PURPOSE Head and neck squamous cell carcinoma (HNSCC) incidence is high in South America, where recent data on survival are sparse. We investigated the main predictors of HNSCC survival in Brazil, Argentina, Uruguay, and Colombia. METHODS Sociodemographic and lifestyle information was obtained from standardized interviews, and clinicopathologic data were extracted from medical records and pathologic reports. The Kaplan-Meier method and Cox regression were used for statistical analyses. RESULTS Of 1,463 patients, 378 had a larynx cancer (LC), 78 hypopharynx cancer (HC), 599 oral cavity cancer (OC), and 408 oropharynx cancer (OPC). Most patients (55.5%) were diagnosed with stage IV disease, ranging from 47.6% for LC to 70.8% for OPC. Three-year survival rates were 56.0% for LC, 54.7% for OC, 48.0% for OPC, and 37.8% for HC. In multivariable models, patients with stage IV disease had approximately 7.6 (LC/HC), 11.7 (OC), and 3.5 (OPC) times higher mortality than patients with stage I disease. Current and former drinkers with LC or HC had approximately 2 times higher mortality than never-drinkers. In addition, older age at diagnosis was independently associated with worse survival for all sites. In a subset analysis of 198 patients with OPC with available human papillomavirus (HPV) type 16 data, those with HPV-unrelated OPC had a significantly worse 3-year survival compared with those with HPV-related OPC (44.6% v 75.6%, respectively), corresponding to a 3.4 times higher mortality. CONCLUSION Late stage at diagnosis was the strongest predictor of lower HNSCC survival. Early cancer detection and reduction of harmful alcohol use are fundamental to decrease the high burden of HNSCC in South America.

Background: HPV-positive head and neck tumors (HNT) correspond to a unique entity given their clinical behavior and molecular characteristics. These tumors can show distinct features on pretreatment imaging, such as well-defined borders and cystic nodal metastases; therefore, the aim of our study was to evaluate the imaging characteristics and determine if there are differences between HPV-positive and HPV-negative HNT tumors in patients studied at our institution. Design: A retrospective pretreatment imaging review from 35 HNT cases recruited under INTERCHANGE- IARC project in Latin America between 11-2014 and 12-2016 was performed. Imaging evaluation included primary lesion and nodal metastases. Initial evaluation by radiologists was blinded for patients' histological findings and HPV status. Radiology was evaluated for: location, tumor size, tumor border morphology, contrast enhancement, nodal metastases, size of metastasis and morphology of nodal metastasis. Radiological findings were correlated with histology and p16 INK4a inmunohistochemistry using clone E6H4 (HPV surrogate marker). Results: Pretreatment images were available for review only in 17 of 35 cases (48,5%). 10 cases had computerized tomography (CT) examination, 1 case magnetic resonance (MR) and 6 cases had 18F-FDG PET-CT. 6/17 cases (35.3%) were excluded due to no visualization of the primary tumor or due to limitation artifacts (amalgam). From the 11 cases available for review, 7 were from the oropharynx (OP), 2 from the oral cavity (OC) and 1 from the larynx (LA). All OP tumors were positive for p16 and all the rest tumors were p16 negative. Tumor size ranged from 7 to 51 mm in greatest dimension. Well-defined borders were present in 4/7 p16 positive tumors vs 2/4 p16 negative tumors. Tumor enhancement with contrast was present and able to evaluate only in 5 out of 11 tumors (3 p16 + and 2 p16 -). All the OP p16 positive tumors presented with nodal metastasis greater than 10 mm in dimension. 6/7 had nodal cystic change and these p16 positive cases were more likely to have large cystic nodal metastases with a cystic component larger than 50% of the nodal size (6/7) than p16/HPV negative tumors (1 out of 4 cases had smaller nodal metastasis with cystic component <50%). Conclusion: Large nodal metastasis (>10 mm) with cystic component larger than 50% of the node size is an important finding seen in p16 HNT. One should consider these findings when examining neck images in patients with unknown primary in order to exclude malignancy given that usually cystic nodes could be misdiagnosed as benign. Our nondiagnostic imaging rate pretreatment was 35%; in order to improve the use of diagnostic tools we recommend the use of MR especially in patients with amalgams and/or tumor located at the oral cavity and oropharynx. Further studies are granted with a larger sample size in order to validate and confirm imaging characteristics in p16/HPV positive HNT. Citation Format: Nicolás Useche, Oscar Torres, Maria M. Rojas, Mauricio Palau-Lázaro, Marcela Mejía-Arango, Ana Margarita Baldión, José A. Hakim, Johanna Campos, Alberto Escallon, Aylen Vanessa Ospina, Sandra Perdomo, Paula A. Rodríguez-Urrego. Imaging characteristics of head and neck tumors according to human papillomavirus (HPV) status in Bogotá, Colombia [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; April 23-25, 2017; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(23_Suppl):Abstract nr 03.

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In 2018, almost 36,477 new head and neck cancer (HNC) cases were estimated to occur in South America. Colombia presents an intermediate age-standardized rate per 100,000 of 178.8 for both sexes. However, the incidence has not decreased in the las 10 years. Here, we present a description of the epidemiological and clinical characteristics of HNC patients studied in a private institution in Bogotá, Colombia. Between November 2014 and October 2018, 73 HNC cases were enrolled in the InterCHANGE- project: HNC in Latin America (http://interchange.iarc.fr/index.php). All cases had information on sociodemographic and lifestyle factors and complete clinical data. Stage at diagnosis was based on the 8th TNM AJCC classification. Inmmunohistochemical HPV studies included evaluation of p16INK4a (Clone E6H4). Mean age of diagnosis was 66 (SD 11.8), 66% of cases were male, 64% identified themselves as mestizos, 66% had superior complete educational level. 41% were nonsmokers, 56% former smokers and 52% current drinkers. 64% reported ever practiced oral sex. Tumors were mostly localized in the oral cavity (41.1%) and the oropharynx (41.1%), followed by larynx (16.4%) and hypopharynx (1.3%). 45% of cases were diagnosed at stage I and surgical treatment of primary tumor was performed in 66% of cases. Overall, 45% of cases were p16 positive. Interestingly, 93% of oropharyngeal cases were p16 positive, majority male (82%) with a mean age of diagnosis of 63 (SD 11.8) and among them, only 34% were nonsmokers. After a 2-year period of follow-up 82% of all cases were alive.In our population alcohol consumption and HPV infection are the major lifestyle risk factors associated to HNC. Oropharyngeal tumors were predominantly associated to HPV infection. Stage at diagnosis and percentage of survival is higher from what has been reported in other South American populations. Citation Format: Sandra P. Perdomo, Paula A. Rodriguez, Jose A. Hakim, Yubelly Avello, David A. Suarez, Alberto Escallón, Vanessa Ospina, Nicolás Useche, Alvaro Muñoz, Margarita Baldion, Mauricio Palau. Epidemiological and clinical description of head and neck cancer cases in Bogotá, Colombia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4193.