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A model using concomitant markers for predicting outcome in human papillomavirus positive oropharyngeal cancer
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap. Dept. of Medicine, Karolinska Institutet, Stockholm, Sweden.
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2017 (Engelska)Ingår i: Oral Oncology, ISSN 1368-8375, E-ISSN 1879-0593, Vol. 68, s. 53-59Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: Head-neck cancer therapy has become intensified. With radiotherapy alone, 3-year disease-free survival (DFS) is 80% for HPV-positive TSCC/BOTSCC and better for patients with favorable characteristics, suggesting therapy could be tapered for some, decreasing side-effects. Therefore, we built a model to predict progression-free survival for patients with HPV-positive TSCC and BOTSCC. Material and methods: TSCC/BOTSCC patients treated curatively between 2000 and 2011, with HPV16 DNA/E7 mRNA positive tumors examined for CD8(+) TILs, HPV16 mRNA and HLA class I expression were included. Patients were split randomly 65/35 into training and validation sets, and LASSO regression was used to select a model in the training set, the performance of which was evaluated in the validation set. Results: 258 patients with HPV DNA/E7 mRNA positive tumors could be included, 168 and 90 patients in the respective sets. No treatment improved prognosis compared to radiotherapy alone. CD8(+) TIL counts and young age were the strongest predictors of survival, followed by T-stage <3 and presence of HPV16 E2 mRNA. The model had an area under curve (AUC) of 76%. A model where the presence of three of four of these markers defined good prognosis captured 56% of non-relapsing patients with a positive predictive value of 98% in the validation set. Furthermore, the model identified 35% of our cohort that was over-treated and could safely have received de-escalated therapy. Conclusion: CD8(+) TIL counts, age, T-stage and E2 expression could predict progression-free survival, identifying patients eligible for randomized trials with milder treatment, potentially reducing side effects without worsening prognosis.

Ort, förlag, år, upplaga, sidor
Elsevier, 2017. Vol. 68, s. 53-59
Nyckelord [en]
HPV, Oropharyngeal cancer tonsillar cancer, Base of tongue cancer, Biomarkers, Survival
Nationell ämneskategori
Cancer och onkologi Odontologi
Identifikatorer
URN: urn:nbn:se:umu:diva-137406DOI: 10.1016/j.oraloncology.2017.03.007ISI: 000402469100009PubMedID: 28438294OAI: oai:DiVA.org:umu-137406DiVA, id: diva2:1119740
Tillgänglig från: 2017-07-04 Skapad: 2017-07-04 Senast uppdaterad: 2018-06-09Bibliografiskt granskad

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Mints, Michael

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