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JAMA Network Open Aug 2021Recent insights into the biologic characteristics and treatment of oropharyngeal cancer may help inform improvements in prognostic modeling. A bayesian multistate model...
IMPORTANCE
Recent insights into the biologic characteristics and treatment of oropharyngeal cancer may help inform improvements in prognostic modeling. A bayesian multistate model incorporates sophisticated statistical techniques to provide individualized predictions of survival and recurrence outcomes for patients with newly diagnosed oropharyngeal cancer.
OBJECTIVE
To develop a model for individualized survival, locoregional recurrence, and distant metastasis prognostication for patients with newly diagnosed oropharyngeal cancer, incorporating clinical, oncologic, and imaging data.
DESIGN, SETTING, AND PARTICIPANTS
In this prognostic study, a data set was used comprising 840 patients with newly diagnosed oropharyngeal cancer treated at a National Cancer Institute-designated center between January 2003 and August 2016; analysis was performed between January 2019 and June 2020. Using these data, a bayesian multistate model was developed that can be used to obtain individualized predictions. The prognostic performance of the model was validated using data from 447 patients treated for oropharyngeal cancer at Erasmus Medical Center in the Netherlands.
EXPOSURES
Clinical/oncologic factors and imaging biomarkers collected at or before initiation of first-line therapy.
MAIN OUTCOMES AND MEASURES
Overall survival, locoregional recurrence, and distant metastasis after first-line cancer treatment.
RESULTS
Of the 840 patients included in the National Cancer Institute-designated center, 715 (85.1%) were men and 268 (31.9%) were current smokers. The Erasmus Medical Center cohort comprised 300 (67.1%) men, with 350 (78.3%) current smokers. Model predictions for 5-year overall survival demonstrated good discrimination, with area under the curve values of 0.81 for the model with and 0.78 for the model without imaging variables. Application of the model without imaging data in the independent Dutch validation cohort resulted in an area under the curve of 0.75. This model possesses good calibration and stratifies patients well in terms of likely outcomes among many competing events.
CONCLUSIONS AND RELEVANCE
In this prognostic study, a multistate model of oropharyngeal cancer incorporating imaging biomarkers appeared to estimate and discriminate locoregional recurrence from distant metastases. Providing personalized predictions of multiple outcomes increases the information available for patients and clinicians. The web-based application designed in this study may serve as a useful tool for generating predictions and visualizing likely outcomes for a specific patient.
Topics: Bayes Theorem; Biomarkers, Tumor; Female; Forecasting; Humans; Male; Michigan; Middle Aged; Models, Theoretical; Netherlands; Oropharyngeal Neoplasms; Prognosis; Survival Analysis; Treatment Outcome; United States
PubMed: 34369988
DOI: 10.1001/jamanetworkopen.2021.20055 -
Otolaryngologia Polska = the Polish... Aug 2022To investigate the impact on local relapse rate (LRR) and disease specific survival (DSS) of intraoperative margins (FS) obtained by circumferential sampling method,...
OBJECTIVES
To investigate the impact on local relapse rate (LRR) and disease specific survival (DSS) of intraoperative margins (FS) obtained by circumferential sampling method, corresponding to the lesion shape and marked using clock-face orientation combined with narrow band imaging (NBI) in head and neck squamous cell carcinoma Materials and Methods: 147 consecutive patients who underwent primary surgery with radical intent for oral and oropharyngeal cancer between 2011 and 2016 were prospectively enrolled. Patients were assigned to 3 groups with different sampling methods. In group A (n=44) a classical FS sampling method was used. In group B (n=73), the clock-face orientation sampling method (FS oclock) was used, whereas in group C (n=30), the FS oclock method combined with NBI. The primary outcome measure was the interdependence between FS sampling methods and oncological outcomes measured by LRR and DSS.
RESULTS
In total, 1534 FS samples were obtained with range of 3-24 FS taken per case, median 7.25 in group A, 8.15 in group B and 7.52 in group C. When compared FS histology and final histology in all groups the sensitivity, specificity and accuracy were 61.54%, 98.51% and 95.24%, respectively. The overall LRR equaled 8.8%. The lowest LRR was observed in FS oclock method combined with NBI (6.67%) followed by FS oclock (6.85%) and FS classic (13.64%). For all patients, DSS achieved 95.92% - 95.45% in FS classic, 95.89% in FS oclock and 96.67%. in FS oclock combined with NBI.
CONCLUSION
The FS oclock sampling method combined with NBI increases the chance of achieving tumor-negative margins and in result improves the treatment outcome reflected by LRR and DSS.
Topics: Humans; Head and Neck Neoplasms; Narrow Band Imaging; Oropharyngeal Neoplasms; Margins of Excision
PubMed: 36805982
DOI: 10.5604/01.3001.0015.9678 -
Oncology Reports Aug 2022The clinical introduction of molecular imaging for the management of oropharyngeal squamous cell carcinoma (OPSCC) relies on the identification of relevant...
The clinical introduction of molecular imaging for the management of oropharyngeal squamous cell carcinoma (OPSCC) relies on the identification of relevant cancer‑specific biomarkers. The application of three membrane‑bound receptors, namely urokinase‑type plasminogen activator receptor (uPAR), tissue factor (TF) and EGFR have been previously explored for targeted imaging and therapeutic strategies in a broad range of solid cancers. The present study aimed to investigate the expression patterns of uPAR, EGFR and TF by immunohistochemistry (IHC) to evaluate their potential for targeted imaging and prognostic value in OPSCC. In a retrospective cohort of 93 patients with primary OPSCC, who were balanced into the 45 human papillomavirus (HPV)‑positive and 48 HPV‑negative groups, the IHC‑determined expression profiles of uPAR, TF and EGFR in large biopsy or tumor resection specimens were analyzed. Using the follow‑up data, overall survival (OS) and recurrence‑free survival were measured. Specifically, associations between survival outcome, biomarker expression and clinicopathological factors were examined using Cox proportional hazards model and log‑rank test following Kaplan‑Meier statistics. After comparing the expression pattern of biomarkers within the tumor compartment with that in the adjacent normal tissues, uPAR and TF exhibited a highly tumor‑specific expression pattern, whereas EGFR showed a homogeneous expression within the tumor compartment as well as a consistent expression in the normal mucosal epithelium and salivary gland tissues. The positive expression rate of uPAR, TF and EGFR in the tumors was 98.9, 76.3 and 98.9%, respectively. No statistically significant association between biomarker expression and survival outcome could be detected. Higher uPAR expression levels had a trend towards reduced OS according to results from univariate analysis (P=0.07; hazard ratio=2.01; 95% CI=0.92‑4.37). Taken together, these results suggest that uPAR, TF and EGFR may be suitable targets for molecular imaging and therapy in OPSCC. In particular, uPAR may be an attractive target owing to their high positive expression rates in tumors and a highly tumor‑specific expression pattern.
Topics: Biomarkers, Tumor; ErbB Receptors; Humans; Molecular Imaging; Molecular Targeted Therapy; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis; Receptors, Urokinase Plasminogen Activator; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck; Thromboplastin
PubMed: 35775375
DOI: 10.3892/or.2022.8359 -
International Journal of Clinical... Aug 2023Classical oropharyngeal squamous cell carcinoma (OPSCC) caused by alcohol consumption and smoking and HPV-associated OPSCC caused by human papillomavirus (HPV) infection... (Review)
Review
Classical oropharyngeal squamous cell carcinoma (OPSCC) caused by alcohol consumption and smoking and HPV-associated OPSCC caused by human papillomavirus (HPV) infection have different etiologies, incidences, and prognoses. Therefore, the 8th American Joint committee on Cancer (AJCC) and Union for International Cancer Control (UICC) TNM classifications propose distinguishing HPV-associated OPSCC from classical OPSCC and classifying it as an independent disease. Therefore, this review provides an overview of HPV-associated OPSCC from the perspectives of epidemiology, carcinogenesis, development, diagnosis, treatment, and prevention. The incidence of HPV-associated OPSCC is increasing. Although HPV vaccination has been shown to be effective at reducing the incidence of cervical cancer, it is still unclear how it affects the incidence of HPV-associated OPSCC. Additionally, the prognosis of patients with HPV-associated OPSCC is extremely favorable compared to that of patients with classical OPSCC. Therefore, patients with HPV-associated OPSCC may undergo reduced-dose therapy, although attempts to reduce treatment intensity should be carefully planned to ensure they do not compromise oncological outcomes, and large-scale trials aimed at reducing treatment intensity are ongoing.
Topics: Humans; Squamous Cell Carcinoma of Head and Neck; Human Papillomavirus Viruses; Carcinoma, Squamous Cell; Oropharyngeal Neoplasms; Papillomavirus Infections; Papillomaviridae; Prognosis; Head and Neck Neoplasms
PubMed: 37093464
DOI: 10.1007/s10147-023-02336-8 -
BMC Cancer Mar 2021Positron-emission tomography (PET) is widely used to detect malignancies, but consensus on its prognostic value in oropharyngeal cancer has not been established. The...
BACKGROUND
Positron-emission tomography (PET) is widely used to detect malignancies, but consensus on its prognostic value in oropharyngeal cancer has not been established. The purpose of this study was to analyze the PET parameters associated with tumor extent and survival in resectable oropharyngeal cancer.
METHODS
The PET parameters in oropharyngeal cancer patients with regional node metastasis who underwent surgery and postoperative radiotherapy between January 2005 and January 2019 were analyzed. We calculated the SUVmax, tumor-to-liver ratio (TLR), metabolic tumor volume (MTV, volume over SUV 2.5), and total lesion glycolysis (TLG, MTV x mean SUV) of the primary lesion and metastatic nodes. Histologic findings, patient survival, and recurrence were reviewed in the medical records.
RESULTS
Fifty patients were included, and the PET parameters were extracted for 50 primary lesions and 104 nodal lesions. In the survival analysis, MTV and TLG of the primary lesions showed significant differences in overall survival (OS) and recurrence-free survival (RFS). In the multiple regression analysis, TLG of the primary lesion was associated with the depth of invasion (DOI). MTV of the nodes was a significant factor affecting extranodal extension (ENE).
CONCLUSIONS
PET parameters could be related with OS, RFS, DOI of the primary tumor, and ENE. PET would be expected to be a useful diagnostic tool as a prognosticator of survival and pathologic findings in oropharyngeal cancer.
Topics: Adult; Aged; Disease Progression; Disease-Free Survival; Feasibility Studies; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Oropharynx; Pharyngectomy; Positron-Emission Tomography; Prognosis; Radiopharmaceuticals; Radiotherapy, Adjuvant; Retrospective Studies; Tumor Burden
PubMed: 33765966
DOI: 10.1186/s12885-021-08035-9 -
Head and Neck Pathology Dec 2021Primary mixed neuroendocrine-nonneuroendocrine neoplasm (MiNEN) of the head and neck region is a rare biphasic tumor with an aggressive biological behavior. This report... (Review)
Review
Primary mixed neuroendocrine-nonneuroendocrine neoplasm (MiNEN) of the head and neck region is a rare biphasic tumor with an aggressive biological behavior. This report highlights an additional case of oropharyngeal MiNEN in a 46-year-old male patient with a previous long-term smoking history. Histologic evaluation revealed a biphasic tumor infiltrating the lamina propria. The first component consisted of a classic keratinizing squamous cell carcinoma. The second component consisted of small-to-intermediate sized cells with neuroendocrine features. Synaptophysin and CD56 immunohistochemical stains confirmed neuroendocrine lineage in this component. The presence of two morphological components with neuroendocrine and nonneuroendocrine features on histologic assessment should alert the pathologist to consider a MiNEN in their case work-up.
Topics: Biomarkers, Tumor; Diagnosis, Differential; Humans; Male; Middle Aged; Neoplasms, Complex and Mixed; Neuroendocrine Tumors; Oropharyngeal Neoplasms; Smokers; Tomography, X-Ray Computed
PubMed: 33709305
DOI: 10.1007/s12105-021-01312-w -
British Journal of Cancer Apr 2021Oral and gut microbiomes have emerged as potential biomarkers in cancer. We characterised the oral and gut microbiomes in a prospective observational cohort of HPV+... (Observational Study)
Observational Study
BACKGROUND
Oral and gut microbiomes have emerged as potential biomarkers in cancer. We characterised the oral and gut microbiomes in a prospective observational cohort of HPV+ oropharyngeal squamous cell carcinoma (OPSCC) patients and evaluated the impact of chemoradiotherapy (CRT).
METHODS
Saliva, oropharyngeal swabs over the tumour site and stool were collected at baseline and post-CRT. 16S RNA and shotgun metagenomic sequencing were used to generate taxonomic profiles, including relative abundance (RA), bacterial density, α-diversity and β-diversity.
RESULTS
A total of 132 samples from 22 patients were analysed. Baseline saliva and swabs had similar taxonomic composition (R = 0.006; p = 0.827). Oropharyngeal swabs and stool taxonomic composition varied significantly by stage, with increased oral RA of Fusobacterium nucleatum observed in stage III disease (p < 0.05). CRT significantly reduced the species richness and increased the RA of gut-associated taxa in oropharyngeal swabs (p < 0.05), while it had no effect in stool samples. These findings remained significant when adjusted by stage, smoking status and antibiotic use.
CONCLUSIONS
Baseline oral and gut microbiomes differ by stage in this HPV+ cohort. CRT caused a shift towards a gut-like microbiome composition in oropharyngeal swabs. Stage-specific features and the transitions in oral microbiome might have prognostic and therapeutic implications.
Topics: Carcinoma, Squamous Cell; Chemoradiotherapy; Female; Follow-Up Studies; Gastrointestinal Microbiome; Humans; Male; Mouth Mucosa; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis; Prospective Studies; Saliva
PubMed: 33750907
DOI: 10.1038/s41416-020-01253-1 -
Clinical Cancer Research : An Official... Apr 2024Our goal was to demonstrate that lymphatic drainage fluid (lymph) has improved sensitivity in quantifying postoperative minimal residual disease (MRD) in locally...
PURPOSE
Our goal was to demonstrate that lymphatic drainage fluid (lymph) has improved sensitivity in quantifying postoperative minimal residual disease (MRD) in locally advanced human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) compared with plasma, and leverage this novel biofluid for patient risk stratification.
EXPERIMENTAL DESIGN
We prospectively collected lymph samples from neck drains of 106 patients with HPV (+) OPSCC, along with 67 matched plasma samples, 24 hours after surgery. PCR and next-generation sequencing were used to quantify cancer-associated cell-free HPV (cf-HPV) and tumor-informed variants in lymph and plasma. Next, lymph cf-HPV and variants were compared with TNM stage, extranodal extension (ENE), and composite definitions of high-risk pathology. We then created a machine learning model, informed by lymph MRD and clinicopathologic features, to compare with progression-free survival (PFS).
RESULTS
Postoperative lymph was enriched with cf-HPV compared with plasma (P < 0.0001) and correlated with pN2 stage (P = 0.003), ENE (P < 0.0001), and trial-defined pathologic risk criteria (mean AUC = 0.78). In addition, the lymph mutation number and variant allele frequency were higher in pN2 ENE (+) necks than in pN1 ENE (+) (P = 0.03, P = 0.02) or pN0-N1 ENE (-) (P = 0.04, P = 0.03, respectively). The lymph MRD-informed risk model demonstrated inferior PFS in high-risk patients (AUC = 0.96, P < 0.0001).
CONCLUSIONS
Variant and cf-HPV quantification, performed in 24-hour postoperative lymph samples, reflects single- and multifeature high-risk pathologic criteria. Incorporating lymphatic MRD and clinicopathologic feature analysis can stratify PFS early after surgery in patients with HPV (+) head and neck cancer. See related commentary by Shannon and Iyer, p. 1223.
Topics: Humans; Human Papillomavirus Viruses; Papillomavirus Infections; Neoplasm, Residual; Prognosis; Neoplasm Staging; Oropharyngeal Neoplasms; Head and Neck Neoplasms; Squamous Cell Carcinoma of Head and Neck; Retrospective Studies
PubMed: 37939112
DOI: 10.1158/1078-0432.CCR-23-1789 -
Cancer Treatment and Research... 2021Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET-CT) is clinically useful and extensively used... (Observational Study)
Observational Study
INTRODUCTION
Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET-CT) is clinically useful and extensively used in initial staging and follow-up of patients with head and neck squamous cell carcinoma (HNSCC). We studied the potential prognostic significance of primary tumor maximum standard uptake value (SUVmax) by 18F-FDG PET-CT in oropharyngeal cancer.
METHODS
Sixty patients with early and locally advanced histopathologically proven oropharyngeal squamous cell cancer were staged using FDG PET-CT at diagnosis. All patient received radiation therapy and concurrent chemotherapy (in stage III and IVA disease) and were assessed prospectively for treatment outcome. Groups were created based on stage and cut off for SUVmax. The association of SUVmax of primary tumour and stage with disease-free survival and overall survival was analyzed by univariate and multivariate statistics.
RESULTS
In univariate analysis, a primary tumour SUVmax of greater than 13.0 and advanced stage (IVA) predicted inferior disease-free survival (P=0.0241 and 0.0005, respectively) and overall survival (P=0.0510, toward significance and 0.0003, respectively). In proportional hazards analysis, stage was significant only when adjusted for primary SUVmax.
CONCLUSION
SUVmax failed to demonstrate predictive significance in oropharyngeal cancer, and an increase in primary tumor uptake is possibly a direct effect of advanced disease and consequently increased metabolic activity and aggressiveness.
Topics: Adult; Aged; Chemoradiotherapy; Disease-Free Survival; Feasibility Studies; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Oropharyngeal Neoplasms; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Radiopharmaceuticals; Risk Assessment; Squamous Cell Carcinoma of Head and Neck; Tissue Distribution
PubMed: 33461080
DOI: 10.1016/j.ctarc.2021.100305 -
Head & Neck Nov 2020Self-management regimens for oral and oropharyngeal cancer survivors can be complex and challenging. Effective self-management skills can foster better outcomes. We...
BACKGROUND
Self-management regimens for oral and oropharyngeal cancer survivors can be complex and challenging. Effective self-management skills can foster better outcomes. We report on the development, feasibility, and pilot testing of a web-based self-management tool called "Empowered Survivor" (ES) for survivors of oral and oropharyngeal cancer.
METHODS
ES content was developed in two phases, with modules focusing on oral care, swallowing and muscle strength, and long-term follow-up. This single-arm pilot study consisted of a pre-, 2-month, and a 6-month postintervention survey.
RESULTS
Enrollment rates were relatively low. Once enrolled, data collected from the ES website indicated that 81.8% viewed ES. Participants provided positive evaluations of ES. Preliminary results indicate that ES had a beneficial impact on self-management self-efficacy, preparedness for survivorship care, and quality of life. ES improved survivors' engagement in oral self-exams and head and neck strengthening exercises, improved ability to address barriers, and decreased information and support needs.
CONCLUSIONS
This study provides preliminary evidence of engagement, acceptability, and beneficial impact of ES, which should be evaluated in a larger controlled clinical trial.
Topics: Humans; Oropharyngeal Neoplasms; Pilot Projects; Quality of Life; Self-Management; Survivors; Telemedicine
PubMed: 32830404
DOI: 10.1002/hed.26403