Objectives Recent studies have found that cases with oropharyngeal squamous cell carcinoma (OPSCC) positive for HPV16 genotype have better overall survival compared with cases positive for other HPV genotypes. We sought to further replicate these studies and determine if this relationship is modified by expression of p16 tumor suppressor protein. Material and Methods We identified 238 OPSCC cases from the Carolina Head and Neck Cancer Study (CHANCE) study, a population based case-control study. Tumors that tested positive solely for HPV16 genotype and no other genotypes with PCR were classified as HPV16-positive. Tumors positive for any other high-risk HPV genotype were classified as non-HPV16-positive. Expression of p16 in the tumor was determined with immunohistochemistry. Follow-up time was calculated from the date of diagnosis to date of death or December 31, 2013. Overall survival was compared with the Kaplan-Meier curves and log-rank test. Hazard ratios (HR) adjusted for smoking, alcohol use, sex, race, and age was calculated with the Cox proportional hazard regression. Results Cases with HPV16-positive OPSCC had better overall survival than cases with non-HPV16-positive OPSCC (log-rank p-value: 0.010). When restricted to OPSCC cases positive for p16 expression, the same trend continued (log-rank p-value: 0.002). In the adjusted model, cases with non-HPV16-positive OPSCC had greater risk of death compared to cases with HPV16-positive tumors (HR: 1.92; 95% CI: 1.03, 3.60). Conclusions This finding indicates that HPV genotyping carries valuable prognostic significance in addition to p16 status and future survival studies of OPSCC should take into account differing HPV genotypes.
Diets high in fruits and vegetables and low in red meat intake have been associated with decreased risk of head and neck cancer. Additionally, chronic inflammation pathways and their association with cancer have been widely described. We hypothesized a proinflammatory diet, as measured by the dietary inflammatory index (DII ), is associated with increased risk of head and neck cancer. We used the Carolina Head and Neck Cancer (CHANCE) study, a population-based case-control study of head and neck squamous cell carcinoma. Cases were recruited from a 46-county region in central North Carolina. Controls, frequency-matched on age, race, and sex were identified through the North Carolina Department of Motor Vehicle records. The DII score, adjusted for energy using the density approach (E-DII), was calculated from a food frequency questionnaire and split into four quartiles based on the distribution among controls. Adjusted odds ratios (ORs) were estimated with unconditional logistic regression. Cases had higher E-DII scores (i.e., a more proinflammatory diet) compared with controls (mean: -0.14 vs. -1.50; p value < 0.001). When compared with the lowest quartile, the OR for the highest quartile was 2.91 (95% confidence interval (CI): 2.16-3.95), followed by 1.93 (95% CI: 1.43-2.62) for the third quartile, and 1.37 (95% CI: 1.00-1.89) for the second quartile. Both alcohol and smoking had a significant additive interaction with E-DII (smoking relative excess risk due to interaction (RERI): 2.83; 95% CI: 1.36-4.30 and alcohol RERI: 1.75; 95% CI: 0.77-2.75). These results provide additional evidence for the association between proinflammatory diet and head and neck cancer.
Background Our objective was to evaluate differences in baseline characteristics, complications, and mortality among patients receiving a gastrostomy tube (GT) by surgical or non-surgical services. Methods We performed a retrospective analysis of adult patients who underwent GT placement from 2014 to 2017 at a single institution. Using bivariate and multivariable analyses, we compared baseline characteristics, complications, and overall 30-day mortality of patients undergoing GT placement with surgical or non-surgical services. Results Of the 1339 adults who underwent GT placement, surgical and non-surgical services performed 45% (n = 609) and 55% (n = 730) procedures, respectively. Gastrostomy tube-related complications were similar (29.6% surgical vs 28.8% non-surgical, P = .76). Thirty-day mortality was higher among non-surgical services (23.7% vs 16.5%, P = .004). On multivariable analysis, this was not significant (OR 1.21, 95% CI 0.83; 1.77). Conclusion Surgical and non-surgical service placement of GTs had equivalent GT-related mortality and complication rates.
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