Genetic model of transformation and neoplastic progression in laryngeal epithelium

Diagnostic and Prognostic Value of Fibrinogen, Fibrinogen Degradation Products, and Lymphocyte/Monocyte Ratio in Patients With Laryngeal Squamous Cell Carcinoma

OBJECTIVES

Laryngeal squamous cell carcinoma (LSCC) is a common squamous cell carcinoma of the head and neck with no reliable diagnostic biomarkers. However, recent studies have shown that inflammation plays an essential role in tumor development, and several inflammation-based biomarkers have been shown to have prognostic value. This study aimed to investigate the auxiliary value of fibrinogen (FIB), fibrinogen degradation products (FDP), and lymphocyte/monocyte ratio (LMR) in LSCC diagnosis and prognosis.

METHODS

Clinical data from 218 patients recently diagnosed with LSCC and 207 diagnosed with benign laryngeal lesions (BLLs) were retrospectively reviewed. Potential diagnostic biomarkers were evaluated using univariate and multivariate analyses; receiver operating characteristic (ROC) curve analysis was used to identify cut-off values and diagnostic efficiency. Least absolute shrinkage and selection operator (LASSO) Logistic regression analysis was used to screen for independent risk factors to construct a diagnostic nomogram. The chi-squared test and Kaplan-Meier method were performed to investigate the correlation of clinicopathological characteristics and 3-year overall survival (OS) with FIB, FDP, and LMR in patients with LSCC.

RESULTS

FIB, FDP, and LMR levels were significantly different between the LSCC and BLL groups (P < .001), and all were independent risk factors for LSCC. The area under the ROC curve of the diagnostic nomogram was .894. Additionally, FIB, FDP, and LMR were correlated with some invasive clinicopathological features, and LMR ≥4.29 was associated with reduced OS (P = .038).

CONCLUSION

FIB, FDP, and LMR demonstrated potential as biomarkers for the diagnosis and prognosis of LSCC; however, further studies are needed to confirm their efficacy.

The sensitivity of laryngeal findings in predicting high-grade dysplasia in patients with vocal fold leukoplakia undergoing office-based biopsies: A retrospective analysis of 100 cases

Objective

To investigate the sensitivity of laryngeal findings in predicting high-grade dysplasia/carcinoma in situ (CIS) and squamous cell carcinoma (SCC) in patients with vocal fold leukoplakia.

Methods

A retrospective review of the medical records and video recordings of the laryngeal examination of patients with vocal fold leukoplakia who underwent un-sedated office-based laryngeal biopsy in a tertiary referral center between January 2022 and August 2023 was conducted. Laryngeal findings included the size, surface, projection, and edges of the lesion. Vocal fold leukoplakia was classified according to the WHO as benign, low-grade dysplasia, high-grade dysplasia/CIS, and squamous cell carcinoma.

Results

Seventy patients with 100 vocal fold leukoplakia were included. Size was found to have the highest sensitivity with an AUC of 0.730 (95% CI [0.618-0.842], p = 0.002) followed by surface and projection with AUCs of 0.672 (95% CI [0.548-0.795], p = 0.019) and 0.675 (95% CI [0.546-0.804], p = 0.017), respectively. Furthermore, the odds of diagnosing high-risk lesions (high-grade dysplasia/CIS and SCC) were the greatest when the lesion was large and rough (OR = 10.28; 95% CI [3.08-34.36]).

Conclusion

The morphological features of vocal fold leukoplakia may assist the physician in predicting the risk of malignancy. Large and rough lesions were more likely to harbor high-grade dysplasia/CIS and SCC compared to small and smooth lesions.

Office-Based Blue Laser Therapy for Vocal Fold Leukoplakia: A Preliminary Report of 12 Cases

Objective

To report the efficacy of office-based blue laser therapy for vocal fold leukoplakia.

Study Design

A retrospective case series.

Setting

A tertiary care center.

Methods

A retrospective chart review of patients with vocal fold leukoplakia who underwent office-based blue laser therapy between July 2019 and October 2022 was conducted. The video recordings of their laryngeal examination and their voice evaluation were analyzed before and after surgical intervention.

Results

A total of 10 patients, eight with unilateral disease and 2 with bilateral disease, were included in this study. In total, 12 vocal folds with leukoplakia were treated. Nine had a single session and 3 had 2 sessions due to incomplete regression of the lesion after the first laser therapy session. Following treatment, 9 regressed completely (75%) and 3 regressed partially (25%). The mean Voice Handicap Index-10 (VHI-10) score decreased significantly from 15.4 ± 12.9 preoperatively to 3.8 ± 2.86 after surgery (p = .023). There was a statistically significant decrease in the means of grade, roughness, breathiness, asthenia, and strain (p < .05). There was also a statistically significant decrease in the jitter and shimmer percent (p = .008 and p = .048, respectively) and a significant increase in the maximum phonation time from 9.63 ± 3.83 to 13.54 ± 5.92 seconds (p = .039).

Conclusion

This preliminary study indicates that office-based blue laser therapy is an effective treatment modality for vocal fold leukoplakia.

Diagnostic Yield of Office-Based Laryngeal Biopsy in Patients With Leukoplakia; A Case Study With Review of the Literature

OBJECTIVE

To review the authors experience in un-sedated office-based biopsies of patients with vocal fold leukoplakia and to review the literature.

MATERIAL AND METHOD

A retrospective review of 29 patients was conducted.

RESULTS

A total of 41 office-based procedures were performed (eight patients had bilateral vocal fold lesions and four patients had the procedure performed twice). In 26 out of the 41 biopsies, the pathology revealed benign lesion. In eight cases, the pathology showed dysplasia (four high-grade and four low-grade). Seven biopsies revealed squamous cell carcinoma. Five patients underwent suspension micro-laryngoscopy for definitive diagnosis. Four of whom had a change in their diagnosis.

CONCLUSION

Un-sedated office-based biopsy of vocal fold leukoplakia is an alternative to suspension microlaryngoscopy in case of carcinoma or nonmalignant lesions.

A New Online Dynamic Nomogram: Construction and Validation of an Assistant Decision-Making Model for Laryngeal Squamous Cell Carcinoma

Background

Laryngeal squamous cell carcinoma (LSCC) is the most common type of head and neck squamous cell carcinoma. However, there are currently no reliable biomarkers for the diagnosis and prognosis of LSCC. Thus, this study aimed to identify the independent risk factors and develop and validate a new dynamic web-based nomogram that can predict auxiliary laryngeal carcinogenesis.

Methods

Data on the medical history of 221 patients who were recently diagnosed with LSCC and 359 who were recently diagnosed with benign laryngeal lesions (BLLs) at the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed. Using the bootstrap method, 580 patients were divided in a 7:3 ratio into a training cohort (LSCC, 158 patients; BLL, 250 patients) and an internal validation cohort (LSCC, 63 patients; BLL, 109 patients). In addition, a retrospective analysis of 31 patients with LSCC and 54 patients with BLL from Fuyang Hospital affiliated with Anhui Medical University was performed as an external validation cohort. In the training cohort, the relevant indices were initially screened using univariate analysis. Then, least absolute shrinkage and selection operator logistic analysis was used to evaluate the significant potential independent risk factors (P<0.05); a dynamic online diagnostic nomogram, whose discrimination was evaluated using the area under the ROC curve (AUC), was constructed, while the consistency was evaluated using calibration plots. Its clinical application was evaluated by performing a decision curve analysis (DCA) and validated by internal validation of the training set and external validation of the validation set.

Results

Five independent risk factors, sex (odds ratio [OR]: 6.779, P<0.001), age (OR: 9.257, P<0.001), smoking (OR: 2.321, P=0.005), red blood cell width distribution (OR: 2.698, P=0.001), albumin (OR: 0.487, P=0.012), were screened from the results of the multivariate logistic analysis of the training cohort and included in the LSCC diagnostic nomogram. The nomogram predicted LSCC with AUC values of 0.894 in the training cohort, 0.907 in the internal testing cohort, and 0.966 in the external validation cohort. The calibration curve also proved that the nomogram predicted outcomes were close to the ideal curve, the predicted outcomes were consistent with the real outcomes, and the DCA curve showed that all patients could benefit. This finding was also confirmed in the validation cohort.

Conclusion

An online nomogram for LSCC was constructed with good predictive performance, which can be used as a practical approach for the personalized early screening and auxiliary diagnosis of the potential risk factors and assist physicians in making a personalized diagnosis and treatment for patients.

Overview on Molecular Biomarkers for Laryngeal Cancer: Looking for New Answers to an Old Problem

Laryngeal squamous cell cancer (LSCC) accounts for almost 25-30% of all head and neck squamous cell cancers and is clustered according to the affected districts, as this determines distinct tendency to recur and metastasize. A major role for numerous genetic alterations in driving the onset and progression of this neoplasm is emerging. However, major efforts are still required for the identification of molecular markers useful for both early diagnosis and prognostic definition of LSCC that is still characterized by significant morbidity and mortality. Non-coding RNAs appear the most promising as they circulate in all the biological fluids allowing liquid biopsy determination, as well as due to their quick and characteristic modulation useful for non-invasive detection and monitoring of cancer. Other critical aspects are related to recent progress in circulating tumor cells and DNA detection, in metastatic status and chemo-refractoriness prediction, and in the functional interaction of LSCC with chronic inflammation and innate immunity. We review all these aspects taking into account the progress of the technologies in the field of next generation sequencing.

Biomarkers for Malignant Potential in Vocal Fold Leukoplakia: A State of the Art Review

OBJECTIVE

To explore biomarkers that are candidates for understanding potential degeneration to malignancy of vocal fold leukoplakia (VFL), with the goal of guiding future diagnostic and treatment recommendations.

DATA SOURCES

PubMed and Medline search engines.

REVIEW METHODS

A systematic review was conducted by searching the following key words: vocal fold or laryngeal, coupled with leukoplakia or dysplasia, and combined with the term prognostic markers. We collated the biomarkers and their significance, followed by observing the power of their evidence by assessing the quality of the studies according to guidelines of tumor marker prognostic studies (REMARK).

CONCLUSIONS

Prognostic biomarkers in the 16 studies are generally divided into 3 categories according to their biological roles: proliferation (Ki-67, CK-1 RS14024 SNP), cell cycle control (P53, p16, cyclin D1, p57kip2, interleukin-10 [IL-10], miR-10a, and miR-34c), cell adhesion, and invasion (neutrophil-to-lymphocyte ratio, OPN/CD44v6 axis, MMP-1, vascular endothelial growth factor A, MMP-9, serpin peptidase inhibitor 1, plasminogen activator, CTNN/B1, β-catenin, NANOG, HERG1). The prognostic use of these biomarkers is limited due to the variable methodologies, study design, assay methods, and statistical analysis performed.

IMPLICATIONS FOR PRACTICE

Prognostic factors in vocal fold leukoplakia have important clinical implications regarding the potential for malignant degeneration. Although further study is needed, the currently available evidence suggests that p53, p16, cyclin D1, IL-10, NLR, OPN and CD44v6, CTNNB1, and CTTN and FAK might be of particular interest in determining prognosis of VFL as related to malignancy. Future, large, well-designed, prospective studies are expected to determine the prognostic power of these biomarkers before their implementation in routine clinical practice.

Vocal fold leukoplakia: incidence, management, and prevention

PURPOSE OF REVIEW

The purpose of this article is to provide an update on English-language literature evaluating the current understanding of incidence, management, and prevention of vocal fold leukoplakia focusing on premalignancy.

RECENT FINDINGS

Recent studies have continued to try to elucidate factors influencing recurrence and progression of dysplastic disease, though results vary. Although advanced diagnostic techniques have attempted to predict disease behavior, tissue diagnosis continues to be essential. Studies reinforce the necessity of removal of disease as the primary treatment, whereas use of photoangiolytic lasers via the ablative technique has increased, as has transition of some patients into the office-based settings for treatment. Although genetic and molecular testing may hold promise for predictive purposes, further study is necessary, and chemotherapy for recalcitrant disease continues to be an area of study with few case studies being reported.

SUMMARY

Management of vocal fold leukoplakia continues to progress in terms of identification and treatment. Although many work to advance our knowledge in the field and push treatment strategies toward newer avenues, pathologic diagnosis, eradiation of disease on the basis of experience and skill, and close surveillance continue to be paramount.

Mutational profiling can identify laryngeal dysplasia at risk of progression to invasive carcinoma

Early diagnosis of laryngeal squamous cell carcinoma (LSCC) at the stage of dysplasia could greatly improve the outcome of affected patients. For the first time we compared the mutational landscape of non-progressing dysplasia (NPD; n = 42) with progressing dysplasia (PD; n = 24), along with patient-matched LSCC biopsies; a total of 90 samples. Using targeted next-generation sequencing identified non-synonymous mutations in six genes (PIK3CA, FGFR3, TP53, JAK3, MET, FBXW7), and mutations were validated by Sanger sequencing and/or qPCR. Analysis was extended in silico to 530 head and neck (HNSCC) cases using TCGA data. Mutations in PIK3CA and FGFR3 were detected in PD and LSCC cases, as well as other HNSCC cases, but absent in NPD cases. In contrast, mutations in JAK3, MET and FBXW7 were found in NPD cases but not PD, LSCC or other HNSCC cases. TP53 was the most frequently mutated gene in both PD and NPD cases. With the exception of R248W, mutations were mutually exclusive. Moreover, five of seven PD mutations were located in motif H2 of p53, whereas none of the NPD mutations were. In summary, we propose that the mutational profile of laryngeal dysplasia has utility for the early detection of patients at risk of progression.

Current understanding of the tumor microenvironment of laryngeal dysplasia and progression to invasive cancer

PURPOSE OF REVIEW

This review examines the historical tumor progression genetic model of laryngeal carcinomas, from dysplasia to invasive carcinoma and the role of infiltrating immune and inflammatory cells as contributors to this process.

RECENT FINDINGS

Classically, the genetic model of carcinogenesis describes overexpression of oncogenes and/or silencing of tumor suppressor genes which, when combined with exposure to environmental carcinogens over the course of time, results in damage to cellular DNA. Increasing evidence indicates that innate and adaptive immune mediators also play an important role in tumor progression of laryngeal carcinomas. Cellular mediators of immune suppression are often over represented in the tumor microenvironment and these cells release cytokines, which perpetuate immune suppression allowing for tumor immune evasion.

SUMMARY

Future therapies targeting laryngeal malignancies should focus on a combined approach which targets both genetic variations and immune mediators.

Alterations of p14 ARF , p15 INK4b , and p16 INK4a Genes in Primary Laryngeal Squamous Cell Carcinoma

The 9p21 gene cluster, harboring growth suppressive genes p14 ^ARF , p15 ^INK4b , and p16 ^INK4a , is one of the major aberration hotspots in head and neck cancers. We try to elucidate specific aberrations affecting this region, throughout methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) assay. Methylation of the gene was investigated by MS-MLPA in a well-characterized series of 27 laryngeal squamous cell carcinomas and 20 samples of healthy mucosa. Aberrant promoter hypermethylation was confirmed using and methylation-specific. All samples studied except 3 (11 %) presented losses at 9p21 segment. The most common finding was the small deletion (exon 1α) of the p16 ^INK4a locus (44 %). Deletion of the 9p21 gene cluster was identified in 5 cases (18 %). We only found methylation in 8 samples (30 %) for p15 ^IK4b -exon 1. Promoter methylation of p14 ^ARF , p15 ^IK4b and p16 ^INK4a was not detected in any tumor sample. Methylation-specific polymerase chain reaction confirmed the results. Our data indicate that there may be a subgroup of patients in which epigenetic regulation of 9p21 segment might have little relevance. Nevertheless, MS-MLPA could not be suitable for the study of methylation at this region and further research is required.

Laryngeal Squamous Intraepithelial Lesions: An Updated Review on Etiology, Classification, Molecular Changes, and Treatment

Laryngeal carcinogenesis is a multistep process, characterized by an accumulation of genetic changes associated with architectural and cytologic alterations, ranging from squamous hyperplasia to carcinoma in situ and encompassed by the terminology of squamous intraepithelial lesions (SILs). The etiology, classification, genetic changes, and malignant progression of these lesions are reviewed. Tobacco remains the principal etiological factor with gastroesophageal reflux disease recently considered as a possible factor. In contrast, there is little evidence that microbiological agents, especially human papillomavirus infection, are frequently involved in laryngeal carcinogenesis and probably <10% of SILs are driven by biologically active human papillomavirus infection. Light microscopy, despite a degree of subjectivity, remains the mainstay of accurate diagnosis, prognosis, and guidance for a patient's treatment. The currently used classifications, the dysplasia system, squamous intraepithelial neoplasia, and the Ljubljana classification, reflect different standpoints on this important topic. The modified Ljubljana classification, with good interobserver agreement, could be considered as a proposal for a unified classification of laryngeal SILs. This review also briefly discusses recently discovered genetic changes, such as CDKN2A and CTNNB1 genes, and chromosome instability of chromosomes 1 and 7; however, none of these can at present improve histologic diagnosis. Malignant progression of precursor lesions varies from 2% to 74%, according to different studies. Cold-steel microinstruments, CO2 laser, and radiotherapy are used to treat the different grades of precursor lesions. There is as yet no worldwide agreement on the treatment of high-grade lesions and carcinoma in situ.

Genetic gains and losses in oral squamous cell carcinoma: impact on clinical management

PURPOSE

The identification of genetic markers associated with oral cancer is considered essential to improve the diagnosis, prognosis, early tumor and relapse detection and, ultimately, to delineate individualized therapeutic approaches. Here, we aimed at identifying such markers.

METHODS

Multiplex Ligation-dependent Probe Amplification (MLPA) analyses encompassing 133 cancer-related genes were performed on a panel of primary oral tumor samples and its corresponding resection margins (macroscopically tumor-free tissue) allowing, in both types of tissue, the detection of a wide arrange of copy number imbalances on various human chromosomes.

RESULTS

We found that in tumor tissue, from the 133 cancer-related genes included in this study, those that most frequently exhibited copy number gains were located on chromosomal arms 3q, 6p, 8q, 11q, 16p, 16q, 17p, 17q and 19q, whereas those most frequently exhibiting copy number losses were located on chromosomal arms 2q, 3p, 4q, 5q, 8p, 9p, 11q and 18q. Several imbalances were highlighted, i.e., losses of ERBB4, CTNNB1, NFKB1, IL2, IL12B, TUSC3, CDKN2A, CASP1, and gains of MME, BCL6, VEGF, PTK2, PTP4A3, RNF139, CCND1, FGF3, CTTN, MVP, CDH1, BRCA1, CDKN2D, BAX, as well as exon 4 of TP53. Comparisons between tumor and matched macroscopically tumor-free tissues allowed us to build a logistic regression model to predict the tissue type (benign versus malignant). In this model, the TUSC3 gene showed statistical significance, indicating that loss of this gene may serve as a good indicator of malignancy.

CONCLUSIONS

Our results point towards relevance of the above mentioned cancer-related genes as putative genetic markers for oral cancer. For practical clinical purposes, these genetic markers should be validated in additional studies.

Genetic and protein markers related to laryngeal epithelial precursor lesions and their neoplastic progression

CONCLUSION

Various biomarkers might ultimately prove to have prognostic value and could be clinically relevant. It is mandatory confirm the prognostic power of these markers in large, well-designed, and prospective studies.

OBJECTIVE

The aim of this study was to investigate the possible role of specific genes and proteins in laryngeal tumorigenesis.

METHODS

Genetic analysis by multiple ligation-dependent probe amplification and analysis of protein expression by immunohistochemistry were carried out in a series of 50 tissue samples.

RESULTS

In the smoker normal mucosa group TP53 loss was predominant, whereas in the epithelial precursor lesions (EPLs) CDKN2A loss and BCL2L1 gain were most frequent. EPL with progression presented CTNNB1 loss. Positivity at cytoplasm for β-catenin, cyclin D1 and p53 was detected in all EPL cases with progression to invasive carcinoma. Multivariate analysis showed that expression of β-catenin and loss of CTTNB1 were associated with laryngeal cancer risk.