Salivary microbiome changes distinguish response to chemoradiotherapy in patients with oral cancer

BACKGROUND

Oral squamous cell carcinoma (SCC) is associated with oral microbial dysbiosis. In this unique study, we compared pre- to post-treatment salivary microbiome in patients with SCC by 16S rRNA gene sequencing and examined how microbiome changes correlated with the expression of an anti-microbial protein.

RESULTS

Treatment of SCC was associated with a reduction in overall bacterial richness and diversity. There were significant changes in the microbial community structure, including a decrease in the abundance of Porphyromonaceae and Prevotellaceae and an increase in Lactobacillaceae. There were also significant changes in the microbial community structure before and after treatment with chemoradiotherapy, but not with surgery alone. In patients treated with chemoradiotherapy alone, several bacterial populations were differentially abundant between responders and non-responders before and after therapy. Microbiome changes were associated with a change in the expression of DMBT1, an anti-microbial protein in human saliva. Additionally, we found that salivary DMBT1, which increases after treatment, could serve as a post-treatment salivary biomarker that links to microbial changes. Specifically, post-treatment increases in human salivary DMBT1 correlated with increased abundance of Gemella spp., Pasteurellaceae spp., Lactobacillus spp., and Oribacterium spp. This is the first longitudinal study to investigate treatment-associated changes (chemoradiotherapy and surgery) in the oral microbiome in patients with SCC along with changes in expression of an anti-microbial protein in saliva.

CONCLUSIONS

The composition of the oral microbiota may predict treatment responses; salivary DMBT1 may have a role in modulating the oral microbiome in patients with SCC. After completion of treatment, 6 months after diagnosis, patients had a less diverse and less rich oral microbiome. Leptotrichia was a highly prevalent bacteria genus associated with disease. Expression of DMBT1 was higher after treatment and associated with microbiome changes, the most prominent genus being Gemella Video Abstract.

Community Behaviors That Affect the Incidence of Leptospirosis in West Jakarta, Indonesia

Background: Leptospirosis is an infectious disease caused by a pathogenic Leptospira species transmitted directly or indirectly from animals to humans. It is endemic in Southeast Asia in several countries, including Indonesia and Thailand. Therefore, this study aimed to determine the effect of community behavior on the incidence of leptospirosis in West Jakarta in 2019. Methods: The study used a case-control design, and data were obtained from the West Jakarta Health Office. The sample included 140 respondents, consisting of 70 leptospirosis patients (cases) and 70 participants who did not suffer from the disease (controls) in a 1:1 ratio. Results: In the bivariate analysis, there were significant effects on leptospirosis incidence from knowledge (odds ratio [OR] = 18.789), occupation (OR = 31.875), injury history (OR = 20.842), and recreation (OR = 0.294). Multivariate analysis showed significant effects based on occupation, present wounds, and recreation records. Occupation was a dominant factor in leptospirosis in West Jakarta (OR 54.116: 95% confidence interval: 4.435-660.372). Conclusion: The dominant factors for leptospirosis were risky occupations, followed by a history of injuries.

Abstract P3-12-28: Reproductive factors and molecular subtypes of breast cancer in premenopausal and postmenopausal women from 3 Colombian cities: PRECAMA & POSCAMA studies

Objectives: This study examined the association between reproductive factors and risk of breast cancer (BC) according to the expression of hormone receptors (HR) in women from three Colombian cities. Methodology: 316 cases were recruited between 2012 and 2019 from major general or cancer-dedicated hospitals were women diagnosed with first primary invasive breast cancer confirmed with a biopsy with a clinical staging according to the international tumor-node-metastasis (TNM) classification and residents for at least 3 years in the cities of Barranquilla, Cali, and Medellin. Controls were selected from the general population residing in the same city district as the case for at least 3 years using a multilevel sampling frame. They were matched to cases on age (± 3 years) and city district of residence. Cases and controls were recruited and interviewed by trained health staff, and provided blood samples and tumor tissues, prior to any treatment. Socioeconomic (education level and type of health insurance), anthropometric (weight, height, waist circumference, and body mass index), family history of BC, history of benign breast disease, lifestyle and reproductive (age at menarche, pregnancy ever, parity,. breastfeeding, and its duration) variables were considered. A conditional logistic regression model was used to estimate Odds Ratios (OR) and 95% confidence intervals (95% CI) and evaluate the association of reproductive factors. The final multivariate models were adjusted for factors that changed the risk estimate by more than 10%, including level of education, history of benign breast disease, and health insurance. P values <0.05 were considered statistically significant. Results: Pregnancy ever (OR = 0.48; 95% CI, 0.26-0.90), parity (OR = 0.89; 95% CI, 0.79-0.99 per child), breastfeeding (OR = 0.97; 95% CI, 0.95-0.99) and its longer duration (OR = 0.35; 95% CI, 0.18-0.71 > 12 months) were associated with a decrease in the risk of BC. When combining the reproductive variables, in women who had more than 2 children and breastfed (OR 0.25 95% CI 0.13-0.50), whose last pregnancy was less than 19 years (OR = 0.32 95% CI, 0.17-0.63) and with age at first full-term pregnancy (FFTP) older than 21 years (OR = 0.33 95% CI, 0.17-0.63), the reduction in BC risk was greater than when evaluating the variables individually. The risk of ER+ BC was inversely related to parity (OR = 0.78 95% CI, 0.63-0.95), having breastfed (OR = 0.47 95% CI, 0.26-0.87) and the use of oral contraceptives (OR = 0.56 95% CI, 0.32 -0.99). Although an increased risk for ER- and TN tumors was observed with the use of oral contraceptives, this was not significant probably due to insufficient sample size. Conclusions: As has been observed in other studies in this Colombian population, reproductive factors and the use of hormonal contraceptives were differentially associated with the BC risk. Our data can be useful to identify risk groups to design prevention measures tailored to the specific population. Conflict of interest: None of the authors declare that they have a conflict of interest.

Table 1.Odds ratios and 95% confidence intervals of association between breast cancer and reproductive factors and combination of reproductive variables.FactorNMatchedap-valueaMultivariatebp-valuebCases/ControlsOR (95% CI)cOR (95% CI)cEducation levelPrimary school or less119/1371.001.00High School140/1411.34 (0.88-2.03)0.167750.90 (0.60-1.34)0.5901Above High School57/382.27 (1.24-4.04)0.007831.29 (0.74-2.26)0.3710Health Insurance (Contributive)241/1942.24(1.49, 3.38)<0.00011.72 (1.14-2.59)0.0104History of benign breast disease (Yes)158/2314.5 (7.64-27.52)<0.000112.18 (7.5-19.9)<0.0001Pregnancy ever (Yes)263/2960.34 (0.20-0.59)0.00010.48 (0.26-0.90)0.0226Parityd (per child)0.78 (0.69-0.87)<0.00010.89 (0.79-0.99)0.0414Nulliparous61/211.001.001 child68/610.43 (0.24-0.79)0.005970.44 (0.22-0.88)0.019932 children83/970.29 (0.16-0.53)<0.00010.41 (0.21-0.80)0.00849≥3 children104/1370.23 (0.12-0.42)<0.00010.34 (0.17-0.65)0.00119Breastfeeding ever (Yes)75/1200.47 (0.32-0.68)<0.00010.50 (0.34-0.75)0.00089Duration of breastfeeding (months)d0.97 (0.95-0.99)0.01380.97 (0.95-0.99)0.01263Never114/701.001.00≤12155/1610.86 (0.46-1.61)0.64200.66 (0.35-1.19)0.17976>1247/850.41 (0.20-0.84)0.01470.35 (0.18-0.71)0.00328Combination: Parity and breast feedingNulliparous61/211.001.00≥1 children, never breastfeed181/1750.37 (0.21-0.63)0.00020.47 (0.25-0.87)0.01711 child, ever breastfeed13/200.25 (0.11-0.60)0.00190.32 (0.12-0.86)0.0238≥ 2 children, ever breastfeed61/1000.19 (0.10-0.35)<0.00010.25 (0.13-0.50)<0.0001Combination: Parity and time since last birthNulliparous61/211.001.001 child, < 19 years since last birth49/410.46 (0.27-0.90)0.02250.47 (0.22-0.99)0.04611 child, ≥ 19 years since last birth19/200.31 (0.13-0.78)0.01300.36 (0.14-0.94)0.0376≥ 2 children, < 19 years since last birth79/1060.25 (0.13-0.47)<0.00010.32 (0.17-0.63)0.0009≥ 2 children, ≥ 19 years since last birth108/270.27 (0.14-0.52)<0.00010.42 (0.22-0.81)0.0097Combination: Parity and age at FFTPeNulliparous61/211.001.001 Child, age at FFTP <2115/140.48 (020-1.14)0.094440.33 (0.12-0.92)0.03471 child, age at FFTP >2152/470.40 (0.21-0.76)0.005460.47 (0.23-0.97)0.0413>2 Children, age at FFTP <21100/1160.28 (0.15-0.50)<0.00010.43 (0.22-0.82)0.0110>2Children, age at FFTP >2181/1170.25 (0.14-0.45)<0.00010.33 (0.17-0.63)0.0008aConditional logistic regression matched on age, Location, bConditional logistic regression matched on age, Location and adjusted for education level, history of benign breast disease and Health Insurance. cORs are given for both continuous (unit of change) and catrgorical variables. dParous women only; FFTP: first full-term pregnancy, eFFTP: First full-term pregnancy, median age = 21

Table 2.Association of breast cancer and reproductive factors by hormone receptor statusReproductive variablesER+ vs Control (n = 208)ER- vs Control (n = 94)TN vs Control (n = 56)ORa (95% CI)p-valuebORa (95% CI)p-valuebORa (95% CI)p-valuebPregnancy ever0.29(0.11-0.80)0.020.55 (0.16-1.94)0.360.64 (0.2-2.8)0.55Parityd0.78(0.63-0.95)0.010.86 (0.66-1.1)0.240.94 (0.66-1.34)0.72Breastfeeding everc0.47(0.26-0.87)0.010.59 (0.26-1.4)0.220.62 (0.2-1.93)0.41Hormonal contraceptive use0.54(0.29-1.01)0.051.37 (0.5-3.5)0.511.61 (0.46-5.67)0.46Pills0.56(0.32-0.99)0.041.25 (0.51-3.1)0.621.81 (0.53-6.17)0.34aORs are given for continuous variables (unit change). bConditional logistic regression matched on age, Location, and adjusted for education level, history of benign breast disease and Health Insurance. cParous women only. dParity: number of childbirths

Citation Format: Juanvilson A Zambrano, SM, Maria Del Mar Idarraga, SM, Samuel Agudelo, BSc, William Arias, MSc, Yina Zambrano, BsC, Karen Cardenas, MSc, Daniel Jurado, M. Sc, Maria C Agudelo, PhD(c), Emanuel Vasco, MD, Alison Mondul, PhD, Laura Rozek, PhD, Andres Ossa, MD, Mauricio Borrero, MD, Fernando Herazo, MD, Edgar Navarro, MD, Roberto Jaramillo, MD, Isabelle Romieu, PhD, Sabina Rinaldi, PhD and Gloria I Sánchez, PhD. Reproductive factors and molecular subtypes of breast cancer in premenopausal and postmenopausal women from 3 Colombian cities: PRECAMA & POSCAMA studies [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-12-28.

Health Behaviors During the COVID-19 Epidemic: Perspectives From Studying International Coping and Compliance

Control of the COVID-19 pandemic requires significant changes in people's health behaviors. We offer this multidisciplinary perspective on the extent of compliance with social distancing recommendations and on coping with these measures around the globe in the first months of the pandemic. We present descriptive data from our survey of 17,650 respondents across 18 countries and territories in June 2020. The majority of respondents worried about contracting the virus. Nearly all engaged in at least some preventive behaviors, particularly handwashing, mask wearing, and avoiding social events. Most reported that it would be difficult to continue these behaviors for more than a few months, and about half reported feeling more anxious since the start of the pandemic. Commonly reported coping behaviors included news consumption, watching television, and sleeping. Our cross-national study highlights areas for developing and implementing health behavior interventions in the global fight to stop the spread of COVID-19.

Characterization of the immune response in patients with cancer of the oral cavity after neoadjuvant immunotherapy with the IRX-2 regimen

OBJECTIVE

IRX-2 is a homologous cell-derived multi-cytokine biologic with multifaceted immune modulatory effects that has been shown to induce increased lymphocyte infiltration into primary tumors in oral cavity carcinoma. Our objective was to characterize tumor immune gene expression and epigenomic changes after neoadjuvant IRX-2 immunotherapy in patients with squamous cell carcinoma of the oral cavity.

METHODS

A randomized phase II trial was conducted of the IRX regimen 3 weeks prior to surgery for previously untreated patients with Stage II-IV oral cavity carcinoma. The treatment regimen consisted of low dose (300 mg/m²) cyclophosphamide (day 1) followed by 10 days of regional perilymphatic IRX-2 cytokine injections and daily oral indomethacin, zinc and omeprazole (Regimen 1) compared to the identical regimen without the IRX-2 cytokines (Regimen 2). The NanoString immune panel (730 genes) and Infinium MethylationEPIC BeadChip were performed to assess the gene expression and DNA methylation signatures, respectively, in pre- and post-immunotherapy tumor samples.

RESULTS

A total of 51 and 79 immune-related genes were found upregulated and downregulated, respectively, in the samples from Regimen 1 patients after treatment, while 51 and 56 were found upregulated and downregulated in the samples for Regimen 2. When comparing the changes between the two regimens, we identified 9 genes significantly different, including DMBT1, a potential tumor suppressor, functioning in tumor invasion of head and neck cancer. The exploration of DNA methylation showed slight overall hypermethylation after treatment in both regimens, especially for Regimen 1 immune responders, and methylation-based cell type deconvolution demonstrated high concordance with tumor infiltrating T lymphocyte cell counts.

CONCLUSION

While a consistent patient response after treatment was observed, most changes were similar between regimens, indicating a subtle, targeted, or patient-specific effect of IRX-2 cytokines. Change in DMBT1 expression was a unique finding that will require further study to better understand its significance.

The existence and characteristics of rats and shrews in endemic leptospirosis areas and types of ectoparasites: a case study of West Jakarta, Indonesia

Background: This study aimed to determine the presence and species of the rats and shrews that can potentially cause leptospirosis in West Jakarta, Indonesia, and the species of ectoparasites found in them. Methods: The research was a descriptive study employing a cross-sectional approach. The study population was all species of rats and shrews in the region and the sample collection technique used was purposive sampling. The traps were installed in the homes of respondents who had suffered from leptospirosis and their closest neighbors, with a total of 521 traps. Leptospirosis data based on secondary data was obtained from West Jakarta Health Office (2016-August 2019). The technique for catching rats involved using humane live traps, while the identification of the rats and ectoparasites was done in the laboratory. Results: It was found that more rats were caught in Cengkareng Timur sub-district, Cengkareng District, with a percentage of 14.8%, while the least in Duri Kepa, Kapuk, Kedaung Kali Angke and Kedoya Utara with a percentage of 3.7%. The rats were mostly found in East Cengkareng Sub-District, with the most common type being Rattus rattus (74.1 %) and the least Suncus murinus (11.1%); more male rats were caught (66.7%) than female (33.3%). The type of ectoparasite found in the rats was fleas. Xenopsylla cheopis was the most common type, at 83.3% and more fleas were male, at 66.7%. The most common rat species was Rattus rattus. The ectoparasite most commonly found in them was the female flea Xenopsylla cheopis.Conclusions:  Rattus rattus and Xenopsylla cheopis were found in an East Cengkareng sub-district. Surveys, monitoring, and control of rats and ectoparasites are essential for the preparedness and development of an early warning system of possible diseases that they can cause.

Opium use and the risk of head and neck squamous cell carcinoma

Scant evidence exists to support the association of opium use with head and neck cancer, limited to the larynx and oral cavity. In a multicenter case-control study-Iran Opium and Cancer study, we recruited 633 cases of head and neck squamous cell carcinoma (HNSCC) (254 lip and oral cavity, 54 pharynx, 327 larynx and 28 other subsites within the head and neck) and 3065 frequency-matched controls from April 2016 to April 2019. Odds ratios (ORs) for opium use and 95% confidence intervals (95% CIs) were obtained using mixed-effects logistic regression because of heterogeneity among centers. The adjusted OR (95% CI) for regular opium use was 3.76 (2.96-4.79) for all HNSCC combined. Strong dose-response effects were observed by frequency or amount of use, and duration of use. Regular opium uses significantly increased the risk of HNSCC of the pharynx, larynx and other subsites within the head and neck with OR (95% CI) of 2.90 (1.40-6.02), 6.55 (4.69-9.13) and 5.95 (2.41-14.71), respectively. The observed associations were significant even among never tobacco smokers (including cigarette and water-pipe smoking). Moreover, by the multiplicative interaction scale, the effect of opium use could be varied by cigarette smoking on HNSCC, 8.16 (6.20-10.74). For the first time, the current study showed opium users have an increased risk of several anatomic subsites of HNSCC.

Abstract 3391: Statin use and head and neck cancer outcomes

Background: The purpose of this study is to examine the association between statin use and head and neck squamous cell carcinoma (HNSCC) outcomes: overall death, HNSCC-specific death and recurrence. Statins possess anti-cancer properties such as anti-inflammatory and immunomodulatory effects, and have been found to be protective against cancer risk and mortality across various cancer sites. However, little research has been done examining the association between statin use and HNSCC outcomes.

Methods: Incident HNSCC patients (n=1,843) were recruited through the University of Michigan Rogel Cancer Center to participate in the University of Michigan Head and Neck Cancer Specialized Program of Research Excellence (SPORE) from 2003-2014. Statin data were collected retrospectively from SPORE participants through medical record review. Participants were identified as being a statin user if they had used a statin at or after diagnosis. Outcome data were also collected through medical record review as well as Social Security Death Master File and LexisNexis. Our analytic cohort included 1,642 SPORE participants who had information on both statin use and HNSCC outcomes. Cox proportional hazard models were used to estimate the association between ever statin use and HNSCC outcomes. The following factors were considered as potential confounders; age, gender, race, comorbidities, smoking status, body mass index (BMI) and education. All estimates presented are from the final multivariable models which included age, comorbidities and BMI as only these variables changed the point estimate by >10%.

Results: 35.9% of participants were ever statin users. Overall, we observed a statistically significant inverse association between ever using a statin and both overall death (HR=0.74, 95%CI=0.63-0.88) and HNSCC-specific death (HR=0.79, 95%CI=0.63-0.99). We observed an inverse association with recurrence, although it was not statistically significant (HR=0.85, 95%CI=0.70-1.04). We observed a statistically significant interaction such that the inverse associations for HNSCC-specific death and recurrence were restricted to patients with human papillomavirus (HPV) positive disease (HNSCC-specific death: HPV+ HR=0.43, 95%CI=0.21-0.86; HPV- HR=1.02, 95%CI=0.71-1.47; p-int-0.02; recurrence: HPV+ HR=0.50, 95%CI=0.30-0.86; HPV- HR=1.02, 95%CI=0.74-1.41; p-int-0.02); statins were inversely associated with overall death in both HPV positive and negative patients. Analyses stratified by disease site supported the HPV interaction; the strongest inverse association was observed for oropharyngeal cancers.

Conclusion: Our findings from this large, prospective study demonstrate that statin use may be protective for adverse outcomes in HNSCC patients, particularly those with HPV positive disease. If true, these findings could have a meaningful impact on tertiary prevention for this cancer, which currently has unacceptably low survival rates.

Citation Format: Kayla R. Getz, Emily Bellile, Katie Zarins, Steven Chinn, Jeremy Taylor, Laura Rozek, Gregory Wolf, Alison Mondul. Statin use and head and neck cancer outcomes [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3391.

Tumor infiltrating lymphocytes after neoadjuvant IRX-2 immunotherapy in oral squamous cell carcinoma: Interim findings from the INSPIRE trial

OBJECTIVES

IRX-2 is a primary-cell-derived immune-restorative consisting of multiple human cytokines that act to overcome tumor-mediated immunosuppression and provide an in vivo tumor vaccination to increase tumor infiltrating lymphocytes (TILs). A randomized phase II trial was conducted of the IRX regimen 3 weeks prior to surgery consisting of an initial dose of cyclophosphamide followed by 10 days of regional perilymphatic IRX-2 cytokine injections and daily oral indomethacin, zinc and omeprazole (Regimen 1) compared to the identical regimen without IRX-2 cytokines (Regimen 2).

METHODS

A total of 96 patients with previously untreated, stage II-IV oral cavity SCC were randomized 2:1 to experimental (1) or control (2) regimens (64:32). Paired biopsy and resection specimens from 62 patients were available for creation of tissue microarray (n = 39), and multiplex immunohistology (n = 54). Increases in CD8+ TIL infiltrate scores of at least 10 cells/mm² were used to characterize immune responders (IR).

RESULTS

Regimen 1 was associated with significant increases in CD8+ infiltrates (p = 0.01) compared to Regimen 2. In p16 negative cancers (n = 26), significant increases in CD8+ and overall TILs were evident in Regimen 1 (p = 0.004, and 0.04 respectively). IRs were more frequent in Regimen 1 (74% vs 31%, p = 0.01). Multiplex immunohistology for PD-L1 expression confirmed an increase in PD-L1 H score for Regimen 1 compared to Regimen 2 (p = 0.11).

CONCLUSIONS

The findings demonstrate significant increases in TILs after perilymphatic IRX-2 injections. Three quarters of patients showed significant immune responses to IRX-2. (NCT02609386).

Association of physical activity, body mass index and reproductive history with breast cancer by menopausal status in Iranian women

BACKGROUND

The incidence rate of breast cancer (BC) is increasing in low- and middle-income countries (LMICs), including Iran. We investigated the association between BC risk and physical activity (PA), body mass index (BMI), and reproductive history among Iranian women.

METHODS

We conducted a large hospital-based case-control study and compared 958 BC cases with 967 controls at the Cancer Institute of Iran during 2011-2016. We used multiple logistic regression models and adjusted for potential confounders to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs) for the associations between BC and different risk factors, including low physical activity.

RESULTS

Women with high levels of physical activity had a lower risk of BC compared to those who were inactive (OR = 0.55, 95%CI: 0.41, 0.75). In premenopausal women, the association was observed only in normal-weight women (OR = 0.31, 95%CI: 0.13, 0.75), while it was limited to obese women in the postmenopausal group (OR = 0.29, 95%CI: 0.12, 0.66). We found a high risk of postmenopausal BC among overweight (OR = 1.69; 95%CI: 1.01, 2.81) and obese women (OR = 1.9; 95%CI: 1.14, 3.14) compared to women with a normal BMI. We observed an inverse association among postmenopausal women who had between three and five children (OR = 0.31, 95%CI 0.14, 0.64) and more than six children (OR = 0.21, 95%CI 0.12, 0.42) compared to nulliparous women.

CONCLUSIONS

Low levels of physical activity, low parity, and being overweight or obese were major risk factors for BC. For the first time, we report a strong association between physical activity and BC risk in Iranian women.

Associations Between a Priori-Defined Diet Quality Indices and Survival in a Longitudinal Cohort Study of Head and Neck Squamous Cell Carcinoma Patients

Objectives

Use of diet quality indices has become increasingly common. However, there are no studies, to date, that have examined the relationship of a priori indices with prognostic outcomes in the head and neck squamous cell carcinoma (HNSCC) population. The purpose of this analysis was to examine associations between diet quality in the first two years after diagnosis and mortality in a sample of HNSCC patients.

Methods

This was a secondary analysis of 396 newly diagnosed HNSCC patients recruited from the University of Michigan Head and Neck Specialized Programs of Research Excellence longitudinal cohort study. Participants completed food frequency questionnaires (FFQs) and health surveys at the time of diagnosis, 1-year post-diagnosis (n = 341), and 2-years post-diagnosis (n = 217). Cox Proportional Hazards models assessed associations between diet quality index score (categorized as quintiles and modeled as a time-varying covariate), all-cause-, and cancer-specific mortality. The indices chosen for examination included the Alternative Mediterranean Diet Index (aMED), Alternate Healthy Eating Index-2010 (AHEI-2010), Dietary Approaches to Stop Hypertension (DASH), and a ketogenic diet index. All models adjusted for age, sex, BMI, HPV-status, tumor site, stage, education, smoking, drinking, and total calorie intake (modeled as time-varying).

Results

There were 105 total deaths and 67 cancer-related deaths, during a median follow-up time of 3 years. Higher aMED and AHEI-2010 scores were significantly inversely associated with all-cause (HRaMED 0.33, 95% CI: 0.18–0.59, ptrend < 0.0001; HRaHEI 0.34, 95% CI: 0.20–0.58, ptrend < 0.001) and cancer-related mortality (HRaMED 0.28, 95% CI: 0.13–0.59, ptrend = 0.001; HRaHEI 0.35, 95% CI: 0.18–0.71, ptrend < 0.0001). There were no significant associations found with the DASH index. The ketogenic diet index showed an attenuated significant inverse association for the fifth quintile, but there was a lack of linear trend.

Conclusions

Developing and testing interventions that follow food and quantity guidelines emphasized by the aMED and AHEI-2010 diet quality indices among HNSCC survivors, is warranted.

Funding Sources

NIH/NCI and a USDA/NIFA Hatch Project.

Barriers to cervical cancer screening and acceptability of HPV self-testing: a cross-sectional comparison between ethnic groups in Southern Thailand

BACKGROUND

Cervical cancer rates are higher in low-resourced countries than high, partly due to lower rates of screening. Incidence in Thailand is nearly three times higher than in the USA (16.2 vs 6.5 age-standardised incidence), even with Thailand's universal health coverage, which includes screening, suggesting that alternative methods are needed to reduce the burden. We investigated barriers to screening, as well as acceptability of self-collection human papillomavirus (HPV) testing as a primary form of cervical cancer screening among Buddhist and Muslim communities in Southern Thailand.

METHODS

267 women from the Buddhist district of Ranot and Muslim district of Na Thawi, Songkhla were recruited to complete a survey assessing knowledge and risk factors of HPV and cervical cancer. Participants were offered an HPV self-collection test with a follow-up survey assessing acceptability. Samples were processed at Prince of Songkhla University and results were returned to participants.

RESULTS

267 women participated in the study (132 Buddhist, 135 Muslim), 264 (99%) self-collecting. 98% reported comfort and ease, and 70% preferred it to doctor-facilitated cytology. The main predictor of prior screening was religion (92% Buddhist vs 73% Muslim reporting prior Pap). After adjustment with multivariate logistic models, Muslim women had an OR of prior Pap of 0.30 compared with Buddhist (95% CI: 0.12 to 0.66).

CONCLUSIONS

Self-collection HPV testing was highly acceptable across religious groups, suggesting that it could be beneficial for cervical cancer reduction in this region. Focus should be put into educating women from all backgrounds about the importance of screening to further improve screening rates among Thai women.

Prognostic Value of Tumor-Infiltrating Lymphocytes in Head and Neck Squamous Cell Carcinoma

Importance

Biomarkers that reflect prognosis and cellular immunity in patients with head and neck squamous cell carcinoma (HNSCC) are a prerequisite for improving individualized treatment that limits the intensity and morbidity of conventional treatment and may be useful in the introduction of new immunotherapy regimens.

Objective

To determine if specific classes of tumor-infiltrating lymphocytes (TILs) in pretreatment biopsy specimens have prognostic value for outcomes in a large training and validation cohort of patients with HNSCC.

Design, Setting, and Participants

In this prospective, epidemiologic study with a median follow-up of 47.5 months, in 464 previously untreated patients with available tissue for construction of tissue microarray, HNSCC disease sites included oral cavity (228), oropharynx (147), larynx (74), and hypopharynx (15). The training cohort consisted of 241 patients and the validation cohort consisted of 223 patients. Overall tumor stage was I (55), II (69), III (71), or IV (269). Patients were enrolled between November 2008 to October 2014. Data were analyzed between October 2018 to April 2019.

Main Outcomes and Measures

Semiquantitative levels of CD4, CD8, and FoxP3 lymphocytes were assessed by immunohistologic analysis and correlations with clinical prognostic factors, initial treatment modality, and overall survival (OS) and disease-specific (DSS) survival were determined. A principal component analysis was performed to generate a combined TIL-weighted sum score (TILws).

Results

Of the 464 participants, 135 (29%) were women; mean (SD) age was 61.1 (11.8) years. Higher CD8 counts were associated with improved OS in both training and validation sets (HR, 0.94; 95% CI, 0.90-0.98; and HR, 0.97; 95% CI, 0.95-0.99, respectively). Higher TILws levels were associated with improved OS and DSS in both the training set (HR, 0.91; 95% CI, 0.86-0.96; and HR, 0.93; 95% CI, 0.87-0.99, respectively) and validation set (HR, 0.96; 95% CI, 0.93-0.99; and HR, 0.94; 95% CI, 0.89-0.99, respectively). A multivariable Cox model controlling for batch, age, clinical stage, disease site, comorbidities, HPV status, and smoking, showed that higher TILws levels were associated with improved OS and DSS (HR, 0.94; 95% CI, 0.92-0.97; and HR, 0.94; 95% CI, 0.90-0.98, respectively). When grouped by treatment (surgery vs chemoradiation) and tested for interaction, treatment was found to be an effect modifier for CD4 levels and OS. Low CD4 levels were showed greater association with decreased survival in the chemoradiation cohort than the surgery cohort.

Conclusions and Relevance

The findings from this large cohort study suggest that levels of TILs are an independent prognostic factor in patients with HNSCC. Subsets of TILs and combined TIL scores may be clinically useful predictive and prognostic factors.

Temporal Trends and Geographic Patterns of Lung Cancer Incidence by Histology in Thailand, 1990 to 2014

Purpose

Lung cancer is one of the most common cancers worldwide and in Thailand. We characterize and forecast region-specific patterns of lung cancer incidence by histology and sex.

Methods

We analyzed lung cancer incidence trends in Thailand by histology (adenocarcinoma [AdC]; squamous cell carcinoma [SCC]; and large-cell, small-cell, and other carcinomas) from 1990 to 2014 in four cancer registries in three regions (north, Chiang Mai Province and Lampang Province; northeast: Khon Kaen Province; south: Songkhla Province). Annual percent change (APC) was calculated to quantify the incidence rate trends using joinpoint regression. Age-period-cohort models were used to examine the temporal trends of AdC and SCC by age, calendar year, and birth cohort. We projected the incidence of AdC and SCC up to 2030 using three independent approaches: joinpoint, age-period-cohort, and Nordpred models.

Results

AdC incidence significantly increased from 1990 to 2012 in Chiang Mai males (APC, 1.3%), Songkhla males from 2004 to 2014 (APC, 2.5%), Songkhla females from 1990 to 2014 (APC, 5.9%), and Khon Kaen females from 2005 to 2014 (APC, 3.1%). Conversely, SCC incidence significantly decreased from 1990 to 2012 in Chiang Mai males and females (APC, −1.2% and −4.8%, respectively), Lampang males and females from 1993 to 2014 (APC, −5.4% and −5.2%, respectively), and Songkhla females from 1990 to 2014 (APC, −2.1%). In general, trends of AdC and SCC correlated more with birth cohort than with calendar year. Three projection models suggested that incidence rates of AdC in Songkhla may continue to increase until 2030.

Conclusion

Temporal trends of lung cancer by histology varied among regions in Thailand. Reduction of lung cancer incidence in Thailand likely will require prevention strategies tailored to each specific region.

Abstract 4325: 5-hydroxymethylation captures the heterogeneity in keratinization and cytoskeletal rearrangement processes in head & neck cancers

Infection with high-risk HPV, or human papillomavirus, has been shown to be a risk factor for head and neck squamous cell carcinoma (HNSCC) development in addition to the classical risk factors of tobacco and alcohol usage. Previous studies have identified epigenetic differences between these two classes of HNSCC, including DNA methylation, histone modifications and non-coding RNAs. 5-hydroxymethylation (5hmC) is an oxidative derivative of 5-methylcytosine (5mC) and is depleted in human cancers of many different origins. However, the roles of 5hmC in HNSCC is still unknown. Our study is the first to characterize 5hmC in HNSCC, which we profiled in 18 HPV(+) and 18 HPV(-) HNSCC tumors. Since previous studies found higher levels of 5hmC in more differentiated cells and lower levels in stem-like cells, we hypothesized an overall higher 5hmC level in HPV(-) tumors, which tend to be more differentiated in nature.

Consistent with our hypothesis, results showed significant hyper-hydroxymethylation in HPV(-) tumors, and detected multiple cancer-related genes with hyper-hydroxymethylation in either HPV(+) and HPV(-) tumors. For example, CDKN2A (p16) and MTAP were the most hyper-methylated genes in HPV(+) tumors, while 5hmC levels of HPV(-) tumors were particularly high in CDH13, TIMP2, and BCAR1. We found that the two HPV(+) subtypes defined by Zhang et al., IMU (heightened immune response, more mesenchymal differentiation) and KRT (more keratinization, more likely viral integration), explained a high level of heterogeneity in 5hmC levels at promoter and enhancer regions. By testing for genes and pathways that demonstrate concordant changes in gene expression and 5hmC levels, we found that keratinocyte differentiation, cell-cell adhesion and adherens junction pathways are both up-regulated and have hyper-hydroxymethylation in HPV(-) tumors. Using predicted enhancers of epidermal keratinocytes, we found a much higher portion of hydroxymethylated regions fall in enhancer regions for HPV(-) samples compared with HPV(+) samples. The higher differential 5hmC in enhancer regions was further validated by stronger histone marks of H3K4me1 and H3K27ac in HPV(-) tumors. Since some of these enhancers can be linked to differentially expressed target genes, this result indicates that the enhancer hydryoxymethylation in HNSCC could also play an important role in downstream gene regulation. We hope that this study could partially explain the different mechanisms and cast light on potential targeted therapies in HNSCC both based on HPV status and different HPV(+) subtypes.

Citation Format: Siyu Liu, Katie Zarins, Evan Fernandez, Laura Rozek, Maureen Sartor. 5-hydroxymethylation captures the heterogeneity in keratinization and cytoskeletal rearrangement processes in head & neck cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4325.

Interaction Effects of Vitamin D Receptor Polymorphisms and Vitamin D3 Supplementation on Plasma Oxidative Stress and Apoptotic Biomarkers Among Breast Cancer Survivors (P05-027-19)

Objectives

Interactions of human genes and environmental exposures play a crucial role in cancer etiology and prognosis. We investigated whether response to vitamin D3 supplementation in terms of plasma oxidative stress (OS) and apoptotic biomarkers were mediated by the vitamin D receptor (VDR) single-nucleotide polymorphisms (SNPs) among breast cancer survivors.

Methods

Two hundred and fourteen women who were diagnosed with breast cancer (invasive or in situ) and had completed all treatment regimens received 4000 IU of vitamin D3 daily for 12 weeks. Anthropometric, dietary, sun exposure, physical activity, as well as laboratory assessments including plasma superoxide dismutase (SOD), total antioxidant capacity (TAC), malondialdehyde (MDA), 8-hydroxy-2′-deoxyguanosine (8-OHdG), and Bcl2 were performed at enrolment and post-intervention. VDR genotyping was performed at ApaI, TaqI, FokI, BsmI, and Cdx-2. Linear regression was used to analyze whether the effect of vitamin D3 supplementation on response variables was modulated by the selected VDR SNPs.

Results

Linear regression analysis adjusted for age, BMI, on-study plasma 25(OH)D changes, and baseline circulating 25(OH)D indicated that the AA genotype of the ApaI on VDR was associated with greater increase and decrease in plasma Bcl2 [0.21, 95% Confidence Interval (CI) (0.03, 0.39)] and MDA [−0.68, 95% CI (−1.35, −0.02)] compared to aa respectively. This association did not remain statistically significant after correction for multiple testing. Overall, we found no statistically significant interaction of the VDR SNPs and inferred haplotypes with the circulating OS and apoptotic biomarkers except for the FokI BsmI ApaIhaplotype and circulating MDA (p-value for global score = 0.02) after multiple testing correction.

Conclusions

Our findings indicate a weak interaction between the VDR haplotypes and responses of plasma OS and apoptotic biomarkers to vitamin D3 supplementation. However, further assessments of additional genes and biomarkers with longer intervention periods may further explain the complex interplay between genes and nutrients.

Funding Sources

Cancer Research Center, National Nutrition and Food Technology Research Institute, and the Endocrine Research Center of Shahid Beheshti University of Medical Sciences.

Childhood cancer incidence and survival in Thailand: A comprehensive population-based registry analysis, 1990-2011

BACKGROUND

Southeast Asia is undergoing a transition from infectious to chronic diseases, including a dramatic increase in adult cancers. Childhood cancer research in Thailand has focused predominantly on leukemias and lymphomas or only examined children for a short period of time. This comprehensive multisite study examined childhood cancer incidence and survival rates in Thailand across all International Classification of Childhood Cancer (ICCC) groups over a 20-year period.

METHODS

Cancer cases diagnosed in children ages 0-19 years (n = 3574) from 1990 to 2011 were extracted from five provincial population-based Thai registries, covering approximately 10% of the population. Descriptive statistics of the quality of the registries were evaluated. Age-standardized incidence rates (ASRs) were calculated using the Segi world standard population, and relative survival was computed using the Kaplan-Meier method. Changes in incidence and survival were analyzed using Joinpoint Regression and reported as annual percent changes (APC).

RESULTS

The ASR of all childhood cancers during the study period was 98.5 per million person-years with 91.0 per million person-years in 1990-2000 and 106.2 per million person-years in 2001-2011. Incidence of all childhood cancers increased significantly (APC = 1.2%, P < 0.01). The top three cancer groups were leukemias, brain tumors, and lymphomas. The 5-year survival for all childhood cancers significantly improved from 39.4% in 1990-2000 to 47.2% in 2001-2011 (P < 0.01).

CONCLUSIONS

Both childhood cancer incidence and survival rates have increased, suggesting improvement in the health care system as more cases are identified and treated. Analyzing childhood cancer trends in low- and middle-income countries can improve understanding of cancer etiology and pediatric health care disparities.

Histologic pattern of invasion and epithelial-mesenchymal phenotype predict prognosis in squamous carcinoma of the head and neck

INTRODUCTION

Disruption of E-cadherin function and increased expression of vimentin and the transcriptional oncogene, SOX2, are thought to characterize epithelial to mesenchymal transition (EMT) in HNSCC that contributes to invasive and metastatic behavior. To determine if such changes relate to prognosis or host immune response, expression of these markers and correlations with clinical characteristics, histologic worst pattern of invasion (WPOI) and tumor infiltrating lymphocytes (TIL) and survival were assessed.

METHODS

Immunohistologic expression of markers was determined in tissue microarrays from 274 previously untreated HNSCC patients. Expression was correlated with levels of TILs in microcores and WPOI in biopsy specimens. Correlations were assessed by Kruskal-Wallis testing and Spearman correlation coefficients where appropriate. Overall and relapse-free survival were analyzed with Cox proportional hazards models. Median follow up was 60.0 months.

RESULTS

Loss of E-cadherin expression was significantly associated with low or absent SOX2 expression (R = 0.433, p < 0.0001). SOX2 expression and low grade WPOI were significantly associated with favorable overall (OS) and relapse free (RFS) survival in multivariable analysis. E-cadherin expression did not correlate with TILs, however WPOI score correlated indirectly with CD4, CD8, and FoxP3 levels. When grouped by primary treatment, lower grades (1, 2) of WPOI predicted improved RFS and OS in patients treated with primary surgery but not for patients treated with chemoradiation.

CONCLUSION

The findings suggest that SOX2 expression and WPOI are significant prognostic factors and that WPOI correlates with decreased T cell infiltration. The combination of markers and TILs might be useful in selecting patients for primary surgery.

Trends of Colorectal Cancer Incidence in Thailand by Age, Gender, and Region

Background: Colorectal cancer (CRC) is the third most common cancer in the world. While CRC incidence has decreased in many western countries over the last decades, largely thanks to screening, it is increasing in low and middle-income countries, including Thailand. However, it is unclear if these increases are consistent across different regions, gender and age groups. Aim: To understand the age-, gender- and region-specific temporal variation in CRC incidence in Thailand since the 1990s. Methods: We analyzed CRC incidence data from the Thailand National Cancer Network (TCIN) cancer registries, which include Chiang Mai (1990-2012), Lampang (1993-2014), Lopburi (2000-2014), Khon Kaen (1990-2014) and Songkhla (1990-2014) cancer registries. Trends in age-adjusted incidence (measured by annual percentage change (APC)) were assessed using Joinpoint regression. Trends by birth-year and calendar-year were assessed using age-period-cohort models. All analyses were done by region, gender, and age group (30-49, 50-84, 30-84). Results: CRC incidence has been increasing significantly in all regions, gender, and age groups; Overall, the APC was 3.82 for men and 3.84 for women (Chiang Mai, 4.34 for men & 3.26 for women; Khon Kaen, 2.69 for men & 3.68 for women; Lampang, 2.13 for men & 3.37 for women; Lopburi, 5.31 for men & 4.67 for women; Songkhla, 4.67 for men & 4.32 for women). The increase in incidence was higher for ages 50-84 (APC = 3.99 for men & 4.04 for women) compared with ages 30-49 (APC=2.97 for men & 3.09 for women). Test of parallelism suggests that increases are consistent between gender (P-value=0.97). The age-period-cohort analysis suggests that both calendar-year and birth-year are strongly correlated with CRC incidence trends, with a stronger relationship with birth-year than calendar-year for both genders. Conclusion: In contrast to western countries such as the US, CRC incidence is increasing across all age groups in Thailand, with faster increase in older ages. This highlights the needs for establishing population-wide screening programs to reduce the burden and stop the rise of CRC in Thailand and low-middle income countries.

E6 and E7 Antibody Levels Are Potential Biomarkers of Recurrence in Patients with Advanced-Stage Human Papillomavirus-Positive Oropharyngeal Squamous Cell Carcinoma

Purpose: There is a paucity of biomarkers to predict failure in human papillomavirus-positive (HPV⁺) oropharyngeal squamous cell carcinoma (OPSCC) following curative therapy. E6/E7 viral oncoproteins are constitutively expressed in HPV⁺ tumors and highly immunogenic, resulting in readily detected serum antibodies. The purpose of this study is to determine whether serum E6 and E7 antibody levels can potentially serve as a biomarker of recurrence in patients with HPV+OPSCC.Experimental Design: We evaluated E6/E7 antibody levels in patients with previously untreated, advanced stage (III, IVa-b), HPV+OPSCC receiving definitive chemoradiation under a uniform protocol from 2003 to 2010. Baseline and longitudinal serum samples were obtained from our archived repository. E6/E7 serum levels were measured using a glutathione-S-transferase capture ELISA and quantified by approximating the area under the dilution curve, and were analyzed using ANOVA and linear mixed model for longitudinal analysis.Results: We compared 22 HPV+OPSCC patients who developed recurrence with 30 patients who remained disease-free. There were no differences in T classification, N classification, disease subsite, or smoking status between the groups. In a longitudinal analysis, recurrent patients had significantly higher E6 and E7 serum antibody levels than the nonrecurrent patients over the follow-up period (P = 0.02 and P = 0.002, respectively). Patients who recurred had a lower clearance of E7 antibody than patients who remained disease-free (P = 0.0016).Conclusions: Patients with HPV+OPSCC whose disease recurs have a lower clearance of E6 and E7 antibodies than patients who do not have recurrence. The ratio of E7 antibody at disease recurrence compared with baseline is potentially a clinically significant measurement of disease status in HPV+OPSCC. Clin Cancer Res; 23(11); 2723-9. ©2016 AACR.

Feasibility of Non-invasive Brain Modulation for Management of Pain Related to Chemoradiotherapy in Patients with Advanced Head and Neck Cancer

Patients with head and neck cancer often experience a significant decrease in their quality of life during chemoradiotherapy (CRT) due to treatment-related pain, which is frequently classified as severe. Transcranial direct current stimulation (tDCS) is a method of non-invasive brain stimulation that has been frequently used in experimental and clinical pain studies. In this pilot study, we investigated the clinical impact and central mechanisms of twenty primary motor cortex (M1) stimulation sessions with tDCS during 7 weeks of CRT for head and neck cancer. From 48 patients screened, seven met the inclusion criteria and were enrolled. Electroencephalography (EEG) data were recorded before and after tDCS stimulation as well as across the trial to monitor short and long-term impact on brain function. The compliance rate during the long trial was extremely high (98.4%), and patients mostly reported mild side effects in line with the literature (e.g., tingling). Compared to a large standard of care study from our institution, our initial results indicate that M1-tDCS stimulation has a pain relief effect during the CRT that resulted in a significant attenuation of weight reduction and dysphagia normally observed in these patients. These results translated to our patient cohort not needing feeding tubes or IV fluids. Power spectra analysis of EEG data indicated significant changes in α, β, and γ bands immediately after tDCS stimulation and, in addition, α, δ, and θ bands over the long term in the seventh stimulation week (p < 0.05). The independent component EEG clustering analysis showed estimated functional brain regions including precuneus and superior frontal gyrus (SFG) in the seventh week of tDCS stimulation. These areas colocalize with our previous positron emission tomography (PET) study where there was activation in the endogenous μ-opioid system during M1-tDCS. This study provides preliminary evidence demonstrating the feasibility and safety of M1-tDCS as a potential adjuvant neuromechanism-driven analgesic therapy for head and neck cancer patients receiving CRT, inducing immediate and long-term changes in the cortical activity and clinical measures, with minimal side-effects.

Abstract 3114: Soy isoflavones modulate global methylation in head and neck squamous cell carcinoma (HNSCC)

Soy intake has been associated with improved survival in HNSCC and soy isoflavones have been suggested as potential chemopreventive agents with a favorable therapeutic index and safety profile. Multiple in vivo and in vitro anti-cancer effects have been postulated including modulation of gene methylation. To determine if high dose soy isoflavone treatment changes methylation of genes associated with cancer outcomes, we measured genomic and gene-specific methylation in tumor tissue collected as a part of a multi-institutional neoadjuvant soy isoflavone clinical trial in HNSCC patients undergoing definitive surgical management.

Methods: Thirty-nine patients participated in this clinical trial. Patients were scheduled to receive 2 weeks (range 7-39 days, median = 15.2) of soy isoflavone supplements (300 mg/day G-2535; DCP, NCI, NIH) orally prior to surgery. Levels of methylation of LINE-1 (global methylation), and 6 other candidate genes previously associated with HNSCC (p16, DCC, NDN, CD1a, CCNA1 and Gadd45α) were measured by pyrosequencing in biopsy, resection and whole blood specimens. Twelve patients were stage I/II, 27 were stage III/IV. Thirty one patients had cancer of the oral cavity, 4 had larynx and 4 had oropharynx cancer. Mean age of the patients was 60.1 (sd = 12.5). Changes in methylation were tested using paired t-tests and clinical associations explored using ANOVA.

Results: LINE-1 methylation increased significantly (mean increase 4.9%; range -34.8% to +20.9%) in tumor specimens after soy isoflavone (p&lt;0.005). Amount of change correlated positively with days of isoflavone taken (p = .009). Increases in LINE-1 methylation in tumor were greatest in patients with normal BMI (p&lt;0.03). Similar changes for LINE-1 were not seen in corresponding whole blood samples. No other significant changes in tumor or blood methylation levels were seen in the other candidate genes. Baseline tumor methylation and change in methylation were also studied with respect to nutrition (BMI), drinking, tumor site, tumor stage, nodal status and prior treatment. Baseline CD1a methylation was lowest in current smokers (p&lt;0.04) and increases in CD1a after soy intake were associated with increasing pack years (p&lt;0.02). CD1a methylation was also higher in patients with T1,2 tumors (p&lt;0.03). Pretreatment NDN methylation was lower (p&lt;.008) and LINE-1 higher (p&lt;0.0001) in oral cavity cancer compared to oropharynx or larynx cancers. Toxicity from soy isoflavones was negligible and patient compliance was excellent.

Conclusions: This is the first demonstration of significant increases in tissue-specific global methylation associated with soy isoflavone intake, indicating increased genomic stability. The association of hypomethylation of LINE-1 with genetic instability, carcinogenesis and poor treatment outcomes suggests that soy isoflavones should be studied further as a potential chemopreventive agent in HNSCC.

Citation Format: Laura Rozek, Shama Virani, Emily Bellile, Jeremy Taylor, Maureen Sartor, Alisha Virani, Katie Rentschler, Claire Cote, Francis Worden, Lisa Peterson, Douglas Chepeha, Mark Prince, Scott McLean, George Yoo, Neil F. Saba, Dong M. Shin, Omer Kucuk, Gregory T. Wolf. Soy isoflavones modulate global methylation in head and neck squamous cell carcinoma (HNSCC). [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 3114.

Abstract 5210: Incidence and mortality trends of prostate cancer in southern Thailand

Background: Prostate cancer is one of the most commonly diagnosed cancers in men worldwide. In Asia, the incidence of prostate cancer is expected to increase in the next decades as the population ages and as developing Asian countries undergo the epidemiologic transition. There is a scarcity of studies on the epidemiology of prostate cancer in Thailand. The characterization and projection of the burden of prostate cancer are important to design cost-effective strategies for the prevention and control of this disease. The purpose of this study is to examine incidence and mortality trends of prostate cancer in southern Thailand.

Methods: Incident prostate cancer cases from the Songkhla cancer registry were used to analyze incidence and mortality trends; complete data on incidence was available from 1990-2013 and data on mortality was available from 1990-2010. Characteristics of the cases on sociodemographic factors and tumor characteristics were collected, as was vital status. Joinpoint analysis was used to examine the incidence and mortality trends and calculate the annual percent change (APC). The number of joinpoints, slope of the trends, and their significance was determined by permutation tests. Incidence and mortality rates were standardized to the Segi's world standard population.

Results: Eight hundred fifty-five prostate cancer cases were diagnosed from 1990 to 2013. The median age at diagnosis was 74 and 89.6% of the diagnosed cases were Buddhist, with the remainder being Muslim. The majority (79.8%) of prostate cancers were unstaged. However, among those cases whose tumors were staged, the distribution was as follows: 3.5% stage I, 17.9% stage II, 2.9% stage III, 75.7% stage IV. The proportion of unstaged tumors decreased during the period 2005-2009 compared to earlier periods, and there was an increase in the proportion of stage II tumors for the same period. The overall prostate cancer incidence rates increased significantly at an APC of 5.1% (95%CI: 3.8, 6.4) from 1990 to 2013. Among Buddhist men, the APC was very similar to the overall incidence (APC: 5.2%, 95%CI: 4.0, 6.5), while we observed a very low incidence rate and no evidence of an increasing trend in Muslim men. As of 2010, 72.7% of the cases had died. Similar to incidence rates, prostate cancer mortality rates have significantly increased at and APC of 3.2% (95CI%: 1.7, 4.8) from 1990 to 2010.

Conclusion: This analysis showed that there has been a significant increase in prostate cancer incidence and mortality in Southern Thailand during the period 1990-2013. Next steps include assessing the effects of age, calendar year, and birth-cohort on the incidence and mortality of prostate cancer and projection of the incidence and mortality rates over the next fifteen years in order to fully characterize this cancer and help to design strategies to reduce the future burden of prostate cancer in Thailand.

Citation Format: Christian Alvarez, Shama Virani, Rafael Meza, Laura Rozek, Hutcha Sriplung, Alison M. Mondul. Incidence and mortality trends of prostate cancer in southern Thailand. [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 5210.

Tumor infiltrating lymphocytes and survival in patients with head and neck squamous cell carcinoma

BACKGROUND

Because immune responses within the tumor microenvironment are important predictors of tumor biology, correlations of types of tumor infiltrating lymphocytes (TILs) with clinical outcomes were determined in 278 patients with head and neck squamous cell carcinoma (HNSCC).

METHODS

Infiltrating levels of CD4 (helper T cells), CD8 (cytotoxic/suppressor T cells), FoxP3 (regulatory T cells), CD68 (myeloid-derived suppressor cells,) and CD1a (Langerhans) cells were measured in tissue microarrays (TMAs). Cox models tested associations with patient outcomes after adjusting for all known prognostic factors. Median follow-up was 36.6 months.

RESULTS

Higher CD4 and CD8 TIL levels were associated with improved overall survival (OS; hazard ratio [HR] = 0.77; 95% confidence interval [CI]  = 0.65-0.93; p = .005 and HR = 0.77; 95% CI = 0.64-0.94; p = .008, respectively), and relapse-free survival (RFS; p = .03 and .05, respectively). After controlling for prognostic factors, higher CD4 levels predicted improved OS and disease-specific survival (DSS; p = .003 and p = .004, respectively).

CONCLUSION

The findings suggest that TILs are a significant independent prognostic factor for HNSCC that differ by treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1074-1084, 2016.

Abstract 3645: Racial differences in epigenetic modifications of head and neck squamous cell carcinomas: a preliminary study

Disparities in incidence, mortality and survival are present among head and neck squamous cell carcinoma (HNSCC) patients, with males and African Americans disproportionately affected. Etiologic risk factors for HNSCC include tobacco and alcohol use and human papillomavirus (HPV) infection. Epidemiologically, HPV(+) tumors appreciate a prognostic advantage and have a distinct risk profile compared to HPV(-) HNSCCs. HPV(+) HNSCCs also have a different molecular profile than HPV(-) HNSCCs, specifically a higher somatic mutation rate among HPV(-) tumors and a higher degree of epigenetic modifications among HPV(+) tumors. Although disparities in epigenetic modifications by race have been described for breast, liver and colon cancer, these changes are not well understood among HNSCCs. Here, we described epigenetic modification of candidate genes affecting HNSCC carcinogenesis to understand potential molecular differences in tumor phenotype that may be associated with a distinct racial risk profile in HNSCC patients. We identified formalin-fixed paraffin-embedded (FFPE) HNSCC tissue blocks archived by the Louisiana Cancer Research Consortium Biospecimen Repository for Caucasian and African American patients. Information on site, sex and age was also available. DNA was extracted from tissue collected from areas of &gt;70% cellularity. Using bisulfite sequencing (pyrosequencing), we quantified methylation levels for a panel of candidate genes that have been previously identified as significant in methylation of HNSCCs: CCNA1, CD1A, p16, DCC, GADD45 and NDN. Samples were also tested for HPV status. Using a Mann-Whitney-U test, we compared methylation levels by race, HPV status, sex and age. A total of 24 tissue blocks were retrieved, and we excluded five samples due to inadequate tissue, low DNA concentrations or ambiguous site definitions. The mean age at diagnosis was 56.7 ± 6.5 years and the majority were male (79%). The race distribution was fairly even, with 47.4% African American and 52.6% White. Three HNSCCs were HPV(+), 15 were HPV(-) and one was inconclusive for HPV status. Overall, mean methylation levels were 54.9% for CD1A, 33.9% for CCNA1, 33.5% for DCC, 25.2% for NDN, 6.6% for p16, and 3.4% for GADD45. We noted a significant difference in mean methylation levels of CCNA1 by race (46.8% in African Americans and 19.1% in Whites, p &lt; 0.02). We also found higher methylation levels for CD1A among HPV(+) tumors, 70.7%, compared to HPV(-) tumors, 55.6% (p &lt; 0.04). DCC showed higher methylation levels in males compared to females (38.2% vs. 16.7% respectively; p &lt; 0.04). Our preliminary results suggest that many factors, including race, may be associated with epigenetic modification in HNSCCs, and attention to the somatic profile of HNSCCs may indicate novel avenues for prevention and treatment of this disease.

Citation Format: Lauren E. Cole, Laura Rozek, Shama Virani, Maureen Sartor, Jonathon McHugh, Edward Peters. Racial differences in epigenetic modifications of head and neck squamous cell carcinomas: a preliminary study. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3645. doi:10.1158/1538-7445.AM2013-3645

Gene expression differences between colon and rectum tumors

PURPOSE

Colorectal cancer studies typically include both colon and rectum tumors as a common entity, though this assumption is controversial and only minor differences have been reported at the molecular and epidemiologic level. We conducted a molecular study based on gene expression data of tumors from colon and rectum to assess the degree of similarity between these cancer sites at transcriptomic level.

EXPERIMENTAL DESIGN

A pooled analysis of 460 colon tumors and 100 rectum tumors from four data sets belonging to three independent studies was conducted. Microsatellite instable tumors were excluded as these are known to have a different expression profile and have a preferential proximal colon location. Expression differences were assessed with linear models, and significant genes were identified using adjustment for multiple comparisons.

RESULTS

Minor differences at a gene expression level were found between tumors arising in the proximal colon, distal colon, or rectum. Only several HOX genes were found to be associated with tumor location. More differences were found between proximal and distal colon than between distal colon and rectum.

CONCLUSIONS

Microsatellite stable colorectal cancers do not show major transcriptomic differences for tumors arising in the colon or rectum. The small but consistent differences observed are largely driven by the HOX genes. These results may have important implications in the design and interpretation of studies in colorectal cancer.

Breast cancer histology and receptor status characterization in Asian Indian and Pakistani women in the U.S.--a SEER analysis

Background

Recent reports suggest increase in estrogen receptor (ER), progesterone receptor (PR) negative breast cancer yet little is known about histology or receptor status of breast cancer in Indian/Pakistani women.in the U.S.

Methods

We examined the United States National Cancer Institute's Surveillance Epidemiology and End Results (SEER) Cancer program to assess: a) frequency of breast cancer by age, b) histologic subtypes, c) receptor status of breast cancer and, d) survival in Indians/Pakistanis compared to Caucasians. There were 360,933 breast cancer cases diagnosed 1988-2006. Chi-Square analyses and Cox proportional hazards models, to estimate relative risks for breast cancer mortality after adjusting for confounders, were performed using Statistical Analysis Software 9.2.

Results

Among Asian Indian/Pakistani breast cancer patients, 16.2% were < 40 yrs. old compared to 6.23% in Caucasians (p < 0.0001). Asian Indian women had more invasive ductal carcinoma (69.1 vs. 65.7%, p < 0.0001), inflammatory cancer (1.4% vs. 0.8, p < 0.0001) and less invasive lobular carcinoma (4.2% vs. 8.1%, p < 0.0001) than Caucasians. Asian Indian/Pakistani women had more ER/PR negative breast cancer (30.6% vs. 21.8%, p = 0.0095) than Caucasians. Adjusting for stage at diagnosis, age, tumor grade, nodal status, and histology, Asian Indian/Pakistani women's survival was similar to Caucasians, while African Americans' was worse.

Conclusions

Asian Indian/Pakistani women have higher frequency of breast cancer (particularly in age < 40), ER/PR negative invasive ductal and inflammatory cancer than Caucasians.

Genome-wide association scan identifies a colorectal cancer susceptibility locus on 11q23 and replicates risk loci at 8q24 and 18q21

In a genome-wide association study to identify loci associated with colorectal cancer (CRC) risk, we genotyped 555,510 SNPs in 1,012 early-onset Scottish CRC cases and 1,012 controls (phase 1). In phase 2, we genotyped the 15,008 highest-ranked SNPs in 2,057 Scottish cases and 2,111 controls. We then genotyped the five highest-ranked SNPs from the joint phase 1 and 2 analysis in 14,500 cases and 13,294 controls from seven populations, and identified a previously unreported association, rs3802842 on 11q23 (OR = 1.1; P = 5.8 x 10(-10)), showing population differences in risk. We also replicated and fine-mapped associations at 8q24 (rs7014346; OR = 1.19; P = 8.6 x 10(-26)) and 18q21 (rs4939827; OR = 1.2; P = 7.8 x 10(-28)). Risk was greater for rectal than for colon cancer for rs3802842 (P < 0.008) and rs4939827 (P < 0.009). Carrying all six possible risk alleles yielded OR = 2.6 (95% CI = 1.75-3.89) for CRC. These findings extend our understanding of the role of common genetic variation in CRC etiology.