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Haldeman PB, Ghani MA, Rubio P, Pineda M, Califano J, Sacco AG, Minocha J, Berman ZT. Interdisciplinary Approach to Expedited Outpatient Gastrostomy Tube Placement in Head and Neck Cancer Patients: A Single Center Retrospective Study. Acad Radiol 2024:S1076-6332(24)00149-1. [PMID: 38521613 DOI: 10.1016/j.acra.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/18/2024] [Accepted: 03/04/2024] [Indexed: 03/25/2024]
Abstract
RATIONALE AND OBJECTIVE Treatment for head and neck cancer (HNC) can lead to decreased oral intake which often requires gastrostomy tube (g-tube) placement to provide nutritional support. A multidisciplinary team (MDT) consisting of interventional radiology (IR), HNC oncology and surgery, nutrition, and speech language pathology departments implemented an expedited outpatient g-tube placement pathway to reduce hospital stays and associated costs, initiate feeds sooner, and improve communication between care teams. This single center study investigates differences in complications, time to procedure and costs savings with implementing this pathway. METHODS 142 patients with HNC who underwent elective image guided g-tube placement by IR from 2015 to 2022 were identified retrospectively. 52 patients underwent the traditional pathway, and 90 patients underwent the expedited pathway. Patient demographics, procedure characteristics, periprocedural costs and 90-day complication rates were collected and compared statistically. RESULTS The 90-day complication rate was comparable between groups (traditional=32.7%; expedited=22.2%; p-value=0.17). The expedited pathway decreased the time from consult to procedure by 11.1 days (95% CI 7.6 - 14.6; p < 0.001) and decreased charge per procedure by $2940 (95% CI $989-$4891; p < 0.001). CONCLUSION A MDT for the treatment of patients with HNC successfully provided enteral nutrition support faster, with fewer associated costs, and in a more patient centered approach than previously done at this institution.
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Affiliation(s)
- Pearce B Haldeman
- Department of Interventional Radiology, UC San Diego, La Jolla, California, USA
| | - Mansur A Ghani
- Department of Interventional Radiology, UC San Diego, La Jolla, California, USA
| | - Patricia Rubio
- Moores Cancer Center, UC San Diego, La Jolla, California, USA
| | - Minette Pineda
- Department of Interventional Radiology, UC San Diego, La Jolla, California, USA
| | - Joseph Califano
- Moores Cancer Center, UC San Diego, La Jolla, California, USA; Department of Otolaryngology, UC San Diego, La Jolla, California, USA
| | | | - Jeet Minocha
- Department of Interventional Radiology, UC San Diego, La Jolla, California, USA; Moores Cancer Center, UC San Diego, La Jolla, California, USA
| | - Zachary T Berman
- Department of Interventional Radiology, UC San Diego, La Jolla, California, USA; Moores Cancer Center, UC San Diego, La Jolla, California, USA.
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Voora RS, Stramiello J, Funk E, Califano J. Transoral Excision of a Large Accessory Parotid Gland Tumor. Ear Nose Throat J 2024; 103:156-158. [PMID: 34510932 DOI: 10.1177/01455613211036237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Accessory parotid gland (APG) tumors account for 1% to 7% of all parotid gland neoplasms but are more likely to be malignant than main parotid gland tumors. Management of APG neoplasms entails surgical excision. Four primary approaches to resection have been described in the literature with varying facial nerve outcomes. We report a case of a 4-cm APG pleomorphic adenoma utilizing a transoral approach for excision without postoperative facial nerve injury. A transoral approach is known to mitigate patients' cosmetic concerns; however, prior reports utilized endoscopic assistance on patients with smaller tumors. We conclude that large APG tumors can be excised through a transoral approach without undue risk to the distal facial nerves, though this transoral approach ultimately may not be appropriate for malignant neoplasms or difficult dissections.
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Affiliation(s)
- Rohith S Voora
- University of California, San Diego School of Medicine, La Jolla, CA, USA
- Division of Head and Neck Surgery, Department of Surgery, San Diego, CA, USA
| | - Joshua Stramiello
- Division of Head and Neck Surgery, Department of Surgery, San Diego, CA, USA
| | - Emily Funk
- Division of Head and Neck Surgery, Department of Surgery, San Diego, CA, USA
| | - Joseph Califano
- Division of Head and Neck Surgery, Department of Surgery, San Diego, CA, USA
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Yousef A, Lauthen D, Ramsey C, Zhang X, Athas J, Jenusaitis M, Califano J. Trainees Associated with Improved Wait Times and Patient Satisfaction in a Multidisciplinary Clinic. Laryngoscope 2024; 134:178-184. [PMID: 37314126 DOI: 10.1002/lary.30821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/21/2023] [Accepted: 05/25/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine variables associated with longer wait times and decreased patient satisfaction. To determine the association of trainees with clinic wait times and patient satisfaction scores in an academic center. STUDY DESIGN Cross-sectional study. METHODS We recruited 266 study participants from an interdisciplinary Head and Neck Cancer outpatient clinic setting. Trained observers recorded observations related to wait times, time with individual health care practitioners, and total time spent in clinic. An 11-question survey was given to patients at the end of their visit assessing each patient's satisfaction with their visit, subjective wait time, and their likelihood to recommend the health care provider. RESULTS Increased objective wait times were associated with new patients (p = 0.006) and based on the physician they saw (p < 0.001). Patients who saw a trainee spent less time waiting to see a physician (p = 0.023), more total time with a physician (p = 0.001), and reported higher wait time satisfaction scores (p = 0.001). There was no difference in total visit time if patients saw a trainee (p = 0.42). Patient satisfaction with wait time was correlated with all other aspects of patient satisfaction (p < 0.001). On multivariable analysis, the subjective wait time was associated with the likelihood to recommend (p < 0.001). CONCLUSION Prolonged objective wait times in a multidisciplinary oncology outpatient setting were associated with several factors including specific physicians and new patient status. Trainee interaction with patients led to shorter wait times and improved patient satisfaction scores with wait times. Satisfaction with wait time was positively correlated with all aspects of patient satisfaction and 'likelihood to recommend' scores. LEVEL OF EVIDENCE NA Laryngoscope, 134:178-184, 2024.
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Affiliation(s)
- Andrew Yousef
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, California, USA
| | - David Lauthen
- Moores Cancer Center, University of California, San Diego, California, USA
| | - Celia Ramsey
- Moores Cancer Center, University of California, San Diego, California, USA
| | - Xinlian Zhang
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Jayna Athas
- Moores Cancer Center, University of California, San Diego, California, USA
| | - Matthew Jenusaitis
- Moores Cancer Center, University of California, San Diego, California, USA
| | - Joseph Califano
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, California, USA
- Moores Cancer Center, University of California, San Diego, California, USA
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Gutkind JS, Faraji F, Ramirez S, Clubb L, Sato K, Quiroz PA, Galloway W, Mikulski Z, Hoang T, Medetgul-Ernar K, Marangoni P, Jones K, Officer A, Molinolo A, Kim K, Sakaguchi K, Califano J, Smith Q, Klein O, Tamayo P. YAP-Driven Malignant Reprogramming of Epithelial Stem Cells at Single Cell Resolution. Res Sq 2023:rs.3.rs-3426301. [PMID: 37961717 PMCID: PMC10635308 DOI: 10.21203/rs.3.rs-3426301/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Tumor initiation represents the first step in tumorigenesis during which normal progenitor cells undergo cell fate transition to cancer. Capturing this process as it occurs in vivo, however, remains elusive. Here we employ cell tracing approaches with spatiotemporally controlled oncogene activation and tumor suppressor inhibition to unveil the processes underlying oral epithelial progenitor cell reprogramming into cancer stem cells (CSCs) at single cell resolution. This revealed the rapid emergence of a distinct stem-like cell state, defined by aberrant proliferative, hypoxic, squamous differentiation, and partial epithelial to mesenchymal (pEMT) invasive gene programs. Interestingly, CSCs harbor limited cell autonomous invasive capacity, but instead recruit myeloid cells to remodel the basement membrane and ultimately initiate tumor invasion. CSC transcriptional programs are conserved in human carcinomas and associated with poor patient survival. These findings illuminate the process of cancer initiation at single cell resolution, thus identifying candidate targets for early cancer detection and prevention.
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Affiliation(s)
| | - Farhoud Faraji
- University of California San Diego Health Department of Otolaryngology-Head and Neck Surgery and Moores Cancer Center
| | | | - Lauren Clubb
- University of California San Diego Health Moores Cancer Center
| | - Kuniaki Sato
- University of California San Diego Health Moores Cancer Center
| | | | - William Galloway
- University of California Irvine Department of Chemical and Biomolecular Engineering
| | | | - Thomas Hoang
- University of California San Diego Health Moores Cancer Center
| | | | - Pauline Marangoni
- Craniofacial Biology and Department of Orofacial Sciences, University of California, San Francisco
| | - Kyle Jones
- University of California San Francisco (UCSF)
| | - Adam Officer
- University of California San Diego Health Moores Cancer Center
| | | | | | | | | | - Quinton Smith
- University of California Irvine Department of Chemical and Biomolecular Engineering
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Califano J, Yousef A, Mostafa H, Valsamakis A, Zhang X, Batis N, Varghese C, Parish J, Forman M, Jarrett J, Messer K, Mehanna H. Lead Time to Recurrence After Posttreatment Plasma and Saliva HPV DNA Testing in Patients With Low-Risk HPV Oropharynx Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:812-819. [PMID: 37498566 PMCID: PMC10375388 DOI: 10.1001/jamaoto.2023.1730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023]
Abstract
Importance Head and neck squamous cell carcinoma is a highly lethal cancer that is often associated with human papillomavirus (HPV). Recent studies have shown promise in the use of HPV DNA detection in salivary rinses and plasma as a factor associated with a future diagnosis of HPV-positive oropharynx cancer (HPVOPC). However, the use of plasma and salivary HPV DNA detection in defining risk for recurrence in the context of a prospective, phase 3, clinical trial coupled with standardized clinical surveillance has not been reported. Objective To identify patients with low-risk HPVOPC at risk for recurrence by detection of HPV16 DNA in plasma and salivary rinses. Design, Setting, and Participants In this cohort study, 233 low-risk patients were recruited from 32 head and neck treatment centers in Ireland (1 [3.1%]), the Netherlands (1 [3.1%]), and the UK (30 [93.8%]) as part of the DE-ESCALATE HPV trial, an open-label, phase 3 randomized clinical trial examining treatment with cetuximab vs cisplatin for HPVOPC. Patients were assayed for the presence of HPV16 DNA in plasma and salivary rinse via a quantitative polymerase chain reaction-based assay. Main Outcomes and Measures Assay results were associated with risk of recurrence and lead time from HPV16 DNA detection to recurrence. Results Of 233 patients, 45 (19.3%) were women, and the mean (SD) age was 57.01 (8.45) years. A total 1040 salivary or blood samples were collected during the course of the study. With a median follow-up of 760 days, the sensitivity and specificity of combined plasma and salivary rinse HPV DNA assays for detecting recurrence were 65% and 87%, respectively. There was a median lead time of positive test to event/recurrence date of 19 days (range, 0-536 days) and mean (SD) of 122 (169.8) days. Conclusion and Relevance The results of this cohort study suggest that in the setting of a randomized, prospective, phase 3 trial for low-risk patients with HPVOPC, posttreatment presence of HPV DNA in plasma and salivary rinses is associated with recurrence; a lead time between test positivity and clinical recurrence offers a potential opportunity for earlier detection of recurrence.
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Affiliation(s)
- Joseph Califano
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Diego, La Jolla
- Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Andrew Yousef
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Diego, La Jolla
| | - Heba Mostafa
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexandra Valsamakis
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Roche Diagnostic Solutions, Pleasanton, California
| | - Xinlian Zhang
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Nikolaos Batis
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, England
| | - Christy Varghese
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, England
| | - Joanna Parish
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, England
| | - Michael Forman
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Karen Messer
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, England
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Panuganti BA, Voora R, Coffey C, Orosco R, Weissbrod PA, Califano J. Transoral Laser Microsurgery With Neck Dissection Versus Radiotherapy for T2N0 Supraglottic Cancer. Laryngoscope 2023; 133:601-606. [PMID: 35562187 DOI: 10.1002/lary.30171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To compare overall survival outcomes associated with transoral laser microsurgery (TLM) with neck dissection versus definitive radiotherapy in the management of T2N0 supraglottic squamous cell carcinoma. METHODS Data were extracted from the National Cancer Database concerning patients with cT2N0M0 supraglottic cancer treated with either TLM and neck dissection with minimum lymph node yield of 10 or definitive radiotherapy. Predictors of overall survival were assessed via Cox proportional hazards regression. RESULTS Seventy-six cT2N0 supraglottic squamous cell carcinoma patients who underwent TLM with neck dissection (+/- adjuvant therapy) versus 991 patients who underwent radiotherapy. TLM was associated with an overall survival benefit (OR = 0.574; 95% CI 0.383-0.860) compared with radiotherapy. There was no difference in survival between TLM patients receiving adjuvant treatment and those receiving definitive radiotherapy. CONCLUSIONS An up-front, TLM-based surgical approach to cT2N0 supraglottic cancer may offer an overall survival benefit compared with definitive radiotherapy, and should receive more frequent consideration as a primary approach to this disease process. LEVEL OF EVIDENCE 3 Laryngoscope, 133:601-606, 2023.
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Affiliation(s)
- Bharat Akhanda Panuganti
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, La Jolla, California, USA
| | - Rohith Voora
- School of Medicine, University of California-San Diego, La Jolla, California, USA
| | - Charles Coffey
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, La Jolla, California, USA.,Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California-San Diego, La Jolla, California, USA
| | - Ryan Orosco
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, La Jolla, California, USA.,Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California-San Diego, La Jolla, California, USA
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, La Jolla, California, USA
| | - Joseph Califano
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, La Jolla, California, USA.,Gleiberman Head and Neck Cancer Center, Moores Cancer Center, University of California-San Diego, La Jolla, California, USA
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Voora RS, Panuganti B, Califano J, Coffey C, Guo T. Patterns of Lymph Node Metastasis in Parotid Cancer and Implications for Extent of Neck Dissection. Otolaryngol Head Neck Surg 2023; 168:1067-1078. [PMID: 36939401 DOI: 10.1002/ohn.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/27/2022] [Accepted: 09/10/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The role and extent of neck dissection in primary parotid cancer are controversial. Herein, we characterize patterns of lymph node metastasis in parotid cancer. STUDY DESIGN Retrospective analysis. SETTING National Cancer Database. METHODS Patients with the 6 most common histologic subtypes of parotid cancer were selected. Primary outcomes were the distribution of positive lymph nodes by level and overall survival assessed by Cox analysis. Secondary outcomes included predictors of extended lymph node involvement (≥3 lymph nodes or Level IV/V involvement), via logistic regression. RESULTS Six thousand nine hundred seventy-seven patients with acinic cell carcinoma, adenocarcinoma, adenoid cystic carcinoma, carcinoma ex pleomorphic adenoma (CExPA), mucoepidermoid carcinoma, and salivary duct carcinoma (SDC) were included. Among cN0 patients, 8.2% of low-grade tumor patients had occult nodal metastasis versus 30.9% in high-grade tumor patients. Elective neck dissection was not associated with an overall survival benefit (adjusted hazard ratio: 1.10; 0.94-1.30, p = .238). Among cN+ tumors, CExPA (odds ratio [OR]: 1.88, 1.05-3.39, p = .034) and high-grade pathology (OR: 3.03, 1.87-4.93, p < .001) were predictive of having ≥3 pathologic nodes. CExPA (OR: 2.13, 1.22-3.72, p = .008), adenocarcinoma (OR: 1.60, 1.11-2.31, p = .013), SDC (OR: 1.92, 1.17-3.14, p < .01), and high-grade pathology (OR: 3.61, 2.19-5.97, p < .001) were predictive of Level IV/V neck involvement. CONCLUSIONS In parotid malignancy, nodal metastasis distribution is dependent on histology and grade. High-grade tumors and certain histologies (SDC and adenocarcinoma) had a higher incidence of occult nodes. Comprehensive neck dissection should also be considered for node-positive high-grade tumors, SDC, and adenocarcinoma.
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Affiliation(s)
- Rohith S Voora
- University of California, San Diego School of Medicine, La Jolla, California, USA.,Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Bharat Panuganti
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego School of Medicine, La Jolla, California, USA.,Gleiberman Head and Neck Cancer Center, Moores Cancer Center, La Jolla, California, USA
| | - Joseph Califano
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego School of Medicine, La Jolla, California, USA.,Gleiberman Head and Neck Cancer Center, Moores Cancer Center, La Jolla, California, USA
| | - Charles Coffey
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego School of Medicine, La Jolla, California, USA.,Gleiberman Head and Neck Cancer Center, Moores Cancer Center, La Jolla, California, USA
| | - Theresa Guo
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego School of Medicine, La Jolla, California, USA.,Gleiberman Head and Neck Cancer Center, Moores Cancer Center, La Jolla, California, USA
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Inokawa Y, Hayashi M, Begum S, Noordhuis MG, Sidransky D, Califano J, Koch W, Brait M, Westra WH, Hoque MO. High-risk HPV infection-associated hypermethylated genes in oropharyngeal squamous cell carcinomas. BMC Cancer 2022; 22:1146. [PMID: 36344942 PMCID: PMC9641857 DOI: 10.1186/s12885-022-10227-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022] Open
Abstract
Background HPV-positive oropharyngeal squamous cell carcinomas (OPSCCs) are sensitive to chemo-radiation therapy and have favorable survival outcomes compared with HPV-negative cancers. These tumors are usually not related to tobacco and alcohol exposure. Therefore, diagnosing HPV-positive OPSCCs for the appropriate disease management is crucial, and no suitable markers are available for detecting early malignancies in HPV-infected tissues. In this study, we attempt to find HPV-specific epigenetic biomarkers for OPSCCs. Methods A total of 127 surgical samples were analyzed for HPV positivity and promoter methylation of a panel of genes. HPV detection was performed by PCR detection of HPV E6 and E7 viral oncoproteins. In addition, promoter methylation of a total of 8 genes (DAPK, FHIT, RASSF1A, TIMP3, AGTR1, CSGALNACT2, GULP1 and VGF) was analyzed by quantitative-methylation specific PCR (QMSP), and their associations with HPV positivity or RB/p16 expressions were evaluated. Results AGTR1 and FHIT were frequently methylated in HPV-positive OPSCC samples with a good area under the curve (AUC over 0.70). In addition, these genes' promoter methylation was significantly associated with p16 positive and RB negative cases, which were the characteristics of OPSCC cases with favorable survival outcomes. Either AGTR1 or FHIT methylated cases were significantly associated with HPV-positive cancers with 92.0% sensitivity (P < 0.001). Also, they had significantly better overall survival (P = 0.047) than both unmethylated cases. Conclusions A combination of AGTR1 and FHIT methylation demonstrated a suitable detection marker of OPSCCs derived from the HPV-infected field, familiar with p16-positive and RB-negative phenotypes. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10227-w.
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Yi S, McCracken R, Davide J, Salovich DR, Whitmer T, Bhat A, Vlasak J, Ha S, Sehlin D, Califano J, Ploeger K, Mukherjee M. Development of process analytical tools for rapid monitoring of live virus vaccines in manufacturing. Sci Rep 2022; 12:15494. [PMID: 36109543 PMCID: PMC9476422 DOI: 10.1038/s41598-022-19744-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
In the development of end-to-end large-scale live virus vaccine (LVV) manufacturing, process analytical technology (PAT) tools enable timely monitoring of critical process parameters (CPP) and significantly guide process development and characterization. In a commercial setting, these very same tools can enable real time monitoring of CPPs on the shop floor and inform harvest decisions, predict peak potency, and serve as surrogates for release potency assays. Here we introduce the development of four advanced PAT tools for upstream and downstream process monitoring in LVV manufacturing. The first tool explores the application of capacitance probes for real time monitoring of viable cell density in bioreactors. The second tool utilizes high content imaging to determine optimum time of infection in a microcarrier process. The third tool uses flow virometry (or nanoscale flow cytometry) to monitor total virus particle counts across upstream and downstream process steps and establishes a robust correlation to virus potency. The fourth and final tool explores the use of nucleic acid dye staining to discriminate between “good” and “damaged” virus particles and uses this strategy to also monitor virus aggregates generated sometimes during downstream processing. Collectively, these tools provide a comprehensive monitoring toolbox and represent a significantly enhanced control strategy for the manufacturing of LVVs.
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10
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Shaya J, Cabal A, Nonato T, Torriani F, Califano J, Lippman S, Sacco A, McKay RR. Asymptomatic detection of SARS-CoV-2 among cancer patients receiving infusional anti-cancer therapy. Cancer Med 2021; 10:8763-8767. [PMID: 34708934 PMCID: PMC8646446 DOI: 10.1002/cam4.4373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Little is known regarding the rate and clinical outcomes of asymptomatic carriers of SARS-CoV-2 among patients with cancer. Detection of asymptomatic carriers is important in this population given the use of myelosuppressive and immunomodulating therapies. Understanding the asymptomatic carrier rate will help to develop mitigation strategies in this high-risk cohort. METHODS Retrospective cohort analysis of an asymptomatic screening protocol which required patients receiving infusional anti-cancer therapy to undergo a symptom/exposure screen and SARS-CoV-2 PCR testing 24-96 h prior to their infusion. The primary outcome of this analysis was the rate of asymptomatic SARS-CoV-2 infection. Secondary outcomes included the rate of COVID-19-related hospitalization and mortality and delays in oncologic therapy. RESULTS Among a cohort of 2691 cancer patients who underwent asymptomatic screening, 1.6% (N = 43/2691) of patients were found to be SARS-CoV-2 positive on asymptomatic screening. 11.6% (N = 5/43) of the cohort ultimately developed COVID-19-related symptoms. Four patients required hospitalization for complications of COVID-19 infection. No patient died from COVID-related complications. 97.7% (N = 42/43) had their anti-cancer therapy delayed or deferred with a median delay of 21 days (range: 7-77 days). CONCLUSIONS Overall, among a cohort of active cancer patients receiving anti-cancer therapy, an asymptomatic SARS-CoV2 PCR-based screening protocol detected a small cohort of asymptomatic carriers. The majority of these patients remained asymptomatic on long-term follow-up and outcomes were much more favorable compared to previously described outcomes of cancer patients with symptomatic COVID-19 infection.
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Affiliation(s)
- Justin Shaya
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Angelo Cabal
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Taylor Nonato
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Francesca Torriani
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
- Division of Infectious DiseaseUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Joseph Califano
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Scott Lippman
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Assuntina Sacco
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
| | - Rana R. McKay
- University of California San Diego Moores Cancer CenterLa JollaCaliforniaUSA
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11
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McAllister SD, Abood ME, Califano J, Guzmán M. Cannabinoid Cancer Biology and Prevention. J Natl Cancer Inst Monogr 2021; 2021:99-106. [PMID: 34850900 DOI: 10.1093/jncimonographs/lgab008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 12/18/2022] Open
Abstract
Plant-based, synthetic, and endogenous cannabinoids have been shown to control a diverse array of biological processes, including regulation of cell fate across cancers. Their promise as broad-based antitumor agents in preclinical models has led to the initiation of pilot clinical trials. Session 5 of the National Cancer Institute's Cannabis, Cannabinoids and Cancer Research Symposium provides an overview of this research topic. Overall, the presentations highlight cannabinoid signal transduction and specific molecular mechanisms underlying cannabinoid antitumor activity. They also demonstrate the broad-based antitumor activity of the plant-based, synthetic, and endogenous cannabinoid compounds. Importantly, evidence is presented demonstrating when cannabinoids may be contraindicated as a treatment for cancer, as in the case of human papilloma virus-meditated oropharynx cancer or potentially other p38 MAPK pathway-driven cancers. Finally, it is discussed that a key to advancing cannabinoids into the clinic is to conduct well-designed, large-scale clinical trials to determine whether cannabinoids are effective antitumor agents in cancer patients.
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Affiliation(s)
- Sean D McAllister
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Mary E Abood
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Joseph Califano
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA 92093, USA.,Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Manuel Guzmán
- Department of Biochemistry and Molecular Biology, CIBERNED, IUIN and IRYCIS, Complutense University, Madrid, Spain
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12
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Saddawi-Konefka R, O’Farrell A, Faraji F, Allevato M, Wang Z, Wu V, Yung B, Anang NA, Franiak-Pietryga I, Simon A, Jensen S, Fox B, Sharabi A, Cohen E, Califano J, Silvio Gutkind J. 601 Sequencing immunotherapy before lymphatic ablation unleashes cDC1-dependent antitumor immunity in HNSCC. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundDespite the proven efficacy of immune checkpoint inhibitor (ICI) therapy in the recurrent/metastatic setting for head and neck squamous cell carcinoma (HNSCC), clinical trials of ICI combined with curative-intent therapies have yielded equivocal results [1–4]. Collectively, this highlights gaps in our understanding of rational immune oncology (IO) treatment sequencing and suggests that the efficacy ICI may be disrupted by standard therapies, which necessarily compromise regional lymphatics.MethodsWe employ a preclinical model of tobacco-signature HNSCC to identify sequences of therapy that maximize durable response. By mapping the cervical lymphatic basins in the mouse, we define patterns of active antitumor immunosurveillance. Additionally, we establish tumors with distinct patterns of regional lymphatic drainage and develop a murine neck dissection (ND) model.ResultsWe find that cervical lymphatic ablation, with ND or stereotactic body radiation therapy, in tumor bearing animals abolishes the response to ICI therapy, significantly impacting overall survival. Examination of the tumor immune microenvironment following ND reveals dramatic changes with a ten-fold increase in CD45 cells and exclusion of cytotoxic and antigen-specific lymphocytes. By examining the lymphatics removed at the time of ND, we find that conventional type I dendritic cells (cDC1s) and type I interferon (IFN-I) signaling are significantly increased, suggesting that these effectors are lost after curative-intent therapy. Depleting IFN-I or cDC1s blocks the response to ICI similar to lymphatic ablation. We find that successful primary response to ICI leads to durable immunity, conferred by systemically distributed memory T cells, not impaired by delayed ND. Lastly, we discover a rational IO treatment sequence by delivering neoadjuvant ICI followed by ND. Neoadjuvant ICI leads to complete tumor response, accumulation of nodal cDC1, and durable immunity. Surprisingly, the incidence of nodal metastasis at early timepoints reveals a similar burden of nodal disease between control and ICI-treated animals that decreases at late timepoints only with ICI treatment (44% vs 15%, n=25, p=0.033). This suggests that ICI also drives active immunosurveillance in regional, tumor-draining lymphatics, challenging the landmark findings from the definitive clinical trial demonstrating the benefit of elective versus therapeutic neck dissection for oral SCC patients with clinically negative necks.ConclusionsThis work demonstrates the necessity of preserving tumor-draining lymphatics during the tumor response to ICI therapy in HNSCC. Overall, we define rational IO treatment sequences to achieve optimal primary tumor response, durable antitumor immunity and immunosurveillance of regional metastatic disease. These findings can inform future clinical trials investigating combination IO therapy and treatment sequencing.ReferencesHarrington, K. J. et al. Nivolumab versus standard, single-agent therapy of investigator’s choice in recurrent or metastatic squamous cell carcinoma of the head and neck (CheckMate 141): health-related quality-of-life results from a randomised, phase 3 trial. Lancet Oncology 18, 1104–1115 (2017).Burtness, B. et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. Lancet (London, England) 394, 1915–1928 (2019).Lee, N. Y. et al. Avelumab plus standard-of-care chemoradiotherapy versus chemoradiotherapy alone in patients with locally advanced squamous cell carcinoma of the head and neck: a randomised, double-blind, placebo-controlled, multicentre, phase 3 trial. Lancet Oncol 22, 450–462 (2021).D’Cruz, A. K. et al. Elective versus Therapeutic Neck Dissection in Node-Negative Oral Cancer. New England Journal of Medicine 373, 521–529 (2015).
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13
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Voora RS, Panuganti BA, Flagg M, Nelson T, Kotha NV, Qiao EM, Qian AS, Kumar A, Stewart TF, Rose B, Califano J, Weissbrod PA, Mell LK, Orosco RK. Patterns of Failure After Definitive Treatment of T4a Larynx Cancer. Otolaryngol Head Neck Surg 2021; 167:274-285. [PMID: 34609937 DOI: 10.1177/01945998211049211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Recurrence is known to predict laryngeal squamous cell cancer (LSCC) survival. Recurrence patterns in T4a LSCC are poorly characterized and represent a possible explanation for observed survival discrepancies by treatment rendered. STUDY DESIGN Retrospective database review. SETTING Veterans Affairs national database. METHODS Patients with T4a LSCC between 2000 and 2017 were identified and stratified by treatment (chemoradiotherapy [CRT] vs total laryngectomy + neck dissection + adjuvant therapy [surgical]). Primary outcomes were locoregional and distant recurrence. Secondary outcomes of overall mortality, larynx cancer mortality, and noncancer mortality were evaluated in Cox and Fine-Gray models. RESULTS A total of 1043 patients had comparable baseline demographics: 438 in the CRT group and 605 in the surgical group. Patients undergoing CRT had higher proportions of node positivity (64.6% vs 53.1%, P < .001). Locoregional and distant recurrence were less common in the surgical group (23.0% vs 37.2%, P < .001; 6.8% vs 13.3%, P < .001, respectively); however, distant metastatic rates did not differ within the N0 subgroup (P = .722). On multivariable regression, surgery demonstrated favorable locoregional recurrence (hazard ratio [HR], 0.49; 95% CI, 0.39-0.62; P < .001), distant recurrence (HR, 0.47; 95% CI, 0.31-0.71; P < .001), overall mortality (HR, 0.75; 95% CI, 0.64-0.87; P < .001), and larynx cancer mortality (HR, 0.69; 95% CI, 0.56-0.85; P < .001). CONCLUSION T4a LSCC survival discrepancies between surgical and nonsurgical treatment are influenced by varying recurrence behaviors. Surgery was associated with superior disease control and improved survival. Beyond the known benefit in locoregional control with surgery, there may be a protective effect on distant recurrence that depends on regional disease burden.
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Affiliation(s)
- Rohith S Voora
- School of Medicine, University of California San Diego, San Diego, California, USA.,Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Bharat A Panuganti
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA.,Moores Cancer Center, La Jolla, California, USA
| | - Mitchell Flagg
- School of Medicine, University of California San Diego, San Diego, California, USA.,Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Tyler Nelson
- School of Medicine, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Nikhil V Kotha
- School of Medicine, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Edmund M Qiao
- School of Medicine, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alexander S Qian
- School of Medicine, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Abhishek Kumar
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Tyler F Stewart
- Moores Cancer Center, La Jolla, California, USA.,Divisions of Hematology-Oncology and Blood and Marrow Transplantation, University of California San Diego, San Diego, California, USA
| | - Brent Rose
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Moores Cancer Center, La Jolla, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Joseph Califano
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Moores Cancer Center, La Jolla, California, USA
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA.,Moores Cancer Center, La Jolla, California, USA
| | - Loren K Mell
- Moores Cancer Center, La Jolla, California, USA.,Department of Radiation Medicine and Applied Sciences, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Ryan K Orosco
- Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA.,Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Moores Cancer Center, La Jolla, California, USA
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14
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Pang J, Nguyen N, Luebeck J, Ball L, Finegersh A, Ren S, Nakagawa T, Flagg M, Sadat S, Mischel PS, Xu G, Fisch K, Guo T, Cahill G, Panuganti B, Bafna V, Califano J. Extrachromosomal DNA in HPV-Mediated Oropharyngeal Cancer Drives Diverse Oncogene Transcription. Clin Cancer Res 2021; 27:6772-6786. [PMID: 34548317 DOI: 10.1158/1078-0432.ccr-21-2484] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/20/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Human papillomavirus (HPV) plays a major role in oncogenesis and circular extrachromosomal DNA (ecDNA) is found in many cancers. However, the relationship between HPV and circular ecDNA in human cancer is not understood. EXPERIMENTAL DESIGN Forty-four primary tumor tissue samples were obtained from a cohort of patients with HPV-positive oropharynx squamous cell carcinoma (OPSCC). Twenty-eight additional HPV oropharyngeal cancer (HPVOPC) tumors from The Cancer Genome Atlas (TCGA) project were analyzed as a separate validation cohort. Genomic, transcriptomic, proteomic, computational, and functional analyses of HPVOPC were applied to these datasets. RESULTS Our analysis revealed circular, oncogenic DNA in nearly all HPVOPC, with circular human and human-viral hybrid ecDNA present in over a third of HPVOPC and viral circular DNA in remaining tumors. Hybrid ecDNA highly express fusion transcripts from HPV promoters and HPV oncogenes linked to downstream human transcripts that drive oncogenic transformation and immune evasion, and splice multiple, diverse human acceptors to a canonical SA880 viral donor site. HPVOPC have high E6*I expression with specific viral oncogene expression pattern related to viral or hybrid ecDNA composition. CONCLUSIONS Nonchromosomal circular oncogenic DNA is a dominant feature of HPVOPC, revealing an unanticipated link between HPV and ecDNA that leverages the power of extrachromosomal inheritance to drive HPV and somatic oncogene expression.
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Affiliation(s)
- John Pang
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Nam Nguyen
- UC San Diego Jacobs School of Engineering, Department of Computer Science and Engineering, La Jolla, California
| | - Jens Luebeck
- Bioinformatics & Systems Biology Graduate Program, University of California at San Diego, La Jolla, California
| | - Laurel Ball
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Andrey Finegersh
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Shuling Ren
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Takuya Nakagawa
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Mitchell Flagg
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Sayed Sadat
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Paul S Mischel
- Stanford University School of Medicine, Department of Pathology, ChEM-H, Stanford, California
| | - Guorong Xu
- UC San Diego School of Medicine, Center for Computational Biology and Bioinformatics, La Jolla, California
| | - Kathleen Fisch
- UC San Diego School of Medicine, Center for Computational Biology and Bioinformatics, La Jolla, California
| | - Theresa Guo
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California.,Johns Hopkins University School of Medicine, Otolaryngology-Head and Neck Surgery, Baltimore, Maryland
| | - Gabrielle Cahill
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Bharat Panuganti
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California
| | - Vineet Bafna
- UC San Diego Jacobs School of Engineering, Department of Computer Science and Engineering, La Jolla, California.
| | - Joseph Califano
- UC San Diego School of Medicine, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, La Jolla, California. .,Bioinformatics & Systems Biology Graduate Program, University of California at San Diego, La Jolla, California
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15
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Smith DH, Raslan S, Samuels MA, Iglesias T, Buitron I, Deo S, Daunert S, Thomas GR, Califano J, Franzmann EJ. Current salivary biomarkers for detection of human papilloma virus-induced oropharyngeal squamous cell carcinoma. Head Neck 2021; 43:3618-3630. [PMID: 34331493 DOI: 10.1002/hed.26830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/21/2021] [Accepted: 07/22/2021] [Indexed: 12/25/2022] Open
Abstract
Human papilloma virus (HPV) infection is a key risk factor and etiology for oropharyngeal squamous cell carcinoma (OPSCC). HPV-induced OPSCC is rapidly increasing in incidence, with men experiencing increased mortality. When identified at an early stage, HPV-induced OPSCC can be successfully treated. Diagnosis of HPV-related OPSCC relies on an expert physical examination and invasive biopsy. Since saliva bathes the oropharyngeal mucosa and can be collected noninvasively, saliva obtained via salivary risings is an attractive body fluid for early detection of HPV-induced OPSCC. A plethora of DNA, RNA, and protein salivary biomarkers have been explored. This review discusses these markers and their robustness for detecting oncogenic HPV in OPSCC saliva samples. Methods detecting HPV DNA were more reliable than those detecting RNA, albeit both require time-consuming analyses. Salivary HPV proteomics are a new, promising focus of HPV detection research, and while more practical, lag behind nucleic acid detection methods in their development.
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Affiliation(s)
- Drew H Smith
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Shahm Raslan
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Michael A Samuels
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Thomas Iglesias
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Sapna Deo
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sylvia Daunert
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Giovana R Thomas
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph Califano
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of California - San Diego, San Diego, California, USA
| | - Elizabeth J Franzmann
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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16
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Finegersh A, Voora RS, Panuganti B, Faraji F, Holsinger FC, Brumund KT, Coffey C, Califano J, Orosco RK. Robotic surgery may improve overall survival for T1 and T2 tumors of the hypopharynx: An NCDB cohort study. Oral Oncol 2021; 121:105440. [PMID: 34329867 DOI: 10.1016/j.oraloncology.2021.105440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/08/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hypopharyngeal cancer is associated with poor survival. Robotic surgery is emerging as a treatment for hypopharyngeal tumors, but no rigorous data are available to assess its effect on survival. METHODS The National Cancer Database (NCDB) was used to identify patients with T1 and T2 hypopharyngeal tumors undergoing robotic surgery, laser surgery, and primary radiation with or without chemotherapy from 2010 to 2016. All adult patients with available staging and no distant metastasis were included. RESULTS We compared 57 patients undergoing robotic surgery, 236 undergoing laser surgery, and 5,742 undergoing primary radiation. Compared to laser surgery, patients undergoing robotic surgery were significantly more likely to have negative margins, neck dissection, lower incomes, and care at an academic center. Rates of robotic surgery also significantly increased from 2010 to 2015. After multivariate regression, robotic surgery was associated with significantly improved overall survival compared to laser surgery and primary radiation. CONCLUSION Robotic surgery improves overall survival for T1 and T2 hypopharyngeal tumors compared to laser surgery and primary radiation in this NCDB cohort. This effect may be mediated by decreased positive margin rates relative to laser surgery. Rates of hypopharyngeal robotic surgery are expected to increase with wider adoption of robotic platforms and may improve overall survival rates for hypopharyngeal cancer.
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Affiliation(s)
- Andrey Finegersh
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Rohith S Voora
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Bharat Panuganti
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Farhoud Faraji
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | | | - Kevin T Brumund
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA; Division of Otolaryngology, Department of Surgery, VA San Diego Health System, La Jolla, CA, USA; Moores Cancer Center, La Jolla, CA, USA
| | - Charles Coffey
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA; Division of Otolaryngology, Department of Surgery, VA San Diego Health System, La Jolla, CA, USA; Moores Cancer Center, La Jolla, CA, USA
| | - Joseph Califano
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA; Moores Cancer Center, La Jolla, CA, USA
| | - Ryan K Orosco
- Division of Otolaryngology, Department of Surgery, University of California San Diego, San Diego, CA, USA; Moores Cancer Center, La Jolla, CA, USA.
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17
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Shaya JA, Cabal A, Torriani F, Califano J, Lippman S, Sacco A, McKay RR. Abstract S09-04: Asymptomatic detection of COVID-19 among cancer patients receiving infusional anti-cancer therapy. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.covid-19-21-s09-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction Little is known about the rates of asymptomatic COVID-19 carriers among cancer patients. The rate of asymptomatic carriers is important to understand in this population given the use of myelosuppressive and immunomodulating therapies and the risk of transmission to other patients in shared infusion centers. At UC San Diego, in June 2020, we implemented a COVID-19 asymptomatic screening protocol in which cancer patients receiving anti-cancer therapy in an infusion center must undergo symptom-based screening and then SARS-CoV-2 PCR testing prior to their infusion. Here, we describe the results of this asymptomatic screening protocol. Methods This was a single-center retrospective analysis of patients with active cancer receiving infusional anti-cancer therapy in 5 infusion centers who underwent at least 1 asymptomatic SARS-CoV-2 PCR test between 6/1- 12/1/2020. The primary endpoint was the rate of COVID-19 positivity among asymptomatic patients. Symptomatic patients were excluded. Secondary endpoints included COVID-19-related outcomes and patterns of oncologic management for asymptomatic COVID-19 positive patients. Results A cohort of 2,202 cancer patients received at least 1 asymptomatic SARS-CoV-2 PCR test prior to receipt of infusional anti-cancer therapy. 0.95% (N=21/2202) of patients were found to be PCR-positive on asymptomatic screening. Among positive patients, 9.5% (N=2/21) had hematologic malignancies and 90.5% (N=19/21) had solid tumors. In terms of therapy, 76.2% (N=16) were treated with cytotoxic chemotherapy, 9.5% (N=2) with targeted therapy, 4.7% (N=1) with immunotherapy, and 9.5% (N=2) were on a clinical trial. With a median follow-up of 122 days from positive PCR test (range: 8-186), only 2 of 21 (9.5%) of the cohort ultimately developed COVID-related symptoms. Both patients had a diagnosis of acute leukemia and 1 patient required hospitalization for COVID-related complications. No patients died from COVID-related complications. With regards to oncologic management, 95.2% (N=20/21) of patients had their therapy delayed or deferred with a median delay of 21 days (range: 7-77 days). Only 1 patient proceeded with cytotoxic chemotherapy on schedule in the setting of adjuvant chemoradiation for oropharyngeal squamous cell carcinoma. Among the overall cohort, an additional 26 patients (1.2%) developed cases of symptomatic COVID-19 infection during the study period. Conclusions A strategy of asymptomatic screening of cancer patients receiving anti-cancer therapy in an infusion center detected an extremely low rate of asymptomatic carriers of COVID-19. This low rate of asymptomatic carriers may be due to a number of factors including multiple symptom-based screenings prior to infusion, behavior modification among patients, and/or differential immune responses to COVID-19 infection. Asymptomatic carriers in this cohort appeared to have favorable outcomes with few developing symptoms or requiring hospitalization, though the number of positive patients in our cohort is low, precluding definitive conclusions in this population.
Citation Format: Justin A. Shaya, Angelo Cabal, Francesca Torriani, Joseph Califano, Scott Lippman, Assuntina Sacco, Rana R. McKay. Asymptomatic detection of COVID-19 among cancer patients receiving infusional anti-cancer therapy [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S09-04.
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Affiliation(s)
| | - Angelo Cabal
- 1UC San Diego Moores Cancer Center, La Jolla, CA,
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18
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Panuganti BA, Finegersh A, Flagg M, Tu X, Orosco R, Weissbrod PA, Califano J. Prognostic Significance of HPV Status in Laryngeal Squamous Cell Carcinoma: A Large-Population Database Study. Otolaryngol Head Neck Surg 2020; 165:113-121. [PMID: 33256521 DOI: 10.1177/0194599820976178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To explore the survival implications of human papillomavirus (HPV) positivity and subtype in larynx cancer through a national cancer database. To investigate staging discrepancies in larynx cancer associated with HPV status. STUDY DESIGN Retrospective observational cohort study. SETTING National Cancer Database. METHODS Data were extracted concerning adults with known HPV status who were treated between 2010 and 2016 for laryngeal squamous cell carcinoma. Patients without known HPV subtype were excluded. Cox multivariable regression models were fit to evaluate the survival impact of HPV status, characterized as a binary variable (HPV+ vs HPV-) and by subtype. Two- and 5-year survival rates were calculated via the Kaplan-Meier method and compared by stage between the HPV+ and HPV- cohorts per the log-rank test. RESULTS Patients with HPV+ larynx cancer were younger (60.5 vs 64.3 years, P < .001), more likely to have private insurance (37.2% vs 31.2%, P < .001), more commonly White (84.6% vs 82.4%, P = .013), and more likely to present with nodal disease (42.6% vs 33.0%, P < .001). HPV positivity and HPV subtype 16 were associated with improved overall survival. One-stage discrepancies in 5-year survival were observed between the HPV+ and HPV- cohorts: stage II HPV+ (69.45%) vs stage I HPV- (65.77%); stage IV HPV+ (47.67%) vs stage III HPV- (46.80%). CONCLUSIONS HPV positivity and infection with HPV subtype 16 are correlated with improved overall survival in patients with laryngeal squamous cell carcinoma, manifesting with a 1-stage incremental survival advantage. Future prospective studies are indicated to corroborate the findings from this large-population database retrospective study.
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Affiliation(s)
- Bharat A Panuganti
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Andrey Finegersh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Mitchell Flagg
- School of Medicine, University of California-San Diego, San Diego, California, USA
| | - Xin Tu
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California-San Diego, San Diego, California, USA
| | - Ryan Orosco
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Philip A Weissbrod
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Joseph Califano
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
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19
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Bleier B, Workman A, Burks C, Maxfield A, Stack BC, Nathan CA, McCammon S, Varvares M, Schmalbach C, Wang S, Califano J, Shnayder Y, Gillespie MB, Enepekides D, Witterick I, El-Sayed I, Lin D, Patel U, Kraus D, Randolph G. AHNS endocrine surgery section consensus statement on nasopharyngolaryngoscopy and clinic reopening during COVID-19: How to get back to optimal safe care. Head Neck 2020; 43:733-738. [PMID: 33205536 PMCID: PMC7753703 DOI: 10.1002/hed.26525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 11/08/2022] Open
Abstract
This article provides best practice guidelines regarding nasopharyngolaryngoscopy and OHNS clinic reopening during the COVID-19 pandemic. The aim is to provide evidence-based recommendations defining the risks of COVID-19 in clinic, the importance of pre-visit screening in addition to testing, along with ways to adhere to CDC guidelines for environmental, source, and engineering controls.
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Affiliation(s)
- Benjamin Bleier
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Alan Workman
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Ciersten Burks
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Alice Maxfield
- Department Otolaryngology Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Illinois, IL
| | - Cherie-Ann Nathan
- Department of Otolaryngology-Head and Neck Surgery, LSUHSC, Louisiana New Orleans
| | - Susan McCammon
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Mark Varvares
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Cecelia Schmalbach
- Department of Otolaryngology-HNS Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Steven Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Tucson, AZ
| | - Joseph Califano
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Yelizaveta Shnayder
- Department of Otolaryngology - Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas
| | | | - Danny Enepekides
- Sunnybrook Health Sciences Centre, Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, CA
| | - Ian Witterick
- Department of Otolaryngology- Head and Neck Surgery, University of Toronto, Toronto, CA
| | - Ivan El-Sayed
- Department of Otolaryngology, Northwestern University, Evanston, IL
| | - Derrick Lin
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
| | - Urjeet Patel
- Department of Otolaryngology, Northwestern University, Evanston, IL
| | - Dennis Kraus
- Department of Otolaryngology - Head & Neck Surgery Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, New York
| | - Gregory Randolph
- Massachusetts Eye and Ear, Divisions of Rhinology, Head and Neck Surgery and Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA
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20
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Panuganti BA, Pang J, Califano J, Chan JYK. Procedural precautions and personal protective equipment during head and neck instrumentation in the COVID-19 era. Head Neck 2020; 42:1645-1651. [PMID: 32348594 PMCID: PMC7267451 DOI: 10.1002/hed.26220] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/21/2022] Open
Abstract
Background Otolaryngologists represent a subset of health care workers uniquely vulnerable to COVID‐19 transmission. Given the segmentation of extant guidelines concerning precautions and protective equipment for SARS‐CoV2, we aimed to provide consolidated recommendations regarding appropriate personal protective equipment (PPE) in head neck surgery during the COVID‐19 era. Methods Guidelines published by international and US governing bodies were reviewed in conjunction with published literature concerning COVID‐19 transmission risk, testing, and PPE, to compile situation‐specific recommendations for head and neck providers managing COVID‐19 patients. Results High‐quality data regarding the aerosolization potential of head and neck instrumentation and appropriate PPE during head and neck surgeries are lacking. However, extrapolation of recommendations by governing bodies suggests strongly that head and neck mucosal instrumentation warrants strict adherence to airborne‐level precautions. Conclusion We present a series of situation‐specific recommendations for PPE use and other procedural precautions for otolaryngology providers to consider in the COVID‐19 era.
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Affiliation(s)
- Bharat A Panuganti
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, USA
| | - John Pang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, USA
| | - Joseph Califano
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, USA
| | - Jason Y K Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
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21
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Burton BN, Okwuegbuna O, Jafari A, Califano J, Brumund KT, Gabriel RA. Association of Preoperative Anemia With 30-Day Morbidity and Mortality Among Patients With Thyroid Cancer Who Undergo Thyroidectomy. JAMA Otolaryngol Head Neck Surg 2020; 145:124-131. [PMID: 30489623 DOI: 10.1001/jamaoto.2018.3099] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Despite the ease of preoperative anemia diagnosis and the availability of treatment options, the morbidity and mortality associated with this condition remain unacceptably high, and the literature describing the association of preoperative anemia with postoperative outcomes following thyroid surgery in patients with thyroid cancer remain sparse. Reporting outcomes in this patient population may help to facilitate preoperative optimization. Objective To assess whether an association exists between preoperative anemia and outcomes following thyroid surgery in patients with thyroid cancer. Design, Setting, and Participants This retrospective, cross-sectional, cohort study used the American College of Surgeons National Surgical Quality Improvement Program database to identify 32 166 patients between 2007 and 2016 with Current Procedural Terminology codes for thyroid surgery and with the International Classification of Diseases, Ninth Revision code of malignant thyroid cancer. Exposures Preoperative anemia as defined using the World Health Organization criteria of hematocrit less than 36% in nonpregnant females and less than 39% in males. Main Outcomes and Measures Multivariable logistic regression analysis was conducted to assess the association of preoperative anemia with the following 30-day postoperative outcomes: pulmonary, infectious, and cardiac complications, overall and serious morbidity (surgical site infection and medical complications), prolonged hospital length of stay (≥75th percentile for the cohort), and mortality. Results Among the 24 912 patients with thyroid cancer who underwent thyroidectomy included in the final analysis, the median (interquartile range) age was 51 (40-62) years and the majority were women (18 705 [75.1%]). The prevalence of preoperative anemia was 12.5% (n = 3108). Within the overall study population, hypertension (9242 patients [37.1%]) followed by active smoking (2992 patients [12.0%]) were the most prevalent comorbidities. The unadjusted odds of anemia vs no anemia were significantly higher for every 10-year increase in age (odds ratio [OR], 1.10; 95% CI, 1.08-1.13) and for black vs white patients (OR, 2.82; 95% CI, 2.51-3.17). The adjusted odds of postoperative overall morbidity (OR, 1.68; 95% CI, 1.29-2.17), mortality (OR, 3.36; 95% CI, 1.37-8.28), and pulmonary (OR, 2.36; 95% CI, 1.65-3.34) and infectious (OR, 1.62; 95% CI, 1.12-2.29) complications were higher in patients with preoperative anemia than in those without preoperative anemia. Conclusions and Relevance The findings from this study suggest that preoperative anemia may not only be associated with racial differences and a higher comorbidity burden but may also increase the likelihood of postoperative morbidity and mortality. These results may provide a basis for further risk reduction strategies and preoperative optimization.
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Affiliation(s)
| | | | - Aria Jafari
- Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla
| | - Joseph Califano
- Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla.,Moores Cancer Center, University of California San Diego Health, La Jolla
| | - Kevin T Brumund
- Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla.,Moores Cancer Center, University of California San Diego Health, La Jolla
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, La Jolla.,Division of Biomedical Informatics, University of California, San Diego, La Jolla
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22
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Moss WJ, Finegersh A, Narayanan A, Gillard D, Califano J, Brumund KT, Coffey CS, Orosco RK. Characterizing Posterior Neck Masses: A Single-Institution Retrospective and Systematic Review. Ear Nose Throat J 2019; 100:766S-770S. [PMID: 31608686 DOI: 10.1177/0145561319881845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Posterior neck masses are a relatively poorly characterized entity. The authors attempt to further characterize the anatomy and pathology of the posterior neck by way of a combined single-institution retrospective chart review and systematic review of the literature. METHODS A single-institution retrospective chart review was undertaken for all patients undergoing excision of a posterior neck mass between January 1, 2012, and January 1, 2017. A systematic review of the Medline, Embase, Web of Science, and Cochrane database was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in search of case reports and series describing posterior neck masses. RESULTS A total of 28 patients who underwent excision of a posterior neck mass were encountered during the retrospective chart review. All pathologies were benign, the most prevalent of which was lipoma (22/28, 79%). A total of 19 articles describing a collective 36 posterior neck masses were encountered during the systematic review. Lipomas were the most common pathology (15/36, 42%). All but one of the masses reported were benign (35/36, 97%). CONCLUSIONS Patients presenting with posterior neck masses can be reassured of a low risk of malignancy. The majority of posterior neck masses can be appropriately evaluated via physical examination and ultrasound.
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Affiliation(s)
- William J Moss
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, 8784University of California, San Diego, CA, USA.,Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, 162433Commonwealth Health Center, Northern Mariana Islands, Garapan, Saipan
| | - Andrey Finegersh
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, 8784University of California, San Diego, CA, USA
| | - Ajay Narayanan
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, 89063University of Texas Southwestern, Dallas, TX, USA
| | - Danielle Gillard
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, 8784University of California, San Diego, CA, USA
| | - Joseph Califano
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, 8784University of California, San Diego, CA, USA
| | - Kevin T Brumund
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, 8784University of California, San Diego, CA, USA.,Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Charley S Coffey
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, 8784University of California, San Diego, CA, USA.,Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Ryan K Orosco
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, 8784University of California, San Diego, CA, USA
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23
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Wang Z, Feng X, Molinolo AA, Martin D, Vitale-Cross L, Nohata N, Ando M, Wahba A, Amornphimoltham P, Wu X, Gilardi M, Allevato M, Wu V, Steffen DJ, Tofilon P, Sonenberg N, Califano J, Chen Q, Lippman SM, Gutkind JS. 4E-BP1 Is a Tumor Suppressor Protein Reactivated by mTOR Inhibition in Head and Neck Cancer. Cancer Res 2019; 79:1438-1450. [PMID: 30894372 DOI: 10.1158/0008-5472.can-18-1220] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 11/07/2018] [Accepted: 02/01/2019] [Indexed: 02/05/2023]
Abstract
Aberrant activation of the PI3K-mTOR signaling pathway occurs in >80% of head and neck squamous cell carcinomas (HNSCC), and overreliance on this signaling circuit may in turn represent a cancer-specific vulnerability that can be exploited therapeutically. mTOR inhibitors (mTORi) promote tumor regression in genetically defined and chemically induced HNSCC animal models, and encouraging results have been recently reported. However, the mTOR-regulated targets contributing to the clinical response have not yet been identified. Here, we focused on EIF4E-BP1 (4E-BP1), a direct target of mTOR that serves as key effector for protein synthesis. A systematic analysis of genomic alterations in the PIK3CA-mTOR pathway in HNSCC revealed that 4E-BP1 is rarely mutated, but at least one 4E-BP1 gene copy is lost in over 35% of the patients with HNSCC, correlating with decreased 4E-BP1 protein expression. 4E-BP1 gene copy number loss correlated with poor disease-free and overall survival. Aligned with a tumor-suppressive role, 4e-bp1/2 knockout mice formed larger and more lesions in models of HNSCC carcinogenesis. mTORi treatment or conditional expression of a mutant 4E-BP1 that cannot be phosphorylated by mTOR was sufficient to disrupt the translation-initiation complex and prevent tumor growth. Furthermore, CRISPR/Cas9-targeted 4E-BP1 HNSCC cells resulted in reduced sensitivity to mTORi in vitro and in vivo. Overall, these findings indicate that in HNSCC, mTOR persistently restrains 4E-BP1 via phosphorylation and that mTORi can restore the tumor-suppressive function of 4E-BP1. Our findings also support 4E-BP1 expression and phosphorylation status as a mechanistic biomarker of mTORi sensitivity in patients with HNSCC. SIGNIFICANCE: These findings suggest that EIF4E-BP1 acts as a tumor suppressor in HNSCC and that 4E-BP1 dephosphorylation mediates the therapeutic response to mTORi, providing a mechanistic biomarker for future precision oncology trials.
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Affiliation(s)
- Zhiyong Wang
- Moores Cancer Center, University of California, San Diego, La Jolla, California.,State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaodong Feng
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Alfredo A Molinolo
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Daniel Martin
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Lynn Vitale-Cross
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Nijiro Nohata
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Mizuo Ando
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Amy Wahba
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Panomwat Amornphimoltham
- Moores Cancer Center, University of California, San Diego, La Jolla, California.,International College of Dentistry, Walailak University, Nakhon Si Thammarat, Thailand
| | - Xingyu Wu
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Mara Gilardi
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Michael Allevato
- Moores Cancer Center, University of California, San Diego, La Jolla, California.,Department of Pharmacology, University of California, San Diego, La Jolla, California
| | - Victoria Wu
- Moores Cancer Center, University of California, San Diego, La Jolla, California.,Department of Pharmacology, University of California, San Diego, La Jolla, California
| | - Dana J Steffen
- Moores Cancer Center, University of California, San Diego, La Jolla, California.,Department of Pharmacology, University of California, San Diego, La Jolla, California
| | - Philip Tofilon
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Nahum Sonenberg
- Department of Biochemistry and Goodman Cancer Centre, McGill University, Montreal, Quebec, Canada
| | - Joseph Califano
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Scott M Lippman
- Moores Cancer Center, University of California, San Diego, La Jolla, California.
| | - J Silvio Gutkind
- Moores Cancer Center, University of California, San Diego, La Jolla, California. .,Department of Pharmacology, University of California, San Diego, La Jolla, California
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24
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Gleber-Netto FO, Rao X, Guo T, Xi Y, Gao M, Shen L, Erikson K, Kalu NN, Ren S, Xu G, Fisch KM, Akagi K, Seiwert T, Gillison M, Frederick MJ, Johnson FM, Wang J, Myers JN, Califano J, Skinner HD, Pickering CR. Variations in HPV function are associated with survival in squamous cell carcinoma. JCI Insight 2019; 4:124762. [PMID: 30626753 DOI: 10.1172/jci.insight.124762] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
Incidence of HPV+ oropharyngeal squamous cell carcinoma (OPSCC) has been increasing dramatically. Although long-term survival rates for these patients are high, they often suffer from permanent radiotherapy-related morbidity. This has prompted the development of de-escalation clinical protocols to reduce morbidity. However, a subset of patients do not respond even to standard therapy and have poor outcomes. It is unclear how to properly identify and treat the high- and low-risk HPV+ OPSCC patients. Since HPV positivity drives radiotherapy sensitivity, we hypothesized that variations in HPV biology may cause differences in treatment response and outcome. By analyzing gene expression data, we identified variations in HPV-related molecules among HPV+ OPSCC. A subset of tumors presented a molecular profile distinct from that of typical HPV+ tumors and exhibited poor treatment response, indicating molecular and clinical similarities with HPV- tumors. These molecular changes were also observed in vitro and correlated with radiation sensitivity. Finally, we developed a prognostic biomarker signature for identification of this subgroup of HPV+ OPSCC and validated it in independent cohorts of oropharyngeal and cervical carcinomas. These findings could translate to improved patient stratification for treatment deintensification and new therapeutic approaches for treatment-resistant HPV-related cancer.
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Affiliation(s)
| | - Xiayu Rao
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas. USA
| | - Theresa Guo
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Yuanxin Xi
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas. USA
| | - Meng Gao
- Department of Head and Neck Surgery and
| | - Li Shen
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas. USA
| | | | - Nene N Kalu
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shuling Ren
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Guorong Xu
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Kathleen M Fisch
- Center for Computational Biology & Bioinformatics, Department of Medicine, University of California, San Diego, La Jolla, California. USA
| | - Keiko Akagi
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tanguy Seiwert
- Department of Medicine and Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - Maura Gillison
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Faye M Johnson
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,The University of Texas Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Jing Wang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas. USA.,The University of Texas Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery and.,The University of Texas Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Joseph Califano
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Heath D Skinner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Curtis R Pickering
- Department of Head and Neck Surgery and.,The University of Texas Graduate School of Biomedical Sciences, Houston, Texas, USA
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25
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Sacco AG, Coffey CS, Sanghvi P, Rubio GP, Califano J, Athas J, Tamayo GJ, Linnemeyer K, Barnachea LC, Orosco RK, Brumund KT, Cohen EE, Gold K, Mell LK, Sharabi A, Daniels GA, Abbott Y, Collins R, Clynch K, Noboa M, Blumenfeld L. Development of Care Pathways to Standardize and Optimally Integrate Multidisciplinary Care for Head and Neck Cancer. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/10463356.2018.1527118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | | | | | | | | | - Jayna Athas
- UC San Diego Moores Cancer Center, La Jolla, Calif
| | | | | | | | | | | | | | - Kathryn Gold
- UC San Diego Moores Cancer Center, La Jolla, Calif
| | | | | | | | - Yuko Abbott
- UC San Diego Moores Cancer Center, La Jolla, Calif
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26
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Huynh-Le MP, Williamson C, Califano J, Coffey C, Martin P, Sanghvi P. High Dose Rate Interstitial Lip Brachytherapy Provides Excellent Control and Cosmesis for Patients with Lip Tumors. Brachytherapy 2018. [DOI: 10.1016/j.brachy.2018.04.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Liu C, Guo T, Xu G, Sakai A, Ren S, Fukusumi T, Ando M, Sadat S, Saito Y, Khan Z, Fisch KM, Califano J. Characterization of Alternative Splicing Events in HPV-Negative Head and Neck Squamous Cell Carcinoma Identifies an Oncogenic DOCK5 Variant. Clin Cancer Res 2018; 24:5123-5132. [PMID: 29945995 DOI: 10.1158/1078-0432.ccr-18-0752] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/29/2018] [Accepted: 06/22/2018] [Indexed: 01/26/2023]
Abstract
Purpose: Head and neck squamous cell carcinoma (HNSCC) is one of the most common cancers worldwide, and alternative splicing is considered to play important roles in tumor progression. Our study is designed to identify alternative splicing events (ASEs) in human papillomavirus (HPV)-negative HNSCC.Experimental Design: RNA sequencing data of 407 HPV-negative HNSCC and 38 normal samples were obtained from The Cancer Genome Atlas (TCGA), and splice junctions were discovered using MapSplice. Outlier analysis was used to identify significant splicing junctions between HPV-negative HNSCC and normal samples. To explore the functional role of the identified DOCK5 variant, we checked its expression with qRT-PCR in a separate primary tumor validation set and performed proliferation, migration, and invasion assays.Results: A total of 580 significant splicing events were identified in HPV-negative HNSCC, and the most common type of splicing events was an alternative start site (33.3%). The prevalence of a given individual ASE among the tumor cohort ranged from 9.8% and 64.4%. Within the 407 HPV-negative HNSCC samples in TCGA, the number of significant ASEs differentially expressed in each tumor ranged from 17 to 290. We identified a novel candidate oncogenic DOCK5 variant confirmed using qRT-PCR in a separate primary tumor validation set. Loss- and gain-of-function experiments indicated that DOCK5 variant promoted proliferation, migration, and invasion of HPV-negative HNSCC cells, and patients with higher expression of DOCK5 variant showed decreased overall survival.Conclusions: Analysis of ASEs in HPV-negative HNSCC identifies multiple alterations likely related to carcinogenesis, including an oncogenic DOCK5 variant. Clin Cancer Res; 24(20); 5123-32. ©2018 AACR.
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Affiliation(s)
- Chao Liu
- Moores Cancer Center, University of California San Diego, San Diego, California.,Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Theresa Guo
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Guorong Xu
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California San Diego, San Diego, California
| | - Akihiro Sakai
- Moores Cancer Center, University of California San Diego, San Diego, California
| | - Shuling Ren
- Moores Cancer Center, University of California San Diego, San Diego, California.,Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Takahito Fukusumi
- Moores Cancer Center, University of California San Diego, San Diego, California
| | - Mizuo Ando
- Moores Cancer Center, University of California San Diego, San Diego, California
| | - Sayed Sadat
- Moores Cancer Center, University of California San Diego, San Diego, California
| | - Yuki Saito
- Moores Cancer Center, University of California San Diego, San Diego, California
| | - Zubair Khan
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California San Diego, San Diego, California
| | - Joseph Califano
- Moores Cancer Center, University of California San Diego, San Diego, California. .,Division of Otolaryngology - Head and Neck Surgery, University of California San Diego, San Diego, California
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28
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Rajagopalan P, Patel K, Jain AP, Nanjappa V, Datta KK, Subbannayya T, Mangalaparthi KK, Kumari A, Manoharan M, Coral K, Murugan S, Nair B, Prasad TSK, Mathur PP, Gupta R, Gupta R, Khanna-Gupta A, Califano J, Sidransky D, Gowda H, Chatterjee A. Molecular alterations associated with chronic exposure to cigarette smoke and chewing tobacco in normal oral keratinocytes. Cancer Biol Ther 2018; 19:773-785. [PMID: 29723088 DOI: 10.1080/15384047.2018.1470724] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tobacco usage is a known risk factor associated with development of oral cancer. It is mainly consumed in two different forms (smoking and chewing) that vary in their composition and methods of intake. Despite being the leading cause of oral cancer, molecular alterations induced by tobacco are poorly understood. We therefore sought to investigate the adverse effects of cigarette smoke/chewing tobacco exposure in oral keratinocytes (OKF6/TERT1). OKF6/TERT1 cells acquired oncogenic phenotype after treating with cigarette smoke/chewing tobacco for a period of 8 months. We employed whole exome sequencing (WES) and quantitative proteomics to investigate the molecular alterations in oral keratinocytes chronically exposed to smoke/ chewing tobacco. Exome sequencing revealed distinct mutational spectrum and copy number alterations in smoke/ chewing tobacco treated cells. We also observed differences in proteomic alterations. Proteins downstream of MAPK1 and EGFR were dysregulated in smoke and chewing tobacco exposed cells, respectively. This study can serve as a reference for fundamental damages on oral cells as a consequence of exposure to different forms of tobacco.
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Affiliation(s)
- Pavithra Rajagopalan
- a Institute of Bioinformatics, International Tech Park , Bangalor , India.,b School of Biotechnology , Kalinga Institute of Industrial Technology , Bhubaneswar , India
| | - Krishna Patel
- a Institute of Bioinformatics, International Tech Park , Bangalor , India.,c School of Biotechnology , Amrita Vishwa Vidyapeetham , Kollam , India
| | - Ankit P Jain
- a Institute of Bioinformatics, International Tech Park , Bangalor , India.,b School of Biotechnology , Kalinga Institute of Industrial Technology , Bhubaneswar , India
| | | | - Keshava K Datta
- a Institute of Bioinformatics, International Tech Park , Bangalor , India
| | | | - Kiran K Mangalaparthi
- a Institute of Bioinformatics, International Tech Park , Bangalor , India.,c School of Biotechnology , Amrita Vishwa Vidyapeetham , Kollam , India
| | | | | | | | | | - Bipin Nair
- c School of Biotechnology , Amrita Vishwa Vidyapeetham , Kollam , India
| | - T S Keshava Prasad
- a Institute of Bioinformatics, International Tech Park , Bangalor , India.,e NIMHANS-IOB Bioinformatics and Proteomics Laboratory , Neurobiology Research Centre, National Institute of Mental Health and Neurosciences , Bangalore , India.,f Center for Systems Biology and Molecular Medicine , Yenepoya , Mangalore , India
| | - Premendu P Mathur
- b School of Biotechnology , Kalinga Institute of Industrial Technology , Bhubaneswar , India.,g Dept. of Biochemistry & Molecular Biology , School of Life Sciences, Pondicherry University , Pondicherry , India
| | - Ravi Gupta
- d Medgenome Labs Pvt. Ltd. , Bangalore , India
| | - Rohit Gupta
- d Medgenome Labs Pvt. Ltd. , Bangalore , India
| | | | - Joseph Califano
- h Department of Surgery , UC San Diego, Moores Cancer Center , La Jolla , CA , USA
| | - David Sidransky
- i Department of Otolaryngology-Head and Neck Surgery , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Harsha Gowda
- a Institute of Bioinformatics, International Tech Park , Bangalor , India
| | - Aditi Chatterjee
- a Institute of Bioinformatics, International Tech Park , Bangalor , India
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Guo T, Sakai A, Afsari B, Considine M, Danilova L, Favorov AV, Yegnasubramanian S, Kelley DZ, Flam E, Ha PK, Khan Z, Wheelan SJ, Gutkind JS, Fertig EJ, Gaykalova DA, Califano J. A Novel Functional Splice Variant of AKT3 Defined by Analysis of Alternative Splice Expression in HPV-Positive Oropharyngeal Cancers. Cancer Res 2017; 77:5248-5258. [PMID: 28733453 DOI: 10.1158/0008-5472.can-16-3106] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 05/15/2017] [Accepted: 07/11/2017] [Indexed: 12/28/2022]
Abstract
The incidence of HPV-related oropharyngeal squamous cell carcinoma (OPSCC) has increased more than 200% in the past 20 years. Recent genetic sequencing efforts have elucidated relevant genes in head and neck cancer, but HPV-related tumors have consistently shown few DNA mutations. In this study, we sought to analyze alternative splicing events (ASE) that could alter gene function independent of mutations. To identify ASE unique to HPV-related tumors, RNA sequencing was performed on 46 HPV-positive OPSCC and 25 normal tissue samples. A novel algorithm using outlier statistics on RNA-sequencing junction expression identified 109 splicing events, which were confirmed in a validation set from The Cancer Genome Atlas. Because the most common type of splicing event identified was an alternative start site (39%), MBD-seq genome-wide CpG methylation data were analyzed for methylation alterations at promoter regions. ASE in six genes showed significant negative correlation between promoter methylation and expression of an alternative transcriptional start site, including AKT3 The novel AKT3 transcriptional variant and methylation changes were confirmed using qRT-PCR and qMSP methods. In vitro silencing of the novel AKT3 variant resulted in significant growth inhibition of multiple head and neck cell lines, an effect not observed with wild-type AKT3 knockdown. Analysis of ASE in HPV-related OPSCC identified multiple alterations likely involved in carcinogenesis, including a novel, functionally active transcriptional variant of AKT3 Our data indicate that ASEs represent a significant mechanism of oncogenesis with untapped potential for understanding complex genetic changes that result in the development of cancer. Cancer Res; 77(19); 5248-58. ©2017 AACR.
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Affiliation(s)
- Theresa Guo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Akihiro Sakai
- Moores Cancer Center, University of California San Diego, San Diego, California
| | - Bahman Afsari
- Division of Oncology Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Michael Considine
- Division of Oncology Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Ludmila Danilova
- Division of Oncology Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Alexander V Favorov
- Division of Oncology Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Johns Hopkins University, Baltimore, Maryland.,Vavilov Institute of General Genetics, Moscow, Russia.,Research Institute for Genetics and Selection of Industrial Microorganisms, Moscow, Russia
| | | | - Dylan Z Kelley
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Emily Flam
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Zubair Khan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Sarah J Wheelan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - J Silvio Gutkind
- Moores Cancer Center, University of California San Diego, San Diego, California
| | - Elana J Fertig
- Division of Oncology Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Daria A Gaykalova
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Joseph Califano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland. .,Moores Cancer Center, University of California San Diego, San Diego, California.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, California
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30
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Tota JE, Anderson WF, Coffey C, Califano J, Cozen W, Ferris RL, St John M, Cohen EEW, Chaturvedi AK. Rising incidence of oral tongue cancer among white men and women in the United States, 1973-2012. Oral Oncol 2017; 67:146-152. [PMID: 28351569 DOI: 10.1016/j.oraloncology.2017.02.019] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/18/2017] [Accepted: 02/20/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite significant reductions in tobacco use in the US, oral tongue cancer incidence has reportedly increased in recent years, particularly in young white women. We conducted age-period-cohort analyses to identify birth cohorts that have experienced increased oral tongue cancer incidence, and compared these with trends for oropharyngeal cancer, a cancer caused by human papillomavirus (HPV) that has also recently increased. METHODS We utilized cancer incidence data (1973-2012) from 18 registries maintained by the NCI SEER Program. Incidence trends were evaluated using log-linear joinpoint regression and age-period-cohort modeling was utilized to simultaneously evaluate effects of age, calendar year, and birth year on incidence trends. RESULTS Incidence of oral tongue cancer increased significantly among white women during 1973-2012 (0.6% annual increase, p<0.001) and white men during 2008-2012 (5.1% annual increase, p=0.004). The increase was most apparent among younger white individuals (<50years; annual increase of 0.7% for men [p=0.02] and 1.7% for women [p<0.001] during 1973-2012). Furthermore, the magnitude of the increase during 1973-2012 was similar between young white men and women (2.3 vs. 1.8 cases per million, respectively). Incidence trends for oropharyngeal cancer were similar to trends for oral tongue cancer and similar birth cohorts (born after the 1940s) experienced rising incidence of these cancers (p-value: white men=0.12, white women=0.42), although the magnitude of increase was greater for oropharyngeal cancer. CONCLUSIONS The incidence of oral tongue and oropharyngeal cancer has significantly increased among young white men and women within the same birth cohorts in the US.
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Affiliation(s)
- Joseph E Tota
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Rockville, MD, USA.
| | - William F Anderson
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Rockville, MD, USA
| | | | | | - Wendy Cozen
- University of Southern California, Departments of Preventive Medicine and Pathology, Los Angeles, CA, USA
| | - Robert L Ferris
- University of Pittsburgh, Department of Otolaryngology, Pittsburgh, PA, USA
| | - Maie St John
- UCLA, Department of Head and Neck Surgery, UCLA Head and Neck Cancer Program, Los Angeles, CA, USA
| | | | - Anil K Chaturvedi
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Rockville, MD, USA
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Rosculet N, Zhou XC, Ha P, Tang M, Levine MA, Neuner G, Califano J. Neutrophil-to-lymphocyte ratio: Prognostic indicator for head and neck squamous cell carcinoma. Head Neck 2017; 39:662-667. [PMID: 28075517 DOI: 10.1002/hed.24658] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/09/2016] [Accepted: 10/27/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) has prognostic significance for many cancers, with higher values correlating with poor outcomes. The purpose of this study was to determine the prognostic significance of this inflammatory marker for patients with head and neck squamous cell carcinoma (HNSCC). METHODS Univariate logistic regression and multivariate Cox regression analyses were performed on a retrospective cohort of 123 patients treated with primary chemoradiotherapy. RESULTS The NLR is an indicator of both recurrence-free and overall survival, but the NLR does not have independent prognostic significance when the favorable prognostic influence of human papillomavirus (HPV) status is incorporated into multivariate models. CONCLUSION The interaction between NLR and HPV status suggests that HPV status may be a determining factor in the favorable prognosis associated with a decreased NLR in HNSCC; these findings also suggest that HPV status may interact with the prognostic associations of indicators of systemic inflammation in HNSCC. © 2017 Wiley Periodicals, Inc. Head Neck 39: 662-667, 2017.
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Affiliation(s)
| | - Xian Chong Zhou
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Patrick Ha
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Milton J. Dance Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland.,Head and Neck Oncologic Surgery, Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA
| | - Mei Tang
- Department of Oncology, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Marshall A Levine
- Department of Oncology, Greater Baltimore Medical Center, Baltimore, Maryland.,Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Geoffrey Neuner
- Department of Oncology, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Joseph Califano
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Milton J. Dance Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland.,Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of California, San Diego, CA
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Oweida A, Bhatia S, Hirsch K, Calame D, Griego A, Keysar S, Pitts T, Sharma J, Eckhardt G, Jimeno A, Wang XJ, Parkash G, Califano J, Karam SD. Ephrin-B2 overexpression predicts for poor prognosis and response to therapy in solid tumors. Mol Carcinog 2016; 56:1189-1196. [PMID: 27649287 DOI: 10.1002/mc.22574] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 09/16/2016] [Accepted: 09/16/2016] [Indexed: 12/14/2022]
Abstract
Ephrin B2 is variably expressed on tumor cells and its blockade has been shown to inhibit angiogenesis in animal models of pancreatic, colorectal, lung and head, and neck squamous cell carcinomas. However, the implications of ephrinB2 expression in cancer patients have remained elusive. In this study, we analyzed the cancer genome atlas (TCGA) for ephrinB2 expression. We report significant correlations between EFNB2 expression, overall survival and disease-free survival in head and neck squamous cell carcinoma (HNSCC, n = 519), pancreatic adenocarcinoma (n = 186), and bladder urothelial carcinoma (n = 410). In HNSCC patients, high-EFNB2 mRNA expression was associated with tumor HPV negativity, oral cavity location, alcohol intake, higher TP53 mutation, and EGFR amplification. EphrinB2 overexpression also correlated with worse response to chemotherapy and radiotherapy. The therapeutic potential of blocking ephrinB2 was validated in HNSCC patient-derived tumor xenografts and showed significant improvement in survival and tumor growth delay. Our data shows that ephrinB2 overexpression can serve as a critical biomarker for patient prognosis and response to therapy. These results should guide design of future clinical trials exploring EphrinB2 inhibition in cancer patients. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ayman Oweida
- Department of Radiation Oncology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado
| | - Shilpa Bhatia
- Department of Radiation Oncology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado
| | - Kellen Hirsch
- Department of Radiation Oncology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado
| | - Dylan Calame
- Department of Radiation Oncology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado
| | - Anastacia Griego
- Department of Radiation Oncology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado
| | - Steve Keysar
- Department of Oncology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado
| | - Todd Pitts
- Division of Medical Oncology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado
| | - Jaspreet Sharma
- Department of Radiation Oncology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado
| | - Gail Eckhardt
- Division of Medical Oncology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado
| | - Antonio Jimeno
- Department of Oncology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado
| | - Xiao Jing Wang
- Department of Pathology, Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado
| | - Gill Parkash
- Vasgene Therapeutics, Los Angeles, California.,Department of Oncology, University of Southern California, Los Angeles, Southern California
| | - Joseph Califano
- Department of Otolaryngology, University of Southern California, San Diego, Southern California
| | - Sana D Karam
- Department of Radiation Oncology, Anschutz Medical Campus, University of Colorado Denver, Denver, Colorado
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D'Souza G, Zhang Y, Merritt S, Gold D, Robbins HA, Buckman V, Gerber J, Eisele DW, Ha P, Califano J, Fakhry C. Patient experience and anxiety during and after treatment for an HPV-related oropharyngeal cancer. Oral Oncol 2016; 60:90-5. [PMID: 27531878 DOI: 10.1016/j.oraloncology.2016.06.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/16/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Diagnosis with an HPV-related oropharyngeal cancer includes unique social issues. However, it is unknown how common these psychosocial issues are for patients and whether they continue after treatment. MATERIALS AND METHODS Patients with pathologically confirmed HPV-positive oropharyngeal cancer (HPV-OPC, n=48) were recruited from two medical centers. Participants completed a computer assisted self interview that explored their psychosocial experiences during and after treatment. We examined responses overall and by age. RESULTS The majority of participants with confirmed HPV-OPC, reported being told that HPV could have (90%) or did cause (77%) their malignancy, but only 52% believed that HPV was the main cause of their OPC. Participants over 65years were less likely than younger participants to report that their doctors told them their tumor was HPV-positive (50% vs 84%, p=0.03). Anxiety that their tumor was HPV-related was a major issue among participants when first diagnosed (93%). However, only 17% still reported anxiety after treatment was complete. While many patients reported that providers discussed the emotional effects of diagnosis and treatment adequately (58%), almost half reported discussing these emotional effects inadequately (24%), or not at all (18%). Further, 18% reported that their families still wondered about some questions that they had never asked. CONCLUSION After treatment, some HPV-OPC patients remain concerned about HPV and have unanswered questions about HPV. Older patients had lower awareness of the role of HPV in their cancer.
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Affiliation(s)
- Gypsyamber D'Souza
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 North Wolfe St, Baltimore, MD 21205, United States
| | - Yuehan Zhang
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 North Wolfe St, Baltimore, MD 21205, United States
| | - Samantha Merritt
- Greater Baltimore Medical Association, Department of Otolaryngology - Head and Neck Surgery, 6701 North Charles Street, Baltimore, MD 21204, United States
| | - Dorothy Gold
- Greater Baltimore Medical Association, Department of Otolaryngology - Head and Neck Surgery, 6701 North Charles Street, Baltimore, MD 21204, United States
| | - Hilary A Robbins
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 North Wolfe St, Baltimore, MD 21205, United States
| | - Victoria Buckman
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 North Wolfe St, Baltimore, MD 21205, United States
| | - Jennifer Gerber
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 North Wolfe St, Baltimore, MD 21205, United States
| | - David W Eisele
- Johns Hopkins University, Department of Otolaryngology - Head and Neck Surgery, 601 North Caroline St, Baltimore, MD 21287, United States
| | - Patrick Ha
- Johns Hopkins University, Department of Otolaryngology - Head and Neck Surgery, 601 North Caroline St, Baltimore, MD 21287, United States; University of California San Francisco, Department of Otolaryngology - Head and Neck Surgery, 2380 Sutter St, San Francisco, CA 94115, United States
| | - Joseph Califano
- Johns Hopkins University, Department of Otolaryngology - Head and Neck Surgery, 601 North Caroline St, Baltimore, MD 21287, United States
| | - Carole Fakhry
- Johns Hopkins University, Department of Otolaryngology - Head and Neck Surgery, 601 North Caroline St, Baltimore, MD 21287, United States.
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Gaykalova DA, Kelley D, Guo T, Bohrson C, Tiscareno I, Zizkova V, Considine M, Danilova L, Flam E, Bishop J, Ahn J, Merritt S, Goldsmith M, Zhang C, Koch W, Westra W, Khan Z, Ochs M, Wheelan S, Fertig E, Califano J. Abstract 2880: The discovery of novel GSN alternative splicing in head and neck squamous cell carcinoma. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Alternative splice events (ASES) are significant components of potential oncogenic pathways alterations and play a critical role in malignant cell transformation in a variety of solid and liquid tumors, including head and neck squamous cell carcinoma (HNSCC). However, high throughput analyses performed to date have not considered ASEs. Therefore, they have detected a limited number of genetic alterations for HNSCC, which incompletely describe the HNSCC specific pathway alterations. The heterogeneous nature of these alterations has made the discovery of reliable HNSCC biomarkers and therapeutic targets for this disease challenging.
We performed alternative splice events (ASEs) analysis to enhance our understanding of HNSCC biology. To define ASEs specific to HNSCC we designed a novel bioinformatics pipeline from RNA-sequencing data of HNSCC tumors and independent normal samples. Evaluating the top scoring candidates, we have found several highly promising ASE candidates, including GSN, Gelsolin, an actin-binding protein, a key regulator of actin filament assembly and disassembly.
Previously published literature proposes that GSN demonstrates tumor-suppressor properties by reducing cell proliferation in vivo and in vitro via suppression of protein kinase C (PKC, part of the PI3K pathway which is altered in HNSCC). The alternative splicing event involves an insertion of 110 bp from the 14th intron. This insertion contains a stop codon in frame, and the splice variant gives rise to a truncated (562 amino acids(aa)) protein with only 4 Gelsolin domains (instead of the full-length 731 aa protein with 6 Gelsolin domains). Using RNA-Seq data we demonstrated that 40% of tumor samples harbor the GSN-ASE. QRT-PCR confirmed that while total expression of GSN is decreased in HNSCC samples, GSN is expressed in the alternative truncated form only in HNSCC tumors and not normal tissues. Accordingly, total GSN expression is also seen to be downregulated in breast, lung and colon cancers.
Evaluation of TCGA data confirmed the pre-dominant expression of the truncated GSN isoform over the wt GSN in HNSCC, bladder urothelial carcinoma, colon adenocarcinoma, lung SCC, breast invasive carcinoma, cervical SCC and endocervical adenocarcinoma. Moreover, we confirmed that that the expression of the truncated GSN is important for the migration and invasion of the cancer cells in vitro. These data suggest that alternative splicing plays an important role in the GSN gene for multiple tumor types.
Citation Format: Daria A. Gaykalova, Dylan Kelley, Theresa Guo, Craig Bohrson, Ilse Tiscareno, Veronika Zizkova, Michael Considine, Ludmila Danilova, Emily Flam, Justin Bishop, Julie Ahn, Samantha Merritt, Marla Goldsmith, Chi Zhang, Wayne Koch, William Westra, Zubair Khan, Michael Ochs, Sarah Wheelan, Elana Fertig, Joseph Califano. The discovery of novel GSN alternative splicing in head and neck squamous cell carcinoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2880.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Emily Flam
- 1Johns Hopkins University, Baltimore, MD
| | | | - Julie Ahn
- 1Johns Hopkins University, Baltimore, MD
| | | | | | - Chi Zhang
- 1Johns Hopkins University, Baltimore, MD
| | - Wayne Koch
- 1Johns Hopkins University, Baltimore, MD
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Waldman EH, Goldenberg D, Califano J, Sciubba J, Tunkel DE. Venous malformation of the sternomastoid muscle. Otolaryngol Head Neck Surg 2016; 135:325-7. [PMID: 16890092 DOI: 10.1016/j.otohns.2005.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Accepted: 04/04/2005] [Indexed: 11/16/2022]
Affiliation(s)
- Erik H Waldman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
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36
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Fakhry C, Qualliotine JR, Zhang Z, Agrawal N, Gaykalova DA, Bishop JA, Subramaniam RM, Koch WM, Chung CH, Eisele DW, Califano J, Viscidi RP. Serum Antibodies to HPV16 Early Proteins Warrant Investigation as Potential Biomarkers for Risk Stratification and Recurrence of HPV-Associated Oropharyngeal Cancer. Cancer Prev Res (Phila) 2015; 9:135-41. [PMID: 26701665 DOI: 10.1158/1940-6207.capr-15-0299] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/24/2015] [Indexed: 01/30/2023]
Abstract
Human papillomavirus (HPV) is responsible for increasing incidence of oropharyngeal cancer. At present, there are no biomarkers in the surveillance algorithm for HPV-positive oropharyngeal cancer (HPV-OPC). HPV16 E6 antibody precedes oropharyngeal cancer diagnosis. If HPV16 E6 indeed precedes primary diagnosis, it is similarly expected to precede disease recurrence and may have a potential role as a biomarker for surveillance of HPV-OPC. To determine whether HPV antibody titers have a potential role as early markers of disease recurrence or prognosis, a retrospective pilot study was designed to determine whether HPV16 early antibody titers E6, E7, E1, and E2 decrease after treatment of HPV16-positive OPC. Trends in pretreatment, early (≤6 months after treatment), and late posttreatment (>6 months after treatment) HPV16 antibody titers were examined. There were 43, 34, and 52 subjects with serum samples available for pretreatment, early, and late posttreatment intervals. Mean pretreatment antibody levels were higher than posttreatment antibody levels. Average antibody levels decreased significantly over time for E6 (Ptrend = 0.001) and E7 (Ptrend < 0.001). Six disease recurrences were observed during the follow-up period (median, 4.4 years). In univariate analysis, a log-unit increase in pretreatment E6 titer was significantly associated with increased risk of disease recurrence (HR, 5.42; 95% CI, 1.1-25.7; P = 0.03). Therefore, levels of antibodies to HPV16 early oncoproteins decline after therapy. Higher E6 titers at diagnosis are associated with significant increases in the risk of recurrence. These data support the prospective evaluation of HPV16 antibodies as markers of surveillance and for risk stratification at diagnosis.
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Affiliation(s)
- Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jesse R Qualliotine
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zhe Zhang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishant Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daria A Gaykalova
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin A Bishop
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rathan M Subramaniam
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wayne M Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine H Chung
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Califano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Raphael P Viscidi
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Michailidi C, Noordhuis M, Hadar T, Marchioni L, Fertig E, Agrawal N, Westra W, Koch W, Califano J, Velculescu V, Sidransky D, Guerrero-Preston R. Abstract B1-62: Bumphunting analysis identifies PAX5 promoter methylation and p53 somatic mutations in genomic instability pathways linked to very poor survival in head and neck cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.compsysbio-b1-62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
For years studies have attempted to come up with measures and markers that predict and are linked to cancer survival. Alterations in a subgroup of genes, tumor suppressor genes (TSG), have recently emerged as important in linkage to cancer survival, particularly the silencing that can occur by somatic mutations and promoter DNA methylation. However, the link between TSG silencing and cancer survival is not well understood. If we can understand how TSG silencing is molecularly linked to cancer survival we can improve clinical management and pave the wave for personalized treatment solutions. Head and neck squamous cell carcinoma (HNSCC) is one of the first tumors in which independent somatic mutations and promoter DNA methylation events were shown to inactivate the same gene, CDKN2a, a well-known TSG. HNSCC is also a tumor in which the linkage between causative agents, molecular alterations, and signaling pathways has been studied. We performed an integrated molecular analysis using methylation sequencing, exome sequencing, mRNA expression, and qMSP platforms in 250 HNSCC samples. Our findings were subsequently validated in 517 samples from The Cancer Genome Atlas (TCGA) project.
We uncovered differentially methylated regions and somatic mutations in differentiation and proliferation pathways linked to genomic instability. We uncovered downregulated genes harboring cancer specific promoter methylation including PAX1 and PAX5 and we identified tumor suppressor genes in differentiation and proliferation pathways (HOXC12, CDKN2A, PAX1, PIK3AP1, and HOXC6) inactivated by both promoter methylation and/or somatic mutation in HNSCC. We also found evidence of interplay between mutations in the TP53 and NOTCH1 pathways with gene downregulation associated to PAX5 and PAX1 promoter methylation in HNSCC. Survival analyses revealed that patients with PAX5 (p= 0.001) or NID2 (p=0.05) promoter methylation had a worse outcome than those without it. In subsequent analyses of TCGA data we confirmed that patients with PAX5 methylation had worse survival than those without it (p=0.02). We also found that combined somatic TP53 mutations and PAX5 promoter methylation are linked to worse outcomes when compared to patients with either alteration alone (p<0.012). The next step is to examine the association between survival and combined somatic TP53 mutations and PAX5 promoter methylation in the major HNSCC anatomic subsites: oral cavity, oropharynx and pharynx. This research will be followed by systematic functional studies in short term cultures from patient derived tumorgrafts to obtain a better understanding of sub-site specific molecular and pathways alterations in HNSCC.
Genomic and post-genomic research has shifted to focus on biomarker discovery for diagnosis, prognosis and prediction of treatment response, alongside the development of targeted therapies, with the ultimate goal of creating early detection and personalized therapy for HNSCC. Genetic, epigenetic and molecular advances are revealing new links between TSG silencing and survival in pathways involved in the development and progression of HNSCC. These advances are creating new opportunities to enable increased treatment choices and reduce survival disparities in HNSCC. Similar approaches are being implemented in other tumors.
Citation Format: Christina Michailidi, Maartje Noordhuis, Tal Hadar, Luigi Marchioni, Elana Fertig, Nishant Agrawal, William Westra, Wayne Koch, Joseph Califano, Victor Velculescu, David Sidransky, Rafael Guerrero-Preston. Bumphunting analysis identifies PAX5 promoter methylation and p53 somatic mutations in genomic instability pathways linked to very poor survival in head and neck cancer. [abstract]. In: Proceedings of the AACR Special Conference on Computational and Systems Biology of Cancer; Feb 8-11 2015; San Francisco, CA. Philadelphia (PA): AACR; Cancer Res 2015;75(22 Suppl 2):Abstract nr B1-62.
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Affiliation(s)
| | | | - Tal Hadar
- Johns Hopkins University, Baltimore, MD
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Taghipour M, Marcus C, Califano J, Fakhry C, Subramaniam RM. The value of follow-up FDG-PET/CT in the management and prognosis of patients with HPV-positive oropharyngeal squamous cell carcinoma. J Med Imaging Radiat Oncol 2015; 59:681-6. [DOI: 10.1111/1754-9485.12354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Mehdi Taghipour
- Russell H Morgan Department of Radiology and Radiological Sciences; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Charles Marcus
- Russell H Morgan Department of Radiology and Radiological Sciences; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Joseph Califano
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Carole Fakhry
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore MD USA
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | - Rathan M Subramaniam
- Russell H Morgan Department of Radiology and Radiological Sciences; Johns Hopkins Medical Institutions; Baltimore MD USA
- Department of Otolaryngology and Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore MD USA
- Department of Oncology; Johns Hopkins Medical Institutions; Baltimore MD USA
- Department of Health Policy and Management; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
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Hauser B, Zhao Y, Pang X, Ling Z, Myers E, Wang P, Califano J, Gu X. Functions of MiRNA-128 on the regulation of head and neck squamous cell carcinoma growth and apoptosis. PLoS One 2015; 10:e0116321. [PMID: 25764126 PMCID: PMC4357443 DOI: 10.1371/journal.pone.0116321] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/08/2014] [Indexed: 02/06/2023] Open
Abstract
Background Incidence of head and neck squamous cell carcinoma (HNSCC) has continuously increased in past years while its survival rate has not been significantly improved. There is a critical need to better understand the genetic regulation of HNSCC tumorigenesis and progression. In this study, we comprehensively analyzed the function of miRNA-128 (miR-128) in the regulation of HNSCC growth and its putative targets in vitro and in vivo systems. Methods The function and targets of miR-128 were investigated in human HNSCC cell lines (JHU-13 and JHU-22), which were stably transfected with the miR-128 gene using a lentiviral delivery system. The expression levels of miR-128 and its targeted proteins were analyzed with qRT-PCR, Western blotting and flow cytometry. The binding capacity of miRNA-128 to its putative targets was determined using a luciferase report assay. MTT, colony formation, and a tumor xenograft model further evaluated the effects of miR-128 on HNSCC growth. Results We generated two miR-128 stably transfected human HNSCC cell lines (JHU-13miR-128 and JHU-22miR-128). Enforced expression of miR-128 was detected in both cultured JHU-13miR-128 and JHU-22miR-128 cell lines, approximately seventeen to twenty folds higher than in vector control cell lines. miRNA-128 was able to bind with the 3′-untranslated regions of BMI-1, BAG-2, BAX, H3f3b, and Paip2 mRNAs, resulting in significant reduction of the targeted protein levels. We found that upregulated miR-128 expression significantly inhibited both JHU-13miR-128 and JHU-22miR-128 cell viability approximately 20 to 40%, and the JHU-22miR-128 tumor xenograft growth compared to the vector control groups. Conclusions miR-128 acted as a tumor suppressor inhibiting the HNSCC growth by directly mediating the expression of putative targets. Our results provide a better understanding of miRNA-128 function and its potential targets, which may be valuable for developing novel diagnostic markers and targeted therapy.
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Affiliation(s)
- Belinda Hauser
- Department of Genetics and Human Genetics, Howard University, Washington, DC, United States of America
| | - Yuan Zhao
- Department of Oral Pathology, Howard University, Washington DC, United States of America
| | - Xiaowu Pang
- Department of Oral Pathology, Howard University, Washington DC, United States of America
| | | | - Ernest Myers
- Department of Otolaryngology-Head and Neck Surgery, Howard University, Washington, DC, United States of America
| | - Paul Wang
- Department of Radiology, Howard University, Washington DC, United States of America
- Cancer Center, Howard University, Washington, District of Columbia, United States of America
| | - Joseph Califano
- Departments of Otolaryngology-Head and Neck Surgery, and Head & Neck Research Division, Johns Hopkins University, Baltimore, Maryland, United states of America
| | - Xinbin Gu
- Department of Genetics and Human Genetics, Howard University, Washington, DC, United States of America
- Department of Oral Pathology, Howard University, Washington DC, United States of America
- Cancer Center, Howard University, Washington, District of Columbia, United States of America
- * E-mail:
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Rettig EM, Chung CH, Bishop JA, Howard JD, Sharma R, Li RJ, Douville C, Karchin R, Izumchenko E, Sidransky D, Koch W, Califano J, Agrawal N, Fakhry C. Cleaved NOTCH1 Expression Pattern in Head and Neck Squamous Cell Carcinoma Is Associated with NOTCH1 Mutation, HPV Status, and High-Risk Features. Cancer Prev Res (Phila) 2015; 8:287-95. [PMID: 25633867 DOI: 10.1158/1940-6207.capr-14-0366] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/15/2015] [Indexed: 12/21/2022]
Abstract
The Notch pathway is frequently altered in head and neck squamous cell carcinomas (HNSCC); however, the clinical significance of NOTCH1 dysregulation is poorly understood. This study was designed to characterize expression of the transcriptionally active NOTCH1 intracellular domain (NICD1) in HNSCCs and evaluate its association with NOTCH1 mutation status and clinical parameters. IHC for NICD1 was performed on 79 previously sequenced archival HNSCCs with known NOTCH1 mutation status. Three distinct immunohistochemical staining patterns were identified: positive/peripheral (47%), positive/nonperipheral (34%), and negative (19%). NICD1 expression was associated with NOTCH1 mutation status (P < 0.001). Most NOTCH1-wild-type tumors were peripheral (55%), whereas mutated NOTCH1 tumors were most commonly negative (47%). Nonperipheral tumors were more likely than peripheral tumors to have extracapsular spread [adjusted odds ratio (aOR), 16.01; 95% confidence interval (CI), 1.92-133.46; P = 0.010] and poor differentiation (aOR, 5.27; 95% CI, 0.90-30.86; P = 0.066). Negative staining tumors tended to be poorly differentiated (aOR, 24.71; 95% CI, 1.53-399.33; P = 0.024) and were less likely to be human papillomavirus (HPV) positive (aOR, 0.043; 95% CI, 0.001-1.59; P = 0.087). NOTCH1 mutagenesis was significantly associated with HPV status, with NOTCH1-wild-type tumors more likely to be HPV positive than NOTCH1-mutated tumors (aOR, 19.06; 95% CI, 1.31-276.15; P = 0.031). TP53 disruptive mutations were not associated with NICD1 expression or NOTCH1 mutation. In conclusion, NICD1 is expressed in three distinct patterns in HNSCC that are significantly associated with high-risk features. These findings further support a dual role for NOTCH1 as both tumor suppressor and oncogene in HNSCC. Further research is necessary to clarify the role of NOTCH1 in HNSCC and understand the clinical and therapeutic implications therein.
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MESH Headings
- Biomarkers, Tumor
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/virology
- Female
- Follow-Up Studies
- Head and Neck Neoplasms/genetics
- Head and Neck Neoplasms/metabolism
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/virology
- Humans
- Immunoenzyme Techniques
- Male
- Middle Aged
- Mutation/genetics
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/virology
- Neoplasm Staging
- Papillomaviridae/genetics
- Papillomavirus Infections/genetics
- Papillomavirus Infections/metabolism
- Papillomavirus Infections/pathology
- Papillomavirus Infections/virology
- Prognosis
- Receptor, Notch1/genetics
- Receptor, Notch1/metabolism
- Retrospective Studies
- Risk Factors
- Tumor Suppressor Protein p53
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Affiliation(s)
- Eleni M Rettig
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine H Chung
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin A Bishop
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - Jason D Howard
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rajni Sharma
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins Medicine, Baltimore, Maryland
| | - Ryan J Li
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher Douville
- Johns Hopkins Institute for Computational Medicine and Department of Biomedical Engineering, Baltimore, Maryland
| | - Rachel Karchin
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Johns Hopkins Institute for Computational Medicine and Department of Biomedical Engineering, Baltimore, Maryland
| | - Evgeny Izumchenko
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Sidransky
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wayne Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Califano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Milton J. Dance Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Nishant Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Johns Hopkins University School of Medicine Ludwig Center for Cancer Genetics and Therapeutics, Baltimore, Maryland.
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Milton J. Dance Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Choudhary A, Mambo E, Sanford T, Boedigheimer M, Twomey B, Califano J, Hadd A, Oliner KS, Beaudenon S, Latham GJ, Adai AT. Evaluation of an integrated clinical workflow for targeted next-generation sequencing of low-quality tumor DNA using a 51-gene enrichment panel. BMC Med Genomics 2014; 7:62. [PMID: 25395014 PMCID: PMC4241214 DOI: 10.1186/s12920-014-0062-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 10/22/2014] [Indexed: 12/21/2022] Open
Abstract
Background Improvements in both performance and cost for next-generation sequencing (NGS) have spurred its rapid adoption for clinical applications. We designed and optimized a pan-cancer target-enrichment panel for 51 well-established oncogenes and tumor suppressors, in conjunction with a bioinformatic pipeline informed by in-process controls and pre- and post-analytical quality control measures. Methods The evaluation of this workflow consisted of sequencing mixtures of intact DNA to establish analytical sensitivity and precision, utilization of heuristics to identify systematic artifacts, titration studies of intact and FFPE samples for input optimization, and incorporation of orthogonal sequencing strategies to increase both positive predictive value and variant detection. We also used 128 FFPE samples to assess clinical accuracy and incorporated the previously described quantitative functional index (QFI) for sample qualification as part of detailing complete system performance. Results We observed a concordance correlation coefficient of 0.99 between the observed versus expected percent variant at 250 ng input across 4 independent sequencing runs. A subset of the systematic variants were confirmed to be barely detectable on an independent sequencing platform (Wilcox signed-rank test p-value <10−16), and the incorporation of orthogonal sequencing strategies increased the harmonic mean of sensitivity and positive predictive value of mutation detection by 41%. In one cohort of FFPE tumor samples, coverage and inter-platform concordance were positively correlated with the QFI, emphasizing the need for pre-analytical sample quality control to reduce the risk of false positives and negatives. In a separate cohort of FFPE samples, the 51-gene panel achieved 78% sensitivity (95% CI = 56.3, 92.5) with 100% PPV (95% CI = 81.5, 100.0) based on known mutations at 7.9% median abundance. By sequencing specimens using an orthogonal NGS technology, sensitivity was improved to 87.0% (95% CI = 66.4,97.2) while maintaining PPV. Conclusions The results highlight the value of process integration in a comprehensive targeted NGS system, enabling both discovery and diagnostic applications, particularly when sequencing low-quality cancer specimens. Electronic supplementary material The online version of this article (doi:10.1186/s12920-014-0062-0) contains supplementary material, which is available to authorized users.
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Weed DT, Vella JL, Reis IM, De la Fuente AC, Gomez C, Sargi Z, Nazarian R, Califano J, Borrello I, Serafini P. Tadalafil reduces myeloid-derived suppressor cells and regulatory T cells and promotes tumor immunity in patients with head and neck squamous cell carcinoma. Clin Cancer Res 2014; 21:39-48. [PMID: 25320361 DOI: 10.1158/1078-0432.ccr-14-1711] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Myeloid-derived suppressor cells (MDSC) and regulatory T cells (Treg) play a key role in the progression of head and neck squamous cell carcinoma (HNSCC). On the basis of our preclinical data demonstrating that phosphodiesterase-5 (PDE5) inhibition can modulate these cell populations, we evaluated whether the PDE5 inhibitor tadalafil can revert tumor-induced immunosuppression and promote tumor immunity in patients with HNSCC. EXPERIMENTAL DESIGN First, we functionally and phenotypically characterized MDSCs in HNSCCs and determined, retrospectively, whether their presence at the tumor site correlates with recurrence. Then, we performed a prospective single-center, double-blinded, randomized, three-arm study in which patients with HNSCC undergoing definitive surgical resection of oral and oropharyngeal tumors were treated with tadalafil 10 mg/day, 20 mg/day, or placebo for at least 20 days preoperatively. Blood and tumor MDSC and Treg presence and CD8(+) T-cell reactivity to tumor antigens were evaluated before and after treatment. RESULTS MDSCs were characterized in HNSCC and their intratumoral presence significantly correlates with recurrence. Tadalafil treatment was well tolerated and significantly reduced both MDSCs and Treg concentrations in the blood and in the tumor (P < 0.05). In addition, the concentration of blood CD8(+) T cells reactive to autologous tumor antigens significantly increased after treatment (P < 0.05). Tadalafil immunomodulatory activity was maximized at an intermediate dose but not at higher doses. Mechanistic analysis suggests a possible off-target effect on PDE11 at high dosages that, by increasing intracellular cAMP, may negatively affect antitumor immunity. CONCLUSIONS Tadalafil seems to beneficially modulate the tumor micro- and macro-environment in patients with HNSCC by lowering MDSCs and Tregs and increasing tumor-specific CD8(+) T cells in a dose-dependent fashion.
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Affiliation(s)
- Donald T Weed
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Jennifer L Vella
- Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Isildinha M Reis
- Department of Public Health Sciences and Sylvester Biostatistics and Bioinformatics Core Resource, University of Miami, Miller School of Medicine, Miami, Florida
| | - Adriana C De la Fuente
- Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Carmen Gomez
- Department of Pathology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Zoukaa Sargi
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Ronen Nazarian
- Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Joseph Califano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.,Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Ivan Borrello
- Oncology Department, Johns Hopkins University, Baltimore, Maryland
| | - Paolo Serafini
- Department of Microbiology and Immunology, University of Miami, Miller School of Medicine, Miami, Florida
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Guerrero-Preston R, Michailidi C, Marchionni L, Pickering C, Frederick M, Myers J, Yegnasubramanian S, Hadar T, Noordhuis M, Fertig E, Agrawal N, Westra W, Koch W, Califano J, Velculescu V, Sidransky D. Abstract 2482: Key tumor suppressor genes inactivated by promoter methylation and somatic mutations in head and neck cancer. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The number of known mutations and specific mutational hotspots in Head and Neck Squamous Cell Carcinomas (HNSCCs) only partially explain their biological complexity and limit the development of novel diagnostic markers and therapeutic agents. Tumor suppressor genes (TSGs) are commonly inactivated by somatic mutation and/or promoter hypermethylation yet recent high throughput genomic studies have not identified key TSGs inactivated by both mechanisms. Our aim was to perform a detailed genome wide analysis of the HNSCC methylome to study expression alterations associated with differential methylation patterns in the greater promoter region, focusing on key TSGs also inactivated by somatic mutations.
Methylation Binding Domain Sequencing (MBD-seq), 450K Methylation arrays, whole exome sequencing and whole genome gene expression arrays in 41 primary HNSCC tumors and 16 matched uvulopalatopharyngoplasty tissue samples (UPPPs) were assessed. Results were validated in an independent cohort of 76 tumors and 19 UPPPs using quantitative methylation specific PCR (qMSP) and Sanger sequencing. A second external validation using 279 samples from the TCGA project was also performed.
The integrated molecular analysis identified 186 downregulated genes harboring cancer specific promoter methylation including PAX1 and PAX5 and 10 key tumor suppressor genes inactivated by both promoter methylation and/or somatic mutation. PAX1, ZIC4, PLCB1 and PAX5 were selected for validation. Methylation frequencies in all of them could distinguish tumor from UPPP samples (PAX1, p <0.0001; ZIC4, p<0.0001; PLCB1, p<0.001; PAX5, p <0.0001). A gene panel combining promoter methylation results for these four genes had 96% sensitivity, 94% specificity, a 0.97 AUC and a PPV of 98.5%. Among the novel TSGs discovered with dual mechanisms of inactivation, a high frequency of genomic and epigenomic alterations was observed in the PAX gene family of transcription factors, which selectively impact canonical NOTCH and TP53 pathways to determine cell fate, cell survival, and genome maintenance.
To our knowledge, our study consist the first detailed genome wide analysis of the HNSCC methylome covering expression alterations associated with differential methylation patterns in the greater promoter region, on key TSGs also inactivated by somatic mutations. Characterization of the complete HNSCC methylome has contributed insights into the clustering of specific genetic and epigenetic events, and highlights the importance of understanding the relative contribution of each to the overall frequency of TSG inactivation. Understanding the complete contribution of genomic and epigenomic alterations to specific genes and pathways in cancer will reveal novel high frequency specific markers for better risk assessment and can highlight the true frequency of therapeutic pathways to better target the disease at the molecular level.
Citation Format: Rafael Guerrero-Preston, Christina Michailidi, Luigi Marchionni, Curtis Pickering, Mitchell Frederick, Jeffrey Myers, Srinivasan Yegnasubramanian, Tal Hadar, Maartje Noordhuis, Elana Fertig, Nishant Agrawal, William Westra, Wayne Koch, Joseph Califano, Victor Velculescu, David Sidransky. Key tumor suppressor genes inactivated by promoter methylation and somatic mutations in head and neck cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2482. doi:10.1158/1538-7445.AM2014-2482
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Affiliation(s)
| | | | | | | | | | | | | | - Tal Hadar
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Elana Fertig
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - William Westra
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wayne Koch
- 1Johns Hopkins University School of Medicine, Baltimore, MD
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Loyo M, Kagohara LT, Sun W, Tan M, Fertig E, Ochs M, Izumchenko E, Brait M, Califano J, Sidransky D. Abstract 527: Analysis of the interaction between microRNAs and Notch pathway members in HNSCC (head and neck squamous cell carcinoma). Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Head and neck squamous cell carcinomas (HNSCC) have poor prognosis due in part to diagnosis in advanced stages. Also, little progress on treatment modalities has been observed in the last decades. Identification of early detection molecular markers and new targets for therapy can bring important benefits for HNSCC patients’ survival. Recently, inactivating mutations in the NOTCH1 gene were described as the most frequent after TP53, suggesting an important role of this gene as a tumor suppressor in HNSCC. Another important alteration for HNSCC tumorigenesis is the de-regulated expression of microRNAs (miRs), small molecules known to negatively regulate their target mRNAs. Many studies trying to understand the biogenesis and mechanisms of miRs on gene expression regulation have proved this class of nucleic acids to be a good target for the identification of new biomarkers. In this study, we evaluate possible interactions between miR and the Notch pathway in HNSCC. To identify differentially expressed genes from Notch pathway and those miRs predicted to target components from this pathway, we performed mRNA and miR expression profiling of 44 HNSCC samples and 25 normal samples. Expression patterns were then validated in an independent cohort of 55 HNSCC tumors and 18 normal samples, using qRT-PCR. Microarray data analysis showed significant altered expression of 3 Notch pathway components: up-regulation of JAG1 and MAML1, and down-regulation of NUMBL. After identification of differentially expressed miRs, using online prediction tools, we selected the miRs expected to regulate these genes: miR-23a (MAML1), miR-26a (JAG1, MAML1), miR-146a (NUMBL), and let-7g (NUMBL). All four miRs were down-regulated in the 20 HN cell lines evaluated. Expression analysis in the independent cohort confirmed up-regulation of JAG1 in tumors. miRs expression evaluation confirmed miR-23a up-regulation in HNSCC samples. Forced expression of miR-23a (mimic) resulted in reduced cell proliferation in HN cancer cell lines. Our results suggest that miR-23a plays an important role in HNSCC and may be participating in Notch pathway regulation. To assess this interaction, mRNA expression analysis of members of Notch pathway before and after miR-23a overexpression on the cell lines is ongoing. We are also underway of comparing all the molecular changes observed in the HNSCC samples to demographic and clinicopathological variables to further evaluate Notch pathway alterations as well as miRs as potential HNSCC molecular markers.
Citation Format: Myriam Loyo, Luciane T. Kagohara, Wenyue Sun, Marietta Tan, Elana Fertig, Michael Ochs, Evgeny Izumchenko, Mariana Brait, Joseph Califano, David Sidransky. Analysis of the interaction between microRNAs and Notch pathway members in HNSCC (head and neck squamous cell carcinoma). [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 527. doi:10.1158/1538-7445.AM2014-527
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Guerrero-Preston RE, Michailidi C, Jedlicka A, Thangavel R, Hadar T, Nordhuis MG, Westra W, Koch W, Califano J, Sidransky D. Abstract 870: 16S rRNA saliva analysis unveils microbiome biomonitors linked to human papilloma virus and oropharyngeal squamous cell carcinoma. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Microbiota markers in saliva able to distinguish HPV positive from HPV negative Head and Neck Squamous Cell Carcinoma (HNSCC) patients, as well as HNSCC patients from controls, will enable increases in treatment options, reductions in treatment costs and improvements in survival rates. In the present study we compared the microbiota present in saliva DNA from HPV positive and HPV negative oropharyngeal cancer (OPSCC) patients to saliva DNA from uvulopalatopharyngoplasty (UPPP) patients, used as normal oral mucosa controls.
PCR amplification of the 16S rRNA V3-V5 gene region was performed using the 357F/926R primer set. Amplified fragments were multiplexed on the Roche/454 GS Junior sequencing platform. Data were screened for chimeric sequences and contaminant chloroplast DNA after pre-processing. Passing sequences were characterized for diversity and taxonomic composition using QIIME and R before cross-tabulation analyses were performed.
Bacteroidetes, Firmicutes, and Proteobacteria dominated the microbiome in our sample set with less frequent presence of Actinobacteria and Fusobacteria members. At lower taxonomic levels, the most abundant genera observed were Streptococcus, Prevotella and Veillonella. We found statistically significant associations in the alpha-diversity estimators of UPPP and OPSCC patients. Specifically, the microbiota communities present in UPPP are significantly enriched in the observed_species category (P<0.001). The raw number of operational taxonomic units (OTUs) was also significantly higher in UPPP when compared to OPSCC patients (p=0.02). Specifically, a threshold of 80 OTUs was enough to discriminate UPPP from OPSCC patients.
At the phylum level, we did not detect a significant difference in taxa of UPPP and OPSCC patients. Yet at the family level, the taxon Fusobacteriales_Leptotrichiaceae is dramatically enriched in UPPP samples when compared to OPSCC (p=0.02) and is present in very high numbers in all UPPP samples. A threshold of 10 sequences assigned to Fusobacteriales_Leptotrichiaceae discriminated UPPP from OPSCC patients. At the genera level we found that the genus Tannerella is exclusively observed in UPPP patients (p=0.03).
At the class level, Bacteroidetes_Flavobacteria appears significantly enriched in HPV- when compared to HPV+ OPSCC patients (p=0.02). A threshold of 5 sequences assigned to Flavobacteria discriminated HPV+ from HPV- OPSCC patients. At the class level, we also observed enrichment of the taxon Bacteroidetes_Flavobacteria in UPPP relative to OPSCC HPV+ patients (p=0.03). And at the genus level, the low-level presence of Aerococcaceae_Abiotrophia discriminated UPPP from OPSCC HPV+ patients (p=0.02).
Our preliminary results suggest that the microbial diversity and taxonomic composition of the microbiota in saliva may be useful diagnostic and early detection biomonitors for OPSCC.
Citation Format: Rafael E. Guerrero-Preston, Christina Michailidi, Anne Jedlicka, Rajagowthamee Thangavel, Tal Hadar, Maartje G. Nordhuis, William Westra, Wayne Koch, Joseph Califano, David Sidransky. 16S rRNA saliva analysis unveils microbiome biomonitors linked to human papilloma virus and oropharyngeal squamous cell carcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 870. doi:10.1158/1538-7445.AM2014-870
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Affiliation(s)
| | | | - Anne Jedlicka
- 2Johns Hopkins University School of Public Health, Baltimore, MD
| | | | - Tal Hadar
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - William Westra
- 1Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wayne Koch
- 1Johns Hopkins University School of Medicine, Baltimore, MD
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46
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Wang SJ, Sciubba JJ, Silverman S, Califano J, Richmon JD. Cancer, Canker Sores, and More: High-Risk Oral Cavity Lesions. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Program Description: The myriad lesions that present in the oral cavity can stymie even the most astute otolaryngologist. These may span from the most benign, such as recurrent canker sores, to more ominous malignancies, often with very similar appearances. Furthermore, various systemic illnesses such as Sjogren disease, lichen planus, Crohn disease, lupus, and nutritional deficiencies may present with vexing oral cavity lesions. This evidence-based miniseminar supported by the American Academy of Otolaryngology—Head and Neck Surgery Head and Neck Surgery & Oncology Committee will explore the differential diagnoses, workup, and management of a spectrum of oral lesions as well as early-stage oral cavity cancer. Educational Objectives: (1) Describe and identify some of the more unusual oral conditions that present to the otolaryngologist. (2) Identify signs and symptoms of systemic illness in the oral cavity. (3) Examine the management of premalignant oral lesions, the role for screening and biopsy, and the appropriate workup and surgical management of early oral cancer.
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Akst LM, Altman KW, Burns JA, Califano J, Quon H, Remacle MJ. Vocal Fold Leukoplakia: Controversies in Evaluation and Treatment. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814538403a55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Program Description: This miniseminar comprehensively reviews evaluation and management of laryngeal leukoplakia. Although white vocal fold lesions are common, management remains challenging. Doing too little may allow precancerous lesions to progress, while doing too much may create unnecessary dysphonia. Within a framework balancing oncologic with functional outcomes, and using case-based presentations, this miniseminar highlights challenges, controversies, and emerging paradigms in laryngeal leukoplakia care. Perspectives from laryngology, head and neck oncology, and radiation oncology will discuss innovations such as narrow-band imaging, optical coherence tomography, potassium titanyl phosphate (KTP) and CO2 laser, chemotherapy, radiotherapy, and photodynamic therapy as they apply to current and future state-of-the-art management. Educational Objectives: (1) Understand the risk of progression of laryngeal leukoplakia to carcinoma and need to balance oncologic efficacy with functional outcomes in leukoplakia care. (2) Review current and emerging techniques for accurate diagnosis, staging, and surveillance of laryngeal leukoplakia. (3) Discuss treatment alternatives for laryngeal leukoplakia, emphasizing surgical techniques of KTP, CO2, and cold-instrument phonosurgery and including potential roles of radiotherapy, photodynamic therapy, and chemotherapy.
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Li R, Faden DL, Fakhry C, Langelier C, Jiao Y, Wang Y, Wilkerson MD, Pedamallu CS, Old M, Lang J, Loyo M, Ahn SM, Tan M, Gooi Z, Chan J, Richmon J, Wood LD, Hruban RH, Bishop J, Westra WH, Chung CH, Califano J, Gourin CG, Bettegowda C, Meyerson M, Papadopoulos N, Kinzler KW, Vogelstein B, DeRisi JL, Koch WM, Agrawal N. Clinical, genomic, and metagenomic characterization of oral tongue squamous cell carcinoma in patients who do not smoke. Head Neck 2014; 37:1642-9. [PMID: 24954188 DOI: 10.1002/hed.23807] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/19/2014] [Accepted: 06/18/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Evidence suggests the incidence of oral tongue squamous cell carcinoma is increasing in young patients, many who have no history of tobacco use. METHODS We clinically reviewed 89 patients with oral tongue cancer. Exomic sequencing of tumor DNA from 6 nonsmokers was performed and compared to previously sequenced cases. RNA from 20 tumors was evaluated by massively parallel sequencing to search for potentially oncogenic viruses. RESULTS Non-smokers (53 of 89) were younger than smokers (36 of 89; mean, 50.4 vs 61.9 years; p < .001), and seemed more likely to be women (58.5% vs 38.9%; p = .069). Nonsmokers had fewer TP53 mutations (p = .02) than smokers. No tumor-associated viruses were detected. CONCLUSION The young age of nonsmoking patients with oral tongue cancer and fewer TP53 mutations suggest a viral role in this disease. Our efforts to identify such a virus were unsuccessful. Further studies are warranted to elucidate the drivers of carcinogenesis in these patients.
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Affiliation(s)
- Ryan Li
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel L Faden
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Chaz Langelier
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Yuchen Jiao
- The Ludwig Center and the Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland
| | - Yuxuan Wang
- The Ludwig Center and the Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland
| | - Matthew D Wilkerson
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Chandra Sekhar Pedamallu
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Matthew Old
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio
| | - James Lang
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio
| | - Myriam Loyo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sun Mi Ahn
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marietta Tan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zhen Gooi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason Chan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeremy Richmon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura D Wood
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Ralph H Hruban
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Justin Bishop
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - William H Westra
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Christine H Chung
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Califano
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Meyerson
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Nickolas Papadopoulos
- The Ludwig Center and the Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland
| | - Kenneth W Kinzler
- The Ludwig Center and the Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland
| | - Bert Vogelstein
- The Ludwig Center and the Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland
| | - Joseph L DeRisi
- Howard Hughes Medical Institute, Chevy Chase, Maryland.,Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California
| | - Wayne M Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishant Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,The Ludwig Center and the Howard Hughes Medical Institute at Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland
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Fakhry C, Agrawal N, Califano J, Messing B, Liu J, Saunders J, Ha P, Coquia S, Hamper U, Gillison M, Blanco R. The use of ultrasound in the search for the primary site of unknown primary head and neck squamous cell cancers. Oral Oncol 2014; 50:640-5. [PMID: 24819862 DOI: 10.1016/j.oraloncology.2014.03.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/12/2014] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although human papillomavirus detection in cervical lymph nodes of head and neck squamous cell cancers (HNSCC) of unknown primary site (UP) is indicative of a primary tumor of the oropharynx (OP), localization can remain elusive. Therefore, we investigated ultrasonography (US) for the identification of the primary tumor. METHODS Eligible cases had HNSCC of UP after evaluation by a head and neck surgical oncologist. Controls were healthy volunteers. Transcervical and intraoral ultrasonography was performed by a standard protocol using convex (3.75-6.0 MHz and 5-7.5 MHz) transducers. US findings were compared with operative examination (exam under anesthesia, direct laryngoscopy) and biopsies. The primary outcome of interest was the presence or absence of a lesion on US. RESULTS 10 cases and 20 controls were enrolled. PET/CT scans were negative/nonspecific (9), or suspicious (1) for a primary lesion. On US, predominantly hypoechoic (9 of 10) lesions were visualized consistent with base of tongue (n=7) or tonsil (n=3) primary tumors. On operative examination, 5 of 10 were appreciated. Two additional primaries were confirmed with biopsies "directed" by preoperative US. This represents an overall diagnostic rate of 70%, which is 20% higher than our detection rate for 2008-2010. The three cases in which a suspicious lesion was visualized on US, yet remained UP despite further interventions, could represent false positives, misclassification or operator variability. No lesions were suspected among the controls. CONCLUSION Ultrasound has promise for detection of UPs of the OP and therefore warrants further investigation.
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Affiliation(s)
- Carole Fakhry
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States; Milton J. Dance Jr. Head and Neck Center, Johns Hopkins Head and Neck Surgery, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Nishant Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Joseph Califano
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States; Milton J. Dance Jr. Head and Neck Center, Johns Hopkins Head and Neck Surgery, Baltimore, MD, United States
| | - Barbara Messing
- Milton J. Dance Jr. Head and Neck Center, Johns Hopkins Head and Neck Surgery, Baltimore, MD, United States
| | - Jia Liu
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States
| | - John Saunders
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States; Milton J. Dance Jr. Head and Neck Center, Johns Hopkins Head and Neck Surgery, Baltimore, MD, United States
| | - Patrick Ha
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States; Milton J. Dance Jr. Head and Neck Center, Johns Hopkins Head and Neck Surgery, Baltimore, MD, United States
| | - Stephanie Coquia
- Department of Radiology, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Ulrike Hamper
- Department of Radiology, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Maura Gillison
- Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Ray Blanco
- Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, United States; Milton J. Dance Jr. Head and Neck Center, Johns Hopkins Head and Neck Surgery, Baltimore, MD, United States
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Sanguineti G, Pai S, Agbahiwe H, Ricchetti F, Westra W, Sormani MP, Clemente S, Califano J. HPV-related oropharyngeal carcinoma with Overt Level II and/or III metastases at presentation: The risk of subclinical disease in ipsilateral levels IB, IV and V. Acta Oncol 2014; 53:662-8. [PMID: 24274389 DOI: 10.3109/0284186x.2013.858825] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To assess the risk of subclinical neck nodal involvement of levels IB, IV and V for early T-stage, node positive, human papilloma virus (HPV)-related oropharyngeal carcinoma. MATERIAL AND METHODS We retrospectively identified the patients with clinically positive and un-violated neck that underwent upfront ipsilateral neck dissection for HPV-related oropharyngeal cancer between 1998 and 2010. From the pathology report we extracted the prevalence rate of involvement of each selected level and then estimated the risk that a level that does not contain any node larger than 10 mm at computed tomography (CT) harbors subclinical disease. Predictors of involvement were investigated as well. RESULTS Ninety-one patients were analyzed. The risk of subclinical disease in both levels IB and V is < 5%, while it is 6.5% (95% CI 3.1-9.9%) for level IV. Level IB subclinical involvement slightly exceeds 5% when 2 + ipsilateral levels besides IB are involved. The risk of occult disease in level IV tends to be < 5% when level III is not involved. CONCLUSION These data support the exclusion from the elective nodal volume of level V and level IB but when 2 + other levels are involved. Level IV might also be spared when level III is negative. Clinical implementation within a prospective study is justified.
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Affiliation(s)
- Giuseppe Sanguineti
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University , Baltimore, Maryland , USA
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