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Padegaonkar A, Sharma S, Deshpande M. Prognostic Value of Lymph Node Density in Node-Positive Oral Squamous Cell Carcinoma. Indian J Surg Oncol 2023; 14:487-491. [PMID: 37324308 PMCID: PMC10267025 DOI: 10.1007/s13193-021-01451-0] [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: 06/21/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022] Open
Abstract
Lymph node status is an important prognostic factor in head and neck cancer. The purpose of this study is to investigate the prognostic value of lymph node density (LND) in node-positive oral cavity cancer patients who received surgery plus adjuvant radiotherapy. From January 2008 to December 2013, a total of 61 oral cavity squamous cell cancer patients who had positive lymph node and received surgery and adjuvant radiotherapy were analysed. LND was calculated for each patient. The endpoints were 5-year overall survival (OS) and 5-year disease-free survival. All patients were followed for a period of 5 years. Mean 5-year overall survival for cases with LND of ≤ 0.05 was 56.1 ± 11.6 months, whereas mean 5-year overall survival for cases with LND > 0.05 was 40.0 ± 21.6 months. Log rank is 0.04 95% CI = 53.4-65. Mean 5-year disease-free survival for cases with LND of ≤ 0.05 was 50.5 ± 15.8 months, whereas mean disease-free survival for cases with LND > 0.05 was 15.8 ± 22.9 months. Log rank 0.03 95% CI = 43.3-57.6. Nodal status, disease stage and lymph node density were found to be significant predictors of prognosis in univariate analysis. In multivariate analysis, only lymph node density is found to be the predictor of prognosis. LND is an important prognosis factor for 5-year OS and 5-year DFS in oral cavity squamous cell carcinoma.
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Affiliation(s)
- Amol Padegaonkar
- Department of Surgical Oncology, Apollo Hospital, Seepat Road, Bilaspur, C.G India
| | - Sourabh Sharma
- Department of Surgical Oncology, Pacific Medical College, Udaipur, Rajasthan India
| | - Mandar Deshpande
- Department of Surgical Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra India
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Li F, Huang Q, Hsueh C, Huang H, Zhu Y, Gong H, Tao L, Zhou L, Zhang M. A Survival Nomogram Containing Lymph Node Ratio for Hypopharyngeal Carcinoma Patients After Neck Dissection. Otolaryngol Head Neck Surg 2023; 168:1097-1106. [PMID: 36939525 DOI: 10.1002/ohn.187] [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: 08/13/2022] [Revised: 09/27/2022] [Accepted: 10/09/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of our study is to establish a survival nomogram based on lymph node ratio (LNR) in hypopharyngeal carcinoma. STUDY DESIGN Retrospective cohort study. SETTING Hypopharyngeal squamous cell carcinoma (HPSCC) is prone to regional metastasis. Emerging evidence has shown that LNR is a promising prognostic factor in HPSCC. METHODS From January 2004 to January 2018, 411 HPSCC patients who underwent neck dissection at our institution were retrospectively studied. The enrolled patients were divided into training and validation cohorts at a ratio of 7:3. A survival nomogram was finally built based on factors screened from multivariate analysis using the bidirectional stepwise method. RESULTS LNR was superior to other nodal classifications for survival prediction and was used to establish the R classification. A nomogram was developed using R classification (p < .001), pT classification (p < .001), tumor invasive depth (p < .001), and internal jugular vein adhesion (p = .001). The C-indexes were 0.712 and 0.703 in the training and validation dataset. The 36- and 60-month AUCs were 0.767 and 0.766 in the training dataset and 0.713 and 0.757 in the validation dataset, respectively. The calibration curves showed relatively good agreement between the predicted and actual probability. CONCLUSION Based on the LNR, we developed a survival nomogram for HPSCC after neck dissection, which will be a practical tool to discriminate patients with different survival risks.
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Affiliation(s)
- Feiran Li
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Qiang Huang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chiyao Hsueh
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Huiying Huang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yi Zhu
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Hongli Gong
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Lei Tao
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ming Zhang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
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Lu S, Ling H, Chen J, Tan L, Gao Y, Li H, Tan P, Huang D, Zhang X, Liu Y, Mao Y, Qiu Y. MRI-based radiomics analysis for preoperative evaluation of lymph node metastasis in hypopharyngeal squamous cell carcinoma. Front Oncol 2022; 12:936040. [PMID: 36212477 PMCID: PMC9539826 DOI: 10.3389/fonc.2022.936040] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/06/2022] [Indexed: 12/24/2022] Open
Abstract
ObjectiveTo investigate the role of pre-treatment magnetic resonance imaging (MRI) radiomics for the preoperative prediction of lymph node (LN) metastasis in patients with hypopharyngeal squamous cell carcinoma (HPSCC).MethodsA total of 155 patients with HPSCC were eligibly enrolled from single institution. Radiomics features were extracted from contrast-enhanced axial T-1 weighted (CE-T1WI) sequence. The most relevant features of LN metastasis were selected by the least absolute shrinkage and selection operator (LASSO) method. Univariate and multivariate logistic regression analysis was adopted to determine the independent clinical risk factors. Three models were constructed to predict the LN metastasis status: one using radiomics only, one using clinical factors only, and the other one combined radiomics and clinical factors. Receiver operating characteristic (ROC) curves and calibration curve were used to evaluate the discrimination and the accuracy of the models, respectively. The performances were tested by an internal validation cohort (n=47). The clinical utility of the models was assessed by decision curve analysis.ResultsThe nomogram consisted of radiomics scores and the MRI-reported LN status showed satisfactory discrimination in the training and validation cohorts with AUCs of 0.906 (95% CI, 0.840 to 0.972) and 0.853 (95% CI, 0.739 to 0.966), respectively. The nomogram, i.e., the combined model, outperformed the radiomics and MRI-reported LN status in both discrimination and clinical usefulness.ConclusionsThe MRI-based radiomics nomogram holds promise for individual and non-invasive prediction of LN metastasis in patients with HPSCC.
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Affiliation(s)
- Shanhong Lu
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hang Ling
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, China
| | - Juan Chen
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Lei Tan
- College of Computer and Information Engineering, Hunan University of Technology and Business, Changsha, China
| | - Yan Gao
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Huayu Li
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Pingqing Tan
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Xiangya Medical School, Central South University, Changsha, China
| | - Donghai Huang
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xin Zhang
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yong Liu
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yitao Mao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Yuanzheng Qiu, ; Yitao Mao,
| | - Yuanzheng Qiu
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Yuanzheng Qiu, ; Yitao Mao,
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Pang W, Luo Y, Li J, Cheng D, Rao Y, Mao M, Qiu K, Dong Y, Liu J, Zou J, Wang H, Chen F. The Prognostic Prediction Value of Positive Lymph Nodes Numbers for the Hypopharyngeal Squamous Cell Carcinoma. Front Med (Lausanne) 2022; 9:898483. [PMID: 35860727 PMCID: PMC9291443 DOI: 10.3389/fmed.2022.898483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe current American Joint Committee on Cancer (AJCC) system only considered the importance of the size and laterality of lymph nodes while not the positive lymph node number (PLNN) for hypopharyngeal squamous cell carcinoma (HPSCC).MethodsA total of 973 patients with HPSCC from the Surveillance, Epidemiology, and End Results database (2004–2015) were identified. Univariate and multivariate Cox regression analyses were used to evaluate the prognostic effects. We applied six Cox regression models to compare the survival prognostic values of PLNN and AJCC systems.ResultsPositive lymph node number showed a significant association with overall survival (OS) and cancer-specific survival (CSS) (P < 0.001) in univariate and multivariable analyses. The increased PLNN of HPSCC gave rise to poor OS and CSS. The survival model incorporating a composite of PLNN and TNM classification (C-index for OS:0.682, C-index for CSS:0.702) performed better than other models.ConclusionsA positive lymph node number could serve as a survival predictor for patients with HPSCC and a complement to enhance the prognostic assessment effects of TNM cancer staging systems.
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Affiliation(s)
- Wendu Pang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yaxin Luo
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Junhong Li
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Danni Cheng
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yufang Rao
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Minzi Mao
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Qiu
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yijun Dong
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Liu
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Zou
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Haiyang Wang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
- Haiyang Wang
| | - Fei Chen
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Fei Chen
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Prognostic Value of Pathologically Positive Nodal Number in p16-Negative Oropharyngeal and Hypopharyngeal Squamous Cell Carcinoma with pN3b Status. Diagnostics (Basel) 2022; 12:diagnostics12061443. [PMID: 35741253 PMCID: PMC9222085 DOI: 10.3390/diagnostics12061443] [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: 05/20/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/24/2022] Open
Abstract
In this study, we aimed to investigate the prognostic value of the number of pathologically positive nodes (pN+) in p16-negative oropharyngeal (OPSCC) and hypopharyngeal (HPSCC) squamous cell carcinoma cases with pN3b status after surgery. We reviewed the clinical and pathological features of 120 newly diagnosed p16-negative OPSCC and HPSCC patients with pN3b status after radical surgery. The primary endpoints were the 5-year overall survival (OS), cancer-specific survival (CSS), and their prognostic factors. We used the Cox proportional hazards model for survival analysis. We generated predictive nomograms that incorporated the clinicopathological factors of OS and CSS. The 5-year OS and CSS rates were 44.1% and 59.1%, respectively. The optimal number of pN+ to predict the 5-year OS and CSS was pN+ = 3. In the Cox model, we observed that pN+ ≥ 3 was a significantly negative predictor of OS (HR: 1.9, 95% CI: 1.1–3.2, p = 0.021) and CSS (HR: 2.3; 95% CI: 1.2–4.6; p = 0.015). After adding the pN+ variable, the c-index of the predictive nomogram incorporating assorted clinicopathological factors increased from 0.66 to 0.689 for OS and from 0.713 to 0.75 for CSS. The results highlight the prognostic value of the pN+ number in p16-negative OPSCC and HPSCC patients with pN3b status.
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Li P, Fang Q, Yang Y, Chen D, Du W, Liu F, Luo R. Survival Significance of Number of Positive Lymph Nodes in Oral Squamous Cell Carcinoma Stratified by p16. Front Oncol 2021; 11:545433. [PMID: 33747901 PMCID: PMC7969991 DOI: 10.3389/fonc.2021.545433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 02/08/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives: To analyze the significance of the number of positive lymph nodes in oral squamous cell carcinoma (SCC) stratified by p16. Methods: A total of 674 patients were retrospectively enrolled and divided into 4 groups based on their number of positive lymph nodes (0 vs. 1–2 vs. 3–4 vs. ≥5). The Kaplan-Meier method was used to calculate the disease-free survival (DFS) and disease-specific survival (DSS) rates. Cox model was used to evaluate the independent risk factor. Results: p16 showed positivity in 85 patients with a rate of 12.6%. In patients with p16 negativity, the 5-year DFS rates were 52%, 39%, and 21% in patients with 0, 1–2, and 3–4 positive lymph nodes, respectively, in patients with ≥5 positive lymph nodes, all patients developed recurrence within 2 years after operation, the difference was significant; the 5-year DSS rates were 60, 38, and 18% in patients with 0, 1–2, and 3–4 positive lymph nodes, respectively, in patients with ≥5 positive lymph nodes, all patients died within 4-years after operation. The difference was significant. In p16 positivity patients, the 3-year DFS rates were 41% and 17% in patients with 0–2 and ≥3 positive lymph nodes, respectively, the difference was significant; the 3-year DSS rates were 84 and 46% in patients with 0–2 and ≥3 positive lymph nodes, the difference was significant. Conclusions: The number of positive lymph nodes is significantly associated with the survival in oral SCC, its survival effect is not affected by p16 status.
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Affiliation(s)
- Peng Li
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Qigen Fang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yanjie Yang
- Department of Oral Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Defeng Chen
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Wei Du
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Fei Liu
- Department of Oral Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruihua Luo
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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Topf MC, Philips R, Curry J, Magana LC, Tuluc M, Bar-Ad V, Keane W, Goldman RA, Luginbuhl A, Cognetti D. Impact of Lymph Node Yield in Patients Undergoing Total Laryngectomy and Neck Dissection. Ann Otol Rhinol Laryngol 2020; 130:591-601. [PMID: 33412910 DOI: 10.1177/0003489420964824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the impact of lymph node yield (LNY) in patients undergoing neck dissection at the time of total laryngectomy (TL). To determine the impact of radiation therapy (RT) on LNY. METHODS Retrospective review of LNY and clinical outcomes in 232 patients undergoing primary or salvage total laryngectomy (TL) with ND. RESULTS Preoperative RT significantly decreased mean LNY from 31.7 to 23.9 nodes (P < .001). In primary TL patients, age (P < .001) and positive margins (P = .044) were associated with decreased OS. In salvage TL patients, only positive margins was associated with poorer OS (P = .009). No LNY cutoff provided significant OS or DFS benefit. CONCLUSIONS Radiotherapy significantly reduces LNY in patients undergoing TL and ND. Within a single institution cohort, positive margins, but not LNY, is associated with survival in both primary and salvage TL patients.Level of Evidence: 4.
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Affiliation(s)
- Michael C Topf
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ramez Philips
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Joseph Curry
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Linda C Magana
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Madalina Tuluc
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Voichita Bar-Ad
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - William Keane
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Richard A Goldman
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Adam Luginbuhl
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - David Cognetti
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
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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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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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Abdeyrim A, He S, Zhang Y, Mamtali G, Asla A, Yusup M, Liu J. Prognostic value of lymph node ratio in laryngeal and hypopharyngeal squamous cell carcinoma: a systematic review and meta-analysis. J Otolaryngol Head Neck Surg 2020; 49:31. [PMID: 32471483 PMCID: PMC7257235 DOI: 10.1186/s40463-020-00421-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/22/2020] [Indexed: 12/21/2022] Open
Abstract
Background Several recent studies have indicated that the lymph node ratio (LNR) is an independent prognostic factor for laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC). The purpose of this paper is to assess the prognostic value of LNR and explore appropriate cutoff values by conducting a systematic review and meta-analysis. Methods Pubmed, Embase (via Ovid), and Cochrane library were systematically searched for studies on the prognostic value of LNR in LHSCC up to October 31, 2019. Then, Literature review, data extraction, and quality assessment of eligible studies were performed by two independent reviewers back-to-back. Lastly, Stata 14.0 software was hired to conduct a meta-analysis. Results A total of 445 articles were retrieved, and 13 studies published in English between 2013 and 2019 were included after the title/abstract and full-text screening. Among the 13 studies contributed to 4197 patients, seven studies were about hypopharyngeal squamous cell carcinoma (HPSCC), four studies about laryngeal squamous cell carcinoma (LSCC), and the remaining two studies about LHSCC. The meta-analysis results showed that shorter overall survival (OS) (HR 1.49; 95%CI: 1.18 to 1.88), disease-specific survival (DSS) (HR 1.66; 95%CI: 1.32 to 2.07) and disease-free survival (DFS) (HR 2.04; 95%CI: 1.54 to 2.71) were significantly correlated with a higher LNR in a random-effect model. The cutoff values of eligible studies were varied from 0.03 to 0.14, and the lowest significant LNR was 0.044. Conclusion LNR is a valuable prognostic factor in the survival of LHSCC and may be used to improve the tumor staging systems, which, however, requires the solid support of more high-quality studies.
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Affiliation(s)
- Arikin Abdeyrim
- Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Tianshan, Ürümqi, Xinjiang, 830001, China.
| | - Shizhi He
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Department of Otorhinolaryngology, China-Japan Friendship Hospital, Beijing, China
| | - Gulbostan Mamtali
- Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Tianshan, Ürümqi, Xinjiang, 830001, China
| | - Aibadla Asla
- Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Tianshan, Ürümqi, Xinjiang, 830001, China
| | - Mirkamil Yusup
- Department of Otorhinolaryngology Head and Neck Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Tianshan, Ürümqi, Xinjiang, 830001, China
| | - Jiang Liu
- Department of Neurosurgery, China-Japan Friendship Hospital, No. 2, Yinghua East Street, Chaoyang District, Beijing, 100029, China.
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Grasl S, Janik S, Parzefall T, Formanek M, Grasl MC, Heiduschka G, Erovic BM. Lymph node ratio as a prognostic marker in advanced laryngeal and hypopharyngeal carcinoma after primary total laryngopharyngectomy. Clin Otolaryngol 2019; 45:73-82. [PMID: 31660699 DOI: 10.1111/coa.13468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/27/2019] [Accepted: 10/21/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND We evaluated the prognostic value of lymph node ratio (LNR) in patients with advanced laryngeal and hypopharyngeal squamous cell carcinoma. STUDY DESIGN Retrospective chart review. METHODS Between 1994 and 2018, 79 patients underwent total laryngopharyngectomy and adjuvant therapy. LNR was determined and statistically compared to patients' overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), locoregional and distant failure. RESULTS The 5-year OS, DSS and DFS rates were 45.6%, 73.4% and 56.9%, respectively. 24.1% and 25.3% developed loco- regional failure or distant metastatic disease, respectively. Univariate analyses showed that high LNR (cut-off >0.07) was significantly associated with distant and locoregional failure. On multivariate analysis, LNR remained an independent predictor for OS (P = .004), DSS (P = .009) and DFS (P = .044). CONCLUSION Increased LNR in patients with advanced laryngeal or hypopharyngeal carcinoma is significantly linked to shortened OS, DSS, DFS and higher locoregional and distant metastatic disease.
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Affiliation(s)
- Stefan Grasl
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Janik
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Parzefall
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Formanek
- Department of Otorhinolaryngology and Phonetics, Hospital of St. John of God, Vienna, Austria.,Department of Laryngology, Medical School, Sigmund Freud Private University, Vienna, Austria
| | - Matthaeus C Grasl
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Gregor Heiduschka
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Boban M Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
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12
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Subramaniam N, Balasubramanian D, Kumar N, Murthy S, Vijayan SN, Nambiar A, Vidhyadharan S, Thankappan K, Iyer S. Lymph node staging systems in oral squamous cell carcinoma: A comparative analysis. Oral Oncol 2019; 97:92-98. [DOI: 10.1016/j.oraloncology.2019.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 01/23/2023]
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13
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Lymph node yield and lymph node density for elective level II-IV neck dissections in laryngeal squamous cell carcinoma patients. Eur Arch Otorhinolaryngol 2019; 276:2923-2927. [PMID: 31317320 DOI: 10.1007/s00405-019-05560-z] [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: 06/13/2019] [Accepted: 07/11/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine the minimum lymph node yield (LNY) in patients with laryngeal squamous cell carcinoma (LSCCs). METHODS This retrospective study was performed in a tertiary care hospital setting and included 42 LSCC patients aged 39-81 years (females, n = 2; males, n = 40) who underwent a total or partial laryngectomy and elective bilateral level II-IV neck dissections (unilateral neck dissections: n = 84). RESULTS The average LNY in the unilateral level II-IV lymph node dissections was 25.9 ± 10, and the average metastatic LNY was 0.9 ± 1.9. The unilateral neck dissections were grouped according to the number of lymph nodes. There was no significant difference between the groups in terms of the metastatic LNY (p = 0.5). The metastatic lymph node density (LND) (metastatic lymph node yield/LNY) was 0.043 for unilateral neck level II-IV neck dissections. A Cox regression analysis revealed no significant relationship between survival and the LNY and LND in bilateral neck dissections (p = 0.4 and p = 0.8, respectively). CONCLUSIONS The results revealed no minimum number of lymph nodes that could reliably detect metastatic lymph nodes in LSCC patients.
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14
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Ye LL, Rao J, Fan XW, Ji QH, Hu CS, Ying HM. Impact of tumor dimensions and lymph node density on the survival of patients with hypopharyngeal squamous cell carcinoma. Cancer Manag Res 2018; 10:4679-4688. [PMID: 30425568 PMCID: PMC6201846 DOI: 10.2147/cmar.s178750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose To analyze the potential variables affecting the survival of patients undergoing primary surgery for hypopharyngeal squamous cell carcinoma. Patients and methods Between August 2007 and December 2016, 93 patients with primary hypopharyngeal squamous cell carcinomas undergoing radical surgery at Fudan University Shanghai Cancer Center were reviewed. The clinicopathological features were analyzed retrospectively. The optimal cutoff values were determined based on the receiver operating characteristic curve analysis. Pearson correlation coefficients were used to assess the correlations between variables. The Kaplan–Meier and Cox proportional hazard methods were used to evaluate the impact of variables on overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Results Cox multivariate analysis revealed that a depth of invasion (DOI) ≥ 4.3 mm was correlated with inferior OS (P=0.045), DSS (P=0.046), and DFS (P=0.046). A primary tumor volume (PTV) ≥0.36 mL was related to poor OS (P=0.018), DSS (P=0.026), and DFS (P=0.036). A lymph node density (LND) ≥0.07 was also associated with worse OS (P=0.014) and DSS (P=0.045). Moreover, additional prognostic value was observed in the combined use of PTV and LND. Conclusion The DOI, PTV, and LND obtained from the surgical specimens could provide additional valuable information for prognostic stratification and allowed the more appropriate selection of suitable candidates for more aggressive adjuvant therapy.
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Affiliation(s)
- Lu-Lu Ye
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China,
| | - Jia Rao
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China, .,Department of Pathology
| | - Xing-Wen Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China,
| | - Qing-Hai Ji
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China, .,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China
| | - Chao-Su Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China,
| | - Hong-Mei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, P.R. China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China,
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15
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Zhang X, Yu F, Zhao Z, Mai J, Zhou Y, Tan G, Liu X. The Prognostic Significance of Lymph Node Ratio and Log Odds Ratio in Laryngeal Squamous Cell Carcinoma. OTO Open 2018; 2:2473974X18792008. [PMID: 31535064 PMCID: PMC6737873 DOI: 10.1177/2473974x18792008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate whether lymph node ratio (LNR) and log odds ratio (LODDS) have prognostic significance for overall survival (OS) and disease-free survival (DFS) in patients with laryngeal squamous cell cancer (LSCC) treated with curative intent. Study Design Case-control study. Setting University hospital. Subjects and Methods Records of 229 patients with LSCC who underwent surgery with a curative intent with or without adjuvant treatment from 2000 to 2014 were reviewed. The clinicopathological parameters LNR and LODDS were analyzed; univariate and multivariate analysis was performed to evaluate the prognosis of each for OS and DFS. Results The 5-year OS was 81.7% for LNR ≤0.233 and 47.1% for LNR >0.233, and the 5-year OS was 79.6% for LODDS ≤–0.1 and 51.8% for LODDS >–0.1, respectively. In the univariate analysis, the independent variables were subsites, pT stage (pT1 and pT2 vs pT3 and pT4), pN, pTNM, alcohol consumption, and LNR and LODDS (P < .05). By multivariate analysis, we determined that subsites, pT stage, alcohol consumption, LNR, and LODDS were independent prognostic predictors of survival (P < .05). Univariate and multivariate models identified that both LNR and LODDS were significant prognostic factors for survival. However, the hazard ratio (HR) for LNR >0.233 vs ≤0.233 was 8.95 (95% confidence interval [CI], 3.18-25.16; P < .001) in OS, and the HR was 11.37 (95% CI, 4.02-32.15; P < .001) in DFS. The risk of LNR was noticeably greater than other factors. Conclusions LNR and LODDS were both prognostic factors for OS and DFS. However, LNR was confirmed as a more reliable indicator for evaluating the prognosis, and it can be used to increase the prognostic value of the traditional TNM classification of LSCC.
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Affiliation(s)
- Xinrui Zhang
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Feng Yu
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Zheng Zhao
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, Guangdong, P.R. China.,Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Junhao Mai
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, Guangdong, P.R. China.,Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Yibo Zhou
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Guojie Tan
- Department of Otorhinolaryngology, Guangzhou Otolaryngology-Head and Neck Surgery Hospital, Guangzhou, Guangdong, P.R. China.,Institute of Otolaryngology-Head and Neck Surgery, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Xuekui Liu
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Centre, Guangzhou, Guangdong, P.R. China.,Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
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16
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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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17
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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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18
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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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19
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Ye LL, Oei RW, Kong FF, Du CR, Zhai RP, Ji QH, Hu CS, Ying HM. The prognostic value of preoperative prognostic nutritional index in patients with hypopharyngeal squamous cell carcinoma: a retrospective study. J Transl Med 2018; 16:12. [PMID: 29361946 PMCID: PMC5781337 DOI: 10.1186/s12967-018-1391-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022] Open
Abstract
Background To analyze the prognostic value of preoperative prognostic nutritional index (PNI) in predicting the survival outcome of hypopharyngeal squamous cell carcinoma (HPSCC) patients receiving radical surgery. Methods From March 2006 to August 2016, 123 eligible HPSCC patients were reviewed. The preoperative PNI was calculated as serum albumin (g/dL) × 10 + total lymphocyte count (mm−3) × 0.005. These biomarkers were measured within 2 weeks prior to surgery. The impact of preoperative PNI on overall survival (OS), progression-free survival (PFS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) were analyzed using Kaplan–Meier method and Cox proportional hazards model. Results Median value of 52.0 for the PNI was selected as the cutoff point. PNI value was then classified into two groups: high PNI (> 52.0) versus low PNI (≤ 52.0). Multivariate analysis showed that high preoperative PNI was an independent prognostic factor for better OS (P = 0.000), PFS (P = 0.001), LRFS (P = 0.005) and DMFS (P = 0.016). Conclusions High PNI predicts superior survival in HPSCC patients treated with radical surgery. As easily accessible biomarkers, preoperative PNI together with the conventional TNM staging system can be utilized to enhance the accuracy in predicting survival and determining therapy strategies in these patients.
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Affiliation(s)
- Lu-Lu Ye
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Ronald Wihal Oei
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Fang-Fang Kong
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Cheng-Run Du
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Rui-Ping Zhai
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Chao-Su Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Hong-Mei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dongan Road, Shanghai, 200032, People's Republic of China.
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20
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Suzuki H, Matoba T, Hanai N, Nishikawa D, Fukuda Y, Koide Y, Hasegawa Y. Lymph node ratio predicts survival in hypopharyngeal cancer with positive lymph node metastasis. Eur Arch Otorhinolaryngol 2016; 273:4595-4600. [DOI: 10.1007/s00405-016-4170-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
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21
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Imre A, Pinar E, Dincer E, Ozkul Y, Aslan H, Songu M, Tatar B, Onur I, Ozturkcan S, Aladag I. Lymph Node Density in Node-Positive Laryngeal Carcinoma: Analysis of Prognostic Value for Survival. Otolaryngol Head Neck Surg 2016; 155:797-804. [PMID: 27221573 DOI: 10.1177/0194599816652371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/10/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We investigated the value of lymph node density (LND) as a predictor of survival in patients with laryngeal squamous cell carcinoma (SCC) and positive neck node (pN+) after laryngectomy. STUDY DESIGN Case series with chart review. SETTING Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. SUBJECTS AND METHODS We reviewed the records of 289 patients with newly diagnosed primary laryngeal carcinomas who underwent partial or total laryngectomy and combined neck dissection at a tertiary referral center between June 2006 and December 2014. Patients with pN+ laryngeal SCC (n = 101) were included in the study. Overall survival (OS) and disease-free survival (DFS) were used to evaluate the prognostic significance of LND. RESULTS In 101 patients with pN+ laryngeal SCC, LND ≥0.09 and number of metastatic lymph nodes >4 were significantly associated with OS and DFS but not the overall tumor, node, and metastasis stage. Forward stepwise Cox regression analysis revealed that LND ≥0.09 was the only independent predictor of both DFS and OS. Furthermore, the odds ratio of LND ≥0.09 was 10 times higher in patients with regional recurrence when compared patients without regional recurrence. CONCLUSIONS LND was the only independent prognostic predictor of OS and DFS in patients with pN+ laryngeal SCC. Moreover, patients with LND ≥0.09 were significantly associated with high risk of regional recurrence. Thus, patients with LND ≥0.09 are at high risk of regional recurrence and death and may be considered for adjuvant chemoradiation.
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Affiliation(s)
- Abdulkadir Imre
- Department of Otorhinolaryngology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ercan Pinar
- Department of Otorhinolaryngology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Elif Dincer
- Department of Otorhinolaryngology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Yılmaz Ozkul
- Department of Otorhinolaryngology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Hale Aslan
- Department of Otorhinolaryngology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Murat Songu
- Department of Otorhinolaryngology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Bekir Tatar
- Department of Otorhinolaryngology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Irem Onur
- Department of Pathology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Sedat Ozturkcan
- Department of Otorhinolaryngology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Ibrahim Aladag
- Department of Otorhinolaryngology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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22
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Which is the most suitable lymph node predictor for overall survival after primary surgery of head and neck cancer: pN, the number or the ratio of positive lymph nodes, or log odds? J Cancer Res Clin Oncol 2015; 142:885-93. [PMID: 26711282 DOI: 10.1007/s00432-015-2104-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/18/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the best lymph node (LN) metastasis predictor for overall survival (OS) in head neck cancer (HNC): pN classification, number of positive lymph nodes (PNOD), lymph node ratio (LNR), or log odds of positive lymph nodes (LODDS). METHODS In total, 225 surgically treated HNC patients were evaluated for the different LN classifications and OS. RESULTS Five-year OS was 71.8 %. Mean number of yielded LN and PNOD was 25.3 ± 16.7 and 2.7 ± 5.9, respectively. 64.8 % had a LNR > 0.10 and 64.4 % a LODDS > 10. In univariable analysis, multimodal therapy (p = 0.039), advanced pT (p < 0.0001), advanced UICC stage (p = 0.029), LNR > 0.10 (p = 0.049), and LODDS > -1.0 (p = 0.021) were associated with lower OS. In multivariable analysis, advanced pT [hazard ratio (HR) 2.194; 95 % confidence interval (CI) 1.294-3.722; p = 0.004] and LODDS > -1.0 (HR 1.634; 95 % CI 1.002-2.665; p = 0.059) remained independent predictors for lower OS. CONCLUSIONS It seems useful to analyze the prognostic significance of LODDS in other samples of HNC.
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Hoffmann M, Saleh-Ebrahimi L, Zwicker F, Haering P, Schwahofer A, Debus J, Huber PE, Roeder F. Long term results of postoperative Intensity-Modulated Radiation Therapy (IMRT) in the treatment of Squamous Cell Carcinoma (SCC) located in the oropharynx or oral cavity. Radiat Oncol 2015; 10:251. [PMID: 26637471 PMCID: PMC4670508 DOI: 10.1186/s13014-015-0561-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/27/2015] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND To report our long-term results with postoperative intensity-modulated radiation therapy (IMRT) in patients suffering from squamous-cell carcinoma (SCC) of the oral cavity or oropharynx. METHODS Seventy five patients were retrospectively analyzed. Median age was 58 years and 84 % were male. 76 % of the primaries were located in the oropharynx. Surgery resulted in negative margins (R0) in 64 % of the patients while 36 % suffered from positive margins (R1). Postoperative stages were as follows: stage 1:4 %, stage 2:9 %, stage 3:17 %, stage 4a:69 % with positive nodes in 84 %. Perineural invasion (Pn+) and extracapsular extension (ECE) were present in 7 % and 29 %, respectively. All patients received IMRT using the step-and-shoot approach with a simultaneously integrated boost (SIB) in 84 %. Concurrent systemic therapy was applied to 53 patients, mainly cisplatin weekly. RESULTS Median follow-up was 55 months (5-150). 13 patients showed locoregional failures (4 isolated local, 4 isolated neck, 5 combined) transferring into 5-year-LRC rates of 85 %. Number of positive lymph nodes (n > 2) and presence of ECE were significantly associated with decreased LRC in univariate analysis, but only the number of nodes remained significant in multivariate analysis. Overall treatment failures occurred in 20 patients (9 locoregional only, 7 distant only, 4 combined), transferring into 3-and 5-year-FFTF rates of 77 % and 75 %, respectively. The 3-and 5-year-OS rates were 80 % and 72 %, respectively. High clinical stage, high N stage, number of positive nodes (n > 2), ECE and Pn1 were significantly associated with worse FFTF and OS in univariate analysis, but only number of nodes remained significant for FFTF in multivariate analysis. Maximum acute toxicity was grade 3 in 64 % and grade 4 in 1 %, mainly hematological or mucositis/dysphagia. Maximum late toxicity was grade 3 in 23 % of the patients, mainly long-term tube feeding dependency. CONCLUSION Postoperative IMRT achieved excellent LRC and good OS with acceptable acute and low late toxicity rates. The number of positive nodes (n > 2) was a strong prognostic factor for all endpoints in univariate and the only significant factor for LRC and FFTF in multivariate analysis. Patients with feeding tubes due to postoperative complications had an increased risk for long-term feeding tube dependency.
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Affiliation(s)
- M Hoffmann
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
| | - L Saleh-Ebrahimi
- Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
| | - F Zwicker
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - P Haering
- Department of Radiation Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - A Schwahofer
- Department of Radiation Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - J Debus
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. .,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - P E Huber
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
| | - F Roeder
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
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Chen CC, Lin JC, Chen KW. Lymph node ratio as a prognostic factor in head and neck cancer patients. Radiat Oncol 2015; 10:181. [PMID: 26302761 PMCID: PMC4554293 DOI: 10.1186/s13014-015-0490-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/18/2015] [Indexed: 12/11/2022] Open
Abstract
Background Lymph node status is one prognostic factor in head and neck cancer. The purpose of this study is to investigate the prognostic value of lymph node ratio (LNR) in head and neck cancer patients who received surgery plus postoperative chemoradiotherapy. Methods From May 1991 to December 2012, a total of 117 head and neck cancer patients who received surgery plus postoperative chemoradiotherapy were analyzed. The primary sites were oral cavity (93), oropharynx (13), hypopharynx (6), and larynx (5). All patients had pathologically confirmed squamous cell carcinoma and 63 patients had neck lymph nodes metastasis. LNR was calculated for each patient. The endpoints were overall survival (OS), local failure-free survival (LFFS), and distant metastasis-free survival (DMFS). Results The median follow up time was 36 months, with a range from 3.4 to 222 months. The 3-year rates of OS, LFFS, and DMFS were 59.7, 70.3, and 81.8 %, respectively. The median value of LNR for lymph nodes positive patients was 0.1. In univariate analysis, patients with an LNR value less than 0.1 had better 3-year OS (67.0 % vs.41.0 %, p = 0.004), 3-year LFFS (76.1 % vs. 54.9 %, p = 0.015) and 3-year DMFS (87.2 % vs. 66.4 %, p = 0.06). Multivariate analysis revealed that LNR was an independent prognostic factor for OS (hazard ratio [HR] = 2.92; 95 % confidence interval [CI] = 1.367–6.242; p = 0.006) and LFFS (HR = 4.12; 95 % CI = 1.604–10.59; p = 0.003). Conclusion LNR is an important prognosis factor for OS and LFFS in head and neck cancer patients. Electronic supplementary material The online version of this article (doi:10.1186/s13014-015-0490-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chien-Chih Chen
- Department of Radiation Oncology, Taichung Veterans General Hospital, No.1650, Sect. 4, Taiwan Boulevard, Taichung, 40705, Taiwan, Republic of China.
| | - Jin-Ching Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, No.1650, Sect. 4, Taiwan Boulevard, Taichung, 40705, Taiwan, Republic of China. .,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan, Republic of China.
| | - Kuan-Wen Chen
- Department of Radiation Oncology, Taichung Veterans General Hospital, No.1650, Sect. 4, Taiwan Boulevard, Taichung, 40705, Taiwan, Republic of China.
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Wong TS, Gao W, Chan JYW. Interactions between E-cadherin and microRNA deregulation in head and neck cancers: the potential interplay. BIOMED RESEARCH INTERNATIONAL 2014; 2014:126038. [PMID: 25161999 PMCID: PMC4138976 DOI: 10.1155/2014/126038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/07/2014] [Accepted: 07/11/2014] [Indexed: 12/27/2022]
Abstract
E-cadherin expression in the head and neck epithelium is essential for the morphogenesis and homeostasis of epithelial tissues. The cadherin-mediated cell-cell contacts are required for the anchorage-dependent growth of epithelial cells. Further, survival and proliferation require physical tethering created by proper cell-cell adhesion. Otherwise, the squamous epithelial cells will undergo programmed cell death. Head and neck cancers can escape from anoikis and enter into the epithelial-mesenchymal transition stages via the modulation of E-cadherin expression with epigenetic mechanisms. At epigenetic level, gene expression control is not dependent on the DNA sequence. In the context of E-cadherin regulation in head and neck cancers, 2 major mechanisms including de novo promoter hypermethylation and microRNA dysregulation are most extensively studied. Both of them control E-cadherin expression at transcription level and subsequently hinder the overall E-cadherin protein level in the head and neck cancer cells. Increasing evidence suggested that microRNA mediated E-cadherin expression in the head and neck cancers by directly/indirectly targeting the transcription suppressors of E-cadherin, ZEB1 and ZEB2.
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Affiliation(s)
- Thian-Sze Wong
- Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wei Gao
- Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jimmy Yu-Wai Chan
- Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong
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