Ten years single institutional experience of treatment for advanced hypopharyngeal cancer in Kyoto University

HPV16 status might correlate to increasing tumor-infiltrating lymphocytes in hypopharyngeal cancer

BACKGROUND

Human papillomavirus (HPV) plays a major etiological role in the increasing number of patients with head and neck squamous cell carcinoma (HNSCC).

OBJECTIVES

This study aimed at exploring the relationship between HPV infection and prognosis in patients with hypopharyngeal carcinoma (HPSCC).

METHODS

We retrospectively analyzed 108 consecutive patients diagnosed with HPSCC from 2015 to 2018. Real-time fluorescent quantitative PCR and P16 immunohistochemistry were used to detect HPV infection in tissues of patients with hypopharyngeal carcinoma. The numbers of CD8, CD4 and Foxp3 cells in tumor parenchyma were obtained by immunohistochemical counting. Finally, the analysis was performed according to the clinicopathological variables and prognosis of the patients.

RESULTS

Among 108 patients with HPSCC, 18 cases were detected by qPCR, and 16 subtypes accounted for the majority (77.8%). Kaplan-Meier analysis showed that HPV16+, higher CD8+, higher CD4+ and higher FoxP3+ TIL infiltration was strongly associated with superior three-year disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS). Univariate analysis showed that HPV and CD4+ TIL had higher predictive value for prognosis.

CONCLUSIONS

HPV16 infection is significantly related to tumor immune infiltrating cells (TILs).

Options of medical treatment and laryngeal function preservation in elderly patients with medial wall pyriform sinus cancer

Objective

To retrospectively investigate the clinical efficacy and larynx preservation of two different treatments: radiotherapy followed by surgery (R+S) and surgery followed by radiotherapy (S+R), in elderly patients with medial wall pyriform sinus cancer.

Materials and methods

Medical records from 48 patients over 70 years old with medial wall pyriform sinus cancer who underwent different treatments between 2001 and 2010 were analyzed. Twenty-one patients underwent radiotherapy first followed by surgery (R+S), and the other 27 patients underwent surgery first followed by radiotherapy (S+R). A Kaplan–Meier method was used to calculate the survival rate.

Results

Overall 3-year and 5-year survival rates were 60.4% and 35.4%, respectively. The 5-year survival rates in R+S group and S+R group were 38.1% and 33.3%, respectively, without a statistically significant difference between the two groups (P>0.05). Also, comparisons of the decannulation rates (64.3% for R+S group vs 50.0% for S+R group) and postoperative complication rates (42.9% for R+S group vs 37.0% for S+R group) between the two groups of patients did not show obvious differences. However, the laryngeal preservation rates in R+S group and S+R group were 66.7% and 37.0%, respectively, with significantly statistical difference between the two groups (P<0.05).

Conclusion

Based on the data analysis of 48 patients, the survival rates of elderly patients who underwent R+S or S+R were comparable, but R+S treatment could improve the laryngeal preservation rate of patients. Further study on large-scale sample pool should be performed to confirm this conclusion.

Transcobalamin I: a novel prognostic biomarker of neoadjuvant chemotherapy in locally advanced hypopharyngeal squamous cell cancers

Background

Hypopharyngeal squamous cell carcinoma (HPSCC) is an aggressive head and neck squamous cell carcinoma with poor prognosis. Neoadjuvant chemotherapy (NACT) followed by concurrent chemoradiotherapy could provide better efficacy in HPSCC treatment. Identification of predictive biomarkers is critically needed to improve selection of patients who derive the most benefit from NACT. The aim of this study was to investigate whether transcobalamin I (TCN1) could be a novel predictive biomarker for NACT in HPSCC.

Methods

We collected biopsy specimens from 102 patients with primary locally advanced HPSCC. Messenger RNA (mRNA) and protein expression levels of TCN1 were analyzed using quantitative polymerase chain reaction and immunohistochemistry, respectively. The relationship between TCN1 expression, chemotherapy sensitivity, and clinical outcome was assessed using univariate Kaplan-Meier survival analyses and multivariate analysis with covariate adjustments. Furthermore, we knocked down TCN1 by small interfering RNA (siRNA) in HPSCC cell FaDu, tested the effects of TCN1 knockdown on cisplatin toxicity by MTT assay, and detected cisplatin-induced apoptosis by Western blotting.

Results

TCN1 expression was significantly lower in NACT-sensitive patients than nonsensitive patients at protein level (p=0.013) and mRNA level (p<0.001), indicating that low TCN1 expression predicts better NACT treatment response. Furthermore, TCN1 was an independent prognostic biomarker for both overall survival (p=0.047) and disease-free survival (p=0.05) in advanced HPSCC patients. In addition, in vitro experiments showed that genetic silencing of TCN1 using siRNA sensitized FaDu cells to cisplatin treatment with increased cell apoptosis.

Conclusion

Low expression of TCN1 might be a novel prognostic biomarker for predicting NACT sensitivity and clinical outcome in local advanced HPSCC patients.

The Distribution of Phosphatidylcholine Species in Superficial-Type Pharyngeal Carcinoma

Objectives. Superficial-type pharyngeal squamous cell carcinoma (STPSCC) is defined as carcinoma in situ or microinvasive squamous cell carcinoma without invasion to the muscular layer. An exploration of the biological characteristics of STPSCC could uncover the invasion mechanism of this carcinoma. Phosphatidylcholine (PC) in combination with fatty acids is considered to play an important role in cell motility. Imaging mass spectrometry (IMS) is especially suitable for phospholipid analysis because this technique can distinguish even fatty acid compositions. Study Design. IMS analysis of frozen human specimens. Methods. IMS analysis was conducted to elucidate the distribution of PC species in STPSCC tissues. STPSCC tissue sections from five patients were analyzed, and we identified the signals that showed significant increases in the subepithelial invasive region relative to the superficial region. Results. Three kinds of PC species containing arachidonic acid, that is, PC (16:0/20:4), PC (18:1/20:4), and PC (18:0/20:4), were increased in the subepithelial invasive region. Conclusion. These results may be associated with the invasion mechanism of hypopharyngeal carcinoma.

Contemporary therapeutic management of locally advanced hypopharyngeal cancer: oncologic and functional outcomes - a report on 100 cases

CONCLUSION

A significant proportion of patients with locally advanced hypopharyngeal cancer could not be managed by larynx-sparing therapy. T4 stage is one of the main predictive factors of oncologic and functional outcomes.

OBJECTIVES

To analyze the therapeutic management of patients with locally advanced hypopharyngeal cancer in clinical practice and to report oncologic and functional outcomes.

METHODS

This was a retrospective study of all patients treated for a locally advanced hypopharyngeal squamous cell carcinoma between 2001 and 2012 at our institution.

RESULTS

A total of 100 patients were included in this study. Induction chemotherapy (CT) followed by radiotherapy (RT) ± CT, primary RT + CT, and primary total pharyngolaryngectomy (TPL) comprised the initial therapeutic management for 54, 24, and 20 patients, respectively. Two patients received only supportive care. Overall survival (OS) and cause-specific survival (SS) were 50% and 60% at 3 years, respectively. In the group of patients referred for induction CT, the 3-year OS and SS were 58% and 70%, respectively. In multivariate analysis, T stage (p = 0.05) and ASA score (p = 0.02) were significant predictive factors of OS. T4 tumor stage had a pejorative impact on swallowing function after therapy (p = 0.006). The rate of patients alive, disease-free, and with a functional larynx at 2 years was 23%.

Conservation surgery for hypopharyngeal cancer: changing paradigm from open to endoscopic

CONCLUSIONS

Endoscopic laser microsurgery (ELM) provides comparable oncological outcomes, and improved functional recovery and laryngeal preservation compared with open partial laryngopharyngectomy (OPLP) in patients with early squamous cell carcinoma of the hypopharynx (HPSCC). The use of open surgery is declining. The outcome of the study provides evidence-based recommendations for surgical choices in HPSCC treatment. However, it is not conclusive without a larger prospective study.

OBJECTIVES

To compare the functional and oncological results of ELM and OPLP in HPSCC and examine surgical trends.

METHODS

From 1990 to 2008, 53 HPSCC patients undergoing ELM (n = 25) and OPLP (n = 28) were included. Functional recovery, oncological results, and laryngeal preservation rate were analyzed.

RESULTS

Patients who underwent ELM demonstrated a shorter decannulation period (7 vs 11 days, p = 0.010), time using a nasogastric tube (7 vs 16 days, p = 0.043), and hospitalization stay (12 vs 22 days, p = 0.0061) than those who underwent OPLP. The 3-year overall and disease-specific survival rates were comparable between ELM and OPLP (79% vs 64%, p = 0.151, and 83% vs 71%, p = 0.320, respectively). The ELM patients had better laryngeal preservation (92% vs 71%, p = 0.048). The number of OPLPs performed has decreased since 2000 (68% before vs 32% after, p < 0.0001).

Treatment of hypopharyngeal carcinoma with primary chemoradiotherapy: functional morbidity

PURPOSE OF REVIEW

This review aims at unravelling the medical literature which has reported on the treatment of 'larynx preserving' chemoradiotherapy strategies and separating the treatment sites, larynx and hypopharynx, from each other and reporting on the adverse effects and functional outcomes of patients with hypopharyngeal cancer.

RECENT FINDINGS

The literature reports on the treatment of advanced laryngeal and hypopharyngeal cancer with chemoradiotherapy together as a 'common cancer site'. Although the chemotherapeutic drugs affect the tumour and the normal tissues similarly in both the larynx and hypopharynx, their effects on the patient groups are different, mainly affecting swallow, airway protection mechanisms and voice/speech to a greater or lesser extent. Pretreatment symptoms and function should be documented subjectively and objectively prior to commencing nonsurgical treatment. Hypopharyngeal cancer should be reported separately, and preferably stratified into the three subsites, according to the T stage of disease rather than TNM stage. Equipment for such testing and the process for such documentation are available in most clinical areas, worldwide.

SUMMARY

Future analysis relies on the conscientious monitoring of adverse effects of all treatment modalities and an assessment of function as well as quality of life impact on the patient. Thus, the specialty can make informed decisions on the most appropriate and most suitable mode of treatment for individual patients based upon their tumour, their preoperative organ function, their likely future organ function and the likelihood of cure.