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Szewczyk M, Pazdrowski J, Pieńkowski P, Wojtera B, Więckowska B, Golusiński P, Golusiński W. A Matter of Margins in Oral Cancer-How Close Is Enough? Cancers (Basel) 2024; 16:1488. [PMID: 38672569 PMCID: PMC11048705 DOI: 10.3390/cancers16081488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/07/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
In patients with oral cancer, the risk factors for local, regional, and distant recurrence according to margin status have not been well established. We aimed to determine the risk factors for recurrence by margin status and to identify a margin cut-off point for improved survival in patients with close margins. We retrospectively reviewed adult patients treated at our centre from 2009 to 2021 for primary oral cancer. Margins were classified as positive (<1 mm), close (1 to 4.9 mm), or clear (>5 mm). Univariate and multivariate analyses were performed. A total of 326 patients (210 men) were included. The mean age was 59.1 years. Margin status was close (n = 168, 51.5%), clear (n = 83, 25.4%), or positive (n = 75, 23.0%). In the univariate analysis, positive surgical margins (HR = 7.53) had the greatest impact on distant failure. Positive surgical margins-without nodal involvement-had the greatest impact on the risk of distant failure. In the close margin group, the optimal cut-off for disease-free survival (AUC = 0.58) and overall survival (AUC = 0.63) was a deep margin > 3 mm, with survival outcomes that were comparable to the clear margin group. These finding suggest that margins < 5 mm may be sufficient in certain well-defined cases. Prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Mateusz Szewczyk
- Department of Head and Neck Surgery, Poznań University of Medical Sciences, 61-701 Poznań, Poland; (J.P.); (P.P.); (B.W.); (W.G.)
- The Greater Poland Cancer Center, 61-866 Poznań, Poland
| | - Jakub Pazdrowski
- Department of Head and Neck Surgery, Poznań University of Medical Sciences, 61-701 Poznań, Poland; (J.P.); (P.P.); (B.W.); (W.G.)
- The Greater Poland Cancer Center, 61-866 Poznań, Poland
| | - Piotr Pieńkowski
- Department of Head and Neck Surgery, Poznań University of Medical Sciences, 61-701 Poznań, Poland; (J.P.); (P.P.); (B.W.); (W.G.)
- The Greater Poland Cancer Center, 61-866 Poznań, Poland
| | - Bartosz Wojtera
- Department of Head and Neck Surgery, Poznań University of Medical Sciences, 61-701 Poznań, Poland; (J.P.); (P.P.); (B.W.); (W.G.)
- The Greater Poland Cancer Center, 61-866 Poznań, Poland
| | - Barbara Więckowska
- Department of Computer Science and Statistics, Poznań University of Medical Sciences, 61-701 Poznań, Poland;
| | - Paweł Golusiński
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Góra, 65-417 Zielona Góra, Poland;
| | - Wojciech Golusiński
- Department of Head and Neck Surgery, Poznań University of Medical Sciences, 61-701 Poznań, Poland; (J.P.); (P.P.); (B.W.); (W.G.)
- The Greater Poland Cancer Center, 61-866 Poznań, Poland
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Muhammed Ashique CT, Ramlan S, Basheer M. Patterns of Distant Metastasis in Head and Neck Cancer in a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2023; 75:2107-2111. [PMID: 37636661 PMCID: PMC10447309 DOI: 10.1007/s12070-023-03816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/17/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives/Hypothesis To find out the frequency and location of distant metastasis in head and neck malignancies. Our study also aims to find out the most common site leading to distant metastasis and the management of these distant metastasis cases. Methods 1558 patients treated for head and neck malignancy between 2017 and 2021 were retrospectively reviewed. The frequency and proportions were used to produce descriptive statistics. Results The highest number of head and neck malignancy cases were reported in the oral cavity which included 943 cases (60.52%). Patients with distant metastasis (M1) accounted for 4.73 percent of all cases (n = 90). Nasopharyngeal malignancy cases showed the highest M1 frequency (29.03%), whereas oral cavity patients had the lowest frequency (2.75%). The most common site of distant metastasis was in the lung (64%) followed by bone (18%) and the liver (11%). CT scan of the neck and thorax was the most commonly used diagnostic modality. The most common histopathological finding was squamous cell carcinoma (85%). Multimodality treatment was employed for most of the detected cases. Conclusion Distant metastasis at presentation is rare in head and neck cancer. The rate of distant metastasis in the present study was 4.73%, with the lung being the most common site. The overall survival of these patients depends on a variety of factors and more studies are needed in this regard.
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Affiliation(s)
| | - Sharwak Ramlan
- Yenepoya Medical College, BC Road, Deralakatte, Karnataka India
| | - Mubeena Basheer
- Yenepoya Medical College, BC Road, Deralakatte, Karnataka India
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Zhu RQ, Zhang YM, Luo XY, Shen WY, Zhu HY. A novel nomogram and risk classification system for predicting overall survival in head and neck squamous cell cancer with distant metastasis at initial diagnosis. Eur Arch Otorhinolaryngol 2023; 280:1467-1478. [PMID: 36316576 DOI: 10.1007/s00405-022-07716-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/18/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Head and neck squamous cell carcinoma (HNSCC) is one of the most invasive cancer types globally, and distant metastasis (DM) is associated with a poor prognosis. The objective of this study was designed to construct a novel nomogram and risk classification system to predict overall survival (OS) in HNSCC patients presenting with DM at initial diagnosis. METHODS HNSCC patients with initially diagnosed DM between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Firstly, all patients were randomly assigned to a training cohort and validation cohort (8:2), respectively. The Cox proportional hazards regression model was used to analyze the prognostic factors associated with OS. Then, the nomogram based on the prognostic factors and the predictive ability of the nomogram were assessed by the calibration curves, receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Finally, a risk classification system was established according to the nomogram scores. RESULTS A total of 1240 patients initially diagnosed with HNSCC with DM were included, and the 6-, 12- and 18-month OS of HNSCC with DM were 62.7%, 40.8% and 30%, respectively. The independent prognostic factors for HNSCC patients with DM included age, marital status, primary site, T stage, N stage, bone metastasis, brain metastasis, liver metastasis, lung metastasis, surgery, radiotherapy and chemotherapy. Based on the independent prognostic factors, a nomogram was constructed to predict OS in HNSCC patients with DM. The C-index values of the nomogram were 0.713 in the training cohort and 0.674 in the validation cohort, respectively. The calibration curves and DCA also indicated the good predictability of the nomogram. Finally, a risk classification system was built and it revealed a statistically significant difference among the three groups of patients according to the nomogram scores. CONCLUSIONS Factors associated with the overall survival of HNSCC patients with DM were found. According to the identified factors, we generated a nomogram and risk classification system to predict the OS of patients with initially diagnosed HNSCC with DM. The prognostic nomogram and risk classification system can help to assess survival time and provide guidance when making treatment decisions for HNSCC patients with DM.
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Affiliation(s)
- Run-Qiu Zhu
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Ya-Min Zhang
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Xia-Yan Luo
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Wen-Yi Shen
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Hui-Yong Zhu
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China.
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Bylapudi B, Thakur S, Nihla A, Subash A, Arakeri G, Rao VU. The potential role of immunity in the development of early distant metastases in locoregionally treated oral squamous cell carcinoma. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Yang CY. Distant Metastasis of Tongue Squamous Cell Carcinoma Presenting as Multiple Subdermal and Intramuscular Cysts: A Case Report. EAR, NOSE & THROAT JOURNAL 2022:1455613221095613. [PMID: 35411822 DOI: 10.1177/01455613221095613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The most common sites of distant metastasis (DM) in squamous cell carcinoma (SCC) of the tongue are the lung, bone, and liver; the early identification of metastasis to other sites is difficult. This case report discusses a 48-year-old male initially diagnosed with advanced-stage left tongue SCC, which was treated with wide excision, left radical neck dissection, and adjuvant concurrent chemoradiotherapy. Two months after completing adjuvant therapy, multiple painful nodules without local erythematous changes or warmth were found in the bilateral posterior neck and right medial thigh. Ultrasonography of these nodules revealed a cystic structure. Fine needle aspiration cytology revealed metastatic SCC. The disease progressed despite salvage chemotherapy, and the patient passed away 4 months after the formation of the nodules. Subdermal and intramuscular cysts as the initial presentation of DM have rarely been reported. The identification of unusual cysts, even those outside the head and neck, should raise concern.
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Affiliation(s)
- Chih-Yung Yang
- Otorhinolaryngology Department, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
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Lu HJ, Chiu YW, Lan WS, Peng CY, Tseng HC, Hsin CH, Chuang CY, Chen CC, Huang WS, Yang SF. Prediction Model of Distant Metastasis in Oral Cavity Squamous Cell Carcinoma With or Without Regional Lymphatic Metastasis. Front Oncol 2022; 11:713815. [PMID: 35047382 PMCID: PMC8761851 DOI: 10.3389/fonc.2021.713815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with oral cavity squamous cell carcinoma (OCSCC) who develop distant metastasis (DM) face poor outcomes, and effective prediction models of DM are rare. A total of 595 patients with OCSCC were retrospectively enrolled in this study. Because pathological N staging significantly influences the development and mechanisms of DM, the patients were divided into nodal-negative (pN−) and -positive (pN+) groups. Clinical outcomes, prognoses, and prediction models were analyzed separately for both groups. Overall, 8.9% (53/595) of these patients developed DM. Among the DM cases, 84.9% (45/53) of them developed DM within the first 3 years. The median overall survival, locoregional recurrence-free survival, time until DM development, and postmetastatic survival were 19.8, 12.7, 14.6, and 4.1 months, respectively. Distinguishing patients who only developed locoregional recurrence from those with DM according to locoregional conditions was difficult. Age, surgical margin, and early locoregional recurrence were predictors of DM that were independent of time until DM in the pN− group; the lymphocyte-to-monocyte ratio, presence of lymphovascular invasion, and early locoregional recurrence in the pN+ group were determined. If one point was scored for each factor, then two scoring systems were used to classify the patients into low- (score = 0), intermittent- (score = 1), or high- (score = 2 or 3) risk for the pN− and pN+ groups. According to this scoring system, the 3-year DM rates for the low, intermittent, and high risk subgroups were 0.0%, 5.9%, and 17.8% for the pN− group and 7.1%, 44.9%, and 82.5% for the pN+ group, respectively. These systems also effectively predicted DM, and the areas under the curve predicted DM occurring within the first 3 years were 0.744 and 0.820 for the pN− and pN+ groups, respectively. In conclusion, effective scoring models were established for predicting DM.
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Affiliation(s)
- Hsueh-Ju Lu
- Division of Hematology and Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Wei Chiu
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-San Lan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chih-Yu Peng
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
| | - Hsien-Chun Tseng
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Han Hsin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Yi Chuang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Chia Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Division of Plastic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wei-Shiou Huang
- Division of Hematology and Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
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Zanoni DK, Mayor CV, McGill MR, Montero PH, Shah JP, Wong RJ, Ganly I, Patel SG. Distant metastasis in oral squamous cell carcinoma: Does the neutrophil-to-lymphocyte ratio act as a surrogate of the host immune status? Oral Oncol 2022; 124:105641. [PMID: 34864297 PMCID: PMC9377276 DOI: 10.1016/j.oraloncology.2021.105641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Distant metastasis (DM) is an important prognostic factor for oral squamous cell carcinoma (OSCC). The aim of this study is to evaluate the influence of host and tumor factors in development of DM. MATERIALS AND METHODS After IRB approval, 1369 patients with OSCC undergoing primary surgery were eligible for the study. The primary endpoint was the development of distant metastasis (DM). Patients were pathologically staged according to the American Joint Committee on Cancer, 8th Edition. Pre-operative peripheral blood counts were used to calculate neutrophil-to-lymphocyte ratio (NLR). RESULTS Median follow-up was 39 months (range 1-221). DM were identified in 126 patients during follow-up. When analyzed as a time-dependent covariate, neck recurrence (NR) was a significant predictor of DM (HR 16.35, 95% CI: 11.39-23.47, p < 0.001). NLR, margin status, vascular invasion, perineural invasion (PNI), grade, pT, number of metastatic lymph nodes, level IV involvement, and extra nodal-extension (ENE) were also significant. In multivariable analysis, NLR, margins, PNI, number of metastatic lymph nodes, and ENE maintained independent predictive capacity. Patients with NLR ≥ 5.7 were 3 times more likely to develop DM compared to NLR ≤ 2.9 (95% CI: 1.74-5.59, p < 0.001), patients with ≥ 5 metastatic lymph nodes were 2 times more likely to develop DM (95% CI: 1.18-3.60, p = 0.011), and those with ENE were 4 times more likely (95% CI: 2.67-8.20, p < 0.001) when compared to pNx/pN0 patients. CONCLUSIONS NLR, number of metastatic lymph nodes, and ENE were the strongest independent predictors of DM in OSCC treated with primary surgery and appropriate adjuvant therapy.
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Brandenburg LS, Metzger MC, Poxleitner P, Voss PJ, Vach K, Hell J, Hasel K, Weingart JV, Schwarz SJ, Ermer MA. Effects of Red Blood Cell Transfusions on Distant Metastases of Oral Squamous Cell Carcinomas. Cancers (Basel) 2021; 14:cancers14010138. [PMID: 35008301 PMCID: PMC8750075 DOI: 10.3390/cancers14010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Patients with distant metastasis of oral squamous cell carcinoma should be identified at an early stage of disease. In this study, we investigated if patients who received red blood cell transfusions are at risk for the development of distant metastasis. A positive correlation was found between RBC transfusion (HR = 2.42) and the occurrence of M+ in a multivariate regression model. Therefore, the administration of RBC can be considered as an independent prognostic factor and special attention should be paid to its detrimental effects in the perioperative management of OSCC patients. Abstract There is no consensus on the effect of red blood cell (RBC) transfusions on patients with oral squamous cell carcinoma (OSCC). The aim of this study was to investigate the association between RBC administration and the occurrence of distant metastases (M+) after surgical treatment of OSCC. All medical records of patients who underwent primary surgery for OSCC in our department (2003–2019) were analyzed retrospectively (n = 609). Chi and Cox regression models were used to analyze the influence of transfusion on the development of M+, and survival rates. Kaplan–Meier curves were used for graphical presentation. A multitude of patient-specific factors showed a statistical impact in univariate analysis (transfusion, age, gender, diabetes, pT, pN, L, V, Pn, G, UICC, adjuvant therapy, free microvascular transplant, preoperative hemoglobin level). Transfusion status and pN stage were the only variables that showed a significant correlation to M+ in the multivariate Cox model. The hazard ratios for the occurrence of M+ were 2.42 for RBC transfusions and 2.99 for pN+. Administration of RBC transfusions was identified as a significant prognostic parameter for the occurrence of distant metastases after surgical treatment of OSCC. Hence, the administration of RBC transfusions should be considered carefully in the perioperative management.
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Affiliation(s)
- Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
- Correspondence: ; Tel.: +49-761-270-49240
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Philipp Poxleitner
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Zinkmattenstr. 6A, 79108 Freiburg, Germany;
| | - Johannes Hell
- Department of Anesthesiology and Critical Care, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany;
| | - Konstantin Hasel
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Julia Vera Weingart
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Steffen Jochen Schwarz
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
| | - Michael Andreas Ermer
- Department of Oral and Maxillofacial Surgery, Clinic, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany; (M.C.M.); (P.P.); (P.J.V.); (K.H.); (J.V.W.); (S.J.S.); (M.A.E.)
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Chiesa-Estomba CM, Lechien JR, Ayad T, Calvo-Henriquez C, González-García JÁ, Sistiaga-Suarez JA, Dequanter D, Fakhry N, Melesse G, Piazza C. Clinical and histopathological risk factors for distant metastasis in head and neck cancer patients. ACTA ACUST UNITED AC 2021; 41:6-17. [PMID: 33746217 PMCID: PMC7982761 DOI: 10.14639/0392-100x-n0879] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/06/2020] [Indexed: 12/18/2022]
Abstract
The incidence of distant metastasis (DM) in head and neck squamous cell cancer (HNSCC) is relatively low. Multiple risk factors have been described for development of DM at baseline and after treatment. However, to date, there is no meta-analysis or systematic review investigating the relationships between clinical and histopathological factors and the appearance of DM in HNSCC patients. Among 1,272 eligible articles, 23 met inclusion criteria for qualitative analysis, and 6 for quantitative analysis. The meta-analysis on 5,353 patients showed that hypopharyngeal site, T3-T4 categories, extranodal extension, positive lymph node size > 6 cm, locoregional failure after previous treatment(s) and poor differentiation all significantly increase the risk of DM. According to our results, patients with the above-mentioned clinical and histopathological risk factors should be considered at high risk for DM and therefore submitted to strict pre-treatment assessment and undergo careful post-therapeutic follow-up.
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Affiliation(s)
- Carlos Miguel Chiesa-Estomba
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain.,Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS)
| | - Jerome R Lechien
- Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Department of Human Anatomy and Experimental Oncology, University of Mons, Mons, Belgium
| | - Tareck Ayad
- Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Division of Otolaryngology - Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Christian Calvo-Henriquez
- Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Department of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Ángel González-García
- Department of Otorhinolaryngology - Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | | | - Didier Dequanter
- Department of Otolaryngology - Head and Neck Surgery, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Nicolas Fakhry
- Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).,Department of Otolaryngology - Head and Neck Surgery, Universitary Hospital of la Conception, Marseille, France
| | - Gebeyehu Melesse
- Department of Otolaryngology - Head and Neck Surgery, Bahir Dar University, Tibebe Ghion Specialised Hospital, Bahir Dar, Ethiopia
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
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Risk factors for distant metastasis in locoregionally controlled oral squamous cell carcinoma: a retrospective study. Sci Rep 2021; 11:5213. [PMID: 33664318 PMCID: PMC7933271 DOI: 10.1038/s41598-021-84704-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/18/2021] [Indexed: 11/08/2022] Open
Abstract
The control of distant metastasis in oral squamous cell carcinoma is an important determinant of improved prognosis. The study aimed to identify risk factors for distant metastasis in patients with locoregionally controlled oral carcinoma. We identified 982 patients with oral squamous cell carcinoma treated at our hospital between January 2008 and December 2017. After excluding patients with distant metastasis at initial treatment, patients with metastasis to the oral cavity, those receiving palliative treatment, and those lacking follow-up data, 941 patients were selected. Finally, among these 941 patients, 887 with locoregionally controlled oral squamous cell carcinoma were included in the study. Among the 887 patients, 36 had confirmed distant metastasis (4.1%), and the lung was the most common site (31/36 patients, 86.1%). Multivariate analysis showed that the incidence of primary intraosseous carcinoma of the mandible, cervical lymph node metastasis at levels IV and V, and the presence of pathological extranodal extension were significant risk factors for distant metastasis. When treating patients with oral squamous cell carcinoma who are positive for the aforementioned risk factors, the possibility of developing distant metastases must be accounted for, and aggressive treatment should be planned accordingly.
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11
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Predictive factors for simultaneous distant metastasis in head and neck cancer patients during the diagnostic work-up. Eur Arch Otorhinolaryngol 2021; 278:4483-4489. [PMID: 33550436 DOI: 10.1007/s00405-021-06678-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The incidence of distant metastasis (DM) in patients affected by head and neck squamous cell carcinoma (HNSCC) is relatively low, and multiple risk factors were described for the development of distant metastasis. MATERIALS AND METHODS Retrospective study of patients diagnosed with a HNSCC between July 2016 and July 2020 in a tertiary university hospital. RESULTS Five-Hundred and sixty-nine patients meet inclusion criteria. In the univariate analysis we found a statistical correlation in those patients affected by a hypopharyngeal tumour (p = < 0.0001), patients older than 60 years old (p = 0.01), advanced T stage (p = < 0.0001), a proven positive lymph node (p = 0.02), poorly differentiated tumour (p = < 0.0001), patients with 3 or more positive lymph nodes (p = 0.0001), with ECS (p = 0.0001) and a second primary tumour (p = 0.03). However, according to those results from our multivariable analysis, the factor related to an increased or higher chance to detect a DM during the diagnosis work-up were the presence of a hypopharyngeal primary tumor with a hazard ratio (HR) of 1.14, p = < 0.0001, advanced T stage (T3-T4) with a HR of 1.21, p = 0.001, poorly differentiated tumor with a HR of 1.04, p = < 0.0001, have proven positive lymph node with a HR of 1.03, p = 0.04, have more than three positive lymph node metastases with a HR of 1.25, p = 0.003, the presence of ECS with a HR of 1.40, p = 0.002, and have a second primary tumor with a HR of 1.05, p = 0.01. CONCLUSION According to the present study, factors such as hypopharyngeal tumours, advanced T-stage, poor differentiation grade, have more than three positive lymph nodes, ECS and have a second primary tumour should be considered as high-risk indicators for screening. Based on these results, the authors recommend considered an extensive diagnostic work-up in all patients with a high risk of DM development.
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Predictors for distant metastasis in head and neck cancer, with emphasis on age. Eur Arch Otorhinolaryngol 2020; 278:181-190. [PMID: 32542417 PMCID: PMC7811512 DOI: 10.1007/s00405-020-06118-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Distant metastasis (DM) in patients with head and neck squamous cell carcinoma (HNSCC) is uncommon, but strongly deteriorates prognosis. Controversy exists regarding age as a predictor for the presence and development of DM. The aim of this study was to investigate age and other predictors for DM in HNSCC patients. METHODS From 1413 patients diagnosed with a primary HNSCC between 1999 and 2010 in a tertiary referral centre, patient, disease and pathological characteristics were extracted from patient files. Uni- and multivariable Cox regression analyses were performed to identify risk factors for DM as primary outcome. RESULTS DM occurred in 131 (9.3%) patients, of which 27 (1.9%) were diagnosed simultaneously with the primary tumour, 27 (1.9%) were diagnosed synchronous, and 77 (5.4%) were diagnosed metachronous. The most common site of DM was lung (51.1%), followed by bone (19.1%) and liver (11.5%). Multivariable analysis identified male gender (HR = 1.95, 95% CI 1.23-3.10) hypopharyngeal tumours (HR = 3.28, 95% CI 1.75-6.14), advanced T-stage (HR = 1.61, 95% CI 1.09-2.38), poor differentiation grade (HR = 2.49, 95% CI 1.07-5.78), regional lymph node metastasis (HR = 5.35, 95% CI 3.25-8.79) and extranodal extension of regional lymph nodes metastasis (HR = 3.06, 95% CI 1.39-6.72) as independent prognostic factors for the presence or development of DM. No relation with age was found. CONCLUSION Age is not related to the presence or development of DM. This study emphasizes the importance of screening for DM, especially in males, patients with hypopharyngeal tumours, advanced T-stage, histopathological poor differentiation grade, regional lymph node metastasis and extranodal extension.
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Park SI, Park W, Choi S, Jang Y, Kim H, Kim SH, Noh JM, Chung MK, Son YI, Baek CH, Jeong HS. Clinical Outcome of Minor Salivary Gland Cancers in the Oral Cavity: A Comparative Analysis With Squamous Cell Carcinomas of the Oral Cavity. Front Oncol 2020; 10:881. [PMID: 32582548 PMCID: PMC7283496 DOI: 10.3389/fonc.2020.00881] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose: Salivary gland cancer (SGC) in the oral cavity is not common and has been less studied in comparison with oral squamous cell carcinoma (SCC). This study aimed to identify the clinical characteristics and outcomes of SGC in the oral cavity compared with oral SCC. Methods: The medical charts of the patients with SGC (N = 68) arising from minor salivary glands and SCC (N = 750) in the oral cavity between 1995 and 2017 were reviewed retrospectively. The clinical and pathological factors and treatment outcomes were compared to identify clinical differences between oral SGC and SCC in total cases and in tumor size and subsite (propensity score)-matched pairs (N = 68 in each group). In addition, pattern of local invasion was pathologically assessed in a subset of SGC and SCC tumors. Results: Patients with SGC in the oral cavity showed >90% survival at 5 years. Most common pathologies of SGC were mucoepidermoid carcinoma (39.7%) and adenoid cystic carcinoma (35.3%), where high-grade tumors (including adenoid cystic carcinomas having solid components, grade 2 or 3) represented only 36.8%. Compared with oral SCC, surgery for SGC had narrow surgical safety margin. However, local control was very successful in SGC even with <5 mm or positive resection margin through surgery plus adjuvant radiation treatments or surgery alone for small low-grade tumors. Pathologic analysis revealed that the frequency of oral SGC with infiltrative tumor border was significantly lower than that of oral SCC (46.4 vs. 87.2%, P < 0.001). Conclusions: SGC in the oral cavity represents relatively good prognosis and has a locally less aggressive pathology compared with oral SCC. Adjuvant radiation can be very effective to control minimal residual disease in oral SGC. Our study proposed that a different treatment strategy for oral SGC would be reasonable in comparison with oral SCC.
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Affiliation(s)
- Song I Park
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Woori Park
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sungyong Choi
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yunjeong Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyunjin Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seok-Hyung Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Pisani P, Airoldi M, Allais A, Aluffi Valletti P, Battista M, Benazzo M, Briatore R, Cacciola S, Cocuzza S, Colombo A, Conti B, Costanzo A, della Vecchia L, Denaro N, Fantozzi C, Galizia D, Garzaro M, Genta I, Iasi GA, Krengli M, Landolfo V, Lanza GV, Magnano M, Mancuso M, Maroldi R, Masini L, Merlano MC, Piemonte M, Pisani S, Prina-Mello A, Prioglio L, Rugiu MG, Scasso F, Serra A, Valente G, Zannetti M, Zigliani A. Metastatic disease in head & neck oncology. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2020; 40:S1-S86. [PMID: 32469009 PMCID: PMC7263073 DOI: 10.14639/0392-100x-suppl.1-40-2020] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The head and neck district represents one of the most frequent sites of cancer, and the percentage of metastases is very high in both loco-regional and distant areas. Prognosis refers to several factors: a) stage of disease; b) loco-regional relapses; c) distant metastasis. At diagnosis, distant metastases of head and neck cancers are present in about 10% of cases with an additional 20-30% developing metastases during the course of their disease. Diagnosis of distant metastases is associated with unfavorable prognosis, with a median survival of about 10 months. The aim of the present review is to provide an update on distant metastasis in head and neck oncology. Recent achievements in molecular profiling, interaction between neoplastic tissue and the tumor microenvironment, oligometastatic disease concepts, and the role of immunotherapy have all deeply changed the therapeutic approach and disease control. Firstly, we approach topics such as natural history, epidemiology of distant metastases and relevant pathological and radiological aspects. Focus is then placed on the most relevant clinical aspects; particular attention is reserved to tumours with distant metastasis and positive for EBV and HPV, and the oligometastatic concept. A substantial part of the review is dedicated to different therapeutic approaches. We highlight the role of immunotherapy and the potential effects of innovative technologies. Lastly, we present ethical and clinical perspectives related to frailty in oncological patients and emerging difficulties in sustainable socio-economical governance.
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Affiliation(s)
- Paolo Pisani
- ENT Unit, ASL AT, “Cardinal Massaja” Hospital, Asti, Italy
| | - Mario Airoldi
- Medical Oncology, Città della Salute e della Scienza, Torino, Italy
| | | | - Paolo Aluffi Valletti
- SCDU Otorinolaringoiatria, AOU Maggiore della Carità di Novara, Università del Piemonte Orientale, Italy
| | | | - Marco Benazzo
- SC Otorinolaringoiatria, Fondazione IRCCS Policlinico “S. Matteo”, Università di Pavia, Italy
| | | | | | - Salvatore Cocuzza
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Italy
| | - Andrea Colombo
- ENT Unit, ASL AT, “Cardinal Massaja” Hospital, Asti, Italy
| | - Bice Conti
- Department of Drug Sciences, University of Pavia, Italy
- Polymerix S.r.L., Pavia, Italy
| | | | - Laura della Vecchia
- Unit of Otorhinolaryngology General Hospital “Macchi”, ASST dei Settelaghi, Varese, Italy
| | - Nerina Denaro
- Oncology Department A.O.S. Croce & Carle, Cuneo, Italy
| | | | - Danilo Galizia
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo,Italy
| | - Massimiliano Garzaro
- SCDU Otorinolaringoiatria, AOU Maggiore della Carità di Novara, Università del Piemonte Orientale, Italy
| | - Ida Genta
- Department of Drug Sciences, University of Pavia, Italy
- Polymerix S.r.L., Pavia, Italy
| | | | - Marco Krengli
- Dipartimento Medico Specialistico ed Oncologico, SC Radioterapia Oncologica, AOU Maggiore della Carità, Novara, Italy
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | | | - Giovanni Vittorio Lanza
- S.O.C. Chirurgia Toracica, Azienda Ospedaliera Nazionale “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | | | - Maurizio Mancuso
- S.O.C. Chirurgia Toracica, Azienda Ospedaliera Nazionale “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Roberto Maroldi
- Department of Radiology, University of Brescia, ASST Spedali Civili Brescia, Italy
| | - Laura Masini
- Dipartimento Medico Specialistico ed Oncologico, SC Radioterapia Oncologica, AOU Maggiore della Carità, Novara, Italy
| | - Marco Carlo Merlano
- Oncology Department A.O.S. Croce & Carle, Cuneo, Italy
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo,Italy
| | - Marco Piemonte
- ENT Unit, University Hospital “Santa Maria della Misericordia”, Udine, Italy
| | - Silvia Pisani
- Immunology and Transplantation Laboratory Fondazione IRCCS Policlinico “S. Matteo”, Pavia, Italy
| | - Adriele Prina-Mello
- LBCAM, Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin 8, Ireland
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland
| | - Luca Prioglio
- Department of Otorhinolaryngology, ASL 3 “Genovese”, “Padre Antero Micone” Hospital, Genoa, Italy
| | | | - Felice Scasso
- Department of Otorhinolaryngology, ASL 3 “Genovese”, “Padre Antero Micone” Hospital, Genoa, Italy
| | - Agostino Serra
- University of Catania, Italy
- G.B. Morgagni Foundation, Catania, Italy
| | - Guido Valente
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Micol Zannetti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Angelo Zigliani
- Department of Radiology, University of Brescia, ASST Spedali Civili Brescia, Italy
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Cai X, Huang J. Distant metastases in newly diagnosed tongue squamous cell carcinoma. Oral Dis 2019; 25:1822-1828. [PMID: 31206925 DOI: 10.1111/odi.13147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/05/2019] [Accepted: 06/08/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize the incidence and survivals of patients with distant metastases in newly diagnosed tongue squamous cell carcinoma. MATERIALS AND METHODS Patients with distant metastases in newly diagnosed tongue squamous cell carcinoma were collected from the Surveillance, Epidemiology, and End Results database. Data were classified by sex, age, race, insurance status, T stage, N stage and grade. Multivariable logistic and Cox regression were used to demonstrate risk factors of the presence of distant metastases and hazards related to mortality, respectively. RESULTS We found 92 patients with distant metastases in newly diagnosed tongue squamous cell carcinoma, including lung, bone, liver, and brain, representing 1.08% of the entire cohort. 69 were male and 23 were female. Median survival among patients with distant metastases was 4.0 months. CONCLUSION The study describes the incidence and prognosis of patients with distant metastases in newly diagnosed tongue squamous cell carcinoma based on population estimates. The findings lend support to closely monitor the development of distant metastases among patients with predictors at the time of diagnosis of tongue squamous cell carcinoma.
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Affiliation(s)
- Xinjia Cai
- Department of Oral Pathology, Xiangya Stomatological Hospital, Central South University, Changsha, China
| | - Junhui Huang
- Department of Oral Pathology, Xiangya Stomatological Hospital, Central South University, Changsha, China
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Sharma A, Kim JW, Paeng JY. Clinical analysis of neck node metastasis in oral cavity cancer. J Korean Assoc Oral Maxillofac Surg 2018; 44:282-288. [PMID: 30637242 PMCID: PMC6327011 DOI: 10.5125/jkaoms.2018.44.6.282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives The purpose of this study was to evaluate the neck node metastasis pattern and related clinical factors in oral cavity cancer patients. Materials and Methods In total, 76 patients (47 males, 29 females) with oral squamous cell carcinoma (OSCC) who had no previous malignancies and were not undergoing neoadjuvant concomitant chemoradiotherapy or radiotherapy were selected for analysis. Results Occult metastases were found in 8 of 52 patients with clinically negative nodes (cN0, 15.4%). Neck node metastases were found in 17 patients (22.4%). There was a statistically significant relationship between neck node metastasis and T stage (P=0.014) and between neck node metastasis and distant metastasis (Fisher's exact test, P=0.019). Conclusion Neck node metastasis was significantly related to tumor size and distant metastasis during follow-up.
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Affiliation(s)
- Aditi Sharma
- Department of Oral and Maxillofacial Surgery, Kyungpook National University School of Dentistry, Daegu, Korea
| | - Jin-Wook Kim
- Department of Oral and Maxillofacial Surgery, Kyungpook National University School of Dentistry, Daegu, Korea
| | - Jun-Young Paeng
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Seoul, Korea
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Barrett TF, Gill CM, Miles BA, Iloreta AMC, Bakst RL, Fowkes M, Brastianos PK, Bederson JB, Shrivastava RK. Brain metastasis from squamous cell carcinoma of the head and neck: a review of the literature in the genomic era. Neurosurg Focus 2018; 44:E11. [DOI: 10.3171/2018.2.focus17761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Squamous cell carcinoma of the head and neck (HNSCC) affects nearly 500,000 individuals globally each year. With the rise of human papillomavirus (HPV) in the general population, clinicians are seeing a concomitant rise in HPV-related HNSCC. Notably, a hallmark of HPV-related HNSCC is a predilection for unique biological and clinical features, which portend a tendency for hematogenous metastasis to distant locations, such as the brain. Despite the classic belief that HNSCC is restricted to local spread via passive lymphatic drainage, brain metastases (BMs) are a rare complication that occurs in less than 1% of all HNSCC cases. Time between initial diagnosis of HNSCC and BM development can vary considerably. Some patients experience more than a decade of disease-free survival, whereas others present with definitive neurological symptoms that precede primary tumor detection. The authors systematically review the current literature on HNSCC BMs and discuss the current understanding of the effect of HPV status on the risk of developing BMs in the modern genomic era.
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Affiliation(s)
| | | | | | | | | | - Mary Fowkes
- 4Pathology, Mount Sinai Medical Center, New York, New York; and
| | - Priscilla K. Brastianos
- 5Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
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18
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Naruse T, Tokuhisa M, Yanamoto S, Sakamoto Y, Okuyama K, Tsuchihashi H, Umeda M. Lower gingival squamous cell carcinoma with brain metastasis during long-term cetuximab treatment: A case report. Oncol Lett 2018; 15:7158-7162. [PMID: 29725438 PMCID: PMC5920247 DOI: 10.3892/ol.2018.8261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/16/2018] [Indexed: 01/11/2023] Open
Abstract
Long-term cetuximab treatment can lead to acquired resistance, and tumor progression and/or new lesions often occur. The present report describes a case of lower gingival squamous cell carcinoma with brain metastasis during long-term cetuximab treatment in a 60-year-old man, including findings of an immunohistochemical study. The resected primary tumors, biopsy of the lung metastasis before administration of cetuximab, and brain metastasis specimens mediated by cetuximab were immunohistochemically examined. Histologically, the metastatic brain lesion showed hyperkeratinizing tumor cells with deeply stained irregular nuclei with necrotizing tumor cells, and a decrease in cell density was exhibited in part of the tumor nest. Moreover, the brain lesion was less malignant compared with the primary tumor and metastatic lung lesions. Immunohistochemically, the metastatic brain lesions showed low expression of epidermal growth factor receptor (EGFR) and high expression of N-cadherin compared with the primary tumor and metastatic lung lesions. These results suggest that acquired resistance to cetuximab may be associated with low EGFR expression and increased epithelial-to-mesenchymal transition potential.
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Affiliation(s)
- Tomofumi Naruse
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8588, Japan
| | - Mitsuko Tokuhisa
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8588, Japan
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8588, Japan
| | - Yuki Sakamoto
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8588, Japan
| | - Kohei Okuyama
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8588, Japan
| | - Hiroki Tsuchihashi
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8588, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8588, Japan
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19
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Aires FT, Lin CS, Matos LL, Kulcsar MAV, Cernea CR. Risk Factors for Distant Metastasis in Patients with Oral Cavity Squamous Cell Carcinoma Undergoing Surgical Treatment. ORL J Otorhinolaryngol Relat Spec 2018; 79:347-355. [PMID: 29393250 DOI: 10.1159/000485627] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the clinical and pathological factors related to distant metastasis in patients with oral cavity squamous cell carcinoma (OCSCC) undergoing surgery. STUDY DESIGN A retrospective data review was conducted on patients who underwent primary surgery for OCSCC at the Instituto do Cancer do Estado de São Paulo (ICESP) between 2009 and 2015. Distant metastasis rates were calculated and predictive factors were determined by the Cox proportional-hazards model. RESULTS There was a total of 274 patients, including 210 (76.6%) men and 64 (23.4%) women, with a mean age of 59.9 ± 10.9 years. The incidence of distant metastasis was 9.6%, with the lung being the most common site. The mean time interval between surgical treatment and the diagnosis of distant metastasis was 12 months (range 2-40 months). In the multivariate analysis, angiolymphatic invasion (HR = 2,87; p = 0.023), contralateral cervical metastasis (HR = 3.3; p = 0,007), tumor thickness >25 mm (HR = 3.50; p = 0.009), and locoregional recurrence (HR = 6.59; p < 0.0001) were the only independent risk factors for distant metastasis. CONCLUSION Patients with OCSCC who have contralateral lymph node metastasis, tumors with a thickness >25 mm, angiolymphatic invasion, or locoregional recurrence after surgical treatment have a greater risk of developing distant metastasis.
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Affiliation(s)
- Felipe Toyama Aires
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Chin Shien Lin
- Department of Head and Neck Surgery, Instituto do Cancer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Leandro Luongo Matos
- Department of Head and Neck Surgery, Instituto do Cancer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | | | - Claudio Roberto Cernea
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
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20
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Lymph node ratio relationship to regional failure and distant metastases in oral cavity cancer. Radiother Oncol 2017; 124:225-231. [DOI: 10.1016/j.radonc.2017.06.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/12/2017] [Accepted: 06/15/2017] [Indexed: 11/21/2022]
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Duprez F, Berwouts D, De Neve W, Bonte K, Boterberg T, Deron P, Huvenne W, Rottey S, Mareel M. Distant metastases in head and neck cancer. Head Neck 2017. [DOI: 10.1002/hed.24687] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Fréderic Duprez
- Department of Radiation Oncology; Ghent University Hospital; Ghent Belgium
| | - Dieter Berwouts
- Department of Nuclear Medicine; Ghent University Hospital; Ghent Belgium
| | - Wilfried De Neve
- Department of Radiation Oncology; Ghent University Hospital; Ghent Belgium
| | - Katrien Bonte
- Department of Head and Neck Surgery; Ghent University Hospital; Ghent Belgium
| | - Tom Boterberg
- Department of Radiation Oncology; Ghent University Hospital; Ghent Belgium
| | - Philippe Deron
- Department of Head and Neck Surgery; Ghent University Hospital; Ghent Belgium
| | - Wouter Huvenne
- Department of Head and Neck Surgery; Ghent University Hospital; Ghent Belgium
| | - Sylvie Rottey
- Department of Medical Oncology; Ghent University Hospital; Ghent Belgium
| | - Marc Mareel
- Department of Radiation Oncology; Ghent University Hospital; Ghent Belgium
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22
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Cho JK, Hyun SH, Choi JY, Choi N, Kim MJ, Lee SH, Baek KH, Jeong HS. Prognostic significance of clinical and 18 F-FDG PET/CT parameters for post-distant metastasis survival in head and neck squamous cell carcinoma patients. J Surg Oncol 2016; 114:888-894. [PMID: 27546387 DOI: 10.1002/jso.24412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/03/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Distant metastasis (M1) to vital organs remains a major cause of death in patients with head and neck squamous cell carcinomas (HNSCC). Clinically the survival periods vary in individual M1 HNSCC patients and a prognostic indicator has not been fully studied. Here, we evaluated the prognostic factors for survival including 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters in M1 HNSCC patients. METHODS The study included 108 patients with newly diagnosed M1 HNSCC (68 during clinical courses, 40 at presentation) who underwent FDG PET/CT. Maximum standardized uptake value (SUVmax) of metastatic tumors was measured by FDG PET/CT. Associations of primary tumor or metastatic tumor variables with overall survival were assessed with Cox regression models. RESULTS Multivariate analyses demonstrated that nasopharynx primary and incomplete response of loco-regional disease to treatment were significant prognostic factors. In addition, adverse prognostic factors included short distant metastasis-free period (<10 months), high number (≥5), and high PET SUVmax (≥6.3) of metastatic lesions. The patients with at least one of these adverse features had a median survival <14 months. CONCLUSION PET SUVmax of the metastatic tumors in M1 HNSCC patients can be a good predictor for survival. J. Surg. Oncol. 2016;114:888-894. © 2016 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jae-Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min-Ji Kim
- Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Se-Hoon Lee
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwan-Hyuck Baek
- Department of Molecular and Cellular Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi, Republic of Korea.
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Naruse T, Yanamoto S, Matsushita Y, Sakamoto Y, Morishita K, Ohba S, Shiraishi T, Yamada SI, Asahina I, Umeda M. Cetuximab for the treatment of locally advanced and recurrent/metastatic oral cancer: An investigation of distant metastasis. Mol Clin Oncol 2016; 5:246-252. [PMID: 27446558 PMCID: PMC4950138 DOI: 10.3892/mco.2016.928] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/21/2016] [Indexed: 11/10/2022] Open
Abstract
The aim of this retrospective study was to assess the efficacy and safety of cetuximab therapy for patients with locally advanced (LA) and recurrent/metastatic (R/M) oral squamous cell carcinoma (OSCC), with a specific focus on distant metastases (DMs). Data from 21 patients with unresectable LA and R/M OSCC treated with cetuximab therapy in our department between December, 2012 and July, 2015 were reviewed. The endpoint was the time-to-progression and the assessments made were tumor response rate, progression-free survival (PFS), overall survival (OS) and safety. The overall response rate was 57.1%, with a complete response (CR) rate of 33.3%. The overall median PFS and OS were 5.5 and 8.0 months, respectively. For patients with DMs, the overall response rate was 60.0%, with a CR rate of 40.0%. The median PFS and OS were 3.8 and 5.8 months, respectively. In addition, improved 1-year OS was observed following approval of cetuximab, although the differences between the group of patients treated after that time and historical controls were not statistically significantly (P=0.246). Grade 3–4 adverse events included infusion reaction (4 cases), neutropenia, hypophosphatemia, upper gastrointestinal hemorrhage, liver toxicity and mucositis (1 case each). There was one cetuximab-related death due to interstitial pneumonia. An acne-like rash was observed in all cases, but no grade 3 or 4 rash was reported. Hypomagnesemia was observed in 10 cases. Our results suggest that cetuximab may display significant therapeutic efficacy in patients with unresectable LA and R/M OSCC, including those with DMs.
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Affiliation(s)
- Tomofumi Naruse
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University Hospital, Nagasaki, Nagasaki 852-8588, Japan
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University Hospital, Nagasaki, Nagasaki 852-8588, Japan
| | - Yuki Matsushita
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University Hospital, Nagasaki, Nagasaki 852-8588, Japan
| | - Yuki Sakamoto
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University Hospital, Nagasaki, Nagasaki 852-8588, Japan
| | - Kota Morishita
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University Hospital, Nagasaki, Nagasaki 852-8588, Japan
| | - Seigo Ohba
- Department of Regenerative Oral Surgery, Graduate School of Biomedical Sciences, Nagasaki University Hospital, Nagasaki, Nagasaki 852-8588, Japan
| | - Takeshi Shiraishi
- Department of Regenerative Oral Surgery, Graduate School of Biomedical Sciences, Nagasaki University Hospital, Nagasaki, Nagasaki 852-8588, Japan
| | - Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan
| | - Izumi Asahina
- Department of Regenerative Oral Surgery, Graduate School of Biomedical Sciences, Nagasaki University Hospital, Nagasaki, Nagasaki 852-8588, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Graduate School of Biomedical Sciences, Nagasaki University Hospital, Nagasaki, Nagasaki 852-8588, Japan
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24
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Sakamoto Y, Matsushita Y, Yamada SI, Yanamoto S, Shiraishi T, Asahina I, Umeda M. Risk factors of distant metastasis in patients with squamous cell carcinoma of the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:474-80. [DOI: 10.1016/j.oooo.2015.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 10/08/2015] [Accepted: 11/28/2015] [Indexed: 10/22/2022]
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25
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Hasegawa T, Tanakura M, Takeda D, Sakakibara A, Akashi M, Minamikawa T, Komori T. Risk factors associated with distant metastasis in patients with oral squamous cell carcinoma. Otolaryngol Head Neck Surg 2015; 152:1053-60. [PMID: 25883102 DOI: 10.1177/0194599815580980] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/18/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to retrospectively evaluate the incidence of distant metastasis (DM) after curative surgical treatment and assess the multivariate relationships among various risk factors for DM in patients with oral squamous cell carcinoma (OSCC). STUDY DESIGN Case series with chart review. SETTING Tertiary referral center. SUBJECTS AND METHODS The medical records of all patients with OSCC without DM who underwent curative surgery with or without postoperative adjuvant chemoradiation between January 2001 and February 2014 at our institution were retrospectively reviewed. There were a total of 451 patients, including 271 men and 180 women, with a mean age of 65.9 ± 13.5 years. RESULTS Of these patients, 30 (6.7%) developed DM. During the follow-up period, the 5-year overall survival rate was 76.2%. Sites of DM comprised the lungs (80.0%), skin (13.3%), liver (10.0%), bone (6.7%), and brain (3.3%). We found the T classification and N classification as well as the histologic grade to be significant risk factors associated with the development of DM in the univariate analysis only (P = .003), whereas locoregional failure (odds ratio [OR], 4.03), multiple lymph node metastases (more than 4 positive nodes; OR, 3.32) and positive extracapsular spread (OR, 3.06) were identified to be significant risk factors associated with the development of DM in the multivariate analysis. CONCLUSION We demonstrated multivariate relationships among various risk factors for DM in OSCC patients. Clinicians should consider these risk factors and pay special attention to detecting DM early during the postoperative management of OSCC patients with these risk factors.
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Affiliation(s)
- Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makiko Tanakura
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akiko Sakakibara
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsutomu Minamikawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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26
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McBride SM, Busse PM, Clark JR, Wirth LJ, Ancukiewicz M, Chan AW. Long-term survival after distant metastasis in patients with oropharyngeal cancer. Oral Oncol 2013; 50:208-12. [PMID: 24387975 DOI: 10.1016/j.oraloncology.2013.10.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 10/26/2013] [Accepted: 10/30/2013] [Indexed: 01/29/2023]
Abstract
OBJECTIVES For patients with oropharyngeal squamous cell carcinoma (OPSCC), especially for those with HPV-positive tumors, locoregional control is excellent. Distant metastasis, however, remains a substantial problem. The purpose of our study was to evaluate outcomes and predictors of survival after distant metastasis in OPSCC. MATERIALS AND METHODS Between June 2002 and January 2011, 25 OPSCC patients treated with curative intent subsequently developed distant metastasis. The primary end-points evaluated were time-to-distant metastasis and overall survival after development of distant metastasis. Predictors of outcome were evaluated with median regression analysis or Cox regression. Best subset models were chosen to minimize the Bayesian Information Criterion (BIC). A prognostic index for survival after distant failure was created based on the selected model. RESULTS Median time-to-distant metastasis after completion of radiation was 7.9 months (range, 1.6-25.4). Median overall survival from distant metastasis was 18.3 months (95% CI, 14.3-39.8). The overall survival rates at 1- and 2-year after development of distant metastasis were 72.0% (95% confidence interval [CI], 53.4-89.6) and 40.8% (95% CI, 20.6-61.0), respectively. In multivariate analysis, Karnofsky Performance Status score (KPS) > or = 80 (p=0.01, hazard ratio [HR] 0.15, 95% CI, 0.04-0.52) and limited, single-organ disease (p=0.003, HR 0.13, 95% CI 0.03-0.61) predicted for increased survival from distant metastasis. Patients with both limited disease and good KPS formed the most favorable risk group with a 2-year survival of 100%. Two patients with human papilloma virus (HPV)-positive tumors were alive without any evidence of disease at 64.6 and 60.4 months, respectively, after aggressive local treatment of solitary metastasis. CONCLUSION For OPSCC patients with limited, single-organ disease and good KPS, long-term survival can be achieved.
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Affiliation(s)
- Sean M McBride
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, United States
| | - Paul M Busse
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - John R Clark
- Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lori J Wirth
- Department of Medicine, Division of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Marek Ancukiewicz
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Annie W Chan
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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27
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Sumioka S, Sawai NY, Kishino M, Ishihama K, Minami M, Okura M. Risk Factors for Distant Metastasis in Squamous Cell Carcinoma of the Oral Cavity. J Oral Maxillofac Surg 2013; 71:1291-7. [DOI: 10.1016/j.joms.2012.12.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/28/2012] [Accepted: 12/30/2012] [Indexed: 11/29/2022]
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28
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Allen CT, Law JH, Dunn GP, Uppaluri R. Emerging insights into head and neck cancer metastasis. Head Neck 2012; 35:1669-78. [PMID: 23280716 DOI: 10.1002/hed.23202] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2012] [Indexed: 01/09/2023] Open
Abstract
The purpose of this review was to provide biological concepts of head and neck cancer metastasis. To attain this goal, we analyzed peer-reviewed articles related to head and neck cancer metastasis obtained though PubMed and archived articles. Articles related to the biologic principles of head and neck cancer metastasis were reviewed and summarized. As locoregional control has improved for patients with head and neck cancer, rates of distant metastasis have not decreased. As patients live longer, many will die of complications related to the development of disease at sites below the clavicles. Emerging evidence now suggests a more complicated framework of metastatic behavior for head and neck cancer. Here, we review the role of regional lymph nodes in containing advanced head and neck cancer, evidence for active as opposed to passive tumor cell metastasis, and clinical implications these concepts have on both treatment of head and neck cancer and future research.
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Affiliation(s)
- Clint T Allen
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
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29
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Takes RP, Rinaldo A, Silver CE, Haigentz M, Woolgar JA, Triantafyllou A, Mondin V, Paccagnella D, de Bree R, Shaha AR, Hartl DM, Ferlito A. Distant metastases from head and neck squamous cell carcinoma. Part I. Basic aspects. Oral Oncol 2012; 48:775-9. [DOI: 10.1016/j.oraloncology.2012.03.013] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 03/09/2012] [Accepted: 03/17/2012] [Indexed: 11/24/2022]
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30
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Vázquez-Mahía I, Seoane J, Varela-Centelles P, Tomás I, Álvarez García A, López Cedrún JL. Predictors for tumor recurrence after primary definitive surgery for oral cancer. J Oral Maxillofac Surg 2011; 70:1724-32. [PMID: 21940087 DOI: 10.1016/j.joms.2011.06.228] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 06/25/2011] [Accepted: 06/27/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to identify significant predictors for oral squamous cell carcinoma recurrence. PATIENTS AND METHODS This Ambispective cohort study was performed in consecutive metastasis-free patients treated for oral squamous cell carcinoma with curative intent from 1998 through 2003. Variables included gender, age, tumor site, macroscopic pattern of the lesion, coexisting disorders (diabetes, hepatic and heart disorders, other tumors/diseases), degree of differentiation, and pathologic TNM stage. Tumor recurrence was considered the dependent variable (outcome). The distribution of recurrences was assessed with χ(2) test. Survival times were estimated by Kaplan-Meier curves and differences were examined with log-rank test. Multiple Cox regression study was also performed. The significance level chosen for all tests was P < .05. RESULTS One hundred eighteen patients entered the study. Tumor recurrence was 44.9% during the follow-up period (10% local, 29.7% regional, and 5% distant). The mean period that had elapsed before recurrence was 15 months (1.5 to 81.8), with most recurrences (66%) during the first year after treatment (84.9% before 2 years). Multivariate Cox regression analysis indicated the presence of a coexisting disorder (P = .022) as the most relevant prognostic factor for relapse, because patients with associated diseases had a 2.43-fold risk of recurrence. Tumor stage (P = .037), degree of differentiation (P = .042), and macroscopic pattern of the lesion (P = .022) were also identified as prognostic factors for relapse. CONCLUSIONS The risk profile for oral cancer recurrence includes patients younger than 60 years with coexisting diseases whose primary tumor occurred as an ulcerated lesion, and diagnosed at an advanced stage with a poorly differentiated tumor.
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Affiliation(s)
- Inés Vázquez-Mahía
- Service of Maxillofacial Surgery, A Coruña University Hospital, A Coruña, Spain
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31
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Lim YC, Oh SY, Cha YY, Kim SH, Jin X, Kim H. Cancer stem cell traits in squamospheres derived from primary head and neck squamous cell carcinomas. Oral Oncol 2010; 47:83-91. [PMID: 21167769 DOI: 10.1016/j.oraloncology.2010.11.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 11/18/2010] [Accepted: 11/18/2010] [Indexed: 02/08/2023]
Abstract
A subpopulation of cancer stem cells (CSCs), but not the majority of non-tumorigenic cancer cells, in a variety of human malignancies plays a critical role in cancer cell proliferation, invasion, metastasis, and tumor recurrence post-therapies. We report the isolation of sphere-forming cells (squamospheres) from primary head and neck squamous cell carcinomas (HNSCCs), and characterization of their CSC properties. Squamospheres appeared within 2 weeks after seeding as single-dissociated cells obtained from primary HNSCC specimens in serum-free culture conditions. Real-time RT-PCR and immunocytochemistry assays revealed that a number of stem cell markers, including CK5, OCT4, SOX2, and nestin, were up-regulated in HNSCC-driven squamospheres. Fluorescence-activated cell sorting (FACS) analysis showed that squamospheres contain enriched side population cells compared to serum-induced differentiated squamosphere cells. Furthermore, HNSCC-driven squamospheres appeared to be chemoresistant to cisplatin, 5-fluorouracil (FU), paclitaxel and doxetaxel, and showed increased levels of ABCG2, one of the ATP-binding cassette (ABC) transporters. Of particular interest, in sharp contrast to subcutaneous injection of 1×10(6) differentiated squamosphere cells, as few as 100 squamosphere cells were able to give rise to tumors in nude mice. Altogether, we assert that primary HNSCC-driven squamospheres possess CSC properties, and its functional analysis may provide a novel tool for investigating the tumorigenic process of HNSCC.
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Affiliation(s)
- Young Chang Lim
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Republic of Korea
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