Contribution of tobacco and alcohol to the high rates of squamous cell carcinoma of the supraglottis and glottis in Central Europe

Head-and-neck Cancer in the Emergency Department: A Contemporary Review of Common Presentations and Management

Head-and-neck cancer (HNC) can present with life.threatening symptoms in the emergency department. Patients can sometimes be misdiagnosed with pulmonary disease due to similar signs and symptoms, ultimately leading to delayed diagnosis and potentially devastating consequences. Reasons for this include lack of awareness of patient risk factors and knowledge of the myriad of presenting complaints in the disease process among physicians working in primary care and in the emergency department. This article explores the contemporary risk factors and common presenting symptoms and discusses initial management for a patient with potential head-and-neck malignancy. Emergency presentations of HNC are wide ranging and can overlap with common respiratory pathologies. Clinician awareness of this can assist the team in deciding what appropriate examination and investigations are required to reduce the risk of delaying diagnosis and further treatment.

Investigating Disparities in Hypopharyngeal/Laryngeal Cancer Survival in Florida With Geospatial Mapping Analysis

OBJECTIVE

Identify predictors of overall survival (OS) after hypopharyngeal/laryngeal cancer in Florida.

MATERIAL AND METHODS

We conducted a retrospective cohort study using data from the Florida Cancer Data System (FCDS) on patients diagnosed with hypopharyngeal or laryngeal cancer from 2010-2017. Primary outcome was OS. Hazard ratios (HRs) were estimated from univariable and multivariable Cox regression models for OS. Data was analyzed from November 1, 2022, to June 30, 2023.

RESULTS

We analyzed 6771 patients, who were primarily male (81.2%), White non-Hispanic (WNH) (78.2%), publicly insured (70.1%), married (51.8%), and residents of urban counties (73.6%). Black patients were more likely to be younger at diagnosis (38.9%), single (43.4%), to have distant SEER stage disease (25.6%). Median OS were lowest among patients who were uninsured (34 months), with hypopharyngeal site disease (18 months), and a smoking history (current: 34 months, former: 46 months, no smoking: 63 months). Multivariable Cox regression analysis showed worse OS for single/unmarried vs married (HR 1.47 [95%CI: 1.36-1.59], P < .001), history of tobacco use (current: HR 1.62 [95%CI: 1.440-1.817], P < .001; former smokers: (HR 1.28 [95%CI: 1.139-1.437], P < .001) vs no history). Improved OS was observed among White Hispanics (WH) vs WNH (HR .73 [95%CI: .655-.817], P < .001) and women vs men (HR .88 [95%CI: .807-.954], P = .002). Geographical mapping showed that mortality rates were highest in census tracts with low income and education.

CONCLUSION

Our findings suggest that sociodemographic and clinical factors impact OS from hypopharyngeal/laryngeal cancer in Florida and vary geographically within the state. These results will help guide future public health interventions.

Imaging Recommendations for Diagnosis, Staging and Management of Larynx and Hypopharynx Cancer

We discussed the imaging recommendations for diagnosis, staging, and management of larynx and hypopharynx cancer. Carcinoma of the larynx is a common cancer, with males being affected more. Hypopharyngeal carcinoma is less common than laryngeal malignancies. Squamous cell carcinoma is the most common histological type. Nonsquamous cell malignant lesions are rare and mostly submucosal lesions. Clinical examination and endoscopy play an integral role in its detection and staging. Imaging also plays a major role in its staging, including local disease extent, nodal and distant metastatic status, as well as to assess response to therapy. Follow-up of treated cases and differentiation of recurrence from post treatment changes can be done on imaging. Early stage disease is treated with single modalities such as radiotherapy or surgery. Advanced disease is treated with multimodality of either chemoradiotherapy or surgery followed by adjuvant radiotherapy with or without concurrent chemotherapy.

Epidemiological, Clinical, and Oncological Outcomes of non-Alcohol Drinking and non-Smoking Laryngeal Squamous Cell Carcinoma Patients: A Distinct Entity

Purpose: To explore the discrepancy in clinicopathological and prognostic features between smoking and alcohol drinking (SA) and non-smoking and non-alcohol drinking (NSNA) patients with laryngeal squamous cell carcinoma (LSCC). Methods: This retrospective study including 1735 patients with LSCC was conducted from January 2005 to December 2010, which were categorized into 4 groups, NSNA group, smoking only group, alcohol-drinking only group, and SA group. We compared overall survival (OS) and disease-free survival (DFS) using the Kaplan-Meier method and indicated clinicopathological features by Cox proportional hazards regression models before and after propensity score matching (PSM). Results: A total of 415 patients (23.92%) were identified as NSNA. The SA group was predominantly patients ≤60 years old (46.63%) while the NSNA group was more older (58.07%). NSNA group was more likely to present at earlier disease stage and more female. No significant difference in OS (P = .685) and DFS (P = .976) was found between the 2 groups. In addition to age and recurrence and metastasis being common independent prognostic factors in terms of OS in both groups of patients, NSNA group also exhibited other factors, namely tumor area >3.7 cm² and positive resection margin. For DFS, N + stage, tumor size >3.7 cm², and positive resection margin were prognostic features specific to NSNA group. Conclusion: The outcome is similar in LSCC patients with and without SA. NSNA group shows a distinct profile from that found in SA group. Clinicopathological features from NSNA group should be considered for LSCC management.

Simultaneously targeting ErbB family kinases and PI3K in HPV-positive head and neck squamous cell carcinoma

OBJECTIVES

To identify the most effective PI3K and EGFR inhibitors in HPV-positive head and neck squamous cell carcinoma (HNSCC) and investigate the efficacy of a combination of an ErbB family kinase inhibitor and a PI3K inhibitor to inhibit cell proliferation of HPV-positive HNSCC.

MATERIALS AND METHOD

HPV-positive HNSCC cell lines were treated with the FDA approved ErbB kinase inhibitor, Afatinib or FDA-approved PI3K inhibitor, Copanlisib, alone or in combination, and phosphorylation and total protein levels of cells were assessed by Western blot analysis.Cell proliferation and apoptosis were examined by MTS assay, flow cytometry, and Western blots, respectively.

RESULTS

Copanlisib more effectively inhibited cell proliferation in comparison to other PI3K inhibitors tested. HPV-positive HNSCC cells differentially responded to cisplatin, Afatinib, or Copanlisib. The combination of Afatinib and Copanlisib more effectively suppressed cell proliferation and induced apoptosis compared to either treatment alone. Mechanistically, the combination of Afatinib and Copanlisib completely blocked phosphorylation of EGFR, HER2, HER3, and Akt as well as significantly decreased the HPV E7 expression compared to either treatment alone.

CONCLUSION

Afatinib and Copanlisib more effectively suppress cell proliferation and survival of HPV-positive HNSCC in comparison to either treatment alone.

Vocal Outcome After Cordectomy by Transoral CO2 Laser Microsurgery in Patients With Laryngeal Intraepithelial Neoplasia and Non-neoplastic Lesions

OBJECTIVES

This study investigates vocal outcome after cordectomy by transoral CO2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy.

STUDY DESIGN

Prospective, longitudinal, quasi-experimental time series.

METHODS

Consecutively included patients (n = 155) with LIN (n = 84) or NNL (n = 71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings.

RESULTS

Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy.

CONCLUSION

Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands.

Alcohol and Head and Neck Cancer: Updates on the Role of Oxidative Stress, Genetic, Epigenetics, Oral Microbiota, Antioxidants, and Alkylating Agents

Head and neck cancer (HNC) concerns more than 890,000 patients worldwide annually and is associated with the advanced stage at presentation and heavy outcomes. Alcohol drinking, together with tobacco smoking, and human papillomavirus infection are the main recognized risk factors. The tumorigenesis of HNC represents an intricate sequential process that implicates a gradual acquisition of genetic and epigenetics alterations targeting crucial pathways regulating cell growth, motility, and stromal interactions. Tumor microenvironment and growth factors also play a major role in HNC. Alcohol toxicity is caused both directly by ethanol and indirectly by its metabolic products, with the involvement of the oral microbiota and oxidative stress; alcohol might enhance the exposure of epithelial cells to carcinogens, causing epigenetic modifications, DNA damage, and inaccurate DNA repair with the formation of DNA adducts. Long-term markers of alcohol consumption, especially those detected in the hair, may provide crucial information on the real alcohol drinking of HNC patients. Strategies for prevention could include food supplements as polyphenols, and alkylating drugs as therapy that play a key role in HNC management. Indeed, polyphenols throughout their antioxidant and anti-inflammatory actions may counteract or limit the toxic effect of alcohol whereas alkylating agents inhibiting cancer cells’ growth could reduce the carcinogenic damage induced by alcohol. Despite the established association between alcohol and HNC, a concerning pattern of alcohol consumption in survivors of HNC has been shown. It is of primary importance to increase the awareness of cancer risks associated with alcohol consumption, both in oncologic patients and the general population, to provide advice for reducing HNC prevalence and complications.

Bile reflux and hypopharyngeal cancer (Review)

Laryngopharyngeal reflux, a variant of gastroesophageal reflux disease, has been considered a risk factor in the development of hypopharyngeal cancer. Bile acids are frequently present in the gastroesophageal refluxate and their effect has been associated with inflammatory and neoplastic changes in the upper aerodigestive tract. Recent in vitro and in vivo studies have provided direct evidence of the role of acidic bile refluxate in hypopharyngeal carcinogenesis and documented the crucial role of NF-κB as a key mediator of early oncogenic molecular events in this process and also suggested a contribution of STAT3. Acidic bile can cause premalignant changes and invasive squamous cell cancer in the affected hypopharynx accompanied by DNA damage, elevated p53 expression and oncogenic mRNA and microRNA alterations, previously linked to head and neck cancer. Weakly acidic bile can also increase the risk for hypopharyngeal carcinogenesis by inducing DNA damage, exerting anti-apoptotic effects and causing precancerous lesions. The most important findings that strongly support bile reflux as an independent risk factor for hypopharyngeal cancer are presented in the current review and the underlying mechanisms are provided.

Prevalence of cancer susceptibility variants in patients with multiple Lynch syndrome related cancers

Along with early-onset cancers, multiple primary cancers (MPCs) are likely resulting from increased genetic susceptibility; however, the associated predisposition genes or prevalence of the pathogenic variants genes in MPC patients are often unknown. We screened 71 patients with MPC of the stomach, colorectal, and endometrium, sequencing 65 cancer predisposition genes. A subset of 19 patients with early-onset MPC of stomach and colorectum were further evaluated for variants in cancer related genes using both normal and tumor whole exome sequencing. Among 71 patients with MPCs, variants classified to be pathogenic were observed in 15 (21.1%) patients and affected Lynch Syndrome (LS) genes: MLH1 (n = 10), MSH6 (n = 2), PMS2 (n = 2), and MSH2 (n = 1). All carriers had tumors with high microsatellite instability and 13 of them (86.7%) were early-onset, consistent with LS. In 19 patients with early-onset MPCs, loss of function (LoF) variants in RECQL5 were more prevalent in non-LS MPC than in matched sporadic cancer patients (OR = 31.6, 2.73–1700.6, p = 0.001). Additionally, there were high-confidence LoF variants at FANCG and CASP8 in two patients accompanied by somatic loss of heterozygosity in tumor, respectively. The results suggest that genetic screening should be considered for synchronous cancers and metachronous MPCs of the LS tumor spectrum, particularly in early-onset. Susceptibility variants in non-LS genes for MPC patients may exist, but evidence for their role is more elusive than for LS patients.

Molecular Pathways and Druggable Targets in Head and Neck Squamous Cell Carcinoma

Head and neck cancers are a heterogeneous group of neoplasms, affecting an ever increasing global population. Despite advances in diagnostic technology and surgical approaches to manage these conditions, survival rates have only marginally improved and this has occurred mainly in developed countries. Some improvements in survival, however, have been a result of new management and treatment approaches made possible because of our ever-increasing understanding of the molecular pathways triggered in head and neck oncogenesis, and the growing understanding of the abundant heterogeneity of this group of cancers. Some important pathways are common to other solid tumours, but their impact on reducing the burden of head and neck disease has been less than impressive. Other less known and little-explored pathways may hold the key to the development of potential druggable targets. The extensive work carried out over the last decade, mostly utilising next generation sequencing has opened up the development of many novel approaches to head and neck cancer treatment. This paper explores our current understanding of the molecular pathways of this group of tumours and outlines associated druggable targets which are deployed as therapeutic approaches in head and neck oncology with the ultimate aim of improving patient outcomes and controlling the personal and economic burden of head and neck cancer.

The Burden of Head and Neck Cancer in the United States, 1990 - 2017

PURPOSE

Head and neck cancers (HNC) are among the most common malignancies in the United States and are a significant cause of morbidity and mortality. Traditional risk factors for HNC include tobacco, alcohol, and Human Papilloma Virus (HPV) infection. Geographic location has also been shown to play a role, whether directly or indirectly. The purpose of this study was to describe the incidence, mortality and geographic variability of HNC within the United States between 1990 and 2017.

MATERIALS AND METHODS

The Global Burden of Diseases Study 2017, which models incidence and mortality, was used to obtain incidence and mortality data for "lip and oral cavity cancer", "nasopharynx cancer", "other pharynx cancer" (tonsil, oropharynx, and hypopharynx) and "larynx cancer" for the United States between 1990 and 2017.

RESULTS

The overall incidence rate of HNC increased (annual percent change (APC) = 0.23. 95% CI: 0.1-0.3) from 1990 through 2017 while overall mortality decreased (APC = -0.37. 95% CI: -0.4 to -0.3). The anatomic sub-site which saw the largest increase in incidence was "other pharynx" (APC=1.07. 95% CI: 0.9-1.2). In 2017, those in the West had the lowest incidence while those in the South had the highest (15.7 and 20.8 per 100,000 individuals, respectively).

CONCLUSIONS

The incidence of HNC in the United States increased between 1990 and 2017. This was driven by larger increases in those sites more prone to HPV-related HNC. While there exists geographic variability in the burden of this disease, additional studies are needed to further understand the impact of patient-specific factors.

Molecular landscape of head and neck cancer and implications for therapy

Head and neck squamous cell carcinomas (HNSCC) arising from the oral cavity, pharynx, and larynx constitute the 6^th most common human cancer. Human papillomavirus (HPV)-positive tumours are distinct from HPV-negative counterparts, with HPV status affording clear clinical utility, prognostic benefit and better treatment outcomes. In contrast to their HPV-positive counterparts, HPV-negative tumours are characterized by high mutational load and chromosomal aberrations, with varying copy number alteration (CNA) profiles. HNSCC are distinct tumours at the chromosomal, gene and expression levels, with additional insight gained from immune profiling. Based on mutational analyses, HNSCC are categorized as HPV-positive, HPV-negative CNA-silent, and HPV-negative CNA-high tumours. Furthermore, gene expression profiling segregates these tumours into atypical, classical, basal, and mesenchymal, with clear differences observed between tumours of the oral cavity, oropharynx, hypopharynx and larynx. Additional immune profiling further classifies tumours as either immune-active or immune-exhausted. The clinical utility and impact of these tumour molecular subtypes however remains to be determined. HNSCC harbor high levels of somatic mutations. They display loss at 3p and 18q and gain at 3q and 8q, with mutations in CDKN2A, TP53, CCND1, EGFR, PIK3CA, PTEN, NOTCH1, NSD1, FAT1, AJUBA and KMT2D. Important pathways include the p53 and RB pathways which are involved in cell cycle control and are frequently lost in HPV-negative tumours, the WNT-β-catenin pathway related to the mesenchymal subtype and smoking etiology, and the PI3K pathway which includes the most common genetic alteration in HPV-positive HNSCC. Understanding the mutational, genomic and transcriptomic landscape of HNSCC has leveraged better therapeutic approaches to manage this group of diseases, and it is hoped that additional insight into the molecular subtypes of HNSCC and its specific subsites will further drive improved strategies to stratify and treat patients with this debilitating disease.

A roadmap of six different pathways to improve survival in laryngeal cancer patients

PURPOSE OF REVIEW

Laryngeal cancer continues to require improvement in earlier stage diagnosis and better imaging delineation of disease, and hence 'more evidence-based' selection of treatment, as recent evidence suggests that related mortality, in the last decades, has not significantly decreased worldwide. Even though the reasons are not fully understood, there persists an urgency for a review and development of future strategies to embrace such clinical and diagnostic challenges from a political, societal, as well as scientific and clinical points of view.

RECENT FINDINGS

This review of the published literature suggests that survival improvement in laryngeal cancer may be achieved by fuelling and combining at least some or all of six targeted agendas: documentation of disease global incidence and national burden monitoring; development and implementation of high-quality cancer registries; education on risk factors and hazardous habits associated with laryngeal cancer for the general population; active modification of proven at-risk population lifestyles; centralization of treatment; and use of machine learning of gathered 'big data' and their integration into approaches for the optimization of prevention and treatments strategies.

SUMMARY

Laryngeal cancer should be tackled on several fronts, commencing with disease monitoring and prevention, up to treatment optimisation. Available modern resources offer the possibility to generate significant advances in laryngeal cancer management. However, each nation needs to develop a comprehensive approach, which is an essential prerequisite to obtain meaningful improvement on results.

Continuing education activities improve dentists' self-efficacy to manage oral mucosal lesions and oral cancer

OBJECTIVES

This cross-sectional study aims to evaluate whether Continuing Education Activities (CEA) influence dentists' behaviour in relation to oral lesions. The secondary aim is to assess the association between dentists' perception of learning adequacy and self-efficacy for oral mucosal lesion management.

METHODS

A self-administered online questionnaire was conducted on dentists working at the public health system of Rio Grande do Sul State, Brazil. The questionnaire included questions pertaining to perception of adequacy for oral diagnosis classes upon graduation, participation in oral cancer CEA and self-efficacy in managing oral mucosal lesions.

RESULTS

221 dentists from 91 municipalities answered the questionnaire. Most participants were female (71.5%) with a mean age of 38.3 years. Perception of learning as adequate during undergraduate coursework was associated with self-efficacy to diagnose, biopsy, and treat oral mucosal lesions (P < .05, Chi-squared test). However, 83.3% of dentists considered the time devoted to these topics prior to graduation insufficient. The frequency of oral lesion detection was related to self-efficacy to treat oral lesions and detecting oral cancer (P < .05, Chi-squared test). Among dentists who detected oral lesions frequently, 88.9% had attended CEA, whereas 11.1% of them had never attended these activities.

CONCLUSIONS

CEA may improve awareness and efficacy of primary healthcare professional's detection of oral cancer.

The temporal effects of topical NF-κB inhibition, in the in vivo prevention of bile-related oncogenic mRNA and miRNA phenotypes in murine hypopharyngeal mucosa: a preclinical model

Supraesophageal bile reflux at strongly acidic pH can cause hypopharyngeal squamous cell cancer, through activation of the oncogenic NF-κB-related pathway. We hypothesize that topical pre- or post-application of pharmacologic NF-κB inhibitor, BAY 11-7082 (0.25 μmol), on murine (C57BL/6J) HM (twice a day for 10 days) can effectively inhibit acidic bile (10 mmol/l; pH 3.0) induced oncogenic molecular events, similar to prior in vitro findings. We demonstrate that the administration of BAY 11-7082, either before or after acidic bile, eliminates NF-κB activation, prevents overexpression of Bcl2, Rela, Stat3, Egfr, Tnf, Wnt5a, and deregulations of miR-192, miR-504, linked to bile reflux-related hypopharyngeal cancer. Pre- but not post-application of NF-κB inhibitor, significantly blocks overexpression of Il6 and prostaglandin H synthases 2 (Ptgs2), and reverses miR-21, miR-155, miR-99a phenotypes, supporting its early bile-induced pro-inflammatory effect. We thus provide novel evidence that topical administration of a pharmacological NF-κB inhibitor, either before or after acidic bile exposure can successfully prevent its oncogenic mRNA and miRNA phenotypes in HM, supporting the observation that co-administration of NF-κB inhibitor may not be essential in preventing early bile-related oncogenic events and encouraging a capacity for further translational exploration.

Distinct Biomarker Profiles and Clinical Characteristics in T1-T2 Glottic and Supraglottic Carcinomas

Background

In early stage laryngeal squamous cell carcinoma (LSCC) radiotherapy with curative intent is a major treatment modality. TNM classification is used to define patients eligible for radiotherapy. Studies in early stage glottic LSCC identified several predictive biomarkers associated with local control. However, we recently reported that this predictive value could not be confirmed in supraglottic LSCC.

Objective

To examine whether clinical behavior and protein expression patterns of these biomarkers differ between glottic and supraglottic LSCC.

Study Design

Retrospective cohort study.

Methods

Tumor tissue sections of 196 glottic and 80 supraglottic T1‐T2 LSCC treated primarily with RT were assessed immunohistochemically for expression of pAKT, Ki‐67 and β‐Catenin. Expression data of HIF‐1α, CA‐IX, OPN, FADD, pFADD, Cyclin D1, Cortactin and EGFR in the same cohort of glottic and supraglottic LSCC, were retrieved from previously reported data. The relationship between glottic and supraglottic sublocalization and clinicopathological, follow‐up, and immunohistochemical staining characteristics were evaluated using logistic regression and Cox regression analyses.

Results

Glottic LSCC were correlated with male gender (P = .001), hoarseness as a primary symptom (P < .001), T1 tumor stage (P < .001), negative lymph node status (P < .001), and an older age at presentation (P = .004). Supraglottic LSCC patients developed more post‐treatment distant metastasis when adjusted for gender, age, and T‐status. While supraglottic LSCC was associated with higher expression of HIF‐1α (P = .001), Cortactin (P < .001), EGFR (P < .001), and Ki‐67 (P = .027), glottic LSCC demonstrated higher expression of CA‐IX (P = .005) and Cyclin D1 (P = .001).

Conclusion

Differences in clinicopathological and immunohistochemical staining characteristics suggest that T1‐T2 glottic and supraglottic LSCC should be considered as different entities.

Level of Evidence

N/A. Laryngoscope, 2020

Incidence and mortality of laryngeal cancer in China, 2015

Objective

Using data from cancer registries to estimate laryngeal cancer incidence and mortality in China, 2015.

Methods

Data submitted from 501 cancer registries were checked and evaluated according to the criteria of data quality control and 368 registries’ data were qualified for the final analysis. Data were stratified by area (urban/rural), sex, age group and combined with national population data to estimate laryngeal cancer incidence and mortality in China, 2015. China population census in 2000 and Segi’s population were used for age-standardized.

Results

The percentage of cases morphological verified (MV%) of laryngeal cancer was 74.18%. The percentage of death certificate-only cases (DCO%) was 2.10%. And the mortality to incidence (M/I) ratio was 0.55. About 25,300 new cases of laryngeal cancer were diagnosed in 2015 and 13,700 deaths were reported. The crude rate of laryngeal cancer was 1.84 per 100,000 (males and females were 3.20 and 0.42 per 100,000, respectively). Age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 1.18 and 1.19 per 100,000, respectively. The cumulative incidence rate (0−74 years old) was 0.15%. The crude mortality rate was 1.00 per 100,000. Age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 0.61 and 0.61 per 100,000, respectively, with the cumulative rate (0−74 years old) was 0.07%. Incidence and mortality of laryngeal cancer in males were higher than those in females. And the rates in urban areas were higher than those in rural areas.

Conclusions

The incidence and mortality of laryngeal cancer in China were low. And the rates were significantly higher in males than in females. Risk factor control and targeted prevention should be strengthened.

Biliary reflux as a causal factor in hypopharyngeal carcinoma: New clinical evidence and implications

BACKGROUND

Recent preclinical explorations strongly support the tumorigenic potential of bile on laryngopharyngeal mucosa. Herein, the authors describe, in bile-related human hypopharyngeal squamous cell carcinoma (HSCC), NF-κB-related messenger RNA (mRNA) and microRNA (miRNA) oncogenic phenotypes similar to those previously identified in acidic bile-exposed premalignant murine hypopharyngeal mucosa.

METHODS

In this pilot study, the authors included human HSCC specimens paired with their adjacent normal tissue (ANT) derived from 3 representative patients with documented biliary laryngopharyngeal reflux (bile[+]) compared with 5 control patients without signs of bile reflux disease (bile[-]). Immunohistochemical, quantitative polymerase chain reaction, and miRNA analyses were used to detect the levels of activated NF-κB and expression levels of STAT3, EGFR, BCL2, WNT5A, IL-6, IL-1B, ΔNp63, cREL, TNF-α, TP53, NOTCH1, NOTCH2, NOTCH3, miR-21, miR-155, miR-192, miR-34a, miR-375, miR-451a, miR-489, miR-504, and miR-99a.

RESULTS

Bile(+) HSCC demonstrated an intense NF-κB activation accompanied by significant overexpression of RELA(p65), EGFR, STAT3, BCL-2, cREL, ΔNp63, WNT5A, IL-6, and IL1B; upregulation of oncomir miR-21; and downregulation of tumor suppressor miR-375 compared with their respective ANTs. Bile(+) HSCC demonstrated significantly higher mRNA levels of all the analyzed genes, particularly RELA(p65), IL-6, EGFR, and TNF-α compared with bile(-) tumors. The miR-21/miR-375 ratio, which previously has been linked to tumor aggressiveness, was found to be >260-fold and >30-fold higher, respectively, in bile(+) HSCCs compared with their ANTs and bile(-) tumors.

CONCLUSIONS

Although limitations apply to this pilot study due to the small number of patients with HSCC, the novel findings suggest that a history of bile as a component of esophageal reflux disease may represent an independent risk factor for hypopharyngeal carcinogenesis.

Alcohol consumption, tobacco smoking, betel quid chewing and oral health associations with hypopharyngeal cancer among men in Central South China: a case-control study

Background

Hypopharyngeal cancer has relatively high incidence rates in China, especially in high-risk areas. However, data on the role of major risk factors in these areas of China are still limited.

Methods

We have evaluated the roles of alcohol, tobacco and betel quid consumption, and oral health, based on 278 hypopharyngeal cancer cases and 693 controls from two centers in Central South China. The odds ratio (OR) and 95% confidence interval (CI) values were estimated using logistic regression.

Results

We found that alcohol drinkers had a risk of hypopharyngeal cancer that was up to seven times higher than that for those who had never drunk. A very strong effect of traditional liquor as compared to other alcohol types was observed, with the OR reaching 11.26 (CI 6.53–19.41) for this cancer. Tobacco smokers were up to four times more likely to develop hypopharyngeal cancer than never smokers. The OR for betel quid chewing was 1.86 (CI 1.26–2.75) as compared to never users. Poor oral hygiene had a risk of hypopharyngeal cancer that was two times higher than that for normal oral hygiene.

Conclusion

In this study, we have shown for what is believed to be the first time the association of increased hypopharyngeal cancer incidence with alcohol, tobacco, betel quid and oral hygiene in China. Alcohol may play a larger role for hypopharyngeal cancer in this population than in populations in other areas.

Biliary tumorigenic effect on hypopharyngeal cells is significantly enhanced by pH reduction

Biliary reflux has been considered a potential risk factor in upper aerodigestive tract malignancies. It is not yet clearly known how pH affects the bile-induced activation of NF-κB and its related oncogenic pathway previously linked to hypopharyngeal carcinogenesis. In this study, repetitive applications of conjugated primary bile acids with unconjugated secondary bile acid, deoxycholic acid (DCA), on human hypopharyngeal primary cells reveal that strongly acidic pH (4.0) optimally enhances the tumorigenic effect of bile, by inducing activation of NF-κB, STAT3 nuclear translocation, bcl-2 overexpression and significant overexpression of the oncogenic mRNA phenotype, compared to weakly acidic pH (5.5) or neutral pH (7.0). As the pH becomes less acidic the partially activated primary bile acids and activated DCA begin to exert their influence; however, with significantly less intensity compared to bile acids at strongly acidic pH. Our findings suggest that biliary tumorigenic effect is strongly pH dependent. Controlling pH during reflux events may be therapeutically effective in reducing the potential risk of bile-induced hypopharyngeal cancer.

Pepsin promotes IL-8 signaling-induced epithelial-mesenchymal transition in laryngeal carcinoma

Background

Laryngopharyngeal reflux (LPR), with its increasing morbidity, is attracting considerable attention. In recent years, the causal role between LPR and laryngeal carcinoma has been debated. The main harmful component of LPR is pepsin, which has been shown to induce mucosal inflammation by damaging the mucous membrane. Thus, pepsin is linked to an increased risk of laryngeal carcinoma, although the potential mechanism remains largely unknown.

Methods

The human laryngeal carcinoma cell lines Hep-2 and Tu212 were exposed to different pepsin concentrations and the morphology, proliferation, migration, secretion of inflammatory cytokines, and epithelial–mesenchymal transition (EMT) of the cells were assessed. To evaluate whether interleukin-8 (IL-8) had a causal relationship with pepsin and EMT, an IL-8 inhibitor was used to suppress IL-8 secretion during pepsin exposure and the expression of EMT markers, cell proliferation, and migration were analyzed.

Results

Pepsin promoted proliferation, colony formation, migration, and IL-8 secretion of Hep-2 and Tu212 cells in vitro. Furthermore, increased pepsin concentrations changed the morphology of Hep-2 and Tu212 cells; levels of the epithelial marker E-cadherin were reduced and those of mesenchymal markers vimentin and β-catenin and the transcription factors snail and slug were elevated. A similar effect was observed in laryngeal carcinoma tissues using immunohistochemistry. IL-8 level was reduced and EMT was restored when pepsin was inhibited by pepstatin. EMT was weakened after exposure to the IL-8 inhibitor, with significant reduction in pepsin-induced cell proliferation and migration.

Conclusions

Pepsin may induce EMT in laryngeal carcinoma through the IL-8 signaling pathway, which indicates that it has potential role in enhancing cell proliferation and metastasis of laryngeal carcinoma.

Electronic supplementary material

The online version of this article (10.1186/s12935-019-0772-7) contains supplementary material, which is available to authorized users.

Prognostic role of resection margin in open oncologic laryngeal surgery: survival analysis of a cohort of 139 patients affected by squamous cell carcinoma

INTRODUCTION

The treatment of laryngeal squamous cell carcinoma needs accurate risk stratification, in order to choose the most suitable therapy. The prognostic significance of resection margin is still highly debated, considering the contradictory results obtained in several studies regarding the survival rate of patients with a positive resection margin.

OBJECTIVE

To evaluate the prognostic role of resection margin in terms of survival and risk of recurrence of primary tumour through survival analysis.

METHODS

Between 2007 and 2014, 139 patients affected by laryngeal squamous cell carcinoma underwent partial or total laryngectomy and were followed for mean of 59.44±28.65 months. Resection margin status and other variables such as sex, age, tumour grading, pT, pN, surgical technique adopted, and post-operative radio- and/or chemotherapy were investigated as prognostic factors.

RESULTS

45.32% of patients underwent total laryngectomy, while the remaining subjects in the cohort underwent partial laryngectomy. Resection margins in 73.39% of samples were free of disease, while in 21 patients (15.1%) anatomo-pathological evaluation found one of the margins to be close; in 16 subjects (11.51%) an involved resection margin was found. Only 6 patients (4.31%) had a recurrence, which occurred in 83.33% of these patients within the first year of follow-up. Disease specific survival was 99.24% after 1 year, 92.4% after 3 years, and 85.91% at 5 years. The multivariate analysis of all covariates showed an increased mortality rate only with regard to pN (HR=5.043; p=0.015) and recurrence (HR=11.586; p=0.012). Resection margin did not result an independent predictor (HR=0.757; p=0.653).

CONCLUSIONS

Our study did not recognize resection margin as an independent prognostic factor; most previously published papers lack unanimous, methodological choices, and the cohorts of patients analyzed are not easy to compare. To reach a unanimous agreement regarding the prognostic value of resection margins, it would be necessary to carry out meta-analyses on studies sharing definition of resection margin, methodology and post-operative therapeutic choices.

NF-κB inhibition reverses acidic bile-induced miR-21, miR-155, miR-192, miR-34a, miR-375 and miR-451a deregulations in human hypopharyngeal cells

We previously demonstrated that acidic bile activates NF-κB, deregulating the expression of oncogenic miRNA markers, in pre-malignant murine laryngopharyngeal mucosa. Here, we hypothesize that the in vitro exposure of human hypopharyngeal cells to acidic bile deregulates cancer-related miRNA markers that can be reversed by BAY 11-7082, a pharmacologic NF-κB inhibitor. We repetitively exposed normal human hypopharyngeal primary cells and human hypopharyngeal keratinocytes to bile fluid (400 μmol/L), at pH 4.0 and 7.0, with/without BAY 11-7082 (20 μmol/L). We centred our study on the transcriptional activation of oncogenic miR-21, miR-155, miR-192, miR-34a, miR-375, miR-451a and NF-κB-related genes, previously linked to acidic bile-induced pre-neoplastic events. Our novel findings in vitro are consistent with our hypothesis demonstrating that BAY 11-7082 significantly reverses the acidic bile-induced oncogenic miRNA phenotype, in normal hypopharyngeal cells. BAY 11-7082 strongly inhibits the acidic bile-induced up-regulation of miR-192 and down-regulation of miR-451a and significantly decreases the miR-21/375 ratios, previously related to poor prognosis in hypopharyngeal cancer. This is the first in vitro report that NF-κB inhibition reverses acidic bile-induced miR-21, miR-155, miR-192, miR-34a, miR-375 and miR-451a deregulations in normal human hypopharyngeal cells, suggesting that acidic bile-induced events are directly or indirectly dependent on NF-κB signalling.

Inhibition of NF-κB prevents the acidic bile-induced oncogenic mRNA phenotype, in human hypopharyngeal cells

Bile-containing gastro-duodenal reflux has been clinically considered an independent risk factor in hypopharyngeal carcinogenesis. We recently showed that the chronic effect of acidic bile, at pH 4.0, selectively induces NF-κB activation and accelerates the transcriptional levels of genes, linked to head and neck cancer, in normal hypopharyngeal epithelial cells. Here, we hypothesize that NF-κB inhibition is capable of preventing the acidic bile-induced and cancer-related mRNA phenotype, in treated normal human hypopharyngeal cells. In this setting we used BAY 11-7082, a specific and well documented pharmacologic inhibitor of NF-κB, and we observed that BAY 11-7082 effectively inhibits the acidic bile-induced gene expression profiling of the NF-κB signaling pathway (down-regulation of 72 out of 84 analyzed genes). NF-κB inhibition significantly prevents the acidic bile-induced transcriptional activation of NF-κB transcriptional factors, RELA (p65) and c-REL, as well as genes related to and commonly found in established HNSCC cell lines. These include anti-apoptotic bcl-2, oncogenic STAT3, EGFR, ∆Np63, TNF-α and WNT5A, as well as cytokines IL-1β and IL-6. Our findings are consistent with our hypothesis demonstrating that NF-κB inhibition effectively prevents the acidic bile-induced cancer-related mRNA phenotype in normal human hypopharyngeal epithelial cells supporting an understanding that NF-κB may be a critical link between acidic bile and early preneoplastic events in this setting.

MicroRNA differential expression spectrum and microRNA-125a-5p inhibition of laryngeal cancer cell proliferation

The present study aimed to screen and analyze the differential expression spectrum of microRNA (miRNA) between laryngeal cancer tissue and surrounding normal laryngeal mucosa in order to provide an indication for further study to determine the role of miRNA in the initiation and development of laryngeal cancer. A total of 42 pairs of specimens of laryngeal carcinoma tissues and adjacent normal laryngeal mucosa were collected. A total of 10 pairs of specimens were randomly selected for miRNA microarray gene chip analysis, and the remaining 32 pairs of specimens were used for reverse transcription-quantitative polymerase chain reaction (RT-qPCR) verification to identify miRNA that were differentially expressed in laryngeal cancer tissues. Methylthiazolyldiphenyl-tetrazolium bromide and clone formation assays were utilized to elucidate the physiological relevance of the miRNA miR-125a-5p on the proliferation of laryngeal cancer human epithelial type 2 (Hep2) cells. Results demonstrated that the expression levels of six miRNA were significantly downregulated in laryngeal carcinoma tissue, as identified by gene chip analysis and RT-qPCR (P<0.05). The six miRNA included let-7f-5p, miR-10a-5p, miR-125a-5p, miR-144-3p, miR-195-5p and miR-203. Compared with the control group, the proliferative ability of laryngeal cancer Hep2 cells was inhibited in a transfected miR-125a-mimics group. In contrast, proliferation was promoted in a transfected miR-125a-inhibitor group. In conclusion, the results of gene chip analysis were consistent with that of RT-qPCR. Results demonstrated that miRNA in laryngeal cancer and normal laryngeal mucosa exhibited evident differential expression, which may contribute to the laryngeal cancer incidence and invasion. miR-125a was able to inhibit the proliferation of Hep2 laryngeal cancer cells and, therefore, may serve as a novel target for laryngeal cancer biological therapy.

Circulating calprotectin as a biomarker of laryngeal carcinoma

Calprotectin is an S100 protein and marker of inflammation found in neutrophils and monocytes; S100 proteins are a family of calcium-modulated proteins. The aim of this study was to determine if the serum concentration of calprotectin is higher in patients with laryngeal carcinoma than in patients with benign laryngeal pathologies and controls. The study included 107 participants. The serum calprotectin concentration was analyzed using the calprotectin ELISA (enzyme-linked immunosorbent assay) kit (Calpo AS, Norway). EDTA-serum for analysis was collected prior to surgery from patients with laryngeal carcinoma (n = 41), those with a benign laryngeal pathology (Reinke's edema, vocal nodules, etc.) (n = 32), and healthy controls (n = 34). The median serum calprotectin concentration was significantly higher in the laryngeal carcinoma group (2179.6 μg L^-1) than in the benign laryngeal pathology group (727.84 μg L^-1) and control group (733.73 μg L^-1) (P < 0.05). The median serum calprotectin concentration in patients with advanced-stage laryngeal cancer (5854.,4 μg L^-1) was significantly higher than in those with early-stage laryngeal cancer (971.84 μg L^-1) (P < 0.05); however, there was not a significant difference in the median calprotectin concentration between the control and benign laryngeal pathology groups (P > 0.05). Furthermore, the median serum calprotectin concentration in the patients with early-stage laryngeal cancer (n = 21) (971.84 μg L^-1) was significantly higher than that in the benign laryngeal pathology and control groups (n = 64) (730.6 μg L^-1) (P < 0.05). The serum calprotectin concentration was strongly correlated with poor survival and advanced-stage laryngeal carcinoma. Malignant laryngeal cancer patients (n = 4) that died during follow-up had a higher median serum calprotectin concentration (9468.4 μg L^-1) than those that remained alive (n = 37) (857.78 μg L^-1) (P < 0.05). The serum calprotectin concentration is higher in patients with laryngeal carcinoma than in those with benign laryngeal pathologies and healthy controls. The present findings show that the serum calprotectin concentration might be used as a marker to discriminate between laryngeal carcinoma and benign laryngeal pathologies. Additional research is needed to further assess the value of this parameter as a useful tumor marker for the diagnosis, treatment, and follow-up of laryngeal carcinoma.

Expression of polysialic acid in primary laryngeal squamous cell carcinoma

AIMS

Expression of polySia is associated with metastatic dissemination and progression of various malignant diseases. In particular, it may contribute to tumorigenesis by a negative modulatory effect on cellular signaling cascades responsible for cellular migration, differentiation and proliferation. In this study, we investigated the expression of polySia in primary metastatic and non-metastatic laryngeal squamous cell carcinoma (LSCC) tumor tissues and its potential impact on the LSCC progression.

MAIN METHODS

The expression of polySia in metastatic and non-metastatic primary laryngeal squamous cell carcinoma (LSCC) tumor biopsy specimens was investigated by immunohistochemistry, while the expression of polysialyltransferase IV (ST8SiaIV)(), fibroblast growth factor receptor 1 (FGFR1), extracellular signal regulated kinases 1 and 2 (Erk 1/2) and c-Raf was tested in metastatic and non-metastatic primary tumor tissues (including the corresponding non-tumor control tissues) by Western blot analysis.

KEY FINDINGS

The expression of polySia was detected in LSCC biopsies specimens with generally stronger immunoreactivity in non-metastatic tumor LSCC sections and in histologically undifferentiated tumors. Also, increased polySia expression was observed in adjacent histologically unaltered laryngeal tumor-associated tissue of the metastatic sections. In addition, we provide an evidence of increased polysialyltransferase IV (ST8SiaIV) expression, involved in polySia synthesis in both metastatic and non-metastatic primary tumors which is accompanied by decreased levels of FGFR1, Erk 1/2 and c-Raf.

SIGNIFICANCE

We present for the first time the evidence for the polySia expression in LSCC biopsies specimens which suggests its potential impact on initial steps of LSCC malignant transformation.

The In Vitro Effect of Acidic-Pepsin on Nuclear Factor KappaB Activation and Its Related Oncogenic Effect on Normal Human Hypopharyngeal Cells

Background

Extra-esophageal carcinogenesis has been widely discussed in relation to the chronic effects of laryngopharyngeal reflux and most prominently with pepsin historically central to this discussion. With refluxate known to include gastric (pepsin) and duodenal (bile) fluids, we recently demonstrated the mechanistic role of NF-κB in mediating the preneoplastic effects of acidic-bile. However, the role of pepsin in promoting hypopharyngeal premalignant events remains historically unclear. Here, we investigate the in vitro effect of acidic-pepsin on the NF-κB oncogenic pathway to better define its potential role in hypopharyngeal neoplasia.

Methods

Human hypopharyngeal primary cells (HHPC) and keratinocytes (HHK) were repetitively exposed to physiologic pepsin concentrations (0.1 mg/ml) at pH 4.0, 5.0 and 7.0. Cellular localization of phospho-NF-κB and bcl-2 was determined using immunofluorescence and western blotting. NF-κB transcriptional activity was tested by luc reporter and qPCR. Analysis of DNA content of pepsin treated HHK and HHPC was performed using Fluorescence-activated-cell sorting assay. To explore a possible dose related effect, pepsin concentration was reduced from 0.1 to 0.05 and 0.01 mg/ml.

Results

At physiologic concentration, acidic-pepsin (0.1 mg/ml at pH 4.0) is lethal to most normal hypopharyngeal cells. However, in surviving cells, no NF-κB transcriptional activity is noted. Acidic-pepsin fails to activate the NF-κB or bcl-2, TNF-α, EGFR, STAT3, and wnt5α but increases the Tp53 mRNAs, in both HHPC and HHK. Weakly acidic-pepsin (pH 5.0) and neutral-pepsin (pH 7.0) induce mild activation of NF-κB with increase in TNF-α mRNAs, without oncogenic transcriptional activity. Lower concentrations of pepsin at varying pH do not produce NF-κB activity or transcriptional activation of the analyzed genes.

Conclusion

Our findings in vitro do not support the role of acidic-pepsin in NF-κB related hypopharyngeal carcinogenesis.

Characteristics of cigarette smoking without alcohol consumption and laryngeal cancer: overall and time-risk relation. A meta-analysis of observational studies

Tobacco smoking was one of the risk factors for upper aerodigestive tract cancer, but exclusive quantification of the impact of cigarette smoking on laryngeal cancer had not been investigated. A meta-analysis of researches that had reported quantitative estimates of cigarette smoking and risk of laryngeal cancer by March 2016 was performed. Pooled estimates of relative risks and their 95% confidence intervals were obtained and summarized. Sensitivity analysis and subgroup analysis were implemented to find out sources of research heterogeneity and the effect of potential confounders. Publication bias was investigated and corrected if found to be present through Egger's and Begg's test, and trim and fill algorithm. Thirty researches based on a total of 14,292 cases from three cohort and fifteen case-control studies were included and pooled estimate for the correlation between cigarette smoking and the risk of laryngeal cancer was 7.01 (95% confidence interval 5.56-8.85), with moderate heterogeneity across the researches (I ² = 56.7%, p = 0.002). The RRs were 5.04 (95% CI 3.09-8.22) for cohort studies (p = 0.121), 7.59 (95% CI 5.86-9.82) for case-control studies (p = 0.005). The risk kept elevated within the first fifteen years of quitting smoking(RR 3.62, 95% CI 1.88-7.00) but dropped in the 16 years and more after smoking cessation(RR 1.88, 95% CI 1.16-3.05). Individuals who smoked with 40 or more pack-years had nine times the risk of laryngeal cancer(RR 9.14; 95% CI 6.24-13.39). Subjects who smoked 30 or more cigarettes a day had sevenfolds the risk of laryngeal cancer (RR 7.02; 95% CI 4.47-11.02) and who smoked 40 or more years had five times the risk versus never smokers (RR 5.76; 95% CI 3.69-8.99). Evidence of publication bias was not detected for the correlation between current cigarette smoking and risk of laryngeal cancer (p = 0.225 with Begg's test, p = 0.317 with Egger's test). The results demonstrated strong correlation referring to dose-response and time-response between cigarette smoking and risk of laryngeal cancer for both men and women. The probability of developing laryngeal cancer was decreased by quitting smoking, particularly among former cigarette smokers who had stopped smoking for 15 or more years. The subgroup analysis demonstrated that study type influenced the RRs estimates of the studies.

Site-specific treatment outcome in smokers following 12 months of supportive periodontal therapy

Aim

To evaluate the effect of cigarette smoking on periodontal health at patient, tooth, and site levels following supportive therapy.

Materials and Methods

Eighty chronic periodontitis patients, 40 smokers and 40 non‐smokers, were recruited to a single‐arm clinical trial. Periodontal examinations were performed at baseline (T0), 3 months following active periodontal therapy (T1), and 12 months following supportive periodontal therapy (T2). Smoking status was validated measuring serum cotinine levels. Probing depth (PD) ≥ 5 mm with bleeding on probing (BoP) was defined as the primary outcome. Logistic regression analyses adjusted for clustered observations of patients, teeth, and sites and mixed effects models were employed to analyse the data.

Results

All clinical parameters improved from T0 to T2 (p < 0.001), whereas PD, bleeding index (BI), and plaque index (PI) increased from T1 to T2 in smokers and non‐smokers (p < 0.001). An overall negative effect of smoking was revealed at T2 (OR = 2.78, CI: 1.49, 5.18, p < 0.001), with the most pronounced effect at maxillary single‐rooted teeth (OR = 5.08, CI: 2.01, 12.78, p < 0.001). At the patient level, less variation in treatment outcome was detected within smokers (ICC = 0.137) compared with non‐smokers (ICC = 0.051).

Conclusion

Smoking has a negative effect on periodontal health following 12 months of supportive therapy, in particular at maxillary single‐rooted teeth.

Expression of Th1- Th2- and Th17-associated cytokines in laryngeal carcinoma

T-helper (Th) 0 cell differentiation into Th1 or Th2 cells is dependent on a number of transcription factors that act at specific time points to regulate gene expression. Th17 cells, a subset of interleukin (IL)-17-producing T cells distinct from Th1 or Th2 cells, are considered to exhibit a critical function in inflammation and autoimmune diseases, as well as cancer development. In the present study, the expression of Th1-, Th2- and Th17-associated cytokines in laryngeal cancer and pericarcinoma tissues obtained from 57 laryngeal carcinoma patients was investigated. The association between Th1, Th2 and Th17 infiltration and tumor development was also evaluated. Reverse transcription-polymerase chain reaction and western blotting results revealed that the mRNA and protein expression of Th2 cytokines was lower, while the expression of Th1 and Th17 cytokines was higher in tumor tissues than in pericarcinoma tissues. Furthermore, the early stage cancer patients exhibited a higher level of interferon-γ, IL-2 and IL-17 mRNA expression than those at advanced stages. Cancer tissues exhibited higher Th17 cytokine expression than pericarcinoma tissues. By contrast, Th1 cytokine expression was increased in pericarcinoma tissues compared with cancer tissues. These results indicate that high expression of Th1- and Th17-associated cytokines in laryngeal carcinoma may contribute to suppression of cancer development and a relatively good prognosis.

Incidence of and survival after glottic squamous cell carcinoma in Denmark from 1971 to 2011-A report from the Danish Head and Neck Cancer Group

AIM

To describe the incidence, disease-specific mortality (DSM), and overall survival (OS) of patients with glottic squamous cell carcinomas (SCC) in Denmark from 1971-2011 in a national population-based cohort of consecutive patients.

MATERIALS AND METHODS

All patients diagnosed with glottic SCC stage I-IV between 1971 and 2011 in Denmark were included. Patients were identified from the Danish Head and Neck Cancer database, which has a coverage of approximately 100% of registered glottic cancer in Denmark. Information on vital status and cause of death were updated using patient charts and national registries.

RESULTS

In total 5132 patients with glottic SCC were included. The yearly number of new cases increased from 107 in the 1970s to 139 in the 2000s. Overall, the incidence increased from 1.9 to 2.6 per 100,000, with a more prominent increase in men (3.5 to 4.7) compared with women (0.4 to 0.6). The 5-year DSM was 16% (15-17%) and the 5-year OS was 63% (61-64). The hazard rate of DSM adjusted for patient characteristics, tumour characteristics and waiting-time was significantly lower in the 2000s (p < 0.01), and the hazard rate of OS was significantly higher (p < 0.01) compared to the earlier decades. Longer waiting-time for treatment (>25 d) significantly increased DSM and reduced OS.

CONCLUSION

Despite being highly avoidable with smoking cessation, the incidence of glottic SCC increased in Denmark from 1971-2011. The adjusted hazard rate of DSM and overall death after glottic SCC was significantly lower in the 2000s compared to previous decades. Waiting-time for treatment significantly influenced DSM and OS.

HPV vaccination in boys and men

Human papillomaviruses are DNA viruses that infect skin or mucosal cells. In the genital tract HPV (especially types 6 and 11) cause genital warts, the commonest viral sexually transmitted disease. At least 13 of the more than 100 known HPV genotypes are oncogenic "high-risk" genotypes. The 2 most common of these (genotypes 16 and 18) cause approximately 70% of all cervical cancers. Oncogenic HPVs particularly HPV 16 are associated with other anogenital cancers, anus, vagina, vulva and penis, and cancers of the head and neck and current estimates are that 5.2% of all cancers are HPV associated. In industrialised countries cervical cancer is controlled by secondary intervention other HPV associated malignancies are increasing in incidence and the burden of HPV associated disease in men is now comparable to that in women in economically developed countries. Randomized control trials with the quadrivalent HPV VLP vaccine demonstrate robust antibody responses and high efficacy against genital warts anal precancers in men. Few countries have recommended male vaccination on the basis that this is not cost effective. However gender-neutral vaccination has been recommended in the USA, Canada, Austria, and Australia. Careful cost effective modeling has preceded these decisions showing that when the burden of disease in men is included in the models then, depending upon coverage, vaccine price, and other factors male vaccination can become cost effective.

A Population-Based Cross-Sectional Study of Alcohol Consumption and Risk of Benign Laryngeal Disease in Korean Adults

OBJECTIVE

Studies on alcohol consumption and benign laryngeal disease (BLD) in the general population are rare. The aim of this study was to investigate the relationship between alcohol consumption and BLD in the Korean general population.

STUDY DESIGN

This was a cross-sectional study of a national health survey.

MATERIALS AND METHODS

Subjects were 3141 noninstitutionalized civilian adults older than 19 years (1313 men and 1828 women) who completed the laryngeal examination of the Korea National Health and Nutrition Examination Survey of 2008. Frequency of drinking was classified into less than once per week, two to three times per week, and more than four times per week. Binge drinking was defined as five or more drinks (≥61 g of alcohol) per episode for men and as four or more drinks (≥41 g of alcohol) per episode for women. Poisson regression analyses were conducted to examine the relationship between alcohol drinking and BLD.

RESULTS

Adjusting for covariates (age, sex, income, level of education, occupation, and cigarette smoking), it was found that those who drank more than four times a week, compared with those who drank less than once per week, were more likely to have BLD (risk ratio = 2.15, 95% confidence interval: 1.01-4.59, P < 0.05). However, the amount of alcohol consumed was not associated with BLD.

CONCLUSIONS

Frequent drinking (ie, more than four times a week) was found to be a risk factor for BLD.

HPV vaccination: acceptance and influencing factors among young men in Germany

AIMS

This study aims to determine the factors that influence the acceptance of the HPV vaccination among German males.

PATIENT & METHODS

In 2014, we conducted a population-based cross-sectional study in men aged 15-25 years. A questionnaire was mailed to male trainees of the Bayerische Motorenwerke AG (BMW) insured at the BMW health insurance company.

RESULTS

The response rate was 10.8%. Of the 378 included men, 74.1% would agree to receive HPV vaccination. Most men primarily consult their physician for health-related topics, but 92.9% had never been informed about HPV infection, risk factors and prevention methods by their doctor.

CONCLUSION

Our results demonstrate a high acceptance of male HPV vaccination. Education about HPV infection is low and should be intensified by medical professionals.

Correlation between levels of expression of minichromosome maintenance proteins, Ki-67 proliferation antigen and metallothionein I/II in laryngeal squamous cell cancer

MCM2, MCM3 and MCM7 are minichromosome maintenance proteins found in dividing cells and they play a role in DNA synthesis. Increased MCM expression level is observed in cells of different cancer types. Additionally, metallothioneins (MT-I/II) are involved in control of cell proliferation and differentiation and changes of their expression are observed in many types of cancer. Ki-67 is known cancer cell proliferation antigen currently used in prognostic evaluation. The study material consisted of 83 laryngeal squamous cell cancer (LSCC) cases and 10 benign hypertrophic lesions of larynx epithelium as a control group. For the present study, laryngeal cancer cell line HEp-2 and human keratinocytes were employed, and to evaluate expression of all the markers, immunohistochemical method (IHC), immunofluorescence (IF) and western blot analysis were used. Statistical analysis showed strong positive correlation between expression of MCM2, MCM3, MCM7 and Ki-67 antigen in LSCC. Additionally, moderate positive correlation was observed between MCM3 and MT-I/II expression. In cancer cells, the level of expression of MCM3, MCM2, MCM7 and Ki-67 markers was increasing with the grade of LSCC malignancy. IF and western blot analysis showed higher MCM2, MCM3, MCM7 expression in HEp-2 cells in comparison to their expression in keratinocytes. MCM proteins might be useful markers of cell proliferation in LSCC.

CYP1A1 rs1048943 and rs4646903 polymorphisms associated with laryngeal cancer susceptibility among Asian populations: a meta-analysis

Many studies have investigated the association between CYP1A1 rs1048943 and rs4646903 polymorphisms and laryngeal cancer risk, but their results have been inconsistent. The PubMed and CNKI were searched for case–control studies published up to 01 July 2015. Data were extracted and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated. In this meta‐analysis, we assessed 10 published studies involving comprising 748 laryngeal cancer cases and 1558 controls of the association between CYP1A1 rs1048943 and rs4646903 polymorphisms and laryngeal cancer risk. For CYP1A1 rs1048943 of the homozygote G/G and G allele carriers (A/G + G/G) versus A/A, the pooled ORs were 1.77 (95% CI = 1.28–2.81, P = 0.007 for heterogeneity) and 1.86 (95% CI = 1.45–2.40, P = 0.000 for heterogeneity). For CYP1A1 rs4646903 of the homozygote G/G and G allele carriers (A/G + G/G) versus A/A, the pooled ORs were 1.53 (95% CI = 1.31–2.21, P = 0.012 for heterogeneity) and 1.33(95% CI = 1.04–1.71, P = 0.029 for heterogeneity). In the stratified analysis by ethnicity, the significantly risks were found among Asians for both the G allele carriers and homozygote G/G. However, no significant associations were found in Caucasian population all genetic models. These results from the meta‐analysis suggest that CYP1A1 rs1048943 and rs4646903 polymorphisms contribute to risk of laryngeal cancer among Asian populations.

Evaluation of the Dysphonic Patient (in: Function Preservation in Laryngeal Cancer)

The evaluation of the dysphonic patient begins with a complete understanding of the laryngeal anatomy and physiology of voice production. A thorough history must be taken regarding the dysphonia qualities, alarming symptoms, and confounding factors. The complete head and neck examination culminates in a detailed visualization of the vocal folds using image-capturing laryngoscopy as well as stroboscopy or high-speed digital imaging to fully evaluate the viscoelastic properties of the vocal fold cover-body structure and function. Finally, the evaluation leads to the biopsy of any concerning lesions either under magnification in the operating room or topical anesthesia in the office.

Gene expression analysis of laryngeal squamous cell carcinoma

Laryngeal squamous cell carcinoma (LSCC) is one of the most common malignancies of the head and neck tumors Zhang et al., 2013 [1]). Previous studies have associated its occurrence with social activities, such as tobacco and alcohol consumption (Hashibe et al., 2007a [2]; Hashibe et al., 2007b [3]; Shangina et al., 2006 [4]). Here, we performed a genome-wide gene expression profiling in thirty-one patients positively diagnosed for LSCC, in order to investigate new targets involved in tumorigenesis.

MiR-221 as a pre- and postoperative plasma biomarker for larynx cancer patients

OBJECTIVE

In order to identify a plasma microRNA (miRNA) signature of larynx cancer (LCa), we examined miRNAs profile of plasma samples obtained from 30 LCa patients (preoperative and postoperative serum samples) and 30 healthy controls.

STUDY DESIGN

Basic science research study.

METHODS

MicroRNA profiling of eight plasma samples (four from preoperative, four from control individuals) were performed using miRNA microarray. Two of the significantly deregulated miRNAs were selected for further confirmation in the remaining samples using quantitative reverse-transcription polymerase chain reaction (qRT-PCR).

RESULTS

Microarray profiling and qRT-PCR analysis showed that miR-221 was upregulated in LCa plasma samples. Further qRT-PCR analysis demonstrated that miR-221 was at normal levels in postoperative plasma samples.

CONCLUSIONS

Plasma miR-221 may have a potential as a novel diagnostic/prognostic marker and might be considered as a therapeutic target in LCa.

LEVEL OF EVIDENCE

N/A.

Epidemiology of head and neck cancer

This article discusses risk factors, incidence trends, and prognostic considerations for head and neck cancer (HNC). The primary causes of HNC are tobacco and alcohol use, and human papillomavirus (HPV). Tobacco-related HNC incidence rates are decreasing in countries where tobacco use has declined. HPV-HNC, which occurs primarily in the oropharynx and is associated with sexual behaviors, has been increasing over the past several decades, among white men in particular. The prognosis for HNC overall has improved slightly since the 1990s, and is influenced by site, stage, and HPV status. Prognosis for HPV-HNC is significantly better than for HPV-negative disease.

Higher levels of total pepsin and bile acids in the saliva as a possible risk factor for early laryngeal cancer

Background

Gastroesophageal reflux is suspected to be an etiological factor in laryngeal and pharyngeal cancer. The aim of this study was to establish, using a non-invasive method, whether laryngopharyngeal reflux (LPR) appears more often in patients with early laryngeal cancer than in a control group.

Patients and methods

We compared the pH, the level of bile acids, the total pepsin and the pepsin enzymatic activity in saliva in a group of 30 patients with T1 laryngeal carcinoma and a group of 34 healthy volunteers.

Results

The groups differed significantly in terms of levels of total pepsin and bile acids in the saliva sample. Higher levels of total pepsin and bile acids were detected in the group of cancer patients. No significant impact of other known factors influencing laryngeal mucosa (e.g. smoking, alcohol consumption, and the presence of irritating substances in the workplace) on the results of saliva analysis was found.

Conclusions

A higher level of typical components of LPR in the saliva of patients with early laryngeal cancer than in the controls suggests the possibility that LPR, especially biliary reflux, has a role in the development of laryngeal carcinoma.

Genetic association between p73 G4C14-A4T14 polymorphism and risk of squamous cell carcinoma

This study is to evaluate the association between p73 G4C14-A4T14 polymorphism and squamous cell carcinoma (SCC) risk in diverse populations. We searched the PubMed, Embase, China National Knowledge Infrastructure, and Chinese Biomedicine databases for all articles on the association between p73 G4C14-A4T14 polymorphism and SCC risk through March 2014. We performed a comprehensive meta-analysis of six case-control studies that included 1,758 SCC cases and 2,970 case-free controls. All analyses were performed using STATA 11.0, using two-sided P values. Overall, this meta-analysis showed that the p73 G4C14-A4T14 polymorphism was associated with a significantly increased risk of SCC in three genetic models. However, after excluding one study deviating from Hardy-Weinberg equilibrium, the results then demonstrated that the p73 G4C14-A4T14 polymorphism was only associated with elevated risk of cervical squamous cell carcinoma (for AT/GC vs GC/GC: OR 1.51, 95 % CI 1.14-2.00, P heterogeneity = 0.996; for AT/AT+AT/GC vs GC/GC: OR 1.42, 95 % CI 1.08-1.87, P heterogeneity = 0.994) in subgroup analysis by tumor sites. No publication bias was found in the present study. This meta-analysis suggests that the p73 G4C14-A4T14 polymorphism is associated with an increased risk of cervical squamous cell carcinoma. Further large and well-designed studies are needed to confirm this association.