aid in development of novel therapeutics for these patients. In addition, use of circulating tumor DNA may lead to early detection and supplement imaging in the follow up of these patients. Loco-regional treatments may also play a key role in the management of metastatic HPV OPSCC depending on the pattern of presentation. Our case series highlights all these novelties that could lead to better treatment outcomes.

Multilevel Disparities of Sex-Differentiated Human Papilloma Virus-Positive Oropharyngeal Cancers in the United States

Objectives: This study used multilevel social determinants of health (SDoH) models to determine how SDoH influence different sexes of patients diagnosed with HPV-positive oropharyngeal squamous cell cancers (OPSCC) across the US. Methods: This was a retrospective cohort study assessing HPV-confirmed patients with oropharyngeal squamous cell cancers from 2010 to 2018 using census-level Yost Index socioeconomic status (SES) score and rurality-urbanicity measures alongside individual-level race-ethnicity while stratifying by biological sex. Age-adjusted multivariate regressions were performed for survival, treatment receipt, and delay of treatment initiation (of 3+ months). Results: Across 14,076 OPSCC-HPV-positive patients, delay of treatment uniquely featured positive predictors for males of black race-ethnicity (OR, 2.07; 95% CI, 1.68-2.54) and poor Yost SES (1.43; 1.24-1.65). Five-year all-cause mortality uniquely showed positive predictors of females of black race-ethnicity (2.74; 1.84-4.71) and of males with poor Yost SES (1.98; 1.79-2.19). Three-year all-cause mortality shared positive predictors across sexes but were exacerbated in females of black race-ethnicity (2.50; 1.82-3.44) compared to males (2.23; 1.91-2.60); this was reversed for poor Yost SES (male, 1.92, 1.76-2.10; female, 1.60, 1.32-1.95). Surgery showed negative predictors of black race-ethnicity that displayed worsened effects in females (0.60, 0.44-0.79) versus males (0.75, 0.66-0.86). First-line radiation receipt uniquely featured negative predictors for males of black race-ethnicity (0.73; 0.62-0.86) with poor Yost SES (0.74; 0.68-0.82). Conclusions: Comprehensive models of multilevel SDoH displayed exacerbated disparity effects of community-level SES in males and black race-ethnicity among female HPV-positive OPSCC patients. These objective comparisons of specific SDoH factors inform providers and policy direction on how to strategically target the most pertinent SDoH factors affecting a rapidly growing cancer population.

Incremental net benefit of extending human papillomavirus vaccine to boys in oropharyngeal cancer burden: Meta-analysis of cost-effectiveness studies

Background/purpose

The incidence of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) is increasing worldwide. HPV vaccines have shown efficacy in preventing diseases in both males and females. Therefore, there is a need to develop cost-effective strategies for HPV vaccines to prevent HPV-related OPC. This meta-analysis aimed to evaluate cost-effectiveness using the global mean of incremental cost-effectiveness ratios compared to the willingness-to-pay threshold and incremental net benefits (INBs) of HPV vaccination strategies between boys' extension vaccine and girls only. These recommendations will be useful for countries that have not implemented universal HPV vaccines in national programs, such as Taiwan.

Materials and methods

Studies evaluating the cost-effectiveness of HPV vaccination strategies in the prevention of OPC that included both sexes versus girls only were identified through the Cochrane Library, EMBASE, PubMed, ScienceDirect, and Web of Science databases on February 05, 2024, and a meta-analysis of pooled INBs was performed using a random-effects model. The outcome was an effective measurement of the OPC burden. The results are represented in USD (2024).

Results

Fifteen model analyses were included. All the studies were conducted in high-income countries. The global mean of incremental cost-effectiveness ratio was $39,553 (95% CI, $27,008-66,641) per quality-adjusted life years gained, which was below the global mean of the willingness-to-pay threshold of $65,473 (95% CI, $52,138-83,755). Pooled INBs of $9370 (95% CI, $5046-13,695; P < 0.001) favored the extended HPV in boys.

Conclusion

HPV vaccination strategies that include boys are cost-effective compared to those with girls only in preventing OPC burden. By implementing a universal HPV vaccination program, countries can receive $9370 in additional monetary benefits per patient. Given its relevance to high-income countries, this study offers key insights that can aid policymakers in Taiwan.

cIAP-2 protein is upregulated by human papillomavirus in oropharyngeal cancers: role in radioresistance in vitro

BACKGROUND

High-risk human papillomaviruses are the causal agents of a subset of head and neck cancers. A previous transcriptomic analysis showed that cIAP2 protein, involved in cell survival and apoptosis, is upregulated in OKF6 oral cells that express HPV16 E6/E7. In addition, cIAP2 promotes radioresistance, a very important concern in HNC treatment. However, cIAP2 increase has not yet been evaluated in oropharyngeal carcinomas (OPCs), nor has been the role of cIAP2 in HNC radioresistance.

METHODS

We carried out a descriptive-analytical retrospective study in 49 OPCs from Chilean patients. We determined the expression of cIAP2 at transcript and proteins levels using reverse-transcriptase -polymerase chain reaction and immunohistochemistry, respectively. HPV and p16 expression were previously analyzed in these specimens. In addition, SCC-143 HNC cells ectopically expressing HPV16 E6/E7 were analyzed for cIAP2 expression and after transfection with a siRNA for HPV16 E6/E7 knocking down.

RESULTS

We found a statistically significant association between HPV presence and cIAP2 expression (p = 0.0032 and p = 0.0061, respectively). An association between p16 and cIAP2 levels was also found (p = 0.038). When SCC-143 cells were transfected with a construct expressing HPV16 E6/E7, the levels of cIAP2 were significantly increased (p = 0.0383 and p = 0.0115, respectively). Conversely, HPV16 E6 and E7 knocking down resulted in a decrease of cIAP2 levels (p = 0.0161 and p = 0.006, respectively). Finally, cIAP2 knocking down in HPV16 E6/E7 cells resulted in increased apoptosis after exposure to radiation at 4 and 8 Gy (p = 0.0187 and p = 0.0061, respectively).

CONCLUSION

This study demonstrated for the first time a positive relationship between HPV presence and cIAP2 levels in OPCs. Additionally, cIAP2 knocking down sensitizes HNC cells to apoptosis promoted by radiation. Therefore, cIAP2 is a potential therapeutic target for radiation in HPV-driven HNC.

Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination

Cervical cancer is the first cancer deemed amenable to elimination through prevention, and thus lessons from the epidemiology and prevention of this cancer type can provide information on strategies to manage other cancers. Infection with the human papillomavirus (HPV) causes virtually all cervical cancers, and an important proportion of oropharyngeal, anal and genital cancers. Whereas 20th century prevention efforts were dominated by cytology-based screening, the present and future of HPV-associated cancer prevention relies mostly on HPV vaccination and molecular screening tests. In this Review, we provide an overview of the epidemiology of HPV-associated cancers, their disease burden, how past and contemporary preventive interventions have shaped their incidence and mortality, and the potential for elimination. We particularly focus on the cofactors that could have the greatest effect on prevention efforts, such as parity and human immunodeficiency virus infection, as well as on social determinants of health. Given that the incidence of and mortality from HPV-associated cancers remain strongly associated with the socioeconomic status of individuals and the human development index of countries, elimination efforts are unlikely to succeed unless prevention efforts focus on health equity, with a commitment to both primary and secondary prevention.

Human papillomavirus circulating tumor DNA assays as a mechanism for head and neck cancer equity in rural regions of the United States

The rates of human papillomavirus-positive oropharyngeal cancer (HPV-OPC) are rising worldwide and in the United States, particularly in rural regions including Appalachia. Rural areas face unique health challenges resulting in higher cancer incidence and mortality rates, and this includes HPV-OPC. The recent advent of highly sensitive liquid biopsies for the non-invasive detection of HPV-OPC recurrence (circulating tumor HPV DNA, HPV ctDNA) has been swiftly adopted as part of surveillance paradigms. Though knowledge gaps persist regarding its use and clinical trials are ongoing, the ease of collection and cost-effectiveness of HPV ctDNA make it more accessible for HPV-OPC survivors than usual surveillance methods of frequent exams and imaging. Herein, we discuss how implementing HPV ctDNA assays in rural regions of the United States provide one poignant example of how liquid biopsies can improve cancer care equity.

Gingiva squamous-cell carcinoma in a non-smoking patient with occupational exposure to solvent siphoning using mouth: case report and literature review

Background

While overall head and neck cancer incidence decreases due to reduced tobacco and alcohol consumption, the incidence of HPV negative oral cavity squamous cell carcinoma (SCC) is raising in several industrialized countries, especially in non-smoking and non-drinking patients.

Case presentation

We document a case of gingiva SCC in a 56 years old never-smoker patient reporting low alcohol consumption and unusual occupational solvent exposure. The HPV-negative lesion was surgically removed in 2018, and the patient remains in complete remission 4 years after recurrent surgery in 2019. In 2021, the patient was referred to the occupational cancer consultation. The patient worked as screen printer for 18 years. He reported mouth siphoning every 2-3 days to transfer organic solvents (mainly aromatic hydrocarbons and ketones) from containers into smaller recipients, with regular passage of solvents into his mouth.

Conclusion

According to the literature, the frequency of solvent siphoning using mouth is likely to be underestimated. While our review did not find studies reporting longterm consequences to the oral cavity of mouth siphoning, current evidence supports a positive association of upper aero digestive tract SCC with occupational exposures to organic solvents and printing processes. In absence of major extraprofessional factors, the HPV-negative gingiva SCC of this patient might be attributable to the regular occupational oral solvent exposure. While the available evidence remains limited to formally establish a causal relationship, clinicians should investigate this hazardous work practice in patients with OSCC and history of solvent exposures.

Global burden of head and neck cancers from 1990 to 2019

Head and neck cancer (HNC) exerts a significant healthcare burden worldwide. Insufficient data impedes a comprehensive understanding of its global impact. Through analysis of the 2019 Global Burden of Disease (GBD) database, our secondary investigation unveiled a surging global incidence of HNC, yet a decline in associated mortality and disability-adjusted life years (DALYs) owing to enhanced prognosis. Particularly noteworthy is the higher incidence of escalation among females compared to males. Effective resource allocation, meticulous control of risk factors, and tailored interventions are imperative to curtail mortality rates among young individuals afflicted with HNC in underprivileged regions, as well as in elderly individuals grappling with thyroid cancer.

Human Papilloma Virus Positive Oropharyngeal Squamous Cell Carcinoma and the Immune System: Pathogenesis, Immunotherapy and Future Perspectives

Oropharyngeal squamous cell carcinoma (OPSCC), a subset of head and neck squamous cell carcinoma (HNSCC), involves the palatine tonsils, soft palate, base of tongue, and uvula, with the ability to spread to adjacent subsites. Personalized treatment strategies for Human Papillomavirus-associated squamous cell carcinoma of the oropharynx (HPV+OPSCC) are yet to be established. In this article, we summarise our current understanding of the pathogenesis of HPV+OPSCC, the intrinsic role of the immune system, current ICI clinical trials, and the potential role of small molecule immunotherapy in HPV+OPSCC.

Rapid multi-task diagnosis of oral cancer leveraging fiber-optic Raman spectroscopy and deep learning algorithms

Introduction

Oral cancer, a predominant malignancy in developing nations, represents a global health challenge with a five-year survival rate below 50%. Nonetheless, substantial reductions in both its incidence and mortality rates can be achieved through early detection and appropriate treatment. Crucial to these treatment plans and prognosis predictions is the identification of the pathological type of oral cancer.

Methods

Toward this end, fiber-optic Raman spectroscopy emerges as an effective tool. This study combines Raman spectroscopy technology with deep learning algorithms to develop a portable intelligent prototype for oral case analysis. We propose, for the first time, a multi-task network (MTN) Raman spectroscopy classification model that utilizes a shared backbone network to simultaneously achieve different clinical staging and histological grading diagnoses.

Results

The developed model demonstrated accuracy rates of 94.88%, 94.57%, and 94.34% for tumor staging, lymph node staging, and histological grading, respectively. Its sensitivity, specificity, and accuracy compare closely with the gold standard: routine histopathological examination.

Discussion

Thus, this prototype proposed in this study has great potential for rapid, non-invasive, and label-free pathological diagnosis of oral cancer.