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Locatello LG, Costantino A, Maniaci A, Fermi M, Barillari MR, Sampieri C, Bellini E, Serafini E, Jiang S, Nocera F, Asaro A, Midolo M, Rodio A, Piersiala K, Sooriyamoorthy T, Dimitriadis PA, Mannelli G. Does sex influence the prognosis of laryngeal cancer? A systematic review and a meta-analysis. Am J Otolaryngol 2024; 45:104195. [PMID: 38134851 DOI: 10.1016/j.amjoto.2023.104195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Luca Giovanni Locatello
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria; Department of Otorhinolaryngology, University Hospital "Santa Maria Della Misericordia", Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, MI, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, MI, Italy
| | - Antonino Maniaci
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria; Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Italy; Faculty of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Maria Rosaria Barillari
- Department of Mental and Physical Health and Preventive Medicine, Audiology and Phoniatrics Unit, Luigi Vanvitelli University Hospital, Naples, Italy
| | - Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Elisa Bellini
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Edoardo Serafini
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Serena Jiang
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Nocera
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Italy
| | - Antonino Asaro
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Italy
| | - Mario Midolo
- Department of Medical, Surgical Sciences and Advanced Technologies, G.F. Ingrassia, University of Catania, Italy
| | - Angelica Rodio
- Department of Mental and Physical Health and Preventive Medicine, Audiology and Phoniatrics Unit, Luigi Vanvitelli University Hospital, Naples, Italy
| | - Krzysztof Piersiala
- Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Thushanth Sooriyamoorthy
- Department of Otolaryngology - Head and Neck Surgery, Lister Hospital, Coreys Mill Lane, SG1 4AB Stevenage, UK
| | - Panagiotis A Dimitriadis
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria; Department of Otolaryngology - Head and Neck Surgery, Lister Hospital, Coreys Mill Lane, SG1 4AB Stevenage, UK
| | - Giuditta Mannelli
- Young Confederation of European ORL-HNS, Y-CEORL-HNS, Vienna, Austria; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Beynon RA, Lang S, Schimansky S, Penfold CM, Waylen A, Thomas SJ, Pawlita M, Tim Waterboer, Martin RM, May M, Ness AR. Tobacco smoking and alcohol drinking at diagnosis of head and neck cancer and all-cause mortality: Results from head and neck 5000, a prospective observational cohort of people with head and neck cancer. Int J Cancer 2018; 143:1114-1127. [PMID: 29607493 PMCID: PMC6099366 DOI: 10.1002/ijc.31416] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/16/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022]
Abstract
Tobacco smoking and alcohol consumption are well-established risk factors for head and neck cancer. The prognostic role of smoking and alcohol intake at diagnosis have been less well studied. We analysed 1,393 people prospectively enrolled into the Head and Neck 5000 study (oral cavity cancer, n=403; oropharyngeal cancer, n=660; laryngeal cancer, n=330) and followed up for a median of 3.5 years. The primary outcome was all-cause mortality. We used Cox proportional hazard models to derive minimally adjusted (age and gender) and fully adjusted (age, gender, ethnicity, stage, comorbidity, body mass index, HPV status, treatment, education, deprivation index, income, marital status, and either smoking or alcohol use) mortality hazard ratios (HR) for the effects of smoking status and alcohol intake at diagnosis. Models were stratified by cancer site, stage and HPV status. The fully-adjusted HR for current versus never-smokers was 1.7 overall (95% confidence interval [CI] 1.1, 2.6). In stratified analyses, associations of smoking with mortality were observed for oropharyngeal and laryngeal cancers (fully adjusted HRs for current smokers: 1.8 (95% CI=0.9, 3.40 and 2.3 (95% CI=0.8, 6.4)). We found no evidence that people who drank hazardous to harmful amounts of alcohol at diagnosis had a higher mortality risk compared to non-drinkers (HR=1.2 (95% CI=0.9, 1.6)). There was no strong evidence that HPV status or tumour stage modified the association of smoking with survival. Smoking status at the time of a head and neck cancer diagnosis influenced all-cause mortality in models adjusted for important prognostic factors.
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Affiliation(s)
- Rhona A. Beynon
- Population Health SciencesBristol Medical School, University of Bristol, Canynge HallBristolBS8 2PSUnited Kingdom
- MRC Integrative Epidemiology Unit (IEU)BristolBS8 2BNUnited Kingdom
| | - Samantha Lang
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Sarah Schimansky
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Christopher M. Penfold
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Andrea Waylen
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
- School of Oral and Dental Sciences, University of BristolBS1 2LYUnited Kingdom
| | - Steven J. Thomas
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
- School of Oral and Dental Sciences, University of BristolBS1 2LYUnited Kingdom
| | - Michael Pawlita
- Molecular Diagnostics of Oncogenic Infections DivisionGerman Cancer Research Center (DKFZ), Im Neuenheimer Feld 280Heidelberg69120Germany
| | - Tim Waterboer
- Molecular Diagnostics of Oncogenic Infections DivisionGerman Cancer Research Center (DKFZ), Im Neuenheimer Feld 280Heidelberg69120Germany
- Infections and Cancer EpidemiologyGerman Cancer Research Center (DKFZ), Im Neuenheimer Feld 280Heidelberg69120Germany
| | - Richard M. Martin
- Population Health SciencesBristol Medical School, University of Bristol, Canynge HallBristolBS8 2PSUnited Kingdom
- MRC Integrative Epidemiology Unit (IEU)BristolBS8 2BNUnited Kingdom
| | - Margaret May
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Andy R. Ness
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
- School of Oral and Dental Sciences, University of BristolBS1 2LYUnited Kingdom
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3
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Abrahão R, Anantharaman D, Gaborieau V, Abedi-Ardekani B, Lagiou P, Lagiou A, Ahrens W, Holcatova I, Betka J, Merletti F, Richiardi L, Kjaerheim K, Serraino D, Polesel J, Simonato L, Alemany L, Agudo Trigueros A, Macfarlane TV, Macfarlane GJ, Znaor A, Robinson M, Canova C, Conway DI, Wright S, Healy CM, Toner M, Cadoni G, Boccia S, Gheit T, Tommasino M, Scelo G, Brennan P. The influence of smoking, age and stage at diagnosis on the survival after larynx, hypopharynx and oral cavity cancers in Europe: The ARCAGE study. Int J Cancer 2018; 143:32-44. [PMID: 29405297 DOI: 10.1002/ijc.31294] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/19/2018] [Accepted: 01/23/2018] [Indexed: 01/23/2023]
Abstract
Head and neck cancer (HNC) is a preventable malignancy that continues to cause substantial morbidity and mortality worldwide. Using data from the ARCAGE and Rome studies, we investigated the main predictors of survival after larynx, hypopharynx and oral cavity (OC) cancers. We used the Kaplan-Meier method to estimate overall survival, and Cox proportional models to examine the relationship between survival and sociodemographic and clinical characteristics. 604 larynx, 146 hypopharynx and 460 OC cancer cases were included in this study. Over a median follow-up time of 4.6 years, nearly 50% (n = 586) of patients died. Five-year survival was 65% for larynx, 55% for OC and 35% for hypopharynx cancers. In a multivariable analysis, we observed an increased mortality risk among older (≥71 years) versus younger (≤50 years) patients with larynx/hypopharynx combined (LH) and OC cancers [HR = 1.61, 95% CI 1.09-2.38 (LH) and HR = 2.12, 95% CI 1.35-3.33 (OC)], current versus never smokers [HR = 2.67, 95% CI 1.40-5.08 (LH) and HR = 2.16, 95% CI 1.32-3.54 (OC)] and advanced versus early stage disease at diagnosis [IV versus I, HR = 2.60, 95% CI 1.78-3.79 (LH) and HR = 3.17, 95% CI 2.05-4.89 (OC)]. Survival was not associated with sex, alcohol consumption, education, oral health, p16 expression, presence of HPV infection or body mass index 2 years before cancer diagnosis. Despite advances in diagnosis and therapeutic modalities, survival after HNC remains low in Europe. In addition to the recognized prognostic effect of stage at diagnosis, smoking history and older age at diagnosis are important prognostic indicators for HNC.
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Affiliation(s)
- Renata Abrahão
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Devasena Anantharaman
- Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
| | - Valérie Gaborieau
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Behnoush Abedi-Ardekani
- Genetic Cancer Susceptibility Group, International Agency for Research on Cancer, Lyon, France
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Areti Lagiou
- Department of Public Health and Community Health, School of Health Professions, Athens University of Applied Sciences, Athens, Greece
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - Ivana Holcatova
- Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University of Prague, Prage, Czech Republic
| | - Jaroslav Betka
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University of Prague, Prague, Czech Republic
| | - Franco Merletti
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Diego Serraino
- Unit of Cancer Epidemiology, Aviano National Cancer Institute, IRCCS, Aviano, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Aviano National Cancer Institute, IRCCS, Aviano, Italy
| | - Lorenzo Simonato
- Department of Cardiovascular and Thoracic Sciences, University of Padova, Padova, Italy
| | - Laia Alemany
- Institut Català d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Catalonia, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Tatiana V Macfarlane
- Epidemiology Group, University of Aberdeen, Aberdeen, United Kingdom
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Gary J Macfarlane
- Epidemiology Group, University of Aberdeen, Aberdeen, United Kingdom
| | - Ariana Znaor
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Max Robinson
- Center for Oral Health Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Cristina Canova
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - David I Conway
- School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Sylvia Wright
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Claire M Healy
- Trinity College School of Dental Science, Dublin, Ireland
| | - Mary Toner
- Trinity College School of Dental Science, Dublin, Ireland
| | - Gabriella Cadoni
- Institute of Othorinolaringoiatry, Università Cattolica del Sacro Cuore, Fondazione Policlinico 'Agostino Gemelli', Rome, Italy
| | - Stefania Boccia
- Section of Hygiene - Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico 'Agostino Gemelli', Rome, Italy
| | - Tarik Gheit
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France
| | - Ghislaine Scelo
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Paul Brennan
- Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France
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Schlüter A, Weller P, Kanaan O, Nel I, Heusgen L, Höing B, Haßkamp P, Zander S, Mandapathil M, Dominas N, Arnolds J, Stuck BA, Lang S, Bankfalvi A, Brandau S. CD31 and VEGF are prognostic biomarkers in early-stage, but not in late-stage, laryngeal squamous cell carcinoma. BMC Cancer 2018. [PMID: 29523110 PMCID: PMC5845191 DOI: 10.1186/s12885-018-4180-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Patients suffering from squamous cell carcinoma of the larynx (LSCC) with lymphatic metastasis have a relatively poor prognosis and often require radical therapeutic management. The mechanisms which drive metastasis to the lymph nodes are largely unknown but may be promoted by a pro-angiogenic tumor microenvironment. In this study, we examined whether the number of microvessels and the expression level of vascular endothelial growth factor (VEGF) in the primary tumor are correlated with the degree of lymph node metastasis (N-stage), tumor staging (T) and survival time in LSCC patients. Methods Tissue-Microarrays of 97 LSCC patients were analyzed using immunohistochemistry. The expression of VEGF was scored as intensity of staining (low vs high) and the number of CD31-positive vessels (median </≥7 vessels per visual field) was counted manually. Scores were correlated with N-stage, T-stage and 5-year overall survival rate. Results A high expression of angiogenic biomarkers was not associated with poor overall survival in the overall cohort of patients. Instead high CD31 count was associated with early stage cancer (p = 0.004) and in this subgroup high VEGF expression correlated with poor survival (p = 0.032). Additionally, in early stage cancer a high vessel count was associated with an increased recurrence rate (p = 0.004). Conclusion Only in the early stage subgroup a high expression of angiogenic biomarkers was associated with reduced survival and an increased rate of recurrence. Thus, biomarkers of angiogenesis may be useful to identify high risk patients specifically in early stage LSCC.
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Affiliation(s)
- Anke Schlüter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Patrick Weller
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Oliver Kanaan
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Ivonne Nel
- Molecular Oncology Risk-Profile Evaluation, Department of Medical Oncology, West German Cancer Center, University Duisburg-Essen, 45122, Essen, Germany.,Present address: ABA GmbH & Co.KG, BMZ2, 44227, Dortmund, Germany
| | - Lukas Heusgen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany.,Present address: Martha-Maria Hospital Munich Solln, Munich, Germany
| | - Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Pia Haßkamp
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Sebastian Zander
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Magis Mandapathil
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany.,Present address: Department of Otorhinolaryngology, Head and Neck Surgery, Asklepios Kliniken Hamburg, Hamburg, Germany
| | - Nina Dominas
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Judith Arnolds
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Boris A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany.,Present address: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Marburg, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Agnes Bankfalvi
- Institute for Pathology, University Hospital Essen, Essen, Germany
| | - Sven Brandau
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany. .,Experimental and Translational Research, Department of Otorhinolaryngology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
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Supraglottic squamous cell carcinomas have distinctive clinical features and prognosis based on subregion. PLoS One 2017; 12:e0188322. [PMID: 29155864 PMCID: PMC5695779 DOI: 10.1371/journal.pone.0188322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/03/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyze the clinicopathologic characteristics and prognosis of patients with squamous cell carcinoma localized to different supraglottic subregions. METHODS Clinicopathologic data were reviewed retrospectively for 111 patients with supraglottic squamous cell carcinoma who were diagnosed between January 1, 1995 and December 31, 2005 and were initially treated with surgery. DNA from human papillomavirus (HPV) 16 and (or /and) HPV 18 were detected in all the 111 supraglottic carcinoma specimens using in situ hybridization. Survival analysis was performed by Kaplan-Meier analysis, factors were compared using log-rank test, and prognostic factors were determined using Cox proportional hazards model. The relationship between subregions and clinicopathologic factors was analyzed using Chi-square tests. RESULTS HPV prevalence differed between patients with aryepiglottic fold carcinoma and ventricle carcinoma (P < .05). The local-regional control rates, overall survival rates or cancer specific survival rates were significantly different between different subregions. Univariate analysis indicated that pTNM classification, pN spread, and subregion were associated with prognosis (P < .05). Multivariate analysis indicated that pTNM classification and subregion were associated with supraglottic carcinoma prognosis. The survival rate was better for patients with carcinoma of the epiglottis or ventricular bands compared to those with carcinoma in the aryepiglottic fold or ventricle (P = .012). CONCLUSIONS Subregion may be a new prognostic factor for supraglottic squamous cell carcinoma. Different supraglottic carcinoma subregions have distinct clinical features such as HPV expression, lymph node metastasis rate, local-regional control and prognosis. Therefore, it is necessary to subdivide supraglottic squamous cell carcinomas into several subregion groups to individualize therapy.
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Giraldi L, Leoncini E, Pastorino R, Wünsch-Filho V, de Carvalho M, Lopez R, Cadoni G, Arzani D, Petrelli L, Matsuo K, Bosetti C, La Vecchia C, Garavello W, Polesel J, Serraino D, Simonato L, Canova C, Richiardi L, Boffetta P, Hashibe M, Lee YCA, Boccia S. Alcohol and cigarette consumption predict mortality in patients with head and neck cancer: a pooled analysis within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. Ann Oncol 2017; 28:2843-2851. [PMID: 28945835 PMCID: PMC5834132 DOI: 10.1093/annonc/mdx486] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study evaluated whether demographics, pre-diagnosis lifestyle habits and clinical data are associated with the overall survival (OS) and head and neck cancer (HNC)-specific survival in patients with HNC. PATIENTS AND METHODS We conducted a pooled analysis, including 4759 HNC patients from five studies within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. Cox proportional hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were estimated including terms reported significantly associated with the survival in the univariate analysis. RESULTS Five-year OS was 51.4% for all HNC sites combined: 50.3% for oral cavity, 41.1% for oropharynx, 35.0% for hypopharynx and 63.9% for larynx. When we considered HNC-specific survival, 5-year survival rates were 57.4% for all HNC combined: 54.6% for oral cavity, 45.4% for oropharynx, 37.1% for hypopharynx and 72.3% for larynx. Older ages at diagnosis and advanced tumour staging were unfavourable predictors of OS and HNC-specific survival. In laryngeal cancer, low educational level was an unfavourable prognostic factor for OS (HR = 2.54, 95% CI 1.01-6.38, for high school or lower versus college graduate), and status and intensity of alcohol drinking were prognostic factors both of the OS (current drinkers HR = 1.73, 95% CI 1.16-2.58) and HNC-specific survival (current drinkers HR = 2.11, 95% CI 1.22-3.66). In oropharyngeal cancer, smoking status was an independent prognostic factors for OS. Smoking intensity (>20 cigarettes/day HR = 1.41, 95% CI 1.03-1.92) was also an independent prognostic factor for OS in patients with cancer of the oral cavity. CONCLUSIONS OS and HNC-specific survival differ among HNC sites. Pre-diagnosis cigarette smoking is a prognostic factor of the OS for patients with cancer of the oral cavity and oropharynx, whereas pre-diagnosis alcohol drinking is a prognostic factor of OS and HNC-specific survival for patients with cancer of the larynx. Low educational level is an unfavourable prognostic factor for OS in laryngeal cancer patients.
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Affiliation(s)
- L Giraldi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Leoncini
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Pastorino
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - V Wünsch-Filho
- Public Health, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - M de Carvalho
- Department of Head and Neck, Heliopolis Hospital, São Paulo, Brazil
| | - R Lopez
- Cancer Institute of the State of São Paulo, São Paulo, Brazil
| | - G Cadoni
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Arzani
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Petrelli
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - K Matsuo
- Aichi Cancer Center Research Institute, Nagoya, Japan
| | - C Bosetti
- Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - W Garavello
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - J Polesel
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - D Serraino
- Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - L Simonato
- Department of Cardiologic, Vascular, Thoracic Sciences and Public Health of the University of Padova, Padova, Italy
| | - C Canova
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - L Richiardi
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - P Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, NY, USA; Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Hashibe
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA
| | - Y C A Lee
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - S Boccia
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico "A. Gemelli," Rome, Italy
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Saini AT, Genden EM, Megwalu UC. Sociodemographic disparities in choice of therapy and survival in advanced laryngeal cancer. Am J Otolaryngol 2016; 37:65-9. [PMID: 26954853 DOI: 10.1016/j.amjoto.2015.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine if sociodemographic factors are associated with treatment choice and survival in patients with advanced stage laryngeal cancer in the U.S. DESIGN/SETTING/SUBJECTS/METHODS Population-based, non-concurrent cohort study of 5381 patients diagnosed with stage III or IV laryngeal squamous cell carcinoma from 1992-2009. Data was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. MAIN OUTCOME(S) AND MEASURES Choice of therapy (surgical vs. non-surgical) and disease-specific survival (DSS). RESULTS Age ≥60 years (odds ratio [OR]=0.78; 95% CI, 0.70-0.88) and more recent year of diagnosis (OR=0.89; 95% CI, 0.87-0.90) decreased the odds of receiving surgical therapy, while residing in a county with low median household income (OR=1.36; 95% CI, 1.17-1.57) increased the odds of receiving surgical therapy. Age ≥60 years (hazard ratio [HR]=1.45; 95% CI, 1.33-1.59) and Black race (HR=1.14; 95% CI, 1.02-1.27) were negatively associated with DSS, while female sex (HR=0.81; 95% CI, 0.72-0.90) and married status (HR=0.69; 95% CI, 0.63-0.75) were positively associated with DSS. CONCLUSIONS AND RELEVANCE For patients with advanced laryngeal cancer, younger age and residing in a low-income county increase the likelihood of receiving surgical therapy. Female sex and married status provide a survival benefit, while Black race appears to be a negative prognostic factor. This highlights the impact of sociodemographic factors on treatment strategies and outcomes and highlights areas for further research on health disparities.
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8
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Clinical features and prognostic factors in patients with head and neck cancer: Results from a multicentric study. Cancer Epidemiol 2015; 39:367-74. [PMID: 25770642 DOI: 10.1016/j.canep.2015.02.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 02/12/2015] [Accepted: 02/18/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND The purpose of this study is to evaluate whether demographics, lifestyle habits, clinical data and alcohol dehydrogenase polymorphisms rs1229984 and rs1573496 associated with first primary head and neck (HNC) are associated with overall survival, recurrence, and second primary cancer (SPC). METHODS We conducted a follow-up study in five centres including 801 cases. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for overall survival, recurrence and SPC. RESULTS Five-years overall survival was 62% for HNC cases, 55% for oral cavity, 53% for oropharynx, 41% for hypopharynx, and 71% for larynx. Predictors of survival were older ages (HR=1.18 for 5 years increase; CI: 1.07-1.30), higher tumour stage (HR=4.16; CI: 2.49-6.96), and high alcohol consumption (HR=3.93; CI: 1.79-8.63). A combined therapy (HR=3.29; CI: 1.18-9.13) was associated with a worst prognosis for oral cavity cancer. The only predictor was higher tumour stage (HR=2.25; CI: 1.26-4.03) for recurrence, and duration of smoking (HR=1.91; CI: 1.00-3.68) for SPC. ADH1B rs1229984 polymorphism HRs for HNC and oesophageal cancer death and for alcohol related cancer death were 0.67 (95% CI: 0.42-1.08), and 0.64 (95% CI: 0.40-1.03), respectively. CONCLUSIONS The survival expectation differs among HNC sites. Increasing age and stage, and high alcohol consumption were unfavourable predictors of HNC survival overall. Duration of tobacco consumption before the first primary tumour was a risk factor for SPC.
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Guo SS, Huang PY, Chen QY, Liu H, Tang LQ, Zhang L, Liu LT, Cao KJ, Guo L, Mo HY, Guo X, Hong MH, Mai HQ. The impact of smoking on the clinical outcome of locoregionally advanced nasopharyngeal carcinoma after chemoradiotherapy. Radiat Oncol 2014; 9:246. [PMID: 25424191 PMCID: PMC4251838 DOI: 10.1186/s13014-014-0246-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 10/31/2014] [Indexed: 02/02/2023] Open
Abstract
Background Cigarette smoking is a common risk factor for developing nasopharyngeal carcinoma. However, the relationship between smoking and clinical outcomes remains uncertain. Methods The patients who participated in this study were drawn from a randomized clinical trial, for which the purpose was to compare the efficacy of induction chemotherapy plus concurrent chemoradiotherapy with that of induction chemotherapy plus radiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma. The patients who ever smoked were divided into the following categories of cumulative smoking exposure based on the duration of smoking and the quantity of cigarettes smoked: light, short-term smokers; light, long-term smokers; heavy, short-term smokers; and heavy, long-term smokers. A log-rank test and Cox models were used to assess the association between smoking and the clinical outcomes of overall survival (OS), failure-free survival (FFS), locoregional recurrence failure-free survival (LRFFS) and distant failure-free survival (DFFS). Results We found that ever-smokers experienced significantly shorter LRFFS times than never-smokers (5-year LRFFS rates: 85.8% vs. 88.5%, P = 0.022). The amount of smoking was significantly associated with FFS (P = 0.046) and LRFFS (P = 0.001) in the different ever-smoker groups. The amount of smoking was associated with LRFFS [P = 0.002, HR = 2.069 (95% confident interval (CI), 1.298-3.299)] even after a multivariable adjustment. Conclusions Smoking increases the risk of locoregional recurrence. Furthermore, the amount of smoking influences the prognosis of smokers, and these effects are dose-dependent.
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Affiliation(s)
- Shan-Shan Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
| | - Pei-Yu Huang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
| | - Qiu-Yan Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
| | - Huai Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
| | - Lin-Quan Tang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
| | - Lu Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
| | - Li-Ting Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
| | - Ka-Jia Cao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
| | - Ling Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
| | - Hao-Yuan Mo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
| | - Xiang Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
| | - Ming-Huang Hong
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,GCP Center, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.
| | - Hai-Qiang Mai
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, P. R. China.
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Sharp L, McDevitt J, Carsin AE, Brown C, Comber H. Smoking at Diagnosis Is an Independent Prognostic Factor for Cancer-Specific Survival in Head and Neck Cancer: Findings from a Large, Population-Based Study. Cancer Epidemiol Biomarkers Prev 2014; 23:2579-90. [DOI: 10.1158/1055-9965.epi-14-0311] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Shen GP, Xu FH, He F, Ruan HL, Cui C, Chen LZ, Zeng YX, Jia WH. Pretreatment lifestyle behaviors as survival predictors for patients with nasopharyngeal carcinoma. PLoS One 2012; 7:e36515. [PMID: 22590554 PMCID: PMC3348163 DOI: 10.1371/journal.pone.0036515] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 04/02/2012] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Lifestyle behaviors have been widely reported to influence the survival of patients with head and neck cancer. However, the relationship between pretreatment lifestyle behaviors and survival among patients with nasopharyngeal carcinoma (NPC) is unclear. METHODS A prospective cohort study was designed to determine the relationship between lifestyle behaviors and survival in 1,533 NPC patients recruited from October 2005 to October 2007. Pretreatment lifestyle behaviors (such as body-mass index [BMI], smoking, alcohol, diet) of the patients were investigated. Univariate and multivariate proportional-hazards models were used to assess the impact of lifestyle behaviors on patient survival. RESULTS Smoking was a predictor of survival; both current smokers (hazard ratio [HR] = 1.88; 95% CI, 1.33 to 2.65) and heavy smokers (≥ 25 Pack-years; HR = 1.84; 95% CI, 1.30 to 2.60) showed associations with poor survival. Higher BMI was significantly associated with a lower risk of death (P(trend) = 0.002). Compared with under/normal-weight patients (BMI less than 22.99 kg/m(2)), the multivariate HR for survival was 0.66 (95% CI, 0.48 to 0.90) and 0.47 (95% CI, 0.23 to 0.97) for overweight and obese patients, respectively. No alcohol intake and high fruit intake were associated with favorable survival in the univariate analysis but lost significance in the multivariate model. CONCLUSION Our findings indicate that pretreatment lifestyle behaviors, especially smoking status and BMI, as easily available data, provide prognostic value for survival in NPC patients.
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Affiliation(s)
- Guo-Ping Shen
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Feng-Hua Xu
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Fen He
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Department of Radiation Oncology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hong-Lian Ruan
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Cui Cui
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Li-Zhen Chen
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Yi-Xin Zeng
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Wei-Hua Jia
- State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, China
- * E-mail:
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López RVM, Zago MA, Eluf-Neto J, Curado MP, Daudt AW, da Silva-Junior WA, Zanette DL, Levi JE, de Carvalho MB, Kowalski LP, Abrahão M, de Góis-Filho JF, Boffetta P, Wünsch-Filho V. Education, tobacco smoking, alcohol consumption, and IL-2 and IL-6 gene polymorphisms in the survival of head and neck cancer. Braz J Med Biol Res 2011; 44:1006-12. [PMID: 21845339 DOI: 10.1590/s0100-879x2011007500097] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 07/27/2011] [Indexed: 12/16/2022] Open
Abstract
The association of education, tobacco smoking, alcohol consumption, and interleukin-2 (IL-2 +114 and -384) and -6 (IL-6 -174) DNA polymorphisms with head and neck squamous cell carcinoma (HNSCC) was investigated in a cohort study of 445 subjects. IL-2 and IL-6 genotypes were determined by real-time PCR. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) of disease-specific survival according to anatomical sites of the head and neck. Mean age was 56 years and most patients were males (87.6%). Subjects with 5 or more years of schooling had better survival in larynx cancer. Smoking had no effect on HNSCC survival, but alcohol consumption had a statistically significant effect on larynx cancer. IL-2 gene +114 G/T (HR = 0.52; 95%CI = 0.15-1.81) and T/T (HR = 0.22; 95%CI = 0.02-3.19) genotypes were associated with better survival in hypopharynx cancer. IL-2 +114 G/T was a predictor of poor survival in oral cavity/oropharynx cancer and larynx cancer (HR = 1.32; 95%CI = 0.61-2.85). IL-2 -384 G/T was associated with better survival in oral cavity/oropharynx cancer (HR = 0.80; 95%CI = 0.45-1.42) and hypopharynx cancer (HR = 0.68; 95%CI = 0.21-2.20), but an inverse relationship was observed for larynx cancer. IL-6 -174 G/C was associated with better survival in hypopharynx cancer (HR = 0.68; 95%CI = 0.26-1.78) and larynx cancer (HR = 0.93; 95%CI = 0.42-2.07), and C/C reduced mortality in larynx cancer. In general, our results are similar to previous reports on the value of education, smoking, alcohol consumption, and IL-2 and IL-6 genetic polymorphisms for the prognosis of HNSCC, but the risks due to these variables are small and estimates imprecise.
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Affiliation(s)
- R V M López
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil.
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Farshadpour F, Kranenborg H, Calkoen EVB, Hordijk GJ, Koole R, Slootweg PJ, Terhaard CH. Survival analysis of head and neck squamous cell carcinoma: Influence of smoking and drinking. Head Neck 2010; 33:817-23. [DOI: 10.1002/hed.21549] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2010] [Indexed: 01/02/2023] Open
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14
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Vilela LD, Allison PJ. An investigation of the role of sense of coherence in predicting survival among Brazilians with head and neck cancer. Oral Oncol 2010; 46:531-5. [DOI: 10.1016/j.oraloncology.2010.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 03/17/2010] [Accepted: 03/17/2010] [Indexed: 10/19/2022]
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Dikshit RP, Gillio-Tos A, Brennan P, De Marco L, Fiano V, Martinez-Peñuela JM, Boffetta P, Merletti F. Hypermethylation, risk factors, clinical characteristics, and survival in 235 patients with laryngeal and hypopharyngeal cancers. Cancer 2007; 110:1745-51. [PMID: 17786935 DOI: 10.1002/cncr.22975] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It has been established that promoter hypermethylation occurs in several genes during the pathogenesis of head and neck cancer. The authors investigated the role played by the hypermethylation of 4 cancer-related genes in the survival of patients who had laryngeal and hypopharyngeal cancer and in the occurrence of second primary tumors. METHODS Archival paraffin-embedded tissue (PET) samples were available from patients who were enrolled in a multicentric European case-control study that was performed between 1979 and 1982 and was followed up to 2000. Genomic DNA extracted from 235 PET samples were analyzed for promoter methylation status of the p16, O(6)-methylguanine-DNA methyltransferase (MGMT), death-associated protein kinase (DAP-K), and E-cadherin genes by using a methylation-specific polymerase chain reaction assay. RESULTS Hypermethylation was present in 44% of samples for p16, in 27% of samples for MGMT, in 42% of samples for DAP-K, and in 43% of samples for E-cadherin. Hypermethylation of either individual genes or their combination was not associated with mortality from all causes, mortality from upper aerodigestive tract cancer, or the occurrence of second primary tumors. CONCLUSIONS The analysis of a large series of patients with laryngeal and hypopharyngeal cancer suggested that hypermethylation is a frequent event in laryngeal and hypopharyngeal cancer, but it is not a predictor of mortality or second primary cancer.
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Affiliation(s)
- Rajesh P Dikshit
- Department of Lifestyle, Environment, and Cancer, International Agency for Research on Cancer, Lyon, France
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16
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Gillio-Tos A, De Marco L, Fiano V, Garcia-Bragado F, Dikshit R, Boffetta P, Merletti F. Efficient DNA extraction from 25-year-old paraffin-embedded tissues: study of 365 samples. Pathology 2007; 39:345-8. [PMID: 17558863 DOI: 10.1080/00313020701329757] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS Archival fixed paraffin-embedded tissue (PET) is a valuable source for population-based molecular genetic studies but the extraction of high quality DNA is still a problematic issue. The present study tested the grade of DNA fragmentation and the DNA adequacy for genetic investigations in a large series of tissue specimens that were formalin- or Bouin-fixed and paraffin-embedded between 1979 and 1983. Specific aims were to: (1) estimate the amount of archival tissue samples from which DNA is recoverable by conventional methods and the influence of variables (origin, fixative, section size) on DNA recovery; and (2) evaluate the feasibility of genetic investigations in large scale population studies. METHODS DNA was extracted in 2005 from 365 PET samples from Italy and Spain and subjected to PCR analysis targeting fragments of 152, 268 and 676 bp of the beta-globin gene. RESULTS Amplification of a 152 bp fragment was obtained in 252/365 (69%) PET samples, a 268 bp fragment in 62/365 (17%), a 676 bp fragment in 19/365 (5%) and no amplification for any fragment was obtained in 113/365 (31%). A second processing of newly cut sections performed in a 25% simple random sample gave comparable results, with substantial concordance between the first and second tests (kappa value 0.62 [95% CI 0.59-0.64]). CONCLUSIONS The results of this study show that DNA can be efficiently extracted from PETs archived for more than 20 years, and that large scale population studies based on PCR amplification of short target sequences are feasible.
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Affiliation(s)
- Anna Gillio-Tos
- Unit of Cancer Epidemiology, CERMS, University of Turin, Italy.
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Koskinen WJ, Brøndbo K, Mellin Dahlstrand H, Luostarinen T, Hakulinen T, Leivo I, Molijn A, Quint WG, Røysland T, Munck-Wikland E, Mäkitie AA, Pyykkö I, Dillner J, Vaheri A, Aaltonen LM. Alcohol, smoking and human papillomavirus in laryngeal carcinoma: a Nordic prospective multicenter study. J Cancer Res Clin Oncol 2007; 133:673-8. [PMID: 17486368 DOI: 10.1007/s00432-007-0219-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 03/23/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE Human papillomavirus (HPV) has been linked to oropharyngeal carcinomas, but its role in laryngeal squamous cell carcinoma (LSCC) is not clear. A prospective multicenter study based on known tumor-cell percentage of fresh frozen carcinoma biopsies was established to determine the HPV prevalence. Moreover risk factors such as smoking, alcohol abuse, chronic laryngitis and gastroesophageal reflux disease (GERD) were evaluated METHODS Fresh-frozen laryngeal cancer biopsies from 108 patients in Finland, Norway, and Sweden were investigated. Patients whose biopsy samples contained at least 20% tumor tissue (N = 69) entered the study. HPV DNA was determined with MY09/11 and GP5+/6+ nested PCR and SPF10 PCR hybridization assay. Patients were examined by an ENT specialist and an extensive questionnaire concerning risk factors was filled in. RESULTS Only three patients (4.4%) harbored HPV DNA in their carcinoma sample. Heavy alcohol drinking was associated with an increased risk of death, advanced-stage disease, and younger age at diagnosis. Chronic laryngitis, GERD, and orogenital sex contacts were rare. Poor oral hygiene was not associated with survival, although it correlated with heavy drinking. CONCLUSION In our series HPV was not important in LSCC. Heavy drinking led to major mortality in LSCC and promoted early carcinogenesis.
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Affiliation(s)
- Walter J Koskinen
- Department of Virology, Haartman Institute, University of Helsinki, Haartmaninkatu 3, P.O. Box 21, 00014 Helsinki, Finland.
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Groome PA, Schulze KM, Keller S, Mackillop WJ, O'Sullivan B, Irish JC, Bissett RJ, Dixon PF, Eapen LJ, Gulavita SPP, Hammond JA, Hodson DI, Mackenzie RG, Schneider KM, Warde PR. Explaining socioeconomic status effects in laryngeal cancer. Clin Oncol (R Coll Radiol) 2006; 18:283-92. [PMID: 16703745 DOI: 10.1016/j.clon.2005.12.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION People with lower socioeconomic status (SES) experience shorter survival times after a cancer diagnosis for many disease sites. We determined whether area-level SES was associated with the outcomes: cause-specific survival and local-regional failure in laryngeal cancer in Ontario, Canada. When we found an association we sought explanations that might be related to access to care including age, sex, rural residence, tumor stage, lymph node status, use of diagnostic imaging, treatment type, percentage of prescribed radiotherapy delivered, number of radiotherapy interruption days, treatment waiting time, and treating cancer center. MATERIALS AND METHODS The study population consisted of 661 glottic and 495 supraglottic stage-stratified randomly-sampled patients identified using the Ontario Cancer Registry. Area-level SES quintiles were assigned using adjusted median household income from the Canadian Census. Other data were collected from patient charts. Explanations for SES effects were determined by measuring whether the effect moved toward the null value by at least 10% when an access indicator was added to a the model. RESULTS Socioeconomic status was not related to either outcome for those with supraglottic cancer, but an association was present in glottic cancer. With the highest socioeconomic status quintile as the referent group, the relative risks for patients in the lowest socioeconomic quintile were 2.75 (95% CI 1.48, 5.12) for cause-specific survival and 1.90 (95% CI 1.24, 2.93) for local-regional failure. Disease stage as measured by T-category explained between 3% and 23% of these socioeconomic effects. None of the other access indicators met our 10% change criterion. CONCLUSION We question why people in lower socioeconomic quintiles were not diagnosed earlier in the disease progression. Having ruled out several variables that may be related to access to care, additional biologic and social variables should be examined to further understand socioeconomic status effects.
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Affiliation(s)
- P A Groome
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
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Woods LM, Rachet B, Coleman MP. Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol 2006; 17:5-19. [PMID: 16143594 DOI: 10.1093/annonc/mdj007] [Citation(s) in RCA: 478] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cancer survival is known to vary by socio-economic group. A review of studies published by 1995 showed this association to be universal and resilient to the many different ways in which socio-economic status was determined. Differences were most commonly attributed to differences in stage of disease at diagnosis. MATERIALS AND METHODS A review of research published since 1995 examining the association of cancer survival with socio-economic variables. RESULTS An association between socio-economic status and cancer survival has continued to be demonstrated in the last decade of research. Stage at diagnosis and differences in treatment have been cited as the most important explanatory factors. Some research has evaluated the psychosocial elements of this association. CONCLUSIONS Socio-economic differences in cancer survival are now well documented. The explanatory power of stage at diagnosis, although great, should not detract from the evidence of differential treatment between social groups. Neither factor can completely explain the observed socio-economic differences in survival, however, and the importance of differences in tumour and patient factors should now be quantified.
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Affiliation(s)
- L M Woods
- Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK.
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Dikshit RP, Boffetta P, Bouchardy C, Merletti F, Crosignani P, Cuchi T, Ardanaz E, Brennan P. Lifestyle habits as prognostic factors in survival of laryngeal and hypopharyngeal cancer: a multicentric European study. Int J Cancer 2005; 117:992-5. [PMID: 15986425 DOI: 10.1002/ijc.21244] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Little information is available on the role of tobacco, alcohol and diet in the survival of upper aero digestive cancers. Our study analysed the survival of 931 laryngeal and hypopharyngeal cancer patients, enrolled in a population based case-control study conducted at 5 centres in southeast Europe during 1979-1982. Age at the time of diagnosis and site of origin of tumour were observed to be predictors of the survival. Cigarette smoking, and to a limited extent alcohol drinking, before the diagnosis of tumour seem to influence the overall survival whereas high intakes of vegetables and vitamin C were observed to favourably affect the prognosis. For mortality from upper aerodigestive cancer protective effects of high intakes of vegetables, fibres and vitamin C were observed. Our results support the hypothesis that there is a role for dietary intervention to improve survival of laryngeal and hypopharyngeal cancer patients.
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Dikshit RP, Boffetta P, Bouchardy C, Merletti F, Crosignani P, Cuchi T, Ardanaz E, Brennan P. Risk factors for the development of second primary tumors among men after laryngeal and hypopharyngeal carcinoma. Cancer 2005; 103:2326-33. [PMID: 15852357 DOI: 10.1002/cncr.21051] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Second primary tumors (SPT) constitute a major threat to the survival of patients with laryngeal carcinoma. However, to the authors' knowledge little is known regarding the risk factors for developing SPTs or about the strategy to be followed to avoid them. METHODS Eight hundred seventy-six male patients with laryngeal/hypopharyngeal carcinoma enrolled in a population-based, case-control study in 5 centers from South Europe during 1979-1982 were followed up to ascertain the occurrence of SPTs. Standardized incidence ratios were calculated to estimate the risk of SPT occurring in the cohort. Cox proportional hazard models were fitted to estimate the hazard ratio for development of SPTs in relation to use of tobacco smoking, alcohol consumption, and dietary habits before the first primary tumor. RESULTS One hundred forty-five patients developed an SPT with an annual average rate of 2.1%. An excess risk of developing an SPT of the tongue, mouth, esophagus, and lung was observed. No elevated risks of SPTs were observed in other organs. Alcohol consumption strongly increased the risk of developing an SPT of the upper aerodigestive tract (UADT). Heavy cumulative cigarette smoking increased the risk of developing a lung SPT. A protective effect of high intake of citrus fruit was noticed for SPT in the lung, whereas high butter intake was associated with an increased risk for SPT of the UADT. CONCLUSIONS Continuous medical surveillance was essential in the UADT and lung to reduce the risk from an SPT after initial laryngeal/hypopahryngeal carcinoma. Alcohol consumption before the first primary tumor was a risk factor for SPT of the UADT. The study suggested a protective role of citrus fruits in the development of a lung SPT.
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Affiliation(s)
- Rajesh P Dikshit
- Gene-Environment Epidemiology Group, International Agency for Research on Cancer, Lyon, France
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22
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Vlachtsis K, Nikolaou A, Markou K, Fountzilas G, Daniilidis I. Clinical and molecular prognostic factors in operable laryngeal cancer. Eur Arch Otorhinolaryngol 2005; 262:890-8. [PMID: 15739081 DOI: 10.1007/s00405-005-0916-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2004] [Accepted: 12/10/2004] [Indexed: 01/05/2023]
Abstract
Many factors affect the prognosis in operable laryngeal squamous cell carcinoma (LSCC). Many clinical factors have been implicated in tumor recurrence and poor survival of the patients. The aim of the present study is to investigate the demographic, clinical and histological characteristics as prognostic factors. Moreover, our aim is to analyze the role of modern molecular biomarkers in the prognosis of patients with LSCC. One hundred patients with operable laryngeal carcinoma underwent surgery as primary treatment between April 1999 and April 2002. Ninety-four of them were men and 6 women, with a median age of 62 years (39-77). All demographic data of the patients were recorded. Staging of the tumor revealed 20 cases with T2 cancer, 46 cases with T3 and 34 cases with T4, while N classification included 91 patients with N0 tumor, 3 with N1 and 6 with N2. Among the 100 cases, 47 were located in the glottis, 46 in the supraglottic region and 7 were transglottic. Histology grading revealed 35 cases of grade G1, 50 cases of G2 and 15 cases of G3. Postoperatively, all patients were followed regularly for the possibility of tumor relapse, with a median follow-up period of 40.2 months (4.8-58.4). During the operation, a tissue specimen was collected from the tumor. The specimens were used for RNA and DNA extraction. Isolated RNA was used to investigate the expression of wt-p53, bcl-2, VEGF and EGFR by the reverse transcriptase PCR method (RT-PCR) using specific primers, while genomic DNA was used for the detection of EBV and HPV (16/18 subtypes) by the consensus primer-mediated polymerase chain reaction method (PCR). All data such as tumor recurrence and survival were recorded. Statistical analysis was performed using the SPSS and STATA statistical packages in order to investigate the role of all clinical and molecular factors and their combinations as significant prognostic markers. The tumor recurrence rate was 31%, while the tumor associated death rate was 27% and total death rate 30%. Univariate analysis for overall survival showed significance for the T stage, TNM stage and site of the tumor. Univariate analysis for the time to progression showed significance for the T stage, N stage, TNM stage, site of the tumor and tumors simultaneously positive for EGFR and VEGF, while EGFR expression was borderline insignificant. Multivariate analysis revealed TNM stage as the only significant factor for overall survival, and TNM stage, site of the tumor and EGFR expression as significant factors for time to progression. The molecular biomarkers EGFR and VEGF have a prognostic significance in laryngeal cancer in addition to the established clinical prognostic factors such as the stage and site of the tumor. These markers, apart from their role in carcinogenesis, seem to play an important role in tumor relapse.
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Affiliation(s)
- Konstantinos Vlachtsis
- Department of Otorhinolaryngology Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece.
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23
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Teppo H, Soini Y, Melkko J, Koivunen P, Alho OP. Prognostic factors in laryngeal carcinoma: the role of apoptosis, p53, proliferation (Ki-67) and angiogenesis. APMIS 2003; 111:451-7. [PMID: 12780518 DOI: 10.1034/j.1600-0463.2003.1110401.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Even though the roles of different known or suggested prognostic factors in laryngeal cancer have been studied in detail, clinical stage at time of diagnosis and anatomic subsite of the tumour remain the only practical predictors of clinical outcome and offer the only guidelines in the planning of treatment. In this study, the relative roles of known demographic and clinical prognostic factors, in addition to four histopathological factors, were evaluated in a sample of 100 laryngeal carcinoma patients with multivariate analysis using the Cox regression model. In addition to advanced stage (stage III-IV) (relative hazard of death (HR) 8.9, p=0.01) and supraglottic disease (HR 5.6, p=0.02), high apoptotic index (HR 11.1, p=0.05) was significantly associated with poor survival. Cell proliferation, p53 and angiogenesis did not significantly affect the prognosis. In the future, high degree of apoptosis could be used to identify patients with poor prognosis in laryngeal cancer.
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Affiliation(s)
- Heikki Teppo
- Department of Otorhinolaryngology, University of Oulu, Finland
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24
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Gorey KM, Holowaty EJ, Fehringer G, Laukkanen E, Richter NL, Meyer CM. An international comparison of cancer survival: metropolitan Toronto, Ontario, and Honolulu, Hawaii. Am J Public Health 2000; 90:1866-72. [PMID: 11111258 PMCID: PMC1446420 DOI: 10.2105/ajph.90.12.1866] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii. METHODS Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 1986-1990, followed until 1996). Socioeconomic data for each person's residence at the time of diagnosis were taken from population censuses. RESULTS Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in Toronto experienced 5-year survival advantages for breast and prostate cancer. In support of the health insurance hypothesis, between-country differences were smaller than those observed with other state samples and the Canadian advantage was larger among younger women. CONCLUSIONS Hawaii seems to provide better cancer care than many other states, but patients in Toronto still enjoy a significant survival advantage. Although Hawaii's employer-mandated health insurance coverage seems an effective step toward providing equitable health care, even better care could be expected with a universally accessible, single-payer system.
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Affiliation(s)
- K M Gorey
- School of Social Work, University of Windsor, Ontario, Canada.
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25
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Severi G, Plesko I, Robertson C, Obsitnikova A, Boyle P. Larynx cancer in Slovakia and the role of anatomical subsites. Oral Oncol 1999; 35:564-70. [PMID: 10705091 DOI: 10.1016/s1368-8375(99)00035-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During the time period 1968-92, 6958 laryngeal cancers (6602 in men and 356 in women) were diagnosed in Slovakia and notified to the National Cancer Registry. We analysed long-term trends in incidence, mortality and survival. Mortality and incidence rates in Slovakian men rose rapidly until 1980 and more slowly subsequently. The mortality-to-incidence ratio initially was 40% and increased to 70% in the period 1985-88. A log-linear model showed that the more recent generations experienced the slowest increase in incidence. Incidence and mortality rates in women remained stable and did not exceed 1 per 100,000. The 5-year survival probability from invasive larynx cancer was 47%. Survival rates had shown no particular trend by year and age at diagnosis. The main finding was that 5-year survival from supraglottis cancer is 20% poorer than survival from glottis cancer. Supraglottis is the prevalent larynx subsite in countries with high larynx, oropharynx and oesophagus incidence rates. This supports the hypothesis that supraglottis cancer is more strongly linked to a synergistic effect of smoking and alcohol than glottis cancer.
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Affiliation(s)
- G Severi
- Division of Epidemiology and Biostatistics, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy.
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26
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Magnano M, De Stefani A, Usai A, Lerda W, Albera R, Ragona R, Bussi M, Airoldi M, Cortesina G. Carcinoma of the larynx in the elderly: analysis of potentially significant prognostic variables. AGING (MILAN, ITALY) 1999; 11:316-22. [PMID: 10631881 DOI: 10.1007/bf03339806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The incidence reported for carcinomas of the head and neck currently peaks between the sixth and seventh decades of life. In this retrospective study we were interested in learning whether age is a potentially significant prognostic factor for survival. We considered a set of variables in a series of 134 patients, divided into two groups; between 65 and 70 years of age, and older than 70. Stage I-II tumors were present in 44 patients, while locally advanced lesions (stages III-IV) were present in 90. Statistical analysis of survival was performed using the actuarial survival rates according to Kaplan-Meier; significance was evaluated using the log-rank test. Multivariate analysis was performed according to the Cox logistic regression model to determine the prognostic significance of any of the variables. Univariate analysis was performed on a series of variables regarding the patient, tumor and treatment. In the younger group, age appeared to be a favorable prognostic factor. Tumor size had a significant effect on disease-free survival, both globally and between the two groups (p < 0.05). Lymph node status substantially influenced the five-year survival rate (p = 0.001). Tumor invasion of the lymph nodes led to a difference between the two groups. Survival was lower in the younger than in the older group. There was a significant difference (p < 0.01) in survival between patients who had undergone surgery (75%) and those who received radiotherapy alone (33%). Multivariate analysis of these variables showed that disease stage, and treatment of lymph nodes were both significant (p = 0.0016 and p = 0.0002, respectively). Survival rates for the so-called "young elderly" (65-70 years) are generally higher than that for those aged 70 and over. Following accurate and comprehensive assessment by the anesthesiologist and the internist, and appropriate adjustment of the patient's nutritional and metabolic status, combined radical surgery and radiotherapy can and must be performed. Minimal palliative interventions, in the belief that tumor growth is biologically less aggressive in the elderly patient, should be avoided.
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Affiliation(s)
- M Magnano
- Division of Otorhinolaryngology, Ospedale Mauriziano Umberto I, Torino, Italy.
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