1
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Yalamanchali A, Griffith C, Reddy CA, Koyfman SA, Woody NM, Campbell SR, Silver N, Scharpf J, Lorenz RR, Prendes B, Ku JA, Lamarre E, Geiger JL. Evaluating the impact of the degree of extranodal extension on outcomes in locally advanced oral cavity cancer. Head Neck 2024. [PMID: 38660928 DOI: 10.1002/hed.27782] [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: 01/29/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Evaluate whether extranodal extension (ENE) extent impacts outcomes in patients with oral cavity squamous cell carcinoma (OCSCC). METHODS From an institutional database, patients with OCSCC and pathologic ENE who received adjuvant treatment were included. Surgical slides were reviewed to confirm ENE extent. Multivariable Cox regression was used to relate patient/treatment characteristics with disease-free survival (DFS) and overall survival (OS). ENE was analyzed as both a dichotomous and continuous variable. RESULTS A total of 113 patients were identified. Between major (>2 mm) versus minor ENE (≤2 mm), there was no significant difference in DFS (HR 1.18, 95%CI 0.72-1.92, p = 0.51) or OS (HR 1.17, 95%CI 0.70-1.96, p = 0.55). There was no significant association between ENE as a continuous variable and DFS (HR 0.97 per mm, 95%CI 0.87-1.4, p = 0.96) or OS (HR 0.96 per mm, 95%CI 0.83-1.11, p = 0.58). CONCLUSION No significant relationship was seen between ENE extent and DFS or OS in individuals with OCSCC.
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Affiliation(s)
- Anirudh Yalamanchali
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher Griffith
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Natalie Silver
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brandon Prendes
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jamie A Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jessica L Geiger
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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2
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Namavarian A, Gabinet-Equihua A, Deng Y, Khalid S, Ziai H, Deutsch K, Huang J, Gilbert RW, Goldstein DP, Yao CMKL, Irish JC, Enepekides DJ, Higgins KM, Rudzicz F, Eskander A, Xu W, de Almeida JR. Length of Stay Prediction Models for Oral Cancer Surgery: Machine Learning, Statistical and ACS-NSQIP. Laryngoscope 2024. [PMID: 38651539 DOI: 10.1002/lary.31443] [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: 01/27/2024] [Revised: 03/17/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Accurate prediction of hospital length of stay (LOS) following surgical management of oral cavity cancer (OCC) may be associated with improved patient counseling, hospital resource utilization and cost. The objective of this study was to compare the performance of statistical models, a machine learning (ML) model, and The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator in predicting LOS following surgery for OCC. MATERIALS AND METHODS A retrospective multicenter database study was performed at two major academic head and neck cancer centers. Patients with OCC who underwent major free flap reconstructive surgery between January 2008 and June 2019 surgery were selected. Data were pooled and split into training and validation datasets. Statistical and ML models were developed, and performance was evaluated by comparing predicted and actual LOS using correlation coefficient values and percent accuracy. RESULTS Totally 837 patients were selected with mean patient age being 62.5 ± 11.7 [SD] years and 67% being male. The ML model demonstrated the best accuracy (validation correlation 0.48, 4-day accuracy 70%), compared with the statistical models: multivariate analysis (0.45, 67%) and least absolute shrinkage and selection operator (0.42, 70%). All were superior to the ACS-NSQIP calculator's performance (0.23, 59%). CONCLUSION We developed statistical and ML models that predicted LOS following major free flap reconstructive surgery for OCC. Our models demonstrated superior predictive performance to the ACS-NSQIP calculator. The ML model identified several novel predictors of LOS. These models must be validated in other institutions before being used in clinical practice. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Amirpouyan Namavarian
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Yangqing Deng
- Department of Biostatistics, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - Shuja Khalid
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Konrado Deutsch
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jingyue Huang
- Department of Biostatistics, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - Danny J Enepekides
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Kevin M Higgins
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Frank Rudzicz
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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3
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Liu B, Li M, Chen S, Cui Q. A study on the survival prediction for patients with oral cancer in southwest China. Oral Dis 2024; 30:966-976. [PMID: 36630586 DOI: 10.1111/odi.14500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The prognostic value of the variables were evaluated in 418 postoperative oral cancer patients with oral cancer in southwest China between January 2013 and December 2020. Nomogram was developed based on the study, and its predictive performance and clinical utility were evaluated. RESULTS The univariate analysis showed gender, preoperative fibrinogen, preoperative platelet-to-lymphocyte ratio (PLR), and preoperative neutrophil-to-lymphocyte ratio, flap repair of defect, functional neck dissection (FND), tumor differentiation, tumor, node, metastasis stage, lymph node metastasis, the maximum tumor diameter, and postoperative radiotherapy had a significant influence on the survival of patients with oral cancer in southwest China (p < 0.05).The multivariate analysis showed preoperative PLR value, FND, and tumor differentiation had significant influence on the prediction of survival (p < 0.05). However, smoking and drinking are not prognostic risk factors for oral cancer. The discriminant analysis showed 66.3% of the patients could be correctly predicted for postoperative survival, while both the C-index and decision curve analysis (DCA) showed this study may be taken as a reference for predicting the postoperative survival of patients with oral cancer. CONCLUSION Preoperative PLR, FND, and tumor differentiation are independent prognostic factors for patients with oral cancer in southwest China. The results of this study have been visualized using a nomogram and a DCA.
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Affiliation(s)
- Bo Liu
- Department of Oral and Maxillofacial Surgery, Kunming Medical University School and Hospital of Stomatology, Kunming, China
- Yunnan Key Laboratory of Stomatology, Kunming, China
| | - Ming Li
- Department of Oral and Maxillofacial Surgery, Kunming Medical University School and Hospital of Stomatology, Kunming, China
- Yunnan Key Laboratory of Stomatology, Kunming, China
| | - Siyu Chen
- Yunnan Key Laboratory of Stomatology, Kunming, China
- Department of the First Outpatient, Kunming Medical University School and Hospital of Stomatology, Kunming, China
| | - Qingying Cui
- Department of Oral and Maxillofacial Surgery, Kunming Medical University School and Hospital of Stomatology, Kunming, China
- Yunnan Key Laboratory of Stomatology, Kunming, China
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4
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Wang Y, Wang M, Hou L, Xiang F, Zhao X, Qian M. Incidence and risk factors of surgical site infection in patients with head and neck cancer: A meta-analysis. Head Neck 2023; 45:2925-2944. [PMID: 37676108 DOI: 10.1002/hed.27504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/08/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023] Open
Abstract
We systematically review the incidence and risk factors of surgical site infection (SSI) in patients with head and neck cancer. PubMed, Embase, Cochrane Library, and Web of Science databases were searched to obtain studies on the risk factors for SSI in patients with HNC. The retrieval time was from the establishment of the database to February 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Meta-analysis was performed by using Stata 15.1 software. A total of 32 articles including 128 919 patients with head and neck cancer and 2949 cases of SSI were included in this meta-analysis. The incidence rate of SSI in head and neck cancer ranges from 19% to 29%, and the overall infection rate was 24%. Meta-analysis indicated that BMI < 20 kg/m2 (OR, 2.64; 95% CI, 1.74-4.00; I2 , 0%), diabetes (OR, 3.00; 95% CI, 2.12-4.16; I2 , 60.6%), ASA score (OR, 1.51; 95% CI, 1.29-1.77; I2 , 0%), radiotherapy (OR, 2.27; 95% CI, 1.87-2.77; I2 , 44.8%), chemotherapy (OR, 2.36; 95% CI, 1.64-3.40; I2 , 0%), clindamycin antibiotic (OR, 2.99; 95% CI, 1.82-2.93; I2 , 36.5%), deficit repair (OR, 3.76; 95% CI, 1.22-11.59; I2 , 91.4%), neck dissection (OR, 2.13; 95% CI, 1.63-2.79; I2 , 16.4%), blood transfusion (OR, 2.29; 95% CI, 1.52-3.45; I2 , 66.2%), mandibular (OR, 3.17; 95% CI, 1.85-5.42; I2 , 73%), tracheostomy (OR, 2.51; 95% CI, 1.74-3.62; I2 , 86.4%), operation time (OR, 1.42; 95% CI, 1.16-1.74; I2 , 86.4%), ALB (OR, 2.48; 95% CI, 1.95-3.15; I2 , 5.3%) were risk factors of surgical site infection in patients with head and neck cancer (p < 0.05). The results of the sensitivity analysis showed good agreement in all risk factors and the results had stability. The present meta-analysis suggests that BMI < 20 kg/m2 , diabetes, ASA score, radiotherapy, chemotherapy, clindamycin antibiotic, deficit repair, neck dissection, blood transfusion, mandibular, tracheostomy, operation time, and ALB were significant risk factors for SSI.
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Affiliation(s)
- Yu Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Nursing, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyi Wang
- Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Hou
- Department of Nursing, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuping Xiang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Nursing, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaomei Zhao
- Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meizhen Qian
- Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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5
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Mariani P, Russo D, Maisto M, Troiano G, Caponio VCA, Annunziata M, Laino L. Pre-treatment neutrophil-to-lymphocyte ratio is an independent prognostic factor in head and neck squamous cell carcinoma: Meta-analysis and trial sequential analysis. J Oral Pathol Med 2022; 51:39-51. [PMID: 34797592 PMCID: PMC9299721 DOI: 10.1111/jop.13264] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022]
Abstract
Inflammation seems to play a critical role in the development and progression of different cancers. Neutrophil-to-lymphocyte ratio (NLR) is an easily measurable marker of systemic inflammation. The purpose of this systematic review and meta-analysis was to evaluate the prognostic role of the pre-treatment NLR, in terms of overall survival (OS) and disease-free survival (DFS), in patients with primary head and neck squamous cell carcinoma (HNSCC) treated by surgery alone or followed by chemo/radiotherapy. This systematic review was performed according to the guidelines reported in the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Meta-analysis of OS and DFS was performed using the inverse of variance test. Fixed-effect models were used on the basis of the presence of heterogeneity. Risk of bias assessment and trial sequential analysis (TSA) were also performed; the quality of the evidence was evaluated via the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The analysis revealed that a higher value of pre-treatment NLR correlates with a statistically significant decrease of OS (HR, 1.56; 95% CI: [1.35, 1.80]; p < 0.00001) and a lower DFS (HR, 1.64; 95% CI: [1.30, 2.07]; p < 0.0001) in HNSCC patients.
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Affiliation(s)
- Pierluigi Mariani
- Multidisciplinary Department of Medical‐Surgical and Odontostomatological SpecialtiesUniversity of Campania "Luigi Vanvitelli"NaplesItaly
| | - Diana Russo
- Multidisciplinary Department of Medical‐Surgical and Odontostomatological SpecialtiesUniversity of Campania "Luigi Vanvitelli"NaplesItaly
| | - Marco Maisto
- Multidisciplinary Department of Medical‐Surgical and Odontostomatological SpecialtiesUniversity of Campania "Luigi Vanvitelli"NaplesItaly
| | - Giuseppe Troiano
- Department of Clinical and Experimental MedicineUniversity of FoggiaFoggiaItaly
| | | | - Marco Annunziata
- Multidisciplinary Department of Medical‐Surgical and Odontostomatological SpecialtiesUniversity of Campania "Luigi Vanvitelli"NaplesItaly
| | - Luigi Laino
- Multidisciplinary Department of Medical‐Surgical and Odontostomatological SpecialtiesUniversity of Campania "Luigi Vanvitelli"NaplesItaly
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6
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Davies JC, Hugh S, Rich JT, de Almeida JR, Gullane PJ, Orsini M, Eskander A, Monteiro E, Mimica X, McGill M, Cohen MA, Cracchiolo JR, Teaima A, Tam S, Wei D, Goepfert R, Zafereo M, Su J, Xu W, Goldstein DP. Association of Pharyngocutaneous Fistula With Cancer Outcomes in Patients After Laryngectomy: A Multicenter Collaborative Cohort Study. JAMA Otolaryngol Head Neck Surg 2021; 147:1027-1034. [PMID: 34323968 DOI: 10.1001/jamaoto.2021.1545] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Pharyngocutaneous fistula (PCF) results in an inflammatory reaction, but its association with the rate of locoregional and distant control, disease-free survival, and overall survival in laryngeal cancer remains uncertain. Objective To determine if pharyngocutaneous fistula after salvage laryngectomy is associated with locoregional and distant control, disease-free survival, and/or overall survival. Design, Setting, and Participants A multicenter collaborative retrospective cohort study conducted at 5 centers in Canada and the US of 550 patients who underwent salvage laryngectomy for recurrent laryngeal cancer from January 1, 2000, to December 31, 2014. The median follow-up time was 5.7 years (range, 0-18 years). Main Outcomes and Measures Outcomes examined included locoregional and distant control, disease-free survival, and overall survival. Fine and Gray competing risk regression and Cox-proportional hazard regression models were used for outcomes. Competing risks and the Kaplan-Meier methods were used to estimate outcomes at 3 years and 5 years. Results In all, 550 patients (mean [SD] age, 64 [10.4] years; men, 465 [85%]) met inclusion criteria. Pharyngocutaneous fistula occurred in 127 patients (23%). The difference in locoregional control between the group of patients with PCF (75%) and the non-PCF (72%) group was 3% (95% CI, -6% to 12%). The difference in overall survival between the group with PCF (44%) and the non-PCF group (52%) was 8% (95% CI, -2% to 20%). The difference in disease-free survival between PCF and non-PCF groups was 6% (95% CI, -4% to 16%). In the multivariable model, patients with PCF were at a 2-fold higher rate of distant metastases (hazard ratio, 2.00; 95% CI, 1.22 to 3.27). Distant control was reduced in those with PCF, a 13% (95% CI, 3% to 21%) difference in 5-year distant control. Conclusions and Relevance This multicenter retrospective cohort study found that development of PCF after salvage laryngectomy is associated with an increased risk for the development of distant metastases.
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Affiliation(s)
- Joel C Davies
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Hugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jason T Rich
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - John R de Almeida
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Gullane
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mario Orsini
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Head & Neck Cancer Care, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Head & Neck Cancer Care, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Mt Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ximena Mimica
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marlena McGill
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc A Cohen
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Ahmed Teaima
- Department of Head & Neck Surgery, Division of Surgery, MD Anderson Cancer Center, The University of Texas, Houston
| | - Samantha Tam
- Department of Head & Neck Surgery, Division of Surgery, MD Anderson Cancer Center, The University of Texas, Houston
| | - Dongmin Wei
- Department of Head & Neck Surgery, Division of Surgery, MD Anderson Cancer Center, The University of Texas, Houston
| | - Ryan Goepfert
- Department of Head & Neck Surgery, Division of Surgery, MD Anderson Cancer Center, The University of Texas, Houston
| | - Mark Zafereo
- Department of Head & Neck Surgery, Division of Surgery, MD Anderson Cancer Center, The University of Texas, Houston
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David P Goldstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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7
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Stabenau KA, Akakpo KE, Richmon JD, McMullen C, Holcomb AJ, Graboyes EM, Gross J, Pipkorn P, Puram SV, Zenga J. Postoperative wound infections in head and neck surgery: The current state of antiseptic and antibiotic practices. Oral Oncol 2021; 118:105361. [PMID: 34083128 DOI: 10.1016/j.oraloncology.2021.105361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Kaleigh A Stabenau
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kenneth E Akakpo
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jeremy D Richmon
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Caitlin McMullen
- Department of Otolaryngology-Head and Neck Surgery, Moffitt Cancer Center, Tampa, FL, United States
| | - Andrew J Holcomb
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Omaha, NE, United States
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States; Department Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Jennifer Gross
- Department of Otolaryngology-Head and Neck Surgery, Emory School of Medicine, Atlanta, GA, United States
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Sidharth V Puram
- Department of Genetics, Washington University School of Medicine, Saint Louis, MO, United States
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States.
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8
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Lee J, Liu SH, Dai KY, Huang YM, Li CJ, Chen JCH, Leu YS, Liu CJ, Chen YJ. Sarcopenia and Systemic Inflammation Synergistically Impact Survival in Oral Cavity Cancer. Laryngoscope 2020; 131:E1530-E1538. [PMID: 33135827 DOI: 10.1002/lary.29221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Sarcopenia and systemic inflammation can affect survival of advanced-stage oral squamous cell carcinoma (OSCC) patients; however, their reciprocal associations with survival outcomes are yet to be investigated. STUDY DESIGN Retrospective review at a tertiary cancer center. METHODS Patients with stage III-IVB OSCC that underwent surgery and (chemo)radiotherapy at our institution between 2010 and 2015 were reviewed. Skeletal muscle index (SMI) was assessed using computed tomography scans at the C3 vertebra. Sarcopenia was defined at the lowest sex-specific tertile for SMI. Systemic inflammation was estimated using the modified Glasgow prognostic score (mGPS), which ranges from 0 to 2 based on serum C-reactive protein and albumin levels. The predictors of overall survival (OS) were evaluated using Cox regression models. RESULTS A total of 174 patients were included in the study. The cut-off values for sarcopenia were set at SMI <52.4 cm2 /m2 (men) and < 36.2 cm2 /m2 (women) corresponding to the lowest sex-specific tertile. An mGPS 1-2 was independently associated with sarcopenia (odds ratio: 2.05; 95% confidence interval: 1.06-3.97; P = .03). On multivariate analysis for OS, sarcopenia and mGPS 1-2 independently predicted OS (hazard ratio: 2.12; 95% confidence interval: 1.17-3.85; P = .01 and hazard ratio: 7.85; 95% confidence interval: 3.7-16.65; P < .001, respectively). Patients with both sarcopenia and mGPS 1-2 (vs. neither) had worse OS (hazard ratio: 16.80; 95% confidence interval: 6.01-46.99; P < .001). CONCLUSIONS Sarcopenia and systemic inflammation may exert a negative synergistic prognostic impact in advanced-stage OSCC patients. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1530-E1538, 2021.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Shih-Hua Liu
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Kun-Yao Dai
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Ming Huang
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Jung Li
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - John Chun-Hao Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Death Care Service, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Yi-Shing Leu
- Department of Otorhinolaryngology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chung-Ji Liu
- Department of Oral and Maxillofacial Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
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Wu X, Yang R, Yuan Y, Xiong Y, Su T, Jiang C, Jian X, Guo F. Application of a chimeric ALT perforator flap with vastus lateralis muscle mass in the reconstruction of the defects after radical resection of a buccal carcinoma: A retrospective clinical study. J Surg Oncol 2020; 122:632-638. [PMID: 32830325 DOI: 10.1002/jso.25926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/25/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Aggressive resection of buccal cancer simultaneously leaves both oral and lateral facial defects. It is unknown whether a perforator-based chimeric anterolateral thigh (ALT) flap, with a muscular component, is suitable for the reconstruction of these complicated defects. METHODS In this retrospective study, 48 patients with a buccal carcinoma (T2 N0-1 M0), who underwent extensive surgical resection, were enrolled. Twenty-seven cases underwent reconstruction using the classical ALT perforator flap (classical group), and 21 cases used the chimeric ALT perforator flap with vastus lateralis muscle mass (chimeric group). The incidence of wound infection, lower limb extremity function, facial appearance, survival curves, and quality of life were compared between groups. RESULTS The incidence of wound infection or effusion was lower in the chimeric group than in the classical group. The aesthetic result achieved in the chimeric group was better than in the classical group. Meanwhile, there was no significant difference in the function of the donor site between groups. CONCLUSIONS The chimeric ALT perforator flap, with a muscular component, can reconstruct both the oral and lateral face defects accurately. It sustains the profile of the lateral face and decreases the incidence of wound infection.
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Affiliation(s)
- Xiaoshan Wu
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Rong Yang
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yongxiang Yuan
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Yafei Xiong
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tong Su
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Canhua Jiang
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Xinchun Jian
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Feng Guo
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
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Treatment implications of postoperative chemoradiotherapy for squamous cell carcinoma of the oral cavity with minor and major extranodal extension. Oral Oncol 2020; 110:104845. [PMID: 32615441 DOI: 10.1016/j.oraloncology.2020.104845] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate adjuvant chemoradiotherapy (CRT) for patients with oral cavity squamous cell carcinoma (OSCC) with minor or major extranodal extension (ENE). MATERIALS AND METHODS Surgically resected OSCC with pathologically involved lymph node(s) (pN+) between 2006 and 2017. Sections of pN+ were re-reviewed and classified as no, minor (≤2 mm), or major (>2 mm) ENE. Patterns of failure and survival were compared between the groups and stratified by adjuvant treatment. Multivariable (MVA) analysis assessed the value of adjuvant treatment for minor and major ENE. RESULTS Total of 384 patients, 62 had minor and 114 had major ENE. Adjuvant CRT was delivered in 32(15%), 21(34%), and 45(39%) of patients with no, minor and major ENE, respectively. Patients with minor ENE had similar 5-year loco-regional control (LRC) and distant control (DC) but lower disease-free survival (DFS) (38% vs. 51%, p = 0·02) compared to patients with no ENE, while patients with major ENE had marginally lower LRC (59% vs 74%, p = 0·07), lower DC (58% vs 82%,p = 0·005) and DFS (13% vs. 38%, p=·001) compared to those with minor. On MVA, adjuvant chemotherapy was associated with improved DFS for major ENE (adjusted HR = 0·49; 95% CI 0·29-0·85, p = 0·01) but not for minor ENE after adjusting for age, ECOG status, T-, N-category, margin status, and radiotherapy. CONCLUSIONS Adjuvant chemoradiotherapy improves outcomes in patients with major ENE, but the benefit is unclear in patients with minor ENE. Future trials should focus on intensification of treatment for patients with major ENE and alternative adjuvant strategies for patients with minor ENE.
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Lu Z, Yan W, Liang J, Yu M, Liu J, Hao J, Wan Q, Liu J, Luo C, Chen Y. Nomogram Based on Systemic Immune-Inflammation Index to Predict Survival of Tongue Cancer Patients Who Underwent Cervical Dissection. Front Oncol 2020; 10:341. [PMID: 32219070 PMCID: PMC7078378 DOI: 10.3389/fonc.2020.00341] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/27/2020] [Indexed: 12/24/2022] Open
Abstract
Aim: The aim of this study was to evaluate the prognostic significance of the preoperative systemic immune-inflammation index (SII) and to establish a nomogram for prediction of survival of tongue squamous cell carcinoma (TSCC) patients who underwent primary surgery and cervical dissection. Methods: 120 patients diagnosed with TSCC who underwent primary tumor and neck dissection without preoperative treatment were included to develop the nomogram. This model was externally validated in an independent data cohort of 50 TSCC patients. X-tile software was used to identify the optimal cut-off value. Prognostic factors were identified by Univariate and multivariate analyses. A nomogram based on the multivariate analysis results was built to predict the survival rate and calibration curves and concordance index (C-index) were used to determine predictive and discriminatory capacity. Results: The optimal cut-off value was 569×109/L for SII. In the training cohort, a high preoperative SII (>569) was significantly related to tumor size, histological grade, depth of invasion, lymph node density (LND). A Kaplan-Meier survival analysis showed that patients with a lower SII had a significantly better 5-year overall survival (OS) and disease-free survival (DFS) than patients with high SII (80.8% vs. 43.5% and 72.7% vs. 36.2%, respectively, P<0.001). Univariate analyses of training cohort revealed that age, clinical stage, depth of invasion, LND, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and SII were significant prognostic factors for OS. Moreover, the receiver operating characteristics (ROC) curve showed that SII was superior to NLR and PLR for predicting clinical outcomes. However, multivariate analysis found that age, LND, and SII were independent risk factors for OS. The C-index of the nomograms based on independent prognostic factors was 0.716 for OS and 0.723 for DFS. The C-indexes for external validation of OS and DFS were 0.852 and 0.754, respectively. The calibration curves showed good agreement between predicted and actual observations of OS and DFS. Conclusion: SII can serve as a novel independent prognostic factor for OS and DFS of patients with TSCC. The prognostic nomogram based on SII is a reliable model for predicting survival of patients with TSCC after surgery.
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Affiliation(s)
- Zhiyuan Lu
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wangxiang Yan
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jianfeng Liang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China
| | - Mei Yu
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiayu Liu
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiansuo Hao
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Quan Wan
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiameng Liu
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Chongdai Luo
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yiyang Chen
- Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children's Medical Center, Guangzhou, China
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