HPV-16 infection modifies overall survival of Puerto Rican HNSCC patients.

BACKGROUND: HPV-16 modifies the overall survival (OS) of patients with oropharyngeal cancer (OPSCC). HPV-16 has been established as risk factor for OPSCC, but HPV-16 infection may also reside in the larynx and oral cavity. We evaluated HPV-16 status on OS of Head and Neck Squamous Cell Carcinoma (HNSCC) patients. METHODS: HPV-16 infection was confirmed by amplification of E6 and E7 viral oncogenes through PCR assay and E6 IHC in 185 HNSCC samples. Associations between HPV-16 status and clinicopathological parameters were performed using Fisher's exact test and x(2). Survival analysis was completed using Kaplan-Meier estimator and multivariate Cox regression analysis. RESULTS: OS of HPV-16 positive patients was longer compared to HPV-16 negative patients (P = 0.002). HPV-16 positive tumors of the larynx (LSCC) and pharynx (PSCC) showed improved OS compared to HPV-16 negative tumors. Also, HPV-16 positive patients exposed to radiotherapy presented a better survival. CONCLUSIONS: HPV-16 status has a positive prognostic value in HNSCC. Addition of HPV-16 status to the TNM staging can provide better assessment in prognosis and guide treatment for HNSCC patients.

Clinicopathologic characteristics of head and neck squamous cell carcinoma in Puerto Ricans.

OBJECTIVE: The purpose of this study is to characterize head and neck squamous cell carcinoma (HNSCC) in the Puerto Rican population. This is a follow-up to our initial published report on the first 134 patients. Specifically, demographic characteristics, stage at presentation, initial treatment given, and rate of recurrence were studied. METHODS: Relevant data was obtained from 445 histologically confirmed HNSCC cases identified through the University of Puerto Rico School of Medicine Otolaryngology Department Head and Neck Cancer Clinics between August 1993 and January 2003. Data collected after informed consent included demographic factors (sex, age, areas of residence, income); risk factors (occupation, alcohol intake, cigarette usage); and pathological variables (tumor location, histopathology, stage at presentation, current disease status, tumor recurrence). RESULTS: The average age at diagnosis was 64.0 years (range 18-98); 84.5% of the patients were male, 16% were females. The most frequent anatomical sites of the primary tumor were the larynx (36.4%) and the oral cavity (29.9%). The majority of patients (61.1%) presented with advanced stage (III-IV) disease at the time of diagnosis and over half (55.5%) had moderately-differentiated tumors. Most patients had less than 12 years of formal education (81.2%). Prolonged use of tobacco and alcohol identified in 88.1% and 79.8% of patients, respectively. The most frequent therapeutic modality used was radiation therapy followed by the combination of radiation and surgery. Twenty five percent of the cases experienced a recurrence of disease during the follow-up period. CONCLUSIONS: These findings emphasize the need for early detection programs for HNSCC in Puerto Rican patients given the high rate of advanced-stage disease at time of diagnosis. The key role of heavy alcohol intake and tobacco use as risk factors in the development of HNSCC is once again highlighted.

High frequency of HPV16-associated head and neck squamous cell carcinoma in the Puerto Rican population.

BACKGROUND: Recent evidence has accumulated suggesting that human papillomavirus (HPV) plays a role in the development of head and neck squamous cell carcinoma (HNSCC). HPV16 is the most common of the HPV subtypes associated with oral and laryngeal malignancies. This study estimated the prevalence of HPV16 DNA in Puerto Rican patients with HNSCC. METHODS: DNA was extracted from frozen tissue of 118 HNSCCs. Genomic DNA was screened for the presence of HPV16 DNA with E6-specific and E7-specific primers. RESULTS: HPV16 was detected in tumor tissue of 52 patients (44%) with HNSCC. The oropharynx had a slightly higher incidence of HPV16 DNA. Fifteen of 66 patients with HPV16-negative HNSCC later had recurrences. Positivity for HPV16 was independent of the tumor grade, tumor stage, nodal status, and tobacco or alcohol use. The 3-year survival rate was higher in HPV16-positive patients than in HPV16-negative patients (36% vs 21%). CONCLUSIONS: Our findings suggest that HPV16 may play a role in the etiology of a subgroup of HNSCC in Puerto Ricans. Overall survival times of the HPV16-positive patients were not significantly different from those of HPV16-negative patients. Increasing our understanding of the role of HPV16 in the etiology of HNSCC might facilitate the development of new treatment modalities for this subgroup of HNSCC.

Radiation therapy of early vocal cord carcinoma stage T1N0 twenty-one years' experience at Isaac González Martínez Oncologic Hospital

Se llevó a cabo un análisis detallado retrospectivo de 72 pacientes con cáncer de cuerda vocal estádio T1N0M0 tratados en el Departamento de Radioterapia del Hospital Oncológico Isaac González Martínez en San Juan, Puerto Rico desde enero de 1960 hasta diciembre de 1980. La edad de la mayoría de los pacientes fluctuaba de 50 a 79 años y el 88% eran varones. Todos los pacientes tuvieron un periodo de seguimiento mínimo de cinco años. La sobrevida global a cinco años fue de un 86% . Trece pacientes tuvieron recidiva local del tumor de los cuales diez fueron rescatados mediante cirugía. El control local final fue de un 96% . El tiempo medio para recidiva fue de 25 meses. Se diagnosticaron segundos tumores primarios en 12 pacientes durante el seguimiento. Los resultados de este estudio confirman el valor de la radioterapia como modalidad de tratamiento primário para el cáncer temprano de las cuerdas vocales ofreciendo una excelente curabilidad y preservación de la voz

Foreign body aspiration: experience at the University Pediatric Hospital

Cincuenta y ocho pacientes con el diagnóstico de aspiración de cuerpo extraño fueron admitidos al Hospital Pediátrico Universitario desde agosto de 1986 a enero de 1991. De estas 58 admisiones se analizaron 40 expedientes médicos para incidencia, manifestaciones clínicas y radiológicas, moriblidad y naturaleza del cuerpo extraño aspirado. Esta data fue comparada con los resultados de otros centros, inclcuyendo un estudio previo de nuestra institución. Nuestra data presenta la aspiración de cuerpo extraño más comunmente en niños entre las edades de 1-2 años en 18 (45%) de los casos y una proporción de niño a niña de 1:3. Dicisieta (42.5%) de los casos se diagnosticaron durante las primeras 24 horas después del evento y 42.5% fueron diagnosticados después de 48 horas. Tos y episodio de ahogamiento fueron los signos de presentación más comunes; hiperareación del pulmón izquierdo como hallazgo radiológico; el bronquio mayor izquierdo como sitio de alojamiento y el maní como objeto aspirado fueron los hallazgos más comunes en 37%, 30% y 22.5% respectivamente. La mortalidad fue un 7.5%. Es importante descartar la aspiración de cuerpo extraño en niños con episodios de ahogamiento, estridor y tos crónica para evitar complicaciones y muerte. Así mismo es importante orientar a la comunidad en torno a medidas básicas de resuscitación e identificar aquellos niños con mayor riesgo