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Toppenberg AGL, Nijboer TS, van der Laan WGWJ, Wedman J, Schwandt LQ, Plaat RE, Witjes MJH, Wegner I, Halmos GB. Predictors for Success and Failure in Transoral Robotic Surgery-A Retrospective Study in the North of the Netherlands. Cancers (Basel) 2024; 16:1458. [PMID: 38672541 PMCID: PMC11048242 DOI: 10.3390/cancers16081458] [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: 03/14/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Transoral Robotic Surgery (TORS) is utilized for treating various malignancies, such as early-stage oropharyngeal cancer and lymph node metastasis of an unknown primary tumor (CUP), and also benign conditions, like obstructive sleep apnea (OSA) and chronic lingual tonsillitis. However, the success and failure of TORS have not been analyzed to date. In this retrospective observational multicenter cohort study, we evaluated patients treated with TORS using the da Vinci surgical system. Success criteria were defined as identification of the primary tumor for CUP, >2 mm resection margin for malignant conditions, and improvement on respiratory polygraphy and tonsillitis complaints for benign conditions. A total of 220 interventions in 211 patients were included. We identified predictors of success, such as low comorbidity status ACE-27, positive P16 status, and lower age for CUP, and female gender and OSA severity for benign conditions. For other malignancies, no predictors for success were found. Predictors of failure based on postoperative complications included high comorbidity scores (ASA) and anticoagulant use, and for postoperative pain, younger age and female gender were identified. This study provides valuable insights into the outcomes and predictors of success and failure in TORS procedures across various conditions and may also help in patient selection and counseling.
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Affiliation(s)
- Alexandra G. L. Toppenberg
- Department of Ear Nose Throat Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (A.G.L.T.); (T.S.N.); (W.G.W.J.v.d.L.); (J.W.); (I.W.)
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands; (L.Q.S.); (R.E.P.)
| | - Thomas S. Nijboer
- Department of Ear Nose Throat Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (A.G.L.T.); (T.S.N.); (W.G.W.J.v.d.L.); (J.W.); (I.W.)
- Department of Oral Maxillo Facial Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands;
| | - Wisse G. W. J. van der Laan
- Department of Ear Nose Throat Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (A.G.L.T.); (T.S.N.); (W.G.W.J.v.d.L.); (J.W.); (I.W.)
| | - Jan Wedman
- Department of Ear Nose Throat Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (A.G.L.T.); (T.S.N.); (W.G.W.J.v.d.L.); (J.W.); (I.W.)
| | - Leonora Q. Schwandt
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands; (L.Q.S.); (R.E.P.)
| | - Robert E. Plaat
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands; (L.Q.S.); (R.E.P.)
| | - Max J. H. Witjes
- Department of Oral Maxillo Facial Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands;
| | - Inge Wegner
- Department of Ear Nose Throat Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (A.G.L.T.); (T.S.N.); (W.G.W.J.v.d.L.); (J.W.); (I.W.)
| | - Gyorgy B. Halmos
- Department of Ear Nose Throat Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (A.G.L.T.); (T.S.N.); (W.G.W.J.v.d.L.); (J.W.); (I.W.)
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Faisal M, Le NS, Grasl S, Pammer J, Janik S, Heiduschka G, Schratter-Sehn AU, Franz P, Königswieser M, Grasl MC, Erovic BM. Survival Outcome in True Carcinoma of Unknown Primary (tCUP) with p16 + Cervical Metastasis. Int Arch Otorhinolaryngol 2023; 27:e687-e693. [PMID: 37876688 PMCID: PMC10593513 DOI: 10.1055/s-0042-1759575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 08/22/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Age and lymph node ratio have been attributed as independent predictors for survival and recurrence in carcinoma of unknown primary (CUP). Objective The purpose of this study was to analyze the prognostic value of p16 overexpression for CUP in the absence of true primary (TP). Methods The study involved 43 patients who underwent therapeutic lymph node dissection (LND) from 2000 to 2015 after all the diagnostic work up for CUP. Immunohistochemistry for p16 overexpression was performed. Cox proportional hazard regression analysis was used to analyze the prognostic impact on 5-year overall survival (OS) and recurrence-free survival (RFS). Results The male-to-female ratio was 5.1:1, with a median age of 62 years. The clinicopathological data, except for p16 overexpression, did not differ significantly in terms of 5-year OS and RFS. The Cox regression analysis proposed p16 positivity to be an independent prognosticator of regional recurrence-free survival (RRFS) (hazard ratio [HR] 6.180, p = 0.21). The median time to recurrence and death were 10 and 25 months, respectively. Conclusion Cervical metastasis with p16 overexpression is a significant prognostic factor of improved RFS after surgery in CUP. The prognostic significance of lymph node p16 positivity should be further studied.
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Affiliation(s)
- Muhammad Faisal
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
| | - Nguyen-Son Le
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Pammer
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Gregor Heiduschka
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Peter Franz
- Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Hospital, Vienna, Austria
| | - Meinhard Königswieser
- Department of Otorhinolaryngology, Head and Neck Surgery, Rudolfstiftung Hospital, Vienna, Austria
| | - Matthaeus Ch. Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
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Meulemans J, Voortmans J, Nuyts S, Daisne JF, Clement P, Laenen A, Delaere P, Van Lierde C, Poorten VV. Cervical squamous cell carcinoma of unknown primary: Oncological outcomes and prognostic factors. Front Oncol 2022; 12:1024414. [PMID: 36452507 PMCID: PMC9702087 DOI: 10.3389/fonc.2022.1024414] [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: 08/21/2022] [Accepted: 10/26/2022] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND/OBJECTIVES Cervical squamous cell carcinoma of unknown primary (SCCUP) is a rare entity within head and neck cancer and both treatment regimens as well as identified potential predictors for oncological outcomes vary between published series. In this study, we evaluated oncological outcomes and identified potential prognostic factors for outcome. PATIENTS AND METHODS This retrospective monocentric cohort study includes 82 SCCUP patients diagnosed and treated between January 2000 and June 2021. Overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS) and locoregional recurrence-free survival (LRFS) were evaluated. The Cox proportional hazards model was used to analyze the prognostic effect of patient and tumor characteristics on oncological outcomes. RESULTS Five year OS, DSS, DFS and LRFS were respectively 53.9%, 72.2%, 68.9% and 67.3%. The p16 status was evaluated in 55 patients with 40% being p16 positive. On univariable analysis, p16 negative SCCUPs had significantly worse survival and recurrence rates in the presence of clinical extranodal extension (cENE) (OS: p=0.0013, DSS: p=0.0099, DFS: p=0.0164, LRFS: p=0.0099) and radiological extranodal extension (rENE) (OS: p=0.0034, DSS: p=0.0137, DFS: p=0.0167, LRFS: p=0.0100). In p16 positive SCCUP patients, rENE had a significantly negative prognostic effect on DFS (p=0.0345) and LRFS (p=0.0367). Total group multivariate analysis identified rENE as an independent negative predictor for all oncological outcomes. The "number of positive lymph nodes" was a second independent predictor for DSS (p=0.0257) and DFS (p=0.0435). CONCLUSIONS We report favorable oncological outcomes, comparable to previously published results. Although the presence of rENE seems associated with poor oncological outcomes, the differential effect of clinical, radiological and pathological ENE in both p16 positive and negative subgroups remain to be elucidated by further prospective research.
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Affiliation(s)
- Jeroen Meulemans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Jens Voortmans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Sandra Nuyts
- Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Experimental Radiotherapy, KU Leuven, Leuven, Belgium
| | | | - Paul Clement
- Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - Pierre Delaere
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Charlotte Van Lierde
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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