Association of Estrogen Receptor Alpha Expression With Survival in Oropharyngeal Cancer Following Chemoradiation Therapy

Maria B. Koenigs, Armida Lefranc-Torres, Juliana Bonilla-Velez, Krupal B. Patel, D. Neil Hayes, Krzysztof Glomski, Paul M. Busse, Annie W. Chan, John R. Clark, Daniel G. Deschler, Kevin S. Emerick, Rebecca Hammon, Lori J. Wirth, Derrick T. Lin, Edmund A. Mroz, William C. Faquin, James W. Rocco

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Oropharyngeal squamous carcinoma (OPSC) continues to increase in incidence secondary to human papillomavirus (HPV) infection. Despite the good overall prognosis for these patients, treatment with chemoradiation is associated with morbidity and treatment failure. Better predictors for disease outcome are needed to guide de-intensification regimens. We hypothesized that estrogen receptor α (ERα), a prognostic biomarker in oncology with therapeutic implications, might have similar utility in OPSC. METHODS: To investigate associations among ERα and demographics, HPV status, and survival, we analyzed ERα mRNA expression of head and neck squamous carcinomas (HNSC) from The Cancer Genome Atlas (TCGA) and immunohistochemistry (IHC) of pretreatment biopsy specimens from an independent group of 215 OPSC patients subsequently treated with primary chemoradiation (OPSC-CR). Associations among variables were evaluated with Fisher exact tests and logistic regression; associations with survival were evaluated with log-rank tests and Cox proportional hazards regression. RESULTS: Among 515 patients in TCGA, ERα mRNA expression was highest in HPV-positive OPSC. High ERα mRNA expression was associated with improved survival among those receiving chemoradiation (hazard ratio adjusted for HPV status = 0.44, 95% confidence interval = 0.21 to 0.92). In OPSC-CR, ERα was positive by IHC in 51.6% of tumors and was associated with improved overall, disease-specific, progression-free, and relapse-free survival (log-rank tests: P < .001, P < .001, P = .002, P = .003, respectively); statistically significant associations of ERα positivity with improved survival were maintained after adjusting for clinical risk factors including HPV status. CONCLUSION: In two independent cohorts, ERα is a potential biomarker for improved survival that also may represent a therapeutic target in OPSC.

Original languageEnglish (US)
Pages (from-to)933-942
Number of pages10
JournalJournal of the National Cancer Institute
Volume111
Issue number9
DOIs
StatePublished - Sep 1 2019

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Oropharyngeal Neoplasms
Estrogen Receptor alpha
Estrogen Receptors
Squamous Cell Carcinoma
Survival
Atlases
Therapeutics
Messenger RNA
Biomarkers
Immunohistochemistry
Genome
Neoplasms
Papillomavirus Infections
Treatment Failure
Disease Progression
Neck
Logistic Models
Head
Demography
Confidence Intervals

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Koenigs, M. B., Lefranc-Torres, A., Bonilla-Velez, J., Patel, K. B., Hayes, D. N., Glomski, K., ... Rocco, J. W. (2019). Association of Estrogen Receptor Alpha Expression With Survival in Oropharyngeal Cancer Following Chemoradiation Therapy. Journal of the National Cancer Institute, 111(9), 933-942. https://doi.org/10.1093/jnci/djy224

Association of Estrogen Receptor Alpha Expression With Survival in Oropharyngeal Cancer Following Chemoradiation Therapy. / Koenigs, Maria B.; Lefranc-Torres, Armida; Bonilla-Velez, Juliana; Patel, Krupal B.; Hayes, D. Neil; Glomski, Krzysztof; Busse, Paul M.; Chan, Annie W.; Clark, John R.; Deschler, Daniel G.; Emerick, Kevin S.; Hammon, Rebecca; Wirth, Lori J.; Lin, Derrick T.; Mroz, Edmund A.; Faquin, William C.; Rocco, James W.

In: Journal of the National Cancer Institute, Vol. 111, No. 9, 01.09.2019, p. 933-942.

Research output: Contribution to journalArticle

Koenigs, MB, Lefranc-Torres, A, Bonilla-Velez, J, Patel, KB, Hayes, DN, Glomski, K, Busse, PM, Chan, AW, Clark, JR, Deschler, DG, Emerick, KS, Hammon, R, Wirth, LJ, Lin, DT, Mroz, EA, Faquin, WC & Rocco, JW 2019, 'Association of Estrogen Receptor Alpha Expression With Survival in Oropharyngeal Cancer Following Chemoradiation Therapy', Journal of the National Cancer Institute, vol. 111, no. 9, pp. 933-942. https://doi.org/10.1093/jnci/djy224
Koenigs, Maria B. ; Lefranc-Torres, Armida ; Bonilla-Velez, Juliana ; Patel, Krupal B. ; Hayes, D. Neil ; Glomski, Krzysztof ; Busse, Paul M. ; Chan, Annie W. ; Clark, John R. ; Deschler, Daniel G. ; Emerick, Kevin S. ; Hammon, Rebecca ; Wirth, Lori J. ; Lin, Derrick T. ; Mroz, Edmund A. ; Faquin, William C. ; Rocco, James W. / Association of Estrogen Receptor Alpha Expression With Survival in Oropharyngeal Cancer Following Chemoradiation Therapy. In: Journal of the National Cancer Institute. 2019 ; Vol. 111, No. 9. pp. 933-942.
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abstract = "BACKGROUND: Oropharyngeal squamous carcinoma (OPSC) continues to increase in incidence secondary to human papillomavirus (HPV) infection. Despite the good overall prognosis for these patients, treatment with chemoradiation is associated with morbidity and treatment failure. Better predictors for disease outcome are needed to guide de-intensification regimens. We hypothesized that estrogen receptor α (ERα), a prognostic biomarker in oncology with therapeutic implications, might have similar utility in OPSC. METHODS: To investigate associations among ERα and demographics, HPV status, and survival, we analyzed ERα mRNA expression of head and neck squamous carcinomas (HNSC) from The Cancer Genome Atlas (TCGA) and immunohistochemistry (IHC) of pretreatment biopsy specimens from an independent group of 215 OPSC patients subsequently treated with primary chemoradiation (OPSC-CR). Associations among variables were evaluated with Fisher exact tests and logistic regression; associations with survival were evaluated with log-rank tests and Cox proportional hazards regression. RESULTS: Among 515 patients in TCGA, ERα mRNA expression was highest in HPV-positive OPSC. High ERα mRNA expression was associated with improved survival among those receiving chemoradiation (hazard ratio adjusted for HPV status = 0.44, 95{\%} confidence interval = 0.21 to 0.92). In OPSC-CR, ERα was positive by IHC in 51.6{\%} of tumors and was associated with improved overall, disease-specific, progression-free, and relapse-free survival (log-rank tests: P < .001, P < .001, P = .002, P = .003, respectively); statistically significant associations of ERα positivity with improved survival were maintained after adjusting for clinical risk factors including HPV status. CONCLUSION: In two independent cohorts, ERα is a potential biomarker for improved survival that also may represent a therapeutic target in OPSC.",
author = "Koenigs, {Maria B.} and Armida Lefranc-Torres and Juliana Bonilla-Velez and Patel, {Krupal B.} and Hayes, {D. Neil} and Krzysztof Glomski and Busse, {Paul M.} and Chan, {Annie W.} and Clark, {John R.} and Deschler, {Daniel G.} and Emerick, {Kevin S.} and Rebecca Hammon and Wirth, {Lori J.} and Lin, {Derrick T.} and Mroz, {Edmund A.} and Faquin, {William C.} and Rocco, {James W.}",
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T1 - Association of Estrogen Receptor Alpha Expression With Survival in Oropharyngeal Cancer Following Chemoradiation Therapy

AU - Koenigs, Maria B.

AU - Lefranc-Torres, Armida

AU - Bonilla-Velez, Juliana

AU - Patel, Krupal B.

AU - Hayes, D. Neil

AU - Glomski, Krzysztof

AU - Busse, Paul M.

AU - Chan, Annie W.

AU - Clark, John R.

AU - Deschler, Daniel G.

AU - Emerick, Kevin S.

AU - Hammon, Rebecca

AU - Wirth, Lori J.

AU - Lin, Derrick T.

AU - Mroz, Edmund A.

AU - Faquin, William C.

AU - Rocco, James W.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - BACKGROUND: Oropharyngeal squamous carcinoma (OPSC) continues to increase in incidence secondary to human papillomavirus (HPV) infection. Despite the good overall prognosis for these patients, treatment with chemoradiation is associated with morbidity and treatment failure. Better predictors for disease outcome are needed to guide de-intensification regimens. We hypothesized that estrogen receptor α (ERα), a prognostic biomarker in oncology with therapeutic implications, might have similar utility in OPSC. METHODS: To investigate associations among ERα and demographics, HPV status, and survival, we analyzed ERα mRNA expression of head and neck squamous carcinomas (HNSC) from The Cancer Genome Atlas (TCGA) and immunohistochemistry (IHC) of pretreatment biopsy specimens from an independent group of 215 OPSC patients subsequently treated with primary chemoradiation (OPSC-CR). Associations among variables were evaluated with Fisher exact tests and logistic regression; associations with survival were evaluated with log-rank tests and Cox proportional hazards regression. RESULTS: Among 515 patients in TCGA, ERα mRNA expression was highest in HPV-positive OPSC. High ERα mRNA expression was associated with improved survival among those receiving chemoradiation (hazard ratio adjusted for HPV status = 0.44, 95% confidence interval = 0.21 to 0.92). In OPSC-CR, ERα was positive by IHC in 51.6% of tumors and was associated with improved overall, disease-specific, progression-free, and relapse-free survival (log-rank tests: P < .001, P < .001, P = .002, P = .003, respectively); statistically significant associations of ERα positivity with improved survival were maintained after adjusting for clinical risk factors including HPV status. CONCLUSION: In two independent cohorts, ERα is a potential biomarker for improved survival that also may represent a therapeutic target in OPSC.

AB - BACKGROUND: Oropharyngeal squamous carcinoma (OPSC) continues to increase in incidence secondary to human papillomavirus (HPV) infection. Despite the good overall prognosis for these patients, treatment with chemoradiation is associated with morbidity and treatment failure. Better predictors for disease outcome are needed to guide de-intensification regimens. We hypothesized that estrogen receptor α (ERα), a prognostic biomarker in oncology with therapeutic implications, might have similar utility in OPSC. METHODS: To investigate associations among ERα and demographics, HPV status, and survival, we analyzed ERα mRNA expression of head and neck squamous carcinomas (HNSC) from The Cancer Genome Atlas (TCGA) and immunohistochemistry (IHC) of pretreatment biopsy specimens from an independent group of 215 OPSC patients subsequently treated with primary chemoradiation (OPSC-CR). Associations among variables were evaluated with Fisher exact tests and logistic regression; associations with survival were evaluated with log-rank tests and Cox proportional hazards regression. RESULTS: Among 515 patients in TCGA, ERα mRNA expression was highest in HPV-positive OPSC. High ERα mRNA expression was associated with improved survival among those receiving chemoradiation (hazard ratio adjusted for HPV status = 0.44, 95% confidence interval = 0.21 to 0.92). In OPSC-CR, ERα was positive by IHC in 51.6% of tumors and was associated with improved overall, disease-specific, progression-free, and relapse-free survival (log-rank tests: P < .001, P < .001, P = .002, P = .003, respectively); statistically significant associations of ERα positivity with improved survival were maintained after adjusting for clinical risk factors including HPV status. CONCLUSION: In two independent cohorts, ERα is a potential biomarker for improved survival that also may represent a therapeutic target in OPSC.

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