Incidence Of Oropharyngeal Carcinoma Research Articles

Forecasting Rural and Urban Otolaryngologists, Radiation Oncologists, and Oropharyngeal Carcinoma.

To forecast oropharyngeal carcinoma (OPC) incidence with otolaryngologist and radiation oncologist numbers per population by rural and urban counties through 2030. Incident OPC cases were abstracted from the Surveillance, Epidemiology, and End Results 19 database, and otolaryngologists and radiation oncologists from the Area Health Resources File by county from 2000 to 2018. Variables were analyzed by metropolitan counties with over 1,000,000 people (large metros), rural counties adjacent to a metro (rural adjacent), and rural counties not adjacent to a metro (rural not adjacent). Data were forecasted via an unobserved components model with regression slope comparisons. Per 100,000 population, forecasted OPC incidence increased from 2000 to 2030 (large metro: 3.6 to 10.6 cases; rural adjacent: 4.2 to 11.9; rural not adjacent: 4.3 to 10.1). Otolaryngologists remained stable for large metros (2.9 to 2.9) but declined in rural adjacent (0.7 to 0.2) and rural not adjacent (0.8 to 0.7). Radiation oncologists increased from 1.0 to 1.3 in large metros, while rural adjacent remained similar (0.2 to 0.2) and rural not adjacent increased (0.2 to 0.6). Compared to large metros, regression slope comparisons indicated similar forecasted OPC incidence for rural not adjacent (p = 0.58), but greater for rural adjacent (p < 0.001, r = 0.96). Otolaryngologists declined for rural regions (p < 0.001 and p < 0.001, r = -0.56, and r = -0.58 for rural adjacent and not adjacent, respectively). Radiation oncologists declined in rural adjacent (p < 0.001, r = -0.61), while increasing at a lesser rate for rural not adjacent (p = 0.002, r = 0.96). Rural OPC incidence disparities will grow while the relevant, rural health care workforce declines. NA Laryngoscope, 134:136-142, 2024.

New progress in diagnosis and treatment of HPV-positive oropharyngeal carcinoma

In recent years, the incidence of oropharyngeal carcinoma （OPC） is increasing, while the better prognosis of patients with Human papillomavirus （HPV） positive oropharyngeal carcinoma has been confirmed in a number of studies. There are a variety of detection methods for HPV-associated oropharyngeal carcinoma. Including P16 immunohistochemistry, Polymerase Chain Reaction （PCR） or In situ hybridization （ISH） detection of HPV DNA, HPV RNA, Revers transcriptase Polymerase Chain Reaction （RT PCR） was used to detect HPV RNA. The better prognosis of patients with HPV-positive oropharyngeal carcinoma has led to the emergence of a large number of degraded treatment trials. The traditional P16 test has certain limitations in the diagnosis of patients with HPV-positive oropharyngeal carcinoma. It is necessary to combine with other detection methods to accurately screen out patients with HPV-positive oropharyngeal carcinoma and better apply to degraded therapy. In this article, we will briefly introduce the trend of HPV-associated oropharyngeal carcinoma, the detection methods and the new progress of degraded treatment trials.

Carcinoma de paladar blando. Descripción de una serie de casos

Introducción y objetivo: Describir las características clínicas, anatómicas y el trata-miento quirúrgico, incluyendo las distintas opciones de reconstrucción de los tumo-res de paladar blando. Descripción: Estudio retrospectivo de 6 pacientes diagnosti-cados y tratados en el servicio de Otorrinolaringología del hospital San Pedro de Logroño entre los años 2018 y 2019. Discusión: Exponemos los resultados de nues-tros pacientes y realizamos una revisión de los tumores de orofaringe localizados en el paladar blando, los detalles anatómicos y técnicas quirúrgicas reconstructivas más utilizadas en el tratamiento quirúrgico de los tumores de paladar blando. Conclusio-nes: La prevalencia de los tumores de orofaringe ha aumentado en los últimos años a expensas de la infección por el virus del papiloma humano (VPH). Sin embargo, los carcinomas de paladar blando son mayoritariamente P16 negativos. Estos tumores son poco sintomáticos en fases iniciales y es necesario un alto índice de sospecha para evitar diagnósticos tardíos. El desarrollo de la cirugía transoral ha impulsado el tratamiento quirúrgico de los tumores de paladar blando y puede reducir la necesidad de tratamientos complementarios hasta en un 40% de los casos. La reconstrucción se hace necesaria en resecciones mayores del 50%.

Frequency of human papilloma virus in Oropharyngeal Carcinoma at tertiary level Hospital in Bangladesh

Background: The incidence of oropharyngeal carcinoma has been increasing in many parts of the world. The potential etiologic role of human papillomavirus (HPV) infection in head and neck squamous cell carcinomas has been recognized for more than 3 decades.Aim: To assess the frequency of human papilloma virus in oropharyngeal carcinoma.Methodology: This cross-sectional study has been conducted in a tertiary level hospital at the Department of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka, Bangladesh. 20 cases of oropharyngeal carcinoma enrolled as a sample in this study. PCR has performed to detect HPV DNA of those cases who were histologically proven oropharyngeal carcinoma. The results were expressed as percentage and p value

Anatomía quirúrgica en el carcinoma de paladar blando. Revisión bibliográfica

Introducción y objetivo: Describir las características clínicas y anatómicas, y el trata-miento quirúrgico que incluye varias técnicas de cirugía reconstructiva de carcinomas de paladar blando. Método: Realizamos una revisión narrativa sobre los carcinomas de paladar blando. Hicimos una revisión sobre los tumores del paladar blando seña-lando detalles anatómicos y la mayoría de las técnicas quirúrgicas reconstructivas empleadas para la extirpación del carcinoma del paladar blando. Conclusiones: la incidencia de carcinoma orofaríngeo está aumentando en todo el mundo esencial-mente debido a la creciente prevalencia del virus del papiloma humano. Inicialmente, los tumores del paladar blando son silenciosos y debemos sospechar que eviten el diagnóstico tardío. El desarrollo de la cirugía transoral ha promovido el tratamiento quirúrgico en estos tumores y permite un mejor manejo y la necesidad de terapia adyuvante. La reconstrucción es obligatoria cuando la resección es superior al 50% del paladar blando.

Analysis of prognostic factors and patterns of failure in patients of oropharyngeal squamous cell carcinoma treated by definitive radiotherapy in a tertiary care cancer center of Northern India

Background: The incidence of oropharyngeal carcinoma is increasing despite decline in the incidence of head and neck cancers of other sites. Functional organ preservation with minimal toxicity and better survival is the management goal in oropharyngeal cancers (OPCs). Morbidity of surgery favors radiotherapy as primary modality in OPCs. Here, we have reviewed and analyzed various prognostic factors and results of conventional radiotherapy in patients treated at our institute with two-dimensional planning. Materials and Methods: The records of 70 patients who were treated radically with radiotherapy with or without concurrent chemotherapy from January 2014 to May 2018 were analyzed in our institute. Results: The median age was 61.5 years with male:female ratio of 6:1. History of tobacco use was present in 83%. Stage IVA comprised the bulk with 63% of cases. Eighty-one percent of the patients received concurrent cisplatin. Median disease-free survival at 1 and 5 years was 71.4% and 54.3%, respectively. Median overall survival at 1 and 5 years was 74.3% and 60%, respectively. Conclusion: Varied patient-related, tumor-related, and treatment-related factors determine the clinical severity and tumor stage and help in predicting survival in oropharyngeal carcinoma.

Current Status of therapy and prophylaxis of oropharyngeal carcinoma

Incidence of oropharyngeal carcinoma (OPSCC) is increasing significantly worldwide. Due to its association with chronic tobacco/alcohol consumption, but increasingly also with the human papillomavirus HPV-16, oropharyngeal carcinoma is a genetically heterogeneous tumor group with high prognostic diversification. HPV-associated OPSCC respond significantly better to previous treatment concepts than non-HPV-associated. Both after primary surgical as well as after radiotherapie, radiochemotherapie and anti-EGFR treatment, this tumor group shows a significantly better survival. There is no evidence that in HPV association only primary radiotherapy concepts should be used. Currently, in the 8th edition of the TNM classification (UICC, AJCC), the HPV-associated different prognostic consideration with a rearrangement of the tumor stages and the N status was taken into account. Regardless of the known blur, p16 status detection is the most practicable and least expensive method of detection today, and is therefore consistently recommended (also by the AJCC and UICC TNM committees). HPV16 positive non-smokers differ from HPV-16 negative smokers by nearly 50 % in 5-year survival. Transoral robot surgery (TORS), which is highly acclaimed in the US today, with the Da Vinci Telemanipulator (Intuitive Surgical) has triggered a downright euphoric discussion on the minimally invasive surgery of resectable OPSCC. Based on a stable data set, it is now clear that an R0 resection must be sought regardless of the surgical procedure. Resection margins < 5 mm (R0 < 5 mm) are considered to be an "intermediate risk" situation and, like the N status, influence the adjuvant concept (radiochemotherapy). During and after transoral surgical procedures, the risk of rebleeding should never be underestimated and can not be ruled out with the utmost care.

The Role of Transoral Oropharyngectomy in the Management of Oropharyngeal Cancers

The incidence of oropharyngeal carcinoma is increasing as a result of increasing Human Papilloma Virus (HPV subtypes 16 and 18) infection of the oropharynx. 31 patients with oropharyngeal squamous cell carcinoma were treated in a university teaching hospital. The primary cancer was resected by either transoral laser microsurgery or transoral robotic surgery. Patients underwent simultaneous neck dissection when indicated. The Multidisciplinary Team (MDT) decided whether patients required postoperative radiotherapy/ chemoradiotherapy depending on tumour and patient factors. Survival was analyzed using a Kaplan-Meier estimator. The results were discussed alongside a literature search on oropharyngeal carcinoma management. 87.4% patients were disease free at 1 year, and 77.2 % at both 3 and 5 years. Overall survival at 1 year was 92% and 76.4% at both 3 and 5 years.

Incidence and survival of oropharyngeal cancer in Denmark: a nation-wide, population-based study from 1980 to 2014

Background: Oropharyngeal carcinomas (OPCs) constitute a significant and increasing proportion of head and neck carcinomas and are an important global cause of morbidity and mortality. The purpose of this study was to determine trends in incidence and survival in OPC in the Danish population from 1980 to 2014.Methods: This study included all patients registered in the nationwide Danish Cancer Registry over the period 1980–2014. The age-adjusted incidence rates (AAIR) per 100,000, annual percentage change (APC) and average annual percent change (AAPC) were evaluated. Five-year relative survival (RS) was calculated with Cox regression analyses in relation to gender, anatomical location and histology.Results: A total of 6555 patients (69% male) were included, with a median age at diagnosis of 60 years. The AAIR of patients with OPC increased from 0.815 per 100,000 in 1980 to 4.51 per 100,000 in 2014 with an AAPC of 5.3. The 5-year RS increased significantly from 33.1% over the period 1980–1984 to 58.5% (25.4% points) over the period 2010–2014. With no significant difference stratified for gender. Tumors located at the palatine tonsils (n = 3333) and salivary gland OPC (n = 90) had significantly better survival compared with other sub-locations and histology subtypes. In the APC model the birth cohort effect rate ratio increased until 1925 and then decreased until 1935 from which point it increased in the last cohorts.Conclusions: In this population-based study, we observed a significant increase in the incidence of OPCs and in the RS for OPC. We also identified a profound birth cohort effect on the incidence.

The epidemiology of head and neck squamous cell carcinoma in The Netherlands during the era of HPV-related oropharyngeal squamous cell carcinoma. Is there really evidence for a change?

Several recent studies have shown that incidence of oropharyngeal carcinomas is rising in the Western World. This increase has been attributed to changes in the etiology of oropharyngeal carcinomas with a growing role for infections with Human Papilloma viruses. This nationwide study evaluates and compares trends in incidence, clinical behavior and tumor characteristics of oropharyngeal and oral squamous cell cancer. This study comprised all 16,480 patients with primary squamous cell carcinoma of the oral tongue (OTSCC), oral cavity excluding oral tongue (OCSCC), and oropharynx (OPSCC) diagnosed from 1989 through 2008 in The Netherlands. We assessed trends in age-standardized incidence, second cancer risk and subsite specific relative survival (RS) over time. Incidence of OTSCC and OPSCC in males and incidence of all subsites in females increased significantly from 1989 through 2008. In males increases in incidence were largely restricted to the 50-64 year age group (estimated annual percentage change 2.2% and 3.2% for OTSCC and OPSCC, respectively), while in females incidence increased for most age groups. The incidence of OCSCC (excl. oral tongue) and OPSCC before 50 years of age decreased. Patients with OPSCC showed the poorest prognosis with a relative survival of 41.6% after 5 years and 29.4% after 10 years (P<0.001) over the entire period 1989-2008. However survival increased substantially for OPSCC patients over time (5-year RS of 37.2% in 1989-1993 to 47.6% in 2004-2008, P<0.001). Although incidence of OPSCC did increase since 1989, especially in females, similar increases were seen for OCSCC (excl. oral tongue) and OTSCC. Our study does not appear to support that HPV is the main contributor to a rising incidence of OPSCC as the effects of changes in smoking and alcohol use cannot be discounted.

The Impact of Tonsillectomy upon the Risk of Oropharyngeal Carcinoma Diagnosis and Prognosis in the Danish Cancer Registry.

The incidence of oropharyngeal carcinoma, involving palatine and lingual tonsils, is increasing globally. This significant rise is driven by human papillomavirus. Whether palatine tonsillectomy affects risk of diagnosis with oropharyngeal carcinoma is unknown. The association between tonsillectomy and incidence of oropharyngeal carcinoma was explored in the Danish Cancer Registry. The association between tonsillectomy and oropharyngeal carcinoma was analyzed by time since first registration of tonsillectomy. Tonsillectomy was a time-dependent variable. Individuals were censored for death, emigration, or tonsillectomy within incident year of diagnosis. Incidence rate ratios (RR) were estimated by Poisson regression models and adjusted for confounders. Kaplan-Meier survival analyses were compared by the log-rank test, and HRs were estimated by Cox proportional hazards models. From 1977 to 2012, the incidence of tonsillectomies significantly decreased, whereas the incidence of oropharyngeal carcinoma significantly increased. Tonsillectomy was not associated with risk of oropharyngeal carcinoma or malignancies of other anatomic sites, including base of tongue. However, tonsillectomy significantly reduced risk of diagnosis with tonsil carcinoma [RR, 0.40; 95% confidence interval (CI), 0.22-0.70]. The risk of diagnosis with tonsil carcinoma at age <60 years was significantly decreased (RRadj, 0.15; 95% CI, 0.06-0.41) after tonsillectomy. Tonsillectomy within 1 year of diagnosis with tonsil carcinoma was associated with significantly improved overall survival (HR, 0.53; 95% CI, 0.38-0.74). In conclusion, remote history of tonsillectomy reduces the risk of diagnosis with tonsil carcinoma. These data inform risk and benefit of tonsillectomy, a common procedure and design of secondary prevention trials.

Racial Disparities in Incidence of Human Papillomavirus–Associated Oropharyngeal Cancer in an Urban Population

Objectives: (1) Determine whether there is a difference in the incidence of human papillomavirus (HPV)–associated oropharyngeal carcinoma (OPC) between non-Hispanic Caucasians and minorities in an institutional series drawn from the highly urbanized population of New York City. Methods: Several recent studies suggest that rates of HPV-associated OPC are higher in Caucasians than in minorities. We hypothesized that this difference would be lower in the highly diverse, urban population of New York City. This is a retrospective chart review of 240 patients with surgically treated OPC at the Icahn School of Medicine at Mount Sinai (ISMMS) between 1999 to 2013. Researchers determined age, sex, race, ethnicity, and tumor site of study participants. Polymerase chain reaction (PCR) was used to detect the presence of oncogenic HPV-DNA in paraffin tumor blocks. Incidence of HPV-positive cancers was compared between Caucasians and minorities (defined as African Americans, Asians, and Hispanics) using Fisher’s exact test. Results: We found a higher incidence of HPV-positive OPC HPV in Caucasians than racial minorities within the ISMMS population ( P = .010). HPV incidence detected by PCR was 149 out of 192 (77.6%) for Caucasians and 28 out of 48 (58.3%) for minorities. Specifically, there was a higher incidence in Caucasians compared with African Americans ( P = .024), but no significant difference between Caucasians and Hispanics ( P = .218). There were no significant differences between the 2 cohorts in sex or age. Conclusions: The incidence of HPV-positive OPC is higher in non-Hispanic Caucasians than in minorities in New York City. This observation is consistent with previously reported trends from study populations in less urbanized areas.

中咽頭癌72例の臨床統計

The incidence of oropharyngeal carcinoma has been increasing in Japan. We retrospectively analyzed 72 fresh cases of oropharyngeal carcinoma who were treated between 2005 and 2012 in our department. The subjects were 57 males and 15 females, aged 39 to 84 years with an average of 63.8 years. Sixty-five patients (90.3%) were in stages III/IV. The overall 5-year crude survival, disease-specific survival and local control rates determined by the Kaplan-Meier method were 46.4%, 61.4% and 70.3%, respectively. Both survival and local control rates were significantly higher in patients at T1/2 than in those at T3/4. Of 35 patients at T1/2, 27 (77.1%) were N(+). Twenty-two patients (30.6%) underwent surgery for the primary lesion, and in most of the other 50 patients, complete response of the primary lesion was obtained by chemoradiotherapy without surgery. These results indicate that oropharyngeal carcinomas are prone to metastasize to regional lymph nodes even if the primary lesion is small, but small primary lesions still lead to a good prognosis. The present data also suggested that oropharyngeal carcinomas are highly sensitive to chemoradiotherapy. A better prognosis and functional preservation may be achieved by detecting early primary lesions and distinguishing chemoradiotherapy-sensitive and insensitive cases in the future.

131 oral THE INFLUENCE OF COMORBIDITY, SMOKING BEHAVIOUR AND HUMAN PAPILLOMAVIRUS ON OVERALL SURVIVAL IN 1091 PATIENTS WITH OROPHARYNGEAL CARCINOMA: THE DAHANCA EXPERIENCE

Purpose: Cigarette smoking is a well known risk factor for head and neck squamous cell carcinoma (HNSCC). Besides the carcinogenesis effect, smoking is also associated with other systemic comorbidities such as pulmonary and cardiovascular diseases. During the past 30 years the incidence of oropharyngeal carcinomas (OC) in the Western world has increased and Human papillomavirus (HPV) seems to be the predominant cause. In the same period, a decrease in smoking has led to a decline in the incidence of HNSCC at other sites than the oropharynx. Due to demographic changes, the general population becomes older and consequently more HNSCC patients may suffer from comorbidity. The purpose of this study was to investigate the impact of comorbidity, smoking behaviour and tumour HPV-associated p16-status on overall survival (OS) in patients with OC treated with primary radiotherapy (RT). Materials: The DAHANCA database contains information on all HNSCCpatients in Denmark from 1971 to 2006 (17.784 patients). Complete data on comorbidity, smoking behaviour and p16-status was available for 1091 patients with OC treated with primary RT. Information on comorbidity prior to diagnosis of HNSCC was obtained from the National Patient Registry which contains discharge diagnoses from all hospital admissions and outpatient visits in Denmark. This data was adapted to the Charlson Comorbidity Index (CCI). Information on current smoking status and pack-years was included in the DAHANCA-forms Evaluation of HPV-status was done by p16immunohistochemistry, and tumours were classified as either p16-positive or negative. Results: In total 18% of patients had CCI-score 2+. Median age was 61 yrs and 74% were males. 64% were current smokers with a median of 37 packyears. There was no significant difference in CCI score between genders. 5% of HPV-pos patients had CCI-score 2+ compared to 21% in the HPV-neg group. In univariate analysis OS was significantly improved for patients without comorbidity (5-year actuarial values 53% vs 38%, p 60 years (1.40[1.16-1.69]). Conclusions: Treatment outcome for OC not only depends on the extent of cancer disease at time of diagnosis, but is also strongly influenced by comorbidity, smoking habits and tumour HPV status. Optimisation of comorbidity and avoidance of smoking may add to improve efficacy of treatment.

Site-specific localization of Epstein-Barr virus in pharyngeal carcinomas.

In this study, the correlations of factors with Epstein‐Barr virus (EBV)‐association were investigated in 50 patients with nasopharyngeal carcinoma (NPC), 61 with oropharyngeal carcinoma (OPC), and 55 with hypopharyngeal carcinoma (HPC) in Okinawa and Osaka prefectures in Japan. The incidence of pharyngeal carcinoma in Okinawa was previously found to be higher than that in Osaka; the incidence of OPC was approximately 6 times higher and that of HPC was two times higher. The EBV genome was detected in the tumor cells of the present patients; 83% of the Okinawa and 92% of the Osaka NPC patients. The EBV genome was not detected in OPC or HPC. A univariate analysis showed that sex, the location of the tumor, histology, and the degree of lymphocytic infiltration correlated with the EBV‐positive rate. A multivariate analysis revealed that only the location of the tumor was independently correlated with the EBV‐positive rate. Histology and tumor size were factors affecting the prognosis of the patients with NPC. The NPC of poorly differentiated type frequently showed the EBV genome, and NPC with lymphocytic infiltration showed a more favorable prognosis compared to the other NPC types. These findings suggest that latent genes of EBV expressed in cancer cells might trigger a cytotoxic T cell reaction against the cancer.