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6th ICHNO
page 51
6
th
ICHNO Conference
International Conference on innovative approaches in Head and Neck Oncology
16 – 18 March 2017
Barcelona, Spain
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hypothesised an element of age bias in relation to
determining p16 status, and questioned its justification.
Despite Public Health efforts reducing tobacco
consumption, a well-recognised causal agent of OPSCC,
the expected decrease in OPSCC incidence was only brief,
before resurging dramatically. In the United States alone,
the percentage of OPSCC p16 positive cases has risen from
16% in 1989 to over 70% in 2004
3
, whilst studies in
Scandinavia have suggested HPV becoming the sole
progenitor of OPSCC, foreboding a virus-induced
carcinoma epidemic
4
.
Material and Methods
75 cases of OPSCC admitted to our Centre in 2015, were
identified using CaPPs (Cancer Patient Pathway System).
Using Electronic Care Records, 67 (89%) of these cases had
p16 status confirmed either on initial or secondary testing.
Results
Of the 67 cases tested, 37 (55%) were p16 positive. Of
these 37 p16 positive cases, 78% were male, with 65%
being males aged 40-69, compared with 16% females aged
40-69. This is comparable with evidence that p16 positive
OPSCC is a disease of the middle-aged male
5
. All cases
were ethnically white.
There was evidence of age bias in our Centre in relation
to determining p16 status from age 60 onwards. Per
decade there was a step-wise percentage reduction of
OPSCC cases being stratified by p16 status. Of the total
OPSCC cohort tested: 100% aged 30-59 were tested; 91%
aged 60-69; 80% of ages 70-79; and only 50% of those over
80 were tested. However, this was followed by a
comparable step-wise decrease in p16 positive incidence
per decade also, from 100% in cases aged 40-49, 60% aged
50-59, to 33% aged over 80. Incidentally, the youngest
case of p16 positivity was a 32-yr-old female, the eldest
an 85-yr-old male. The youngest p16 negative case was a
50-yr-old male.
Conclusion
Despite a decreasing incidence of HPV p16 positivity with
older age, there were nonetheless cases of such identified
in our cohort. We know that p16 status is associated with
a better prognosis, especially when other risk factors such
as tobacco and alcohol are less. As tobacco consumption
decreases, the increasing primacy of OPSCC p16 positivity
will endure. With trials underway on therapy de-
intensification, there is a duty to assess all OPSCC for p16
status to offer the opportunity for prognostic discussion
and the possibility of older patients to be represented in
these trials. We feel there is justification to test all OPSCC
for p16 status.
PO-106 Prognostic significance of cyclin D1 and pRb
expression in oropharyngeal carcinoma
M.A. Broglie
1
, M.M. Plath
1
, S.J. Stoeckli
1
, W. Jochum
2
1
Kantonsspital St. Gallen, Otorhinolaryngology- Head and
Neck Surgery, St Gallen, Switzerland
2
Kantonsspital St. Gallen, Institute of Pathology, St
Gallen, Switzerland
Purpose or Objective
In oropharyngeal squamous cell carcinoma (OPSCC), high-
risk human papilloma virus (HR-HPV) infection is
associated with deregulated expression of cell cycle
associated proteins, including cyclin D1 and pRb. Based on
studies analysing patient cohorts with predominantly
advanced tumour stages and heterogeneous treatment
modalities, Cyclin D1 and pRb overexpression has been
linked to poor prognosis in OPSCC.The objective of our
study was to evaluate the prognostic significance of cyclin
D1 and pRb expression in surgically treated OPSCC
patients.
Material and Methods
Retrospective
analysis
of
clinicopathological
characteristics of surgically treated OPSCC patients was
performed. Tumour tissue samples were tested for HR-
HPV DNA using PCR. Cyclin D1, pRb and p16
immunohistochemistry were performed using OPSCC tissue
microarrays and were scored positive if more than 25%
(Cyclin D1, pRb) and 70% (p16) of tumour cells stained
positive, respectively. Overall survival (OS) and disease-
specific survival (DSS) were analysed by Kaplan-Meier
curves and log-rank test. The prognostic significance of
cyclin D1 and pRb expression was assessed by uni- and
multivariate cox regression analysis, adjusted for
established prognostic factors.
Results
322 OPSCC patients treated with surgery alone (n=110) or
surgery with adjuvant radio-(chemo) therapy (n=212) were
included in the analysis. Cyclin D1 and pRb expression was
found in 42% and 49% of tumours, respectively. 48% of
OPSCC had a positive HR-HPV status defined as the
combined positivity for HR-HPV DNA and p16 expression.
Cyclin D1and pRb was inversely correlated with tumoral
HR-HPV status (p<0.001). Cyclin D1 expression of tumour
cells was associated with reduced 5-year OS (81.2% versus
66.7%, p=0.01) and DSS (87.8% versus 80.6%, p=0.03). This
result was even more pronounced with pRb expression5-
year OS (85% versus 67%, p=0.0001) and DSS (92% versus
77%, p=0.0001) In multivariate analysis, including tumour
stage, HR-HPV status and smoking history, cyclin D1 and
pRb expression lost its prognostic Impact whereas only
tumoral HR-HPV status positively influenced survival.
Conclusion
Cyclin D1 protein and pRb expression is inversely
correlated with tumour HR-HPV positivity and may serve
as a diagnostic and prognostic marker in OPSCC patients in
addition to the HR-HPV
status.
Acknowledgement:
This study was supported by the Swiss
Cancer League. The authors appreciate the contribution
of the other investigators of the Swiss Cohort of
Oropharyngeal Cancer Patients (SCOC).
PO-107 Clinical outcomes of HPV-positive non-
oropharyngeal squamous cell carcinoma: analysis of the
NCDB
H. Ko
1
, R. Sacotte
2
, M. Yu
1
, S. Chen
1
, A. Wieland
1
, M.
Witek
1
1
Univ. of Wisconsin School of Medicine and Public H,
Human Oncology, Madison WI, USA
2
Northwestern University, Feinberg School of Medicine,
Chicago, USA
Purpose or Objective
The favorable prognosis of patients with HPV-positive
oropharyngeal squamous cell carcinoma (OPSCC) is well
established. Conversely, the clinical significance of HPV-
positive non-OPSCC is controversial. We sought to
describe patient characteristics and clinical outcomes for
HPV-positive non-OPSCC using the National Cancer
Database (NCDB).