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Simple Summary Many individuals with head and neck cancer do not survive, even with intense treatment. Patients with HPV-positive tumors generally have better survival; however, for yet unknown reasons, a subset are unresponsive to therapy. One strategy to monitor cancers for progression and recurrence is evaluation of extracellular vesicles, released by tumor cells into the blood and other body fluids. We can also understand differences in tumors and their behavior by comparing the molecules packaged into vesicles that are released from tumor cells. Our study examined differences in the proteins contained within extracellular vesicles released from head and neck cancer cells. We found that key extracellular vesicle proteins differed based on HPV status of the originating cell line and tumor, as well as how responsive the originating tumor was to treatment. Our findings suggest that these extracellular vesicle proteins may be important markers for continued investigation. Abstract To identify potential extracellular vesicle (EV) biomarkers in head and neck squamous cell carcinoma (HNSCC), we evaluated EV protein cargo and whole cell lysates (WCL) from HPV-positive and -negative HNSCC cell lines, as well as normal oral keratinocytes and HPV16-transformed cells. EVs were isolated from serum-depleted, conditioned cell culture media by polyethylene glycol (PEG) precipitation/ultracentrifugation. EV and WCL preparations were analyzed by LC-MS/MS. Candidate proteins detected at significantly higher levels in EV compared with WCL, or compared with EV from normal oral keratinocytes, were identified and confirmed by Wes Simple Western protein analysis. Our findings suggest that these proteins may be potential HNSCC EV markers as proteins that may be (1) selectively included in EV cargo for export from the cell as a strategy for metastasis, tumor cell survival, or modification of tumor microenvironment, or (2) representative of originating cell composition, which may be developed for diagnostic or prognostic use in clinical liquid biopsy applications. This work demonstrates that our method can be used to reliably detect EV proteins from HNSCC, normal keratinocyte, and transformed cell lines. Furthermore, this work has identified HNSCC EV protein candidates for continued evaluation, specifically tenascin-C, HLA-A, E-cadherin, EGFR, EPHA2, and cytokeratin 19.

Background Validated depression and anxiety symptom screeners are commonly used in clinical settings. How results from different brief depression and anxiety symptom assessment tools compare to each other is not well established, especially in real world healthcare settings. This study aimed to compare the Depression Anxiety Stress Scales 21 Depression scale (DASS-Depression) and Anxiety (DASS-Anxiety) scale to the Patient Health Questionnaire 8 (PHQ-8) and Generalized Anxiety Disorder 7 (GAD-7) respectively, in a real-world virtual behavioral healthcare setting. Methods This was a retrospective comparison study of clinical data from a population of adults who completed a consultation via telephone or secure video with a licensed therapist as part of a standardized, evidence-based, virtual behavioral therapy program for individuals with comorbid medical and behavioral health conditions. The joint distributions and correlations between scores yielded by each depression and anxiety scale were assessed using descriptive and Spearman correlation statistics. Results The DASS-Depression and PHQ-8 were highly correlated (r = .71; p=, Depression, Anxiety, Symptom Assessment, Patient Health Questionnaire, Generalized Anxiety Disorder 7, Depression Anxiety Stress Scales 21.

Background and objectives Human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) is increasing globally. In Taiwan, HPV-positive OPSCC is obscured by tobacco, alcohol, and betel quid use. We investigated the role of high-risk HPV (hrHPV) in a large retrospective Taiwan OPSCC cohort. Methods and results The cohort of 541 OPSCCs treated at Chang Gung Memorial Hospital from 1998–2016 consisted of 507 men (94%) and 34 women (6%). Most used tobacco (81%), alcohol (51%), and betel quid (65%). Formalin-fixed, paraffin-embedded tissue was used for p16 staining (a surrogate marker for HPV) and testing for HPV DNA presence and type by Multiplex HPV PCR-MassArray. HPV DNA and/or p16 staining (HPV-positive) was found in 28.4% (150/528) tumors. p16 and HPV DNA were strongly correlated (F < 0.0001). HPV16 was present in 82.8%, and HPV58 in 7.5% of HPV-positive tumors. HPV was associated with higher age (55.5 vs. 52.7 years, p = 0.004), lower T-stage (p = 0.008) better overall survival (OS) (hazard ratio [HR] 0.58 [95% CI 0.42–0.81], p = 0.001), and disease-free survival (DFS) (HR 0.54 [95% CI 0.40–0.73], p < 0.0001). Alcohol was strongly associated with recurrence and death (OS: HR 2.06 [95% CI 1.54–2.74], p < 0.0001; DFS: HR 1.72 [95% CI 1.33–2.24], p < 0.0001). OS and DFS in HPV-positive cases decreased for alcohol users (p < 0.0001). Obscured by the strong alcohol effect, predictive associations were not found for tobacco or betel quid. Conclusions As with HPV-positive OPSCC globally, HPV is an increasingly important etiological factor in Taiwanese OPSCC. HPV-positive OPSCC has considerable survival benefit, but this is reduced by alcohol, tobacco, and betel quid use. hrHPV is a cancer risk factor in males and females. Vaccinating both sexes with a multivalent vaccine including HPV58, combined with alcohol and tobacco cessation policies will be effective cancer-prevention public health strategies in Taiwan.

Background In North America and Western Europe, human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) has increased dramatically over the past 40 years, whereas HPV-negative OPSCC, typically associated with alcohol and tobacco as etiological factors, has declined. In Taiwan, the OPSCC rate is increasing; however, there is limited understanding of the role of HPV, as tobacco, alcohol, and betel quid use are still very prominent. Here we investigated the involvement of HPV and its prognostic implications for OPSCC in Taiwan. Methods and findings We studied a retrospective cohort of 541 OPSCCs undergoing care between 1998 and 2016 at the Chang Gung Memorial Hospital-Linkou, Taiwan. Clinical and risk exposure data were retrieved from hospital charts. Most cases were males (94%) and had concomitant (87%) exposure to alcohol (51%), tobacco (83%), and betel quid (65%). Formalin-fixed, paraffin-embedded tissue sections were immunostained for p16, a surrogate for active HPV, and DNA was tested for HPV detection and genotyping by Multiplex PCR-MassArray. Tumors with p16 and/or HPV DNA positivity were identified as HPV-positive. HPV status was assigned to 528 tumors. The prevalence of HPV-positive OPSCC was 28.4% (150/528), with a strong correlation between p16 and HPV DNA results (F Among males more tumors were HPV-negative than positive, but among the 34 females more tumors were HPV-positive (62% vs. 38%, p For all patients, HPV-positive OPSCC was associated with higher age at diagnosis (55.5 vs. 52.7 years, p = 0.004), and lower T-stage (p = 0.02). HPV-positivity in OPSCC tumors was an independent predictor of better overall survival (OS) (hazard ratio [HR] 0.57 [95% CI 0.41-0.80], p = 0.0009), and disease-free survival (DFS) (HR 0.53 [95% CI 0.40-0.72], p Conclusions Consistent with the increasing role of HPV on OPSCC globally, HPV is an important etiological factor in more than one-fourth of OPSCC cases from Chang Gung Hospital. Like in Western countries, HPV provides considerable independent survival benefits to OPSCC, but the added prognostic value is reduced by exposure to the risk factors, alcohol, smoking, and betel quid. There is a need to consider HPV as an etiologic factor in treatment and in cancer-prevention policies in Taiwan. AUTHOR SUMMARY Why was this study done? Oropharyngeal squamous cell carcinoma (OPSCC) caused by human papillomavirus (HPV) has been increasing with epidemic proportions in North America and West Europe during the last 40 years. Socioeconomic changes have propelled the advance of this disease, and transformation from the classic etiology of OPSCC, alcohol, and tobacco, to HPV. Contrarily, in Taiwan, OPSCC has been drastically increasing due to persistent heavy consumption of alcohol, smoking, and betel quid chewing, limiting the understanding of HPV contribution to OPSCC. This study investigated the role of HPV in OPSCC in Taiwan. What did the researchers do and find? We conducted a comprehensive retrospective cohort study for 541 OPSCC cases diagnosed between 1998-2016 at the Chang Gung Memorial Hospital-Linkou, Taiwan. We found that OPSCCs mostly occurred in men (94%) and risk factors, including use of alcohol, tobacco, and betel quid was high (87%). Active HPV was present in 28.4% of the cases, 25% of tumors from males and 62% of tumors from females were HPV-positive. HPV16 was the most prevalent genotype (76.9%), followed by HPV58 (7.5%). Most of the HPV-positive OPSCCs originated in the tonsils, and females were less likely to abuse alcohol, tobacco, and betel quid than the males. Furthermore, outcome analysis showed that for the whole cohort, HPV positivity was associated with significantly better OPSCC survival. Alcohol was a strong negative prognostic factor. The robust prognostic benefit of HPV persisted in the presence of all other risk factors. What do these findings mean? HPV is an important emerging etiologic factor of OPSCC in Taiwan, and an independent predictor for better prognosis. The strong association of HPV with OPSCC over a period of 18 years suggests that societal behavioral changes are occurring; and, that there is a potential for benefit from interventions to improve treatment and prevent HPV-positive OPSCC in Taiwan and South-East Asia.

Introduction: Taiwan has a high rate of oropharyngeal squamous cell carcinoma (OPSCC). The etiologic factors are primarily tobacco and alcohol abuse. High-risk human papillomaviruses (hrHPV) have been reported in oral cancers in Taiwan, but their role in oropharyngeal cancer has not been studied. We investigated the possible role of hrHPV in OPSCC Taiwanese patients. Materials and Methods: We identified 546 OPSCC tumors from patients undergoing standard care and informed consent, between 1998 and 2016, at the Chang Gung Memorial Hospital (CGMH) in Taiwan. Formalin-fixed, paraffin-embedded (FFPE) tissue sections from 504 patients were screened by p16 immunostaining, a surrogate marker for active HPV (Ventana antibody, Cat. No. 725-4713, prediluted), and scored for intensity and proportion of positive tumor cells according to the 2018 College of American Pathologists recommendations. Genomic DNA was extracted from FFPE sections (AllPrep Kit, Qiagen) and HPV was detected and genotyped by Multiplex PCR-Mass Array (PCR-MA) analysis designed to detect 15 high-risk, 1 intermediate-risk, and 2 low-risk HPV types. Results: Of the 504 OPSCC tumors tested for p16, 104 (20.6%) were positive, 380 (75.4%) negative, and 20 (4.0%) could not be scored. Spearman nonparametric correlation analysis demonstrated a linear increase in p16 positivity with time from 1998 to 2015 in this Taiwanese population (r= 0.6320, p= 0.003; R2= 0.4901, p= 0.0012). To date, HPV genotyping in 179 Taiwan tumors showed that 38 (21.2%) were hrHPV positive, 120 (67.0%) negative, and 21 (11.7%) had insufficient DNA. Of the 38 HPV-positive tumors, HPV16 alone was found in 31 (81.6%), HPV39 and HPV59 were each found once in separate tumors, and several tumors had two HPV types present: HPV16 and HPV18 were present together in 2 tumors, and each of the following pairs were found in one tumor each: HPV16 with HPV35, HPV16 with HPV59, and HPV16 with HPV6. Of the tumors tested by both p16 and PCR-MA, there was 97% concordance between the results (130/134). Conclusion: Our preliminary findings indicate that the proportion of hrHPV positive OPSCC tumors in this Taiwanese population is increasing over the period from 1998 to 2015 in Taiwan. The concordance of p16 and HPV DNA is very high (p Citation Format: Guadalupe Lorenzatti Hiles, Chun-I Wang, Lisa M. Pinatti, Christine M. Goudsmit, Lila Peters, Hannah L. Briggs, Trey B. Thomas, Mohammed Charara, Reem A. Khatib, Macy A. Afsari, Anna C. Morris, Nadine Jawad, Devraj Som, Kai-Ping Chang, Thomas E. Carey, Heather M. Walline. High-risk human papillomavirus association with oropharyngeal squamous cell carcinoma in Taiwan [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B07.