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Recurrence in patients with oral and oropharyngeal squamous cell carcinoma: human papillomavirus and other risk factors
Malmö högskola, Faculty of Odontology (OD).
Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden.
Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden.
Department of Oncology, Lund University Hospital, Lund, Sweden.
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2007 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 127, no 9, p. 980-987Article in journal (Refereed) Published
Abstract [en]

Conclusions: The results confirm that tumour stage influences the risk of recurrence/second primary tumour (SPT). High-risk human papillomavirus (HPV)-infected patients have a significantly higher risk of recurrence/SPT compared with high-risk HPV-negative patients. High alcohol consumption was associated with a higher risk of recurrence/SPT. In this study, the competing risk of death in intercurrent disease (DICD) was given special consideration. Objectives: The aim of the present study was to evaluate whether any of the factors which were found to increase the risk of oral and oropharyngeal squamous cell carcinoma (OOSCC) in previous analyses (smoking tobacco, alcohol, high-risk HPV infection, oral hygiene, missing teeth and dentures) have an influence on recurrence or the occurrence of a new SPT of OOSCC within the first 3 years following diagnosis. Patients and methods: One hundred and twenty-eight consecutive cases with planned curative treatment, who were part of a population-based case-control study carried out in southern Sweden between September 2000 and January 2004, were included. Only patients for whom the intention was curative treatment were eligible. The cases were followed to the first event of recurrence/SPT, death, loss to follow-up, 30 June 2005 or a maximum of 3 years. Time to the first event of recurrence/SPT was analysed by cumulative incidence, where DICD was a competing risk. Regression was performed on cause-specific hazard rates. Results: After a median follow-up time of 22 months (range 0–36 months), 30 recurrences, 2 SPT, 12 lost to follow-up and 21 deaths before recurrence or SPT were observed. Tumour stage was associated with both a higher risk of recurrence/SPT and of DICD. In univariate analysis, patients with tonsillar carcinoma had a significantly higher risk of recurrence/SPT than patients with carcinoma at other sites, but there was no difference according to site in multivariate analyses. High alcohol consumption was associated with a higher risk of recurrence/SPT, but not of DICD. There was no increased risk of recurrence/SPT related to smoking, but there was an association between smoking and DICD. High-risk HPV-positive cases had a higher risk of recurrence/SPT, but a lower risk of DICD compared with high-risk HPV-negative cases. This seemingly higher risk should be interpreted by taking the competing risk of DICD into account.

Place, publisher, year, edition, pages
Informa Healthcare, 2007. Vol. 127, no 9, p. 980-987
National Category
Otorhinolaryngology
Identifiers
URN: urn:nbn:se:mau:diva-66398DOI: 10.1080/00016480601110162ISI: 000248942100014PubMedID: 17712679Scopus ID: 2-s2.0-34548303929OAI: oai:DiVA.org:mau-66398DiVA, id: diva2:1845733
Available from: 2024-03-20 Created: 2024-03-20 Last updated: 2024-03-20Bibliographically approved
In thesis
1. Risk factors in oral and oropharyngeal squamous cell carcinoma
Open this publication in new window or tab >>Risk factors in oral and oropharyngeal squamous cell carcinoma
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

År 2002 drabbades omkring 275 000 individer runt om i världen av cancer i munhålan. Mer än hälften av dessa kommer att dö av sin sjukdom inom 5 år. Förekomsten av cancer i munhåla och svalg (Oral and Oropharyngeal Squamous Cell Carcinoma, OOSCC) varierar i olika delar av världen. Det är en ovanlig lokalisation av cancer i Sverige, men antalet nya fall ökar. I Sverige svarar sjukdomen för omkring 1 % av all cancer, vilket är lågt jämfört med förekomsten i Indien och andra delar av Asien där den är en av de vanligaste formerna av cancer. Studien omfattar 132 konsekutiva patienter i Södra sjukvårdsregionen som under perioden september 2000 - januari 2004 fått primärdiagnosen OOSCC. De inkluderade patienterna motsvarar 80 % av samtliga fall. Ur befolkningsregistret identifierades 396 ålders-, köns-, och länsmatchade cancerfria kontrollpersoner av vilka 320 (81 %) samtyckte till att medverka. Fall och kontroller genomgick en standardiserad intervju, identisk undersökning av munhåla inklusive panoramaröntgen samt uppsamling av celler från munhålan för bestämning av humant papillomvirus (HPV). En journal speciellt designad för studien användes. Syftet med studien var att utvärdera potentiella riskfaktorer för OOSCC - munhygien, tandstatus, munslemhinneförändringar, alkohol, tobak, virus och vissa livsstilsfaktorer - och att analysera i vilken grad de var för sig eller tillsammans ökar risken för OOSCC. Ett ytterligare syfte var att bedöma om dessa faktorer påverkar frekvensen av recidiv. Statistiska analyser visade att medelmåttig och dålig munhygien ökar risken för OOSCC. Fler än 20 förlorade tänder och/eller dåligt fungerande/defekta helproteser utgör också en ökad risk. Regelbundna tandläkarbesök är däremot förenat med minskad risk för OOSCC.

Abstract [en]

In the year 2002, about 275,000 inhabitants around the world developed oral cancer and over half of them will die of their disease within 5 years. Oral and oropharyngeal squamous cell carcinoma (OOSCC) accounts for about 1% of all cancers in Sweden – which is low compared to the incidence on the Indian subcontinent and in other parts of Asia, where it is one of the most common forms of cancer. The incidence in Sweden is increasing, however. The study comprised 80% (132/165) of all consecutive cases living in the Southern Healthcare Region, born in Sweden and without previous cancer diagnosis (except skin cancer), who were diagnosed with OOSCC during the period September 2000 to January 2004. Using the Swedish Population Register, 396 cancer-free controls were identified and matched by age, gender and county. Of these individuals, 320 (81%) agreed to take part in the study. Cases and controls were subjected to a standardised interview, identical oral examinations including panoramic radiographs, and cell sampling for human papillomavirus (HPV) analysis. In total 128 patients with planned curative treatment were followed for a median time of 22 months (range 0 – 36). The aims were to assess different potential risk factors in OOSCC such as oral hygiene, dental status, oral mucosal lesions, alcohol and tobacco use, virus infection, and some related to lifestyle. A further aim was to assess the influence of these factors on recurrence or occurrence of a new second primary tumour (SPT) of squamous cell carcinoma. In multivariate analysis average oral hygiene (OR 2.0; 95% CI 1.1–3.6) and poor oral hygiene (OR 5.3; 95% CI 2.5–11.3), more than 5 defective teeth (OR 3.1; 95% CI 1.2–8.2) and more than 20 teeth missing (OR 3.4; 95% CI 1.4-8.5), as well as defective or malfunctioning complete dentures (OR 3.8; 95 % CI 1.3–11.4) were identified as significant risk factors for development of OOSCC. Regular dental care reduced the risk of OOSCC (OR 0.4; 95% CI 0.2–0.6). The cases reported a higher consumption of alcohol than the controls. More than 350 g of alcohol per week (OR 2.6; 95% CI 1.3–5.4) and 11–20 cigarettes per day (OR 2.4; 95% CI 1.3-4.1) were dose-dependent risk factors. The results showed a tendency for women to have a greater risk (OR 1.8) than men at any given level of tobacco consumption. There was no increased risk of OOSCC among users of Swedish moist snuff. There was a significant relationship between high-risk human papillomavirus (HPV) infection and OOSCC (OR 63; 95% CI 14–280). Forty-seven of the cases (36%) were high-risk HPV infected and 7 (5.3%) were low-risk HPV infected in the specimens collected from the oral cavity. The corresponding figures for the controls were 3 (0.94%) and 13 (4.1%), respectively. The high-risk HPV types found in the oral cavity were the same types as observed in cervical cancer. Tumour stage was associated with both higher relative rate (RR) of recurrence or second primary tumour (SPT) of squamous cell carcinoma, and death in intercurrent diseases (DICD), defined as death before the occurrence of recurrence or SPT. High-risk HPV infected patients had an almost threefold increased RR of recurrence/SPT, but seemingly a lower RR of DICD compared to high-risk negative cases. Patients with tonsillar carcinoma had a significantly higher cause-specific RR of recurrence/SPT (RR 2.06; CI 0.99 - 4.28) compared to patients with OSCC of other sites. High alcohol consumption was associated with a high RR of recurrence/SPT, but not with DICD. There was no increased RR of recurrence/SPT related to smoking, but an association between smoking and DICD. In conclusion, the results in this study confirm that both smoking tobacco and alcohol consumption are risk factors for OOSCC. The use of Swedish moist snuff had no effect on the risk. Independent risk factors identified are poor oral hygiene, inadequate dental status and malfunctioning complete dentures. Regular dental check-ups are a preventive factor. Among other possible risk factors studied, high-risk HPV infection appears to be the strongest. Highrisk HPV infection increases the cause-specific RR of recurrence or SPT. Tumour stage influences the rate of recurrence/SPT.

Place, publisher, year, edition, pages
Malmö University, Centre for Oral Health Sciences, 2005
Series
Swedish dental journal. Supplement, ISSN 0348-6672
Keywords
alcohol, case-control study, dental status, epidemiology, human papillomavirus, oral cancer, oral hygiene, oral mucosal lesions, population-based, prognosis, recurrence, risk factors, smokeless tobacco, smoking
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7662 (URN)16335030 (PubMedID)2-s2.0-33644815072 (Scopus ID)1798 (Local ID)91-628-6628-1 (ISBN)1798 (Archive number)1798 (OAI)
Note

Paper IV in dissertation as manuscript with title "Recurrence in relation to human papillomavirus infection and other risk factors in patients with oral and orophanryngeal squamous cell carcinoma included in a population-based case-control study"

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-12-02Bibliographically approved

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