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Contrera KJ, Huang AT, Shenson JA, Tang C, Roberts D, Myers JN, Weber RS, Lai SY, Williams M, El-Hallal M, Jacob D, Zafereo M. Primary and recurrent regional metastases for lateralized oral cavity squamous cell carcinoma. Surg Oncol 2022; 44:101804. [DOI: 10.1016/j.suronc.2022.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/17/2022] [Accepted: 07/03/2022] [Indexed: 10/16/2022]
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Chegini S, Schilling C, Walgama ES, Yu KM, Thankappan K, Iyer S, Cariati P, Balasubramanian D, Kanatas A, Lai SY, McGurk M. Neck failure following pathologically node-negative neck dissection (pN0) in oral squamous cell carcinoma: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 59:1157-1165. [PMID: 34281738 DOI: 10.1016/j.bjoms.2021.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
Due to the risk of occult cervical metastasis, elective neck dissection (END) is recommended in the management of patients with early oral cavity squamous cell carcinoma (OSCC) and a clinically node-negative (cN0) neck. This paper presents a systematic review and meta-analysis of studies that recorded isolated regional recurrence (RR) in the pathologically node-negative neck dissection (pN0) neck following END in order to quantify the failure rate. Pubmed and Ovid databases were systematically searched for relevant articles published between January 2009 and January 2019. Studies reporting RR following END in patients with OSCC who had no pathological evidence of lymph node metastasis were eligible for inclusion in this meta-analysis. In addition, a selection of large head and neck units were invited to submit unpublished data. Search criteria produced a list of 5448 papers, of which 18 studies met the inclusion criteria. Three institutions contributed unpublished data. This included a total of 4824 patients with median follow-up of 34 months (2.8 years). Eight datasets included patients staged T1-T4 with RR 17.3% (469/2711), 13 datasets included patients staged T1-T2 with RR 7.5% (158/2113). Overall across all 21 studies, isolated neck recurrence was identified in 627 cases giving a RR of 13.0% (627/4824) on meta-analysis. Understanding the therapeutic effectiveness of END provides context for evaluation of clinical management of the cN0 in these patients. A pathologically negative neck does not guarantee against future recurrence.
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Affiliation(s)
- S Chegini
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom.
| | - C Schilling
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom
| | - E S Walgama
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K M Yu
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K Thankappan
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - S Iyer
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - P Cariati
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario de Albacete, Albacete, Spain
| | - D Balasubramanian
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - A Kanatas
- Leeds General Infirmary, Great George St, Leeds LS1 3EX, United Kingdom
| | - S Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M McGurk
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom
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Li B, Wang C, Yuan X, Wang Z, Kim K, Li J, Cheng A, Han Z, Feng Z. Is it necessary to receive radiation for pT3-4N0 oral cancer without other adverse risk features? Oral Dis 2020; 26:1124-1130. [PMID: 32219927 DOI: 10.1111/odi.13336] [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: 12/28/2019] [Revised: 03/05/2020] [Accepted: 03/18/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the necessity of adjuvant radiotherapy for well-differentiated pT3-4aN0M0 OSCC without other negative features histologically. PATIENTS AND METHODS This is a double-center, ambispective cohort study enrolling 250 patients with well-differentiated pT3-4aN0M0 OSCC. RESULTS A total of 250 patients were enrolled in the double-center study, 155(62.0%) men and 95 (38.0%) women, and the mean age was 60.1 ± 11.1 years. T staging was classified as follows: T3 (n = 99, 39.6%) and T4a (n = 151, 60.4%). Kaplan-Meier analysis showed that there was no significant difference in the DSS between patients who received adjuvant radiotherapy (72.2%) and those who did not (77.4%) (p = .615). Specifically, no significant difference was found in the DSS of pT3N0M0 or pT4aN0M0 patients who received adjuvant radiotherapy compared with those who did not (pT3N0M0: 71.9% vs. 75.8%, p = .993; pT4aN0M0: 72.4% vs. 78.5%, p = .491). The Cox proportional hazards regression models showed that no factor was independent prognostic factor for pT3-4aN0M0 patients, or pT3N0M0 subgroup or pT4aN0M0 subgroup in DSS. And no independent prognostic factor was found for the surgery-alone subgroup and adjuvant radiotherapy subgroup. CONCLUSIONS The results showed that adjuvant radiotherapy did not obviously improve the prognosis of pT3-4aN0M0 well-differentiated OSCC without other negative features.
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Affiliation(s)
- Bo Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Chong Wang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Xiaohong Yuan
- Department of Oral Pathology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Zhen Wang
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China
| | - Kyojin Kim
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Jinzhong Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Aoming Cheng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Zhengxue Han
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
| | - Zhien Feng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, P.R. China
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Singh V, Dwivedi SN, Deo SVS. Ordinal logistic regression model describing factors associated with extent of nodal involvement in oral cancer patients and its prospective validation. BMC Med Res Methodol 2020; 20:95. [PMID: 32336269 PMCID: PMC7183690 DOI: 10.1186/s12874-020-00985-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/20/2020] [Indexed: 01/09/2023] Open
Abstract
Background Oral cancer is the most common cancer among Indian men, and has strong tendency of metastatic spread to neck lymph node which strongly influences prognosis especially 5 year survival-rate and also guides the related managements more effectively. Therefore, a reliable and accurate means of preoperative evaluation of extent of nodal involvement becomes crucial. However, earlier researchers have preferred to address mainly its dichotomous form (involved/not-involved) instead of ordinal form while dealing with epidemiology of nodal involvement. As a matter of fact, consideration of ordinal form appropriately may increase not only the efficiency of the developed model but also accuracy in the results and related implications. Hence, to develop a model describing factors associated with ordinal form of nodal involvement was major focus of this study. Methods The data for model building were taken from the Department of Surgical Oncology, Dr.BRA-IRCH, AIIMS, New Delhi, India. All the OSCC patients (duly operated including neck dissection) and confirmed histopathologically from 1995 to 2013 were included. Further, another data of 204 patients collected prospectively from 2014 to 2015 was considered for the validation of the developed model. To assess the factors associated with extent of nodal involvement, as a first attempt in the field of OSCC, stepwise multivariable regression procedure was used and results are presented as odds-ratio and corresponding 95% confidence interval (CI). For appropriate accounting of ordinal form, the ordinal models were assessed and compared. Also, performance of the developed model was validated on a prospectively collected another data. Results Under multivariable proportional odds model, pain at the time of presentation, sub mucous fibrosis, palpable neck node, oral site and degree of differentiation were found to be significantly associated factors with extent of nodal involvement. In addition, tumor size also emerged to be significant under partial-proportional odds model. Conclusions The analytical results under the present study reveal that in case of ordinal form of the outcome, appropriate ordinal regression may be a preferred choice. Present data suggest that, pain, sub mucous fibrosis, palpable neck node, oral site, degree of differentiation and tumor size are the most probable associated factors with extent of nodal involvement.
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Affiliation(s)
- Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - S V S Deo
- Department of Surgical Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India
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MUC1 gene silencing inhibits proliferation, invasion, and migration while promoting apoptosis of oral squamous cell carcinoma cells. Biosci Rep 2019; 39:BSR20182193. [PMID: 31439759 PMCID: PMC6747000 DOI: 10.1042/bsr20182193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/12/2019] [Accepted: 07/29/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study is to investigate the role of RNA interference in the inhibition of MUC1 gene expression in occurrence and metastasis of oral squamous cell carcinoma (OSCC) and its in-depth mechanisms. The OSCC and normal oral mucosa tissues, as well as normal oral epithelial cell line HOK and OSCC cell line SCC-4, Cal-27, TSCCA, Tca8113 were obtained to detect the expression of MUC1. Slug expression in OSCC and normal oral mucosa tissues was also determined. The OSCC cells were grouped to investigate the role of MUC1 gene silencing on proliferation, DNA replication, cell cycle distribution, apoptosis, colony formation ability, epithelial-mesenchymal transition (EMT), invasion, and migration of OSCC cells. We first found higher positive rate of MUC1 and Slug expression in OSCC tissues. Next, it was determined that higher expression of MUC1 was found in OSCC tissues and cells. Furthermore, silencing of MUC1 declined Slug expression, inhibited the proliferation, DNA replication, cell cycle progression, and EMT while inducing apoptosis of OSCC cells. Our study suggests that overexpression of MUC1 is found in OSCC, and MUC1 gene silencing could inhibit the proliferation, invasion, and migration while inducing apoptosis of OSCC cells.
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Chang WC, Chang CF, Li YH, Yang CY, Su RY, Lin CK, Chen YW. A histopathological evaluation and potential prognostic implications of oral squamous cell carcinoma with adverse features. Oral Oncol 2019; 95:65-73. [PMID: 31345396 DOI: 10.1016/j.oraloncology.2019.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/16/2019] [Accepted: 06/07/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study aimed to evaluate the adverse clinicopathologic features of oral squamous cell carcinoma (OSCC), including margin status, depth of invasion, lymphovascular invasion, perineural invasion, and extranodal extension that significantly affect survival outcomes. MATERIALS AND METHODS This retrospective cross-sectional study included 341 patients with OSCC who underwent therapeutic surgical treatment in Taiwan. The Kaplan-Meier method was used to estimate survival outcomes. A multivariable Cox regression model was used to evaluate the associations of various clinicopathologic features with 5-year overall survival (OS) outcomes in patients with pN0 and pN+ tumors. RESULTS Overall, the patients had 5-year OS and progression-free survival rates of 60.0 and 47.9%, respectively. In the pN0 group, the multivariate analysis identified a positive margin (odds ratio [OR] = 16.3, 95% confidence interval [95% CI]: 3.7-72.3; P = 0.001), depth of invasion >5 mm (OR = 2.1, 95% CI: 1.2-3.7; P = 0.012), presence of lymphovascular space invasion (OR = 5.4, 95% CI: 1.3-22.0; P = 0.018), and presence of perineural invasion (OR = 4.3, 95% CI: 1.7-11.1; P = 0.002) as independent and significant prognosticators of OS. In the pN+ group, only the presence of extranodal extension independently predicted OS (OR = 1.7, 95% CI: 1.1-2.7; P = 0.0026). CONCLUSIONS When determining survival prognosis for patients with a pN0 status, we recommended including all adverse features. In contrast, extranodal extension was the most important prognostic factor for patients with a pN+ status.
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Affiliation(s)
- Wei-Chin Chang
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei City, Taiwan, ROC; School of Dentistry, National Defense Medical Center, Taipei City, Taiwan, ROC
| | - Ching-Fen Chang
- Department of Internal Medicine, China Medical University Hospital, Taichung City, Taiwan, ROC
| | - Yu-Hsuan Li
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei City, Taiwan, ROC; School of Dentistry, National Defense Medical Center, Taipei City, Taiwan, ROC
| | - Cheng-Yu Yang
- School of Dentistry, National Defense Medical Center, Taipei City, Taiwan, ROC
| | - Ruei-Yu Su
- Department of Pathology, Division of Clinical Pathology, Tri-Service General Hospital, Taipei City, Taiwan, ROC; Department of Pathology and Laboratory Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC; National Defense Medical Center, Taipei City, Taiwan, ROC
| | - Chih-Kung Lin
- Department of Pathology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei City, Taiwan, ROC
| | - Yuan-Wu Chen
- Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, Taipei City, Taiwan, ROC; School of Dentistry, National Defense Medical Center, Taipei City, Taiwan, ROC.
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Management of the Neck in Oral Squamous Cell Carcinoma: Background, Classification, and Current Philosophy. Oral Maxillofac Surg Clin North Am 2019; 31:69-84. [PMID: 30449527 DOI: 10.1016/j.coms.2018.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nodal metastasis is the single most prognostic determinant in patients with oral squamous cell carcinoma (OSCC). Since its inception more than a century ago, the management of the neck has led to decreased surgical morbidity, with continued preservation of oncologic safety for OSCC. Nodal metastasis is the single most prognostic determinant in patients with OSCC. The decision for the extent of the neck dissection is tailored to tumor-specific characteristics, which dictate the probability and extent of nodal metastasis, including tumor size, location, histopathologic characteristics, and the presence or absence of clinical nodal disease. These factors are tools to aid diagnosticians in their decision making for individual patients.
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Liao CT, Lee LY, Hsueh C, Lin CY, Fan KH, Wang HM, Hsieh CH, Ng SH, Lin CH, Tsao CK, Kang CJ, Fang TJ, Huang SF, Chang KP, Yang LY, Yen TC. Pathological risk factors stratification in pN3b oral cavity squamous cell carcinoma: Focus on the number of positive nodes and extranodal extension. Oral Oncol 2018; 86:188-194. [PMID: 30409299 DOI: 10.1016/j.oraloncology.2018.09.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/16/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE According to the AJCC 2017 Staging Manual, oral cavity squamous cell carcinoma (OCSCC) with pN2 disease (based on the AJCC 2010 criteria) and extra-nodal extension (ENE) should be classified as pN3b. We performed a detailed outcome analyses in this patient subgroup. MATERIAL AND METHODS We retrospectively reviewed the clinical records of consecutive OCSCC patients who underwent radical surgery between 1996 and 2017. Patients with pN3b disease (n = 365) were divided into a pN+ ≥8/ENE ≥5 subgroup (defined by the presence of pN+ ≥8 nodes or ENE ≥5 nodes, n = 77) and a pN+ ≤7/ENE ≤4 subgroup (defined by the presence of pN+ ≤7 nodes and ENE ≤4 nodes, n = 288). Patients with pN0/pN1/pN2 (n = 1192/179/197) disease were included for comparison purposes. RESULTS Patients in the pN+ ≥8/ENE ≥5 subgroup had less favorable 5-year outcomes than those in the pN+ ≤7/ENE ≤4/pN2/pN1/pN0 groups (local control, 64%/79%/86%/83%/88%, p < 0.001; neck control, 55%/75%/80%/86%/93%, p < 0.001; distant metastases, 67%/28%/20%/12%/3%, p < 0.001; disease-free survival, 21%/51%/64%/72%/82%, p < 0.001; disease-specific survival, 25%/55%/71%/82%/92%, p < 0.001; overall survival, 19%/40%/54%/64%/82%, p < 0.001; respectively). Among patients with pN3b disease, multivariable analysis identified the pN+ ≥8/ENE ≥5 subgroup, lower neck (level IV/V) metastases, and depth of invasion ≥25 mm as independent adverse prognostic factors for 5-year distant metastases and survival rates. CONCLUSIONS Patients in the pN+ ≥8/ENE ≥5 subgroup have an unfavorable prognosis and their classification as pN3b is advisable. In contrast, patients in the pN+ ≤7/ENE ≤4 subgroup should be classified as pN3a.
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Affiliation(s)
- Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Yu Lee
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Pathology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chuen Hsueh
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Pathology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chien-Yu Lin
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kang-Hsing Fan
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hung-Ming Wang
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Medical Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Medical Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shu-Hang Ng
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Hung Lin
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chung-Kan Tsao
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Plastic and Reconstructive Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Lan Yan Yang
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Biostatistics and Informatics Unit, Clinical Trial Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tzu-Chen Yen
- Department of Head and Neck Oncology Group, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC; Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
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Feng Z, Xu QS, Wang C, Li B, Li JZ, Mao MH, Li H, Qin LZ, Han Z. Clinicopathological features, management and outcome of patients with poorly-differentiated oral and oropharyngeal squamous cell carcinoma. J Craniomaxillofac Surg 2017; 45:1478-1485. [PMID: 28743604 DOI: 10.1016/j.jcms.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/20/2017] [Accepted: 06/27/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The purpose of this study was to explore the clinicopathological features, risk factors, and management of poorly differentiated oral and oropharyngeal squamous cell carcinoma (OOSCC) patients in the northern Chinese population. METHOD A total of 118 poorly differentiated OOSCC patients from 2236 consecutive cases were retrospectively enrolled in this study. RESULTS Cox regression analysis showed that site (hazard ratio (HR): 2.561, 95% confidence interval (CI): 1.064-6.164, p = 0.036) and lymph node ratio (LNR) (HR: 3.915, 95% CI: 1.797-8.530, p = 0.001) were independent predictive factors for 5-year disease-specific survival (DSS). LNR >0.036, oropharynx site, and advanced clinical stage formulate a model of risk stratification. The patients with a risk score of ≥2 were identified as the high-risk population, and patients with a risk score of 0 or 1 were identified as the low-risk population. Patients in the high-risk population who underwent surgery plus concurrent chemoradiotherapy (CCRT) had markedly better 5-year DSS than those who only underwent surgery (60.0% vs. 20.0%, p = 0.016). However, patients in the low-risk population who underwent surgery alone exhibited a similar 5-year DSS (68.2%) compared with those who received surgery plus radiotherapy (RT) (68.2%) or surgery plus CCRT (50.0%) (p = 0.907). CONCLUSIONS High LNR, oropharynx site and advanced clinical stage constitute a model of risk stratification for patients with poorly differentiated OOSCC. If two or more risk factors are present, surgery and adjuvant chemoradiotherapy can give the best prognosis.
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Affiliation(s)
- Zhien Feng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Qiao Shi Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Chong Wang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Bo Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Jin Zhong Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Ming Hui Mao
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Hua Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Li Zheng Qin
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
| | - Zhengxue Han
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China.
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Influence of the RPL34 gene on the growth and metastasis of oral squamous cell carcinoma cells. Arch Oral Biol 2017; 83:40-46. [PMID: 28697409 DOI: 10.1016/j.archoralbio.2017.06.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) accounts for almost 3% of all malignant tumors all over the world. This study aims to investigate the correlation of RPL34 with the cell growth and metastasis of oral squamous cell carcinoma (OSCC) as well as its clinical prognosis. METHOD Quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry were conducted to determine the RPL34 expression in 85 OSCC tissues and 30 normal oral mucosa tissues. Besides, OSCC cell lines SCC-4 were divided into blank group, negative control (NC) group and RPL34-shRNA group. The qRT-PCR and western blot were performed to measure RPL34 expression, CCK-8 and flow cytometry to observe cell growth and apoptosis, and wound healing and transwell to detect cell migration and invasion. RESULTS The RPL34 gene expression was up-regulated in OSCC tissues and cells. The RPL34 expression was significantly correlated with differentiation degree, TNM stage and lymph node metastasis. Patients with positive RPL34 expression had a poorer prognosis. After inhibition of RPL34 expression, the proliferation of SCC-4 cells was slowed down at 24h, 48h, 72h and 96h respectively, and both the migration distance and the number of invasive cells were reduced, while there was an increase in the ratio of cells at G0/G1 stage and cell apoptosis. CONCLUSION The RPL34 gene was highly expressed in OSCC, while silencing RPL34 could block cell proliferation and metastasis, but promote cell apoptosis, suggesting the RPL34 gene to be a new promising clinical target for OSCC therapy.
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Jin X, Liu D, Zhao X, Zhou Y, Jiang L, Li J, Zeng X, Chen Q. Analysis of clinicopathological characteristics associated with the outcome of oral squamous cell carcinoma and the establishment of tissue microarrays. Oncol Lett 2016; 12:3175-3182. [PMID: 27899978 PMCID: PMC5103915 DOI: 10.3892/ol.2016.5120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/12/2016] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to evaluate clinicopathological risk factors associated with the fatal outcome of oral squamous cell carcinoma (OSCC) in a large cohort of Chinese patients, and to construct tissue microarrays (TMAs) using this cohort. Univariate and multiple logistic regression analyses were performed to evaluate the predictors of poor prognosis in a cohort of 232 patients with OSCC, after which the patient tumor tissues were used to construct TMAs. Univariate logistic regression analysis indicated that a poor outcome of OSCC was associated with the male gender, a history of smoking, the tumor-node-metastasis stage and lymph node metastasis. Multiple logistic regression analysis demonstrated that an increased risk of mortality in patients with OSCC was significantly and independently associated with lymph node metastasis (odds ratio, 3.421; 95% confidence interval, 1.609-7.273). Therefore, the results of the present study suggested that lymph node metastasis is an independent risk factor associated with a poor prognosis of OSCC patients. TMAs of OSCC were successfully constructed, and are the first TMAs to be reported in mainland Chinese patients.
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Affiliation(s)
- Xin Jin
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China; College of Stomatology, Chongqing Medical University, Chongqing 400016, P.R. China; Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, P.R. China
| | - Dongjuan Liu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xin Zhao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yu Zhou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Lu Jiang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jing Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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12
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Chang CF, Kuo YL, Pu C, Chou YJ. Neck dissection and stroke in patients with oral cavity cancer: A population-based cohort study. Head Neck 2016; 39:63-70. [DOI: 10.1002/hed.24535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chia-Fan Chang
- Department of Otolaryngology, Head and Neck Surgery; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine, School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Hospital and Health Care Management, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Yen-Ling Kuo
- Department of Otolaryngology; National Yang-Ming University Hospital; Yilan County Taiwan
- Faculty of Medicine, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Christy Pu
- Institute of Public Health, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine; National Yang-Ming University; Taipei Taiwan
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13
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Gupta K, Panda NK, Bakshi J, Das A. To evaluate disparity between clinical and pathological tumor-node-metastasis staging in oral cavity squamous cell carcinoma patients and its impact on overall survival: An institutional study. South Asian J Cancer 2016; 4:183-5. [PMID: 26981511 PMCID: PMC4772397 DOI: 10.4103/2278-330x.175957] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Accurate clinical staging is important for patient counseling, treatment planning, prognostication, and rational design of clinical trials. In head and neck squamous cell carcinoma, discrepancy between clinical and pathological staging has been reported. Objective: To evaluate any disparity between clinical and pathological tumor-node-metastasis (TNM) staging in oral cavity squamous cell carcinoma (OCSCC) patients and any impact of the same on survival. Materials and Methods: Retrospective chart review from year 2007 to 2013, at a tertiary care center. Statistical Analysis: All survival analyses were performed using SPSS for Windows version 15 (Chicago, IL, USA). Disease-free survival curves were generated using Kaplan–Meier algorithm. Results: One hundred and twenty-seven patients with OCSCC were analyzed. Seventy-nine (62.2%) were males and 48 (37.8%) females with a mean age at presentation 43.6 years (29–79 years). The highest congruence between clinical and pathological T-staging seen for clinical stage T1 and T4 at 76.9% and 73.4% with pathological T-stage. Similarly, the highest congruence between clinical and pathological N-stage seen for clinical N0 and N3 at 86.4% and 91.7% with pathological N-stage. Of clinically early stage patients, 67.5% remained early stage, and 32.5% were upstaged to advanced stage following pathological analysis. Of the clinically advanced stage patients, 75% remained advanced, and 25% were pathologically downstaged. This staging discrepancy did not significantly alter the survival. Conclusion: Some disparity exists in clinical and pathological TNM staging of OCSCC, which could affect treatment planning and survival of patients. Hence, more unified and even system of staging for the disease is required for proper decision-making.
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Affiliation(s)
- Karan Gupta
- Department of Otolaryngology and Head-Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh K Panda
- Department of Otolaryngology and Head-Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaimanti Bakshi
- Department of Otolaryngology and Head-Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Farnedi A, Rossi S, Bertani N, Gulli M, Silini EM, Mucignat MT, Poli T, Sesenna E, Lanfranco D, Montebugnoli L, Leonardi E, Marchetti C, Cocchi R, Ambrosini-Spaltro A, Foschini MP, Perris R. Proteoglycan-based diversification of disease outcome in head and neck cancer patients identifies NG2/CSPG4 and syndecan-2 as unique relapse and overall survival predicting factors. BMC Cancer 2015; 15:352. [PMID: 25935541 PMCID: PMC4429505 DOI: 10.1186/s12885-015-1336-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/22/2015] [Indexed: 01/07/2023] Open
Abstract
Background Tumour relapse is recognized to be the prime fatal burden in patients affected by head and neck squamous cell carcinoma (HNSCC), but no discrete molecular trait has yet been identified to make reliable early predictions of tumour recurrence. Expression of cell surface proteoglycans (PGs) is frequently altered in carcinomas and several of them are gradually emerging as key prognostic factors. Methods A PG expression analysis at both mRNA and protein level, was pursued on primary lesions derived from 173 HNSCC patients from whom full clinical history and 2 years post-surgical follow-up was accessible. Gene and protein expression data were correlated with clinical traits and previously proposed tumour relapse markers to stratify high-risk patient subgroups. Results HNSCC lesions were indeed found to exhibit a widely aberrant PG expression pattern characterized by a variable expression of all PGs and a characteristic de novo transcription/translation of GPC2, GPC5 and NG2/CSPG4 respectively in 36%, 72% and 71% on 119 cases. Importantly, expression of NG2/CSPG4, on neoplastic cells and in the intralesional stroma (Hazard Ratio [HR], 6.76, p = 0.017) was strongly associated with loco-regional relapse, whereas stromal enrichment of SDC2 (HR, 7.652, p = 0.007) was independently tied to lymphnodal infiltration and disease-related death. Conversely, down-regulated SDC1 transcript (HR, 0.232, p = 0.013) uniquely correlated with formation of distant metastases. Altered expression of PGs significantly correlated with the above disease outcomes when either considered alone or in association with well-established predictors of poor prognosis (i.e. T classification, previous occurrence of precancerous lesions and lymphnodal metastasis). Combined alteration of all three PGs was found to be a reliable predictor of shorter survival. Conclusions An unprecedented PG-based prognostic portrait is unveiled that incisively diversifies disease course in HNSCC patients beyond the currently known clinical and molecular biomarkers. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1336-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Farnedi
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology, University of Bologna, Bellaria Hospital, Bologna, Italy.
| | - Silvia Rossi
- COMT - Centre for Molecular Translational Oncology & Department of Life Sciences, University of Parma, Parma, Italy.
| | - Nicoletta Bertani
- COMT - Centre for Molecular Translational Oncology & Department of Life Sciences, University of Parma, Parma, Italy.
| | - Mariolina Gulli
- Department of Life Sciences, Division of Genetics and Environmental Biotechnology, University of Parma, Parma, Italy.
| | - Enrico Maria Silini
- COMT - Centre for Molecular Translational Oncology & Department of Life Sciences, University of Parma, Parma, Italy. .,Department of Pathology and Laboratory Medicine, University of Parma, Parma, Italy.
| | - Maria Teresa Mucignat
- S.O.C. of Experimental Oncology 2, The National Tumour Institute Aviano - CRO-IRCCS, Aviano, Pordenone, Italy.
| | - Tito Poli
- Maxillofacial Surgery Section, Head and Neck Department, University of Parma, Parma, Italy.
| | - Enrico Sesenna
- Maxillofacial Surgery Section, Head and Neck Department, University of Parma, Parma, Italy.
| | - Davide Lanfranco
- Maxillofacial Surgery Section, Head and Neck Department, University of Parma, Parma, Italy.
| | - Lucio Montebugnoli
- Unit of Maxillo-Facial Surgery, Department of Oral Sciences, University of Bologna, Bellaria Hospital, Bologna, Italy.
| | - Elisa Leonardi
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology, University of Bologna, Bellaria Hospital, Bologna, Italy.
| | - Claudio Marchetti
- Department of Biomedical and Neuromotor Sciences, Unit of Maxillo-Facial Surgery, University of Bologna, S. Orsola Hospital, Bologna, Italy.
| | - Renato Cocchi
- Unit of Maxillo-facial Surgery at Bellaria Hospital, Bologna, Italy. .,Unit of Maxillo-facial Surgery, "Casa Sollievo della Sofferenza", San Giovanni in Rotondo, Italy.
| | - Andrea Ambrosini-Spaltro
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology, University of Bologna, Bellaria Hospital, Bologna, Italy.
| | - Maria Pia Foschini
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology, University of Bologna, Bellaria Hospital, Bologna, Italy.
| | - Roberto Perris
- COMT - Centre for Molecular Translational Oncology & Department of Life Sciences, University of Parma, Parma, Italy. .,S.O.C. of Experimental Oncology 2, The National Tumour Institute Aviano - CRO-IRCCS, Aviano, Pordenone, Italy.
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15
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Karino M, Nakatani E, Hideshima K, Nariai Y, Tsunematsu K, Ohira K, Kanno T, Asahina I, Kagimura T, Sekine J. Applicability of preoperative nuclear morphometry to evaluating risk for cervical lymph node metastasis in oral squamous cell carcinoma. PLoS One 2014; 9:e116452. [PMID: 25549090 PMCID: PMC4280216 DOI: 10.1371/journal.pone.0116452] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/08/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We previously reported the utility of preoperative nuclear morphometry for evaluating risk for cervical lymph node metastases in tongue squamous cell carcinoma. The risk for lymph node metastasis in oral squamous cell carcinoma, however, is known to differ depending on the anatomical site of the primary tumor, such as the tongue, gingiva, mouth floor, and buccal mucosa. In this study, we evaluated the applicability of this morphometric technique to evaluating the risk for cervical lymph node metastasis in oral squamous cell carcinoma. METHODS A digital image system was used to measure the mean nuclear area, mean nuclear perimeter, nuclear circular rate, ratio of nuclear length to width (aspect ratio), and nuclear area coefficient of variation (NACV). Relationships between these parameters and nodal status were evaluated by t-test and logistic regression analysis. RESULTS Eighty-eight cases of squamous cell carcinoma (52 of the tongue, 25 of the gingiva, 4 of the buccal mucosa, and 7 of the mouth floor) were included: 46 with positive node classification and 42 with negative node classification. Nuclear area and perimeter were significantly larger in node-positive cases than in node-negative cases; however, there were no significant differences in circular rate, aspect ratio, or NACV. We derived two risk models based on the results of multivariate analysis: Model 1, which identified age and mean nuclear area and Model 2, which identified age and mean nuclear perimeter. It should be noted that primary tumor site was not associated the pN-positive status. There were no significant differences in pathological nodal status by aspect ratio, NACV, or primary tumor site. CONCLUSION Our method of preoperative nuclear morphometry may contribute valuable information to evaluations of the risk for lymph node metastasis in oral squamous cell carcinoma.
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Affiliation(s)
- Masaaki Karino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Eiji Nakatani
- Translational Research Informatics Center, Kobe, Japan
| | - Katsumi Hideshima
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yoshiki Nariai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kohji Tsunematsu
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Koichiro Ohira
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Izumi Asahina
- Department of Regenerative Oral Surgery, Nagasaki University Graduate School of Medical Science, Nagasaki, Japan
| | | | - Joji Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
- * E-mail:
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16
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Chen MM, Roman SA, Sosa JA, Judson BL. Predictors of survival in carcinoma ex pleomorphic adenoma. Head Neck 2014; 36:1324-8. [DOI: 10.1002/hed.23453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/07/2013] [Accepted: 08/12/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Michelle M. Chen
- Department of Surgery; Yale University School of Medicine; New Haven Connecticut
| | - Sanziana A. Roman
- Department of Surgery; Duke University School of Medicine; Durham North Carolina
| | - Julie A. Sosa
- Department of Surgery; Duke University School of Medicine; Durham North Carolina
| | - Benjamin L. Judson
- Department of Surgery; Yale University School of Medicine; New Haven Connecticut
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17
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Zhang H, Dziegielewski PT, Biron VL, Szudek J, Al-Qahatani KH, O’Connell DA, Harris JR, Seikaly H. Survival outcomes of patients with advanced oral cavity squamous cell carcinoma treated with multimodal therapy: a multi-institutional analysis. J Otolaryngol Head Neck Surg 2013; 42:30. [PMID: 23672952 PMCID: PMC3651227 DOI: 10.1186/1916-0216-42-30] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/22/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The oral cavity is the most common site for head and neck squamous cell carcinoma. Treatment of advanced stage oral cavity squamous cell carcinoma (OCSCC) has classically involved surgical resection with postoperative adjuvant radiotherapy (S-RT).Despite this aggressive dual modality therapy, the disease outcomes have remained poor. The treatment options expanded in 2004 when two international trials showed the addition of postoperative chemotherapy to radiation improved outcomes. These trials were, however not oral cavity site specific. OBJECTIVE To assess survival outcomes of advanced OCSCC treated by differing modalities. The primary goal was to determine if the addition of postoperative chemotherapy (S-CRT) improves survival compared to other treatment regimens. METHODS Demographic, pathologic, treatment, and survival data was obtained from patients diagnosed with OCSCC from 1998-2010 in Alberta, Canada. 222 patients were included in the final analysis from 895 OCSCC patients. Actuarial overall, disease-specific, disease-free, and metastasis-free survivals were estimated with Kaplan-Meier and Cox regression analyses. Patients were grouped by treatment. RESULTS Patients receiving S-CRT had improved overall, disease-specific, disease-free, and metastasis-free survival compared to S-RT, CRT or RT(p < 0.05). Two and five year estimated overall survival was significantly higher in the S-CRT group at 77 and 58% (p < 0.05), versus S-RT with 55 and 40% rates(p < 0.05). Results were similar for disease-specific, disease-free, and metastasis free survival with S-CRT being favoured. Patients with extracapsular spread (ECS) treated with S-CRT versus S-RT had 55% survival advantage at 5 years (p < 0.05). CONCLUSION This study shows that adding adjuvant chemotherapy to S-RT improves survival outcomes in advanced OCSCC, especially in patients with ECS.
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MESH Headings
- Adolescent
- Adult
- Aged
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Squamous Cell/therapy
- Chemotherapy, Adjuvant
- Comorbidity
- Disease-Free Survival
- Female
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/epidemiology
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Head and Neck Neoplasms/therapy
- Humans
- Male
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/epidemiology
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Squamous Cell Carcinoma of Head and Neck
- Young Adult
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Affiliation(s)
- Han Zhang
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Peter T Dziegielewski
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vince L Biron
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jacek Szudek
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Khaled H Al-Qahatani
- Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Daniel A O’Connell
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey R Harris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
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18
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Biron VL, O'Connell DA, Seikaly H. The impact of clinical versus pathological staging in oral cavity carcinoma--a multi-institutional analysis of survival. J Otolaryngol Head Neck Surg 2013; 42:28. [PMID: 23663449 PMCID: PMC3651235 DOI: 10.1186/1916-0216-42-28] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 04/01/2013] [Indexed: 11/17/2022] Open
Abstract
Objectives To evaluate any disparity in clinical versus pathological TNM staging in oral cavity squamous cell carcinoma (OCSCC) patients and any impact of this on survival. Design Demographic, survival, staging, and pathologic data on all patients undergoing surgical treatment for OCSCC in Alberta between 1998 and 2006 was collected. Clinical and pathological TNM staging data were compared. Patients were stratified as pathologically downstaged, upstaged or unchanged. Setting Tertiary care centers in Alberta, Canada. Main outcome measures Survival differences between groups were analyzed using Kaplan-Meier and Cox regression models. Results Patients with clinically early stage tumors were pathologically upstaged in 21.9% of cases and unchanged in 78.1% of cases. Patients with clinically advanced stage tumors were pathologically downstaged in 7.9% of cases and unchanged in 92.1% of cases. Univariate and multivariate estimates of disease-specific survival showed no statistically significant differences in survival when patients were either upstaged or downstaged. Conclusions Some disparity exists in clinical versus pathological staging in OCSCC, however, this does not have any significant impact on disease specific survival.
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Affiliation(s)
- Vincent L Biron
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, University of Alberta Hospital, Edmonton, AB, 1E4,33 WMC, , Canada.
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Shibuya Y, Hasegawa T, Akashi M, Shigeta T, Minamikawa T, Komori T. Oral Squamous Cell Carcinoma With Multiple Neck Metastases—Cases With More Than Ten Pathologically Positive Lymph Nodes in the Unilateral Side. J Oral Maxillofac Surg 2013; 71:793-7. [DOI: 10.1016/j.joms.2012.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/02/2012] [Accepted: 10/02/2012] [Indexed: 11/26/2022]
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20
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Vincent N, Dassonville O, Chamorey E, Poissonnet G, Pierre CS, Nao EEM, Peyrade F, Benezery K, Viel D, Sudaka A, Marcy PY, Vallicioni J, Demard F, Santini J, Bozec A. Clinical and histological prognostic factors in locally advanced oral cavity cancers treated with primary surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:291-6. [PMID: 23149218 DOI: 10.1016/j.anorl.2012.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 01/05/2012] [Accepted: 01/17/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The primary objective of this study was to determine the clinical and pathological prognostic factors in locally advanced oral cavity cancers treated by primary surgery. METHODS All patients treated by primary surgery with free-flap reconstruction for locally advanced oral cavity squamous cell carcinoma in our institution between 2000 and 2010 were included in this retrospective study. Overall, cause-specific and locoregional disease-free survivals were determined by Kaplan-Meier analyses. Clinical and histological prognostic factors were assessed by univariate (Log Rank tests) and multivariate (Cox models) analyses. RESULTS A total of 149 patients (102 men and 47 women; mean age=61.3±12.1 years) were included in the study. Five-year overall, cause-specific and locoregional disease-free survivals were 55%, 68% and 71%, respectively. Age, comorbidity and tumour size (histological evaluation) were significantly correlated with overall survival (P<0.05). Age, tumour size, bone invasion and surgical margins were significantly correlated with locoregional disease-free survival (P<0.05). CONCLUSION The main prognostic factors identified in this study were clinical (age and comorbidity) and histological (pathological tumour size, bone invasion and surgical margins).
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Affiliation(s)
- N Vincent
- Département de chirurgie, institut universitaire de la face et du cou, centre Antoine-Lacassagne, 31, avenue de Valombrose, 06107 Nice, France
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