Socioeconomic characteristics of patients with oropharyngeal carcinoma according to tumor HPV status, patient smoking status, and sexual behavior

Backround/Aim. Considering the distinct increase in the incidence of oropharyngeal cancer over oral cavity cancers and changing epidemiology with human papilloma virus (HPV) infection emerging as an important risk factor, there is a need to establish better treatment choices in specific groups of patients with oropharyngeal cancer. The aim of this study was to assess the quality of life (QOL) and functional performance and the impact of different demographical data, stage of disease, and treatment type on these parameters in patients with oropharyngeal cancer with successfully achieved locoregional control a year after the treatment. Methods. Study included 87 patients who underwent QOL and functional impairment assessment 12 to 14 months after finished oncological treatment with the following questionnaires: the European Organization for Research and Treatment of Cancer Quality-of Life-Questionnaire-C30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of- Life Questionnaire-Head and Neck 35 (EORTC QLQ-H&N35) and The Karnofsky Performance Scale (KPS). Results. Specific groups of patients had significantly different post-treatment QOL scores. The factors associated with the worse QOL scores were female gender, not being in a partnership, level of education and HPV status. Conclusion. Clinicians should consider socioeconomic factors and HPV status in planning the recovery after treatment of patients with oropharyngeal carcinoma. Gender, education level and employment are the variables that form a certain risk profiles associated with the lower QOL.

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Impact of ECOG performance status on recurrent/metastatic head and neck squamous cell carcinomas treated with anti-PD1 inhibitors.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18004 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18004-e18004

Author(s):

Cameron Chalker ◽

Vicky Wu ◽

Jenna M. Voutsinas ◽

Victoria Hwang ◽

Christina S Baik ◽

...

Keyword(s):

Overall Survival ◽

Clinical Outcomes ◽

Squamous Cell ◽

Smoking Status ◽

Demographic Data ◽

Performance Status ◽

Univariate Analysis ◽

Single Agent ◽

Ecog Performance Status ◽

Hpv Status

e18004 Background: Anti-PD1 checkpoint inhibitors (ICI) represent an established standard of care for patients with recurrent/metastatic head & neck squamous cell carcinoma (RMHNSCC). Landmark studies excluded patients with ECOG performance status (PS) ≥ 2; the benefit of ICI in this population is therefore unknown. Methods: We retrospectively reviewed RMHNSCC patients who received at least 1 dose of ICI at our institution. Demographic data and clinical outcomes were obtained; the latter included objective response to ICI (ORR), physician-documented CTCAE grade 2+ toxicity (irAE), and any unplanned hospitalization within 100-days of last ICI dose (UH). Associations between demographic data and clinical outcomes were explored using both uni- and multivariate analysis. Overall survival (OS) was estimated using a Cox proportional hazards model; ORR, irAE, and UH were evaluated with logistic regression. This project was approved by our institutional IRB. Results: We identified 152 RMHNSCC patients who were treated with ICI between 1/2013 and 1/2019. ECOG PS was 0 in 42 (27%), 1 in 75 (50%), 2 in 27 (18%), 3 in 2 (1%), and unknown in 6 (4%) patients. The median age was 61 (range: 25 - 90). 124 (82%) were male, 124 (82%) were white, and 69 (45%) were never-smokers. The most common primary sites were the oropharynx (n = 59, 40%), oral cavity (n = 39, 26%), nasopharynx (n = 11, 7%), and larynx (n = 10, 6%). 54 (36%) were p16+ oropharynx cancers. CPS score was available in 10 (6.6%). Single agent ICI was received by 118 (77%) patients. 66 (44%) had a documented irAE and 54 (36%) had an UH. A multivariate model for OS containing PS, smoking status and HPV status showed a strong association between inferior OS and ECOG 2/3 compared to 0/1 (p < 0.001; HR = 3.30, CI = 2.01-5.41), as well as former (vs. never) smoking status (p < 0.001; HR = 2.17, CI = 1.41-3.35). Current smoking (p = 0.25) did not reach statistical significance. On univariate analysis, poor PS was associated with inferior ORR (p = 0.03; OR = 0.25, CI = 0.06-0.77) and increased UH (p = 0.04; OR = 2.43, CI = 1.05—5.71). There was no significant association between irAE and any patient characteristic. Conclusions: We observed inferior overall survival among ICI-treated RMHNSCC patients with ECOG 2/3 in our single-institution, retrospective series. Our findings help frame discussion of therapeutic options in this poor-risk population. Further study must be done to determine which interventions are of greatest benefit for RMHNSCC patients with declining performance status.

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Annexin A1 and HPV in oropharyngeal squamous cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e22150 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e22150-e22150

Author(s):

Cleberson Jean dos Santos Queiroz ◽

Cintia Mara de Amorim Gomes Nakata ◽

Amilcar Sabino Damazo

Keyword(s):

Hpv Infection ◽

Oropharyngeal Carcinoma ◽

Annexin A1 ◽

Hpv Dna ◽

Hpv Status ◽

Formalin Fixed Paraffin Embedded ◽

P53 Status ◽

Bonferroni Test ◽

The Difference ◽

Student’S T

e22150 Background: Annexin-A1 (ANXA1) is a protein involved in signal transduction and inflammation. Its expression is increased in some tumors (i.e. hepatocellular carcinomas, gliomas, pancreatic adenocarcinomas), but in head and neck tumors, its expression is usually reduced. Tumor suppressor p53 is frequently expressed in cancers due to mutation. HPV infection is strongly linked to oropharyngeal tumors. Methods: We analyzed 21 formalin-fixed paraffin-embedded samples of oropharyngeal carcinoma. Using immunofluorescence (IF), ANXA1 expression was quantified by measuring mean optical density (MOD). We also evaluated p53 positivity using IF. Presence of HPV DNA (serotypes 16/18 and 31/33) was analyzed through chromogenic in situ hybridization. Interaction between ANXA1, p53 and HPV was performed by Student's t test and ANOVA, with Bonferroni test, using the software Graph Pad Prism. Results: HPV DNA was found in 12 of 21 cases (57%). Serotypes 16/18 were found in all HPV + samples, whereas serotypes 31/33 were found in 2 of the 12. Among HPV+ cases, we noticed a decreased expression of ANXA1 in tumor compared to epithelium, independent of p53 status. With respect to HPV- cases, we have found a reduced expression of ANXA1 in the tumor versus epithelium, but the difference was only statistically significant in p53+ samples. In epithelia, we observed an increased expression of ANXA1 in HPV+ compared with HPV- samples. Conclusions: Our results confirm a decreased expression of ANXA1 in oropharyngeal carcinoma independently of HPV status, suggesting its involvement in the carcinogenesis. There was no difference in the expression of ANXA1 according to p53 status. In normal epithelia, we observed an increased expression of ANXA1 in HPV+ samples, which may suggest the involvement of the protein in the early stages of HPV-driven carcinogenesis. [Table: see text]

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Impact of Smoking Status on Survival Outcomes of Human Papilloma Virus (HPV) Positive Locally Advanced Oropharyngeal Carcinoma Stratified by Treatment Modality

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2017.12.060 ◽

2018 ◽

Vol 100 (5) ◽

pp. 1328-1329

Author(s):

N. Vawda ◽

R.N. Banerjee ◽

B.J. Debenham

Keyword(s):

Human Papilloma Virus ◽

Treatment Modality ◽

Smoking Status ◽

Locally Advanced ◽

Survival Outcomes ◽

Oropharyngeal Carcinoma ◽

Papilloma Virus

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PO-119: IMRT for Oropharyngeal Carcinoma: Preliminary Results Focusing on the Impact of HPV Status and Risk Categories

Radiotherapy and Oncology ◽

10.1016/s0167-8140(15)34738-1 ◽

2013 ◽

Vol 106 ◽

pp. S50-S51

Author(s):

E. Orlandi ◽

E. Iannacone ◽

L. Locati ◽

P. Bossi ◽

R. Granata ◽

...

Keyword(s):

Oropharyngeal Carcinoma ◽

Preliminary Results ◽

Hpv Status ◽

The Impact ◽

Risk Categories

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Prevalence of human papillomavirus in oropharyngeal squamous cell carcinoma in Serbia

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1806271m ◽

2018 ◽

Vol 146 (5-6) ◽

pp. 271-278

Author(s):

Jovica Milovanovic ◽

Ana Jotic ◽

Dragoslava Andrejic ◽

Aleksandar Trivic ◽

Bojan Pavlovic ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Disease Free Survival ◽

Tnm Stage ◽

Treatment Modalities ◽

Oropharyngeal Carcinoma ◽

Disease Specific Survival ◽

Cancer Etiology ◽

Hpv Status ◽

Disease Specific

Introduction/Objective. Oropharyngeal carcinoma makes up to 3% of all newly diagnosed carcinomas in the world. In Serbia, oropharyngeal carcinoma constitutes 1.8% of all malignancies. Studies have shown a growing role of infections with human papilloma viruses (HPV) in oropharyngeal cancer etiology. HPV positive patients have a more favorable prognosis and significantly higher rate of overall survival. The purpose of this paper was to establish how HPV status influenced Serbian patients? overall survival and the disease-free survival according to known risk factors (tobacco and alcohol consummation), clinical TNM stage of the disease, and modality of treatment. Methods. The study included 87 patients treated for oropharyngeal carcinoma in a one-year period with a five-year follow-up. Treatment modalities included surgery with or without postoperative radio- or chemoradiotherapy, only radiotherapy or chemoradiotherapy. Sex, common risk factors, TNM stage, and treatment method were considered, as well as the influence of HPV status on the overall survival and the disease-specific survival depending on the presence of risk factors. Results. HPV-positive patients with oropharyngeal carcinoma were more frequently men, smokers, and alcohol consumers. Considering clinical T, N, and M stage of the disease, the overall survival and the disease-specific survival rates were better in HPV-positive patients, who had better survival if they were treated with primary surgical therapy rather than primary radiotherapy. Conclusion. HPV status significantly influenced survival and locoregional control in Serbian patients with oropharyngeal carcinoma. This implies possible modifications of treatment strategies for these patients in order to further improve their prognosis and treatment outcomes.

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Radiographic extracapsular extension (ECE) and treatment outcomes in locally advanced oropharyngeal carcinoma (OPC).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6019 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6019-6019

Author(s):

Benjamin H. Kann ◽

Michael Buckstein ◽

Todd J. Carpenter ◽

Ava Golchin ◽

Richard Lorne Bakst ◽

...

Keyword(s):

Multivariate Analysis ◽

Cox Regression ◽

Univariate Analysis ◽

Locally Advanced ◽

Hazard Ratio ◽

Smoking History ◽

Oropharyngeal Carcinoma ◽

Treatment Type ◽

Hpv Status ◽

Significant Difference

6019 Background: Pathologic ECE (pECE) of tumor through lymph node (LN) is a poor prognosticator for OPC and typically diagnosed upon surgical LN removal. At our institution, experienced radiologists routinely identify ECE on pretreatment CT. The prognostic value of radiographic ECE (rECE) is less clear and may prove clinically useful. In this study, we evaluate rECE as an independent prognosticator in OPC. Methods: Retrospective review of 185 patients with locally advanced OPC treated in our department from 2006-2012. 109 patients had accessible pretreatment CT reports clearly stating the presence or absence of rECE. Patients were treated with definitive concurrent chemoradiation therapy (CCRT) (30%), induction chemo then CCRT (47%), or surgery with adjuvant CCRT (14%) or RT (9%). Kaplan-Meier survival analysis compared these cohorts for locoregional control (LRC), distant control (DC), and progression-free (PFS) and overall survival (OS); log-rank tests were performed for significance. Multivariate analysis was conducted via cox-regression. Results: Median follow-up of the 109 patients was 31 months (range: 1-80 months). 61 patients had rECE(+) and 48 had rECE(-) scans. There was no significant difference between the cohorts in terms of median age, stage, treatment type, smoking history, or tumor HPV status. There was a difference in nodal stage with 83% of rECE(+) patients having N2-3 disease versus 67% of rECE(-) patients (p=0.02). On univariate analysis, there were differences between the rECE(-) versus rECE(+) cohorts in OS (4yr: 92% vs 72%, p=0.01), PFS (4yr: 92% vs 62%, p=0.002), and DC (4yr: 98% vs 76%, p=0.006), with no difference in LRC (4yr: 95% vs 91%, p=0.35). On multivariate analysis factoring in age, smoking history, stage, and treatment type, rECE presence was a negative predictor of OS (hazard ratio, 0.26; 95% CI, 0.07 to 0.95) and PFS (hazard ratio, 0.23; 95% CI, 0.06 to 0.81), with DC approaching significance (hazard ratio, 0.13; 95% CI, 0.02 to 1.05). Conclusions: While pECE is an established risk factor for locally advanced OPC, this study suggests that rECE may be an independent poor prognosticator of PFS, OS and DC with potential importance in guiding clinical management.

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