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Head & Neck May 2019The objective of the present study is to assess differences in the competing causes of death in patients with oropharyngeal carcinoma (OPC) as a function of the human... (Comparative Study)
Comparative Study
BACKGROUND
The objective of the present study is to assess differences in the competing causes of death in patients with oropharyngeal carcinoma (OPC) as a function of the human papillomavirus (HPV) status.
METHODS
We studied retrospectively 423 patients with OPC with known HPV status. Among the patients included in the study, 53 (12.5%) were HPV-positive. We analyzed overall survival and competing causes of mortality according to the HPV status of the patients.
RESULTS
Patients with HPV-negative tumors had lower OPC cancer-specific survival (P = .0001), second primary neoplasm survival (P = .0001), and noncancer-related causes survival (P = .13) than patients with HPV-positive tumors. This resulted in significant differences in overall survival depending on HPV status (P = .0001).
CONCLUSION
Conclusion: HPV-positive OPC has a better overall survival than HPV-negative OPC. Patients with HPV-positive tumors presented a significant lower OPC cancer-specific and second primary neoplasm mortality and a marginally nonsignificant lower noncancer mortality as compared to HPV-negative tumors.
Topics: Adult; Aged; Cause of Death; Databases, Factual; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Papillomavirus Infections; Prognosis; Regression Analysis; Retrospective Studies; Risk Assessment; Squamous Cell Carcinoma of Head and Neck; Statistics, Nonparametric; Survival Analysis
PubMed: 30549389
DOI: 10.1002/hed.25559 -
Seminars in Oncology Oct 2022The development of deintensified therapies aiming at reducing the treatment-related toxicity while not impairing the outcome is an unmet need in HPV+ oropharyngeal...
The development of deintensified therapies aiming at reducing the treatment-related toxicity while not impairing the outcome is an unmet need in HPV+ oropharyngeal carcinoma patients. Several deintensification approaches have been explored in this setting, including induction chemotherapy with reduced chemoradiation dose in responding pts. The findings of the studies conducted so far show that the available deescalated therapy should be based on the disease risk profile. At present, we still lack robust high level data to infer that the cited interventions are equivalent or superior to standard of care treatments. However, literature data suggest that approximately 70% of low-risk patients might receive a deintensified approach by including either surgery or induction chemotherapy. In the context of high-risk disease, more than 80% of patients may undergo a deintensified loco-regional treatment by neoadjuvant systemic therapy. Epidemiological data suggest that in the next decades, most of the HPV-related OPSCC patients will be made of old and possibly frail individuals. However, this patient population was excluded from most of the studies conducted so far. Therefore, there is a strong need for clinical trials to define risk-based deescalation strategies in this population and in younger patients as well.
Topics: Humans; Papillomavirus Infections; Oropharyngeal Neoplasms; Chemoradiotherapy; Combined Modality Therapy; Carcinoma
PubMed: 36241485
DOI: 10.1053/j.seminoncol.2022.09.007 -
ORL; Journal For Oto-rhino-laryngology... 2022This study seeks to (1) demonstrate how machine learning (ML) can be used for prediction modeling by predicting the treatment patients with T1-2, N0-N1 oropharyngeal...
OBJECTIVES
This study seeks to (1) demonstrate how machine learning (ML) can be used for prediction modeling by predicting the treatment patients with T1-2, N0-N1 oropharyngeal squamous cell carcinoma (OPSCC) receive and (2) assess the impact patient, socioeconomic, regional, and institutional factors have in the treatment of this population.
METHODS
A retrospective cohort of adults diagnosed with T1-2, N0-N1 OPSCC from 2004 to 2013 was obtained using the National Cancer Database. The data was split into 80/20 distribution for training and testing, respectively. Various ML algorithms were explored for development. Area under the curve (AUC), accuracy, precision, and recall were calculated for the final model.
RESULTS
Among the 19,111 patients in the study, the mean (standard deviation) age was 61.3 (10.8) years, 14,034 (73%) were male, and 17,292 (91%) were white. Surgery was the primary treatment in 9,533 (50%) cases and radiation in 9,578 (50%) cases. The model heavily utilized T-stage, primary site, N-stage, grade, and type of treatment facility to predict the primary treatment modality. The final model yielded an AUC of 78% (95% CI, 77-79%), accuracy of 71%, precision of 72%, and recall of 71%.
CONCLUSION
This study created a ML model utilizing clinical variables to predict primary treatment modality for T1-2, N0-N1 OPSCC. This study demonstrates how ML can be used for prediction modeling while also highlighting that tumor and facility realted variables impact the decision making process on a national level.
Topics: Head and Neck Neoplasms; Humans; Machine Learning; Male; Middle Aged; Oropharyngeal Neoplasms; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck
PubMed: 33730728
DOI: 10.1159/000515334 -
Head & Neck May 2014Human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OSCC) is emerging as a different subtype of head and neck cancer. The authors conducted a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OSCC) is emerging as a different subtype of head and neck cancer. The authors conducted a systematic review and meta-analysis to examine the predictive role of HPV in patients with OSCC treated with radiotherapy-based modality therapy.
METHODS
The authors performed a PubMed search to identify published trials that evaluated the outcome of HPV+ OSCC treated with radiotherapy. Hazard ratios (HRs) were extracted and pooled by using random or fixed effects models. The primary endpoints were overall survival (OS), disease-specific survival, (DSS), and disease-free survival (DFS).
RESULTS
Thirty trials were available for HPV analysis. HPV+ status is associated with better OS (HR = 0.33; p < .00001), DSS (HR = 0.24; p < .00001), and DFS (HR = 0.31; p < .00001).
CONCLUSION
HPV+ OSCC has a better survival compared to HPV-negative disease when treated with radiotherapy-based modality therapy.
Topics: Carcinoma, Squamous Cell; Disease-Free Survival; Female; Human papillomavirus 16; Humans; Male; Oropharyngeal Neoplasms; Papillomavirus Infections; Predictive Value of Tests; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Survival Analysis; Treatment Outcome
PubMed: 23606404
DOI: 10.1002/hed.23351 -
HNO Feb 2021At the beginning of 2017, the 8th edition of the TNM classification was presented. For oropharyngeal carcinoma, this was accompanied by a paradigm shift, as... (Review)
Review
At the beginning of 2017, the 8th edition of the TNM classification was presented. For oropharyngeal carcinoma, this was accompanied by a paradigm shift, as a separation of the classification depending on the association with human papillomavirus (HPV) status has been established. By considering the literature, this paper provides an overview of the characteristics of HPV-associated carcinomas, the new features of the TNM classification, and the existing points of discussion. The revision has improved the prognostic significance of the TNM classification; however, there are still tumor- and patient-dependent influencing factors that must be considered for future versions.
Topics: Carcinoma; Humans; Neoplasm Staging; Oropharyngeal Neoplasms; Papillomaviridae; Prognosis
PubMed: 32385531
DOI: 10.1007/s00106-020-00875-4 -
Bulletin Du Cancer May 2014Oropharyngeal carcinomas, contrary to other head and neck carcinomas are of increasing frequency, mostly due to a frequent association with human papillomavirus... (Review)
Review
Oropharyngeal carcinomas, contrary to other head and neck carcinomas are of increasing frequency, mostly due to a frequent association with human papillomavirus infection. Pluridisciplinary management is necessary. New techniques as transoral surgery or intensity-modulated radiation therapy have the potential to reduce toxicities and morbidity while offering equivalent local control rates. Early stages may be treated with single modality treatment (surgery or radiotherapy) with five-year overall survival rate exceeding 80%. Advanced stages need therapeutic associations and five-years survival rates are inferior to 40%.
Topics: Alcohol Drinking; Humans; Induction Chemotherapy; Organ Sparing Treatments; Oropharyngeal Neoplasms; Papillomavirus Infections; Risk Factors; Smoking
PubMed: 24886893
DOI: 10.1684/bdc.2014.1957 -
Head & Neck Aug 2022This study evaluated whether fluorescence lifetime imaging (FLIm), coupled with standard diagnostic workups, could enhance primary lesion detection in patients with p16+...
BACKGROUND
This study evaluated whether fluorescence lifetime imaging (FLIm), coupled with standard diagnostic workups, could enhance primary lesion detection in patients with p16+ head and neck squamous cell carcinoma of the unknown primary (HNSCCUP).
METHODS
FLIm was integrated into transoral robotic surgery to acquire optical data on six HNSCCUP patients' oropharyngeal tissues. An additional 55-patient FLIm dataset, comprising conventional primary tumors, trained a machine learning classifier; the output predicted the presence and location of HNSCCUP for the six patients. Validation was performed using histopathology.
RESULTS
Among the six HNSCCUP patients, p16+ occult primary was surgically identified in three patients, whereas three patients ultimately had no identifiable primary site in the oropharynx. FLIm correctly detected HNSCCUP in all three patients (ROC-AUC: 0.90 ± 0.06), and correctly predicted benign oropharyngeal tissue for the remaining three patients. The mean sensitivity was 95% ± 3.5%, and specificity 89% ± 12.7%.
CONCLUSIONS
FLIm may be a useful diagnostic adjunct for detecting HNSCCUP.
Topics: Carcinoma, Squamous Cell; Fluorescence; Head and Neck Neoplasms; Humans; Neoplasms, Unknown Primary; Oropharyngeal Neoplasms
PubMed: 35511208
DOI: 10.1002/hed.27078 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Sep 2023To analysis the clinical features and prognosis in oropharyngeal carcinoma with secondary primary tumor. A retrospective analysis was performed on 468 pathologically...
To analysis the clinical features and prognosis in oropharyngeal carcinoma with secondary primary tumor. A retrospective analysis was performed on 468 pathologically confirmed oropharyngeal cancer as the primary tumor patients with p16 status, excluded distant metastasis, and admitted to the Chinese Academy of Medical Sciences from January 2010 to December 2020. The clinical features and prognosis of the secondary primary tumor were analyzed. Among 468 patients with oropharyngeal cancer treated at initial diagnosed, 222 cases were P16-negative. With a median follow-up time of 64.3 months, 66 cases developed second primary cancer, with an incidence of 29.3%, among which 63.6%(42/66) were synchronous and 36.4%(24/66) were heterochronous, esophagus was the most commonly involved site. The 5-year OS of p16-negative oropharyngeal carcinoma with synchronous second primary cancer, without second primary cancer and with heterogeneous second primary cancer were 26.3% and 57.3% and 73.2%(=0.001); The second primary cancer accounted for 11.2%(12/107) of the deaths in the whole group, among them, the heterochronous second primary accounted for 75.0%(9/12). There were 246 patients with p16 positive, with a median follow-up time of 52.4 months, 20 patients developed second primary cancer(8.1%). Among them, 65.0%(13/20) were synchronous and 35.0%(7/20) were heterochronous. Esophagus was the most commonly involved site. The 4-year OS of p16-positive with synchronous, heterochronous and non-second primary cancer group were 51.9%, 80.7% and 83.3%. Secondary primary cancer accounted for 3.8%(2/52) of all deaths in p16 positvie group. The incidence of second primary cancer of p16 positive and negative oropharyngeal carcinoma were different. The esophagus was the most commonly involved site regardless of p16 status. Regardless of p16 status, the survival of patients with synchronous second primary cancer was worse than those without second primary cancer. For p16-negative oropharyngeal carcinoma, the prognosis was better in patients with heterogeneous second primary cancer, the second primary cancer is one of the main causes of death.
Topics: Humans; Carcinoma; Oropharyngeal Neoplasms; Retrospective Studies; Neoplasms, Second Primary
PubMed: 37640995
DOI: 10.13201/j.issn.2096-7993.2023.09.007 -
Clinical Cancer Research : An Official... Oct 2022Lack of prospectively planned follow-up and minimal characterization of the patient population studied complicate interpretation of circulating human papillomavirus...
Lack of prospectively planned follow-up and minimal characterization of the patient population studied complicate interpretation of circulating human papillomavirus (HPV) DNA as a prognostic biomarker for patients with HPV-associated oropharyngeal carcinoma treated with curative intent. See related article by Berger et al., p. 4292.
Topics: Biomarkers; Carcinoma, Squamous Cell; DNA; Humans; Oropharyngeal Neoplasms; Papillomavirus Infections; Prognosis
PubMed: 35861851
DOI: 10.1158/1078-0432.CCR-22-1711 -
The Laryngoscope Nov 2018To determine if multispectral narrow-band imaging (mNBI) can be used for automated, quantitative detection of oropharyngeal carcinoma (OPC). (Clinical Trial)
Clinical Trial
OBJECTIVE
To determine if multispectral narrow-band imaging (mNBI) can be used for automated, quantitative detection of oropharyngeal carcinoma (OPC).
STUDY DESIGN
Prospective cohort study.
METHODS
Multispectral narrow-band imaging and white light endoscopy (WLE) were used to examine the lymphoepithelial tissues of the oropharynx in a preliminary cohort of 30 patients (20 with biopsy-proven OPC, 10 healthy). Low-level image features from five patients were then extracted to train naïve Bayesian classifiers for healthy and malignant tissue.
RESULTS
Tumors were classified by color features with 65.9% accuracy, 66.8% sensitivity, and 64.9% specificity under mNBI. In contrast, tumors were classified with 52.3% accuracy (P = 0.0108), 44.8% sensitivity (P = 0.0793), and 59.9% specificity (P = 0.312) under WLE. Receiver operating characteristic analysis yielded areas under the curve (AUC) of 72.3% and 54.6% for classification under mNBI and WLE, respectively (P = 0.00168). For classification by both color and texture features, AUC under mNBI increased (80.1%, P = 0.00230) but did not improve under WLE (below 55% for both models, P = 0.180). Cross-validation with five folds yielded an AUC above 80% for both mNBI models and below 55% for both WLE models (P = 0.0000410 and 0.000116).
CONCLUSION
Compared to WLE, mNBI significantly enhanced the performance of a naïve Bayesian classifier trained on low-level image features of oropharyngeal mucosa. These findings suggest that automated clinical detection of OPC might be used to enhance surgical vision, improve early diagnosis, and allow for high-throughput screening.
LEVEL OF EVIDENCE
NA. Laryngoscope, 2514-2520, 2018.
Topics: Aged; Aged, 80 and over; Bayes Theorem; Carcinoma; Diagnosis, Differential; Female; Humans; Machine Learning; Male; Middle Aged; Narrow Band Imaging; Oropharyngeal Neoplasms; Pattern Recognition, Automated; Prospective Studies; Sensitivity and Specificity
PubMed: 29577322
DOI: 10.1002/lary.27159