EGFR mutations and human papillomavirus in squamous cell carcinoma of tongue and tonsil☆
Introduction
Squamous cell carcinoma of the head and neck (HNSCC) is the eighth most common cause of cancer death worldwide.1 Smoking and alcohol consumption are well-established risk factors. However, a small portion of patients with head and neck cancer are nonsmokers and nondrinkers.2, 3 Recent studies have suggested that a human papillomavirus (HPV) infection is a risk factor for HNSCC.4 In addition, some authors have reported that an association between a HPV infection and nonsmokers.5 The association between a HPV infection and a carcinoma of the head and neck varies according to the anatomical site of the primary tumour. Previous studies have shown a strong association between tonsil cancer and a HPV infection.4, 5, 6, 7
Some investigators have reported EGFR mutations in a subset of patients with non-small-cell lung cancer (NSCLC).8, 9 Among several factors, never smoking was associated with the presence of EGFR mutations in NSCLC patients.8, 9 However, the etiology of these EGFR mutations in NSCLC is unknown. Taiwanese studies have suggested that a HPV 16/18 infection might be associated with this type of cancer in nonsmoking, female lung cancer patients.10 These findings suggest a possible association between EGFR mutations and a HPV infection. In addition, some patients with head and neck cancer were responsive to tyrosine kinase inhibitors (TKI) such as gefitinib.11 Another study reported the presence of EGFR mutations in three out of 41 patients with head and neck cancer.12 However, the clinical impact of EGFR mutations in head and neck cancer is not completely understood.
This study tested the hypothesis that a HPV infection is related to EGFR mutations in head and neck cancer. To accomplish this, the prevalence and association of EGFR mutations and HPV infections were evaluated in a subset of patients with head and neck cancer. Patients with tongue and tonsil cancer were selected because previous studies have suggested they have a different association with a HPV infection.4, 5, 7 The data on EGFR mutations and a HPV infection was compared with the clinical features of the patients.
Section snippets
Patients
Patients with squamous cell carcinoma of the tongue and tonsil were identified from the database of the Korea Cancer Centre Hospital (Seoul, Korea). The formalin-fixed paraffin-embedded tissues from 110 patients who underwent a local treatment modality such as surgery and radiation from July 1994 to December 2003 were examined. Patients who presented with a distant metastasis were excluded. Two pathologists reviewed all histology samples. Two cases with a sarcoma were excluded. The extent of
Patient characteristics and treatment
Table 1 shows the baseline characteristics of the patients. Sixty (74%) patients were male. The median age was 52 years. Thirty-nine percent of patients had never smoked. Seventy (65%) patients were diagnosed with tongue cancer. The proportion of patients with stage I–II, III and IV cancer was 50%, 28%, and 22%, respectively. Forty-four (41%) and 22 (20%) patients were treated with radiation or surgery, respectively. Combined modality treatment including neoadjuvant chemotherapy (chemotherapy
Discussion
There was no association found between EGFR mutations and a HPV infection in patients with tonsil and tongue cancer. Although recent studies have reported HPV positivity and EGFR mutantions in HNSCC, no patients who had an EGFR mutation were positive to the HPV in the present study.5, 12 The etiology of EGFR mutations remains unknown. Although this study was not designed to assess the survival outcomes of patients with EGFR mutations, there was no apparent difference in the survival outcome of
Conflict of interest statement
None declared.
Acknowledgement
This work was supported in part by AstraZeneca Pharmaceuticals.
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This work was presented at the 42nd annual meeting of the American Society of Clinical Oncology.