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Simple Summary: In this retrospective study conducted at Taichung Veterans General Hospital, 54,692 participants were examined, including 385 with esophageal, oropharyngeal, or hypopharyngeal squamous cell carcinoma (SCC). Researchers investigated the correlation between cancer incidence and prognosis and a polygenic risk score (PRS) derived from 8353 single-nucleotide polymorphisms. Those with a high PRS (Q4) exhibited a 1.83-fold higher risk of SCCs compared to the low-PRS group (Q1), particularly notable in esophageal and hypopharyngeal cancers. Notably, PGS001087 displayed discernible associations with SCC risk, especially in specific subtypes and advanced stages, although not significantly linked to clinical staging. The study underscores the significance of genetic factors in upper aerodigestive tract cancers, notably esophageal SCC, offering insights for future research and risk assessment strategies. These findings highlight the importance of PRS in understanding cancer susceptibility, guiding targeted interventions, and informing personalized treatment approaches. Esophageal cancer shares strong associations with oropharyngeal and hypopharyngeal cancers, primarily due to shared risk factors like excessive tobacco and alcohol use. This retrospective study at Taichung Veterans General Hospital involved 54,692 participants, including 385 with squamous cell carcinoma (SCC) of the esophagus, oropharynx, or hypopharynx. Using a polygenic risk score (PRS) derived from 8353 single-nucleotide polymorphisms, researchers aimed to assess its correlation with cancer incidence and prognosis. The study found a 1.83-fold higher risk of esophageal, oropharyngeal, and hypopharyngeal SCCs in participants with a high PRS (Q4) compared to the low-PRS group (Q1). Esophageal cancer risk demonstrated a significant positive association with the PRS, as did hypopharyngeal cancer. Clinical parameters and staging showed limited associations with PRS quartiles, and the PRS did not significantly impact recurrence or mortality rates. The research highlighted that a higher PRS is linked to increased susceptibility to esophageal and hypopharyngeal cancer. Notably, a specific polygenic risk score, PGS001087, exhibited a discernible association with SCC risk, particularly in specific subtypes and advanced disease stages. However, it was not significantly linked to clinical cancer staging, emphasizing the multifactorial nature of cancer development. This hospital study reveals that a higher PRS correlates with increased susceptibility to esophageal and hypopharyngeal cancers. Notably, PGS001087 shows a discernible association with SCC risk in specific subtypes and advanced stages, although not significantly linked to clinical cancer staging. These findings enhance our understanding of genetic factors in upper aerodigestive tract cancers, particularly esophageal SCC, guiding future research and risk assessment strategies. [ABSTRACT FROM AUTHOR]

Advances in treatment deintensification for human papillomavirus‐associated oropharyngeal cancer include use of transoral surgery to permit reduction in pathologic risk‐based postoperative therapy after transoral resection. The E3311 cooperative group trial demonstrated 3‐year progression‐free survival (PFS) of 95% for intermediate risk patients treated with 50 Gy radiation alone, with no decrement for those with a smoking history. Favorable risk patients could be observed, with a 3‐year PFS of 93%. Reduction in radiation dose is also feasible for favorable risk patients (low or no smoking history and low stage) treated with chemoradiation on the NRG HN002 trial, where 2‐year PFS was 90.7%. For those favorable risk patients treated with radiation alone, 2‐year PFS was 87.7% and this arm did not meet criteria for further testing. Important phase 3 trials of immunotherapy in first‐line treatment of recurrent and/or metastatic head and neck cancer were also reported in 2022. For patients with nonnasopharyngeal sites of disease, the combination of the programmed death‐1–directed antibody nivolumab plus the anti–CTLA‐4 agent ipilimumab was not superior to chemotherapy plus cetuximab in the Checkmate 651 trial. However, in an important breakthrough for patients with nasopharyngeal cancer, the JUPITER‐02 trial, conducted in China, Singapore, and Taiwan among patients with predominantly Epstein‐Barr virus‐related cancers, demonstrated a significant improvement in PFS (hazard ratio, 0.52) when toripalimab was added to gemcitabine/cisplatin chemotherapy. Immature survival data indicate overall survival will likely also be impacted. Important advances in head and neck cancer treatment include deintensification of postoperative treatment for resected human papillomavirus (HPV)‐associated oropharynx cancer, and use of weekly cisplatin with 60 Gy radiation in favorable risk HPV‐associated oropharynx cancer. Toripalimab added to chemotherapy significantly improved disease control in nasopharyngeal cancer, in areas of endemic Epstein‐Barr virus‐related nasopharynx cancer, making chemotherapy with immunotherapy an appropriate standard of care for these patients. [ABSTRACT FROM AUTHOR]

Background: The incidence of human papillomavirus (HPV) positive oropharyngeal cancer (OPC) is rising but HPV negative OPC is decreasing in Western countries. In Taiwan, the incidence of HPV negative OPC is common but the incidence of HPV positive OPC remains unknown. The objective of this study is to estimate the incidence trend and the survival of HPV positive OPC in Taiwan.Methods: Between 1999 and 2014, primary tumor tissues from 425 incident OPCs were obtained from 5 medical centers in Taiwan. 408 OPCs were evaluated by the EasyChip HPV genotyping (King-Car, I-Lan, Taiwan) and 369 OPCs by p16 staining. The clinical data were retrospectively obtained from the medical records.Results: In our study, 29% of OPCs were HPV positive. The percentage of HPV positive OPC was stable from 1999 to 2014 (25% (1999-2002), 30% (2003-2006), 30% (2007-2010), 29% (2011-2014)). The estimated crude incidence rate of HPV positive OPC increased significantly from 0.62 (1999-2002), 1.06 (2003-2006), 1.52 (2007-2010) to 1.74 (2011-2014) per 100,000 person-year. The sensitivity and specificity of p16 staining for positive HPV infection were 92% and 91%, respectively. The 5-year overall survival rates for patients with HPV positive OPC and with HPV negative OPC were 67.8% and 49.0%, respectively (HR = 0.52 (0.35-0.76), p = 0.0005). Patients with HPV positive OPC but no betel nut/cigarette exposure had the best overall survival (5-year: 88.2%, p < 0.0001). Patients with HPV negative OPC and betel nut/cigarette exposure had the worst overall survival (5-year: 46.6%, p < 0.0001). Patients with HPV positive OPC but also with betel nut/cigarette exposure had poorer 5-year overall survival (48.3%, p < 0.01).Conclusion: The incidence of HPV positive OPC is increasing along with HPV negative OPC, which leads to stably low percentage of HPV positive OPC in Taiwan. HPV positive OPC may become an important head and neck cancer when the incidence of HPV negative OPC declines in the near future. P16 is a useful surrogate marker for HPV infection in OPC and a good prognostic indicator for treatment outcome of OPC. Patients with HPV positive OPC but no betel nut/cigarette exposure has an excellent prognosis. Betel nut/cigarette exposure significantly worsens the prognosis of HPV positive OPC. [ABSTRACT FROM AUTHOR]

Objective: We examined the risk of suicide attempts in patients with head and neck cancer (HNC) in comparison with that in the general population and in patients of other cancers (including all other cancers rather than HNC).Methods: The definition of suicide attempt here is that an attempt of suicide with or without completed suicide. This retrospective cohort study consisted of 66 931 cases of HNC and individual without HNC from the general population assigned to the control group. Cox's proportion hazard regression analysis was conducted to compare the subsequent suicide attempt risk between patients with HNC and the control group.Results: The suicide attempt rate for HNC and control groups were 7.44 and 1.98 per 10 000 person-year, respectively. A more than three-fold higher risk of suicide attempts was observed in the HNC group than in the control group (adjusted hazard ratio [HR]: 3.72; 95% confidence intervals: 2.85, 4.88). Patients of HNC also had a significantly 1.9-fold higher risk of suicide attempt than patients with other cancers. Subsequent stratified analyses revealed a significantly elevated risk of suicide attempts across every cancer anatomic subsite and almost all categories of various demographics, but the risk was limited to male patients and patients with no comorbidity. The suicide attempt rate was the highest among patients with oropharyngeal cancer, and chemotherapy was associated with an elevated risk of suicide attempt.Conclusions: Patients with HNC are vulnerable to an increased risk of suicide attempts than the general population and patients with other cancers. [ABSTRACT FROM AUTHOR]

Background: The incidence of HPV positive oropharyngeal cancer is increasing in Taiwan. Given this, it is critical to understand the prevalence of oral HPV infection since this cancer is potentially preventable. A community-based study was conducted to evaluate the prevalence of oral HPV infection and sexual behavior changes.Methods: Between January and December 2016, 100 subjects between 20 and 70 years-old with current/ever betel nut chewing or current cigarette smoking visited the Department of Health, New Taipei City. Subjects with cancer history or known HIV/AIDS were excluded. Sexual behavior information was collected through a questionnaire. Oral rinse samples and oropharyngeal swabs were obtained for HPV genotyping using the EasyChip HPV genotyping array (King-Car, Taiwan).Results: 92 men and 8 women were recruited. The prevalence of oral HPV infection was 3%, present between 60 and 70 (11%) and between 30 and 40 years old (4%). The prevalence of the first sexual contact at younger than 20 years old were 71.4%, 53.6%, 15.4% and 44% in <40, 40-49, 50-59 and 60+ years old, respectively (p for trend = 0.0036). The prevalence of 3 or more lifetime sexual partners were 60.7%, 57.1%, 23.1% and 16.7%, respectively for <40, 40-49, 50-59 and 60+ years old (p for trend = 0.0005).Conclusion: The prevalence of oral HPV infection is 3%, in current/ever betel nut chewers or current cigarette smokers in Northern Taiwan. Younger generation have more lifetime sexual partners and younger first sexual contact. This could explain the rising incidence of HPV positive oropharyngeal cancer in Taiwan. [ABSTRACT FROM AUTHOR]

Summary Objective: The purpose of this study was to examine the oropharyngeal cancer pattern among different ethnic groups in Taiwan. Methods: The sample population was divided into three ethnic groups: the Fukkien, Hakka, and aboriginal communities. Age-standardized mortality rates (SMRs) and age-standardized incidence rates (SIRs) were estimated among these ethnic groups for the period 1979-199611997. Results: Our study found that the higher oropharyngeal cancer mortality and incidence rates in females of aboriginal groups are statistically significant, and higher than reference groups for both genders (SMR = 3.76, SIR = 2.18). However, in the tower areca quid chewing aboriginal groups, the higher pattern was not seen in females, and the tower pattern was even found in mates. The incidence and mortality rate of oropharyngeal cancer in Hakkas was significantly tower than in the reference group. Conclusions: The pattern of oropharyngeal cancer in Taiwan showed ethnic differences. The differences may be due to variation in exposure to different risk factors; however, in our study, we found that genetic differences might also be considered when explaining the different oropharyngeal cancer patterns among ethnic groups. [ABSTRACT FROM AUTHOR]

Background: Oropharyngeal cancer is the one of the most common cancers in the world. The purpose of this study was to examine the trends in oropharyngeal cancer from 1979 to 1996 in Taiwan.Methods: Traditional cohort analysis was employed to show the birth-cohort effect of oropharyngeal cancer incidence. Age-period-cohort model analysis was used to examine the age, period and cohort effect between intraoral and pharyngeal cancer.Result: A significant increasing trend in oropharyngeal cancer has been seen in males. The principal increases have been seen in tongue and mouth in males, and tongue in females. In males, an increasing trend was found in successive cohorts born after 1929. The increase in incidence of intraoral cancer of males was greater than the increase in incidence of pharyngeal cancer in the younger age group, more recent time periods and the younger cohorts.Conclusion: The increasing incidence in oropharyngeal cancer in Taiwan is probably heavily influenced by the rising consumption of alcohol and use of betel quid. The effect of these etiologies on intraoral cancer was more significant in recent time periods, later cohorts and the younger group. [ABSTRACT FROM AUTHOR]

Objectives: Given a lack of universally-accepted standard-of-care treatment for patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC), study objectives were to assess treatment utilization and survival outcomes for R/M HNSCC in the real-world setting.Materials and Methods: A multi-site retrospective chart review was conducted in Europe (Germany, United Kingdom, Italy, Spain), Asia Pacific (Australia, South Korea, Taiwan), and Latin/North America (Brazil and Canada) to identify patients who initiated first-line systemic therapy for R/M HNSCC between January 2011 and December 2013. Patients were followed through December 2015 to collect clinical characteristics, treatment and survival data.Results: Among 733 R/M HNSCC patients across 71 sites, median age was 60 years (inter-quartile range 54-67), 84% male, and 70% Eastern Cooperative Oncology Group performance status 0-1; 32% had oral cavity and 30% oropharyngeal cancers. The most common first-line regimen across all countries consisted of platinum-based combinations (73%), including platinum + 5-fluorouracil (5-FU) (26%), cetuximab + platinum ± 5-FU (22%), or taxane + platinum ± 5-FU (16%). However, use of different platinum-based combinations varied substantially; administration of cetuximab + platinum ± 5-FU was frequent in Italy (81%), Germany (46%) and Spain (38%), whereas use in other countries was limited. Median follow-up was 22.6 months (95% confidence interval [CI]: 21.5-24.6 months). Median real-world overall survival was only 8.0 months (95% CI: 7.0-8.0), with one-year survival reaching only 30.9% (95% CI: 27.5-34.3).Conclusion: Systemic therapies used in clinical practice for patients with R/M HNSCC vary substantially across countries. Prognosis remains poor in this patient population, highlighting the need for newer, more efficacious treatments. [ABSTRACT FROM AUTHOR]

To identify the risk factors of oral cancer, we investigated the association between chronic hepatitis C (CHC) and oral cancer, and the development of oral cancer after anti-hepatitis C virus (HCV) therapy. We conducted a nationwide, population-based cohort study from 2004 to 2012 from the Taiwan National Health Insurance Research Database. CHC patients without anti-HCV therapy were matched with those non-HCV patients by age, sex and comorbidities. Moreover, CHC patients who underwent pegylated interferon and ribavirin (PegIFN/RBV) anti-HCV therapy were matched with CHC patients without anti-HCV therapy. A total of 100,058 patients were included in the HCV cohort and non-HCV cohorts, respectively. Their mean age was 59 years and 50% of these were male. CHC infection significantly increased the cumulative incidence of lichen planus and oral cancer. After adjustment for confounders and competing mortality, CHC infection significantly increased the risk of oral cancer (hazard ratio [HR]: 1.677, 95% confidence interval [CI]: 1.392-2.020, p < 0.001). Another 23,735 CHC patients without anti-HCV therapy were matched with 23,735 CHC patients in the treatment cohort. After adjustment for confounders and competing for mortality, the risk of oral cancer was significantly reduced in CHC patients receiving anti-HCV therapy (HR: 0.652, 95% CI: 0.479-0.887, p = 0.007). To minimize the inclusion of pre-existing unidentified oral cancer, we excluded oral cancer developed within the first year of CHC or anti-HCV therapy and found these associations remained statistically significant. In conclusion, CHC significantly increases the risk of oral cancer. Moreover, PegIFN/RBV antiviral therapy significantly reduces the risk of HCV-related oral cancer., (© 2019 UICC.)

We conducted a random-effects meta-analysis of 50 publications assessing the relationship between oral/oropharyngeal cancer and chewing betel quid, with (BQ+T) or without added tobacco (BQ-T), a common practice in many parts of Asia and globally among Asian immigrants. Exposure-response, by daily amount and years of BQ chewed, was assessed using spline models. Attributable fractions (PAF%) were calculated to estimate the public health impact if BQ were no longer chewed. The meta-relative risk (mRR) for oral/oropharyngeal cancer in the Indian subcontinent was 2.56 (95%CI, 2.00-3.28; 15 studies) for BQ-T and 7.74 (95%CI, 5.38-11.13; 31 studies) for BQ+T; in Taiwan, China, the mRR for BQ-T was 10.98 (95%CI, 4.86-24.84; 13 studies). Restricting to studies that adjusted for tobacco and alcohol use had only a small effect on the risk estimates. For BQ+T in the Indian subcontinent, the mRR was much higher in women (mRR, 14.56; 95%CI, 7.63-27.76) than in men. Exposure-response analyses showed that the risk of oral/oropharyngeal cancer increased with increasing daily amount and duration (years) of chewing BQ in India and Taiwan, China. Roughly half of oral cancers in these countries could be prevented if BQ were no longer chewed (PAF%=53.7% for BQ-T in Taiwan, China; PAF%=49.5% for BQ+T in India). We demonstrate that betel quid chewing, with or without added tobacco, increases the risk of oral/oropharyngeal cancer in an exposure-dependent manner, independently of tobacco and alcohol use. Further work is needed to explain the higher risks associated with chewing BQ-T in Taiwan, China., (© 2013 UICC.)