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Poissonnet V, Segier B, Lopez R, Siegfried A, Dupret-Bories A, Sarini J, Poulet V, Delanoë F, Vergez S, Chabrillac E. Prognostic implications of mucosal and deep margin distances according to T-status in oral tongue squamous cell carcinoma: A single-center retrospective study. Head Neck 2024. [PMID: 38884458 DOI: 10.1002/hed.27844] [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: 05/01/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVE To elucidate the prognostic implications of mucosal and deep margin distances in oral tongue squamous cell carcinoma (OTSCC), and to assess a different margin cut-off value in T1-T2 versus T3-T4 tumors. METHODS This single-center retrospective study included 223 patients who received surgery for a primary OTSCC between January 2017 and December 2021. RESULTS Multivariable analysis showed that deep margin distance ≥3 mm in T1-T2 tumors and ≥5 mm in T3-T4 tumors was significantly associated with better RFS and OS. Mucosal and deep margin distances were globally clinically useful for 2-year RFS prediction of T1-T2 tumors, for which deep margins seemed to have more clinical utility than mucosal margins. The influence of margin distances on 2-year RFS seemed greater for T1-T2 tumors than T3-T4 tumors. CONCLUSION Mucosal and deep margin distances were associated with OS and RFS in OTSCC. Shorter deep margin distances may be aimed for in T1-T2 versus T3-T4 tumors.
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Affiliation(s)
- Valentine Poissonnet
- Department of Surgery, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
- Department of Ear, Nose & Throat Surgery, Toulouse University Hospital - Larrey Hospital, Toulouse, France
| | - Bertille Segier
- Department of Biostatistics, Claudius Regaud Institute, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
| | - Raphaël Lopez
- Department of Maxillofacial Surgery, Toulouse University Hospital - Pierre Paul Riquet Hospital, Toulouse, France
| | - Aurore Siegfried
- Department of Pathology, University Cancer Institute Oncopole and Toulouse University Hospital, Toulouse, France
| | - Agnès Dupret-Bories
- Department of Surgery, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
- Department of Ear, Nose & Throat Surgery, Toulouse University Hospital - Larrey Hospital, Toulouse, France
| | - Jérôme Sarini
- Department of Surgery, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
| | - Vinciane Poulet
- Department of Maxillofacial Surgery, Toulouse University Hospital - Pierre Paul Riquet Hospital, Toulouse, France
| | - Franck Delanoë
- Department of Maxillofacial Surgery, Toulouse University Hospital - Pierre Paul Riquet Hospital, Toulouse, France
| | - Sébastien Vergez
- Department of Surgery, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
- Department of Ear, Nose & Throat Surgery, Toulouse University Hospital - Larrey Hospital, Toulouse, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute of Toulouse - Oncopole, Toulouse, France
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Chen Y, Zhong NN, Cao LM, Liu B, Bu LL. Surgical margins in head and neck squamous cell carcinoma: A narrative review. Int J Surg 2024; 110:3680-3700. [PMID: 38935830 PMCID: PMC11175762 DOI: 10.1097/js9.0000000000001306] [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: 12/27/2023] [Accepted: 02/26/2024] [Indexed: 06/29/2024]
Abstract
Head and neck squamous cell carcinoma (HNSCC), a prevalent and frequently recurring malignancy, often necessitates surgical intervention. The surgical margin (SM) plays a pivotal role in determining the postoperative treatment strategy and prognostic evaluation of HNSCC. Nonetheless, the process of clinical appraisal and assessment of the SMs remains a complex and indeterminate endeavor, thereby leading to potential difficulties for surgeons in defining the extent of resection. In this regard, we undertake a comprehensive review of the suggested surgical distance in varying circumstances, diverse methods of margin evaluation, and the delicate balance that must be maintained between tissue resection and preservation in head and neck surgical procedures. This review is intended to provide surgeons with pragmatic guidance in selecting the most suitable resection techniques, and in improving patients' quality of life by achieving optimal functional and aesthetic restoration.
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Affiliation(s)
- Yang Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
- Department of Oral & Maxillofacial – Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, People’s Republic of China
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
- Department of Oral & Maxillofacial – Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, People’s Republic of China
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3
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Hung CY, Lee TL, Chang CW, Wang CP, Lin MC, Lou PJ, Chen TC. Margin to depth of invasion ratio as an indicator for stratifying close margins in early-stage oral squamous cell carcinoma. Oral Oncol 2024; 151:106726. [PMID: 38377691 DOI: 10.1016/j.oraloncology.2024.106726] [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: 01/07/2024] [Revised: 02/01/2024] [Accepted: 02/16/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES In early-stage oral squamous cell carcinoma (OSCC) patients, whether the margin-to-depth-of-invasion ratio (MDR) can assist in stratifying the prognosis remains unclear. METHODS Patients diagnosed with early stage OSCC at National Taiwan University Hospital between January 2007 and December 2021 were reviewed. Patients with margin > 1 mm were classified into two groups: MDR < 0.5 and MDR ≥ 0.5. RESULTS We analyzed 911 pT1-2N0M0 OSCC patients, 723 (79.36 %) with MDR ≥ 0.5 and 188 (20.64 %) with MDR < 0.5. Patients in the MDR < 0.5 group displayed a significantly higher local recurrence rate (odds ratio 2.81, p = 0.002) compared with MDR ≥ 0.5 group. The 5-year disease-free survival were 80.8 % for clear margin, 76.3 % for close margin (MDR ≥ 0.5), and 65.2 % for close margin (MDR < 0.5). The overall survival displayed a similar pattern, with 5-year rates of 88.3 % for clear margin, 86.8 % for close margin (MDR ≥ 0.5), and 75.0 % for close margin (MDR < 0.5). There were no significant overall survival differences between the two MDR ≥ 0.5 groups, but both were significantly superior to patients with MDR < 0.5 (p = 0.001; p = 0.01). After multivariant cox analysis, MDR < 0.5 was a significant risk factor for disease-free survival (p < 0.001). CONCLUSION For early stage OSCC patients without positive margin (≦1mm), the survival outcome between MDR ≥ 0.5 group and MDR < 0.5 group was significantly different. The MDR < 0.5 group had significantly higher risk of local recurrence that may warrant adjuvant treatment.
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Affiliation(s)
- Chun-Yang Hung
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tung-Lin Lee
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Wei Chang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mei-Chun Lin
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tseng-Cheng Chen
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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de Boer J, Barnett R, Cardin A, Cimoli M, Davies L, Delany C, Dixon BJ, Evans SM, Findlay MW, Fox C, Ftanou M, Hart CD, Howard M, Iseli TA, Jackson A, Kranz S, Le BH, Lekgabe E, Lennox R, McLean LS, Neeson PJ, Ng SP, O’Reilly LA, Ramakrishnan A, Rowe D, Service C, Singh A, Thai AA, Tiong A, Yap T, Wiesenfeld D. Optimising Patient Outcomes in Tongue Cancer: A Multidisciplinary Approach. Cancers (Basel) 2024; 16:1277. [PMID: 38610956 PMCID: PMC11010906 DOI: 10.3390/cancers16071277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
A multidisciplinary approach to the management of tongue cancer is vital for achieving optimal patient outcomes. Nursing and allied health professionals play essential roles within the team. We developed symposia comprising a series of online lectures offering a detailed perspective on the role each discipline and consumer perspective has in the management of patients with tongue cancer. The topics, including epidemiology and prevention, diagnosis, treatment planning, surgery, adjuvant care, and the management of recurrent or metastatic disease, were thoroughly examined. The symposia highlighted the significance of fostering collaboration and continuous learning through a multidisciplinary approach. This initiative should be relevant to healthcare professionals, researchers, and policymakers striving to enhance patient outcomes in tongue cancer care through innovative collaboration.
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Affiliation(s)
| | - Rebecca Barnett
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
| | - Anthony Cardin
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Michelle Cimoli
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Lauren Davies
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Clare Delany
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Benjamin J. Dixon
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
- Department of Surgery, University of Melbourne, Melbourne 3010, Australia
| | - Sue M. Evans
- Victorian Cancer Registry, Cancer Council Victoria School of Public Health and Preventive Medicine, Monash University, Melbourne 3002, Australia;
| | - Michael W. Findlay
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3010, Australia;
| | - Carly Fox
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Christopher D. Hart
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
| | - Megan Howard
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Tim A. Iseli
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
- Department of Surgery, University of Melbourne, Melbourne 3010, Australia
| | - Andrea Jackson
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
| | - Sevastjan Kranz
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Brian H. Le
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Ernest Lekgabe
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Rachel Lennox
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Luke S. McLean
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Paul J. Neeson
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3010, Australia;
| | - Sweet Ping Ng
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Lorraine A. O’Reilly
- The Walter and Eliza Hall of Medical Research (WEHI), Melbourne 3052, Australia;
| | - Anand Ramakrishnan
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - David Rowe
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Carrie Service
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Ankur Singh
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne 3010, Australia;
| | - Alesha A. Thai
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Albert Tiong
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Tami Yap
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
- Melbourne Dental School, University of Melbourne, Melbourne 3010, Australia
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Wang W, Wang Y, Zeng W, Xie X, Li C, Zhou Q, Shen L. Prognostic factors in surgically treated tongue squamous cell carcinoma in stage T1-2N0-1M0: A retrospective analysis. Cancer Med 2024; 13:e7016. [PMID: 38400675 PMCID: PMC10891452 DOI: 10.1002/cam4.7016] [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: 08/22/2023] [Revised: 11/20/2023] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE The study aimed to retrospectively identify the prognostic factors of surgically treated primary tongue squamous cell carcinoma (TSCC) cases and assess the benefits of surgical neck lymph node dissection (LND) in early-stage cancer. METHODS Patients with primary TSCC with pT1-2N0-1M0 stage without distant metastasis who were treated with surgery during 2014-2016 at Xiangya Hospital, Central South University were included. Univariate and multivariate Cox models were constructed to explore prognostic factors of overall survival (OS), disease-free survival (DFS), and local recurrence-free survival (LRFS). Sub-group analysis was used to assess the effect of adjuvant therapy and the prognostic value of LND for the early-stage patients. RESULTS In total, 440 patients met the inclusion criteria. During the follow-up period, the 5-year OS, DFS, were 84.4% and 70.0%, respectively. Univariate analysis showed that TNM stage, lymphovascular invasion (LVI), and/or perineural invasion (PNI), pathological differentiation, etc. were significant predictors of OS and DFS. Multivariate analysis showed that TNM stage and the degree of pathological differentiation were independent prognostic factors for all outcomes. Besides, the number of cervical LND could independently predict both DFS and LRFS while LVI/PNI were associated with DFS. And high-quality neck LND (≥30) significantly improved DFS and LRFS for patients of pT1cN0M0 or stage I as compared to those without LND. CONCLUSIONS TNM stage and pathological differentiation were crucial prognostic factors for postoperative patients with TSCC. Notably, high-quality cervical LND was beneficial for the improvement of DFS and LRFS for patients of pT1cN0M0 or stage I.
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Affiliation(s)
- Wenxi Wang
- Department of Oncology, Xiangya HospitalCentral South UniversityChangshaHunan ProvinceChina
| | - Yuxiang Wang
- Department of Radiation OncologyFourth Hospital of Hebei Medical UniversityShijiazhuangHebei ProvinceChina
| | - Wenhui Zeng
- Department of Oncology, Xiangya HospitalCentral South UniversityChangshaHunan ProvinceChina
| | - Xubin Xie
- Department of Oncology, Xiangya HospitalCentral South UniversityChangshaHunan ProvinceChina
| | - Chen Li
- Department of Oncology, Xiangya HospitalCentral South UniversityChangshaHunan ProvinceChina
| | - Qin Zhou
- Department of Oncology, Xiangya HospitalCentral South UniversityChangshaHunan ProvinceChina
| | - Liangfang Shen
- Department of Oncology, Xiangya HospitalCentral South UniversityChangshaHunan ProvinceChina
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Spence RN, Efthymiou V, Goss D, Varvares MA. Margin distance in oral tongue cancer surgery: A systematic review of survival and recurrence outcomes. Oral Oncol 2023; 147:106609. [PMID: 37948894 DOI: 10.1016/j.oraloncology.2023.106609] [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: 08/24/2023] [Revised: 10/14/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
The status of resection margins is a proxy for the completeness of resection in oral tongue cancer surgery and is therefore a useful predictor for post-operative prognosis. Historically, a margin distance of 5 mm or greater has been deemed a negative margin and is believed to yield a benefit in terms of control and survival. To summarize the literature more completely on this topic, we conducted a systematic review that examines radial margin distance and its relationship to disease control and survival in oral tongue cancer. Our review includes 34 studies which reported survival and/or recurrence outcomes for oral tongue cancer patients based on margin status. Most studies reported outcomes for the 5 mm margin, while the minority utilized other margin cutoffs. For the 5 mm cutoff, outcomes were generally favorable regarding survival and recurrence outcomes. Nonetheless, studies using 4 mm, 3.3 mm, and 10 mm cutoffs also found favorable survival and recurrence outcomes; however, these are a minority of the included studies.
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Affiliation(s)
- Ryland N Spence
- The Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, USA
| | - Vasileios Efthymiou
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Deborah Goss
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA 02114, USA.
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Qin Z, Hu Z, Lai M, Wang F, Liu X, Yin L. A nomogram for predicting survival in Patients with oral tongue keratinized squamous cell carcinoma: A SEER-based study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101422. [PMID: 36781109 DOI: 10.1016/j.jormas.2023.101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVE Oral tongue keratinized squamous cell carcinoma (OTKSCC), a relatively rare form of tongue cancer (TC) in clinical practice, accompanied by features of cell keratosis, is an uncommon histological subtype. However, its specific clinicopathological features and prognosis have not been adequately described. In this study, we aimed to create a nomogram using R language software to predict overall survival (OS) of patients with OTKSCC to assess the prognosis of OTKSCC patients. METHODS We extracted clinical and related prognostic data of OTKSCC patients from 1975 to 2019 from the Surveillance, Epidemiology, and End Results database. Independent prognostic factors were selected using univariate and multivariate Cox analyses, and a nomogram was constructed using R software. The C-index, area under the curve (AUC) of receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA) were used to assess the clinical utility of the nomogram. Finally, OS was assessed using the Kaplan-Meier method. RESULTS A total of 2450 OTKSCC patients were included in the study. Univariate and multivariate Cox regression analyses were used to identify age, T stage, N stage, surgery, and radiation therapy as independent risk factors (p<0.05). In the training cohort, the calibration index of the nomogram was 0.725, while the AUC values for nomogram, age, T stage, N stage, surgery and radiation therapy were 0.878, 0.639, 0.781, 0.661, 0.724 and 0.354, respectively. At the same time, in the verification queue, the calibration index of the nomogram was 0.726, while the AUC values for nomogram, age, T stage, N stage, surgery and radiation therapy were 0.859,0.612,0.826,0.675,0.758 and 0.303, respectively. Ideal uniformity of the models from the training and validation cohorts was demonstrated in the calibration and DCA curves. Univariate survival analysis showed that age, T stage, N stage, surgery, and radiotherapy were statistically significant for prognosis (p<0.05). CONCLUSION Age, T stage, N stage, surgery, and radiation therapy are independently associated with the OS, and the established nomogram is an effective visualization tool for predicting the OS of OTKSCC patients.
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Affiliation(s)
- Zishun Qin
- The First Clinical Medical College, Lanzhou University, Lanzhou,730000, China; School/Hospital of Stomatology, Lanzhou university, Lanzhou,730000, China.
| | - Zonghao Hu
- School/Hospital of Stomatology, Lanzhou university, Lanzhou,730000, China.
| | - Minqin Lai
- School/Hospital of Stomatology, Lanzhou university, Lanzhou,730000, China.
| | - Feng Wang
- School/Hospital of Stomatology, Lanzhou university, Lanzhou,730000, China
| | - Xiaoyuan Liu
- School/Hospital of Stomatology, Lanzhou university, Lanzhou,730000, China
| | - Lihua Yin
- The First Clinical Medical College, Lanzhou University, Lanzhou,730000, China; School/Hospital of Stomatology, Lanzhou university, Lanzhou,730000, China.
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Riju J, Tirkey AJ, Vidya K, Agarwal M, Babu M, Kurian R, Paulose A. A Site-Based Analysis of Relationship Between Clinicopathological Factors and Their Influence on Locoregional Recurrence in Oral Squamous Cell Carcinoma. Indian J Surg Oncol 2023; 14:733-741. [PMID: 37900650 PMCID: PMC10611655 DOI: 10.1007/s13193-023-01750-8] [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: 12/30/2022] [Accepted: 04/14/2023] [Indexed: 10/31/2023] Open
Abstract
In India, oral cancers are the major cause of cancer-related death. Tongue and buccal mucosa being the major subsites in oral cancer have varying clinicopathological presentations. This study is intended to know the difference in clinicopathological behavior of these two subsites. This retrospective study included 474 patients of which 232 patients had tongue cancer and 242 patients had buccal alveolar complex (BAC) cancer. Comparison between the pathological characters including pattern of nodal involvement was analyzed. Disease-free survival (DFS) and factors influencing the DFS were analyzed and compared using Cox regression analysis. Mean age of the study population was 52.7 years. Tongue oral squamous cell carcinoma (OSCC) differed significantly from BAC OSCC in terms of age of presentation, tumor staging, and perineural invasion. Among neck nodal involvement, tongue OSCC commonly involved level IIa (p < 0.001) whereas BAC involved level Ib (p < 0.001). At a median follow-up of 27 months, 141 patients had disease recurrence, tongue OSCC commonly recurred in neck (p = 0.008), and BAC OSCC relapsed at primary site (p = 0.001). Patients older than 45 years with BAC cancer had lesser risk of recurrence (HR, 0.30; 95% CI, 0.2-0.5; p < 0.0001). Pathological tumor stage in tongue cancer (HR, 14.9; 95% CI, 2.6-84.8; p = 0.002) and grade of tumor differentiation in BAC OSCC (HR, 9.2; 95% CI, 1.9-43.3; p < 0.005) were the most significant factors that influenced tumor recurrence. There was a significant difference in factors influencing disease recurrence among tongue and BAC OSCC. Also, pattern of nodal metastasis and pattern of recurrence were different. Hence, further research on OSCC may be done site specific. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-023-01750-8.
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Affiliation(s)
- Jeyashanth Riju
- Department of Head and Neck Surgery, Christian Medical College, Vellore, India
| | - Amit Jiwan Tirkey
- Department of Head and Neck Surgery, Christian Medical College, Vellore, India
| | - Konduru Vidya
- Department of Head and Neck Surgery, Christian Medical College, Vellore, India
| | - Mansi Agarwal
- Department of Head and Neck Surgery, Christian Medical College, Vellore, India
| | - Malavika Babu
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4YS UK
| | | | - Antony Paulose
- Department of Head and Neck Surgery, Christian Medical College, Vellore, India
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9
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de Koning KJ, van Es RJJ, Klijn RJ, Breimer GE, Willem Dankbaar J, Braunius WW, van Cann EM, Dieleman FJ, Rijken JA, Tijink BM, de Bree R, Noorlag R. Application and accuracy of ultrasound-guided resections of tongue cancer. Oral Oncol 2022; 133:106023. [PMID: 35901543 DOI: 10.1016/j.oraloncology.2022.106023] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/07/2022] [Accepted: 07/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Surgical removal of squamous cell carcinoma of the tongue (SCCT) with tumour-free margin status (≥5 mm) is essential for loco-regional control. Inadequate margins (<5 mm) often indicate adjuvant treatment, which results in increased morbidity. Ultrasound (US)-guided SCCT resection may be a useful technique to achieve more adequate resection margins compared to conventional surgery. This study evaluates the application and accuracy of this technique. METHODS Forty patients with SCCT were included in a consecutive US cohort. During surgery, the surgeon aimed for a 10-mm echographic resection margin, while the tumour border and resection plane were captured in one image. Ex-vivo US measurements of the resection specimen determined whether there was a need for an immediate re-resection. The margin status and the administration of adjuvant treatment were compared those of with a consecutive cohort of 96 tongue cancer patients who had undergone conventional surgery. A receiver operating characteristic analysis was done to assess the optimal margin of ex-vivo US measurements to detect histopathologically inadequate margins. RESULTS In the US cohort, the frequency of free margin status was higher than in the conventional cohort (55% vs. 16%, p < 0.001), and the frequency of positive margins status (<1 mm) was lower (5% vs. 15%, respectively, p < 0.001). Adjuvant radiotherapy was halved (10% vs. 21%), and the need for re-resection was comparable (10% vs. 9%). A cut-off value of 8 mm for ex-vivo measurements prevented histopathologically inadequate margins in 76%. CONCLUSION US-guided SCCT resections improve margin status and reduce the frequency of adjuvant radiotherapy.
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Affiliation(s)
- Klijs J de Koning
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert J J van Es
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Reinoud J Klijn
- Department of Oral and Maxillofacial Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gerben E Breimer
- Department. of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Weibel W Braunius
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen M van Cann
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - François J Dieleman
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes A Rijken
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bernard M Tijink
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rob Noorlag
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
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10
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Barzan L, Montomoli C, Di Carlo R, Bertinazzi M, Colangeli R, Martini A, Nicolai P, Gaio E, Artico R, Lupato V, Giacomarra V, Boscolo Nata F, Tirelli G, Lora L, Politi D, Spinato R, Menegaldo A, Boscolo Rizzo P, Da Mosto MC, Fiorino F, Herman I, Benazzo M, La Boria A, Grandi C, Fanetti G, Franchin G, Canzonieri V, Sulfaro S, Mazzoleni G, Vaccher E. Multicentre study on resection margins in carcinoma of the oral cavity, oro-hypopharynx and larynx. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:126-139. [PMID: 35612504 PMCID: PMC9132003 DOI: 10.14639/0392-100x-n1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/27/2021] [Indexed: 11/25/2022]
Abstract
Objective The prognostic significance of the resection margins is still subject of conflicting opinions. The purpose of this paper is to report the results of a study on the margins in carcinoma of the oral cavity, oro-hypopharynx and larynx. Methods A multicentre prospective study was carried out between 2015 and 2018 with the participation of 10 Italian reference hospitals. The primary objective was to evaluate local control in patients with well-defined clinical characteristics and comprehensive histopathological information. Results During the study period, 455 patients were enrolled; the minimum follow-up was 2 years. Previous treatment, grading and fresh specimen examination were identified as risk factors for local control in multivariate analysis. On the basis of these results, it seems possible to delineate “risk profiles” for different oncological outcomes. Discussion The prognostic significance of the margins is reduced, and other risk factors emerge, which require diversified treatment and follow-up. Conclusions Multidisciplinary treatment with adjuvant therapy, if indicated, reduces the prognostic importance of margins. Collaboration with a pathologist is an additional favourable prognostic factor and quality indicator. An appendix with literature review is present in the online version.
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11
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Daniell JR, Dolja-Gore X, McDowell L, Udovicich C, Rowe D, Iseli TA, Wong T, Magarey MJR, Wiesenfeld D. The impact of travel distance to treatment centre on oral tongue squamous cell carcinoma survival and recurrence. Int J Oral Maxillofac Surg 2021; 51:854-861. [PMID: 34551874 DOI: 10.1016/j.ijom.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/30/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
There have been no prior studies examining the effect of distance to the treatment centre on oral squamous cell carcinoma outcomes in Australia. The purpose of this study was to analyse the impact of travel distance on oral tongue squamous cell carcinoma (OTSCC) outcomes. This was a retrospective analysis of 243 patients who received surgical treatment ± adjuvant therapy between 2007 and 2016. The overall survival (OS), disease-specific survival (DSS), and freedom from loco-regional failure (FFLRF) survival analyses were conducted using Kaplan-Meier curves and a multivariate Cox proportional hazards model. A competing risk (CR) analysis was conducted. Patients living ≥200 km from the treatment centre, when compared with those living within 40 km, had worse OS (hazard ratio (HR) 3.11, 95% confidence interval (CI) 1.74-5.54), DSS (HR 2.58, 95% CI 1.30-5.12), and FFLRF (HR 2.47, 95% CI 1.22-5.01). These discrepancies were significant when adjusted for socioeconomic status (OS P < 0.001, DSS P 0.004, FFLRF P = 0.005) and in the presence of CR (OTSCC-specific death with CR 'non-disease-related death' P =0.030, FFLRF with CR 'any cause death' P = 0.013, FFLRF with CR 'OTSCC-specific death' P = 0.004). Patients with OTSCC living ≥200 km from the treatment centre were found to have worse outcomes than those living within 40 km.
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Affiliation(s)
- J R Daniell
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - X Dolja-Gore
- Research Centre for Generational Health and Ageing, University of Newcastle, New Lambton Heights, NSW, Australia
| | - L McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - C Udovicich
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - D Rowe
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - T A Iseli
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - T Wong
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - M J R Magarey
- Department of Surgical Oncology, Head and Neck Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Medical Education, The University of Melbourne, Parkville, Victoria, Australia
| | - D Wiesenfeld
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
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12
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Chen YH, Chen CH, Chien CY, Su YY, Luo SD, Li SH. Overexpression of UTX promotes tumor progression in Oral tongue squamous cell carcinoma patients receiving surgical resection: a case control study. BMC Cancer 2021; 21:979. [PMID: 34465286 PMCID: PMC8408955 DOI: 10.1186/s12885-021-08726-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Ubiquitously transcribed tetratricopeptide repeat on chromosome X (UTX) has been identified as a histone 3 lysine 27 (H3K27) demethylase and acted as a tumor suppressor gene or oncogenic function. The current study was to explore the significance of UTX in oral tongue squamous cell carcinoma (OTSCC) patients who received surgical resection. Methods A total of 148 OTSCC patients who underwent surgical resection were identified, including 64 patients (43%) with overexpression of UTX and 84 patients (57%) harboring low expression of UTX. We also used two OTSCC cell lines, SAS and Cal 27, to determine the modulation of cancer. Chi-square test was used to investigate the difference of categorical variables between the groups; survival outcome was analyzed using the Kaplan–Meier method in univariate analysis, and a Cox regression model was performed for multivariate analyses. Results Univariate and multivariate analyses showed overexpression of UTX were significantly related to worse disease-free survival (P = 0.028) and overall survival (P = 0.029). The two OTSCC cell lines were treated with GSK-J4, a potent inhibitor of UTX, and transwell migration and invasion assays showed an inhibitory effect with a dose-dependent manner. In addition, western blot analyses also revealed the inhibition of cell cycle and epithelial-mesenchymal transition. Conclusion Our study suggests that UTX plays an important role in the process of OTSCC and overexpression of UTX may predict poor prognosis in OTSCC patients who received surgical resection. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08726-3.
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Affiliation(s)
- Yen-Hao Chen
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan.,Department of Nursing, Meiho University, Pingtung, 912, Taiwan
| | - Chang-Han Chen
- Institute of Medicine, Chung Shan Medical University, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, 402, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yan-Ye Su
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shau-Hsuan Li
- Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan.
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