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Dabas SK, Menon NN, Tiwari S, Shukla H, Ranjan R, Gurung B, Bassan BB, Kapoor R, Verma V, Sharma P, Verma D, Sharma A. Robotic Neck Dissection in Head and Neck Cancer via Modified BABA Technique. Laryngoscope 2024; 134:4045-4051. [PMID: 38676455 DOI: 10.1002/lary.31457] [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: 11/22/2023] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Neck dissection forms an important component in the surgical management of head and neck cancers. By using the conventional techniques of neck dissection, a conspicuous scar is inevitable for the patients. The development of robotic assisted neck dissection provides for a scar-free neck along with good oncological and functional outcomes. METHODS A prospective observational study was conducted in our institute from 2020 March to 2022 March, where robotic-assisted neck dissections performed via the modified bilateral axillo-breast insufflation technique. RESULTS Eighty-two patients underwent robotic neck dissections in our institute. Notably, 79 patients were treatment-naïve. The average docking time was 12 min and console time was 160 ± 15 min. The mean lymph node yield was 28.2. The average post-operative stay was 5.6 days. The average follow-up was noted to be 6.4 months. The mean cosmetic satisfaction score in our patients was 4.45. Only one patient presented with nodal recurrence, who was identified as a defaulter for adjuvant treatment. Robotic neck dissection gives similar functional and oncological outcomes as compared with conventional neck dissection. Patients had excellent cosmetic satisfaction following the procedure. The limitations of these techniques include high cost of procedure and longer operating time. This is a level IV evidence study. CONCLUSION Although good oncological, functional, and cosmetic outcomes have been attained in robotic assisted neck dissection, further randomized controlled studies need to be conducted to justify the added costs, cosmetic advantage, and the time taken. LEVEL OF EVIDENCE IV Laryngoscope, 134:4045-4051, 2024.
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Affiliation(s)
- Surendra K Dabas
- Department of Surgical Oncology, BLK-MAX Super Specialty Hospital, Delhi, India
| | - Nandini N Menon
- Department of Surgical Oncology, BLK-MAX Super Specialty Hospital, Delhi, India
| | - Sukirti Tiwari
- Department of Surgical Oncology, BLK-MAX Super Specialty Hospital, Delhi, India
| | - Himanshu Shukla
- Department of Surgical Oncology, BLK-MAX Super Specialty Hospital, Delhi, India
| | - Reetesh Ranjan
- Department of Surgical Oncology, BLK-MAX Super Specialty Hospital, Delhi, India
| | - Bikas Gurung
- Department of Surgical Oncology, BLK-MAX Super Specialty Hospital, Delhi, India
| | - Bharat B Bassan
- Department of Surgical Oncology, BLK-MAX Super Specialty Hospital, Delhi, India
| | - Rahul Kapoor
- Department of Surgical Oncology, BLK-MAX Super Specialty Hospital, Delhi, India
| | - Vinay Verma
- Department of Surgical Oncology, BLK-MAX Super Specialty Hospital, Delhi, India
| | - Pankaj Sharma
- Department of Plastic Surgery, Max Superspeciality Hospital, Delhi, India
| | - Devesh Verma
- Department of Surgical Oncology, BLK-MAX Super Specialty Hospital, Delhi, India
| | - Ashwani Sharma
- Department of Surgical Oncology, BLK-MAX Super Specialty Hospital, Delhi, India
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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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Reichal P, Ramani P, Kizhakkoottu S. Association of Site and Recurrence in Oral Squamous Cell Carcinoma Patients Visiting Private Hospital in Chennai: A Retrospective Study. Cureus 2024; 16:e52774. [PMID: 38389605 PMCID: PMC10882566 DOI: 10.7759/cureus.52774] [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: 12/21/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is the most common malignant neoplasms of the oral cavity. Tongue, buccal mucosa, and gingivobuccal sulcus are the most commonly involved sites for the local recurrence of OSCC. The site of the tumor can be a critical parameter in relation to the recurrence of OSCC because of the varied action of tumor cells in different tumor macro and microenvironments. Hence, the current study aims to evaluate the correlation between the site and recurrence of OSCC among patients visiting private oral cancer hospitals. MATERIALS AND METHODS Details of n=300 OSCC cases reported during 2019-2023, which included primary and recurrent OSCC, were collected. The sample population selected includes 261 primary and 39 recurrent oral squamous cell carcinoma cases. The demographic and clinicopathological data were retracted from the institution's common clinical database and transported to IBM-SPSS 23 software for statistical analysis. Chi-square was done to evaluate the association between site and recurrence status, and p<0.05 was considered statistically significant. RESULTS Males have a high predilection for OSCC, and the recurrent cases account for 13% of the sample population. The buccal mucosa was the most commonly affected site in primary and recurrent OSCC cases. However, the association between the site of the lesion and the status of recurrence was found to be statistically significant, with a p-value of 0.001. CONCLUSION Even though buccal mucosa was the most common site for recurrent OSCC(p value-0.001), the present study carries a small sample size and a location-specific sampling. Hence, further studies must be conducted with a large sample size to test the significant correlation between the site and recurrence rate among patients diagnosed with OSCC.
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Affiliation(s)
- Prathiba Reichal
- Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Pratibha Ramani
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Suvarna Kizhakkoottu
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Dermody SM, McMichael BM, Bellile E, Marchiano EJ, Chinn SB. Lymph node level ratio as a predictor of survival in oral cavity squamous cell carcinoma. Oral Oncol 2023; 146:106572. [PMID: 37742470 DOI: 10.1016/j.oraloncology.2023.106572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To evaluate whether nodal yields and ratios based on level serves as prognostic indicators in patients with oral cavity squamous cell carcinoma undergoing neck dissection. MATERIALS AND METHODS A retrospective analysis of 342 patients with oral cavity squamous cell carcinoma treated surgically between 1998 and 2017 were included.Demographics and clinicopathologic data were collated. Disease specific survival and overall survival were analyzed via Kaplan-Meier method and log-rank test as well as univariable and multivariable Cox models. RESULTS Total nodal yield is associated with improved overall and disease specific survival (p < 0.01). Total positive nodal yield (p < 0.01), positive nodal ratio per level (p < 0.001), and identification of <4 lymph nodes/level (p < 0.001) are associated with worse disease specific survival and overall survival. A ratio of at least 4 lymph nodes/level dissected yields the maximal hazard ratio on for both disease specific and overall survival optimizes the Kaplan-Meier split between survival groups. After controlling for sex, age, margin status, disease stage, extranodal extension, perineural invasion, and lymphovascular invasion as fixed covariates in the Cox models, a nodal level ratio of 4 lymph nodes/level provides hazard ratio (95% CI) of 3.59 (1.69, 7.60); p < 0.0006) for disease free survival and 2.90 (1.54, 5.46; p < 0.001) for overall survival. CONCLUSION Nodal level ratio of < 4 lymph nodes/level is associated with worse disease specific and overall survival in oral cavity squamous cell carcinoma. This level-specific metric may prove useful qualitatively and in predicting survival in oral cavity cancer with broader utility to address variations in levels of neck dissection performed.
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Affiliation(s)
- Sarah M Dermody
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Brennan M McMichael
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Emily Bellile
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Emily J Marchiano
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
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Faisal M, Le NS, Grasl S, Pammer J, Janik S, Heiduschka G, Schratter-Sehn AU, Franz P, Königswieser M, Grasl MC, Erovic BM. Survival Outcome in True Carcinoma of Unknown Primary (tCUP) with p16 + Cervical Metastasis. Int Arch Otorhinolaryngol 2023; 27:e687-e693. [PMID: 37876688 PMCID: PMC10593513 DOI: 10.1055/s-0042-1759575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 08/22/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Age and lymph node ratio have been attributed as independent predictors for survival and recurrence in carcinoma of unknown primary (CUP). Objective The purpose of this study was to analyze the prognostic value of p16 overexpression for CUP in the absence of true primary (TP). Methods The study involved 43 patients who underwent therapeutic lymph node dissection (LND) from 2000 to 2015 after all the diagnostic work up for CUP. Immunohistochemistry for p16 overexpression was performed. Cox proportional hazard regression analysis was used to analyze the prognostic impact on 5-year overall survival (OS) and recurrence-free survival (RFS). Results The male-to-female ratio was 5.1:1, with a median age of 62 years. The clinicopathological data, except for p16 overexpression, did not differ significantly in terms of 5-year OS and RFS. The Cox regression analysis proposed p16 positivity to be an independent prognosticator of regional recurrence-free survival (RRFS) (hazard ratio [HR] 6.180, p = 0.21). The median time to recurrence and death were 10 and 25 months, respectively. Conclusion Cervical metastasis with p16 overexpression is a significant prognostic factor of improved RFS after surgery in CUP. The prognostic significance of lymph node p16 positivity should be further studied.
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Affiliation(s)
- Muhammad Faisal
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
| | - Nguyen-Son Le
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Pammer
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Gregor Heiduschka
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Peter Franz
- Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Hospital, Vienna, Austria
| | - Meinhard Königswieser
- Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Hospital, Vienna, Austria
| | - Matthaeus Ch. Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
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Stampe H, Jakobsen KK, Tvedskov JF, Wessel I, Kiss K, Friborg J, Andersen AO, Grønhøj C, von Buchwald C, Christensen A. Prognostic Value of Lymph Node Yield, Lymph Node Density, and pN in Oral Cancer. Otolaryngol Head Neck Surg 2023; 169:276-285. [PMID: 36066971 DOI: 10.1177/01945998221123927] [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: 06/02/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate thresholds for lymph node yield (LNY), lymph node density (LND), and pN in patients with oral squamous cell carcinoma in relation to previous findings in the literature. STUDY DESIGN Retrospective register-based study. SETTING Copenhagen Oral Cavity Squamous Cell Carcinoma database. METHODS Appropriate thresholds for LNY, LND, and pN were determined by areas under the curve and subsequently subjected to multivariate analysis. Five-year overall survival and 3-year recurrence-free survival were determined by Kaplan-Meier survival curves. RESULTS In total, 413 patients diagnosed with oral squamous cell carcinoma were included. In the pN0 cohort, no superior/prognostic LNY cutoff values were detected. In the pN+ cohort, areas under the curve determined thresholds of LNY, LND, and pN to be 21 nodes, 5%, and 3 metastases, respectively. The 5-year overall survival was 52% for patients with LNY ≥21 vs 38% for patients with LNY <21 (hazard ratio [HR], 1.49; 95% CI, 1.05-2.11; P < .05), 60% for patients with LND ≤5% vs 38% for patients with LND >6% (HR, 1.63; 95% CI, 1.03-2.57; P < .05), and 43% for patients with pN <3 vs 26% for patients with pN ≥3 (HR, 1.40; 95% CI, 1.04-2.15; P < .05). CONCLUSIONS Increased nodal yield, decreased LND, and decreasing number of pN were associated with significantly improved survival outcomes. LNY might serve as a prognosticator of survival as well as a surgical quality indicator. LND may have implications as a tool in cancer staging and treatment planning.
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Affiliation(s)
- Helene Stampe
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Jesper Filtenborg Tvedskov
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Katalin Kiss
- epartment of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Jeppe Friborg
- Department of Clinical Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Amanda Oester Andersen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Anders Christensen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
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Sundaram GA, Chokkattu JJ, Krishnan M, Kumar SP, M S, Lakshmanan S. Lymph Node Ratio as a Prognostic Factor for Oral Tongue Squamous Cell Carcinoma: A Retrospective Study. Cureus 2023; 15:e44109. [PMID: 37750121 PMCID: PMC10518182 DOI: 10.7759/cureus.44109] [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] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
Background Oral squamous cell carcinoma (OSCC) incidence and its mortality have increased recently. The oral part of the tongue is one of the commonest sites for OSCC. Apart from Tumour-Node-Metastasis (TNM) staging, lymph node ratio (LNR) has been implicated as one of the useful predictors for the better clinical outcome of the disease. The aim of the present study was to assess the LNR as a prognostic factor for patients having oral tongue squamous cell carcinoma (OTSCC). Materials and methods It is a retrospective study of 122 patients with OTSCC who were managed primarily by surgery with curative intent from January 2014 to December 2016. The mean lymph node ratio was measured and compared with various parameters of clinical outcome such as five-year overall survival (OS), five-year disease-free survival (DFS), locoregional failure (LRF) within three years, and distant metastasis (DM) within five years using Kruskal-Wallis Test followed by Mann-Whitney Post Hoc Test. The association of LNR with other tumor characteristic features like perineural invasion, extra-nodal extension (ENE), and histopathological grading was also elicited. Results The study population's mean age was 50.5 ± 11.77 years. Among them, 85 were males and 37 were females. On comparing the mean LNR value with patient status after primary treatment, the patients with minimal LNR value had statistically significant five-year OS and five-year DFS (p< 0.001). High mean LNR values were associated with other adverse features like perineural invasion and ENE, which were statistically significant (p<0.001). Receiver operator characteristics (ROC) curve analysis for the LNR parameter for determining the cut-off (0.02) between OS and DFS had 86% sensitivity and 40% specificity. Conclusion The LNR could be an important prognosis factor for OTSCC that helps in determining better clinical outcomes.
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Affiliation(s)
- Gidean A Sundaram
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | | | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Santhosh P Kumar
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Senthilmurugan M
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Saravanan Lakshmanan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
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Liu Y, Ma Y, Shayan G, Sun S, Huang X, Wang K, Qu Y, Chen X, Wu R, Zhang Y, Liu Q, Zhang J, Luo J, Xiao J, Li Y, Yi J, Wang J. Improved Cancer-Specific Risk Stratification by the Lymph Node Ratio-Based Nomogram: A Potential Role in Guiding Postoperative Management Decisions for Oral Cavity Carcinoma. JCO Precis Oncol 2023; 7:e2200365. [PMID: 36603173 DOI: 10.1200/po.22.00365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To develop and validate a nomogram integrating lymph node ratio (LNR) to predict cancer-specific survival (CSS) and assist decision making for postoperative management in nonmetastatic oral cavity squamous cell carcinoma (OCSCC). MATERIALS AND METHODS We retrospectively retrieved 6,760 patients with OCSCC primarily treated with surgery from surveillance, epidemiology, and end results database between 2010 and 2015. They were randomly divided into training and validation cohorts. Performance of the nomogram was evaluated by calibration curve, consistency index, area under the curve, and decision curve analysis and was compared with that of the LNR, positive lymph nodes (PLN) and tumor node metastasis (TNM) staging. According to the individualized nomogram score, patients were classified into three risk cohorts. The therapeutic efficacy of postoperative radiotherapy and chemotherapy was evaluated in each cohort. RESULTS The nomogram incorporated six independent variables, including race, tumor site, grade, T stage, PLN, and LNR. Calibration plots demonstrated a good match between the predicted and observed CSS. C-indices for training and validation cohorts were 0.746 (95% CI, 0.740 to 0.752) and 0.726 (95% CI, 0.713 to 0.739), compared with 0.687, 0.695, and 0.669 for LNR, PLN, and TNM staging, respectively (P < .001). Decision curve analyses confirmed that nomogram showed the best performance in clinical utility. Postoperative radiotherapy presented survival benefit in medium-and high-risk groups but showed a negative effect in the low-risk group. Chemotherapy was only beneficial in the high-risk group. CONCLUSION The LN status-incorporated nomogram demonstrated good discrimination and predictive accuracy of CSS for patients with OCSCC and could identify those most likely to benefit from adjuvant therapy.
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Affiliation(s)
- Yang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuchao Ma
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gulidanna Shayan
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shiran Sun
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaodong Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Qu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesong Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runye Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingfeng Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianghu Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingwei Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianping Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yexiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences (CAMS), Langfang, China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zubair F, Farooq S, Wright S, Schipani S, McMahon J. Patterns of recurrence amongst patients undergoing resection of oral squamous cell carcinoma with curative intent. Br J Oral Maxillofac Surg 2022; 60:1379-1384. [PMID: 36266196 DOI: 10.1016/j.bjoms.2022.07.015] [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: 05/31/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 12/31/2022]
Abstract
This study was aimed to identify key clinicopathological variables that predict recurrence in those undergoing curative resection of oral squamous cell carcinoma (OSCC) with emphasis on initial treatment failure patterns. Between February 2006 to May 2020, clinicopathological data on 833 patients who underwent curative resection of OSCC were gathered. Outcomes of interest included local, regional, distant, and overall recurrence. Univariate analysis was performed to identify significant clinicopathological variables for each recurrence type, and a multivariate regression analysis was utilised to generate predictive models. A total of 187 patients (22.4%) developed recurrent disease; 79 local, 63 regional, and 46 distant. For local recurrence: tumour depth of invasion (DOI) >5--10 mm, tumour DOI >10 mm and modified Glasgow Prognostic Score (mGPS) 2 were independently predictive (c-index 0.708). For regional recurrence: primary OSCC of hard palate/maxilla, pN1, pN3b, and non-cohesive invasive front were independently predictive (c-index 0.738). For distant recurrence: pN1 pN2a, pN2b, pN2c, pN3b, and tumour DOI >10 mm were independently predictive (c-index 0.809). For recurrence at any site; pN1, pN2a, pN2b, pN2c, pN3b, tumour DOI >5-10 mm, tumour DOI >10 mm, mGPS 2, and involved surgical margins were independently predictive (c-index 0.750). Recurrence events after curative treatment for OSCC are relatively predictable on the basis of available clinicopathological characteristics. It seems likely that trials of adjuvant systemic therapy in high-risk OSCC will continue to be designed with emerging therapeutic agents. Trials should focus on those of highest risk of relapse and this study adds clarity to the selection of the correct target population.
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Affiliation(s)
- Farhan Zubair
- University of Glasgow Medical School, University Avenue, Glasgow G12 8QQ, United Kingdom.
| | - Saadia Farooq
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, United Kingdom.
| | - Sylvia Wright
- Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, United Kingdom.
| | - Stefano Schipani
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom.
| | - Jeremy McMahon
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, United Kingdom.
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Tomo S, Araújo WAF, de Castro TF, Neto SC, Collado FU, Biasoli ÉR, Bernabé DG, Miyahara GI. Potential of lymph-node ratio as a prognostic factor for patients with oral squamous cell carcinoma. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e814-e821. [PMID: 35998818 DOI: 10.1016/j.jormas.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND To analyze the influence of the lymph node ratio (LNR) in survival of patients with OSCC METHODS: Clinicopathologic data from patients with OSCC who were treated with curative surgery and neck dissection (ND) with or without adjuvant therapies from 1991 to 2015 was retrospectively assessed. The impact of LNR and other variables on overall survival (OS) and disease-free survival (DFS) was analyzed in univariate and multivariate analyses. RESULTS One hundred nineteen patients were included. In the univariate analysis the LNR had a significant impact on OS (p = 0.01) and DFS (p = 0.01). In the multivariate analysis, the LNR was the only significantly independent factor influencing in the OS (p = 0.03). The adjuvant therapies did not influence on the OS (p = 0.42) and DFS (p = 0.10). CONCLUSIONS The LNR is an independent prognostic factor in patients with OSCC. The LNR alone is not recommended to indicate the performance of adjuvant therapies.
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Affiliation(s)
- Saygo Tomo
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, OJosé Bonifácio Street, 1193, Araçatuba, São Paulo 16015-050, Brazil; Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
| | - Winicius Arildo Ferreira Araújo
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, OJosé Bonifácio Street, 1193, Araçatuba, São Paulo 16015-050, Brazil; Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
| | - Tamara Fernandes de Castro
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, OJosé Bonifácio Street, 1193, Araçatuba, São Paulo 16015-050, Brazil; Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
| | - Sebastião Conrado Neto
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, OJosé Bonifácio Street, 1193, Araçatuba, São Paulo 16015-050, Brazil
| | - Francisco Urbano Collado
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, OJosé Bonifácio Street, 1193, Araçatuba, São Paulo 16015-050, Brazil
| | - Éder Ricardo Biasoli
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, OJosé Bonifácio Street, 1193, Araçatuba, São Paulo 16015-050, Brazil; Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
| | - Daniel Galera Bernabé
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, OJosé Bonifácio Street, 1193, Araçatuba, São Paulo 16015-050, Brazil; Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil
| | - Glauco Issamu Miyahara
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, OJosé Bonifácio Street, 1193, Araçatuba, São Paulo 16015-050, Brazil; Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, Brazil.
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Tomo S, de Castro TF, Araújo WAF, Collado FU, Neto SC, Biasoli ÉR, Bernabé DG, Miyahara GI. Influence of different methods for classification of lymph node metastases on the survival of patients with oral squamous cell carcinoma. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 124:101311. [PMID: 36261061 DOI: 10.1016/j.jormas.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/07/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite the advances in the classification of oral squamous cell carcinoma (OSCC) based on its extension by the TNM system, there is still a need for methods to better classify the patients to predict prognosis and indicate adjuvant therapy. OBJECTIVES To analyze the influence of the number of positive lymph nodes (PN), lymph node ratio (LNR), and log odds of positive lymph nodes (LODDS) in survival of patients with OSCC. METHODS Clinicopathologic data from patients with OSCC who were treated with curative purposes by surgery and neck dissection (ND) with or without subsequent adjuvant therapies from 1991 to 2015 was retrospectively assessed. The impact of the PN, LNR, LODDS, and other variables on overall survival (OS) and disease-free survival (DFS) was analyzed in univariate and multivariate analyses. RESULTS One hundred nineteen patients were included in this study. In the univariate analysis the PN had a significant impact on OS (p = 0.001) and DFS (p = 0.020), and the LNR had a significant impact on the OS (p = 0.042). In the multivariate analysis with other relevant clinicopathologic variables, the PN was the only significantly independent factor influencing in the OS (p = 0.017) but not in DFS (p = 0.096). CONCLUSIONS The PN is an independent prognostic indicator for OS and DFS in patients with OSCC and has the potential to aggregate the current AJCC classification. The LNR has potential to be an important prognostic indicator, but the methods for this classification require lapidation. The LODDS did not demonstrate prognostic potential.
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Zhang D, Li L, Wen T, Wu Y, Ma F. Prognostic Nomogram for Postoperative Hypopharyngeal Squamous Cell Carcinoma to Assist Decision Making for Adjuvant Chemotherapy. J Clin Med 2022; 11:jcm11195801. [PMID: 36233674 PMCID: PMC9573651 DOI: 10.3390/jcm11195801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022] Open
Abstract
We aimed to investigate the effect of lymph node parameters on postoperative hypopharyngeal squamous cell carcinoma (HSCC) and to establish a nomogram to predict its prognosis and assist in adjuvant chemotherapy decisions. A retrospective analysis of postoperative HSCC in the Surveillance, Epidemiology, and End Results database (2004-2019) was performed. Cutoff points for continuous variables were determined by X-tile software. Univariate and multivariate analyses were performed to identify prognostic factors on overall survival (OS), and these variables were used to construct a nomogram. The nomogram's accuracy was internally validated using concordance index, area under the curve, calibration plot, and decision curve analyses. Furthermore, the value of chemotherapy in each risk subgroup was assessed separately based on individualized scores from the nomogram. In total, 404 patients were eligible for analysis, and the median OS was 39 months. Age, origin, primary site, T stage, number of lymph nodes examined, lymph node ratio, and radiotherapy were identified as prognostic factors for OS and incorporated into the nomogram. In both the training and validation cohorts, favorable performance was exhibited compared with the other stage systems, and patients could be classified into low-, intermediate-, and high-risk subgroups. Chemotherapy significantly improved the OS in the high-risk subgroup, whereas chemotherapy did not confer a survival benefit in the low- or intermediate-risk groups. The lymph node parameter-based nomogram model can better stratify the prognosis of HSCC patients and screen out patients who would benefit from chemotherapy, suggesting that the model could be used as a reference for clinical decision making and to avoid overtreatment.
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Affiliation(s)
| | | | | | | | - Fei Ma
- Correspondence: ; Tel.: +86-010-87788060; Fax: +86-010-87715711
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Gartagani Z, Doumas S, Kyriakopoulou A, Economopoulou P, Psaltopoulou T, Kotsantis I, Sergentanis TN, Psyrri A. Lymph Node Ratio as a Prognostic Factor in Neck Dissection in Oral Cancer Patients: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14184456. [PMID: 36139617 PMCID: PMC9497248 DOI: 10.3390/cancers14184456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Lymph node ratio (LNR) is a well-studied prognostic factor in colorectal and breast cancer, and it has been recently evaluated as a clinically relevant biomarker in oral squamous cell carcinoma. LNR represents the ratio of positive lymph nodes extracted in a neck dissection to the total number of nodes harvested (lymph node yield, LNY). Many single-center cohort studies and a few multicenter have assessed the significance of LNR as a prognostic factor in oral cancer. In this systematic review and meta-analysis of 32 studies and 20,994 oral cancer patients, we demonstrate that LNR is an independent prognostic indicator in patients with oral squamous cell carcinoma. Abstract Many studies have evaluated the clinical implications of lymph node ratio (LNR) as a prognostic factor in patients with oral squamous cell carcinoma (OSCC). The main purpose of this systematic review and meta-analysis was to address LNR as a prognosticator in patients with OSCC. A systematic search was conducted in the following databases: PubMed, EMBASE, Google Scholar, OpenGrey, Cochrane library, and ClinicalTrials.gov, and studies between 2009 and 2020 were sought. The pooled relative risk was calculated along with 95% confidence intervals for the following endpoints: overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), distant metastasis-free survival (DMFS), locoregional disease-free survival (LRDFS), local recurrence-free survival (LRFS), and recurrence-free survival (RFS) according to the random-effects model (Der Simonian–Laird approach). Subgroup and meta-regression analyses were performed as well. Finally, 32 cohort studies were eligible, which included 20,994 patients with OSCC. Patients were subdivided into two categories, group YES (studies that included in their analysis only patients with positive lymph nodes) and group NO (studies that did not exclude LNR = 0 patients). In the group YES, patients with high LNR had shorter OS (RR = 1.68, 95% CI: 1.47–1.91), DFS (RR = 1.68, 95% CI: 1.42–1.99), DSS (RR = 1.94, 95% CI: 1.56–2.42), DMFS (RR = 1.83, 95% CI: 1.13–2.96), LRDFS (RR = 1.55, 95% CI: 1.10–2.20), and LRFS (RR = 1.73, 95% CI: 1.41–2.13) compared to patients with low LNR. In the group NO, patients with high LNR in comparison had shorter OS (RR = 2.38, 95% CI: 1.99–2.85), DFS (RR = 2.04, 95% CI: 1.48–2.81), and DSS (RR = 2.90, 95% CI: 2.35–3.57) compared to patients with low LNR. Based on those findings, LNR might be an independent prognostic factor for OS in patients with OSCC and could be incorporated into future classification systems for better risk stratification.
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Affiliation(s)
- Zoi Gartagani
- Department of Clinical Therapeutics, “Alexandra” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Stergios Doumas
- East Kent Hospitals University NHS Foundation Trust, Kent CT1 3NG, UK
| | - Artemis Kyriakopoulou
- Department of Clinical Therapeutics, “Alexandra” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Panagiota Economopoulou
- Department of Internal Medicine, Section of Medical Oncology, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Clinical Therapeutics, “Alexandra” Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Ioannis Kotsantis
- Department of Internal Medicine, Section of Medical Oncology, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Theodoros N. Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 12243 Athens, Greece
| | - Amanda Psyrri
- Department of Internal Medicine, Section of Medical Oncology, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
- Correspondence:
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Voss JO, Freund L, Neumann F, Mrosk F, Rubarth K, Kreutzer K, Doll C, Heiland M, Koerdt S. Prognostic value of lymph node involvement in oral squamous cell carcinoma. Clin Oral Investig 2022; 26:6711-6720. [PMID: 35895143 PMCID: PMC9643253 DOI: 10.1007/s00784-022-04630-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/12/2022] [Indexed: 12/24/2022]
Abstract
Objectives Different parameters have been identified in patients with oral squamous cell carcinomas (OSCC) that have a serious impact on survival, including residual tumour and extracapsular spread. Moreover, other factors, including the lymph node ratio (LNR) and lymph node yield (LNY), have been suggested as prognostic markers. Material and methods This retrospective study included patients diagnosed with OSCC and cervical lymph node metastases during the years 2010–2020. Patients’ records were evaluated regarding lymph node status, final therapy regime, tumour recurrence, time to death, tumour association with death, disease-free survival (DSF), and overall survival (OS). Results In 242 patients with a mean age of 63.57 ± 11.24 years, treated either by selective neck dissection (SND; n = 70) or by modified radical neck dissection (MRND; n = 172), 5772 lymph nodes were detected. The LNR and LNY were identified as independent risk factors in OS and DFS. The optimal cut-off point for the LNY was ≥ 17 lymph nodes in the SND and ≥ 27 lymph nodes in the MRND group. The metastatic lymph node clearance (MLNC) was established as a score to relate the LNR and LNY to the extent of lymph node removal. Survival analysis showed statistically significant differences among score levels. Conclusions As information about the extent of nodal dissection is excluded from LNR and LNY, we propose the use of a new scoring system comprising individual cut-off values for LNY and LNR with regard to the extent of neck dissection. Clinical Relevance MLNC might help to identify high-risk OSCC patients with metastatic lymph nodes.
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Affiliation(s)
- Jan Oliver Voss
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany. .,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Lea Freund
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Felix Neumann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Friedrich Mrosk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kerstin Rubarth
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117, Berlin, Germany
| | - Kilian Kreutzer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Doll
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Max Heiland
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Steffen Koerdt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
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Kang CJ, Wen YW, Lee SR, Ng SH, Tsai CY, Lee LY, Chu YH, 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. Towards an Improved Pathological Node Classification for Prognostic Stratification of Patients With Oral Cavity Squamous Cell Carcinoma: Results From a Nationwide Registry Study. Front Oncol 2022; 12:910158. [PMID: 35837108 PMCID: PMC9273780 DOI: 10.3389/fonc.2022.910158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/20/2022] [Indexed: 12/30/2022] Open
Abstract
BackgroundTo assess the prognostic significance of different nodal parameters [i.e., number of pathologically positive nodes, log odds of positive lymph nodes, lymph node ratio (LNR), and extra-nodal extension (ENE)] in Taiwanese patients with oral cavity squamous cell carcinoma (OCSCC), and to devise an optimized pN classification system for predicting survival in OCSCC.MethodsA total of 4287 Taiwanese patients with first primary OCSCC and nodal metastases were enrolled. Cox proportional hazards regression analysis with the spline method was applied to identify the optimal cut-off values for LNR, log odds of positive lymph nodes, and number of pathologically positive nodes.ResultsOn multivariable analysis, we identified a LNR ≥0.078/0.079, the presence of at least three pathologically positive nodes, and ENE as independent prognosticators for 5-year disease-specific survival (DSS) and overall survival (OS) rates. We therefore devised a four-point prognostic scoring system according to the presence or absence of each variable. The 5-year DSS and OS rates of patients with scores of 0−3 were 70%/62%/50%/36% (p <0.0001) and 61%/52%/40%25%, respectively (p <0.0001). On analyzing the AJCC 2017 pN classification, patients with pN3a displayed better survival rates than those with pN2 disease. The 5-year DSS and OS rates of patients with pN1/pN2/pN3a/pN3b disease were 72%/60%/67%/43% (p <0.0001) and 63%/51%/67%/33%, respectively (p <0.0001).ConclusionsThree nodal parameters (i.e., a LNR ≥0.078/0.079, the presence of at least three pathologically positive nodes, and ENE) assessed in combination provided a better prognostic stratification than the traditional AJCC pN classification.
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Affiliation(s)
- Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Wen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Ru Lee
- Research Service Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chi-Ying Tsai
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsia Chu
- Department of Pathology, 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
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsun Hsieh
- Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Li-Ang Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ku-Hao Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chien Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ni Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Li-Jen Hsin
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Nai-Ming Cheng
- Department of Nuclear Medicine and Molecular Imaging Center, 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, Taoyuan, Taiwan
- *Correspondence: Chun-Ta Liao,
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Factors Influencing the Outcome of Head and Neck Cancer of Unknown Primary (HNCUP). J Clin Med 2022; 11:jcm11102689. [PMID: 35628814 PMCID: PMC9143827 DOI: 10.3390/jcm11102689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/03/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background: This study on patients with head and neck cancer of unknown primary (HNCUP) assesses the impact of surgical and non-surgical treatment modalities and the tumour biology on the oncological outcome. Methods: A total of 80 patients with HNCUP (UICC I−IV) were treated with simultaneous neck dissection followed by adjuvant therapy, between 1 January 2007 and 31 March 2020. As the primary objective, the influence of treatment modalities on the overall survival (OS), the disease-specific survival (DSS) and the progression-free survival (PFS) were analysed in terms of cox regression and recursive partitioning. The tumour biology served as secondary objectives. Results: The 5-year OS for the entire cohort was 67.7%, (95% CI: 54.2−81.2%), the 5-year DSS was 82.3% (72.1−92.5%) and the 5-year PFS was 72.8% (61.8−83.8%). Cox regression revealed that patients undergoing adjuvant radiotherapy only had a four times higher risk to die compared to patients receiving chemoradiation therapy (HR = 4.45 (1.40; 14.17), p = 0.012). The development of distant metastases had a significantly negative impact on OS (HR = 8.24 (3.21−21.15), p < 0.001) and DSS (HR = 23.79 (6.32−89.56), p < 0.001). Recursive portioning underlined the negative influence of distant metastases on OS (3.2-fold increase in death probability) and DSS (4.3-fold increase in death probability), while an UICC stage of IVb increased the risk for further progression of the disease by a factor of 2. Conclusions: The presence of distant metastases as well as adjuvant treatment with radiation without concomitant chemotherapy, were among others, significant predictors for the overall survival of HNCUP patients, with distant metastases being the most significant predictor.
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Mamic M, Lucijanic M, Lorencin M, Suton P, Luksic I. Impact of lymph node ratio on survival and recurrence outcomes in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2022; 51:1257-1263. [DOI: 10.1016/j.ijom.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/29/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
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Kouka M, Al-Ahmar E, Büntzel J, Kaftan H, Böger D, Müller A, Schultze-Mosgau S, Ernst T, Guntinas-Lichius O. The log odds of positive neck lymph nodes is a superior lymph node predictor for overall survival in head and neck cancer: a population-based analysis in Germany. Eur Arch Otorhinolaryngol 2021; 279:3587-3595. [PMID: 34807283 PMCID: PMC9130179 DOI: 10.1007/s00405-021-07176-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This population-based study investigated the influence of different lymph node (LN) classifications on overall survival (OS) in head and neck cancer (HNC). METHODS 401 patients (median age: 57 years; 47% stage IV) of the Thuringian cancer registries with diagnosis of a primary HNC receiving a neck dissection (ND) in 2009 and 2010 were included. OS was assessed in relation to total number of LN removed, number of positive LN, LN ratio, and log odds of positive LN (LODDS). RESULTS Mean number of LODDS was 0-0.96 ± 0.57. When limiting the multivariate analysis to TNM stage, only the UICC staging (stage IV: HR 9.218; 95% CI 2.721-31.224; p < 0.001) and LODDS > - 1.0 (HR 2.120; 95% CI 1.129-3.982; p = 0.019) were independently associated with lower OS. CONCLUSION LODDS was an independent and superior predictor for OS in HNC in a population-based setting with representative real-life data.
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Affiliation(s)
- Mussab Kouka
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Elisa Al-Ahmar
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Jens Büntzel
- Department of Otorhinolaryngology, Suedharzklinikum Nordhausen, Nordhausen, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany
| | - Daniel Böger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany
| | - Andreas Müller
- Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Stefan Schultze-Mosgau
- Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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19
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Cheng NM, Kang CJ, Tsai CY, Lee LY, Lin CY, Hsueh C, Fan KH, Wang HM, Hsieh CH, Ng SH, Yeh CH, Lin CH, Tsao CK, Fang TJ, Huang SF, Lee LA, Fang KH, Wang YC, Lin WN, Hsin LJ, Yen TC, Liao CT. Improved prognostic stratification of patients with pN3b oral cavity cancer based on maximum standardized uptake value of metastatic nodes, lymph node ratio, and level of cervical nodal metastases. Oral Oncol 2021; 123:105593. [PMID: 34768211 DOI: 10.1016/j.oraloncology.2021.105593] [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: 08/12/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The prognosis of pN3b oral cavity squamous cell carcinoma (OCSCC) remains heterogeneous. We sought to improve the prognostic stratification of patients with pN3b OCSCC through a combined analysis of FDG-PET parameters and clinicopathological risk factors (RFs). METHODS From 2001 to 2019, complete data on maximum standardized uptake values derived from FDG-PET of neck metastatic nodes (SUV-nodal-max) and clinicopathological RFs were available for 257 patients with pN3b disease. RESULTS Using the 5-year disease-free survival (DFS) as the outcome of interest, the optimal cutoff points for SUV-nodal-max and lymph node ratio (LNR) were 15.9 and 0.17, respectively. The 5-year DFS rates/(number of cases) for patients with pN3b disease were as follows: SUV-nodal-max < 15.9 versus ≥ 15.9, 49%(226)/21%(31), p = 0.000003; LNR < 0.17 versus ≥ 0.17, 49%(230)/17%(27), p = 0.000117; absence versus presence of neck level IV/V metastases, 49%(230)/15%(27), p = 0.000004. Multivariable analyses revealed that SUV-nodal-max ≥ 15.9, LNR ≥ 0.17, and level IV/V metastases were independent prognosticators for 5-year distant metastases (DM), DFS, disease-specific survival (DSS), and overall survival (OS) rates. Based on these variables, we devised a scoring system that identified three distinct prognostic subgroups at low (score 0, n = 190), intermediate (score 1, n = 51), and high (scores 2-3, n = 16) risk. The 5-year rates of patients with pN3b disease deemed to be at low/intermediate/high risk were as follows: DM, 31%/52%/89%; DFS, 54%/26%/0%; DSS, 59%/36%/8%; OS, 42%/31%/6%, respectively; all p < 0.001. CONCLUSIONS A scoring system based on SUV-nodal-max, LNR, and level IV/V metastases improves the prognostic stratification of OCSCC patients with pN3b disease.
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Affiliation(s)
- Nai-Ming Cheng
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Nuclear Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chi-Ying Tsai
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Particle Physics and Beam Delivery Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Ang Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ku-Hao Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yu-Chien Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Wan-Ni Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Jen Hsin
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
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20
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Deshmukh A, Rao KN, Arora RD, Nagarkar NM, Singh A, Shetty OS. Molecular Insights into Oral Malignancy. Indian J Surg Oncol 2021; 13:267-280. [DOI: 10.1007/s13193-021-01431-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
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21
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Li X, Lin C, Yan J, Chen Q, Sun X, Liu S, Guo S, Liu L, Xie H, Tang Q, Liang Y, Guo L, Li H, Liu X, Guo X, Tang L, Mai H. Establishment of a prognostic scoring model for regional recurrent nasopharyngeal carcinoma after neck dissection. Cancer Biol Med 2021; 17:227-236. [PMID: 32296590 PMCID: PMC7142849 DOI: 10.20892/j.issn.2095-3941.2019.0263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/30/2019] [Indexed: 11/18/2022] Open
Abstract
Objective: The main aim of this study was to establish a scoring model to predict risk of progression and survival in patients with regionally recurrent nasopharyngeal carcinoma (NPC). Methods: Three hundred and forty-eight patients subjected to neck dissection from 2003 to 2017 were included for study. Clinicopathologic information for each patient was analyzed. Independent prognostic factors were selected using the Cox proportional hazards model and incorporated into the scoring model. Concordance index (C-index) and calibration curves were used to verify discrimination and calibration, respectively and the results validated using bootstrap resampling. Results: Microscopic positive lymph node > 2 [hazard ratio (HR), 2.19; 95% confidence interval (CI), 1.30–3.68; P = 0.003], extranodal extension (HR, 2.75; 95% CI, 1.69–4.47; P < 0.001), and lower neck involvement (HR, 1.78; 95% CI, 1.04–3.04; P = 0.034) were identified from multivariate analysis as independent factors for overall survival (OS). A qualitative 4-point scale was generated to stratify patients into 4 risk groups for predicting OS and progression-free survival (PFS). The novel scoring model demonstrated enhanced discrimination (C-index = 0.69; 95% CI, 0.62–0.76) relative to the original recurrent tumor-node-metastasis (rTNM) staging system (C-index = 0.56; 95% CI, 0.50–0.62), and was internally validated with a bootstrap-adjusted C-index of 0.70. The calibration curve showed good agreement between predicted probabilities and actual observations. Conclusions: The scoring system established in this study based on a large regionally recurrent NPC cohort fills a gap regarding assessment of risk and prediction of survival outcomes after neck dissection in this population and could be further applied to identify high-risk patients who may benefit from more aggressive intervention.
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Affiliation(s)
- Xiaoyun Li
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Chao Lin
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jinjie Yan
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Qiuyan Chen
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xuesong Sun
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Sailan Liu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Shanshan Guo
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Liting Liu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Haojun Xie
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Qingnan Tang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yujing Liang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ling Guo
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hao Li
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xuekui Liu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiang Guo
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Linquan Tang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Haiqiang Mai
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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22
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Megwalu UC, Ma Y. Racial/Ethnic Disparities in Use of High-Quality Hospitals Among Oral Cancer Patients in California. Laryngoscope 2021; 132:793-800. [PMID: 34405895 DOI: 10.1002/lary.29830] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/28/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To examine racial/ethnic differences in use of high-quality hospitals in patients treated for oral cancer in California. STUDY DESIGN Retrospective cancer database cohort study. METHODS Data were extracted from the California Cancer Registry data set linked with discharge records and hospital characteristics from the California Office of Statewide Health Planning and Development, and with neighborhood characteristics from the California Neighborhoods Data System. The study cohort comprised adult patients with oral cavity malignancy diagnosed between 2004 and 2015. Principal component analysis was used to generate the composite oral cancer-specific hospital quality score. The impact of hospital quality on survival was assessed using Cox regression models with robust standard error using sandwich variance estimators. Poisson regression models with robust error variance were used to assess the association between race/ethnicity and use of high-quality hospitals. RESULTS Patients treated in hospitals ranked in the top quartile for quality had improved overall survival (hazard ratio 0.86, 95% confidence intervals [CI] 0.76-0.98), after adjusting for tumor stage, Charlson comorbidity score, neck dissection, radiotherapy, age, sex, race, and insurance status. Black patients (risk ratio 0.87, 95% CI 0.77-0.98) were less likely to be treated in high-quality hospitals compared with non-Hispanic White patients. CONCLUSION Treatment in high-quality hospitals is associated with improved survival for patients with oral cancer. However, black patients are less likely to be treated in high-quality hospitals compared with non-Hispanic white patients. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Yifei Ma
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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23
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Liu XC, Ma SR, Shi S, Zhao YF, Jia J. Prognostic significance of lymph node ratio in patients with squamous cell carcinoma of the floor of the mouth. Int J Oral Maxillofac Surg 2021; 51:307-313. [PMID: 34281747 DOI: 10.1016/j.ijom.2021.07.001] [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: 12/24/2020] [Revised: 04/21/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022]
Abstract
The lymph node ratio (LNR) has been proposed as an independent prognostic factor for survival in patients with oral squamous cell carcinoma (OSCC). However, little attention has been paid to its role in the specific subsite of the floor of the mouth (FOM). The purpose of this study was to evaluate the prognostic significance of the LNR in patients with FOM SCC. A retrospective analysis of 92 patients with FOM SCC who were treated with primary curative resection and neck dissection was conducted. Overall survival (OS) and disease-free survival (DFS) were used to evaluate the prognostic significance of the LNR. Both of these parameters were significantly worse (P < 0.001) in patients with neck metastases. The mean LNR was 0.145 in patients with positive lymph nodes. A LNR <0.145 was predictive of longer DFS, while the receiver operating characteristic curve analysis demonstrated that a LNR ≥0.175 indicated a significantly lower OS. This study confirms that metastatic cervical lymph nodes correlate with an adverse prognosis in patients with FOM SCC, and specifically, a LNR ≥0.145 is predictive. Therefore, the LNR in patients with FOM SCC may be a predictor of survival in these patients.
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Affiliation(s)
- X C Liu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine - Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - S R Ma
- Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - S Shi
- Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Y F Zhao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine - Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - J Jia
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine - Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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24
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Combined role of lymph node ratio and serum thyroglobulin levels in predicting prognosis of papillary thyroid carcinoma. Nucl Med Commun 2021; 41:733-739. [PMID: 32427697 DOI: 10.1097/mnm.0000000000001214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate a prognostic value of the extent of metastatic lymph node combined with TSH-stimulated serum thyroglobulin (sTg) measured just before radioactive iodine (RAI) therapy in patients with papillary thyroid cancer (PTC). METHODS The retrospective study included 468 patients with PTC who underwent total thyroidectomy with neck dissection and postoperative RAI therapy. The extent of metastatic lymph node was evaluated with the lymph node ratio (LNR) which was defined as the number of metastatic lymph nodes out of the number of total removed lymph nodes. We investigated which factors could significantly predict persistent or recurrent disease (PRD). RESULTS LNR ≥0.4 (P = 0.002) and sTg ≥6.0 ng/mL (P < 0.001) were associated with PRD in univariate analysis. In multivariate analysis, only male [hazard ratio: 2.35, 95% confidence interval (CI): 1.18-4.66, P = 0.014] and sTg (hazard ratio: 9.35, 95% CI: 4.44-19.67, P < 0.001) were associated with PRD prediction. When we divided patients into two groups (patients with sTg level < 6.0 ng/mL and those with sTg level ≥ 6.0 ng/mL), LNR (≥0.4) was a significant predictor of PRD in patients with sTg <6.0 ng/mL (hazard ratio: 4.38, 95% CI: 1.22-15.72, P = 0.024). CONCLUSIONS LNR ≥0.4 was a significant predictor of PRD when the sTg level was <6.0 ng/mL. LNR should be used in combination with a relatively low level of serum sTg to predict the prognosis of patients with PTC.
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25
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Hagiwara S, Sasaki E, Hasegawa Y, Suzuki H, Nishikawa D, Beppu S, Terada H, Sawabe M, Takahashi M, Hanai N. Serum CD109 levels reflect the node metastasis status in head and neck squamous cell carcinoma. Cancer Med 2021; 10:1335-1346. [PMID: 33565282 PMCID: PMC7926025 DOI: 10.1002/cam4.3737] [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: 05/27/2020] [Revised: 12/12/2020] [Accepted: 12/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background Various biomarkers are being developed for the early diagnosis of cancer and for predicting its prognosis. The aim of this study is to evaluate the diagnostic significance of serum CD109 in head and neck squamous cell carcinoma (HNSCC). Methods The serum CD109 levels in a total of 112 serum samples collected before and after surgery from 56 HNSCC patients were analyzed with an enzyme‐linked immunosorbent assay (ELISA). The clinical factor that showed a statistically significant association with both the preoperative serum CD109 level, and the CD109 index: which was defined as the ratio of the preoperative serum CD109 level to the postoperative serum CD109 level, were assessed. The correlations between the serum CD109 levels and lymph node density (LND), pathological features such as lymphatic invasion, and serum SCC antigen levels were also assessed. Results The ELISA measurement revealed that preoperative serum CD109 levels were elevated in patients with node metastasis‐positive and stage IV disease, in comparison to those with node metastasis‐negative and Stage I+II+III disease, respectively. A multiple regression analysis indicated that serum CD109 level was significantly associated with the node metastasis status. A Spearman's rank correlation analysis also revealed a positive correlation between the preoperative serum CD109 level and LND. Furthermore, the probabilities of the overall and relapse‐free survival were significantly lower in patients with a preoperative serum CD109 level of ≥38.0 ng/ml and a CD109 index of ≥1.6, respectively, than in others. There was no significant correlation between the serum CD109 and SCC antigen levels. Conclusions The serum CD109 levels were elevated in patients with advanced stage disease, reflecting the node metastasis status. CD109 in sera could be a novel prognostic marker for HNSCC involving lymph node metastasis.
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Affiliation(s)
- Sumitaka Hagiwara
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery - Otolaryngology, Asahi University Hospital, Gifu, Japan
| | - Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Daisuke Nishikawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shintaro Beppu
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hoshino Terada
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Michi Sawabe
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masahide Takahashi
- International Center for Cell and Gene Therapy, Fujita Health University, Toyoake, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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26
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O'Connell JE, Saeed A, Jones HB, Lloyd CJ. Prognostic indicators and outcomes following surgical management of metastatic cutaneous squamous cell carcinoma of the head and neck. Br J Oral Maxillofac Surg 2021; 59:1186-1191. [PMID: 34674892 DOI: 10.1016/j.bjoms.2021.01.003] [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: 09/28/2020] [Accepted: 01/08/2021] [Indexed: 11/24/2022]
Abstract
Metastatic cutaneous SCC carries a poor prognosis with five-year survival of 25%-57%. The aim of this study is to examine the outcomes following surgery with adjuvant therapy for management of metastatic cSCC in a UK-based population. This is a retrospective review of patients with metastatic cSCC of the head and neck who underwent primary surgery at a regional center during a six-year period. Overall and disease specific survival were calculated using Kaplan-Meier and log-rank tests. Results were reported as hazard ratios (HR) with 95% confidence intervals. Forty-five patients met the inclusion criteria. The mean time to discovery of metastases was 9.3 months (range, 0-40 months). Only two patients (4%) had discovery of metastases after two years, with none after 3.3 years. The overall five5-year survival was 31% (95% CI 15%to 48%) with two-year survival at 48% (95% CI 31%to 63%). The median OS survival was 722 days (95% CI 607to 1359). Patients aged >80 years had a decreased OS. This is the largest UK based study documenting the overall and disease specific survival associated with metastatic cutaneous SCC of the head and neck. Our overall survival is comparable to similar studies, but remains poor. Total number of involved nodes, and lymph node ratio were not statistically significant.
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Affiliation(s)
- J E O'Connell
- Department of Maxillofacial, Head and Neck Surgery, Betsi Cadwaladar University Hospital, Glan Clwyd, Bodelwyddan, North Wales LL18 5UJ, UK.
| | - A Saeed
- Department of Maxillofacial, Head and Neck Surgery, Betsi Cadwaladar University Hospital, Glan Clwyd, Bodelwyddan, North Wales LL18 5UJ, UK.
| | - H B Jones
- Department of Maxillofacial, Head and Neck Surgery, Betsi Cadwaladar University Hospital, Glan Clwyd, Bodelwyddan, North Wales LL18 5UJ, UK.
| | - C J Lloyd
- Department of Maxillofacial, Head and Neck Surgery, Betsi Cadwaladar University Hospital, Glan Clwyd, Bodelwyddan, North Wales LL18 5UJ, UK.
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27
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Yang CC, Kang BH, Liu WS, Yin CH, Lee CC. Association of a multiple-step action with cervical lymph node yield of oral cancer patients in an Asian country. BMC Oral Health 2021; 21:29. [PMID: 33441108 PMCID: PMC7805045 DOI: 10.1186/s12903-021-01389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background High quality lymph node (LN) yield could increase survival, however strategies to improve LN yield have been seldom reported. This study aimed to assess the multiple-step action to promote quality of neck dissection in oral cancer. Methods A total of 400 patients with oral cancer who underwent primary tumor resection and neck dissection, including elective and radical neck dissection, were recruited after propensity score matching by clinical T and N categories between January 2009 and September 2018. Patients were treated by two independent departments in our institute. A multiple-step action was initiated in October 2015 in one department, and another department was as a control group. The impact of multiple-step action on LN yield and regional recurrence were analyzed using multivariate analysis and difference-in-differences (DID) linear regression analysis. Results The mean patient age was 55.2 + 11.1 years, and 92% were male. A total of 180 (45%) patients had T3-4 disease, and 129 (32%) patients had N2-3 disease. The multivariate linear regression and DID analyses revealed that multiple-step action had a positive effect on LN yield. A net improvement of LN yield with a coefficient of 13.78 (p < 0.001) after launching multiple-step action (since October 2015) was observed. A borderline protective effect of multiple-step action for cN0 patients with a reduced regional recurrence rate of 11.6% (p = 0.072) through DID analysis was noted. Conclusions Multiple-step action was associated with increased LN yield and decreased regional recurrence in patients with oral cancer. The observed activity may promote surgeons to improve the quality of neck dissections, is feasible, and could be applied to a widespread patient population.
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Affiliation(s)
- Ching-Chieh Yang
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Bor-Hwang Kang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Pharmacy, Tajen University, Pingtung, Taiwan
| | - Wen-Shan Liu
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, 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 Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
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Nocon CC, Kuchta K, Bhayani MK. Prognostic value of lymph node ratio versus American Joint Committee on Cancer N classification for surgically resected human papillomavirus-associated oropharyngeal squamous cell carcinoma. Head Neck 2021; 43:1476-1486. [PMID: 33415799 DOI: 10.1002/hed.26605] [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: 05/30/2020] [Revised: 11/15/2020] [Accepted: 12/30/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We compared prognostic values of lymph node ratio (LNR) and AJCC 8 N classification in surgically resected human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). METHODS Using the National Cancer Database, we identified patients with HPV-associated OPSCC from 2010 to 2016 who underwent definitive surgical resection. Patients were analyzed by nodal grouping (LNR, N stage) and adjuvant radiation therapy(RT). Primary endpoint was overall survival. RESULTS We identified 4166 patients. Survival analysis showed significant improvement for LNR≤6% versus >6% (5 year OS% 92.7% vs. 83.7%, p < 0.001). N classification demonstrated good prognostic ability (5 year OS% for pN0, pN1, pN2 were 91.3%, 90.1%, 78.8%, p < 0.001), but poor separation among stages (compared to pN0: pN1 HR 1.40 [95% CI 0.63, 3.09], p = 0.41; pN2 HR 2.50 [95% CI 1.08, 5.81], p = 0.033). RT improved survival in the LNR > 6% group (5 year OS% 85.4% vs. 74.9%, p < 0.001; HR 0.41 [95% CI 0.28, 0.58], p < 0.001). CONCLUSIONS LNR should be considered an adjunct category in future staging systems for HPV-associated OPSCC.
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Affiliation(s)
- Cheryl C Nocon
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA.,Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Kristine Kuchta
- Research Institute, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Mihir K Bhayani
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA.,Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
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Yang CC, Kang BH, Liu WS, Yin CH, Lee CC. Postoperative radiotherapy is associated with improved survival in pT1-2N1 oral and oropharyngeal cancer without adequate neck dissection. Radiat Oncol 2021; 16:6. [PMID: 33407647 PMCID: PMC7788971 DOI: 10.1186/s13014-020-01736-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background To assess the benefit of postoperative radiotherapy in patients with pT1-2N1M0 oral and oropharyngeal cancer by the quality of neck dissection. Methods In the Surveillance, Epidemiology, and End Results database, pT1-2N1M0 oral and oropharyngeal cancer patients treated by primary tumor resection and neck dissection with or without radiotherapy were included between 2004 and 2015. Univariate and multivariate analysis were used to explore the effect of adjuvant radiotherapy on 5-year overall survival (OS) and disease-specific survival (DSS) among different quality of neck dissection. Results Of the 1765 patients identified, 1108 (62.8%) had oral cancer, 1141 (64.6%) were men, and 1067 (60.5%) underwent adjuvant radiotherapy. After adjusting for confounding factors, postoperative radiotherapy reduced the adjusted hazard ratio (aHR) of 5-year OS to 0.64 (95% confidence interval [CI] 0.49–0.84) in those with < 18 lymph nodes (LNs) removed, but not in those with 19–24 LNs removed (aHR 0.78; 95% CI 0.73–1.13), and in those with ≥ 25 LNs removed (aHR 0.96; 95% CI 0.75–1.24). For 5-year DSS, similar effect was observed. The adjusted hazard ratio was 0.66 (95% confidence interval, 0.45–0.97) in those with < 18 LNs. The protective effect was not seen in those with 18–24 LNs (aHR 1.07; 95% CI 0.59–1.96), and in those with ≥ 25 LNs (aHR 1.12; 95% CI 0.81–1.56). Sensitivity testing also showed a robust protective effect of postoperative radiotherapy in patients with < 18 LNs removed. Conclusion Radiotherapy was associated with improved survival in pT1-2N1M0 oral and oropharyngeal cancer patients without adequate neck dissection.
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Affiliation(s)
- Ching-Chieh Yang
- Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Pharmacy, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Bor-Hwang Kang
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Pharmacy, Tajen University, Pingtung, Taiwan
| | - Wen-Shan Liu
- Department of Radiaton Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, 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. .,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
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León X, Neumann E, Gutierrez A, García J, Quer M, López M. Prognostic Capacity of the Lymph Node Ratio in Squamous Cell Carcinomas of the Head and Neck. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jin W, Zhu Z, Wu Y, Ding X, Wu H, Song X, Wu Y. Prognostic value of log odds of positive lymph nodes in patients with resectable oral squamous cell carcinoma. Oral Oncol 2020; 108:104709. [PMID: 32535340 DOI: 10.1016/j.oraloncology.2020.104709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Log odds of positive lymph nodes (LODDS) was reported to be significantly associated with prognosis in several malignant tumors. However, few are the studies on the correlation between LODDS and overall survival (OS) in patients with oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS A retrospective study including 233 patients with OSCC during 2009 to 2013 was conducted. We probed the correlation between clinicopathological factor, LODDS, lymph node ratio (LNR), pN and OS. The potential prognostic factor and the independent factor were calculated using univariate analysis and multivariate analysis respectively. The goodness of fit and the discriminability was analyzed with Somer's D value, Nagelkerke R2 index, and Akaike information criterion (AIC). Kaplan-Meier survival curve of OS was contrasted by log-rank test in LODDS, LNR and pN, respectively. RESULTS According to the X-tile, the cut-off values are -1.491 and -0.763 for LODDS, 0.024 and 0.133 for LNR. LODDS, LNR and pN were significantly correlated with OS by univariate analysis (P < 0.001). Multivariate analysis demonstrated LODDS, LNR and pN as an independent prognostic factors for OS (P < 0.01). Compared with pN and LNR models, LODDS showed the strongest predictive power. LODDS was superior to LNR and pN in predicting outcomes in patients with no positive lymph nodes and inadequate neck dissection. CONCLUSION LODDS would be incorporated into future N classification, which may be conducive to discern the prognosis of OSCC and make a decision of adjuvant therapy in clinical practice.
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Affiliation(s)
- Wanyong Jin
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Zaiou Zhu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Yuanyuan Wu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Xu Ding
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Heming Wu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Xiaomeng Song
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.
| | - Yunong Wu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China; Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.
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The influence of cervical lymph node number of neck dissection on the prognosis of the early oral cancer patients. J Dent Sci 2020; 15:519-525. [PMID: 33505625 PMCID: PMC7816029 DOI: 10.1016/j.jds.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background/purpose The status of neck lymph nodes (LNs) plays an important role in survival of oral cavity cancer. Early stage oral cancer patients are still at a risk for locoregional metastasis. We aimed to determine the number of LNs that needs to be retrieved for adequate diagnosis and treatment of the neck tumor. Materials and methods We conducted a retrospective study of 126 oral cavity cancer patients who underwent wide excision and 3 types of neck dissection at MacKay Memorial Hospital, Taiwan. Data from the operative and pathology reports were collected and analyzed. The significant difference was defined as p < 0.05 by SPSS 21.0 and Prizm 5 software. Results There was a significant difference between the total retrieved LNs and tumor differentiation and nerve invasion on multivariate analysis. Receiveroperating characteristic (ROC) curve showed significant difference in the total number of neck LNs between the survival and expired groups. The cut-off point was 36.5 nodes. However, there was no difference in survival between supraomohyoid and modified radical neck dissection. Conclusion Retrieval of adequate LNs can improve oral cancer survival rates. If total number of neck nodes examined is <37 with poor differentiation and/or nerve invasion, early oral cancer patients with neck dissection have a lower survival rate and are candidates for adjuvant therapy.
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Zhao TC, Liang SY, Ju WT, Fu Y, Zhou ZH, Wang LZ, Li J, Zhang CP, Zhang ZY, Zhong LP. High-risk lymph node ratio predicts worse prognosis in patients with locally advanced oral cancer. J Oral Pathol Med 2020; 49:787-795. [PMID: 32449223 PMCID: PMC7540480 DOI: 10.1111/jop.13043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 12/24/2022]
Abstract
Background To investigate the prognostic value of lymph node ratio (LNR), as well as the correlation with docetaxel, cisplatin, and 5‐FU (TPF) induction chemotherapy, in patients with locally advanced oral squamous cell carcinoma (OSCC). Methods Two‐hundred and forty‐five patients from a phase 3 trial involving TPF induction chemotherapy in stage III/IVA OSCC patients (NCT01542931) were enrolled in this study between 2008 and 2010. The clinical and pathological data were collected and analyzed. The cutoff value for LNR was calculated on the receiver operating characteristic (ROC) curve. Univariate and multivariate Cox regression models, and Kaplan‐Meier method were used for survival analysis. Results According to the ROC curve, the cutoff value for LNR was 7.6%. With a median follow‐up period of 80 months, the OSCC patients with high‐risk LNR (> 7.6%), or positive extranodal extension (ENE) had significantly worse clinical outcomes than patients with low‐risk LNR (≤7.6%) or negative ENE. Multivariate analysis on pathological covariates showed that only high‐risk LNR was an independent negative predictive factor for survival (P < .05). The cutoff value of LNR of 7.6% was also verified with the similar results using an open TCGA database, high‐risk LNR indicating worse overall survival (P < .001) and disease‐free survival (P < .001). Conclusion Oral squamous cell carcinoma patients with high‐risk LNR have a worse clinical outcome than patients with low‐risk LNR. High‐risk LNR is an independent negative predictive factor for clinical outcome in patients with locally advanced OSCC.
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Affiliation(s)
- Tong-Chao Zhao
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Si-Yuan Liang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wu-Tong Ju
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Fu
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Hang Zhou
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li-Zhen Wang
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Li
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen-Ping Zhang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Yuan Zhang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lai-Ping Zhong
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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León X, Neumann E, Gutierrez A, García J, Quer M, López M. Prognostic capacity of the lymph node ratio in squamous cell carcinomas of the head and neck. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:265-274. [PMID: 32473713 DOI: 10.1016/j.otorri.2020.04.001] [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: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Lymph node density or lymph node ratio (LNR), defined as the quotient between the total number of positive lymph nodes and the total number of dissected lymph nodes, has demonstrated a prognostic capacity in several tumour models, including patients with head and neck squamous cell carcinomas (HNSCC). The aim of the present study is to analyse the prognostic value of LNR in a wide cohort of patients with HNSCC. METHODS We carried out a retrospective study of a cohort of 1,311 patients with HNSCC treated with unilateral or bilateral neck dissections. Of the patients included in the study, 55.0% had lymph node metastases (pN+). We proceeded to calculate the value of the LNR, and its categorization through a recursive partition analysis considering specific survival as the dependent variable. RESULTS Three categories were defined according to the value of the LNR with a cut-off point at the values < of .025 and .118. The 5-year specific survival for patients with an LNR less than .025 (n=654, 49.8%) was 87.2%, for patients with a LNR .025-.118 (n=394, 30.1%) it was 51.6%, and for patients with a LNR greater than .188 (n=263, 20.1%) it was 27.3% (P=.0001). According to the results of a multivariate analysis, the LNR significantly related to specific survival. CONCLUSION The LNR can be a prognostic variable to be considered in the pathological staging of the lymph nodes.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Eduard Neumann
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Alfons Gutierrez
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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Surgical nodal management in hypopharyngeal and laryngeal cancer. Eur Arch Otorhinolaryngol 2020; 277:1481-1489. [PMID: 32048029 PMCID: PMC7160213 DOI: 10.1007/s00405-020-05838-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 01/30/2020] [Indexed: 12/14/2022]
Abstract
Objective The aim of this study is to compare pre-therapeutic staging of the loco-regional lymphatic basin and subsequent surgical management in cN0 versus cN+ hypopharyngeal and laryngeal cancer patients. Methods We analyzed all hypopharyngeal and laryngeal carcinoma patients treated surgically at a single quaternary medical care and cancer center between 2004 and 2014. We established two groups for patients who underwent neck dissection comparing patients with a low LNR (lymph node ratio) to one with a high LNR. Regarding the cN0 cohort, elective neck dissection was evaluated as a secondary predictor variable. Comorbidities, such as anemia and renal insufficiency, were analyzed as potentially influencing disease-free (DFS) and overall survival (OS). Results A total of 310 patients (185 glottic and 125 supraglottic/hypopharyngeal carcinoma) were included. Pre-therapeutic neck MRI-/CT-scan and concomitant neck ultrasound revealed cN+ status in 144 patients resulting in a significant over-staging in 63 patients (44%) who were rated as being pN0 after histological examination. 166 patients were staged cN0 and 21 underwent elective neck dissection (11 local advanced glottic and 10 supraglottic/hypopharyngeal carcinoma). Two cN0 patients showed occult cervical lymph node metastases (10%). Furthermore, we could detect a significant negative impact of the LNR divided by the number of dissected lymph nodes and OS. Conclusion The pre-therapeutic clinical evaluation of lymphatic outgrowth is over-staged. OS decreases with increasing LNR divided by the number of dissected lymph nodes. Renal insufficiency and anemia are significant negative factors, decreasing both OS and DFS.
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Petrarolha S, Dedivitis R, Matos L, Ramos D, Kulcsar M. Lymph node density as a predictive factor for worse outcomes in laryngeal cancer. Eur Arch Otorhinolaryngol 2020; 277:833-840. [DOI: 10.1007/s00405-020-05789-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
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Niu X, Yang B, Liu F, Fang Q. LncRNA HOXA11-AS promotes OSCC progression by sponging miR-98-5p to upregulate YBX2 expression. Biomed Pharmacother 2019; 121:109623. [PMID: 31731187 DOI: 10.1016/j.biopha.2019.109623] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is a type of oral malignancy. Long non-coding RNAs (lncRNAs) have been shown to be related to the occurrence and development of many cancers. Here, we aimed to study the role and molecular mechanism of lncRNA Homeobox A11 antisense RNA (HOXA11-AS) in OSCC. METHODS The expression levels of HOXA11-AS, miR-98-5p and Y box binding protein 2 (YBX2) were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Cell counting kit-8 (CCK-8), flow cytometry and transwell assays were utilized to determine the proliferation, apoptosis, migration and invasion of OSCC cells. Western blot (WB) analysis was conducted to measure the levels of apoptosis, epithelial-mesenchymal transition (EMT), proliferation-related proteins and YBX2 protein. Besides, Dual-luciferase reporter, RNA immunoprecipitation (RIP) and RNA pull down assays were carried out to examine the relationship among HOXA11-AS, miR-98-5p and YBX2. The mice xenograft models were constructed to further determine the effect of HOXA11-AS on OSCC tumor growth in vivo. RESULTS HOXA11-AS was highly expressed in OSCC tissues and cells. Knockdown of HOXA11-AS significantly reduced proliferation, migration, invasion and EMT, while promoted apoptosis of OSCC cells. MiR-98-5p was a target of HOXA11-AS, and its inhibitor could revert the inhibition effect of silenced-HOXA11-AS on the progression of OSCC. Also, YBX2 was a target of miR-98-5p, and its overexpression could invert the suppression effect of miR-98-5p overexpression on the progression of OSCC. YBX2 expression was regulated by HOXA11-AS and miR-98-5p. Furthermore, HOXA11-AS silencing could reduce the tumor growth of OSCC in vivo. CONCLUSION HOXA11-AS plays an active role in the progression of OSCC, and the discovery of HOXA11-AS/miR-98-5p/YBX2 axis provides new therapeutic targets for OSCC.
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Affiliation(s)
- Xingyu Niu
- Department of Oral Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Bin Yang
- Department of Ophtalmology, Huaihe Hospital of Henan University, Kaifeng, China
| | - Fei Liu
- Department of Oral Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qigen Fang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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Is Lymph Node Ratio a Prognostic Factor for Patients With Oral Squamous Cell Carcinoma? J Oral Maxillofac Surg 2019; 77:1510-1519. [DOI: 10.1016/j.joms.2019.01.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/22/2018] [Accepted: 01/20/2019] [Indexed: 01/25/2023]
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Oliver JR, Wu SP, Chang CM, Roden DF, Wang B, Hu KS, Schreiber D, Givi B. Survival of oral tongue squamous cell carcinoma in young adults. Head Neck 2019; 41:2960-2968. [DOI: 10.1002/hed.25772] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/02/2019] [Accepted: 04/02/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
- Jamie R. Oliver
- Department of Otolaryngology, NYU School of Medicine New York New York
| | - S. Peter Wu
- Department of Radiation OncologyNYU Langone Health New York New York
| | - Clifford M. Chang
- Department of Otolaryngology, NYU School of Medicine New York New York
| | - Dylan F. Roden
- Department of OtolaryngologyThomas Jefferson University Philadelphia Pennsylvania
| | - Binhuan Wang
- Department of Population HealthNYU Langone Health New York New York
| | - Kenneth S. Hu
- Department of Radiation OncologyNYU Langone Health New York New York
| | - David Schreiber
- Department of Radiation OncologySUNY Downstate Medical Center Brooklyn New York
| | - Babak Givi
- Department of OtolaryngologyNYU Langone Health New York New York
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Elhusseiny KM, Abd-Elhay FAE, Kamel MG, Abd El Hamid Hassan HH, El Tanany HHM, Hieu TH, Tieu TM, Low SK, Hou V, Dibas M, Huy NT. Examined and positive lymph nodes counts and lymph nodes ratio are associated with survival in major salivary gland cancer. Head Neck 2019; 41:2625-2635. [PMID: 30905082 DOI: 10.1002/hed.25742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/22/2018] [Accepted: 03/05/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to investigate the prognostic role of examined (dissected) lymph nodes (ELNs), negative LNs (NLNs), and positive (metastatic) LNs (PLNs) counts and LN ratio (LNR = PLNs/ELNs×100) in patients with major salivary gland cancer (SGC). METHODS Data were retrieved for major SGC patients diagnosed between 1988 and 2011 from Surveillance, Epidemiology, and End Results program. RESULTS We have included 5446 patients with major SGC. Most patients had parotid gland cancer (84.61%). Patients having >18 ELNs, >4 PLNs, and >33.33% LNR were associated with a worse survival. Moreover, older age, male patients, grade IV, distant stage, unmarried patients, submandibular gland cancer, and received chemotherapy but not received surgery were significantly associated with a worse survival. CONCLUSIONS We demonstrated that patients with >18 ELNs and >4 PLNs counts, and >33.33% LNR were high-risk group patients. We strongly suggest adding the ELNs and PLNs counts and/or LNR into the current staging system.
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Affiliation(s)
- Khaled Mosaad Elhusseiny
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Online Research Club (http://www.onlineresearchclub.org/
| | | | - Mohamed Gomaa Kamel
- Online Research Club (http://www.onlineresearchclub.org/.,Faculty of Medicine, Minia University, Minia, Egypt
| | - Heba Hassan Abd El Hamid Hassan
- Online Research Club (http://www.onlineresearchclub.org/.,Faculty of Pharmacy, Modern University for Technology and Information, Cairo, Egypt
| | | | - Truong Hong Hieu
- Online Research Club (http://www.onlineresearchclub.org/.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thuan Minh Tieu
- Online Research Club (http://www.onlineresearchclub.org/.,McMaster University, Hamilton, Ontario, Canada
| | - Soon Khai Low
- Online Research Club (http://www.onlineresearchclub.org/.,School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Selangor, Malaysia
| | - Vincent Hou
- Online Research Club (http://www.onlineresearchclub.org/.,McMaster University, Hamilton, Ontario, Canada
| | - Mahmoud Dibas
- Online Research Club (http://www.onlineresearchclub.org/.,Sulaiman Al Rajhi Colleges, Al Bukayriya, Saudi Arabia
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group, Ton Duc Thang University, Ho Chi Minh City, 70000, Vietnam.,Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, 70000, Vietnam.,Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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41
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Huang TH, Li KY, Choi WS. Lymph node ratio as prognostic variable in oral squamous cell carcinomas: Systematic review and meta-analysis. Oral Oncol 2019; 89:133-143. [DOI: 10.1016/j.oraloncology.2018.12.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/30/2018] [Indexed: 12/23/2022]
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42
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Morand GB, Ikenberg K, Vital DG, Cardona I, Moch H, Stoeckli SJ, Huber GF. Preoperative assessment of CD44‐mediated depth of invasion as predictor of occult metastases in early oral squamous cell carcinoma. Head Neck 2018; 41:950-958. [DOI: 10.1002/hed.25532] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/31/2018] [Accepted: 09/28/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Grégoire B. Morand
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
| | - Kristian Ikenberg
- Institute of Pathology and Molecular PathologyUniversity Hospital Zurich Zurich Switzerland
| | - Domenic G. Vital
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
| | - Isabel Cardona
- Department of Otolaryngology, Head and Neck SurgeryMcGill University Montreal Québec Canada
| | - Holger Moch
- Institute of Pathology and Molecular PathologyUniversity Hospital Zurich Zurich Switzerland
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology, Head and Neck SurgeryKantonsspital St. Gallen St. Gallen Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
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43
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Rempel V, Safi A, Drebber U, Nickenig H, Neugebauer J, Zöller J, Kreppel M. The prognostic relevance of lymph node ratio in patients with oral squamous cell carcinoma treated with neoadjuvant therapy regimen and radical surgery. J Craniomaxillofac Surg 2018; 46:1659-1663. [DOI: 10.1016/j.jcms.2018.05.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/03/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022] Open
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44
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You H, Yang J, Liu Q, Tang L, Bu Q, Pan Z, Lyu J. The impact of the lymph node density on overall survival in patients with Wilms' tumor: a SEER analysis. Cancer Manag Res 2018; 10:671-677. [PMID: 29670401 PMCID: PMC5896671 DOI: 10.2147/cmar.s163514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Objective The objective of this study was to determine the impact of the lymph node density (LND) on overall survival of patients with Wilms’ tumor (WT) using the Surveillance, Epidemiology, and End Results (SEER) database. Methods Data from the SEER database were extracted from patients with WT in whom the LND could be obtained. Patients were divided into a low LND group and high LND group. Survival curves based on the LND stratification were plotted using the Kaplan–Meier method and compared with the log-rank test. The impact of prognostic factors on overall survival was analyzed using Cox regression models. Results A total of 1,924 patients were identified from the database. Overall survival for the low LND group at 5, 10, and 20 years was significantly better than the high LND group (5-year survival: 94.1% vs 81.4%; 10-year survival: 92.6% vs 80.8%; 20-year survival: 90.6% vs 79.1%; P<0.001). In multivariate analysis, LND was a significant predictor of overall survival, regardless of whether it was a categorical variable or a continuous variable. Other significant predictors included age, race, SEER stage, and tumor laterality. Conclusion LND was a significant risk factor for overall survival of patients with WT. LND may provide a better prediction of the prognosis of WT patients and may be helpful for designing better treatments.
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Affiliation(s)
- Haisheng You
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Jin Yang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Qingqing Liu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Lina Tang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Qingting Bu
- Department of Genetics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Zhenyu Pan
- Department of Pharmacy, The Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
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45
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Cheraghlou S, Otremba M, Kuo Yu P, Agogo GO, Hersey D, Judson BL. Prognostic Value of Lymph Node Yield and Density in Head and Neck Malignancies. Otolaryngol Head Neck Surg 2018; 158:1016-1023. [DOI: 10.1177/0194599818756830] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective Studies have suggested that the lymph node yield and lymph node density from selective or elective neck dissections are predictive of patient outcomes and may be used for patient counseling, treatment planning, or quality measurement. Our objective was to systematically review the literature and conduct a meta-analysis of studies that investigated the prognostic significance of lymph node yield and/or lymph node density after neck dissection for patients with head and neck cancer. Data Sources The Ovid/Medline, Ovid/Embase, and NLM PubMed databases were systematically searched on January 23, 2017, for articles published between January 1, 1946, and January 23, 2017. Review Methods We reviewed English-language original research that included survival analysis of patients undergoing neck dissection for a head and neck malignancy stratified by lymph node yield and/or lymph node density. Study data were extracted by 2 independent researchers (S.C. and M.O.). We utilized the DerSimonian and Laird random effects model to account for heterogeneity of studies. Results Our search yielded 350 nonduplicate articles, with 23 studies included in the final synthesis. Pooled results demonstrated that increased lymph node yield was associated with a significant improvement in survival (hazard ratio, 0.833; 95% CI, 0.790-0.879). Additionally, we found that increased lymph node density was associated with poorer survival (hazard ratio, 1.916; 95% CI, 1.637-2.241). Conclusions Increased nodal yield portends improved outcomes and may be a valuable quality indicator for neck dissections, while increased lymph node density is associated with diminished survival and may be used for postsurgical counseling and planning for adjuvant therapy.
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Affiliation(s)
- Shayan Cheraghlou
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Otremba
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Phoebe Kuo Yu
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - George O. Agogo
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Denise Hersey
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - Benjamin L. Judson
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
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46
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Talmi YP, Takes RP, Alon EE, Nixon IJ, López F, de Bree R, Rodrigo JP, Shaha AR, Halmos GB, Rinaldo A, Ferlito A. Prognostic value of lymph node ratio in head and neck squamous cell carcinoma. Head Neck 2018; 40:1082-1090. [PMID: 29394461 DOI: 10.1002/hed.25080] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 07/10/2017] [Accepted: 12/06/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Lymph node ratio (LNR) is increasingly reported as a potential prognostic tool. The purpose of this review was to analyze the available literature on the prognostic significance of LNR in head and neck squamous cell carcinoma (HNSCC). METHODS A PubMed internet search was performed and articles meeting selection criteria were reviewed. RESULTS Twenty-eight studies were identified in the literature dealing with the prognostic value of LNR. The published results are variable with a range of cutoff values of LNR associated with prognosis (overall survival [OS] and/or disease-specific survival [DSS]) between 0.02 and 0.20, with an average of 0.09. CONCLUSION The LNR is reported to be of value in assessing prognosis in the patients with HNSCC. Although it is easy to calculate and could be considered in the staging of these patients, the currently available evidence in the literature does not yet provide a solid base for implementation.
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Affiliation(s)
- Yoav P Talmi
- Department of Otolaryngology - Head and Neck Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel and the Sackler School of Medicine, Tel Aviv University, Israel
| | - Robert P Takes
- Department of Otolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eran E Alon
- Department of Otolaryngology - Head and Neck Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel and the Sackler School of Medicine, Tel Aviv University, Israel
| | - Iain J Nixon
- Ear, Nose, and Throat Department, NHS Lothian, Lauriston Building, Lauriston Place, Edinburgh, UK
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, and Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.,Head and Neck Oncology Unit, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, and Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.,Head and Neck Oncology Unit, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Groningen University Medical Center Groningen, Groningen, The Netherlands
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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47
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Zirk M, Safi AF, Buller J, Nickenig HJ, Dreiseidler T, Zinser M, Drebber U, Zöller JE, Kreppel M. Lymph node ratio as prognosticator in floor of mouth squamous cell carcinoma patients. J Craniomaxillofac Surg 2018; 46:195-200. [DOI: 10.1016/j.jcms.2017.11.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/20/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022] Open
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48
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Majercakova K, Valero C, López M, García J, Farré N, Quer M, León X. Postoperative staging of the neck dissection using extracapsular spread and lymph node ratio as prognostic factors in HPV-negative head and neck squamous cell carcinoma patients. Oral Oncol 2018; 77:37-42. [DOI: 10.1016/j.oraloncology.2017.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/08/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022]
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49
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Vasan K, Low THH, Gupta R, Ashford B, Asher R, Gao K, Ch'ng S, Palme CE, Clark JR. Lymph node ratio as a prognostic factor in metastatic cutaneous head and neck squamous cell carcinoma. Head Neck 2018; 40:993-999. [DOI: 10.1002/hed.25066] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 09/21/2017] [Accepted: 11/28/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kartik Vasan
- Nepean Blue Mountains Local Health District; Sydney Australia
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse; Sydney Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse; Sydney Australia
- Central Clinical School; University of Sydney; Sydney Australia
| | - Ruta Gupta
- Central Clinical School; University of Sydney; Sydney Australia
- Department of Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Sydney Australia
| | - Bruce Ashford
- School of Biological Sciences; University of Wollongong; Wollongong Australia
- Illawarra Health and Medical Research Institute (IHMRI); Wollongong Australia
- Illawarra and Shoalhaven Local Health District (ISLHD); Wollongong Australia
- Centre for Oncology Education and Research Translation (CONCERT); Liverpool Australia
| | - Rebecca Asher
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse; Sydney Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse; Sydney Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse; Sydney Australia
- Central Clinical School; University of Sydney; Sydney Australia
| | - Carsten E. Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse; Sydney Australia
- Central Clinical School; University of Sydney; Sydney Australia
| | - Jonathan R. Clark
- Nepean Blue Mountains Local Health District; Sydney Australia
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse; Sydney Australia
- Central Clinical School; University of Sydney; Sydney Australia
- South West Clinical School; University of New South Wales; Sydney Australia
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50
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Jacobi C, Rauch J, Hagemann J, Lautz T, Reiter M, Baumeister P. Prognostic value of the lymph node ratio in oropharyngeal carcinoma stratified for HPV-status. Eur Arch Otorhinolaryngol 2017; 275:515-524. [PMID: 29204919 DOI: 10.1007/s00405-017-4833-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/29/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Lymph node ratio (LNR) was shown to be a prognostic factor in laryngeal and oral cavity primaries. The purpose of this study was to investigate the impact of the lymph node ratio in oropharyngeal squamous cell carcinoma (OPSCC) with a high incidence of HPV-related disease. Therefore, the role of LNR was evaluated as an additional predictive parameter to the 8th edition of AJCC TNM staging system. METHODS From December 2009 to August 2015, patients diagnosed with primary oropharyngeal squamous cell carcinoma were prospectively enrolled. After tumor resection with uni- or bilateral neck dissection, patients with ≥ 1 nodal metastasis (pN+) were eligible for a retrospective LNR analysis. RESULTS 137 patients underwent tumor resection with uni- or bilateral neck dissection. The proportion of HPV-associated disease was 42%. Most patients (n = 96; 70%) presented with involved neck nodes. In p16-positive OPSCC, the rate of pN + cases was significantly increased compared to p16-negative OPSCC (86% vs. 58%, p = 0.007). Patients with LNR ≤ 10% had a significant better overall survival (OS) and disease-specific survival (DSS). However, when stratified for p16-status, LNR ≤ 10% had a significant impact on OS only for HPV-associated tumors (p = 0.027), whereas LNR of ≤ 10% was not a significant predictor for better OS in p16-negative OPSCC (p = 0.143). CONCLUSION The LNR with a cut-off value of 10% serves as an additional prognostic parameter in HPV-related OPSCC and may help to improve risk stratification in combination with the revised AJCC 8th edition TNM classification.
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Affiliation(s)
- Christian Jacobi
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany.
| | - Josepha Rauch
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Jan Hagemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Johannes-Gutenberg-University Medical Center, Langenbeckstraße 1, Mainz, 55131, Germany
| | - Thomas Lautz
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian Reiter
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Philipp Baumeister
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, Munich, Germany.,Clinical Cooperation Group Personalized Radiotherapy in Head and Neck Cancer, Helmholtz Center, Munich, Germany
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