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Zhang Y, Su X, Qiao Y, Huang S, Kou Y. Occult lymph node metastasis in the contralateral neck of oropharyngeal squamous cell carcinoma: a meta-analysis and literature review. Eur Arch Otorhinolaryngol 2022; 279:2157-2166. [PMID: 35041065 DOI: 10.1007/s00405-021-07230-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine whether contralateral cervical lymph node dissection is needed in patients with oropharyngeal squamous cell carcinoma (OPSCC) with contralateral cervical cN0. METHODS We searched the PubMed, Web of Science, Embase, Chinese Biomedical Literature Database (CBM) and Cochrane Library databases up to August 14, 2021 for studies examining the contralateral neck occult metastasis rate of patients with ipsilateral clinical neck-negative (cN0) OPSCC and the contralateral neck occult metastasis rate of patients with ipsilateral clinical neck-positive (cN1, cN2a, cN2b) OPSCC. This rate is used to determine whether patients with contralateral cN0 OPSCC need contralateral cervical lymph node dissection. RESULTS A total of 14 articles, including 532 cases, were included in the analysis. When studying the rate of ipsilateral cervical occult metastasis in patients with ipsilateral cN0, 163 cases were included in 11 studies. The results showed that the rate of contralateral cervical occult lymph node metastasis in patients with ipsilateral cN0 was 0.6816% (95% CI 0.0000-4.4880 (P = 0.3005)). In the study of ipsilateral cN+ (cN1, cN2a, cN2b), a total of 369 cases of 10 articles were included in the analysis. The results showed that the rate of contralateral cervical occult lymph node metastasis in patients with ipsilateral cN+ was 11.4920% [95% CI 7.8944-15.5223 (P = 0.0000)]. CONCLUSION For cancer treatment, the ultimate goal is to achieve the best control of cancer and the lowest complications. It seems unnecessary to intervene in the contralateral neck of patients with OPSCC with ipsilateral cN0. For OPSCC with ipsilateral cN+ , this index is a factor that cannot be ignored when making clinical decisions.
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Affiliation(s)
- Ying Zhang
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
| | - Xingzhou Su
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
| | - Yumeng Qiao
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
| | - Shaohui Huang
- Department of Oral Maxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, No. 117. Nanjing Bei Jie, Heping District, Shenyang, 110002, Liaoning Province, China. .,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China.
| | - Yurong Kou
- Department of Oral Biology, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, No. 117 Nanjing North Street, Heping District, Shenyang, 110002, Liaoning Province, China.,School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Diseases, Shenyang, Liaoning Province, China
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Palate Squamous Cell Carcinomas:A Ten-Year Single Institute Experience. CURRENT HEALTH SCIENCES JOURNAL 2020; 46:358-370. [PMID: 33717510 PMCID: PMC7948021 DOI: 10.12865/chsj.46.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022]
Abstract
The literature date estimated that about 5% of all oral cavity cancers are hard palate cancers while soft palate cancers account for about 5-12% of oropharyngeal cancers. Although rare, usually these tumors had a more aggressively behavior than other oral cancer sites. That is why our study aimed to investigate comparatively the epidemiological, clinical and histopathological peculiarities of the two palatal sites of oral squamous cell carcinomas. We conducted a retrospective study limited to a period of 10 years in a single medical institution to investigate the morphoclinical profile of such tumors. We found that patients with hard palate SCCs had an average age slightly larger compared to those who developed soft palate tumors. Also, those with hard palate tumors are mostly diagnosed in less advanced stages compared to those at the level of the soft palate, and implicitly the former had a longer survival time. Histopathologically the most encountered hard palate SCC were the conventional well-differentiated tumor, and from the peculiar SCC variant the papillary and verrucous forms while for the soft palate SCC prevailed the moderate and poor differentiated conventional SCC and from the peculiar SCC variant the basaloid and acantholytic forms. In conclusion hard palate tumors differ in many aspects from those of the soft palate, and thus specification of the origin tumor site become important for the assessment of prognosis, treatment and survival outcome of such patients.
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Zabaleta-López M, Ramos-Casademont L, Gómez-Tomé E, Diaz De Cerio Canduela P, Ibáñez-Muñoz C, Martínez-Torre MI. Carcinoma de paladar blando. Descripción de una serie de casos. REVISTA ORL 2020. [DOI: 10.14201/orl.23565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivo: Describir las características clínicas, anatómicas y el trata-miento quirúrgico, incluyendo las distintas opciones de reconstrucción de los tumo-res de paladar blando. Descripción: Estudio retrospectivo de 6 pacientes diagnosti-cados y tratados en el servicio de Otorrinolaringología del hospital San Pedro de Logroño entre los años 2018 y 2019. Discusión: Exponemos los resultados de nues-tros pacientes y realizamos una revisión de los tumores de orofaringe localizados en el paladar blando, los detalles anatómicos y técnicas quirúrgicas reconstructivas más utilizadas en el tratamiento quirúrgico de los tumores de paladar blando. Conclusio-nes: La prevalencia de los tumores de orofaringe ha aumentado en los últimos años a expensas de la infección por el virus del papiloma humano (VPH). Sin embargo, los carcinomas de paladar blando son mayoritariamente P16 negativos. Estos tumores son poco sintomáticos en fases iniciales y es necesario un alto índice de sospecha para evitar diagnósticos tardíos. El desarrollo de la cirugía transoral ha impulsado el tratamiento quirúrgico de los tumores de paladar blando y puede reducir la necesidad de tratamientos complementarios hasta en un 40% de los casos. La reconstrucción se hace necesaria en resecciones mayores del 50%.
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RAMOS-CASADEMONT L, DÍAZ DE CERIO-CANDUELA P, IBÁÑEZ-MUÑOZ C, LACOSTA-NICOLÁS JL, CARRERAS-ALCARAZ A. Anatomía quirúrgica en el carcinoma de paladar blando. Revisión bibliográfica. REVISTA ORL 2020. [DOI: 10.14201/orl.23103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hardman J, Liu Z, Brady G, Roe J, Kerawala C, Riva F, Clarke P, Kim D, Bhide S, Nutting C, Harrington K, Paleri V. Transoral robotic surgery for recurrent cancers of the upper aerodigestive tract—Systematic review and meta‐analysis. Head Neck 2020; 42:1089-1104. [DOI: 10.1002/hed.26100] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/04/2019] [Accepted: 01/28/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- John Hardman
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - ZiWei Liu
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
| | - Grainne Brady
- Department of Speech and Language Therapy The Royal Marsden NHS Foundation Trust London UK
| | - Justin Roe
- Department of Speech and Language Therapy The Royal Marsden NHS Foundation Trust London UK
- Department of Surgery and Cancer Imperial College London UK
- Department of Otolaryngology Head and Neck Surgery, Imperial College Healthcare NHS Trust London UK
| | - Cyrus Kerawala
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
| | - Francesco Riva
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
| | - Peter Clarke
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Department of Otolaryngology Head and Neck Surgery, Imperial College Healthcare NHS Trust London UK
| | - Dae Kim
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Shreerang Bhide
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Christopher Nutting
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Kevin Harrington
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
| | - Vinidh Paleri
- Head and Neck Unit The Royal Marsden NHS Foundation Trust London UK
- Institute of Cancer Research London UK
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Rapp CT, Chera BS, Morris CG, Amdur RJ, Kirwan JM, Mendenhall WM. Radiation treatment of soft palate squamous cell carcinoma. Head Neck 2019; 42:530-538. [PMID: 31773865 DOI: 10.1002/hed.26035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/21/2019] [Accepted: 11/13/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To report our institution's experience treating soft palate squamous cell carcinoma with radiotherapy alone or combined with adjuvant chemotherapy and/or neck dissection for residual disease. METHODS We analyzed 159 patients treated curatively between 1963 and 2016. Median follow-up was 4 years. RESULTS The 5-year local control rates were T1, 90%; T2, 90%; T3, 70%; and T4, 59%. The 5-year cause-specific survival (CSS) rate was nearly identical for patients with stage I-III disease (88%, 86%, and 88%, respectively) compared to stage IVA/B (58%). Five-year overall survival was similar between patients with stage I-III disease (50%, 57%, and 54%, respectively) and approximately double that of patients with stage IVA/B disease (26%). Thirteen patients (8%) had severe complications related to radiotherapy. CONCLUSIONS The likelihood of cure after definitive radiotherapy is relatively high in patients with stage I-III disease with soft palate carcinoma. Patients with stage IVA/B disease have a lower cure rate but with a 5-year CSS exceeding 50%.
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Affiliation(s)
- Cooper T Rapp
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Robert J Amdur
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Jessica M Kirwan
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
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Schernberg A, Canova C, Blanchard P, Gorphe P, Breuskin I, Mirghani H, Moya-Plana A, Janot F, Bidault F, Chargari C, Bellefqih S, Ruffier A, Even C, Nguyen F, Temam S, Tao Y. Prognostic factors in patients with soft palate squamous cell carcinoma. Head Neck 2019; 41:1441-1449. [PMID: 30636178 DOI: 10.1002/hed.25598] [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: 11/03/2017] [Revised: 10/02/2018] [Accepted: 12/05/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To define the prognostic factors associated with outcome in patients with soft palate squamous cell carcinoma (SCC). METHODS Previously untreated patients with soft palate and uvula SCC treated in our institution between 1997 and 2012 were collected. The prognostic value of clinical, hematological, and treatment characteristics was examined. RESULTS We identified 156 patients, median age 58 years, with 71% drinkers, 91% smokers; 19% had synchronous cancer. Front-line treatment was chemoradiotherapy in 58 (37%), radiotherapy alone in 60 (39%), surgery in 17 (11%), and induction chemotherapy in 21 patients (14%). The 5-year actuarial overall survival (OS) and progression-free survival (PFS) were 41% and 37%, respectively. In univariate analysis, T3-T4 vs T1-T2 stage, N2-N3 vs N0-N1 stage, and neutrophil count >7 g/L were associated with worse OS and PFS (P < .05). CONCLUSION In patients with soft palate SCC, inflammation biomarkers were associated with OS.
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Affiliation(s)
- Antoine Schernberg
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France.,INSERM1030, Gustave Roussy Cancer Campus, Paris, France
| | - Charles Canova
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Pierre Blanchard
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France.,Faculté de Médecine du Kremlin-Bicetre, Université Paris Sud, Université Paris Saclay, Paris, France
| | - Philippe Gorphe
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Ingrid Breuskin
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Haitham Mirghani
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Antoine Moya-Plana
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - François Janot
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Francois Bidault
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Cyrus Chargari
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France.,INSERM1030, Gustave Roussy Cancer Campus, Paris, France.,French Military Health Services Academy, Paris, France.,Institut de Recherche Biomédicale des Armées, Paris, France
| | - Sara Bellefqih
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Amandine Ruffier
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Caroline Even
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - France Nguyen
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Stéphane Temam
- Head and Neck Oncology Department, Gustave Roussy Cancer Campus, Paris, France
| | - Yungan Tao
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Paris, France.,INSERM1030, Gustave Roussy Cancer Campus, Paris, France
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Chan CK, Han AY, Alonso JE, Xu MJ, Mallen-St Clair J, Heaton CM, Ryan WR, Kuan EC, St John MA. Squamous Cell Carcinoma of the Soft Palate in the United States: A Population-Based Study. Otolaryngol Head Neck Surg 2018; 159:662-668. [PMID: 29734872 DOI: 10.1177/0194599818771931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives To describe the incidence and determinants of survival of patients with squamous cell carcinoma of the soft palate (SCCSP) using the Surveillance, Epidemiology, and End Results (SEER) database. Study Design Retrospective, population-based cohort study of patients. Setting SEER cancer registry. Subjects and Methods Patients from the SEER cancer registry from 1973 to 2015 were used to analyze demographics and survival of SCCSP. Results A total of 4366 cases were identified. The average overall survival (OS) and disease-specific survival (DSS) were 68.7 months and 161.3 months, respectively. Multivariate analysis revealed that male sex, stage, and treatment (hazard ratio [HR] = 0.690, P = .019; HR = 1.73, P < .001; HR = 0.64, P < .001, respectively) were independent determinants of better or worse DSS. Age, stage, and treatment (HR = 1.02, P < .001; HR = 1.49, P < .001; HR = 0.66, P < .001; HR = 0.48, P < .001, respectively) were independent determinants of better or worse OS. For stages I, II, and III, radiation alone and surgery alone have nearly equivalent OS. Patients with stage IV disease who underwent both surgery and radiation had a significantly higher median OS at 50.0 months. Conclusion Radiation alone and surgery alone both have nearly equivalent OS benefit for stages I to III, while surgery and radiation provide the most survival benefit for stage IV disease. The large discrepancy between OS and DSS can be due to significant comorbidities. Future studies should aim to address the determinants of quality-of-life variables that help direct treatment decisions and might indirectly affect survival.
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Affiliation(s)
- Carmen K Chan
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Albert Y Han
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Jose E Alonso
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Mary J Xu
- 2 Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco (UCSF) Medical Center, San Francisco, California, USA
| | - Jon Mallen-St Clair
- 2 Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco (UCSF) Medical Center, San Francisco, California, USA
| | - Chase M Heaton
- 2 Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco (UCSF) Medical Center, San Francisco, California, USA
| | - William R Ryan
- 2 Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco (UCSF) Medical Center, San Francisco, California, USA
| | - Edward C Kuan
- 3 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Maie A St John
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA.,4 Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California, USA.,5 UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, California, USA
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Fossum CC, Chintakuntlawar AV, Price DL, Garcia JJ. Characterization of the oropharynx: anatomy, histology, immunology, squamous cell carcinoma and surgical resection. Histopathology 2017; 70:1021-1029. [DOI: 10.1111/his.13140] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Croix C Fossum
- Mayo Medical School; Mayo Clinic Rochester; Rochester MN USA
| | | | - Daniel L Price
- Department of Otorhinolaryngology; Mayo Clinic Rochester; Rochester MN USA
| | - Joaquin J Garcia
- Department of Laboratory Medicine & Pathology; Mayo Clinic Rochester; Rochester MN USA
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Cheng Y, Zhang S, Chen Y, Zhao G. Safe Corridor to Access Clivus for Endoscopic Trans-Sphenoidal Surgery: A Radiological and Anatomical Study. PLoS One 2015; 10:e0137962. [PMID: 26368821 PMCID: PMC4569549 DOI: 10.1371/journal.pone.0137962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/24/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Penetration of the clivus is required for surgical access of the brain stem. The endoscopic transclivus approach is a difficult procedure with high risk of injury to important neurovascular structures. We undertook a novel anatomical and radiological investigation to understand the structure of the clivus and neurovascular structures relevant to the extended trans-nasal trans-sphenoid procedure and determine a safe corridor for the penetration of the clivus. METHOD We examined the clivus region in the computed tomographic angiography (CTA) images of 220 adults, magnetic resonance (MR) images of 50 adults, and dry skull specimens of 10 adults. Multiplanar reconstruction (MPR) of the CT images was performed, and the anatomical features of the clivus were studied in the coronal, sagittal, and axial planes. The data from the images were used to determine the anatomical parameters of the clivus and neurovascular structures, such as the internal carotid artery and inferior petrosal sinus. RESULTS The examination of the CTA and MR images of the enrolled subjects revealed that the thickness of the clivus helped determine the depth of the penetration, while the distance from the sagittal midline to the important neurovascular structures determined the width of the penetration. Further, data from the CTA and MR images were consistent with those retrieved from the examination of the cadaveric specimens. CONCLUSION Our findings provided certain pointers that may be useful in guiding the surgery such that inadvertent injury to vital structures is avoided and also provided supportive information for the choice of the appropriate endoscopic equipment.
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Affiliation(s)
- Ye Cheng
- Department of Neurosurgery, First Hospital of Jilin University, Changchun City, Jilin Province, P. R. China
| | - Siwen Zhang
- Department of Endocrine, First Hospital of Jilin University, Changchun City, Jilin Province, P. R. China
| | - Yong Chen
- Department of Neurosurgery, First Hospital of Jilin University, Changchun City, Jilin Province, P. R. China
| | - Gang Zhao
- Department of Neurosurgery, First Hospital of Jilin University, Changchun City, Jilin Province, P. R. China
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Frandsen VL, Grønhøj Larsen C, von Buchwald C. Prevalence of human papillomavirus in squamous cell carcinomas of the soft palate: Table 1. J Clin Pathol 2015; 68:942-3. [DOI: 10.1136/jclinpath-2015-203081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/10/2015] [Indexed: 01/30/2023]
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12
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Iyer NG, Dogan S, Palmer F, Rahmati R, Nixon IJ, Lee N, Patel SG, Shah JP, Ganly I. Detailed Analysis of Clinicopathologic Factors Demonstrate Distinct Difference in Outcome and Prognostic Factors Between Surgically Treated HPV-Positive and Negative Oropharyngeal Cancer. Ann Surg Oncol 2015; 22:4411-21. [PMID: 25801358 DOI: 10.1245/s10434-015-4525-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Oropharyngeal cancers (OPC) secondary to human papillomavirus (HPV) infections likely represent a completely different disease compared with conventional head and neck cancers. Our objective was to analyze a surgically treated cohort to determine predictors of outcome in HPV-positive versus HPV-negative patients. METHODS HPV positivity was inferred based on p16-immunohistochemistry. Data was available for 201 patients with OPC treated with surgical resection with/without adjuvant radiotherapy between 1985 and 2005. Subsite distribution was: 66 (33 %) tonsil, 46 (23 %) soft palate, and 89 (44 %) tongue base. Patients were classified into low-, intermediate-, and high-risk groups based on p16 status and smoking history. Outcomes stratified by p16 status and risk groups were determined by the Kaplan-Meier method. Factors predictive of outcome were determined by univariate and multivariate analyses. RESULTS In this cohort, 30 % had locally advanced disease (pT3/T4) and 71 % had nodal metastasis. The 5-year overall (OS), disease-specific, and recurrence-free survival rates were 60, 76, and 66 %, respectively. There were 22 % low-, 34 % intermediate-, and 44 % high-risk patients. Patients who were p16-positive had better survival compared with p16-negative (OS, 74 vs. 44 %; p < .001). Similarly, low-risk group patients had a better survival compared with intermediate- and high-risk groups (OS, 76, 68, 45 %, respectively, p < .001). Independent predictors of survival in p16-negative patients included margin status, lymphovascular invasion, pN status, and extracapsular spread. In contrast, none of these were predictive in p16-positive patients. CONCLUSIONS Surgically treated patients with p16-positive OPC have superior survival compared with p16-negative patients. Outcomes in p16-positive and p16-negative OPC are determined by different prognostic factors supporting the notion that these are very different diseases. These should be incorporated into future clinical trials design.
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Affiliation(s)
- N Gopalakrishna Iyer
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Singhealth/Duke-NUS Head and Neck Centre, National Cancer Centre, Singapore, Singapore.
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frank Palmer
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rahmatullah Rahmati
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, NY, USA
| | - Iain J Nixon
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Snehal G Patel
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jatin P Shah
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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