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Ye Z, Tan G, Wang L, Shangguan G, Yao H, Xu X, Ye H, Ding X. Comparison of survival between palliative surgery and no surgery for advanced tongue squamous cell carcinoma: an analysis of SEER data. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00212-1. [PMID: 39025738 DOI: 10.1016/j.ijom.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 06/20/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
The aim of this study was to investigate the survival effect of palliative surgery in advanced tongue squamous cell carcinoma (TSCC). A retrospective analysis of data in the SEER database for 6151 patients with stage III/IV TSCC (American Joint Committee on Cancer (AJCC) staging), diagnosed between 2004 and 2015, was performed. The patients were divided into two groups: palliative surgery and no surgery. Kaplan-Meier and Cox proportional hazards regression analyses were applied to determine risk factors for overall survival (OS) and cancer-specific survival (CSS). A further analysis was performed using 1:1 propensity score matching (PSM) to balance 13 patient variables (sex, age at diagnosis, race, marital status, primary tumour site, SEER stage, AJCC stage, pathological differentiation grade, tumour size, lymph node metastasis, previous lymph node removal, radiotherapy, and chemotherapy). Among the 6151 patients, 706 underwent palliative surgery; the other 5445 did not undergo any kind of surgery. Those who underwent palliative surgery had a higher 5-year survival rate. After PSM, 1274 patients were included in the matched cohort. Multivariate Cox regression analysis showed that patients who underwent palliative surgery had a lower risk of death than those who did not (OS: hazard ratio 0.58, 95% confidence interval 0.49-0.69, P < 0.001; CSS: hazard ratio 0.60, 95% confidence interval 0.49-0.74, P < 0.001). In this comparative study it was found that compared with no surgery, palliative surgery has a positive impact on the survival rate of patients with advanced TSCC.
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Affiliation(s)
- Z Ye
- Department of Maxillofacial Surgery, The People's Hospital of Pingyang (Pingyang Hospital of Wenzhou Medical University), Wenzhou, Zhejiang, PR China
| | - G Tan
- Advanced Neuroimaging Laboratory, Department of Radiology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong, China
| | - L Wang
- School and Hospital of Stomatology, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine and Optional Institutions, Guangzhou Medical University, Guangzhou, Guangdong, PR China
| | - G Shangguan
- Department of Maxillofacial Surgery, The People's Hospital of Pingyang (Pingyang Hospital of Wenzhou Medical University), Wenzhou, Zhejiang, PR China
| | - H Yao
- Department of Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - X Xu
- Department of Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - H Ye
- Institute of Digitized Medicine and Intelligent Technology, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - X Ding
- Department of Maxillofacial Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China.
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Struckmeier AK, Buchbender M, Lutz R, Kesting M. Improved recurrence rates and progression-free survival in primarily surgically treated oral squamous cell carcinoma - results from a German tertiary medical center. Clin Oral Investig 2024; 28:262. [PMID: 38642146 PMCID: PMC11032275 DOI: 10.1007/s00784-024-05644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/01/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES This study aimed to explore survival and recurrence patterns in patients undergoing primarily surgical treatment for oral squamous cell carcinoma (OSCC) at a high-volume tertiary medical center in Germany. MATERIALS AND METHODS The study included 421 patients with primary OSCC who underwent radical tumor resection, neck dissection, and reconstruction with a free flap. Prognostic relevance of clinicopathological characteristics was assessed using Cox proportional-hazards models. Kaplan-Meier method estimated local recurrence-free survival, progression-free survival (PFS), and overall survival (OS), while the log-rank test compared survival outcomes between groups. RESULTS Recurrence manifested in 16.63% of the patients (70 patients), encompassing local recurrence in 54 patients (77.14%) and distant metastasis in 24 patients (34.28%). Neck recurrence occurred in only 1 patient (0.24%) on the contralateral side. The majority of recurrences occurred within the initial twelve months following primary tumor surgery (64.29%). Overall, the 5-year OS stood at 58.29%, while the 5-year PFS reached 72.53%. Patients with early recurrence within ≤ 12 months showed the least favorable prognosis (log-rank, all p < 0.001). CONCLUSIONS Our findings show a significant decrease in recurrence rates and enhanced PFS at a high-volume tertiary medical center in Germany compared to previous studies. Local recurrence was the primary form observed, with most recurrences happening within the initial twelve months post-surgery. Opting for treatment at a high-volume center and devising therapy plans in interdisciplinary tumor boards may not only enhance OS but also contribute to improved PFS. CLINICAL RELEVANCE These findings offer valuable insights for physicians regarding the post-treatment care of patients with OSCC. The results underscore the importance of frequent follow-up appointments, particularly during the initial year, and highlight the critical need for vigilance in monitoring for local recurrence.
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Affiliation(s)
- Ann-Kristin Struckmeier
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Glückstraße 11, 91054, Erlangen, Germany.
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER- EMN), Erlangen, Germany.
| | - Mayte Buchbender
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Glückstraße 11, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER- EMN), Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Glückstraße 11, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER- EMN), Erlangen, Germany
| | - Marco Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Glückstraße 11, 91054, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER- EMN), Erlangen, Germany
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Eltohami Y, Suleiman A. Survival analysis of Sudanese oral squamous cell carcinoma patients with field of cancerization. BMC Cancer 2024; 24:473. [PMID: 38622532 PMCID: PMC11017610 DOI: 10.1186/s12885-024-12197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The late presentation and diagnosis of OSCC account for the large number of patients with the advanced form of the disease. In Sudan, cases with delayed presentation, particularly those with risk factors such as Toombak dipping and alcohol consumption, frequently present with extensive lesions and a wide area of Field cancerization which characterized by the presence of genetic and epigenetic changes in histologically normal-appearing tissues, and have increased risk for recurrent and second primary tumors. This necessitates more aggressive treatment and is usually associated with poorer outcomes. The present study aims to investigate the survival of oral squamous cell carcinoma patients with a wide field of cancerization. METHODS This prospective longitudinal study includes ninety-three oral cancer patients with extensive fields of cancerization who underwent surgical treatment at Khartoum Teaching Dental Hospital (KTDH) conducted from 2019 to 2023. These patients were regularly assessed for clinical changes such as recurrence, the development of second primary tumours, and overall survival over a period of one year. RESULTS Out of the 93 patients, 57 (61.3%) were males, and 36 (38.7%) were females. The majority of the patients (82%) had stage IV tumours, and 62.3% had nodal metastasis. Twenty-eight (30%) patients developed recurrences, and 14 (15%) developed second primary tumours. The overall one-year survival rate was 89%, and all deceased patients passed away within 12 months. The survival rate for patients with different types of recurrences varied, with patients who had regional, local, and locoregional recurrences having survival rates of 87%, 74%, and 72%, respectively. Patients who did not experience a recurrence had a one-year survival rate of 92%. Patients who developed second primary tumours had an 86% survival rate. The survival rates for OSCC patients at stages III, IVa, and IVb were 90%, 90%, and 71%, respectively. CONCLUSION In this study, 62% of patients had nodal metastasis, 30% developed recurrence, and 15% developed second primary tumours. The overall one-year survival rate was 89%, although the development of recurrences and second primary tumours had a negative impact on the survival rate.
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Affiliation(s)
- Yousif Eltohami
- Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan.
| | - Ahmed Suleiman
- Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
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Chang YM, Lee CC. Stromal categorization of recurrent oral cancer after salvage surgery is associated with survival rates. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108009. [PMID: 38342040 DOI: 10.1016/j.ejso.2024.108009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/28/2023] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Recurrent oral cancer incurred grave outcome. Tumor microenvironment features, like tumor-infiltrating lymphocytes (TILs) or tumor stromal ratio (TSR) had prognostic significance in various cancers. We aimed to evaluate the impact of stromal categorization which incorporated the stromal TILs and TSR on survival outcomes in recurrent oral cancer. METHODS 162 patients who received surgery-based treatment between 2010 and 2020 were recruited. Outcomes were 5-year overall survival (OS) and disease-specific survival (DSS). The impact of stromal categorization of recurrent primary tumor or node on 5-year OS and DSS were assessed with the Kaplan-Meier method. Multivariate analysis was performed, incorporating variables at initial treatment and salvage surgery. Patients were further categorized using a survival decision tree. RESULTS Mean age was 56.1 (SD, 11.3) years; 153 patients (94.4%) were male; 51 patients (31.5%) had stromal category III. Local recurrence occurred in 94 patients (58%), regional recurrence in 55 (34%), and loco-regional recurrence in 13 (8%). Patients with stromal category III had poorer 5-year OS and DSS. Prior radiotherapy, advanced recurrent stage, positive surgical margin, and stromal category III were independent prognosticators for 5-year OS and DSS. In survival decision tree analysis, patients with prior radiotherapy and stromal category III had the worst outcomes. CONCLUSION Stromal categorization is associated with outcomes in recurrent oral cancer. Patients with poor prognosticators, such as stromal categorization III, prior radiation, and advanced stage may require closer follow-up and intensive treatment.
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Affiliation(s)
- Yi-Ming Chang
- Department of Pathology and Laboratory, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pathology, Tri-service General Hospital and the Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chao Tung University, Taipei, Taiwan.
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Caprioli S, Giordano GG, Pennacchi A, Campagnari V, Iandelli A, Parrinello G, Conforti C, Gili R, Giannini E, Marabotto E, Kayali S, Bianchi B, Peretti G, Cittadini G, Marchi F. Can High-Frequency Intraoral Ultrasound Predict Histological Risk Factors in Oral Squamous Cell Carcinoma? A Preliminary Experience. Cancers (Basel) 2023; 15:4413. [PMID: 37686688 PMCID: PMC10486952 DOI: 10.3390/cancers15174413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Despite advancements in multidisciplinary care, oncologic outcomes of oral cavity squamous cell carcinoma (OSCC) have not substantially improved: still, one-third of patients affected by stage I and II can develop locoregional recurrences. Imaging plays a pivotal role in preoperative staging of OSCC, providing depth of invasion (DOI) measurements. However, locoregional recurrences have a strong association with adverse histopathological factors not included in the staging system, and any imaging features linked to them have been lacking. In this study, the possibility to predict histological risk factors in OSCC with high-frequency intraoral ultrasonography (IOUS) was evaluated. Thirty-four patients were enrolled. The agreement between ultrasonographic and pathological DOI was evaluated, and ultrasonographic margins' appearance was compared to the Brandwein-Gensler score and the worst pattern of invasion (WPOI). Excellent agreement between ultrasonographic and pathological DOI was found (mean difference: 0.2 mm). A significant relationship was found between ultrasonographic morphology of the front of infiltration and both Brandwein-Gensler score ≥ 3 (p < 0.0001) and WPOI ≥4 (p = 0.0001). Sensitivity, specificity, positive predictive value, and negative predictive value for the IOUS to predict a Brandwein-Gensler score ≥3 were 93.33%, 89.47%, 87.50%, and 94.44%, respectively. The present study demonstrated the promising role of IOUS in aiding risk stratification for OSCC patients.
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Affiliation(s)
- Simone Caprioli
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
| | - Giorgio-Gregory Giordano
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Alessia Pennacchi
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Valentina Campagnari
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Andrea Iandelli
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Giampiero Parrinello
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Cristina Conforti
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
| | - Riccardo Gili
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Medical Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Edoardo Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
| | - Stefano Kayali
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Bernardo Bianchi
- Maxillo-Facial Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Giorgio Peretti
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Giuseppe Cittadini
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
| | - Filippo Marchi
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
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The Role of Peritumoral Depapillation and Its Impact on Narrow-Band Imaging in Oral Tongue Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:cancers15041196. [PMID: 36831538 PMCID: PMC9954546 DOI: 10.3390/cancers15041196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
A recent study reported that the occurrence of depapillated mucosa surrounding oral tongue squamous cell carcinomas (OTSCC) is associated with perineural invasion (PNI). The present study evaluates the reliability of depapillation as a PNI predictor and how it could affect narrow-band imaging (NBI) performance. This is thus a retrospective study on patients affected by OTSCC submitted to radical surgery. The preoperative endoscopy was evaluated to identify the presence of depapillation. Differences in distribution between depapillation and clinicopathological variables were analyzed. NBI vascular patterns were reported, and the impact of depapillation on those was studied. We enrolled seventy-six patients. After evaluation of the preoperative endoscopies, 40 (53%) patients had peritumoral depapillation, while 59 (78%) had a positive NBI pattern. Depapillation was strongly correlated to PNI, 54% vs. 28% (p = 0.022). Regarding the NBI pattern, there was no particular association with depapillation-associated tumors. The presence of depapillation did not affect the intralesional pattern detected by the NBI, while no NBI-positive pattern was found in the depapillation area. Finally, the NBI-guided resection margins were not affected by depapillation. Peritumoral depapillation is a reliable feature for PNI in OTSCC. NBI margin detection is not impaired by depapillation.
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Tsai CY, Wen YW, Lee SR, Ng SH, Kang CJ, Lee LY, Hsueh C, Lin CY, Fan KH, Wang HM, Hsieh CH, Yeh CH, Lin CH, Tsao CK, Fang TJ, Huang SF, Lee LA, Fang KH, Wang YC, Lin WN, Hsin LJ, Yen TC, Cheng NM, Liao CT. Early relapse is an adverse prognostic factor for survival outcomes in patients with oral cavity squamous cell carcinoma: results from a nationwide registry study. BMC Cancer 2023; 23:126. [PMID: 36750965 PMCID: PMC9906940 DOI: 10.1186/s12885-023-10602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The prognostic significance of the relapse interval in patients with resected oral cavity squamous cell carcinoma (OCSCC) is a matter of ongoing debate. In this large-scale, registry-based, nationwide study, we examined whether the time interval between surgery and the first disease relapse may affect survival outcomes in Taiwanese patients with OCSCC. METHODS Data made available by the Taiwan Health Promotion Administration as of 2004 were obtained. The study cohort consisted of patients who were included in the registry between 2011 and 2017. Disease staging was performed according to the American Joint Committee on Cancer (AJCC) Staging Manual, Eight Edition. We retrospectively reviewed the clinical records of 13,789 patients with OCSCC who received surgical treatment. A total of 2327 (16.9%) patients experienced a first disease relapse. The optimal cutoff value for the relapse interval was 330 days when both 5-year disease-specific survival (DSS) and overall survival (OS) (≤ 330/>330 days, n = 1630/697) were taken into account. In addition, we undertook a propensity score (PS)-matched analysis of patients (n = 654 each) with early (≤ 330 days) versus late (> 330 days) relapse. RESULTS The median follow-up time in the entire study cohort was 702 days (433 and 2001 days in the early and late relapse groups, respectively). Compared with patients who experienced late relapse, those with early relapse showed a higher prevalence of the following adverse prognostic factors: pT4, pN3, pStage IV, poor differentiation, depth of invasion ≥ 10 mm, and extra-nodal extension. Multivariable analysis revealed that early relapse was an independent adverse prognostic factor for both 5-year DSS and OS (average hazard ratios [AHRs]: 3.24 and 3.91, respectively). In the PS-matched cohort, patients who experienced early relapse showed less favorable 5-year DSS: 58% versus 30%, p < 0.0001 (AHR: 3.10 [2.69 - 3.57]) and OS: 49% versus 22%, p < 0.0001 (AHR: 3.32 [2.89 - 3.81]). CONCLUSION After adjustment for potential confounders and PS matching, early relapse was an adverse prognostic factor for survival outcomes in patients with OCSCC. Our findings may have significant implications for risk stratification.
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Affiliation(s)
- Chi-Ying Tsai
- grid.145695.a0000 0004 1798 0922Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yu-Wen Wen
- grid.145695.a0000 0004 1798 0922Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan, ROC ,grid.413801.f0000 0001 0711 0593Division of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Shu-Ru Lee
- grid.145695.a0000 0004 1798 0922Research Service Center for Health Information, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shu-Hang Ng
- grid.145695.a0000 0004 1798 0922Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chung-Jan Kang
- grid.145695.a0000 0004 1798 0922Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Yu Lee
- grid.145695.a0000 0004 1798 0922Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chuen Hsueh
- grid.145695.a0000 0004 1798 0922Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chien-Yu Lin
- grid.145695.a0000 0004 1798 0922Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kang-Hsing Fan
- grid.145695.a0000 0004 1798 0922Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hung-Ming Wang
- grid.145695.a0000 0004 1798 0922Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chia-Hsun Hsieh
- grid.145695.a0000 0004 1798 0922Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Hua Yeh
- grid.145695.a0000 0004 1798 0922Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Hung Lin
- grid.413801.f0000 0001 0711 0593Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chung-Kan Tsao
- grid.413801.f0000 0001 0711 0593Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tuan-Jen Fang
- grid.145695.a0000 0004 1798 0922Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shiang-Fu Huang
- grid.145695.a0000 0004 1798 0922Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Ang Lee
- grid.145695.a0000 0004 1798 0922Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ku-Hao Fang
- grid.145695.a0000 0004 1798 0922Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yu-Chien Wang
- grid.145695.a0000 0004 1798 0922Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Wan-Ni Lin
- grid.145695.a0000 0004 1798 0922Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Jen Hsin
- grid.145695.a0000 0004 1798 0922Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tzu-Chen Yen
- grid.145695.a0000 0004 1798 0922Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Nai-Ming Cheng
- grid.145695.a0000 0004 1798 0922Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC. .,Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, at Linkou, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan.
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Outcomes for recurrent oral cavity squamous cell carcinoma. Oral Oncol 2022; 134:106127. [PMID: 36155359 DOI: 10.1016/j.oraloncology.2022.106127] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We sought to determine overall survival (OS), prognostic factors, cost, and functional outcomes after surgery for locally recurrent oral cavity squamous cell carcinoma (OCSCC). MATERIALS AND METHODS We retrospectively reviewed 399 cases of locally recurrent OCSCC from 1997 to 2011, of which 259 patients were treated with salvage surgery. Survival and prognostic factors were evaluated using univariable and multivariable Cox regression, the Kaplan-Meier method, and the log-rank test. RESULTS The 5-year OS for patients undergoing surgical salvage, nonsurgical therapy, or supportive care was 44.2%, 1.5%, and 0%, respectively. For patients who underwent surgical salvage, 133 (51%) patients experienced a second recurrence at a median of 17 months. Factors associated with OS included disease-free interval ≤ 6 months (P =.0001), recurrent stage III-IV disease (P <.0001), and prior radiation (P =.0001). Patients with both advanced stage and prior radiation had a 23% 5-year OS, compared with 70% for those with neither risk (P <.001). Functionally, 85% of patients had > 80% speech intelligibility and 81% were able to eat by mouth following salvage surgery. Of the patients who required tracheostomy, 78% were decannulated. The adjusted median hospital and professional charges for patients were $129,696 (range $9,238-$956,818). CONCLUSIONS Patients with recurrent OCSCC who underwent salvage surgery have favorable functional outcomes with half of alive at 5 years but poorer OS for advanced disease, disease-free interval ≤ 6 months, and prior radiation. Additionally, treatment is associated with high cost, and about half of patients ultimately develop another recurrence.
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Hasegawa T, Kobayashi E, Amano R, Saito I, Takeda D, Kakei Y, Kimoto A, Sakakibara A, Akashi M. Time to Recurrence Associated With Poor Prognosis in Japanese Oral Squamous Cell Carcinoma Patients. J Maxillofac Oral Surg 2022; 21:856-864. [PMID: 36274898 PMCID: PMC9474988 DOI: 10.1007/s12663-021-01527-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/03/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Recurrence in oral squamous cell carcinoma (OSCC) is not rare. Due to lack of studies assessing characteristics of recurrent OSCC, including time to recurrence and outcomes, we sought to investigate its characteristics, time to recurrence, and outcomes in Japanese OSCC patients. Methods This study was a nonrandomized retrospective cohort study in a tertiary referral centre. It included 208 (117 men and 91 women) patients with recurrent oral cancer who underwent major curative surgery in the Department of Oral and Maxillofacial Surgery at Kobe University Hospital between January 1999 and April 2017. The outcomes were disease-specific survival (DSS) and overall survival (OS). Results In multivariable Cox proportional hazards analysis, the time to recurrence (hazard ratio [HR] 3.55, 95% confidence interval [CI] 1.69-6.63; P = 0.001), extranodal extension (ENE, HR 2.72, 95% CI 1.51-4.89; P = 0.001), and high T stage (HR 2.00, 95% CI 1.01-3.97; P = 0.046) were independent predictors of DSS. The time to recurrence (HR 3.29, 95% CI 1.82-5.96; P < 0.001) and ENE (HR 2.64, 95% CI 1.52-4.56; P = 0.001) were independent predictors of OS. Conclusion Time to recurrence, extranodal extension, and higher T stage were independent prognosis predictors in OSCC.
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Affiliation(s)
- Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Erina Kobayashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Rika Amano
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Izumi Saito
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Yasumasa Kakei
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Akira Kimoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Akiko Sakakibara
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
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10
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Lu HJ, Peng CY, Tseng HC, Hsin CH, Chuang CY, Chen CC, Huang WS, Chiu YW, Yang SF. Preoperative prediction model to evaluate salvage surgery in patients with recurrent or second primary oral cavity squamous cell carcinoma. Oral Oncol 2022; 131:105951. [PMID: 35728414 DOI: 10.1016/j.oraloncology.2022.105951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/17/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In approximately 50% of patients with oral cavity squamous cell carcinoma (OCSCC), the disease progresses after curative surgery. However, the role of salvage surgery (SS) is controversial, and life expectancy after SS is unknown. METHODS In this study, 262 patients with OCSCC with locoregional recurrence and second primary OCSCC were retrospectively enrolled and divided into a resectable (55.0%, 144/262) and unresectable (45.0%, 118/262) groups. After excluding neck recurrence only, SS had been performed 195 times in the resectable group. The corresponding preoperative clinicopathologic factors and postsurgery survival (PSS) of each SS were pooled for analysis. RESULTS Median survival after disease progression was 64.2 and 10.4 months for the resectable and unresectable groups, respectively. In the resectable group, one-fifth (19.5%, 37/190) of the patients died within 1 year of SS (PSS < 1 year), and one-third (32.8%, 64/195) of the patients had undergone SS two or more times. The interval from the last surgery ≤ 12 months, depth of invasion of the last surgery > 1 cm, and clinical evidence of nodal disease at the preoperative evaluation were independent predictors of poor PSS. A scoring prediction model was established with 1 point for each factor. The results revealed 1-year postsurgery death rates of 10.3% in the low-risk group (score: 0-1) and 48.6% in the high-risk group (score: 2 or 3) (P < 0.001). CONCLUSIONS In conclusion, an effective scoring model predicting life expectancy after SS for patients with OCSCC was established.
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Affiliation(s)
- Hsueh-Ju Lu
- Division of Hematology and Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chih-Yu Peng
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan; College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsien-Chun Tseng
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Han Hsin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Yi Chuang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Chia Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Plastic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wei-Shiou Huang
- Division of Hematology and Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Wei Chiu
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung, Taiwan; College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.
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11
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Jin Y, Wang Z, Tang W, Liao M, Wu X, Wang H. An Integrated Analysis of Prognostic Signature and Immune Microenvironment in Tongue Squamous Cell Carcinoma. Front Oncol 2022; 12:891716. [PMID: 35912229 PMCID: PMC9326056 DOI: 10.3389/fonc.2022.891716] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022] Open
Abstract
Tongue squamous cell carcinoma (TSCC) is a prevalent cancer of the oral cavity. Survival metrics are usually unsatisfactory, even using combined treatment with surgery, radiation, and chemotherapy. Immune checkpoint inhibitors can prolong survival, especially in patients with recurrent or metastatic disease. However, there are few effective biomarkers to provide prognosis and guide immunotherapy. Here, we utilized weighted gene co-expression network analysis to identify the co-expression module and selected the turquoise module for further scrutiny. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses revealed the innate pathways. The findings indicated that cell junction organization, response to topologically incorrect protein, and regulation of cell adhesion pathways may be essential. Eleven crucial predictive genes (PLXNB1, N4BP3, KDELR2, INTS8, PLAU, PPFIBP2, OAF, LMF1, IL34, ZFP3, and MAP7D3) were used to establish a risk model based on Cox and LASSO analyses of The Cancer Genome Atlas and GSE65858 databases (regarding overall survival). Kaplan–Meier analysis and receiver operating characteristic curve suggested that the risk model had better prognostic effectiveness than other clinical traits. Consensus clustering was used to classify TSCC samples into two groups with significantly different survival rates. ESTIMATE and CIBERSORT were used to display the immune landscape of TSCC and indicate the stromal score; specific types of immune cells, including naïve B cells, plasma cells, CD8 T cells, CD4 memory resting and memory activated T cells, follicular helper T cells, and T regulatory cells, may influence the heterogeneous immune microenvironment in TSCC. To further identify hub genes, we downloaded GEO datasets (GSE41613 and GSE31056) and successfully validated the risk model. Two hub genes (PLAU and PPFIBP2) were strongly associated with CD4+ and CD8+ T cells and programmed cell death protein 1 (PD1) and PD-ligand 1.
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Affiliation(s)
- Yi Jin
- Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Key Laboratory of Translational Radiation Oncology, Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhanwang Wang
- Department of Oncology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Weizhi Tang
- Key Laboratory of Translational Radiation Oncology, Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Department of Oncology, Hunan Academy of Chinese Medicine Affiliated Hospital, Changsha, China
| | - Muxing Liao
- Key Laboratory of Translational Radiation Oncology, Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Department of Oncology, Youxian People’s Hospital, Zhuzhou, China
| | - Xiangwei Wu
- Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Key Laboratory of Translational Radiation Oncology, Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Hui Wang
- Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- Key Laboratory of Translational Radiation Oncology, Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
- *Correspondence: Hui Wang,
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12
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Patil V, Noronha V, Joshi A, Menon N, Mathrudev V, Bhattacharjee A, Chandrasekharan A, Vallathol D, Dsouza H, Srinivas S, Mandal T, Chaturvedi P, Chaukar D, Pai P, Nair S, Thiagrajan S, Laskar S, Nawale K, Babanrao Dhumal S, Tambe R, Banavali S, Prabhash K. RMAC study: A randomized study for evaluation of metronomic adjuvant chemotherapy in recurrent head and neck cancers post salvage surgical resection in those who are ineligible for re-irradiation. Oral Oncol 2022; 128:105816. [DOI: 10.1016/j.oraloncology.2022.105816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
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13
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Shetty KSR, Kurle V, Greeshma P, Ganga VB, Murthy SP, Thammaiah SK, Prasad PK, Chavan P, Halkud R, Krishnappa R. Salvage Surgery in Recurrent Oral Squamous Cell Carcinoma. FRONTIERS IN ORAL HEALTH 2022; 2:815606. [PMID: 35156084 PMCID: PMC8831824 DOI: 10.3389/froh.2021.815606] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/27/2021] [Indexed: 01/09/2023] Open
Abstract
More than half of patients with oral cancer recur even after multimodality treatment and recurrent oral cancers carry a poorer prognosis when compared to other sites of head and neck. The best survival outcome in a recurrent setting is achieved by salvage surgery; however, objective criteria to select an ideal candidate for salvage surgery is difficult to frame, as the outcome depends on various treatment-, tumor-, and patient-related factors. The following is summarizes various tumor- and treatment-related factors that guide our decision-making to optimize oncologic and functional outcomes in surgical salvage for recurrent oral cancers. Short disease-free interval, advanced tumor stage (recurrent and primary), extracapsular spread and positive tumor margins in a recurrent tumor, regional recurrence, and multimodality treatment of primary tumor all portend worse outcomes after surgical salvage. Quality of life after surgical intervention has shown improvement over 1 year with a drastic drop in pain scores. Various trials are underway evaluating the combination of immunotherapy and surgical salvage in recurrent head and neck tumors, including oral cavity, which may widen our indications for salvage surgery with improved survival and preserved organ function.
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14
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Kakabadze MZ, Paresishvili T, Mardaleishvili K, Vadachkoria Z, Kipshidze N, Jangavadze M, Karalashvili L, Ghambashidze K, Chakhunashvili D, Kakabadze Z. Local drug delivery system for the treatment of tongue squamous cell carcinoma in rats. Oncol Lett 2021; 23:13. [PMID: 34820012 PMCID: PMC8607325 DOI: 10.3892/ol.2021.13131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
The present study describes a local drug delivery system with two functions, which can suppress tumor growth and accelerate wound healing. Thе system consists of a two-layer multicomponent fibrin-based gel (MCPFTG). The internal layer of MCPFTG, which is in direct contact with the wound surface, contains cisplatin placed on a CultiSpher-S collagen microcarrier. The external layer of MCPFTG consists of a CultiSpher-S microcarrier with lyophilized bone marrow stem cells (BMSCs). The efficacy of MCPFTG was evaluated in a rat model of squamous cell carcinoma of the tongue created with 4-nitroquinoline 1-oxide. The results of the study showed that, within 20–25 days, a non-healing wound of the tongue was formed in animals that underwent only 85% resection of squamous cell carcinoma, while rapid progression of the residual tumor was concomitantly observed. Immunohistochemical methods revealed high expression of cyclin D1 and low expression of E-cadherin in these animals. Additionally, high expression of p63 and Ki-67 was noted. In 80% of animals with squamous cell carcinoma of the tongue that were treated with MCPFTG after 85% tumor resection, a noticeable suppression of tumor growth was evident throughout 150 days, and tumor recurrence was not detected. Immunohistochemistry revealed low or moderate expression of cyclin D1, and high expression of E-cadherin throughout the whole observation period. The MCPFTG-based local drug delivery system was shown to be effective in suppressing tumor growth and preventing recurrence. MCPFTG decreased the toxicity of cisplatin and enhanced its antitumor activity. In addition, lyophilized paracrine BMSC factors present in MCPFTG accelerated wound healing after tumor removal. Thus, the present study suggests novel opportunities for the development of a multifunctional drug delivery system for the treatment of squamous cell carcinoma.
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Affiliation(s)
- Mariam Z Kakabadze
- Department of Clinical Anatomy and Operative Surgery, Iv. Javakhishvili Tbilisi State University, 0179 Tbilisi, Georgia
| | - Teona Paresishvili
- Department of Clinical Anatomy, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | | | - Zurab Vadachkoria
- Department of Child and Adolescent Maxillo-facial Surgery and Surgical Stomatology, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Nicholas Kipshidze
- Department of Interventional Cardiology, Cardiovascular Research Foundation, New York, NY 10019, USA
| | - Mikheil Jangavadze
- Department of Clinical Anatomy and Operative Surgery, Iv. Javakhishvili Tbilisi State University, 0179 Tbilisi, Georgia
| | - Lia Karalashvili
- Department of Clinical Anatomy, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Ketevan Ghambashidze
- Department of Clinical Anatomy, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - David Chakhunashvili
- Department of Clinical Anatomy, Tbilisi State Medical University, 0186 Tbilisi, Georgia
| | - Zurab Kakabadze
- Department of Clinical Anatomy, Tbilisi State Medical University, 0186 Tbilisi, Georgia
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15
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Yosefof E, Hilly O, Stern S, Bachar G, Shpitzer T, Mizrachi A. Patterns of Regional Recurrence and Salvage Treatment in Patients With Oral Cancer. Laryngoscope 2021; 132:786-792. [PMID: 34397102 DOI: 10.1002/lary.29821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/21/2021] [Accepted: 08/06/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Regional failure after primary treatment for oral squamous cell carcinoma (OSCC) carries a dismal outcome. Our goal was to investigate the recurrence patterns and salvage treatment in patients with OSCC and regional failure. STUDY DESIGN Retrospective chart review of all patients treated for OSCC in a university-affiliated tertiary care center during 2000-2018. METHODS Data collected from patients' medical charts included demographics, clinical and pathological features, staging, treatment modalities and outcomes. Patients with insufficient data or a follow-up of less than 2 years were excluded. RESULTS Out of 266 surgically treated patients, 55 developed regional recurrence and were included in the study cohort. Forty patients received surgical salvage treatment followed by adjuvant chemo-radiotherapy (CRT). Disease specific survival and overall survival were significantly higher in surgically treated patients compared to patients who received non-surgical treatment (46.7% vs. 0%, log-rank P value < .001 and 35.3% vs. 0%, log-rank P value = .001, respectively) and in patients who recurred regionally more than 10 months following initial treatment (40.8% vs 10.7%, log-rank P value = .065). Patients with early recurrence were older (73.6 vs. 61.3 years) and had a deeper invasion of the primary tumor (10.1 vs. 7 mm). CONCLUSIONS Salvage neck dissection is feasible in most cases, providing the best outcomes in patients with OSCC who fail regionally. Close follow-up during the first year after initial treatment is paramount as early recurrence carries a dismal prognosis. Specifically, elderly patients and patients with deeper primary tumor invasion should be closely monitored during the first post-operative year. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Eyal Yosefof
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Stern
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Shpitzer
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Incurable locoregional disease is a strong poor prognostic factor in recurrent or metastatic squamous cell carcinoma of the head and neck. Int J Clin Oncol 2021; 26:1822-1830. [PMID: 34152533 DOI: 10.1007/s10147-021-01965-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Distant metastasis is a poor prognostic factor in recurrent/metastatic squamous cell carcinoma of the head and neck. However, limited information on the prognostic impact of locoregional disease is available, despite its life-threatening features. We investigated the prognostic impact of incurable locoregional disease and distant metastasis in recurrent/metastatic squamous cell carcinoma of the head and neck. METHODS We retrospectively analyzed 156 patients with recurrent/metastatic squamous cell carcinoma of the head and neck who received palliative chemotherapy between August 2006 and December 2019. RESULTS The median follow-up time for all censored patients was 12.1 (range 1.9-63.5) months. The median overall survival was 12.4 (95% confidence interval 10.1-15.1) months. Incurable locoregional disease (hazard ratio: 2.31, P = 0.007), liver metastasis (hazard ratio: 2.84, P = 0.006), disease-free interval > 13 months (hazard ratio: 0.51, P = 0.041), cetuximab use (hazard ratio: 0.59, P = 0.007), and immune checkpoint inhibitor use (hazard ratio: 0.56, P = 0.006) were associated with prognosis. The number of distant metastatic sites was not associated with overall survival (1-2: hazard ratio: 0.60, P = 0.16; 3-4: hazard ratio: 1.34, P = 0.50). Patients with incurable locoregional disease had more life-threatening events than those with curable locoregional disease. CONCLUSION The presence of incurable locoregional disease had a significant prognostic impact, whereas the number of distant metastatic sites had no prognostic impact. Liver metastasis was a poor prognostic factor for recurrent/metastatic squamous cell carcinoma of the head and neck.
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17
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Wang Y, Wang M, Tang Y, Sun B, Wang K, Zhu F. Perioperative mortality of head and neck cancers. BMC Cancer 2021; 21:256. [PMID: 33750338 PMCID: PMC7941918 DOI: 10.1186/s12885-021-07998-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background Head and neck cancers are aggressive cancers, most clinical studies focused on the prognosis of patients with head and neck cancer. However, perioperative mortality was rarely mentioned. Methods A retrospective analysis was performed using all head and neck cancer patients admitting in the Department of Oral and Maxillofacial Surgery of the Second Xiangya Hospital, Central South University from January 2010 to December 2019. The analysis of overall survival and progression-free survival were performed using the Kaplan–Meier method, and cross tabulation with chi-squared testing was applied to analyze the difference in parameters between groups. Results From January 2010 to December 2019, a total of 6576 patients with head and neck cancers were admitted to our department and 7 died in the hospital, all of whom were middle-aged and elderly patients including 6 males and 1 female. The perioperative mortality rate (POMR) was about 1‰. The causes of death included acute heart failure, rupture of large blood vessels in the neck, hypoxic ischemic encephalopathy due to asphyxia, respiratory failure and cardiopulmonary arrest. Conclusion Preoperative radiotherapy, previous chemotherapy, hypertension, diabetes, advanced clinical stage and postoperative infection are risk factors for perioperative mortality of head and neck cancer.
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Affiliation(s)
- Yannan Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mengxue Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yan Tang
- Department of Nursing, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Bincan Sun
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Kai Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Feiya Zhu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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18
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Lupato V, Polesel J, La Torre FB, Fanetti G, Fratta E, Gobitti C, Baldassarre G, Vaccher E, Franchin G, Giacomarra V. A pre-operative prognostic score for the selection of patients for salvage surgery after recurrent head and neck squamous cell carcinomas. Sci Rep 2021; 11:502. [PMID: 33436706 PMCID: PMC7804332 DOI: 10.1038/s41598-020-79759-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/10/2020] [Indexed: 11/09/2022] Open
Abstract
Salvage surgery in recurrent head and neck squamous cell carcinoma has a poor outcome, both in terms of survival and quality of life. Therefore, the identification of pre-operative prognostic factors to improve the selection of patients who could benefit the most from salvage surgery is clinically relevant. The present study is a single-center retrospective analysis of 164 patients treated with salvage surgery after recurrence of head and neck cancer. Progression free survival and overall survival were calculated through Kaplan–Meier method. Hazard risk (HR) and corresponding confidence intervals (CI) were estimated through Cox proportional hazard model, adjusting for potential confounders. Significant predictors were combined into a prognostic score, attributing one point to each factor. Progression-free survival and overall survival were respectively 50.3% and 56.5% at 2 years, and 36.6% and 44.2% at 5 years. Four pre-operative factors were independently associated with poor prognosis: age > 70 years (HR = 2.18; 95% CI 1.27–3.73), initial stage IV (HR = 2.37; 95% CI 1.18–4.76), disease free interval < 12 months (HR = 1.72; 95% CI 1.01–2.94), and loco-regional recurrence (HR = 2.22; 95% CI 1.22–4.04). No post operative factor was associated with oncologic outcomes. Patients with 3–4 unfavorable factors showed a 5-year overall survival of 0.0% compared to 65.7% in those with 0–1 unfavorable factors (HR = 5.61; 95% CI 2.89–10.92). Despite the low number of patients, 3–4 unfavorable factors were associated to worse prognosis in all sub-sites. In conclusion, age > 70 years, initial stage IV, disease-free interval < 12 months, and loco-regional recurrence are strong independent pre-operative predictors of poor outcome in patients undergoing salvage surgery. Patients with two or more of these factors should be informed about the low success rate after salvage surgery and alternative treatments should be considered.
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Affiliation(s)
- Valentina Lupato
- Division of Otolaryngology, General Hospital "Santa Maria Degli Angeli", Pordenone, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Fabio Biagio La Torre
- Division of Otolaryngology, General Hospital "Santa Maria Degli Angeli", Pordenone, Italy
| | - Giuseppe Fanetti
- Division of Radiotherapy, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
| | - Elisabetta Fratta
- Division of Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Carlo Gobitti
- Division of Radiotherapy, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Gustavo Baldassarre
- Division of Molecular Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Emanuela Vaccher
- Division of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giovanni Franchin
- Division of Radiotherapy, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Vittorio Giacomarra
- Division of Otolaryngology, General Hospital "Santa Maria Degli Angeli", Pordenone, Italy
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Olmos M, Glajzer J, Büntemeyer TO, Frohwitter G, Ries J, Eckstein M, Hecht M, Lutz R, Kesting MR, Weber M. Neoadjuvant Immunotherapy of Oral Squamous Cell Carcinoma: Case Report and Assessment of Histological Response. Front Oncol 2021; 11:720951. [PMID: 34368002 PMCID: PMC8334861 DOI: 10.3389/fonc.2021.720951] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/02/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The treatment of oral cancer remains challenging due to its infiltrative nature and a high tendency for tumour relapse leading to an overall poor prognosis. In the case of early recurrence, the patient's prognosis deteriorates dramatically, with survival rate dropping to below 30%. Minimal improvements in survival trends in recurrent and advanced stage tumours have been reported in recent decades. Neoadjuvant immunotherapy may represent a new therapeutic approach changing the standard of care in advanced oral cancer therapy. CASE PRESENTATION We describe the case of a woman in her late 30's who presented in mid-2019 with oral squamous cell carcinoma (OSCC) localized to the floor of the mouth. After initial R0 resection, selective neck dissection, and adjuvant brachytherapy, an early recurrence of OSCC located between the hyoid bone and the mandible was diagnosed at the end of 2019. An off-label treatment regimen was performed with neoadjuvant use of Pembrolizumab 19 days prior to salvage surgery. Radiological and histological assessment of T-cell and programmed cell death protein 1 ligand 1 (PD-L1) expression was performed before and after checkpoint inhibitor application. Neoadjuvant immunotherapy resulted in increased T-cell infiltration and PD-L1 expression, as well as a significant tumour necrosis rate. One cycle of Pembrolizumab led to significant regressive tumour changes with increases in immune infiltration, sclerosis, and necrosis of 75% of the tumour mass with only 25% vital tumour cells remaining. By June 2020, the patient remained without recurrence. CONCLUSIONS The case presented outlines the potential effects of neoadjuvant immunotherapy in recurrent or advanced OSCC prior to definitive surgical tumour treatment. The benefit of additional adjuvant treatment after histologic response will be discussed. The case is also analysed considering ongoing clinical trials of neoadjuvant immunotherapy for head and neck malignancies.
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Affiliation(s)
- Manuel Olmos
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Jacek Glajzer
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Tjark-Ole Büntemeyer
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Gesche Frohwitter
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Jutta Ries
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Markus Eckstein
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.,Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Markus Hecht
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.,Department of Radiation Oncology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Marco Rainer Kesting
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Manuel Weber
- Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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20
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Akali NR, Buggaveeti R, Sukumaran SV, Balasubramanian D, Iyer S, Thankappan K. Prior chemoradiotherapy and pathological perineural invasion predict the survival outcomes of salvage surgery in head and neck squamous cell carcinoma. Head Neck 2020; 43:874-883. [PMID: 33219731 DOI: 10.1002/hed.26547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of the study was to evaluate the oncological outcomes of salvage surgery in squamous cell carcinoma of the head and neck (SCCHN). METHODS This is a retrospective analysis of all patients of SCCHN with recurrence or second primary, post-treatment, who underwent salvage surgery. The outcomes were analyzed in terms of overall survival, overall survival postsalvage surgery and disease-free survival (DFS) postsalvage surgery. Clinical and pathological predictors were considered. RESULTS Two hundred and forty-one patients were included. The mean follow-up was 56.33 months. Five-year survival OS from date of initial diagnosis of the tumor was 61.2%. The 5-year OS survival after salvage surgery was 47.1%. Five-year DFS after salvage surgery was 28.1%. Prior chemoradiotherapy and pathological perineural invasion were independent predictors on multivariate analysis. CONCLUSIONS Survival outcomes after appropriate salvage treatment are good. Prior chemoradiotherapy and perineural invasion on salvage pathology are predictors of poorer outcomes.
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Affiliation(s)
- Nisha Rajrattansingh Akali
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rahul Buggaveeti
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | - Deepak Balasubramanian
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Subramania Iyer
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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21
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van Weert S, Leemans CR. Salvage surgery in head and neck cancer. Oral Dis 2020; 27:117-124. [PMID: 32738064 PMCID: PMC7821237 DOI: 10.1111/odi.13582] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Abstract
Salvage surgery after failed organ preservation treatment offers challenges for both the patient and the surgeon. The outcome is often uncertain and even today, 5‐year overall survival does not exceed 50 per cent. The chemoradiotherapy induced toxicity asks for meticulous discussion and planning in a multidisciplinary manner in a changing environment of increasing incidence of human papillomavirus induced oropharyngeal tumours, evolving surgical techniques and patient participation. Herein, we discuss the latest literature on salvage surgery and the need for identifying the proper prognosticators to ensure for an optimal treatment plan in potentially salvageable patients.
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Affiliation(s)
- Stijn van Weert
- Department of Otolaryngology- Head and Neck Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology- Head and Neck Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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22
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Lin NC, Hsu JT, Tsai KY. Survival and clinicopathological characteristics of different histological grades of oral cavity squamous cell carcinoma: A single-center retrospective study. PLoS One 2020; 15:e0238103. [PMID: 32841288 PMCID: PMC7447052 DOI: 10.1371/journal.pone.0238103] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022] Open
Abstract
The TNM staging system for oral squamous cell carcinoma (OSCC) provides clinicians a dependable foundation for patient prognosis and management decisions, but in clinical practice, treatment outcomes of patients with OSCC are sometimes unsatisfactory. This retrospective study investigated the association between survival and clinicopathological characteristics and histological grades of 2535 patients with OSCC. Additionally, the present study aimed to compare the predictive abilities of histological grades with other common prognostic factors. The enrolled patients were divided into three groups by two experienced pathologists into well-differentiated, moderately differentiated, and poorly differentiated groups, according to the WHO classification. Finally, we designed an observational, retrospective study based on the histological grading of tumors to compare their clinicopathological characteristics and conducted survival analysis among the three groups. Advanced tumor stage was diagnosed in 23.9%, 44.0%, and 55.1% of patients with grades 1–3 OSCC, respectively. By T status, T3 or T4 tumors were found in approximately 22%, 34%, and 40% of patients with grades 1–3 OSCC, respectively. By N status, lymph node metastases were found in 6.1%, 29.3%, and 45.9% of patients with grades 1–3 OSCC, respectively. Thus, significant survival differences were observed based on different OSCC histological grades. Meanwhile, in the multivariate (adjusted) analysis, N1 and N2 stages, extranodal spread, and poor differentiation were associated with a higher recurrence risk than the other common prognostic factors. In conclusion, 5% of patients in our study presented with poorly differentiated OSCC at diagnosis. Furthermore, grade 3 OSCC has worse prognosis and is more aggressive than grades 1 and 2 OSCC. In the future, we should focus on modifying individual therapy for poorly differentiated OSCC to achieve improved outcomes.
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Affiliation(s)
- Nan-Chin Lin
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
- Department of Oral and Maxillofacial Surgery, Changhua Christian Hospital, Taiwan, ROC
| | - Jui-Ting Hsu
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
| | - Kuo-Yang Tsai
- Department of Oral and Maxillofacial Surgery, Changhua Christian Hospital, Taiwan, ROC
- College of Nursing and Health Science, Da-Yeh University, Changhua, Taiwan, ROC
- * E-mail:
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23
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Hoffmann C, Vacher S, Sirven P, Lecerf C, Massenet L, Moreira A, Surun A, Schnitzler A, Klijanienko J, Mariani O, Jeannot E, Badois N, Lesnik M, Choussy O, Le Tourneau C, Guillot-Delost M, Kamal M, Bieche I, Soumelis V. MMP2 as an independent prognostic stratifier in oral cavity cancers. Oncoimmunology 2020; 9:1754094. [PMID: 32934875 PMCID: PMC7466851 DOI: 10.1080/2162402x.2020.1754094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background Around 25% of oral cavity squamous cell carcinoma (OCSCC) are not controlled by the standard of care, but there is currently no validated biomarker to identify those patients. Our objective was to determine a robust biomarker for severe OCSCC, using a biology-driven strategy. Patients and methods Tumor and juxtatumor secretome were analyzed in a prospective discovery cohort of 37 OCSCC treated by primary surgery. Independent biomarker validation was performed by RTqPCR in a retrospective cohort of 145 patients with similar clinical features. An 18-gene signature (18 G) predictive of the response to PD-1 blockade was evaluated in the same cohort. Results Among 29 deregulated molecules identified in a secretome analysis, including chemokines, cytokines, growth factors, and molecules related to tumor growth and tissue remodeling, only soluble MMP2 was a prognostic biomarker. In our validation cohort, high levels of MMP2 and CD276, and low levels of CXCL10 and STAT1 mRNA were associated with poor prognosis in univariate analysis (Kaplan-Meier). MMP2 (p = .001) and extra-nodal extension (ENE) (p = .006) were independent biomarkers of disease-specific survival (DSS) in multivariate analysis and defined prognostic groups with 5-year DSS ranging from 36% (MMP2highENE+) to 88% (MMP2lowENE-). The expression of 18 G was similar in the different prognostic groups, suggesting comparable responsiveness to anti-PD-1. Conclusion High levels of MMP2 were an independent and validated prognostic biomarker, surpassing other molecules of a large panel of the tumor and immune-related processes, which may be used to select poor prognosis patients for intensified neoadjuvant or adjuvant regimens.
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Affiliation(s)
- Caroline Hoffmann
- Paris Sciences and Letters (PSL) University, Paris, France
- INSERM U932 Research Unit, Immunity and Cancer, Paris, France
- Department of Surgical Oncology, Institut Curie, Paris & Saint-Cloud, France
| | - Sophie Vacher
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Genetics, Institut Curie, Paris, France
| | - Philémon Sirven
- Paris Sciences and Letters (PSL) University, Paris, France
- INSERM U932 Research Unit, Immunity and Cancer, Paris, France
| | - Charlotte Lecerf
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris & Saint-Cloud, France
| | - Lucile Massenet
- Paris Sciences and Letters (PSL) University, Paris, France
- INSERM U932 Research Unit, Immunity and Cancer, Paris, France
| | - Aurélie Moreira
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris & Saint-Cloud, France
| | - Aurore Surun
- SIREDO Cancer Center (Care, Innovation and Research in Pediatric, Adolescents and Young Adults Oncology), Institut Curie, Paris, France
- Paris Descartes University, Paris, France
| | - Anne Schnitzler
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Genetics, Institut Curie, Paris, France
| | - Jerzy Klijanienko
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Pathology, Institut Curie, Paris, France
| | - Odette Mariani
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Pathology, Institut Curie, Paris, France
- Biological Resources Center, Institut Curie, Paris, France
| | - Emmanuelle Jeannot
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Pathology, Institut Curie, Paris, France
| | - Nathalie Badois
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Surgical Oncology, Institut Curie, Paris & Saint-Cloud, France
| | - Maria Lesnik
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Surgical Oncology, Institut Curie, Paris & Saint-Cloud, France
| | - Olivier Choussy
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Surgical Oncology, Institut Curie, Paris & Saint-Cloud, France
| | - Christophe Le Tourneau
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris & Saint-Cloud, France
- INSERM U900 Research Unit, Saint-Cloud, France
| | - Maude Guillot-Delost
- Paris Sciences and Letters (PSL) University, Paris, France
- INSERM U932 Research Unit, Immunity and Cancer, Paris, France
- Center of Clinical Investigation, CIC IGR-Curie, Paris, France
| | - Maud Kamal
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris & Saint-Cloud, France
| | - Ivan Bieche
- Paris Sciences and Letters (PSL) University, Paris, France
- Department of Genetics, Institut Curie, Paris, France
- Faculty of Pharmaceutical and Biological Sciences, INSERM U1016 Research Unit, Paris Descartes University, Paris, France
| | - Vassili Soumelis
- Paris Sciences and Letters (PSL) University, Paris, France
- INSERM U932 Research Unit, Immunity and Cancer, Paris, France
- Clinical Immunology Department, Institut Curie, Paris, France
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24
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Emphasize Treatment of Known Disease Rather Than Past Footprints. Int J Radiat Oncol Biol Phys 2020; 106:904. [DOI: 10.1016/j.ijrobp.2019.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/19/2019] [Accepted: 09/13/2019] [Indexed: 11/19/2022]
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25
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Joseph B, Kumar RV, Champaka G, Shenoy A, Sabitha KS, Lokesh V, Ramesh C, Vijay CR. Biological tailoring of adjuvant radiotherapy in head and neck and oral malignancies - The potential role of p53 and eIF4E as predictive parameters. Indian J Cancer 2020; 56:330-334. [PMID: 31607702 DOI: 10.4103/ijc.ijc_56_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recent advances in radiation technology has allowed to significantly reduce toxicity and improve the efficacy of radical radiotherapy in head and neck and oral squamous cell cancers. Insights into molecular biology of carcinogenesis has opened a window for identifying aggressive clinical situations that may benefit with larger clinical target volume (CTV ) margin, broader levels of nodal coverage, or alternative radiation sensitizers. AIM To evaluate the potential role of eukaryotic translation initiation factor 4E (elF4E) and p53 as predictive biomarkers in resected margins of head and neck and oral cancers. MATERIAL AND METHODS Forty patients with oral cancers and 26 patients with head and neck cancers were evaluated for p53 and eIF4E in their negative surgical margins, for pattern of distribution and outcome. RESULTS In oral cancers, 27 patients (67.5%) were positive for p53 and 10 (25%) for eIF4E in surgically negative margins. For head and neck cancer, the values were 13 (50%) for p53 and 9 (34.6%) for eIF4E. Twelve patients with oral cancers and 8 patients with head and neck cancers had local failure or death. The association with these biomarkers did not achieve statistical significance. However, adjuvant radiotherapy had a significant protective value. It improved median survival from 15 to 21 months in patients positive for p53 (P = 0.018) and from 12 to 20 months (P = 0.03) in those with eIF4E. There was no predictive association of subsite, tumor size, or nodal status. CONCLUSION The overexpression of p53 and eIF4E in pathologically negative margins may represent a subset of patients who would benefit from early initiation of adjuvant radiation and tailored intensity-modulated radiotherapy (IMRT).
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Affiliation(s)
- Bindhu Joseph
- Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Rekha V Kumar
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - G Champaka
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Ashok Shenoy
- Department of Head and Neck Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - K S Sabitha
- Department of Oral Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - V Lokesh
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - C Ramesh
- Department of Epidemiology and Statistics, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - C R Vijay
- Department of Epidemiology and Statistics, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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26
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Predictors of locoregional control in stage I/II oral squamous cell carcinoma classified by AJCC 8th edition. Eur J Surg Oncol 2019; 45:2126-2130. [DOI: 10.1016/j.ejso.2019.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/11/2019] [Accepted: 05/17/2019] [Indexed: 11/21/2022] Open
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27
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Chung EJ, Park MW, Kwon KH, Rho YS. Clinical outcomes and prognostic factor analysis after salvage surgery for recurrent squamous cell carcinoma of the oral cavity. Int J Oral Maxillofac Surg 2019; 49:285-291. [PMID: 31492478 DOI: 10.1016/j.ijom.2019.03.967] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/07/2019] [Accepted: 03/17/2019] [Indexed: 01/01/2023]
Abstract
The purpose of this study was to analyze the oncological outcomes and predictive factors for successful curative salvage surgery after recurrent oral cavity squamous cell carcinoma. A retrospective study was conducted involving 73 patients who received surgery-based salvage treatment. The pattern of failure for primary treatment was local failure in 29 patients, regional failure in 29 patients, and loco-regional failure in 15 patients. The 5-year overall, loco-regional failure-free, and disease-free survival rates were 54.8%, 58.9% and 49.3%, respectively. Patients with an advanced initial N stage, previous treatment with combined modality therapy, loco-regional recurrence, advanced recurrent T stage, a disease-free survival of less than 8 months prior to salvage, and recurrence in a previously treated field had a significantly worse prognosis. Given the potential surgical morbidity, salvage surgery should be undertaken after careful consultation with patients who have factors for a poor prognosis.
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Affiliation(s)
- Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min-Woo Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine, Seoul, Republic of Korea
| | - Kee-Hwan Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine, Seoul, Republic of Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine, Seoul, Republic of Korea.
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28
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Prognostic and predictive factors in recurrent and/or metastatic head and neck squamous cell carcinoma: A review of the literature. Crit Rev Oncol Hematol 2019; 137:84-91. [DOI: 10.1016/j.critrevonc.2019.01.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/14/2018] [Accepted: 01/24/2019] [Indexed: 02/06/2023] Open
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29
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Joo YH, Cho JK, Koo BS, Kwon M, Kwon SK, Kwon SY, Kim MS, Kim JK, Kim H, Nam I, Roh JL, Park YM, Park IS, Park JJ, Shin SC, Ahn SH, Won S, Ryu CH, Yoon TM, Lee G, Lee DY, Lee MC, Lee JK, Lee JC, Lim JY, Chang JW, Jang JY, Chung MK, Jung YS, Cho JG, Choi YS, Choi JS, Lee GH, Chung PS. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2019; 12:107-144. [PMID: 30703871 PMCID: PMC6453784 DOI: 10.21053/ceo.2018.01816] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient’s treatment goals.
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Affiliation(s)
- Young-Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Bon Seok Koo
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
| | - Jeong Kyu Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Heejin Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Innchul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jung Je Park
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seongjun Won
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Tae Mi Yoon
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Giljoon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Chul Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Joon Kyoo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeon Yeob Jang
- Department of Otorhinolaryngology Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yuh-Seok Jung
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeong-Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University School of Medicine, Incheon, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Phil-Sang Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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Choi WR, Oh JS, Roh J, Kim JS, Oh I, Choi S, Nam SY, Kim SY. Metabolic tumor volume and total lesion glycolysis predict tumor progression and survival after salvage surgery for recurrent oral cavity squamous cell carcinoma. Head Neck 2019; 41:1846-1853. [DOI: 10.1002/hed.25622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 11/13/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Woo Ri Choi
- Department of OtolaryngologyUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Jungsu S. Oh
- Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Jong‐Lyel Roh
- Department of OtolaryngologyUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Inhye Oh
- Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Seung‐Ho Choi
- Department of OtolaryngologyUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Soon Yuhl Nam
- Department of OtolaryngologyUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Sang Yoon Kim
- Department of OtolaryngologyUniversity of Ulsan College of Medicine Seoul Republic of Korea
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Borsetto D, Higginson JA, Aslam A, Al‐Qamachi L, Dhanda J, Marioni G, Franchella S, Frigo A, Praveen P, Martin T, Parmar S, Nankivell P. Factors affecting prognosis in locoregional recurrence of oral squamous cell carcinoma. J Oral Pathol Med 2019; 48:206-213. [DOI: 10.1111/jop.12815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Daniele Borsetto
- Institute of Head and Neck Studies and Education Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
| | - James A. Higginson
- Institute of Head and Neck Studies and Education Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
| | - Adil Aslam
- Oral and Maxillofacial Department Queen Elizabeth Hospital Birmingham BirminghamUK
| | - Laith Al‐Qamachi
- Oral and Maxillofacial Department Queen Elizabeth Hospital Birmingham BirminghamUK
| | - Jagtar Dhanda
- Oral and Maxillofacial Department Queen Elizabeth Hospital Birmingham BirminghamUK
| | - Gino Marioni
- Department of Neuroscience DNS, Otolaryngology Section University of Padova Padova Italy
| | - Sebastiano Franchella
- Department of Neuroscience DNS, Otolaryngology Section University of Padova Padova Italy
| | - Annachiara Frigo
- Unit of Biostatistics, Epidemiology and Public Health University Hospital of Padova Padova Italy
| | - Prav Praveen
- Oral and Maxillofacial Department Queen Elizabeth Hospital Birmingham BirminghamUK
| | - Tim Martin
- Oral and Maxillofacial Department Queen Elizabeth Hospital Birmingham BirminghamUK
| | - Sat Parmar
- Oral and Maxillofacial Department Queen Elizabeth Hospital Birmingham BirminghamUK
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education Institute of Cancer and Genomic Sciences University of Birmingham Birmingham UK
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Haque S, Karivedu V, Riaz MK, Choi D, Roof L, Hassan SZ, Zhu Z, Jandarov R, Takiar V, Tang A, Wise-Draper T. High-risk pathological features at the time of salvage surgery predict poor survival after definitive therapy in patients with head and neck squamous cell carcinoma. Oral Oncol 2018; 88:9-15. [PMID: 30616803 DOI: 10.1016/j.oraloncology.2018.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/20/2018] [Accepted: 11/07/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Salvage surgical resection is the preferred treatment for head and neck squamous cell carcinoma (HNSCC) patients who develop locally recurrent disease after failing primary therapy. However, salvage surgical resection is not always feasible, and survival outcomes for those that do undergo salvage remain poor. It is well known that patients with adverse pathological features (extracapsular extension (ECE) of lymph nodes (LN), positive margins, perineural invasion (PNI), lymphovascular invasion (LVI), and multiple LN metastases) at the time of primary surgical resection are likely to have relatively poor outcomes. However, the impact of adverse pathological features on outcomes in the salvage setting remains controversial. MATERIALS AND METHODS We retrospectively analyzed 73 patients at a single institution from 2008 to 2017 who developed recurrence and subsequently underwent salvage surgery (SS) after definitive curative-intent therapy including radiation. Demographic and disease control outcomes were reviewed. Kaplan-Meier curves were used to estimate relapse free survival (RFS) and overall survival (OS). RESULTS Median age at diagnosis was 61 years (range 40-86), 49/73 (67%) were male, and 55/73 (75%) had smoked. Patients with any adverse pathological features at SS had worse RFS (HR 3.15 p = 0.0008) and worse OS (3.97 p = 0.0008). Patients who relapsed <6 months after initial therapy had worse OS (HR 2.96 p = 0.004). CONCLUSIONS Patients with adverse pathological features at time of salvage surgery as well as those who have an early recurrence after definitive treatment and salvage surgery have worse outcomes. Prospective studies are necessary to clarify which patients should receive more intense treatment at salvage.
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Affiliation(s)
- Sulsal Haque
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vidhya Karivedu
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Muhammed K Riaz
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David Choi
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Logan Roof
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sarah Z Hassan
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Zheng Zhu
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Roman Jandarov
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alice Tang
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Trisha Wise-Draper
- Department of Internal Medicine, Division of Hematology/Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Subramaniam N, Balasubramanian D, Low THH, Murthy S, Anand A, Prasad C, Vijayan SN, Thankappan K, Iyer S. Role of adverse pathological features in surgically treated early oral cavity carcinomas with adequate margins and the development of a scoring system to predict local control. Head Neck 2018; 40:2329-2333. [DOI: 10.1002/hed.25163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/03/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Narayana Subramaniam
- Department of Head and Neck Oncology; Amrita Institute of Medical Sciences; Kerala India
| | - Deepak Balasubramanian
- Department of Head and Neck Oncology; Amrita Institute of Medical Sciences; Kerala India
| | | | - Samskruthi Murthy
- Department of Head and Neck Oncology; Amrita Institute of Medical Sciences; Kerala India
| | - Adharsh Anand
- Department of Head and Neck Oncology; Amrita Institute of Medical Sciences; Kerala India
| | - Chaya Prasad
- Department of Pathology; Amrita Institute of Medical Sciences; Kerala India
| | - Smitha N. Vijayan
- Department of Pathology; Amrita Institute of Medical Sciences; Kerala India
| | | | - Subramania Iyer
- Department of Head and Neck Oncology; Amrita Institute of Medical Sciences; Kerala India
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Zhong L, Liu Y, Wang K, He Z, Gong Z, Zhao Z, Yang Y, Gao X, Li F, Wu H, Zhang S, Chen L. Biomarkers: paving stones on the road towards the personalized precision medicine for oral squamous cell carcinoma. BMC Cancer 2018; 18:911. [PMID: 30241505 PMCID: PMC6151070 DOI: 10.1186/s12885-018-4806-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/06/2018] [Indexed: 12/20/2022] Open
Abstract
Traditional therapeutics have encountered a bottleneck caused by diagnosis delay and subjective and unreliable assessment. Biomarkers can overcome this bottleneck and guide us toward personalized precision medicine for oral squamous cell carcinoma. To achieve this, it is important to efficiently and accurately screen out specific biomarkers from among the huge number of molecules. Progress in omics-based high-throughput technology has laid a solid foundation for biomarker discovery. With credible and systemic biomarker models, more precise and personalized diagnosis and assessment would be achieved and patients would be more likely to be cured and have a higher quality of life. However, this is not straightforward owing to the complexity of molecules involved in tumorigenesis. In this context, there is a need to focus on tumor heterogeneity and homogeneity, which are discussed in detail. In this review, we aim to provide an understanding of biomarker discovery and application for precision medicine of oral squamous cell carcinoma, and have a strong belief that biomarker will pave the road toward future precision medicine.
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Affiliation(s)
- Liang Zhong
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Yutong Liu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Kai Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Zhijing He
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Zhaojian Gong
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Zhili Zhao
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Yaocheng Yang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Xiaofei Gao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Fangjie Li
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Hanjiang Wu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China
| | - Sheng Zhang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China.
| | - Lin Chen
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, People's Republic of China.
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Predictors of Early Recurrence Prior to Planned Postoperative Radiation Therapy for Oral Cavity Squamous Cell Carcinoma and Outcomes Following Salvage Intensified Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 103:363-373. [PMID: 30244160 DOI: 10.1016/j.ijrobp.2018.09.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine predictors and outcomes for oral squamous cell carcinoma (OSCC) patients who had early recurrence before commencement of postoperative radiation therapy (PORT). METHODS Retrospective review was performed for patients with OSCC treated with PORT between 2003 and 2015 after curative-intent surgery. Early recurrence was defined as tumor recurrence after surgical resection and before initiating planned PORT. Patients were classified into the following groups: (1) adjuvant PORT group (no early recurrence), (2) salvage PORT group (locoregional early recurrence), and (3) palliative PORT group (locoregional and distant early recurrence). For the whole cohort, multivariable analysis (MVA) was applied to identify predictors of early recurrence. In the salvage group, the post-PORT recurrence-free rate was estimated, and MVA was used to identify predictors of recurrence-free rate, disease-free survival, and overall survival (OS). RESULTS Six hundred and one patients were identified, of whom 513 (85%) were treated with adjuvant PORT. Eighty-eight patients (15%) had early recurrence (28 of 88; 32% were biopsy proven) before PORT (70 in the salvage group and 18 in the palliative group). On MVA, oral tongue subsite, microscopic positive resection margin, pT3-4, and pN2-3 were associated with the development of early recurrence (P < .05 for all). The 3-year OS rates for patients with OSCC treated with adjuvant and salvage PORT were 71% (95% confidence interval [CI], 67%-75%) and 41% (95% CI, 30%-56%), respectively (P < .001; median follow-up was 3.4 and 2.9 years, respectively). After salvage PORT, the 3-year recurrence-free rate was 36% (95% CI, 23%-47%). On MVA, extranodal extension and volume of early recurrent gross disease were associated with poor recurrence-free rate, disease-free survival, and OS (P < .05 for all). CONCLUSION Early recurrences are not uncommon in patients with high-risk features, Further study is required to improve prediction and outcomes of this very high-risk group.
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The Current Role of Salvage Surgery in Recurrent Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2018; 10:cancers10080267. [PMID: 30103407 PMCID: PMC6115801 DOI: 10.3390/cancers10080267] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/17/2022] Open
Abstract
Chemoradiotherapy has emerged as a gold standard in advanced squamous cell carcinoma of the head and neck (SCCHN). Because 50% of advanced stage patients relapse after nonsurgical primary treatment, the role of salvage surgery (SS) is critical because surgery is generally regarded as the best treatment option in patients with recurrent resectable SCCHN. Surgeons are increasingly confronted with considering operation among patients with significant effects of failed non-surgical primary treatment. Wide local excision to achieve clear margins must be balanced with the morbidity of the procedure, the functional consequences of organ mutilation, and the likelihood of success. Accurate selection of patients suitable for surgery is a major issue. It is essential to establish objective criteria based on functional and oncologic outcomes to select the best candidates for SS. The authors propose first to understand preoperative prognostic factors influencing survival. Predictive modeling based on preoperative information is now available to better select patients having a good chance to be successfully treated with surgery. Patients with a high comorbidity index, advanced oropharyngeal or hypopharyngeal primary tumors, and both local and regional recurrence have a very limited likelihood of success with salvage surgery and should be strongly considered for other treatments. Following SS, identifying patients with postoperative prognostic factors predicting high risk of recurrence is essential because those patients could benefit of adjuvant treatment or be included in clinical trials. Finally, defining HPV tumor status is needed in future studies including recurrent oropharyngeal SCC patients.
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Paz D, Chang K, Kao H, Lao WW, Huang Y, Chang Y, Huang Y. Clinical Implications of Tumor‐Associated Tissue Eosinophilia in Tongue Squamous Cell Carcinoma. Laryngoscope 2018; 129:1123-1129. [DOI: 10.1002/lary.27413] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Dante Paz
- Department of Otolaryngology–Head and Neck SurgeryChang Gung Memorial Hospital Taoyuan Taiwan
- Department of Head and Neck Surgery San Pedro University Chimbote Peru
| | - Kai‐Ping Chang
- College of Medicine Chang Gung University Taoyuan Taiwan
| | - Huang‐Kai Kao
- Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
| | | | - Yu‐Chen Huang
- Department of Oral and Maxillofacial SurgeryChang Gung Memorial Hospital Taoyuan Taiwan
| | - Yu‐Liang Chang
- Department of Oral and Maxillofacial SurgeryChang Gung Memorial Hospital Taoyuan Taiwan
| | - Yenlin Huang
- Department of Anatomic PathologyChang Gung Memorial Hospital Taoyuan Taiwan
- College of Medicine Chang Gung University Taoyuan Taiwan
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Factors Affecting Survival in Surgically Salvaged Locoregional Recurrences of Squamous Cell Carcinoma of the Tongue. J Oral Maxillofac Surg 2018; 76:1133.e1-1133.e6. [DOI: 10.1016/j.joms.2017.12.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/30/2017] [Accepted: 12/30/2017] [Indexed: 01/09/2023]
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Zenga J, Gross J, Fowler S, Chen J, Vila P, Richmon JD, Varvares MA, Pipkorn P. Salvage of recurrence after surgery and adjuvant therapy: A systematic review. Am J Otolaryngol 2018; 39:223-227. [PMID: 29398187 DOI: 10.1016/j.amjoto.2018.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the oncologic and functional outcomes of patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma after initial management with surgery and adjuvant therapy. DATA SOURCES Ovid Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, and Clinicaltrials.gov. REVIEW METHODS A structured search was performed of the literature to identify studies that included patients undergoing surgical salvage for local, regional, or locoregional recurrent head and neck squamous cell carcinoma without known distant metastases who had been treated with initial surgery and post-operative adjuvant radio- or chemoradiotherapy. Studies were excluded if they did not report at least 1-year survival estimates, included patients who underwent primary non-surgical management, or included those treated with non-surgical salvage therapies or supportive care alone. RESULTS The search strategy yielded 3746 abstracts. After applying exclusion and inclusion criteria, 126 full-texts were reviewed and six studies were included with a total of 222 patients. All studies were retrospective in design and included diverse disease subsites and stages. Complications and functional outcomes were inconsistently reported. Five-year survival estimates ranged between 10% and 40% between studies. CONCLUSIONS Patients undergoing salvage surgery for recurrent head and neck squamous cell carcinoma after initial surgery and adjuvant therapy may have a particularly poor prognosis. Future studies are needed to determine functional and quality of life outcomes in this patient population and to identify specific prognostic factors for re-recurrence and survival.
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Affiliation(s)
- Joseph Zenga
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Otolaryngology, Boston, MA, United States.
| | - Jennifer Gross
- Washington University, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, United States
| | - Susan Fowler
- Washington University, School of Medicine, Saint Louis, MO, United States
| | - Jenny Chen
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Otolaryngology, Boston, MA, United States
| | - Peter Vila
- Washington University, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, United States
| | - Jeremy D Richmon
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Otolaryngology, Boston, MA, United States
| | - Mark A Varvares
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Otolaryngology, Boston, MA, United States
| | - Patrik Pipkorn
- Washington University, Department of Otolaryngology-Head and Neck Surgery, Saint Louis, MO, United States
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Are Fusion Transcripts in Relapsed/Metastatic Head and Neck Cancer Patients Predictive of Response to Anti-EGFR Therapies? DISEASE MARKERS 2017; 2017:6870614. [PMID: 29259349 PMCID: PMC5702394 DOI: 10.1155/2017/6870614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/08/2017] [Indexed: 12/23/2022]
Abstract
Prediction of benefit from combined chemotherapy and the antiepidermal growth factor receptor cetuximab is a not yet solved question in head and neck squamous cell carcinoma (HNSCC). In a selected series of 14 long progression-free survival (PFS) and 26 short PFS patients by whole gene and microRNA expression analysis, we developed a model potentially predictive of cetuximab sensitivity. To better decipher the “omics” profile of our patients, we detected transcript fusions by RNA-seq through a Pan-Cancer panel targeting 1385 cancer genes. Twenty-seven different fusion transcripts, involving mRNA and long noncoding RNA (lncRNA), were identified. The majority of fusions (81%) were intrachromosomal, and 24 patients (60%) harbor at least one of them. The presence/absence of fusions and the presence of more than one fusion were not related to outcome, while the lncRNA-containing fusions resulted enriched in long PFS patients (P = 0.0027). The CD274-PDCD1LG2 fusion was present in 7/14 short PFS patients harboring fusions and was absent in long PFS patients (P = 0.0188). Among the short PFS patients, those harboring this fusion had the worst outcome (P = 0.0172) and increased K-RAS activation (P = 0.00147). The associations between HNSCC patient's outcome following cetuximab treatment and lncRNA-containing fusions or the CD274-PDCD1LG2 fusion deserve validation in prospective clinical trials.
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Liu J, Zhang Y, Li Z, Liu S, Li H, Xu Z. Benefit of salvage total pharyngolaryngoesophagectomy for recurrent locally advanced head and neck cancer after radiotherapy. Radiat Oncol 2017; 12:164. [PMID: 29073917 PMCID: PMC5658928 DOI: 10.1186/s13014-017-0900-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/05/2017] [Indexed: 01/30/2023] Open
Abstract
Background The treatment modalities for recurrent locally advanced head and neck cancer failure after radiotherapy are limited with poor prognosis. Salvage supra-radical operation seems to be an option. It has not been established which patients will benefit from salvage total pharyngolaryngoesophagectomy. Methods We retrospectively reviewed 66 patients with previously irradiated recurrent T4 head and neck cancer who underwent salvage total pharyngolaryngoesophagectomy at our institution between January 2001 and June 2014. The clinical outcome and toxicities were analyzed. Results Flap loss occurred in 2 patients, and the incidence of fistulas and anastomosis strictures was 15.6% (10/66) and 13.6% (9/66), respectively. The median survival time of the entire cohort was 12 months. The interval between radiation and salvage surgery, and microscopic carotid artery invasion were identified as independent prognostic factors for overall survival. The 3-year overall survival rates of patients with (n = 33) and without (n = 33) risk factors were 9.1% and 47.2%, respectively (p = 0.007). A time interval between radiation and salvage surgery ≤6 months and previous concurrent chemotherapy or targeted therapy were risk factors for severe post-operative complications. Conclusions Salvage total pharyngolaryngoesophagectomy is beneficial to selected patients with recurrent locally advanced head and neck cancer after radiotherapy.
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Affiliation(s)
- Jie Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No 17 Panjiayuan Nanli, Chaoyang District, Head and Neck Ward 1, Beijing, 100021, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhengjiang Li
- Department of Head and Neck Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No 17 Panjiayuan Nanli, Chaoyang District, Head and Neck Ward 1, Beijing, 100021, China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No 17 Panjiayuan Nanli, Chaoyang District, Head and Neck Ward 1, Beijing, 100021, China
| | - Huizheng Li
- Department of Otorhinolaryngology, Dalian Friendship Hospital, Dalian, China
| | - Zhengang Xu
- Department of Head and Neck Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No 17 Panjiayuan Nanli, Chaoyang District, Head and Neck Ward 1, Beijing, 100021, China.
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Tam S, Araslanova R, Low THH, Warner A, Yoo J, Fung K, MacNeil SD, Palma DA, Nichols AC. Estimating Survival After Salvage Surgery for Recurrent Oral Cavity Cancer. JAMA Otolaryngol Head Neck Surg 2017; 143:685-690. [PMID: 28448645 DOI: 10.1001/jamaoto.2017.0001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Locoregional recurrence of oral cavity squamous cell carcinoma (OCSCC) continues to be a life-threatening and difficult clinical situation. Salvage surgery can result in significant morbidities, and survival following recurrence is poor. Objective To outline prognostic factors influencing overall survival (OS) following salvage surgery for OCSCC to guide management of treatment for patients with locoregionally recurrent disease. Design, Setting, and Participants The medical records of 293 patients presenting to the London Health Sciences Center with locoregionally recurrent OCSCC between October 5, 1999, and May 2, 2011, were retrospectively reviewed. The primary outcome was OS from salvage treatment to last follow-up or death. Univariate analyses were carried out using the Cox proportional hazards regression model. A recursive partitioning analysis was used to create risk groups based on prognosis. Analysis was conducted from December 8, 2015, to February 26, 2016. Results Of the 293 patients evaluated, 59 (20%) had recurrence identified after their initial OCSCC treatment; 39 (66%) were men, and the mean (SD) age at diagnosis was 62.2 (11.8) years. Thirty-nine (66%) of these patients underwent salvage surgery for locoregional recurrence with curative intent. Five-year OS from the time of salvage surgery was 43%. Recursive partitioning analysis identified 3 risk groups: (1) high risk (patients who received adjuvant chemoradiotherapy or radiotherapy after initial surgery) with 5-year OS rate of 10% (hazard ratio [HR], 9.41; 95% CI, 2.68-33.04), (2) intermediate risk (previous surgery alone, age ≥62 years) with a 5-year OS rate of 39% (HR, 2.95; 95% CI, 0.86-10.09), and (3) low risk (previous surgery alone, age <62 years) with 5-year OS rate of 74%. Conclusions and Relevance This recursive partitioning analysis identified 3 prognostic groups in patients undergoing salvage surgery for recurrent OCSCC. The marked differences in survival between these groups should be taken into consideration when counselling and managing treatment for patients with locoregionally recurrent disease.
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Affiliation(s)
- Samantha Tam
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Rakhna Araslanova
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Andrew Warner
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada4London Regional Cancer Program, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada4London Regional Cancer Program, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada4London Regional Cancer Program, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada4London Regional Cancer Program, London, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada4London Regional Cancer Program, London, Ontario, Canada5Lawson Health Research Institute, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada4London Regional Cancer Program, London, Ontario, Canada5Lawson Health Research Institute, London, Ontario, Canada
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43
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Philouze P, Péron J, Poupart M, Pujo K, Buiret G, Céruse P. Salvage surgery for oropharyngeal squamous cell carcinomas: A retrospective study from 2005 to 2013. Head Neck 2017; 39:1744-1750. [PMID: 28557145 DOI: 10.1002/hed.24827] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 01/07/2017] [Accepted: 04/17/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND In the case of a locoregional recurrence of oropharyngeal squamous cell carcinoma, the curative standard of care is surgery. Our main purpose of this study was to determine the preoperative prognostic factors that would allow us to select the patients on whom we could expect good results with salvage surgery. METHODS We conducted a monocentric retrospective study from 2005 to 2013. It included all patients treated for a recurrence of oropharyngeal squamous cell carcinoma with surgery. Their initial treatment included radiotherapy. RESULTS Fifty-two patients were included. Poor prognostic factors for survival were the cT status (P = .0039) and local recurrences versus secondary localizations in irradiated areas (P = .016) and a relapse less than a year after the end of the initial treatment (P = .050). Recurrence-free survival was 19% at 5 years. Twenty-nine percent of patients presented local complications, which were mainly fistulas and hemorrhaging at the surgical site. CONCLUSION According to the high morbimortality, it is important to carefully select the right patients for surgery.
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Affiliation(s)
- Pierre Philouze
- Department of Head and Neck Surgery, Hospital de la Croix Rousse Hospices Civils de Lyon, Lyon, France
| | - Julien Péron
- Biostatistics Department, CHU Lyon Sud, Hospices Civils de Lyon, Pierre, Benité, France
| | - Marc Poupart
- Department of Head and Neck Surgery, Hospital de la Croix Rousse Hospices Civils de Lyon, Lyon, France
| | - Kevin Pujo
- Department of Ear, Nose, and Throat, Valence Hospital, Valence, France
| | - Guillaume Buiret
- Department of Ear, Nose, and Throat, Valence Hospital, Valence, France
| | - Philippe Céruse
- Department of Head and Neck Surgery, Hospital de la Croix Rousse Hospices Civils de Lyon, Lyon, France.,The University of Lyon 1, France
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44
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Lin HC, Kang CJ, Huang SF, Wang HM, Lin CY, Lee LY, Liao CT, Yen TC. Clinical impact of PET/CT imaging after adjuvant therapy in patients with oral cavity squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2017; 44:1702-1711. [PMID: 28547178 DOI: 10.1007/s00259-017-3713-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE This single-center retrospective study of prospectively collected data was aimed at comparing the clinical outcomes of positron emission tomography/computed tomography (PET/CT) for patients with oral cavity squamous cell carcinoma (OSCC) with symptomatic recurrences identified by PET/CT imaging following adjuvant therapy (Group A) versus those of cases with asymptomatic recurrences diagnosed through periodic post-adjuvant therapy PET/CT surveillance (Group B). We also sought to establish the priority of salvage therapy in the two study groups. METHODS We identified 111 patients with advanced resected OSCC who developed recurrences following adjuvant therapy (51 in Group A and 60 in Group B). Histopathology served as the gold standard for recurrent lesions. The impact of post-adjuvant therapy PET/CT surveillance was examined with Kaplan-Meier curves and Cox proportional hazards regression models. RESULTS The 2-year DSS and OS rates were marginally or significantly higher in Group B than in Group A (P = 0.073 and P = 0.025, respectively). Time-dependent ROC curve analysis demonstrated that the optimal cutoff values for time to positive PET/CT findings in relation to OS were 12 months for Group A and 9 months for Group B, respectively. Independent risk factors identified in multivariate analyses were used to devise two prognostic scoring systems for 2-year DSS and OS in each study group (all P < 0.001). CONCLUSIONS Scheduled periodic PET/CT surveillance is a valuable tool for early detection of recurrent lesion(s) in asymptomatic OSCC patients who bear risk factors for disease recurrence. The presence of clinical symptoms and a short time to positive PET/CT findings were adverse prognostic factors for clinical outcome in patients with advanced OSCC. The priority of salvage therapy is discussed in each patient subgroup according to the devised prognostic scoring systems.
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Affiliation(s)
- Huan-Chun Lin
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, Republic of China
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, Republic of China
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, Republic of China.
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. .,Department of Nuclear Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, Republic of China.
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45
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Potential for low-value palliative care of patients with recurrent head and neck cancer. Lancet Oncol 2017; 18:e284-e289. [PMID: 28456588 DOI: 10.1016/s1470-2045(17)30260-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/22/2016] [Accepted: 01/05/2017] [Indexed: 12/25/2022]
Abstract
Curative treatment for patients with advanced head and neck cancer can be associated with many side-effects, and many patients suffer from persistent treatment-related side-effects. Patients with recurrent cancer bear the burden of these effects along with additional symptoms attributed to the recurrent tumour. To better understand the benefits and burden of palliative treatments for patients with recurrent head and neck cancer, we reviewed the evidence on commonly used palliative treatments and their effect on quality of life. When used for palliative care purposes, chemotherapy and radiotherapy have limited effectiveness in improving quality of life. Moreover, if these treatments are not congruent with a patient's end-of-life goals, they could constitute low-value care. We recommend that patients with advanced and recurrent cancer should be offered early, comprehensive palliative and supportive services to maximise benefit. The principles of beneficence and respect for patients in the context of shared decision making must prevail if the trust of this vulnerable patient population is to be honoured.
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46
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Khoury ZH, Bugshan A, Lubek JE, Papadimitriou JC, Basile JR, Younis RH. Glycogen-Rich Clear Cell Squamous Cell Carcinoma Originating in the Oral Cavity. Head Neck Pathol 2017; 11:552-560. [PMID: 28342060 PMCID: PMC5677064 DOI: 10.1007/s12105-017-0812-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/20/2017] [Indexed: 12/19/2022]
Abstract
Clear cell squamous cell carcinoma (CCSCC) is a rare histological subtype of squamous cell carcinoma (SCC) that was originally described in the skin. Here, we report a case of a 66-year-old female patient who presented with a fungating ulcerative mass of the left lateral tongue extending anteriorly to the floor of the mouth, and posteriorly to the left retromolar fossa and the oropharynx. The patient had a history of SCC of the left posterior tongue that was treated with partial glossectomy and adjuvant radiotherapy. Representative biopsies were obtained from the floor of the mouth, tongue and retromolar fossa. The examined biopsies showed various degrees of dysplastic surface epithelium with transition into infiltrating epithelial tumor nests and cords with clear cytoplasm and malignant cellular features. Pancytokeratin, CK5/6, and p63 were all diffusely positive. S-100, Calponin, and smooth muscle actin (SMA) were negative. PAS stain was diffusely positive and diastase labile in the tumor clear cells. Sparse areas of mucicarmine positivity were noted. Based on these findings a final diagnosis of a glycogen-rich CCSCC was given. This case represents a very rare histological variant of oral SCC, which is significant for the histological differential diagnosis of clear cell tumors of the oral cavity.
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Affiliation(s)
- Zaid H. Khoury
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland Baltimore, 650 West Baltimore Street, 7th Floor North, Baltimore, MD 21201 USA
| | - Amr Bugshan
- Department of Diagnostic Sciences, School of Dental Medicine, Tufts University, Boston, MA 02111 USA ,Department of Biomedical Dental Science, Dental College, Dammam University, Dammam, Saudi Arabia
| | - Joshua E. Lubek
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Maryland Baltimore, Baltimore, MD 21201 USA
| | - John C. Papadimitriou
- Department of Pathology, School of Medicine, University of Maryland Baltimore, Baltimore, MD 21201 USA
| | - John R. Basile
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland Baltimore, 650 West Baltimore Street, 7th Floor North, Baltimore, MD 21201 USA
| | - Rania H. Younis
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland Baltimore, 650 West Baltimore Street, 7th Floor North, Baltimore, MD 21201 USA
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Relationship between the time to locoregional recurrence and survival in laryngeal squamous-cell carcinoma. Eur Arch Otorhinolaryngol 2017; 274:2267-2271. [DOI: 10.1007/s00405-017-4473-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
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48
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Hamoir M, Holvoet E, Ambroise J, Lengelé B, Schmitz S. Salvage surgery in recurrent head and neck squamous cell carcinoma: Oncologic outcome and predictors of disease free survival. Oral Oncol 2017; 67:1-9. [PMID: 28351561 DOI: 10.1016/j.oraloncology.2017.01.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/05/2017] [Accepted: 01/14/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Salvage surgery in recurrent SCCHN is associated with poor outcomes. This study aimed to better identify suitable surgical candidates and those at high risk of new recurrence. MATERIALS AND METHODS Single-center retrospective analysis of 109 patients undergoing salvage surgery for recurrent SCCHN. Univariate and multivariate analyses were used to identify prognostic factors affecting disease-free survival (DFS). RESULTS The following factors showed a significant impact on DFS: Disease-free interval >6months [HR 0.53; p=0.04], age>70years [HR 0.26; p=0.03], primary chemoradiotherapy [HR 2.39; p<0.01] compared to radiotherapy, oropharynx [HR 5.46; p<0.01] and hypopharynx [HR 3.92; p=<0.01] sites, compared to larynx, initial stage III [HR 7.10; p<0.01] and stage IV [HR 4.13; p<0.01], compared to stage I, locoregional recurrence [HR 4.57; p<0.01], compared to local recurrence. Univariate analysis also identified significant postoperative predictors of poor DFS including flap reconstruction [HR 3.44; p<0.01], postoperative complications [HR 2.09; p=0.01], positive margins [HR 3.64; p<0.01] and close margins [HR 3.83; p<0.01]. On multivariate analysis, oropharynx site [HR 3.98; p<0.01], initial stage III [HR 5.93; p<0.01] and locoregional recurrence [HR 2.93; p=0.04] were independent preoperative prognostic factors for DFS. Positive margins [HR 2.32; p=0.04], close margins [HR 2.94; p=0.02], extracapsular spread (ECS) [HR 4.04; p=0.03] and postoperative complications [HR 3.64; p<0.01] were independent postoperative prognostic factors. CONCLUSIONS Patients with advanced primary nonlaryngeal tumor and locoregional recurrence have limited success with salvage surgery. Because patients with positive margins and ECS are at high risk of relapse, adjuvant treatment should be discussed.
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Affiliation(s)
- Marc Hamoir
- Department of Head & Neck Surgery, St Luc University HospitaI and King Albert II Cancer Institute, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium.
| | - Emma Holvoet
- Department of Head & Neck Surgery, St Luc University HospitaI and King Albert II Cancer Institute, Brussels, Belgium
| | - Jerôme Ambroise
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium; Center for Applied Molecular Technologies (CTMA), Université Catholique de Louvain, Brussels, Belgium
| | - Benoît Lengelé
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium; Department of Plastic and Reconstructive Surgery, King Albert II Cancer Institute & St Luc University Hospital, Brussels, Belgium
| | - Sandra Schmitz
- Department of Head & Neck Surgery, St Luc University HospitaI and King Albert II Cancer Institute, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
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Temporal trends in outcome of oral squamous cell cancer in a resource-limited setting. TUMORI JOURNAL 2016; 2016:276-83. [PMID: 26391762 DOI: 10.5301/tj.5000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 02/05/2023]
Abstract
AIMS AND BACKGROUND Improving survival has been documented for oral squamous cell carcinoma in recent years. It is a common malignancy in Pakistan but survival outcomes have not been reported. The objective of this study was to determine survival and identify independent predictors in patients with oral squamous cell cancer in 2 different time periods. METHODS A retrospective review of patients who received treatment between 2003 and 2012 was performed. Patients were divided into two 5 year groups: group 1 (2003-2007) (n = 628) and group 2 (2008-2012) (n = 920). Demographics, risk factors, treatment approaches, and outcomes were compared. Disease-free and overall survival were calculated. Cox proportional hazard model was used to determine independent predictors of survival. RESULTS A significant difference was present for ethnicity and grade and clinical T and N stage of tumors, with earlier presentation in group 2. More patients underwent surgery (p = 0.001) and had radical treatment intent (p<0.0001) in recent years. Induction chemotherapy (p<0.0001) and palliative chemotherapy (p<0.0001) were used more frequently. No significant difference in disease-free survival was observed but overall 5-year survival improved significantly (23% vs 42%) (p<0.0001). Use of palliative chemotherapy reduced risk of death significantly (hazard ratio [HR] 0.1, confidence interval [CI] 0.02-0.4, p = 0.003), while pathologic nodal positivity significantly increased the risk (HR 2.5, CI 1-5.9, p = 0.03). CONCLUSIONS These results from a single cancer hospital demonstrate improvement in overall survival secondary to early detection, better patient selection, and use of palliative chemotherapy in the later period.
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50
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Gañán L, López M, García J, Esteller E, Quer M, León X. Management of recurrent head and neck cancer: variables related to salvage surgery. EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF OTO-RHINO-LARYNGOLOGICAL SOCIETIES (EUFOS) : AFFILIATED WITH THE GERMAN SOCIETY FOR OTO-RHINO-LARYNGOLOGY - HEAD AND NECK SURGERY 2016. [PMID: 27188507 DOI: 10.1007/s00405‐016‐4093‐3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
After a local and/or regional recurrence of head and neck squamous cell carcinoma (HNSCC) not all patients are candidates to salvage treatment. The objective of this study was to identify the variables related to performance of salvage surgery with curative intent in these patients. We performed a retrospective study of 1088 HNSCC patients with a local and/or regional recurrence. According to a multivariate analysis, the variables related to performance of salvage surgery were the Karnofsky index, the location and extension of the primary tumor, the initial treatment, the disease-free interval between treatment of the initial tumor and diagnosis of the recurrence, and the year the recurrence was diagnosed. Considering salvage surgery as the dependent variable, the results of a recursive partitioning analysis defined four categories of patients in function of the category of local and regional extension of the initial tumor, the location of the primary tumor, the initial treatment and the disease-free interval between treatment of the initial tumor and diagnosis of the recurrence.
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Affiliation(s)
- Laura Gañán
- Otorhinolaryngology Department, Hospital Nostra Senyora de Meritxell, Andorra La Vella, Andorra
| | - Montserrat López
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Jacinto García
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Eduard Esteller
- Otorhinolaryngology Department, Hospital General de Catalunya, Universitat Internacional de Catalunya, San Cugat del Vallès, Barcelona, Spain
| | - Miquel Quer
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Xavier León
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain.
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