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Johns JD, Choe EJ, Chisolm PF, Pothast MJ, Randolph JR, Chou J, Maxwell JH. The impact of COVID-19 and vaccination status on outcomes in veterans with head and neck squamous cell carcinoma. Head Neck 2024; 46:1698-1705. [PMID: 38433326 DOI: 10.1002/hed.27714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/03/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The impact of both COVID-19 infection and vaccination status on patients with head and neck squamous cell carcinoma (HNSCC) remains unknown. OBJECTIVE To determine the impact of COVID-19 infection and vaccination status on 60-day mortality, cardiovascular, and respiratory complications in patients with a prior diagnosis of HNSCC. METHODS This was a retrospective cohort study through the Veterans Affairs (VA) Corporate Data Warehouse of Veterans with HNSCC who were tested for COVID-19 during any inpatient VA medical center admission. A cohort of patients was created of Veterans with a diagnosis of HNSCC of the oral cavity,oropharynx, hypopharynx, larynx, and nasopharynx based on International Classification of Disease (ICD) codes. Data collected included clinical/demographic data, vaccination status, and incidence of 60-day mortality, 60-day cardiovascular complication (including myocardial infarction, venous thromboembolism, cerebrovascular accident), and 60-day respiratory complication (including acute respiratory failure, acute respiratory distress syndrome, and pneumonia). The interactions between COVID-19 infection, vaccination status, morbidity and mortality were investigated. RESULTS Of the 14 262 patients with HNSCC who were tested for COVID-19 during inpatient admission, 4754 tested positive (33.3%), and 9508 (67.7%) tested negative. Patients who tested positive demonstrated increased 60-day mortality (4.7% vs. 2.0%, respectively; p < 0.001), acute respiratory failure (ARF; 15.4% vs. 7.1%, p < 0.001), acute respiratory distress syndrome (ARDS; 0.9% vs. 0.2%, p < 0.001), and pneumonia (PNA; 20.0% vs. 6.4%, p < 0.001) compared to those who never tested positive, respectively. Patients who received COVID-19 vaccination between 2 weeks and 6 months prior to a positive test demonstrated decreased rates of ARF (13.2% vs. 16.0%, p = 0.034) and PNA (16.7% vs. 20.9%, p = 0.003) compared to the unvaccinated group. A logistic regression of patients with COVID-19 infections who died within 60 days was performed, with no significant survival advantage among patients vaccinated between 2 weeks and 6 months prior to the positive test. CONCLUSION COVID-19 infection may significantly increase rates of 60-day mortality and respiratory complications in patients with HNSCC. COVID-19 vaccination between 2 weeks and 6 months prior to infection may decrease severity of respiratory complications but did not show significant mortality benefits in this study. These data highlight the need for surveillance of respiratory infection and vaccination in this vulnerable population.
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Affiliation(s)
- James D Johns
- Department of Otolaryngology - Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Erica J Choe
- Georgetown University School of Medicine, Washington, DC, USA
| | - Paul F Chisolm
- Department of Otolaryngology - Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Jackson R Randolph
- Department of Otolaryngology - Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jiling Chou
- Center for Biostatistics, Informatics, and Data Science, MedStar Health Research Institute, Hyattsville, Maryland, USA
| | - Jessica H Maxwell
- Department of Otolaryngology - Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Surgery, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
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Yang Z, Mansour J, Sun P, Wei P, Dahlstrom KR, Zafereo M, Li G, Gross ND. Impact of pretreatment body mass index on the survival of head and neck cancer patients. Head Neck 2024. [PMID: 38269627 DOI: 10.1002/hed.27659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 12/29/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Differences in pretreatment body mass index (BMI) have been associated with survival in squamous cell carcinoma of head and neck (SCCHN). We examined effects of BMI on survival in SCCHN patients after stratifying patients by tumor human papillomavirus (HPV) status and subsite. METHODS Totally 2204 SCCHN patients in a prospective study were included in this secondary analysis. Multivariable Cox models were used to evaluate associations between pretreatment BMI and overall survival, disease-specific survival, and disease-free survival. RESULTS BMI was significantly higher among patients with HPV-positive tumors than HPV-negative tumors. BMI >25 kg/m2 was associated with improved survival, while BMI <18.5 kg/m2 was associated with reduced survival, particularly in patients with HPV-positive oropharyngeal cancer tumors. CONCLUSIONS This exploratory analysis suggests that pretreatment BMI could be an independent prognostic factor of survival outcomes in SCCHN patients, particularly in patients with HPV-positive oropharyngeal cancer tumors. Further prospective investigations are warranted.
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Affiliation(s)
- Zheng Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University; Key Laboratory of Otolaryngology Head and Neck Surgery of the Ministry of Education, Beijing, China
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jobran Mansour
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peng Sun
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Otolaryngology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristina R Dahlstrom
- Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Guojun Li
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Division of Epidemiology, The University of Texas School of Public Health, Houston, Texas, USA
| | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Riju J, Tirkey AJ, Vidya K, Agarwal M, Babu M, Kurian R, Paulose A. A Site-Based Analysis of Relationship Between Clinicopathological Factors and Their Influence on Locoregional Recurrence in Oral Squamous Cell Carcinoma. Indian J Surg Oncol 2023; 14:733-741. [PMID: 37900650 PMCID: PMC10611655 DOI: 10.1007/s13193-023-01750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/14/2023] [Indexed: 10/31/2023] Open
Abstract
In India, oral cancers are the major cause of cancer-related death. Tongue and buccal mucosa being the major subsites in oral cancer have varying clinicopathological presentations. This study is intended to know the difference in clinicopathological behavior of these two subsites. This retrospective study included 474 patients of which 232 patients had tongue cancer and 242 patients had buccal alveolar complex (BAC) cancer. Comparison between the pathological characters including pattern of nodal involvement was analyzed. Disease-free survival (DFS) and factors influencing the DFS were analyzed and compared using Cox regression analysis. Mean age of the study population was 52.7 years. Tongue oral squamous cell carcinoma (OSCC) differed significantly from BAC OSCC in terms of age of presentation, tumor staging, and perineural invasion. Among neck nodal involvement, tongue OSCC commonly involved level IIa (p < 0.001) whereas BAC involved level Ib (p < 0.001). At a median follow-up of 27 months, 141 patients had disease recurrence, tongue OSCC commonly recurred in neck (p = 0.008), and BAC OSCC relapsed at primary site (p = 0.001). Patients older than 45 years with BAC cancer had lesser risk of recurrence (HR, 0.30; 95% CI, 0.2-0.5; p < 0.0001). Pathological tumor stage in tongue cancer (HR, 14.9; 95% CI, 2.6-84.8; p = 0.002) and grade of tumor differentiation in BAC OSCC (HR, 9.2; 95% CI, 1.9-43.3; p < 0.005) were the most significant factors that influenced tumor recurrence. There was a significant difference in factors influencing disease recurrence among tongue and BAC OSCC. Also, pattern of nodal metastasis and pattern of recurrence were different. Hence, further research on OSCC may be done site specific. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-023-01750-8.
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Affiliation(s)
- Jeyashanth Riju
- Department of Head and Neck Surgery, Christian Medical College, Vellore, India
| | - Amit Jiwan Tirkey
- Department of Head and Neck Surgery, Christian Medical College, Vellore, India
| | - Konduru Vidya
- Department of Head and Neck Surgery, Christian Medical College, Vellore, India
| | - Mansi Agarwal
- Department of Head and Neck Surgery, Christian Medical College, Vellore, India
| | - Malavika Babu
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4YS UK
| | | | - Antony Paulose
- Department of Head and Neck Surgery, Christian Medical College, Vellore, India
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Ronen O, Robbins KT, Shaha AR, Kowalski LP, Mäkitie AA, Florek E, Ferlito A. Emerging Concepts Impacting Head and Neck Cancer Surgery Morbidity. Oncol Ther 2023; 11:1-13. [PMID: 36565427 PMCID: PMC9935772 DOI: 10.1007/s40487-022-00217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/01/2022] [Indexed: 12/25/2022] Open
Abstract
All treatment modalities for head and neck cancer carry with them a risk of adverse events. Head and neck surgeons are faced with significant challenges to minimize associated morbidity and manage its sequelae. Recognizing situations in which a surgical complication is an adverse event inherent to the procedure can alleviate the psychologic impact a complication might have on the treatment team and minimize external and internal pressures. Focusing on the complications that can be effectively modified, future complications can be avoided. Also, some surgical morbidities may not be preventable, necessitating the option to reconsider whether the incidents should be labeled toxic reactions rather than a complication. This discussion highlights some of the areas in which additional research is needed to achieve the goal of minimizing the impact of surgical morbidity.
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Affiliation(s)
- Ohad Ronen
- Head and Neck Surgery Unit, Department of Otolaryngology-Head and Neck Surgery, Affiliated With Azrieli Faculty of Medicine, Galilee Medical Center, Bar-Ilan University, POB 21, Nahariya, Safed, 2210001, Israel.
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ewa Florek
- Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, Poznan, Poland
| | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
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Wang CK, Ho CF, Niu KY, Wu CC, Chang YC, Hsiao CH, Yen CC. Risk factors for rebleeding and long-term outcomes in patients with head and neck cancer bleeding: a multicenter study. BMC Cancer 2022; 22:841. [PMID: 35918707 PMCID: PMC9347166 DOI: 10.1186/s12885-022-09945-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Acute, catastrophic bleeding in patients with head and neck cancer (HNC) is challenging and also a burden for their families and frontline physicians. This study analyzed the risk factors for rebleeding and long-term outcomes in these patients with HNC. Methods Patients who presented to the emergency department (ED) with HNC bleeding were enrolled in this study (N = 231). Variables of patients with or without rebleeding were compared, and associated factors were investigated using Cox’s proportional hazard model. Results Of the 231 patients enrolled, 112 (48.5%) experienced a recurrent bleeding event. The cumulative rebleeding incidence rate was 23% at 30 days, 49% at 180 days, and 56% at 1 year. Multivariate Cox regression analyses demonstrated that overweight-to-obesity (HR = 0.52, 95% CI 0.28–0.98, p = 0.043), laryngeal cancer (hazard ratio [HR] = 2.13, 95% confidence interval [CI] 1.07–4.23, p = 0.031), chemoradiation (HR = 1.49, 95% CI 1.001–2.94, p = 0.049), and second primary cancer (HR = 1.75, 95% CI 1.13–2.70, p = 0.012) are significant independent predictors of rebleeding, and the prognostic factors for overall survival included underweight (HR = 1.89, 95% CI 1.22–2.93, p = 0.004), heart rate > 110 beats/min (HR = 1.58, 95% CI 1.04–2.39, p = 0.032), chemoradiation (HR = 2.31, 95% CI 1.18–4.52, p = 0.015), and local recurrence (HR = 1.74, 95% CI 1.14–2.67, p = 0.011). Conclusions Overweight-to-obesity is a protective factor, while laryngeal cancer, chemoradiation and a second primary cancer are risk factors for rebleeding in patients with HNC. Our results may assist physicians in risk stratification of patients with HNC bleeding.
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Affiliation(s)
- Chih-Kai Wang
- Department of Emergency Medicine, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Che-Fang Ho
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuang-Yu Niu
- Department of Emergency Medicine, Keelung Branch, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chia-Chien Wu
- Department of Medical Imaging and Intervention, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yun-Chen Chang
- Department of Otolaryngology Head and Neck Surgery, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Han Hsiao
- Department of Linguistics, Indiana University, Bloomington, IN, USA
| | - Chieh-Ching Yen
- Department of Emergency Medicine, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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