To determine the association between poor dental health and risk of oral cavity squamous cell cancer (OCSCC) at individual tumor subsites.
Case-control and cross-sectional METHODS: A case-control ...study was performed using a population-based cohort in North Carolina (Carolina Head and Neck Cancer Epidemiology Study CHANCE). A secondary cross-sectional analysis was performed with an institutional cohort (WashU/Siteman). Cases were adults with primary OCSCC and an identifiable tumor subsite. In the CHANCE cohort, controls were adults without head and neck cancer. In the Washington University/Siteman cohort, patients with tongue cancer served as the comparator group. We used number of missing teeth (categorized 0-6, 7-24, 25-28) as a surrogate for poor dental health, which was self-reported in CHANCE and measured on a pretreatment computed tomography scan in the WashU/Siteman study. Adjusted odds ratios (aORs) for missing teeth were estimated for each tumor subsite using binomial logistic regression models.
Near complete tooth loss (25-28 teeth) was associated with a 3.5-fold increased risk of alveolar ridge malignancy (aOR: 3.51; 95% confidence interval CI: 1.14-11.01, P = .03) in the CHANCE study. This association was confirmed in our cross-sectional analysis (WashU/Siteman study) where missing 25-28 teeth was associated with an increased risk of alveolar ridge compared to tongue cancer (aOR: 4.60; 95% CI: 1.97-11.10, P = .001).
This study suggests an association between poor dental health and risk of alveolar ridge cancer independent of smoking, alcohol use, age, race, and sex. Future prospective and translational studies are needed to confirm this association and elucidate the mechanism of dental disease in alveolar ridge malignancies.
This study demonstrates that sex affects prognosis differentially in oropharyngeal cancer and nonoropharyngeal cancer. The authors also find that race does not affect survival in oropharyngeal cancer ...after adjustments for human papillomavirus status.
See also pages 1566‐75.
Oropharyngeal squamous cell carcinoma (OPSCC), largely fueled by the human papillomavirus (HPV), has a complex biological and immunologic phenotype. Although HPV/p16 status can be used to stratify ...OPSCC patients as a function of survival, it remains unclear what drives an improved treatment response in HPV-associated OPSCC and whether targetable biomarkers exist that can inform a precision oncology approach. We analyzed OPSCC patients treated between 2000 and 2016 and correlated locoregional control (LRC), disease-free survival (DFS) and overall survival (OS) with conventional clinical parameters, risk parameters generated using deep-learning algorithms trained to quantify tumor-infiltrating lymphocytes (TILs) (OP-TIL) and multinucleated tumor cells (MuNI) and targeted transcriptomics. P16 was a dominant determinant of LRC, DFS and OS, but tobacco exposure, OP-TIL and MuNI risk features correlated with clinical outcomes independent of p16 status and the combination of p16, OP-TIL and MuNI generated a better stratification of OPSCC risk compared to individual parameters. Differential gene expression (DEG) analysis demonstrated overlap between MuNI and OP-TIL and identified genes involved in DNA repair, oxidative stress response and tumor immunity as the most prominent correlates with survival. Alteration of inflammatory/immune pathways correlated strongly with all risk features and oncologic outcomes. This suggests that development of OPSCC consists of an intersection between multiple required and permissive oncogenic and immunologic events which may be mechanistically linked. The strong relationship between tumor immunity and oncologic outcomes in OPSCC regardless of HPV status may provide opportunities for further biomarker development and precision oncology approaches incorporating immune checkpoint inhibitors for maximal anti-tumor efficacy.
Food and nutrition play an important role in head and neck cancer (HNC) etiology; however, the role of carotenoids remains largely undefined. We explored the relation of HNC risk with the intake of ...carotenoids within the International Head and Neck Cancer Epidemiology Consortium. We pooled individual-level data from 10 case-control studies conducted in Europe, North America, and Japan. The analysis included 18,207 subjects (4414 with oral and pharyngeal cancer, 1545 with laryngeal cancer, and 12,248 controls), categorized by quintiles of carotenoid intake from natural sources. Comparing the highest with the lowest quintile, the risk reduction associated with total carotenoid intake was 39 % (95 % CI 29-47 %) for oral/pharyngeal cancer and 39 % (95 % CI 24-50 %) for laryngeal cancer. Intakes of β-carotene equivalents, β-cryptoxanthin, lycopene, and lutein plus zeaxanthin were associated with at least 18 % reduction in the rate of oral and pharyngeal cancer (95 % CI 6-29 %) and 17 % reduction in the rate of laryngeal cancer (95 % CI 0-32 %). The overall protective effect of carotenoids on HNC was stronger for subjects reporting greater alcohol consumption (p < 0.05). The odds ratio for the combined effect of low carotenoid intake and high alcohol or tobacco consumption versus high carotenoid intake and low alcohol or tobacco consumption ranged from 7 (95 % CI 5-9) to 33 (95 % CI 23-49). A diet rich in carotenoids may protect against HNC. Persons with both low carotenoid intake and high tobacco or alcohol are at substantially higher risk of HNC.
Objective
To determine the prognostic significance of smoking in human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) when considering American Joint Committee on Cancer ...eighth edition (AJCC‐8) stage.
Study Design
Retrospective cohort study.
Methods
Three hundred seventeen HPV‐positive OPSCC patients with known AJCC‐8 stage and smoking status (<10 or ≥10 pack‐years) seen at a tertiary center from 1997 to 2017 were studied. We used the Kaplan‐Meier method to compare 5‐year overall survival (OS) by smoking status and by clinical AJCC‐8 stage and smoking status combined. Hazard ratios (HRs) were estimated with Cox proportional hazard regression for the independent effects of smoking and AJCC‐8 stage. We also studied pathologic stage and estimated the combined effects of smoking and clinical stage.
Results
The ≥10 pack‐years smokers had worse 5‐year OS than <10 pack‐years smokers (93.6%; 95% confidence interval (CI): 89.7‐97.8 vs. 82.3%; 95% CI: 76.0%‐89.1%). When stratified by AJCC‐8 clinical stage, only stage I <10 pack‐years smokers (98.7%; 95% CI: 96.3%‐100.0%) had significantly better 5‐year OS than their ≥10 pack‐years (84.8%; 95% CI: 76.4%‐94.1%) counterparts. In a multivariable analysis, ≥10 pack‐years smoking was associated with increased hazard of death when adjusting for AJCC‐8 clinical (HR: 2.52; 95% CI: 1.16‐5.46) and pathologic (HR: 5.21; 95% CI: 1.47‐18.5) stage. In both analyses, stage III patients demonstrated worse survival than stage I, and smoking had greater impact at lower stages.
Conclusions
Smoking is a negative prognosticator in HPV‐positive OPSCC and interacts with AJCC‐8 clinical stage. It is important to understand the impact of smoking in HPV‐positive disease when considering treatment plans and deintensification trials.
Level of Evidence
2b Laryngoscope, 130: 1961–1966, 2020
Background
Oropharyngeal squamous cell carcinoma (OPSCC) epidemiology has not been examined previously in the nationwide Veterans Affairs (VA) population.
Methods
Joinpoint regression analysis was ...applied to OPSCC cases identified from VA administrative data from 2000 to 2012.
Results
We identified 12 125 OPSCC cases (incidence: 12.2 of 100 000 persons). OPSCC incidence declined between 2000 and 2006 (annual percent change APC = −4.27, P < .05), then increased between 2006 and 2012 (APC = 7.02, P < .05). Significant incidence increases occurred among white (APC = 7.19, P < .05) and African American (APC = 4.87, P < .05) Veterans and across all age cohorts. The percentage of never‐smokers increased from 8% in 2000 to 15.7% in 2012 (P < .001), and 2‐year overall survival improved from 31.2% (95% confidence interval (CI) 30‐33.4) to 55.7% (95% CI 54.4‐57.1).
Conclusions
OPSCC incidence is increasing across all racial and age cohorts in the VA population. Smoking rates remain high among Veterans with OPSCC and gains in survival lag those reported in the general population.
Objective/Hypothesis
To assess whether young patients with oral cavity squamous cell carcinoma (OCSCC) demonstrate worse oncologic outcomes than older patients after definitive therapy.
Study Design
...Systematic review and meta‐analysis.
Methods
A medical librarian composed a search strategy to identify relevant studies in Medline, Embase, Scopus, and other major databases (Prospero registration number CRD42019127974). Inclusion criteria were adults with histologically diagnosed OCSCC that underwent treatment, comparator groups with an age cutoff of 40 years old, and reported survival outcomes. Articles were excluded if they contained patients with oropharyngeal squamous cell carcinoma or patients treated for palliative intent. Overall survival hazard ratios were analyzed with a meta‐analysis.
Results
There were 23,382 patients with OCSCC that were treated with definitive therapy from 22 included studies. The pooled cohort contained 2,238 (10%) patients ≤40 years of age. Oral tongue was the most common subsite in both the younger (n = 1,961, 91%) and older (n = 18,047, 88%) cohorts. The majority of OCSCCs were either T1 or T2, representing 859 (80%) malignancies in younger patients and 8,126 (77%) malignancies in older patients. A meta‐analysis of nine studies demonstrated that younger patients did not experience worse survival outcomes than older patients (hazard ratio = 0.97, 95% confidence interval = 0.66–1.41).
Conclusions
Young adults with OCSCC experienced similar oncologic outcomes as older patients with OCSCC after definitive treatment. Until compelling evidence demonstrates clinically relevant differences between these two cohorts, their approach to management should be similar. Future studies should consider comorbidities and using age 40 as a standard age cutoff to provide more uniform data moving forward. Laryngoscope, 131:1310–1319, 2021
Background
Race has been shown to have variable prognostic importance in nasopharyngeal carcinoma (NPC). However, previous studies are limited by a lack of comprehensive treatment, epidemiologic, and ...comorbidity data.
Methods
This was a retrospective cohort study utilizing the National Cancer Database from 2004 to 2016. Multivariable Cox proportional hazards regressions were used to calculate adjusted hazard ratios (aHR) for overall survival.
Results
A cohort of 9995 patients met inclusion and exclusion criteria. Race, insurance, comorbidity, treatment, stage, age, and histology were independent prognosticators. Among patients with keratinizing NPC, Asians and Hispanics had superior survival (aHR 0.58 95% confidence interval (CI) 0.48–0.69, aHR 0.76 95% CI 0.61–0.96) compared to white patients. Among patients with non‐keratinizing differentiated NPC, Asians and black patients had improved survival (aHR 0.71 95% CI 0.56–0.91, aHR 0.72 95% CI 0.54–0.95) compared to white patients. Race was not prognostic in non‐keratinizing undifferentiated NPC.
Conclusion
The prognostic significance of race varies across histological subtypes of NPC.
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