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Han Y, Ren Z, Liu Y, Liu Y. Diagnostic and Prognostic Value of Fibrinogen, Fibrinogen Degradation Products, and Lymphocyte/Monocyte Ratio in Patients With Laryngeal Squamous Cell Carcinoma. EAR, NOSE & THROAT JOURNAL 2024; 103:NP278-NP288. [PMID: 34672822 DOI: 10.1177/01455613211048970] [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] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Laryngeal squamous cell carcinoma (LSCC) is a common squamous cell carcinoma of the head and neck with no reliable diagnostic biomarkers. However, recent studies have shown that inflammation plays an essential role in tumor development, and several inflammation-based biomarkers have been shown to have prognostic value. This study aimed to investigate the auxiliary value of fibrinogen (FIB), fibrinogen degradation products (FDP), and lymphocyte/monocyte ratio (LMR) in LSCC diagnosis and prognosis. METHODS Clinical data from 218 patients recently diagnosed with LSCC and 207 diagnosed with benign laryngeal lesions (BLLs) were retrospectively reviewed. Potential diagnostic biomarkers were evaluated using univariate and multivariate analyses; receiver operating characteristic (ROC) curve analysis was used to identify cut-off values and diagnostic efficiency. Least absolute shrinkage and selection operator (LASSO) Logistic regression analysis was used to screen for independent risk factors to construct a diagnostic nomogram. The chi-squared test and Kaplan-Meier method were performed to investigate the correlation of clinicopathological characteristics and 3-year overall survival (OS) with FIB, FDP, and LMR in patients with LSCC. RESULTS FIB, FDP, and LMR levels were significantly different between the LSCC and BLL groups (P < .001), and all were independent risk factors for LSCC. The area under the ROC curve of the diagnostic nomogram was .894. Additionally, FIB, FDP, and LMR were correlated with some invasive clinicopathological features, and LMR ≥4.29 was associated with reduced OS (P = .038). CONCLUSION FIB, FDP, and LMR demonstrated potential as biomarkers for the diagnosis and prognosis of LSCC; however, further studies are needed to confirm their efficacy.
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Affiliation(s)
- Yanxun Han
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhiyao Ren
- Department of Breast Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuchen Liu
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yehai Liu
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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2
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Kim MJ, Ahn KM. Prognostic factors of oral squamous cell carcinoma: the importance of recurrence and pTNM stage. Maxillofac Plast Reconstr Surg 2024; 46:8. [PMID: 38433140 PMCID: PMC10909804 DOI: 10.1186/s40902-024-00410-3] [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: 09/27/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Oral squamous cell carcinoma has a poor prognosis. Therefore, prognostic factors are important to increase the survival rate. This study assessed the survival rate and the prognostic factors for survival of patients with oral squamous cell carcinoma. METHOD This study included 168 patients who underwent surgery for oral squamous cell carcinoma between January 2006 and December 2021. The survival rate was analyzed with overall survival and disease-specific survival. The patient's age, sex, pTNM stage, primary sites (lip, tongue, mouth of floor, mandibular gingiva, maxillary gingiva, mandibular vestibule, maxillary vestibule, retromolar trigone, palate, buccal mucosa, primary intra-osseous site), smoking and alcohol drinking habits, depth of invasion, perineural and lymphovascular invasion, cell differentiation, and postoperative radiotherapy were evaluated to analyze risk factors. Kaplan-Meier methods were used to estimate the survival rates. Cox regression methods were used to investigate the main independent predictors of survival in univariable and multivariable analysis. RESULTS Sixty-eight patients died of oral squamous cell carcinoma during follow-up periods. Their overall survival for 5 years was 51.2%, and the disease-specific survival was 59.2%. In univariable analysis, seven factors which are neck metastasis, depth of invasion, cell differentiation, lymphovascular invasion, postoperative radiotherapy, pTNM stage, and recurrence were significantly associated with survival. In multivariable analysis, pTNM stage and recurrence were significantly associated with survival. CONCLUSION In patients with oral squamous cell carcinoma, pTNM stage and recurrence were significant prognostic factors. Neck metastasis, depth of invasion, cell differentiation, lymphovascular invasion, and postoperative radiotherapy were also prognostic factors. These factors serve as markers for obtaining prognosis information in oral squamous cell carcinoma.
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Affiliation(s)
- Min Jae Kim
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
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3
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Kurioka K, Rin S, Otsuru M, Naruse T, Hasegawa T, Yamakawa N, Yamada SI, Hirai E, Yamamoto K, Ueda M, Kirita T, Akashi M, Kurita H, Ohiro Y, Okura M. The Impact of Pretreatment Low Body Mass Index on Cause-Specific Mortality in Patients with Squamous Cell Carcinoma of the Oral Cavity. Nutr Cancer 2023; 75:520-531. [PMID: 36223283 DOI: 10.1080/01635581.2022.2125989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The association between the pretreatment body mass index (BMI) and oral squamous cell carcinoma (SCC) outcomes is controversial. We aimed to examine the association between BMI and cause-specific mortality due to cancer of the oral cavity and patterns of failure that correlate with increased mortality. We enrolled 2,023 East Asian patients in this multicenter cohort study. We used the cumulative incidence competing risks method and the Fine-Gray model to analyze factors associated with cause-specific mortality, local recurrence, regional metastasis, and distant metastasis as first events. The median follow-up period was 62 mo. The 5-year cause-specific mortality for patients with underweight was 25.7%, which was significantly higher than that for patients with normal weight (12.7%, P < 0.0001). The multivariate model revealed that underweight was an independent risk factor for cause-specific mortality and regional metastasis (P < 0.05). Moreover, patients with underweight displayed a 51% and 55% increased risk of cause-specific mortality and regional metastasis, respectively, compared with their normal weight counterparts. Local recurrence was not associated with the BMI categories; however, the incidence of distant metastasis inversely decreased with BMI value. In summary, being underweight at diagnosis should be considered a high-risk mortality factor for oral SCC.
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Affiliation(s)
- Kyoko Kurioka
- The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Shin Rin
- Department of Clinical Oral Oncology, Hokkaido Cancer Center, Sapporo, Japan
| | - Mitsunobu Otsuru
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tomohumi Naruse
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuhiro Yamakawa
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, Nara, Japan
| | - Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Eiji Hirai
- Oral and Maxillofacial Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Kozo Yamamoto
- Oral and Maxillofacial Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Michihiro Ueda
- Department of Clinical Oral Oncology, Hokkaido Cancer Center, Sapporo, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, Nara, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoichi Ohiro
- Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Masaya Okura
- The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan.,Oral and Maxillofacial Surgery, Saiseikai Matsusaka General Hospital, Matsusaka, Japan
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Management of lateral neck nodes in common and aggressive variants of thyroid cancer. Curr Opin Otolaryngol Head Neck Surg 2022; 30:130-136. [DOI: 10.1097/moo.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grose EM, Kim JH, Philteos J, Levin M, Lee JW, Monteiro EA. A critical readability and quality analysis of internet-based patient information on neck dissections. World J Otorhinolaryngol Head Neck Surg 2021; 9:59-65. [PMID: 37006742 PMCID: PMC10050963 DOI: 10.1016/j.wjorl.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/06/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Patients are increasingly turning to the Internet as a source of healthcare information. Given that neck dissection is a common procedure within the field of Otolaryngology - Head and Neck Surgery, the aim of this study was to evaluate the quality and readability of online patient education materials on neck dissection. Methods A Google search was performed using the term "neck dissection." The first 10 pages of a Google search using the term "neck dissection" were analyzed. The DISCERN instrument was used to assess quality of information. Readability was calculated using the Flesch-Reading Ease, Flesch-Kincaid Grade Level, Gunning-Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook Index. Results Thirty-one online patient education materials were included. Fifty-five percent (n = 17) of results originated from academic institutions or hospitals. The mean Flesch-Reading Ease score was 61.2 ± 11.9. Fifty-two percent (n = 16) of patient education materials had Flesch-Reading Ease scores above the recommended score of 65. The average reading grade level was 10.5 ± 2.1. The average total DISCERN score was 43.6 ± 10.1. Only 26% of patient education materials (PEMs) had DISCERN scores corresponding to a "good quality" rating. There was a significant positive correlation between DISCERN scores and both Flesch-Reading Ease scores and average reading grade level. Conclusions The majority of patient education materials were written above the recommended sixth-grade reading level and the quality of online information pertaining to neck dissections was found to be suboptimal. This research highlights the need for patient education materials regarding neck dissection that are high quality and easily understandable by patients.
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Affiliation(s)
- Elysia M. Grose
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of Toronto6 Queen's Park Crescent WestTorontoM5S 3H2ONCanada
| | - Joo Hyun Kim
- Temerty Faculty of MedicineUniversity of Toronto1 King's College CircleTorontoM5S 1A8ONCanada
| | - Justine Philteos
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of Toronto6 Queen's Park Crescent WestTorontoM5S 3H2ONCanada
| | - Marc Levin
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of Toronto6 Queen's Park Crescent WestTorontoM5S 3H2ONCanada
| | - Jong Wook Lee
- Department of Otolaryngology ‐ Head and Neck SurgeryUniversity of Toronto6 Queen's Park Crescent WestTorontoM5S 3H2ONCanada
| | - Eric A. Monteiro
- Department of Otolaryngology ‐ Head and Neck SurgerySinai Health System600 University AvenueTorontoM5G 1×5ONCanada
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Heng Y, Zhu X, Zhou L, Zhang M, Li K, Tao L. Risk stratification and corresponding postoperative treatment strategies for occult contralateral lymph node metastasis in pyriform sinus squamous cell carcinoma patients with ipsilateral node-positive necks. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:649. [PMID: 33987347 PMCID: PMC8106010 DOI: 10.21037/atm-20-6037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background To quantitatively predict the probability of occult contralateral lymph node metastasis (cLNM) for pyriform sinus squamous cell carcinoma (PSSC) patients with ipsilateral node-positive necks to guide postoperative adjuvant treatment. Methods Two hundred and twenty-seven PSSC patients with ipsilateral lymph node metastasis (iLNM) were retrospectively analyzed. Results Multivariate logistic analyses showed that five factors including maximum tumor diameter (MTD) of more than 4.0 cm, existence of tumor extension across the midline (EAM), internal jugular vein adhesion (IJVA), lymphovascular invasion (LVI), and lymph nodal fusion (LNF) were independent risk factors for cLNM. A predictive nomogram was created based on these factors. The accuracy and validity of our model were verified by concordance index (C-index) 0.862 [95% confidence interval (CI): 0.810–0.914] in development cohort and 0.860 (95% CI: 0.820–0.900) after 1,000 bootstrapping. The calibration curve also showed a relatively favorable agreement. We then stratified patients into three groups based on their cLNM risk scores. Possible cLNM rates for low-risk, moderate-risk, and relatively high-risk subgroups were 3.6%, 21.8%, and 60.7%, respectively. Conclusions A new postoperative adjuvant radiotherapy (PART) strategy selection flow chart was created for PSSC patients based on our newly built nomogram which can effectively predict the individualized possibility of cLNM. For patients in high-risk subgroup, therapeutic-dose PART is highly recommended even for those with contralateral clinical N0 neck disease. For those in moderate-risk subgroup, prophylactic-dose PART is recommended. However, for patients in low-risk subgroup, regular follow-up is sufficient given the extremely low occult cLNM rate.
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Affiliation(s)
- Yu Heng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xiaoke Zhu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ming Zhang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Kenan Li
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Lei Tao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
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Sim YC, Hwang JH, Ahn KM. Overall and disease-specific survival outcomes following primary surgery for oral squamous cell carcinoma: analysis of consecutive 67 patients. J Korean Assoc Oral Maxillofac Surg 2019; 45:83-90. [PMID: 31106136 PMCID: PMC6502750 DOI: 10.5125/jkaoms.2019.45.2.83] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives This study evaluated the predictive factors for survival of patients with oral squamous cell carcinoma (OSCC) and investigated the overall and disease-specific survival (DSS) outcomes. Materials and Methods A total of 67 consecutive patients who underwent surgery for OSCC from January 2006 to November 2014 were included in this study. Patients were classified according to age, sex, pTNM stages, primary sites, smoking and alcohol drinking habits, depth of invasion, perineural and lymphovascular invasion, cell differentiation and postoperative radiotherapy. Kaplan-Meier methods were used to estimate the survival categorized by patient groups. Cox regression methods were used to investigate the main independent predictors of survival. Results Nineteen patients died of OSCC during follow-up periods. Another five patients died of other diseases including lung adenocarcinoma (n=1), cerebral infarction (n=1), general weakness (n=2), and pneumonia (n=1). The tongue (n=16) was the most common site for primary origin, followed by buccal mucosa (n=15), mandibular gingiva (n=15), maxillary gingiva (n=9), floor of mouth (n=9), retromolar trigone (n=2), and palate (n=1). Eleven patients had pTNM stage I disease, followed by stage II (n=22) and stage IV (n=34). No patients had pTNM stage III disease in this study. The overall survival of all patients was 64.2% and the DSS was 71.6%. DSS of patients with stage I and II disease was 100%. Stepwise Cox regression showed the two predictors for DSS were pTNM stage (P<0.0001, odds ratio=19.633) and presence of metastatic lymph nodes (P=0.0004, odds ratio=0.1039). Conclusion OSCC has been associated with poor prognosis; however, there were improved survival outcomes compared with past studies. Advanced-stage disease and presence of metastatic lymph nodes were associated with poorer survival compared with early-stage OSCC and absence of neck node metastasis. Stage I and II OSCC were associated with excellent survival results in this study.
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Affiliation(s)
| | - Jong-Hyun Hwang
- Department of Oral and Maxillofacial Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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8
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Honda K, Asato R, Tsuji J, Miyazaki M, Kada S, Kataoka Y, Taura A, Morita M. Sensory preservation in neck dissection: outcomes of a sub-sternocleidomastoid approach. Acta Otolaryngol 2018; 138:763-767. [PMID: 29656688 DOI: 10.1080/00016489.2018.1455008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Cutaneous anesthesia in early postoperative period is common after neck dissection even if the cervical nerve (CN) rootlets are preserved. The aim of this study was to evaluate if the preservation of the terminal branches of CNs using sub-sternocleidomastoid (SCM) approach combined with medially placed skin incision can prevent early postoperative anesthesia. MATERIAL AND METHODS A retrospective chart review was performed on 129 neck dissections in 87 head and neck cancer patients. RESULTS The early postoperative sensory preservation rates for the ear tab, submandibular, lateral neck, and sub-clavicular areas of CN rootlet-preserved necks (n = 86) were 75.6%, 20.9%, 74.4%, and 86.0%, respectively, compared with 37.2%, 2.3%, 2.3%, and 4.7%, respectively, in CN rootlet-resected necks (n = 43). In CN rootlet-preserved necks, the sub-SCM approach (n = 54) showed 81.5%, 27.8%, 92.6%, and 94.4% preservation rates, respectively, compared with 65.6%, 9.4%, 43.8%, and 71.9%, respectively, using the conventional subplatysmal approach (n = 32). The rates were significantly better in the submandibular, lateral neck, and sub-clavicular areas after sub-SCM approach. CONCLUSIONS Preservation of CN rootlets is a required element for sensory preservation in neck dissection. The sub-SCM approach can effectively prevent early postoperative cutaneous anesthesia following CN-preserving neck dissection.
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Affiliation(s)
- Keigo Honda
- Department of Otolaryngology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Ryo Asato
- Department of Otolaryngology – Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Jun Tsuji
- Department of Otolaryngology – Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masakazu Miyazaki
- Department of Otolaryngology – Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shinpei Kada
- Department of Otolaryngology – Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yukiko Kataoka
- Department of Otolaryngology – Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akiko Taura
- Department of Otolaryngology – Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mami Morita
- Department of Otolaryngology – Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Sun Q, Chen M, Sun Y, Chen X, Xu H, Rong L, Wu Q, Zhu D. Cervical metastasis of gingival carcinoma misdiagnosed as branchiogenic carcinoma, a rare entity - report of a case and review of literature. BMC Oral Health 2017; 17:139. [PMID: 29183323 PMCID: PMC5706288 DOI: 10.1186/s12903-017-0435-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 11/20/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A cervical cystic mass is associated with a number of pathologies that present with similar symptoms. These conditions are difficult to differentiate using fine-needle aspiration (FNA), ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Another dilemma in the differential diagnosis of cervical cystic masses is due to the controversies associated with the existence of branchiogenic carcinoma (BC). BC is an extremely rare disease that must be differentiated from other conditions presenting with cervical cystic masses, especially cystic metastasis from occult primary lesions. CASE PRESENTATION We present a case report of a right cervical cystic metastasis from a significantly small squamous cell carcinoma primary gingival lesion misdiagnosed as BC by histopathology. A 62-year-old female presented with a painless progressively enlarging cervical mass at the anterior edge of the sternocleidomastoid muscle in the right submandibular region. Preoperative MRI and US revealed a well-defined cystic round mass. Postoperative histological examination indicated BC. Positron emission tomography/computed tomography (PET/CT) revealed high 18F-FDG (18F 2-fluoro-2-deoxy-D-glucose) uptake in surgical regions with a SUV (standard uptake value) max 4.0 and ipsilateral nasopharynx with a SUVmax 4.4, without any distant metastasis. Pathologic results revealed nasopharyngeal lymphadenosis. Considering the low incidence of BC and the limitation of diagnosis in one institution, the patient was referred to another hospital. Physical examination detected a significantly small neoplasm (~3 mm diameter) in the right lower gingiva. Histopathological examination of the neoplasm revealed a well-differentiated squamous cell carcinoma. Surgery, including a partial mandibulectomy and modified neck dissection (neck level I-V and submental lymph nodes) were undertaken. Postoperative histopathological results revealed a well-differentiated squamous cell carcinoma of right lower gingiva and two metastatic lymph nodes in the 18 lymph nodes of level II. A month later, recurrence occurred in the right cervical level II. The patient was placed on postoperative concurrent chemo-radiotherapy and supportive care. The patient suffered from cachexia and survived for only six months after surgery. CONCLUSIONS In cases of cervical cystic masses that appear after the age of 40, clinicians should bear in mind that occult primary lesions should be excluded and examination of the gingiva should be undertaken. PET/CT has a limited role in identifying small occult primary lesions and a comprehensive physical examination must be carefully performed.
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Affiliation(s)
- Qingjia Sun
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Xiantai Street 126, Changchun, 130033 China
| | - Mingxing Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Xiantai Street 126, Changchun, 130033 China
| | - Yuxin Sun
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Xiantai Street 126, Changchun, 130033 China
| | - Xi Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Xiantai Street 126, Changchun, 130033 China
| | - Hongjun Xu
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Xiantai Street 126, Changchun, 130033 China
| | - Lingjun Rong
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Xiantai Street 126, Changchun, 130033 China
| | - Qiong Wu
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Xiantai Street 126, Changchun, 130033 China
| | - Dongdong Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, The China-Japan Union Hospital of Jilin University, Xiantai Street 126, Changchun, 130033 China
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Honda K, Asato R, Tsuji J, Miyazaki M, Kada S, Tsujimura T, Kataoka M. Oncologic safety of cervical nerve preservation in neck dissection for head and neck cancer. Head Neck 2017; 39:1751-1755. [PMID: 28557102 DOI: 10.1002/hed.24826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 02/12/2017] [Accepted: 04/17/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although the functional merits of preserving cervical nerves in neck dissection for head and neck cancer have been reported, the oncologic safety has not yet been determined. Therefore, the purpose of this study was to evaluate the safety of cervical nerve preservation. METHODS A retrospective chart review was performed on patients with head and neck cancer who had been treated by neck dissection between 2009 and 2014 at Kyoto Medical Center. Management of cervical nerves and clinical results were analyzed. RESULTS A total of 335 sides of neck dissection had been performed in 222 patients. Cervical nerves were preserved in 175 neck sides and resected in 160 sides. The 5-year overall survival (OS) rate calculated by the Kaplan-Meier method was 71%. The 5-year neck control rate was 95% in cervical nerve preserved sides and 89% in cervical nerve resected sides. CONCLUSION Preserving cervical nerves in neck dissection is oncologically safe in selected cases.
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Affiliation(s)
- Keigo Honda
- Japanese Red Cross Hospital, Wakayama Medical Center, Department of Otolaryngology, Wakayama, Japan
| | - Ryo Asato
- National Hospital Organization, Kyoto Medical Center, Department of Head and Neck Surgery, Otolaryngology, Kyoto, Japan
| | - Jun Tsuji
- National Hospital Organization, Kyoto Medical Center, Department of Head and Neck Surgery, Otolaryngology, Kyoto, Japan
| | - Masakazu Miyazaki
- National Hospital Organization, Kyoto Medical Center, Department of Head and Neck Surgery, Otolaryngology, Kyoto, Japan
| | - Shinpei Kada
- National Hospital Organization, Kyoto Medical Center, Department of Head and Neck Surgery, Otolaryngology, Kyoto, Japan
| | - Takashi Tsujimura
- National Hospital Organization, Kyoto Medical Center, Department of Head and Neck Surgery, Otolaryngology, Kyoto, Japan
| | - Michiko Kataoka
- National Hospital Organization, Kyoto Medical Center, Department of Head and Neck Surgery, Otolaryngology, Kyoto, Japan
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Ahn SH, Hong HJ, Kwon SY, Kwon KH, Roh JL, Ryu J, Park JH, Baek SK, Lee GH, Lee SY, Lee JC, Chung MK, Joo YH, Ji YB, Hah JH, Kwon M, Park YM, Song CM, Shin SC, Ryu CH, Lee DY, Lee YC, Chang JW, Jeong HM, Cho JK, Cha W, Chun BJ, Choi IJ, Choi HG, Lee KD. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2017; 10:1-43. [PMID: 28043099 PMCID: PMC5327593 DOI: 10.21053/ceo.2016.01389] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
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Affiliation(s)
- Korean Society of Thyroid-Head and Neck Surgery Guideline Task Force
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jun Hee Park
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Hun Hah
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang Myeon Song
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ha Min Jeong
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joon Chun
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kang Dae Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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Goel V, Parihar PS, Parihar A, Goel AK, Waghwani K, Gupta R, Bhutekar U. Accuracy of MRI in Prediction of Tumour Thickness and Nodal Stage in Oral Tongue and Gingivobuccal Cancer With Clinical Correlation and Staging. J Clin Diagn Res 2016; 10:TC01-5. [PMID: 27504375 DOI: 10.7860/jcdr/2016/17411.7905] [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: 10/19/2015] [Accepted: 02/18/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Squamous cell carcinoma of lower gingivo-buccal complex and tongue are the most common cancer in the Indian sub-continent. The value of imaging in the staging of Oral Squamous Cell Carcinoma (OSCC) is in judging operability, assessment of the prognostic characteristics and dimensions of the primary tumour, depth of tumour invasion, the presence of cervical metastasis and detection of bone infiltration. AIM This study evaluated squamous cell carcinomas of the oral cavity (tongue and gingivo-buccal complex) on the basis of their appearance, soft tissue extent, depth of tumour invasion and staging. Further, this study assessed the accuracy of MRI in the detection of cervical lymph nodal metastasis on the basis of ADC values on diffusion weighted MR sequence. MATERIALS AND METHODS T1- and T2-weighted MR, diffusion-weighted sequences and post contrast T1W sequences were performed in various planes on biopsy proven squamous cell carcinomas (61 cases) involving tongue and/or gingivo-buccal region. Depth of tumour invasion was calculated on axial images of post contrast T1W images. The Apparent Diffusion Coefficient (ADC) was measured by using two b factors (500 and 1000 s/mm(2)). MRI findings were compared clinically and histopathologically. RESULTS Average depth of invasion calculated on MRI was 8.47mm and by histopathology was 6.85mm. Pearson's correlation coefficient was 0.988. Shrinkage factor was 0.8. A 71% of patients with depth of invasion greater than 9mm showed evidence of cervical lymph nodal metastasis at one or another levels. Cut-off value to discriminate between malignant and benign lymph nodes was 1.038 x10-3 mm(2)/s in the present study. CONCLUSION Depth of tumour invasion in oral malignancies can be measured reliably on MRI which helps in predicting cervical lymph node metastasis. Benign or malignant cervical lymph nodes can be differentiated on diffusion-weighted imaging of MRI on the basis of their ADC values.
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Affiliation(s)
- Varun Goel
- Post Graduate Student, Datta Meghe Institute of Medical Science , Maharashtra, India
| | - Pratap Singh Parihar
- Associate Professor, Department of Radio-Diagnosis, Datta Meghe Institute of Medical Science , Maharashtra, India
| | - Akhilesh Parihar
- Intern, Datta Meghe Institute of Medical Science , Maharashtra, India
| | - Ashok Kumar Goel
- Radiologist, Datta Meghe Institute of Medical Science , Maharashtra, India
| | - Kapil Waghwani
- Lecturer, Department of Oral and Maxillofacial Surgery, Datta Meghe Institute of Medical Science, Sharad Pawar Dental College , Wardha, Maharashtra, India
| | - Richa Gupta
- Consultant, Department of Oral and Maxillofacial Surgery, Jabalpur Hospital , Madhya Pradesh, India
| | - Umesh Bhutekar
- Lecturer, Department of Oral and Maxillofacial Surgery, Datta Meghe Institute of Medical Science, Sharad Pawar Dental College , Wardha, Maharashtra, India
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Abstract
Head and neck cancer typically refers to epithelial malignancies of the upper aerodigestive tract and may include neoplasms of the thyroid, salivary glands, and soft tissue, bone sarcomas, and skin cancers. Two-thirds of patients present with advanced disease involving regional lymph nodes at the time of diagnosis. A thorough history and detailed examination are integral to oncologic staging and treatment planning. This article begins with an overview of the head and neck examination (with special attention to detailed findings with clinical implications), followed by a discussion of the major head and neck subsites, and clinical pearls surrounding the examination.
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Affiliation(s)
- Rachel Georgopoulos
- Department of Otolaryngology, Temple University School of Medicine, 3440 North Broad Street, Kresge West 3rd Floor, Philadelphia, PA 19140, USA
| | - Jeffrey C Liu
- Department of Otolaryngology, Temple University School of Medicine, 3440 North Broad Street, Kresge West 3rd Floor, Philadelphia, PA 19140, USA; Head and Neck Section, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
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14
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Application of the Submental Island Flap in the Reconstruction of Intraoral Defects. J Craniofac Surg 2014; 25:e309-12. [DOI: 10.1097/scs.0000000000000573] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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15
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Reconstruction of anterior floor of mouth defects by the local mandible myofascial flap following cancer ablation: A pilot study. J Plast Reconstr Aesthet Surg 2013; 66:1238-42. [DOI: 10.1016/j.bjps.2013.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 04/10/2013] [Indexed: 11/19/2022]
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Kastrinidis N, Kuhn FP, Hany TF, Ahmad N, Huber GF, Haerle SK. 18F-FDG-PET/CT for the assessment of the contralateral neck in patients with head and neck squamous cell carcinoma. Laryngoscope 2013; 123:1210-5. [PMID: 23426442 DOI: 10.1002/lary.23944] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/05/2012] [Accepted: 11/26/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim was to compare the value of 18-Fluoro-Deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) regarding contralateral lymph node (LN) metastasis in the neck. STUDY DESIGN Retrospective analysis of 61 patients staged by 18F-FDG-PET/CT. METHODS Cytology/histology served as a reference standard. Further, metabolic midline invasion (MI) of the primary tumor and the presence of bilateral LN metastases were assessed. RESULTS A true positive rate in the ipsilateral neck of 80% versus 65% in the contralateral neck was found (P = 0.067). Median-standardized uptake value (SUV)-max for suspicious LN ipsilaterally was 7.6 versus 5.8 contralaterally (P = 0.038). There was no positive correlation between metabolic MI and bilateral metastasis (P = 0.82). CONCLUSIONS The rate of true positive detected LN by 18F-FDG-PET/CT is less on the contralateral neck side; therefore, all suspicious LNs should be verified by cytology. A high SUV in the contralateral neck suggests metastatic disease regardless of nodal size. Metabolic MI needs to be addressed carefully as it was not predictive for bilateral LN involvement. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Nikos Kastrinidis
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
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17
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D'Souza O, Hasan S, Chary G, Hoisala VR, Correa M. Cervical lymph node metastases in head & neck malignancy - A Clinical /ultrasonographic/ Histopathological comparative study. Indian J Otolaryngol Head Neck Surg 2012; 55:90-3. [PMID: 23119950 DOI: 10.1007/bf02974611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A study was conducted on the value of Ultrasound (US) in the detection of cervical lymph node metastases in cases of Head and Neck malignancy; and its usefulness in planning surgical management. The clinical, ullrasonographic and histopathological examination (HPE) findings were compared in 20 patients as a preliminary assessment of this ongoing study. Clinically and ultrasonogiaphically, patients were assessed for presence of nodes, their size, shape, mobility and overall positivity for malignancy. All patients then underwent neck dissection, and individual nodes from the specimens were assessed by HPE.It was found that US, when compared with clinical examination had a sensitivity of 47.62% versus 43.75%, specificity of 77.78% versus 25.0% and an accuracy of 61.54% as opposed to 38.9%. US proved valuable in detecting sub-clinical nodes, central necrosis, extra-capsular spread, pressure on large vessels - all indicators of metastatic spread. Hence, US was found to be efficient and cost-effective pre-operatively, in planning surgical management.
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Affiliation(s)
- Ophellia D'Souza
- Departments of Otorhinolaryngology & Head & Neck Surgery, India ; Department of ENT, St. John's Medical College Hospital, 560 034 Bangalore, India
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Lim R, Eaton A, Lee NY, Setton J, Ohri N, Rao S, Wong R, Fury M, Schöder H. 18F-FDG PET/CT metabolic tumor volume and total lesion glycolysis predict outcome in oropharyngeal squamous cell carcinoma. J Nucl Med 2012; 53:1506-13. [PMID: 22895812 DOI: 10.2967/jnumed.111.101402] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED Treatment of oropharyngeal squamous cell carcinoma with chemoradiotherapy can now accomplish excellent locoregional disease control, but patient overall survival (OS) remains limited by development of distant metastases (DM). We investigated the prognostic value of staging (18)F-FDG PET/CT, beyond clinical risk factors, for predicting DM and OS in 176 patients after definitive chemoradiotherapy. METHODS The PET parameters maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were recorded. Univariate Cox regression was used to examine the prognostic value of these variables and clinical prognosticators for local treatment failure (LTF), OS, and DM. Multivariate analysis examined the effect of SUVmax, TLG, and MTV in the presence of other covariates. Kaplan-Meier curves were used to evaluate prognostic values of PET/CT parameters. RESULTS Primary tumors were distributed across all stages. Most patients underwent chemoradiotherapy only, and 11 also underwent tonsillectomy. On univariate analysis, primary tumor MTV was predictive of LTF (P = 0.005, hazard ratio [HR] = 2.4 for a doubling of MTV), DM and OS (P < 0.001 for both, HR = 1.9 and 1.8, respectively). The primary tumor TLG was associated with DM and OS (P < 0.001, HR = 1.6 and 1.7, respectively, for a doubling of TLG). The primary tumor SUVmax was associated with death (P = 0.029, HR = 1.1 for a 1-unit increase in standardized uptake value) but had no relationship with LTF or DM. In multivariate analysis, TLG and MTV remained associated with death after correcting for T stage (P = 0.0125 and 0.0324, respectively) whereas no relationship was seen between standardized uptake value and death after adjusting for T stage (P = 0.158). CONCLUSION Parameters capturing the volume of (18)F-FDG-positive disease (MTV or TLG) provide important prognostic information in oropharyngeal squamous cell carcinoma treated with chemoradiotherapy and should be considered for risk stratification in this disease.
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Affiliation(s)
- Remy Lim
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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Amin AA, Sakkary MA, Khalil AA, Rifaat MA, Zayed SB. The submental flap for oral cavity reconstruction: extended indications and technical refinements. HEAD & NECK ONCOLOGY 2011; 3:51. [PMID: 22185515 PMCID: PMC3285538 DOI: 10.1186/1758-3284-3-51] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 12/20/2011] [Indexed: 11/22/2022]
Abstract
Background and purpose The submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. However, its role in composite defects involving the jaw is not clearly defined. Indeed, controversy exists about the flap's interference with an oncologically sound neck dissection Patients and Methods A total of 21 patients with oral cavity cancers over a three year period were included. All patients underwent surgical resection and immediate reconstruction with submental flap except one patient who had delayed reconstruction with reversed flap. The flap was used for reconstruction of intra-oral soft tissue defect in 13 patients and composite defects in 8 patients. Results Of 21 patients 12 were males and 9 were females, age ranged from 32 to 83 years. The primary tumor sites included buccal mucosa (7), tongue (4), alveolar margin (3), floor of mouth (5) and lip (2). Eventually in this study, we adopted completing the neck dissection first before flap harvest. Complete flap loss occurred in 2 whereas 3 patients had partial flap loss. Follow up ranged from 3 to 44 months, one patient died from metastatic disease. Four patients developed neck recurrences. Conclusion The submental flap is a valid option for reconstruction of intra-oral soft tissue as well as composite oral defects particularly in elderly patients. However, oncologically sound neck dissection should be assured.
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Affiliation(s)
- Ayman A Amin
- Surgery department, National Cancer Institute, Cairo, Egypt
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20
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Ashraf M, Biswas J, Jha J, Nayak S, Singh V, Majumdar S, Bhowmick A, Dam A. Clinical utility and prospective comparison of ultrasonography and computed tomography imaging in staging of neck metastases in head and neck squamous cell cancer in an Indian setup. Int J Clin Oncol 2011; 16:686-93. [PMID: 21674359 DOI: 10.1007/s10147-011-0250-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 04/21/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preoperative lymph node screening of all neck compartments is favored by clinicians for the management of the neck. The presence of a metastatic node on one side of the neck reduces the 5-year survival rate to 50%, and the presence of a metastatic node on both sides of the neck reduces the 5-year survival rate to 25%. MATERIALS AND METHODS This study compared the evaluation of lymph node metastases by ultrasonography (USG) and computed tomography (CT) in patients with squamous cell cancer of the head and neck region. RESULTS Five hundred and eighty-four patients with squamous cell cancer of the head and neck were prospectively evaluated for the presence of cervical lymph node metastases. All patients underwent clinical examination (palpation), USG and CT imaging. Neck dissection was performed in all the patients, and the results of the preoperative evaluation were correlated with the surgical and histopathological findings. Metastases in neck nodes were identified in 148 patients by histopathological examination. Doppler USG correctly identified 136 node-positive patients (n = 148; sensitivity 91.8%, specificity 97%). CT imaging correctly identified 122 patients with metastatic lymph nodes (n = 148; sensitivity 83%, specificity 93%). Positive predictive values of USG and CT imaging were 95.6% and 91.3%, respectively, whereas the negative predictive values of these two imaging studies were 95.4% and 89.6%, respectively. CONCLUSIONS The accuracy and sensitivity of USG in detection of cervical lymph node metastases make it a potentially promising and cheap preoperative tool for staging neck node metastases and optimizing the treatment plan for surgeons, especially in countries such as India.
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Affiliation(s)
- Mohammad Ashraf
- Department of Surgical Oncolgy, Chittaranjan National Cancer Institute, 37 S P Mukherjee Road, Kolkata 26, India.
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21
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Manfro G, Cernea C, Faria PASD, Agarez FV, Dias FL, Lima RA, Brandão LG. Can the lymph node reactivity pattern in the pN0 neck analysis provide any additional prognostic information in patients with laryngeal squamous cell carcinoma? EINSTEIN-SAO PAULO 2010; 8:68-74. [PMID: 26761755 DOI: 10.1590/s1679-45082010ao1429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 12/18/2009] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the influence of lymph node reactivity on recurrence and survival rates in a population of pT3 or pT4 pN0 patients with laryngeal squamous cell carcinoma. METHODS Between 2002 and 2005, 105 patients with LSSC underwent total laryngectomy with bilateral selective neck dissection including levels II, III and IV. Most (69) received PO radiotherapy. All pathological specimens were either pT3 or pT4, and all necks were pN0. All lymph nodes were analyzed and their reactivity status were classified as the following four patterns: follicular hyperplasia associated with humoral response, paracortical hyperplasia associated with cellular response, sinus histiocytosis with no association with specific immune response, or normal lymph node. Only the first two patterns were considered stimulated, whereas the last two were considered non-stimulated. The most prevalent pattern in a particular neck specimen was considered for the analysis of recurrence and survival. RESULTS The total number of lymph nodes studied was 3,648, with an average of 34.7 lymph nodes/neck specimens. The most frequent lymph node reactivity patterns were sinusal histiocytosis (50 cases), paracortical hyperplasia (35 cases), and follicular hyperplasia (20 cases). There was no statistical association of these individual patterns with recurrence rate (p = 0.98) or mortality (p = 0.49). However, there was a statistically significant association between paracortical hyperplasia pattern (related to cellular lymph node immunity) and improved five-year survival (76 versus 60%; log-rank = 0.05). CONCLUSIONS There was a positive correlation between stimulated cellular lymph node pattern and improved 5-year survival rate in patients with pN0 laryngeal squamous cell carcinoma, suggesting the indication of adjuvant treatment for those individuals with decreased immune response, even in the absence of pathologic metastases detected by the usual methods.
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Affiliation(s)
| | - Claudio Cernea
- Faculdade de Medicina, Universidade de São Paulo - USP, São Paulo, SP, Brazil
| | | | - Fernando Vaz Agarez
- Department of Pathology, Instituto Nacional de Câncer - INCA, Rio de Janeiro, RJ, Brazil
| | - Fernando Luiz Dias
- Department of Head, Instituto Nacional de Câncer - INCA, Rio de Janeiro, RJ, Brazil
| | - Roberto Araújo Lima
- Department of Head, Instituto Nacional de Câncer - INCA, Rio de Janeiro, RJ, Brazil
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Skinner WKJ, Muse ED, Yaparpalvi R, Guha C, Garg MK, Kalnicki S. Obtaining normal tissue constraints using intensity modulated radiotherapy (IMRT) in patients with oral cavity, oropharyngeal, and laryngeal carcinoma. Med Dosim 2009; 34:279-84. [PMID: 19854386 DOI: 10.1016/j.meddos.2008.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 11/25/2008] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to evaluate normal tissue dose constraints while maintaining planning target volume (PTV) prescription without reducing PTV margins. Sixteen patients with oral cavity carcinoma (group I), 27 patients with oropharyngeal carcinoma (group II), and 28 patients with laryngeal carcinoma (group III) were reviewed. Parotid constraints were a mean dose to either parotid < 26 Gy (PP1), 50% of either parotid < 30 Gy (PP2), or 20 cc of total parotid < 20 Gy (PP3). Treatment was intensity modulated radiation therapy (IMRT) with simultaneous integrated boost (SIB). All patients met constraints for cord and brain stem. The mandibular constraints were met in 66%, 29%, and 57% of patients with oral, oropharyngeal, and laryngeal cancers, respectively. Mean dose of 26 Gy (PP1) was achieved in 44%, 41%, and 38% of oral, oropharyngeal, and laryngeal patients. PP2 (parotid constraint of 30 Gy to less than 50% of one parotid) was the easiest to achieve (group I, II, and III: 82%, 76%, and 78%, respectively). PP3 (20 cc of total parotid < 20 Gy) was difficult, and was achieved in 25%, 17%, and 35% of oral, oropharyngeal, and laryngeal patients, respectively. Mean parotid dose of 26 Gy was met 40% of the time. However, a combination of constraints allowed for sparing of the parotid based on different criteria and was met in high numbers. This was accomplished without reducing PTV-parotid overlap. What dose constraint best correlates with subjective and objective functional outcomes remains a focus for future study.
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Affiliation(s)
- William K J Skinner
- Department of Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA.
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Okura M, Aikawa T, Sawai NY, Iida S, Kogo M. Decision analysis and treatment threshold in a management for the N0 neck of the oral cavity carcinoma. Oral Oncol 2009; 45:908-11. [PMID: 19457712 DOI: 10.1016/j.oraloncology.2009.03.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 03/26/2009] [Accepted: 03/26/2009] [Indexed: 11/28/2022]
Abstract
The optimal method of management of clinical N0 neck in squamous cell carcinoma of the oral cavity remains controversial. We used decision analysis to determine the current optimal strategy in comparison with observation of the neck and elective neck dissection. A total of 165 previously untreated patients with N0 classification were investigated. Probabilities of each recurrence were calculated and probabilities of being cured in each event were substituted with the 5-year overall survival calculation with Kaplan-Meier method. A sensitivity analysis was performed to determine the optimal threshold for treatment of the N0 neck. The threshold of N0 neck was calculated using the formula with putting the three probabilities of being cured. In this study the threshold was estimated at 44.4%. N0 neck of squamous cell carcinoma of the oral cavity should be observed if the probability of occult metastasis is less than 44.4%. Proper calculation of three probabilities of being cured in each institution will make a decision of the optimal method of clinical N0 neck by using the threshold formula.
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Affiliation(s)
- Masaya Okura
- The First Department of Oral and Maxillofacial Surgery, Osaka University Dental Hospital, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Kademani D, Bell RB, Schmidt BL, Blanchaert R, Fernandes R, Lambert P, Tucker WM. Oral and maxillofacial surgeons treating oral cancer: a preliminary report from the American Association of Oral and Maxillofacial Surgeons Task Force on Oral Cancer. J Oral Maxillofac Surg 2008; 66:2151-7. [PMID: 18848117 DOI: 10.1016/j.joms.2008.06.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 02/29/2008] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
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Wang X, Li L, Hu C, Zhou Z, Ying H, Ding J, Feng Y. Patterns of level II node metastasis in nasopharyngeal carcinoma. Radiother Oncol 2008; 89:28-32. [PMID: 18768231 DOI: 10.1016/j.radonc.2008.07.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Revised: 06/27/2008] [Accepted: 07/16/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore the pattern of metastasis to level II nodes and its relationship with tumor range in nasopharyngeal carcinoma (NPC) patients by using magnetic resonance imaging. METHODS AND MATERIALS Magnetic resonance images of 618 NPC patients were reviewed. Nodes were classified as metastatic based on size criteria, the presence of nodal necrosis, and extracapsular spread. RESULTS Patients (87.9%, 543) had lymphadenopathy, 470 (86.5%) in level IIb and 326 (60.0%) in level IIa, respectively. Incidence of RLN involvement was less than that of level IIb node involvement (72.2% vs. 86.5%) in 543 patients with lymphadenopathy. Cranial boundaries (71.1%) of level IIb nodes was below the caudal border of C1, and 5.1% was below the skull base, while all the cranial boundaries of level IIa nodes were below the caudal edge of C1. Incidence of level IIb and/or level IIa node metastasis had no correlation with primary tumor extension. Incidence of level IIb metastasis did not differ significantly among T1, 2, 3, and 4 disease, nor did that of level IIa node. CONCLUSIONS Cervical level IIb nodes were the most commonly involved nodes in NPC. Metastasis to level IIb and level IIa nodes had no correlation with primary tumor extension, or with T stage. Setting the cranial border of level IIb node at the skull base should be considered when delineating nodal target volume.
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Affiliation(s)
- XiaoShen Wang
- Department of Radiation Oncology, Fudan University, Shanghai, People's Republic of China
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26
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Nikolarakos D, Bell RB. Management of the Node-Positive Neck in Oral Cancer. Oral Maxillofac Surg Clin North Am 2008; 20:499-511. [DOI: 10.1016/j.coms.2008.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Brennan PA, Dennis S, Poller D, Quintero M, Puxeddu R, Thomas GJ. Inducible nitric oxide synthase: correlation with extracapsular spread and enhancement of tumor cell invasion in head and neck squamous cell carcinoma. Head Neck 2008; 30:208-14. [PMID: 17657783 DOI: 10.1002/hed.20675] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Extracapsular nodal spread is a major prognostic indicator in head and neck cancer. Nitric oxide (NO), primarily produced by the enzyme inducible NO synthase (iNOS), has a large number of actions in cancer biology, but no studies have investigated its possible role in extracapsular spread or tumor invasion. METHODS Immunochemistry was used to study iNOS expression in 48 patients with either extracapsular or encapsulated metastasis. In vitro invasion assays were performed using H357 (an oral squamous cell carcinoma cell line) using the iNOS inhibitor drug, 1400 W. RESULTS iNOS expression was significantly associated with extracapsular spread, with 22/27 cases showing positive iNOS expression compared with 8/21 cases in the encapsulated group (p = .01). Invasion of H357 cells was inhibited by 1400 W at concentrations of 100 microM and 1 mM (p = .002, p = .003). CONCLUSION iNOS protein seems to be associated with extracapsular spread and invasion in head and neck cancer. Further studies are required to understand this role more fully.
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Affiliation(s)
- Peter A Brennan
- Department of Maxillofacial Head and Neck Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom.
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Okura M, Iida S, Aikawa T, Adachi T, Yoshimura N, Yamada T, Kogo M. Tumor thickness and paralingual distance of coronal MR imaging predicts cervical node metastases in oral tongue carcinoma. AJNR Am J Neuroradiol 2007; 29:45-50. [PMID: 17947369 DOI: 10.3174/ajnr.a0749] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The presence of cervical lymph node metastases is an important prognostic factor for oral tongue cancer. The accurate preoperative assessment is essential for treatment. Several studies have suggested that histologic tumor thickness is related to the metastases. The aim of this study was to determine whether MR images of oral tongue tumor have the potential to predict cervical lymph node metastases. MATERIALS AND METHODS A total of 43 patients with squamous cell carcinoma of the oral tongue were investigated. Tumor thickness, sublingual distance between tumor and sublingual space, and paralingual distance between tumor and paralingual space, as determined from coronal MR imaging, were preoperatively estimated. Logistic regression analysis was used to identify independent predictors of lymph node metastases. RESULTS Univariate logistic regression analysis showed that T classification, N classification, and 3 measured MR imaging distances (millimeters) were significantly associated with lymph node metastases. Multivariate logistic regression analysis showed that tumor thickness (odds ratio, 1.34; 95% confidence interval [CI], 1.11-1.63; P < .005) and paralingual distance (odds ratio, 0.53; 95% CI, 0.35-0.82; P < .005) were significant predictors for lymph node metastases. The probability of metastases was estimated with these models. The preoperative decision (20% probability) as to whether to perform neck dissection could be based on tumor thickness of >9.7 mm and paralingual distance of <5.2 mm. CONCLUSION MR images provide satisfactory accuracy for the preoperative estimation of the tumor thickness and the paralingual distance, which are valuable for predicting cervical lymph node metastases.
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Affiliation(s)
- M Okura
- First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka, Japan
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29
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Donnini S, Finetti F, Solito R, Terzuoli E, Sacchetti A, Morbidelli L, Patrignani P, Ziche M. EP2 prostanoid receptor promotes squamous cell carcinoma growth through epidermal growth factor receptor transactivation and iNOS and ERK1/2 pathways. FASEB J 2007; 21:2418-30. [PMID: 17384145 DOI: 10.1096/fj.06-7581com] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In squamous cell carcinoma, the levels of nitric oxide (NO) derived from inducible NO synthase (iNOS) and prostaglandin E2 (PGE2) derived from cyclooxygenase-2 (COX-2) originated from tumor cells or tumor-associated inflammatory cells have been reported to correlate with tumor growth, metastasis, and angiogenesis. The present study examined the role of the iNOS signaling pathway in PGE2-mediated tumor invasiveness and proliferation in squamous cell carcinoma, A431, and SCC-9 cells. Cell invasion and proliferation promoted by PGE2 were blocked by iNOS silencing RNA or iNOS/guanylate cyclase (GC) pharmacological inhibition. Consistently, iNOS-GC pathway inhibitors blocked mitogen-activated protein kinase-ERK1/2 phosphorylation, which was required to mediate PGE2 functions. In vivo, in A431 cells implanted in nude mice, GC inhibition also decreased the tumor proliferation index and ERK1/2 activation. PGE2 effects were confined to the selective stimulation of the EP2 receptor subtype, leading to epidermal growth factor receptor (EGFR) transactivation via protein kinase A (PKA) and c-Src activation. EP2-mediated ERK1/2 activation and cell functions were abolished by inhibitors of PKA, c-Src, and EGFR, as well as by inhibiting iNOS pathway. Silencing of iNOS also impaired EGFR-induced ERK1/2 phosphorylation. These results indicate that iNOS/GC signaling is a downstream player in the control of EP2/EGFR-mediated tumor cell proliferation and invasion.
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Affiliation(s)
- Sandra Donnini
- Department of Molecular Biology, Pharmacology Angiogenesis Lab., University of Siena, Via Aldo Moro, 2, 53100, Siena, Italy
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Braam PM, Raaijmakers CPJ, Terhaard CHJ. Cranial location of level II lymph nodes in laryngeal cancer: Implications for elective nodal target volume delineation. Int J Radiat Oncol Biol Phys 2007; 67:462-8. [PMID: 17236968 DOI: 10.1016/j.ijrobp.2006.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 10/04/2006] [Accepted: 10/04/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To analyze the cranial distribution of level II lymph nodes in patients with laryngeal cancer to optimize the elective radiation nodal target volume delineation. METHODS AND MATERIALS The most cranially located metastatic lymph node was delineated in 67 diagnostic CT data sets. The minimum distance from the base of the skull (BOS) to the lymph node was determined. RESULTS A total of 98 lymph nodes were delineated including 62 ipsilateral and 36 contralateral lymph nodes. The mean ipsilateral and contralateral distance from the top of the most cranial metastatic lymph node to the BOS was 36 mm (range, -9-120; standard deviation [SD], 17.9) and 35 mm (range, 14-78; SD 15.0), respectively. Only 5% and 12% of the ipsilateral and 3% and 9% of the contralateral metastatic lymph nodes were located within 15 mm and 20 mm below the BOS, respectively. No significant differences were found between patients with only ipsilateral metastatic lymph nodes and patients with bilateral metastatic lymph nodes. Between tumors that do cross the midline and those that do not, no significant difference was found in the distance of the most cranial lymph node to the BOS and the occurrence ipsilateral or contralateral. CONCLUSIONS Setting the cranial border of the nodal target volume 1.5 cm below the base of the skull covers 95% of the lymph nodes and should be considered in elective nodal irradiation for laryngeal cancer. Bilateral neck irradiation is mandatory, including patients with unilateral laryngeal cancer, when elective irradiation is advised.
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Affiliation(s)
- Pètra M Braam
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
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Bell RB, Kademani D, Homer L, Dierks EJ, Potter BE. Tongue Cancer: Is There a Difference in Survival Compared With Other Subsites in the Oral Cavity? J Oral Maxillofac Surg 2007; 65:229-36. [PMID: 17236926 DOI: 10.1016/j.joms.2005.11.094] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Accepted: 11/11/2005] [Indexed: 11/17/2022]
Abstract
PURPOSE Advances in the management of patients with oral squamous cell carcinoma (OSCC) have confounded the importance of site in predicting overall prognosis. The purpose of this retrospective study was to review the outcome of patients with OSCC and to determine if site is a significant predictor of survival or disease-free survival. PATIENTS AND METHODS The records of 233 patients that underwent surgery for resectable OSCC treated at a single institution from 1993 to 2003 were identified. Patients with positive surgical margins, high grade histology, aggressive biologic behavior, or advanced stage disease underwent adjuvant radiotherapy or chemoradiotherapy. The demographics, site, stage, pathologic, treatment, and survival data were collected and statistically analyzed in an attempt to identify predictors of loco-regional control and disease-free survival. Descriptive statistics were calculated for each variable and survival was calculated using the Kaplan-Meier method. For purposes of comparison, patients were divided into 2 groups: those with tongue lesions (n = 73) and all other sites (n = 152). The Cox proportional hazards model was used to distinguish different survival rates between the groups. RESULTS Two hundred fifteen patients consisting of 104 males (48%) and 111 females (52%) met the criteria for inclusion in the study. Overall and disease-free survival rates were 56% and 58%, respectively. Stage and grade were identified as having a statistically significant effect on survival (P = .0014, likelihood ratio chi2 = 0.04, 1 degree of freedom; and P = .026, chi2 = 5, 1 degree of freedom, respectively). There was no significant difference in survival between patients with tongue cancer and other sites in the oral cavity (P = .8, chi2 = .04, 1 degree of freedom). CONCLUSIONS Grade and stage are significant predictors of overall and disease-free survival for patients with OSCC. In this study, however, there was no survival difference between patients with tongue cancer and cancers located at other sites in the oral cavity.
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Affiliation(s)
- R Bryan Bell
- Oral and Maxillofacial Surgery Service, Legacy Emanuel Hospital and Health Center, Portland, OR, USA.
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Abstract
Cancers of the oral cavity and pharynx are the most common head and neck cancers in the United States, and squamous cell carcinoma is the most frequent histologic type. The clinical behavior and outcome of tumors in the oral cavity is distinct from those of the oropharynx. As a general rule, surgical resection is the primary treatment for oral cavity squamous cell carcinoma, whereas oropharyngeal squamous cell carcinomas are treated with radiation with or without chemotherapy. A clear understanding of the anatomy and knowledge of clinical behavior and spread patterns of oral cavity and oropharyngeal squamous cell carcinoma are essential for radiologists to make a meaningful contribution to the treatment of these patients.
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MESH Headings
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Follow-Up Studies
- Humans
- Lymphatic Metastasis
- Magnetic Resonance Imaging
- Mouth/pathology
- Mouth Neoplasms/diagnosis
- Mouth Neoplasms/diagnostic imaging
- Mouth Neoplasms/pathology
- Mouth Neoplasms/surgery
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Staging
- Oropharyngeal Neoplasms/diagnosis
- Oropharyngeal Neoplasms/diagnostic imaging
- Oropharyngeal Neoplasms/drug therapy
- Oropharyngeal Neoplasms/pathology
- Oropharyngeal Neoplasms/radiotherapy
- Oropharynx/pathology
- Palatal Neoplasms/diagnosis
- Palatal Neoplasms/diagnostic imaging
- Palatal Neoplasms/pathology
- Palate, Soft/pathology
- Time Factors
- Tomography, X-Ray Computed
- Tonsillar Neoplasms/diagnosis
- Tonsillar Neoplasms/diagnostic imaging
- Tonsillar Neoplasms/pathology
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Affiliation(s)
- Hilda E Stambuk
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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34
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Woolgar JA. Salvage neck dissections in oral and oropharyngeal squamous cell carcinoma: histological features in relation to disease category. Int J Oral Maxillofac Surg 2006; 35:907-12. [PMID: 17010572 DOI: 10.1016/j.ijom.2006.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 07/26/2006] [Accepted: 08/21/2006] [Indexed: 11/29/2022]
Abstract
The histological findings in a series of 37 salvage neck dissections from patients who had an oral or oropharyngeal squamous cell carcinoma managed initially by primary surgery with or without neck dissection, and without postoperative radiotherapy, are described. None of the cases had an intraoral relapse. Pathological stage N2 or N3 disease was seen in 87% of the 15 salvage dissections from 'wait and watch' necks, 100% of the 10 salvage dissections of contralateral necks and 50% of the 12 salvage dissections of operated necks. The typical 'inverted-cone' pattern of metastasis was seen in 87% of 'wait and watch' necks. Skip or non-contiguous metastases to level III/IV accounted for relapse in 30% of the contralateral and 66% of the operated necks. The median time interval between original surgery and the salvage neck dissection was 15 months (range 1-48 months). In at least 15% of cases, the short time interval coupled with the histopathological features suggested that the metastatic disease suddenly became more rapidly progressive following removal of the primary tumour.
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Affiliation(s)
- J A Woolgar
- Oral Pathology, Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS, UK.
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Ferlito A, Rinaldo A, Silver CE, Gourin CG, Shah JP, Clayman GL, Kowalski LP, Shaha AR, Robbins KT, Suárez C, Leemans CR, Ambrosch P, Medina JE, Weber RS, Genden EM, Pellitteri PK, Werner JA, Myers EN. Elective and therapeutic selective neck dissection. Oral Oncol 2006; 42:14-25. [PMID: 15979381 DOI: 10.1016/j.oraloncology.2005.03.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 03/20/2005] [Indexed: 11/22/2022]
Abstract
Selective neck dissection is a modification of the more comprehensive modified radical or radical neck dissection that is designed to remove only those nodal levels considered to be at risk for harboring nodal metastases. The role of selective neck dissection continues to evolve: while initially designed as a staging and diagnostic procedure for patients without clinical evidence of nodal disease, a growing body of literature suggests that selective neck dissection has a therapeutic role in patients with clinical and histologic evidence of nodal metastases. The rationale behind selective neck dissection, its application in the clinically negative but histologically node-positive neck and the extended application of selective neck dissection in patients with clinical evidence of nodal disease are discussed.
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Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, 33100 Udine, Italy.
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Okura M, Kagamiuchi H, Tominaga G, Iida S, Fukuda Y, Kogo M. Morphological changes of regional lymph node in squamous cell carcinoma of the oral cavity. J Oral Pathol Med 2005; 34:214-9. [PMID: 15752256 DOI: 10.1111/j.1600-0714.2005.00304.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Regional immune responses with various types of cancer have been studied histopathologically, however, the prognostic value remains conflicting. The aim of this study was to evaluate morphological changes related to lymph node metastasis and the prognostic value for oral cavity squamous cell carcinoma. METHODS With histopathologic whole architecture of 430 lymph nodes, gross area, germinal center (GC) area, paracortical area (PA), and tumor area were measured. RESULTS Metastatic node had significantly lower distribution ratio of PA to lymphoarea than that of tumor-free node. GC area was not constantly associated with lymph node metastasis. In Cox multivariate analysis, the mean ratio of PA to gross area/lymphoarea was an independent prognostic factor. CONCLUSIONS The proportion of PA to gross/lymph area was associated with lymph node metastasis and long-term survival and may be useful in stratification of those patients for a requirement of adjuvant treatments.
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Affiliation(s)
- Masaya Okura
- The First Department of Oral and Maxillofacial Surgery, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan.
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Astreinidou E, Dehnad H, Terhaard CHJ, Raaijmakers CPJ. Level II lymph nodes and radiation-induced xerostomia. Int J Radiat Oncol Biol Phys 2004; 58:124-31. [PMID: 14697429 DOI: 10.1016/s0360-3016(03)01391-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the influence of the cranial border of electively irradiated Level II lymph nodes on xerostomia in patients with oropharyngeal cancer using three-dimensional conformal and intensity-modulated radiotherapy (3D-CRT and IMRT). METHODS AND MATERIALS The target volumes and organs at risk were delineated on the planning CT scans of 12 patients. Two elective target volumes were delineated. The first had the transverse process of the C1 atlas and the second had the transverse process of the C2 axis as cranial border of the Level II lymph nodes. 3D-CRT and IMRT planning were performed for both elective volumes, resulting in two plans per patient and technique, called the C1 and C2 plans, respectively. Irradiation of the ipsilateral elective volume up to C1 and the contralateral up to C2 was also performed for IMRT. The normal tissue complication probability (NTCP) for xerostomia 1 year after RT was calculated using the parotid mean dose. RESULTS The average mean dose +/- standard deviation (SD) to the contralateral parotid gland was reduced from 33 +/- 5 Gy for the IMRT C1 plans to 26 +/- 4 Gy for the IMRT C2 plans and from 51 +/- 6 Gy to 49 +/- 7 Gy for the 3D-CRT C1 and C2 plans, respectively. The associated NTCP +/- SD for xerostomia was 38% +/- 10% for IMRT C1 plans and 24% +/- 6% for IMRT up to C2 on the contralateral side, regardless of which cranial border was irradiated on the ipsilateral side. For the 3D-CRT C1 and C2 plans, an NTCP value of 74% +/- 12% and 71% +/- 15% was obtained, respectively. The NTCP for xerostomia of the ipsilateral parotid gland was 53% +/- 17% and 45% +/- 20% for the IMRT C1 and C2 plans and 89% +/- 11% and 87% +/- 12% for the 3D-CRT C1 and C2 plans, respectively. CONCLUSION Lowering the cranial border of the Level II lymph nodes from C1 to C2, in the case of bilateral elective neck irradiation, could be considered on the contralateral side when the risk of metastasis on that side is very low. This is especially true when IMRT is used, because the relative reduction of NTCP for xerostomia 1 year after RT could be up to 68% compared with conventional conformal RT up to C1.
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Affiliation(s)
- Eleftheria Astreinidou
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
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Prins-Braam PM, Raaijmakers CPJ, Terhaard CHJ. Location of cervical lymph node metastases in oropharyngeal and hypopharyngeal carcinoma: implications for cranial border of elective nodal target volumes. Int J Radiat Oncol Biol Phys 2004; 58:132-8. [PMID: 14697430 DOI: 10.1016/s0360-3016(03)00719-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyze the exact location of the most cranial metastatic cervical lymph node in patients with oropharyngeal or hypopharyngeal carcinoma. This was done to specify the cranial border of the elective nodal target volume for improvement of parotid-sparing irradiation. METHODS AND MATERIALS The most cranial metastatic lymph node, ipsilateral and, when present, contralateral, was delineated on 58 diagnostic CT scans of patients with node-positive oropharyngeal or hypopharyngeal carcinoma. The distances from the delineated lymph node to the base of the skull were measured in all planes. RESULTS The mean ipsilateral and contralateral distance to the base of the skull in the coronal plane was 25.6 mm (range 2.6-73.8; SD 14.7) and 34.7 mm (range 10.4-78.9; SD 14.0), respectively (p = 0.002). Ipsilateral and contralateral metastatic lymph nodes were located within 20 mm below the base of the skull in 24 patients (41%) and 3 patients (5%), respectively. CONCLUSION Contralateral metastatic lymph nodes are more caudally located than are ipsilateral metastatic lymph nodes. In elective irradiation, lowering the cranial border of the contralateral nodal target volume with 20 mm below the base of the skull should be considered.
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Affiliation(s)
- Pètra M Prins-Braam
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
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Hodder SC, Evans RM, Patton DW, Silvester KC. Ultrasound and fine needle aspiration cytology in the staging of neck lymph nodes in oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2000; 38:430-6. [PMID: 11010769 DOI: 10.1054/bjom.2000.0332] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We prospectively studied 49 patients with oral squamous cell carcinoma (SCC) who had their cervical regional lymph nodes examined by ultrasound (US), with or without fine needle aspiration cytology (FNAC), for the detection of metastatic spread. They were screened over a two-year period (1993-1995) by computed tomography (CT) and magnetic resonance imaging (MRI) or both to measure the primary tumour. US, with or without FNAC, was used to stage the neck. All tumours were biopsied preoperatively and the diagnosis of SCC conformed by histological examination. Management of the neck was based on US staging. Thirty-five patients had neck dissections and 14 were managed conservatively. Mean follow-up was 30 months (range 24-48). All patients were alive at one year, but one died at 14 months from recurrence of disease in the neck. There were 3 false negatives (6%). We find that US, with or without FNAC, is an accurate (86%), sensitive (92%) and specific (83%) technique for the preoperative assessment of lymph node metastases in patients with SCC.
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MESH Headings
- Biopsy, Needle/instrumentation
- Biopsy, Needle/methods
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Follow-Up Studies
- Humans
- Lymph Nodes/diagnostic imaging
- Lymph Nodes/pathology
- Lymphatic Metastasis
- Mouth Neoplasms/diagnostic imaging
- Mouth Neoplasms/pathology
- Mouth Neoplasms/radiotherapy
- Mouth Neoplasms/surgery
- Neck
- Neck Dissection
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Staging
- Radiotherapy, Adjuvant
- Sensitivity and Specificity
- Treatment Outcome
- Ultrasonography, Interventional/instrumentation
- Ultrasonography, Interventional/methods
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Affiliation(s)
- S C Hodder
- Morriston Hospital, Morriston, Swansea, UK
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Kowalski LP, Bagietto R, Lara JR, Santos RL, Silva JF, Magrin J. Prognostic significance of the distribution of neck node metastasis from oral carcinoma. Head Neck 2000; 22:207-14. [PMID: 10748442 DOI: 10.1002/(sici)1097-0347(200005)22:3<207::aid-hed1>3.0.co;2-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Carcinoma of the oral cavity presents a high risk for neck metastasis, which reduces the probability of regional control and survival. OBJECTIVES The main objective of this study is to analyze prognostic implications of the distribution of neck metastasis in 513 patients with squamous cell carcinoma of the oral cavity. PATIENTS AND METHODS All patients underwent surgery from 1970-1992. Tumor stages were I, 63; II, 120; III, 173; and IV, 157. Neck dissections were performed in 448 patients (115 bilateral). RESULTS By use of multivariate regression techniques the level of lymph node involvement was the most important prognostic factor (relative risks from 1.8 to 2.5). The following variables were also associated with prognosis: mobility of lymph nodes, sex, T stage, age, and tumor thickness. CONCLUSIONS The level of ipsilateral lymph node involvement was the most significant prognostic factor patients with in oral cancer who underwent surgical treatment. A significant decrease in survival also was seen with regard to the involvement of multiple contralateral lymph nodes. Our results support the indication of elective neck dissections in high-risk patients because among the cases that had metastases at follow-up, 50% were not candidates for salvage treatment.
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Affiliation(s)
- L P Kowalski
- Head and Neck Surgery Department, Hospital A. C. Camargo, Fundação Antonio Prudente, 211, 01509-010, São Paulo, Brazil
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Pande P, Mathur M, Shukla NK, Ralhan R. Ets-1: a plausible marker of invasive potential and lymph node metastasis in human oral squamous cell carcinomas. J Pathol 1999; 189:40-5. [PMID: 10451486 DOI: 10.1002/(sici)1096-9896(199909)189:1<40::aid-path405>3.0.co;2-#] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The proto-oncogene Ets-1 is a transcription factor known to regulate the expression of a number of genes involved in extracellular matrix remodelling. It has been postulated to play a role in angiogenesis, cell migration, and regulation of tumour invasion. In betel and tobacco-related oral tumourigenesis, oral squamous cell carcinomas (SCCs) having a poor prognosis often exhibit extensive local disease with spread into regional lymph nodes. At present, no tumour marker is available to predict the metastatic potential of oral carcinomas. To elucidate the involvement of Ets-1 in human oral tumourigenesis, 60 cases of oral SCC, 30 potentially malignant lesions, and 30 samples of normal oral mucosa were examined by immunohistochemistry and the findings corroborated with immunoblotting. The relationship of Ets-1 expression with the degree of differentiation, lymph node metastasis, and tumour stage was determined in oral SCCs. Ets-1 was not detected in the normal oral epithelium. Among the 60 cases of oral SCC, 35 cases (58 per cent) showed positive staining for the Ets-1 protein in tumour cells. In potentially malignant lesions, 14 of 30 cases (47 per cent) showed Ets-1 immunopositivity. Ets-1 expression correlated significantly with tumour stage ( p=0.01) and lymph node metastasis ( p=0.005). The presence of Ets-1 mRNA in oral SCCs was confirmed by reverse transcription-polymerase chain reaction (RT-PCR). These findings suggest that overexpression of Ets-1 in potentially malignant lesions may be related to angiogenesis and its expression in oral SCCs may be one of the factors involved in tumour progression and lymph node metastasis.
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Affiliation(s)
- P Pande
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi-110029, India
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Kowalski LP, Bagietto R, Lara JR, Santos RL, Tagawa EK, Santos IR. Factors influencing contralateral lymph node metastasis from oral carcinoma. Head Neck 1999; 21:104-10. [PMID: 10091977 DOI: 10.1002/(sici)1097-0347(199903)21:2<104::aid-hed2>3.0.co;2-l] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND An ipsilateral neck dissection is mandatory during initial treatment stages II-IV oral carcinomas. However, no consensus exists whether or not to perform an elective contralateral neck dissection. METHODS Five hundred thirteen consecutive cases of squamous cell carcinoma (269 tongue, 135 floor of the mouth, 44 inferior gingiva, 65 retromolar trigone) were reviewed. Tumor stages were: 69 T1, 227 T2, 217 T3-T4, 263 N0, 250 N1-N3. A total of 563 neck dissections were performed in 448 patients. Univariate and multivariate analysis of risk factors were performed using logistic regression. RESULTS Two hundred twenty-three patients (49.8%) had positive nodes in the specimen (182 ipsilateral, 36 bilateral, 5 contralateral). Contralateral neck recurrences occurred in 38 cases (33 not submitted to a contralateral neck dissection initially). Multivariate logistic regression analysis demonstrated that clinical stage (p = .0001), tumor crossing midline (p = .0011), and floor of the mouth involvement (p = .0236) were the most important predictors of contralateral metastasis. CONCLUSION The contralateral side of the neck is a common and potentially preventable site of recurrence in tumors of the oral cavity. The multivariate model obtained discriminates patients with low and high risk (more than 20%) of contralateral metastasis. The application of this mathematical model can be useful for the indication of contralateral neck dissections, because not all tumors crossing midline are associated to a high risk (stages I and II tumors not involving the floor of the mouth) and not all tumors not crossing midline are at low risk (stages III and IV tumors involving the floor of the mouth).
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Affiliation(s)
- L P Kowalski
- Head and Neck Surgery Department, Hospital A.C. Camargo, Fundação Antonio Prudente, São Paulo, Brazil
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Ferlito A, Rinaldo A. Selective lateral neck dissection for laryngeal cancer with limited metastatic disease: is it indicated? J Laryngol Otol 1998; 112:1031-3. [PMID: 10197138 DOI: 10.1017/s0022215100142392] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The most important prognostic factor in cancer of the larynx is the presence of cervical metastatic disease, which is the most common type of recurrence in such patients. Because micrometastases cannot be detected pre-operatively at present, selective lateral neck dissection is increasingly recommended as the standard treatment for patients with a clinically negative neck in order to reduce the recurrence rate. In cases of N+ disease, selective lateral neck dissection can be as valid as modified radical neck dissection, providing patients have only limited, occult metastatic disease.
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Affiliation(s)
- A Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Italy
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Abstract
Squamous cell carcinoma of the upper respiratory and digestive tract has a high risk for neck metastasis, which reduces the probability of regional control and survival. We analyzed the literature and our own experience to review the possible risk factors for the occurrence of metastasis. The most significant risk factors were: tumor site and size, grade of histologic differentiation, tumor thickness (tongue and floor of mouth carcinoma), vascular embolization, and perineural infiltration. A series of biomarkers has been studied over the last 10 years, but no one has proved to be significant enough for clinical use. Based on several multivariate analysis, it is recommended elective treatment of the neck for high-risk patients.
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Affiliation(s)
- L P Kowalski
- Head and Neck Surgery Department, Centro de Tratamento e Pesquisa Hospital do Câncer A C Camargo, São Paulo, Brazil
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Gallo O, Masini E, Morbidelli L, Franchi A, Fini-Storchi I, Vergari WA, Ziche M. Role of nitric oxide in angiogenesis and tumor progression in head and neck cancer. J Natl Cancer Inst 1998; 90:587-96. [PMID: 9554441 DOI: 10.1093/jnci/90.8.587] [Citation(s) in RCA: 311] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Angiogenesis (formation of new blood vessels) is associated with tumor growth and metastasis in patients with solid tumors, including those of the head and neck. Nitric oxide (NO) production may contribute to these processes. We assessed the role of the NO pathway in angiogenesis and tumor progression in patients with head and neck cancer. METHODS Biochemical assays were used to measure NO synthase (NOS) activity and cyclic guanosine monophosphate (cGMP) levels in specimens of tumor and normal mucosa obtained from 27 patients. Microvessels in tumor specimens were identified by CD-31-specific immunohistochemical staining. Associations between microvessel densities, levels of NOS, and cGMP were examined by use of two-sided statistical tests. Tumor specimens and human squamous carcinoma A-431 cells were grown as explants on the corneas of rabbits, and the effect of the NOS inhibitor N(omega)-nitro-L-arginine-methyl ester (L-NAME) was tested. RESULTS Levels of total NOS, inducible NOS, and cGMP were higher in tumor specimens than in specimens of normal mucosa (all P<.0001). Tumor specimens from patients with lymph node metastases presented a higher total NOS activity (P = .005) and were markedly more vascularized than tumor specimens from patients with no lymph node involvement (P = .0002). Microvessel density at the tumor edge was an independent predictor of metastasis for this series of patients (odds ratio = 1.19; 95% confidence interval = 1.07-2.89; P = .04). A-431 cells and tumor specimens exhibiting high levels of NOS activity induced angiogenesis in the rabbit cornea assay; when NO production was blocked, tumor angiogenesis and growth were repressed. CONCLUSIONS The NO pathway appears to play a key role in tumor angiogenesis and spread in patients with head and neck cancer.
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Affiliation(s)
- O Gallo
- Institute of Otolaryngology Head and Neck Surgery, University of Florence, Italy
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Nason RW, Anderson BJ, Gujrathi DS, Abdoh AA, Cooke RC. A retrospective comparison of treatment outcome in the posterior and anterior tongue. Am J Surg 1996; 172:665-70. [PMID: 8988673 DOI: 10.1016/s0002-9610(96)00291-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The perceived poor survival for tongue base cancer compared with the anterior tongue influences selection of treatment. METHODS Treatment outcome is compared in patients with epidermoid carcinoma of the tongue base (n = 112) and anterior tongue (n = 188). A multivariate Cox's proportional hazard model is used to assess the independent effect of tumor location on survival. RESULTS Seventy-one percent of patients with tongue base tumors had advanced stages of disease (Stages III & IV) at presentation compared with 32% for the anterior tongue (P = .000). Disease-specific survival at 5 years for the tongue base was 26%, and for the anterior tongue was 64%. Significant risk factors for disease relapse included age > 50 years, advanced stages of disease, and radiotherapy as a single treatment modality. The adjusted hazard ratio for disease relapse for the tongue base compared with the oral tongue was 1.2 (95% CI = 0.83, 1.74; P = .332). CONCLUSIONS Treatment response for tongue base and anterior tongue tumors is similar. The pessimism that besets the management of cancer of the tongue base may not be justified in all patients.
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Affiliation(s)
- R W Nason
- Department of Surgical Oncology, Manitoba Cancer Treatment and Research Foundation, Winnipeg, Canada
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Gallo O, Boddi V, Bottai GV, Franchi A, Storchi OF. Prognostic significance of clinically false positive cervical lymph nodes in patients with laryngeal carcinoma. Cancer 1995; 75:1077-83. [PMID: 7850704 DOI: 10.1002/1097-0142(19950301)75:5<1077::aid-cncr2820750505>3.0.co;2-a] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND A significant proportion of clinically positive palpable cervical lymph nodes in patients with head and neck cancer are histologically benign. The biologic and prognostic significance of this reactive lymph node enlargement has not been fully clarified. METHODS In this study, the incidence of clinically positive microscopically negative cervical lymph nodes in a series of 902 patients who had neck procedures as a part of their primary treatment for N0-2 laryngeal cancer was analyzed and survival rates of 342 patients with true negative lymph nodes (N0- necks) were compared with those of 106 patients with clinically false positive lymph nodes (N1-2b- necks). In 86 patients with false positive lymph nodes, a histopathologic analysis was performed to determine the histomorphologic pattern of the enlarged lymph nodes and to evaluate which parameters, if any, correlated with 5-year patient survival. RESULTS Overall actuarial survival did not differ significantly in the two groups. However, the actuarial survival curves in the false positive group were clearly better compared with those of the true negative group with more advanced laryngeal cancers, particularly T4 lesions (P < 0.05). Interestingly, the analysis of pattern of recurrence showed a higher incidence of distant metastases in false positive patients with advanced stage laryngeal cancer than in true negative subjects. In addition, the histologic examination of 375 enlarged hyperplastic cervical lymph nodes from 86 neck specimens showed the prevalence of sinus histiocytosis in the false positive group and its favorable prognostic significance. No statistically significant differences with regard to the number and size of enlarged lymph nodes were found. On the contrary, lymph node location seems to have a prognostic impact on survival and the reactive benign enlargement of a digastric lymph node is a possible poor prognostic factor. CONCLUSIONS Survival of patients with clinically false positive, histologically benign hyperplastic cervical lymph nodes who have more advanced laryngeal carcinoma is higher than clinically negative patients, suggesting that the presence of palpable benign nodes may be a sign of the host's immune activation, with favorable prognostic significance.
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Affiliation(s)
- O Gallo
- Institute of Otolaryngology Head and Neck Surgery, Florence, Italy
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