Prognostic impact of family history in southern Chinese patients with undifferentiated nasopharyngeal carcinoma

Potential causal links of long-term exposure to PM2.5 and its chemical components with the risk of nasopharyngeal carcinoma recurrence: A 10-year cohort study in South China

There is a lack of evidence from cohort studies on the causal association of long-term exposure to ambient fine particulate matter (PM2.5) and its chemical components with the risk of nasopharyngeal carcinoma (NPC) recurrence. Based on a 10-year prospective cohort of 1184 newly diagnosed NPC patients, we comprehensively evaluated the potential causal links of ambient PM2.5 and its chemical components including black carbon (BC), organic matter (OM), sulfate (SO4 2-), nitrate (NO3 -), and ammonium (NH4 +) with the recurrence risk of NPC using a marginal structural Cox model adjusted with inverse probability weighting. We observed 291 NPC patients experiencing recurrence during the 10-year follow-up and estimated a 33% increased risk of NPC recurrence (hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 1.02-1.74) following each interquartile range (IQR) increase in PM2.5 exposure. Each IQR increment in BC, NH4 +, OM, NO3 -, and SO4 2- was associated with HRs of 1.36 (95%CI: 1.13-1.65), 1.35 (95%CI: 1.07-1.70), 1.33 (95%CI: 1.11-1.59), 1.32 (95%CI: 1.06-1.64), 1.31 (95%CI: 1.08-1.57). The elderly, patients with no family history of cancer, no smoking history, no drinking history, and those with severe conditions may exhibit a greater likelihood of NPC recurrence following exposure to PM2.5 and its chemical components. Additionally, the effect estimates of the five components are greater among patients who were exposed to high concentration than in the full cohort of patients. Our study provides solid evidence for a potential relationship between long-term exposure to PM2.5 and its components and the risk of NPC recurrence.

Epidemiology of nasopharyngeal carcinoma: current insights and future outlook

Nasopharyngeal carcinoma (NPC) is characterised by its remarkable geographical and ethnic distribution. The interplay between genetic susceptibility, environmental exposures, and Epstein-Barr virus (EBV) infections is indicated in the development of NPC. Exposure to tobacco smoking, dietary factors, and inhalants has been associated with the risk of NPC. Genetic association studies have revealed NPC-associated susceptibility loci, including genes involved in immune responses, xenobiotic metabolism, genome maintenance, and cell cycle regulation. EBV exposure timing and strain variation might play a role in its carcinogenicity, although further investigations are required. Other factors including medical history and oral hygiene have been implicated in NPC. Prevention strategies, including primary prevention and secondary prevention through early detection, are vital in reducing mortality and morbidity of NPC. The current review discusses the global and regional distribution of NPC incidences, the risk factors associated with NPC, and the public health implications of these insights. Future investigations should consider international, large-scale prospective studies to elucidate the mechanisms underlying NPC pathogenesis and develop individualized interventions for NPC.

Epidemiological, Clinicopathological and Prognosis Features of Moroccan Patients with Nasopharyngeal Carcinoma

PROPOSAL

A distinct epidemiology, etiology, clinical characteristics, and therapeutic outcomes characterize nasopharyngeal carcinoma (NPC) from other head and neck cancers. An actualized analysis of NPC patients' features enables a global view of NPC management. Accordingly, the current study investigated the epidemiological and clinical characteristics of Moroccan patients with NPC, as well as their 4-years survival outcomes and influencing prognostic factors.

METHODS

We prospectively analyzed data of 142 histologically confirmed Moroccan patients with NPC between October 2016 and February 2019. Kaplan-Meier and Cox regression analyses were used to assess predictive prognostic factors related to NPC. All analyses were conducted using SPSS version 21 statistical software.

RESULTS

In the present study, a net male predominance was found, with a mean age of 44±16.3 years old. Advanced stages of NPC were observed in 64.1% of patients, and 32.4% of patients presented with distant metastasis at diagnosis. The 4-years overall survival, locoregional relapse-free survival, distant metastasis-free survival and progression-free survival were 68.0%, 63.0%, 53.9%, and 39.9%, respectively. Age, N category and distant metastasis were identified as the most important independent prognosis factors for NPC in this cohort (p<0.05).

CONCLUSION

In conclusion, NPC affects young adults and is frequently diagnosed at advanced disease stages, impacting therefore negatively patients survival; which is in line with data from endemic areas for NPC. The current study clearly highlights that a greater attention should be directed to improving the management of this aggressive malignancy.

Concurrent chemoradiotherapy versus radiotherapy alone for stage II nasopharyngeal carcinoma in the era of intensity-modulated radiotherapy

BACKGROUND

Concurrent chemoradiotherapy has long been a standardized therapy for localized advanced nasopharyngeal cancer. It is widely used in clinical applications. In contrast, NCCN guidelines highlight that the efficacy of concurrent chemoradiotherapy for stage II nasopharyngeal cancer in the new era of intensity-modulated radiotherapy has not been defined. Thus, we systematically reviewed the significance of concurrent chemoradiotherapy for stage II nasopharyngeal cancer.

METHODS

We searched the relevant literature in PubMed, EMBASE, and Cochrane, extracting relevant data from the searched literature. The main items extracted were hazard ratios (HRs), risk ratios (RRs) and 95% confidence intervals (CIs). When the HR could not be extracted from the literature, we used Engauge Digitizer software for extraction. Data analysis was accomplished using the Review Manager 5.4 tool.

RESULTS

Our study included seven articles involving 1633 cases of stage II nasopharyngeal cancer. The survival outcomes were overall survival (OS) (HR = 1.03, 95% CI (0.71-1.49), P = 0.87), progression-free survival (PFS) (HR = 0.91, 95% CI (0.59-1.39), P = 0.66), distant metastasis-free survival (DMFS) (HR = 1.05, 95% CI (0.57-1.93), P = 0.87), local recurrence-free survival (LRFS) (HR = 0.87, 95% CI (0.41-1.84), P = 0.71, P > 0.05), and locoregional failure-free survival (LFFS) (HR = 1.18, 95% CI (0.52-2.70), P = 0.69).

CONCLUSIONS

In the era of intensity-modulated radiotherapy, concurrent chemoradiotherapy and radiotherapy alone have the same survival benefits, and concurrent chemoradiotherapy increases acute hematological toxicity. Subgroup analysis showed that for people with N1 nasopharyngeal cancer at risk of distant metastases, concurrent chemoradiotherapy and radiotherapy alone also had equal survival benefits.

Prognostic models for early and late tumor progression prediction in nasopharyngeal carcinoma: An analysis of 8292 endemic cases

OBJECTIVES

The time for posttreatment tumor progression differs between nasopharyngeal carcinoma (NPC) patients. Herein, we established effective nomograms for predicting early tumor progression (ETP) and late tumor progression (LTP) in NPC patients.

METHODS

We retrospectively enrolled 8292 NPC patients (training cohort: n = 6219; validation cohort: n = 2073). The ELP and LTP were defined as the time to tumor progression ≤24 and >24 months after treatment, respectively.

RESULTS

The ETP and LTP accounted for 52.6 and 47.4% of the total patient cohort, respectively. Patients who developed ETP had markedly worse overall survival (OS) versus patients who suffered from LTP (5-year OS: 26.2% vs. 59.7%, p < 0.001). Further, we identified 10/6 predictive factors significantly associated with ETP/LTP via logistic regression analyses. These indicators were used separately to construct two predictive nomograms for ETP and LTP. In the training group, the ETP nomogram [Harrell Concordance Index (C-index) value: 0.711 vs. 0.618; p < 0.001] and LTP nomogram (C-index value: 0.701 vs. 0.612; p < 0.001) were significantly superior for risk stratification than the TNM staging. These results were supported in the validation group with a C-index value of 0.753 and 0.738 for the ETP and LTP nomograms, respectively. High-risk patients defined by ETP/LTP nomograms had shorter progression-free survival than low-risk patients (all p < 0.001).

CONCLUSION

The established nomograms can help in ELP or LTP risk stratification for NPC patients. Our current results might also provide insights into individualized treatment decisions and designing surveillance strategies for NPC patients.

Recommendation for imaging follow-up strategy based on time-specific disease failure for nasopharyngeal carcinoma

BACKGROUND

To develop a common follow-up strategy for appropriate imaging examination at an appropriate time for nasopharyngeal carcinoma (NPC).

METHODS

Independent prognostic factors were identified by Cox regression analysis, and a nomogram model was developed. Random survival forest (RSF) model was constructed to depict probability of disease failure during a 5-year follow-up and establish a reasonable risk-based follow-up strategy.

RESULTS

The nomogram model finally categorized the patients into three risk groups. RSF model demonstrated distribution trends for local and regional recurrences, bone metastasis, liver metastasis, and lung metastasis of NPC. Adequate imaging at follow-up should be considered between 10 and 21 months for patients at moderate-risk of recurrence or metastasis and 7-36 months for those at high-risk.

CONCLUSIONS

The temporal distribution of incidence rates of recurrence or metastasis varied among different risk groups. We recommend implementing a focused and targeted imaging surveillance intervention at appropriate times to improve its efficiency and reduce costs.

Nasopharyngeal necrosis contributes to overall survival in nasopharyngeal carcinoma without distant metastasis: a comprehensive nomogram model

OBJECTIVES

This study focused on developing and validating a nomogram to predict the overall survival (OS) of patients with nasopharyngeal carcinoma (NPC) without distant metastasis based on their clinical characteristics, serum biomarkers, and presence of nasopharyngeal (NP) necrosis.

METHODS

This study included 9298 patients with NPC. Patients from January 2009 to December 2014 were randomly categorized into the training cohort and validation cohort A. Validation cohort B, whose data were collected from January 2015 to December 2017, was also included. OS was the primary endpoint of this study. Cox regression analysis was used to detect independent risk variables. Decision curve analysis, calibration curve, time-dependent receiver operating characteristic (ROC) curve, and concordance index (C-index) were used to evaluate the performance of the nomogram model.

RESULTS

A total of 267 patients developed NP necrosis after the first routine radiotherapy. After radiotherapy, patients with NP necrosis had significantly lower OS than other patients in all three cohorts (p < 0.001). Eleven factors, including NP necrosis, were involved in the nomogram, which had favorable discrimination and calibration with a C-index of 0.768 in the training cohort, 0.749 in validation cohort A, and 0.739 in validation cohort B. The nomogram exhibited a significantly larger area under the ROC curve for predicting OS than the TNM stage and Epstein-Barr virus (EBV) DNA (p < 0.001).

CONCLUSION

Compared with the TNM system and EBV DNA, we established a nomogram model with an accurate prognostic prediction for patients with NPC, which might help with patient management in NPC.

KEY POINTS

• This study included 9298 patients with NPC, and 11 factors were involved in the final model. • The nomogram had a significantly higher C-index and area under the ROC curve than the TNM stage and EBV DNA. • We established the first nomogram model for NPC involving the occurrence of NP necrosis, which was valuable for providing individual counseling and clinical assessments.

Family history of cancer is a prognostic factor for better survival in operable esophageal squamous cell carcinoma: A propensity score matching analysis

Lay summary

Patients with a family history of cancer, especially digestive tract cancer and esophageal cancer, a family history of cancer in the first degree, and more than one relative affected by cancer were associated with favorable survival when compared to those without a family history of cancer.

Precis for use in the Table of Contents

A family history of cancer is a favorable independent prognostic factor in ESCC. Patients with a family history of cancer, especially digestive tract cancer and esophageal cancer, a family history of cancer in the first degree, and more than one relative affected by cancer were associated with favorable survival when compared to those without a family history of cancer.

Background

A family history of cancer (FH) is closely associated with the risk and survival of many cancers. However, the effect of FH on the prognosis of patients with esophageal squamous cell carcinoma (ESCC) remains unclear. We performed a large cohort study in the Chinese population to obtain insight into the prognostic value of FH in patients with operable ESCC.

Methods

A total of 1,322 consecutive patients with thoracic ESCC who had undergone esophagectomy between January 1997 and December 2013 were included. The FH group included patients with any degree of FH, while the non-FH group included patients without any degree of FH. In total, 215 patients with FH and 215 without FH were matched using the propensity score matching analysis method to adjust for differences in baseline variables between the two groups. The impact of FH on disease-free survival (DFS) and overall survival (OS) was estimated using the Kaplan-Meier method and Cox's proportional hazards models.

Results

Before matching, 280 (21.2%) patients were included in the FH group and 1,042 (78.8%) in the non-FH group. FH was associated with early pathological T stage (p = 0.001), lymph node-negative status (p = 0.022), and early pathological stage (p = 0.006). After matching, FH was an independent prognostic factor for DFS and OS in ESCC patients. Patients with FH had 35% lower risk of disease progression (hazard ratio [HR] = 0.65, 95% CI: 0.51-0.84, p = 0.001) and 34% lower risk of death (HR = 0.66, 95% CI: 0.51-0.86, p = 0.002) than those without FH. Patients with a family history of digestive tract cancer (FH-DC), a family history of esophageal cancer (FH-EC), FH in first-degree relatives (FH-FD), and more than one relative affected by cancer were associated with favorable DFS and OS as compared to those without FH.

Conclusion

FH is a favorable independent prognostic factor in ESCC. Patients with FH, especially those with FH-DC, FH-EC, FH-FD, and more than one relative affected by cancer, had improved survival.

Family History of Cancer is associated with poorer prognosis in Oral Squamous Cell Carcinoma

OBJECTIVE

The purpose of this study was to investigate the prognostic value of the family history of cancer (FHC) in predicting survival and clinicopathological features in oral squamous cell carcinoma (OSCC) patients.

MATERIALS AND METHODS

This single-institution study utilized data from 610 patients undergoing surgery from 2014 to 2020 that was prospectively collected and cataloged for research purposes. All patients underwent standard surgery with/without radiotherapy or chemoradiotherapy. We statistically evaluated whether FHC was associated with changes in disease-free survival (DFS) and disease-specific survival (DSS).

RESULTS

Among 610 patients, 141 (23.1%) reported a family history of cancer. The distribution of clinicopathological characteristics was balanced between FHC-positive and FHC-negative OSCC patients. FHC-positive patients had decreased DFS (P=0.005) and DSS (P=0.018) compared to FHC-negative patients.

CONCLUSIONS

FHC-positive OSCC patients have a poorer prognosis. FHC positivity is an independent predictor of negative outcomes based on DFS and DSS. FHC should be a consideration in screening, evaluating, counseling, and treating OSCC patients.

MR Imaging of Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is endemic in parts of the world such as southern China and Southeast Asia. It is predominantly an undifferentiated carcinoma with a strong genetic basis and a close association with the Epstein-Barr virus. The ability of MR imaging to depict the boundaries of the primary tumor and its relationship with the complex structures of the skull base makes it the technique of choice for imaging of this disease in the head and neck. This article describes the MR imaging findings pertinent to staging and management and a new role of MR imaging in early cancer detection, in addition to a brief discussion of differential diagnoses.

MACC1 Is Associated With Epithelial-Mesenchymal Transition and Can Predict Poor Prognosis in Nasopharyngeal Carcinoma

Background

Given the reported correlation between the oncogene metastasis-associated in colon cancer 1 (MACC1) and nasopharyngeal carcinoma (NPC), as well as between MACC1 and epithelial–mesenchymal transition (EMT), we speculated that EMT is a likely causative link between MACC1 expression and poor NPC prognosis. Thus, we aim to clarify the relationship between MACC1 and EMT in NPC prognosis.

Material and Methods

We performed immunohistochemical examination of tissue sections from 128 NPC patients that were divided into six groups corresponding to high and low protein expression of MACC1 and two EMT-related proteins, vimentin and E-cadherin, and Kaplan–Meier (KM) survival analyses were performed.

Results

KM survival analysis showed that upregulation of MACC1 and vimentin and downregulation of E-cadherin were significantly associated with reduced survival in NPC. Short hairpin RNA (shRNA) interference and immunoblotting in the NPC cell line HNE-1 led to increased E-cadherin but decreased vimentin levels. MACC1 overexpression was significantly correlated with poor 5-year overall survival, metastasis-free survival, and disease-free survival (P<0.05) but not with poor relapse-free survival (P>0.05). Univariate analyses revealed that MACC1, E-cadherin, and vimentin levels along with T and N tumor classifications and cancer staging are significant prognostic factors of NPC (P<0.05).

Conclusion

Our findings showed the association between MACC1 and EMT in NPC malignancy and support the role of MACC1 as a prognostic biomarker and molecular target for NPC treatment.

Circulating cell-free epstein-barr virus DNA levels and clinical features in Moroccan patients with nasopharyngeal carcinoma

Background

The identification of effective prognosis biomarkers for nasopharyngeal carcinoma (NPC) is crucial to improve treatment and patient outcomes. In the present study, we have attempted to evaluate the correlation between pre-treatment plasmatic Epstein-Barr virus (EBV) DNA load and the conventional prognostic factors in Moroccan patients with NPC.

Methods

The present study was conducted on 121 histologically confirmed NPC patients, recruited from January 2017 to December 2018. Circulating levels of EBV DNA were measured before therapy initiation using real-time quantitative PCR.

Results

Overall, undifferentiated non-keratinizingcarcinoma type was the most common histological type (90.1 %), and 61.8 % of patients were diagnosed at an advanced disease stage (IV). Results of pre-treatment plasma EBV load showed that 90.9 % of patients had detectable EBV DNA, with a median plasmatic viral load of 7710 IU/ml. The correlation between pre-treatment EBV DNA load and the conventional prognostic factors showed a significant association with patients’ age (p = 0.01), tumor classification (p = 0.01), lymph node status (p = 0.003), metastasis status (p = 0.00) and overall cancer stage (p = 0.01). Unexpectedly, a significant higher level of pre-treatment EBV DNA was also found in plasma of NPC patients with a family history of cancer (p = 0.04). The risk of NPC mortality in patients with high pretreatment EBVDNA levels was significantly higher than that of those with low pre-treatment plasma EBV-DNA levels (p < 0.05). Furthermore, patients with high pre-treatment EBV-DNA levels (≥ 2000, ≥ 4000) had a significant low overall survival (OS) rates (p < 0.05). Interestingly, lymph node involvement, metastasis status and OS were found to be the most important factors influencing the EBV DNA load in NPC patients.

Conclusions

The results of the present study clearly showed a high association between pre-treatment EBV DNA load, the crucial classical prognostic factors (T, N, M and disease stage) of NPC and OS, suggesting that pre-treatment EBV DNA can be a useful prognostic biomarker in clinical decision-making and improving NPC treatment in Morocco.

An optimal posttreatment surveillance strategy for cancer survivors based on an individualized risk-based approach

The optimal post-treatment surveillance strategy that can detect early recurrence of a cancer within limited visits remains unexplored. Here we adopt nasopharyngeal carcinoma as the study model to establish an approach to surveillance that balances the effectiveness of disease detection versus costs. A total of 7,043 newly-diagnosed patients are grouped according to a clinic-molecular risk grouping system. We use a random survival forest model to simulate the monthly probability of disease recurrence, and thereby establish risk-based surveillance arrangements that can maximize the efficacy of recurrence detection per visit. Markov decision-analytic models further validate that the risk-based surveillance outperforms the control strategies and is the most cost-effective. These results are confirmed in an external validation cohort. Finally, we recommend the risk-based surveillance arrangement which requires 10, 11, 13 and 14 visits for group I to IV. Our surveillance strategies might pave the way for individualized and economic surveillance for cancer survivors.

Comparison Between PET-CT-Guided Neck Dissection and Elective Neck Dissection in cT1-2N0 Tongue Squamous Cell Carcinoma

Objective: Neck management in cT1-2N0 tongue squamous cell carcinoma (SCC) remains controversial. Our goal was to compare the survival difference between PET-CT–guided neck dissection and elective neck dissection (END) for the treatment of cT1-2 tongue SCC.

Methods: Patients with surgically treated cT1-2N0 tongue SCC were retrospectively enrolled. These patients were divided into two groups. Group A: The decision of whether to perform neck dissection was mainly based on the results of preoperative PET-CT examinations. Group B: Patients received END treatment without preoperative PET-CT examinations. The study endpoints were regional control (RC) and disease-specific survival (DSS). The Kaplan–Meier method was used to calculate the survival rates.

Results: Group A consisted of 66 patients, and 16 patients underwent neck dissection owing to positive PET-CT results. Group B consisted of 169 patients. The 5-year RC rates in group A and group B were 86 and 87%, respectively, and the difference was not significant (p = 0.731). The 5-year DSS rates in group A and group B were 93 and 90%, respectively, and the difference was not significant (p = 0.583).

Conclusions: Neck dissection can be safely avoided when the PET-CT scan reveals no neck lymph node involvement.

Significance of PET-CT for Detecting Occult Lymph Node Metastasis and Affecting Prognosis in Early-Stage Tongue Squamous Cell Carcinoma

Objective: We aimed to clarify the significance of PET-CT for detecting occult lymph node metastasis and for affecting prognosis in early-stage tongue squamous cell carcinoma (SCC). Methods: Patients with surgically treated primary cT1-2N0 tongue SCC who agreed to undergo a preoperative PET-CT scan were prospectively enrolled. The primary study outcomes were occult neck lymph node metastasis and locoregional control (LRC). The Kaplan-Meier method was used to analyze the LRC rate, and then the factors that were significant in the Kaplan-Meier method were assessed in the Cox model to determine the independent factors. Results: A total of 135 patients were included, and the median maximum standardized uptake value (SUV max) of the primary tumor was 9.0. When analyzing the PET-CT results, 18 patients were recognized as having neck lymph node metastasis, and 12 patients were proven to have pathologic lymph nodes. A total of 117 patients did not have neck lymph node metastasis reported by PET-CT, and five patients were proven to have pathologic lymph nodes. The sensitivity and specificity of PET-CT for predicting occult metastasis were 70.6 and 94.9%, respectively. In patients with an SUV max ≤ 9.0, the 5-year LRC rate was 95%; in patients with an SUV max >9.0, the 5-year LRC rate was 85%, and the difference was significant. Further Cox model analyses confirmed the independence of the SUV max for predicting LRC. Conclusion: PET-CT has a high specificity for predicting occult lymph node metastasis, and an SUV max >9.0 is significantly associated with worse LRC in cT1-2N0 tongue SCC.

Significance of SUV Max for Predicting Occult Lymph Node Metastasis and Prognosis in Early-Stage Tongue Squamous Cell Carcinoma

Objective

Our goal was to clarify the significance of SUV max for predicting occult lymph node metastasis and prognosis in early-stage tongue squamous cell carcinoma (SCC).

Methods

cT1-2N0 tongue SCC patients who underwent a preoperative PET-CT examination were prospectively enrolled. The association between SUV max and occult lymph node metastasis was analyzed. The main study endpoint was locoregional control (LRC). The Cox model was used to determine the independent factors.

Results

A total of 120 patients were included for analysis, and the median SUV max was 9.7. In 60 patients with an SUV max ≤9.7, 5 patients had occult metastasis; in 60 patients with an SUV max >9.7, 13 patients had occult metastasis, and the difference was significant (p=0.041). In patients with an SUV max ≤9.7, the 5-year LRC rate was 93%; in patients with an SUV max >9.7, the 5-year LRC rate was 81%, and the difference was significant (p=0.045).

Conclusion

An SUV max >9.7 was a marker for occult lymph node metastasis and could decrease LRC in patients with cT1-2N0 tongue SCC.

Prognostic Value of a Family History of Oral Tongue Squamous Cell Carcinoma: A Matched-Pair Study

OBJECTIVES/HYPOTHESIS

To analyze the prognostic value of a family cancer history for predicting survival in patients with oral tongue squamous cell carcinoma (SCC).

STUDY DESIGN

Retrospective case series.

METHODS

Each patient with a family history was paired with one patient with sporadic oral tongue SCC without a family history. The primary endpoint was disease-specific survival (DSS).

RESULTS

In total, 124 patients were enrolled as participants with a family cancer history, and the 5-year DSS rate was 51%. In the matched group, the 5-year DSS rate was 40%. The difference was significant (P = .032). In the smoking patients with a family history, the 5-year DSS rate was 43%. In the smoking patients from the matched group, the 5-year DSS rate was 17%; the difference was significant (P = .028). In nonsmoking patients with a history of cancer, the 5-year DSS rate was 51%; in nonsmoking patients in the matched group, the 5-year DSS rate was 40%; the difference was not significant (P = .141).

CONCLUSIONS

A family cancer history is associated with improved DSS in surgically treated oral tongue SCC patients.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:E605-E610, 2020.

Association between postoperative cough and thyroidectomy: a prospective study

Background

This study sought to determine whether thyroidectomy is associated with self-reported cough through a prospective analysis.

Methods

Patients undergoing unilateral thyroidectomy were prospectively enrolled. The control group was selected to avoid the effect of general anaesthesia. The experimental group consisted of 300 patients (202 females and 98 males) who underwent thyroidectomy, with a mean age of 48.6 years, and the control group consisted of 103 patients (53 females and 50 males) who underwent other head and neck operations, with a mean age of 50.3 years. All patients were required to complete the Leicester Cough Questionnaire (LCQ) preoperatively and 2 weeks postoperatively.

Results

The postoperative mean total LCQ scores in the experimental and control groups were 17.9 ± 5.0 and 19.8 ± 4.2, respectively; the difference was significant (p = 0.014). Adverse event analysis showed that patients in the experimental group scored significantly worse on items for chest or stomach pains, phlegm, feeling in control of coughing, sleep disturbances, coughing bouts, frustration, and feeling fed up with coughing. In the analysis of the three LCQ domains, a significant difference was noted in the physical domain between the two groups (p < 0.001). In the one-way analysis of variance, the factors of sex and anaesthesia time were associated with the postoperative LCQ score; in further multifactor analysis of variance, only the factor of sex was significantly related to the postoperative LCQ score.

Conclusion

Thyroidectomy may be associated with postoperative cough, and a higher number of female patients complained of cough and related symptoms.

Prognostic impact of family history of cancer in Southern Chinese patients with esophageal squamous cell cancer

Background: First degree family history of cancer is associated with developing esophageal cancer and sparse data is about the impact on poor survival among established esophageal squamous cell cancer (ESCC) patients. In this study, we investigated the prognoses of patients with ESCC with a family history.

Methods: A total of 479 ESCC patients were retrospectively enrolled from a Southern Chinese institution. A positive family history was defined as having malignant cancer among parents and siblings. Kaplan-Meier plots and Cox proportional hazards regressions were applied for overall survival (OS) and progression-free survival (PFS).

Results: Among 479 patients, 119 (24.8%) and 68 (14.2%) reported a first-degree family history of cancer and digestive tract cancer, respectively. Compared with patients without a family history of cancer, the adjusted hazard ratios (HR) among those with it were 1.40 (95% CI, 1.08-1.82, p=0.011) for death, 1.36 (95% CI, 1.05-1.76, p=0.018) for progression. Similar results were observed in those with a family history of digestive tract cancer (HR=1.69, 95%CI, 1.24-1.98, p=0.001 for death and HR=1.77, 95%CI, 1.30-2.37, p<0.001 for progression, respectively). Furthermore, there was a trend for increasing risk of overall mortality (p=0.021, p=0.004, respectively), and progression (p=0.022, p=0.001, respectively) with an increasing number of affected family members.

Conclusion: A first-degree family history of cancer, especially digestive tract cancer is associated with poor survival for established ESCC patients and plays an important role in prognosis. The patients with a family history of cancer might need a greater intensity of treatment and more frequent follow-up.

HLA-A*26-A*30 and HLA-DRB1*10 could be predictors of nasopharyngeal carcinoma risk in high-risk Tunisian families

We investigated human leukocyte antigen (HLA) profiles for Tunisians with nasopharyngeal carcinoma (NPC), their families, and a sample of unrelated healthy Tunisians in order to identify HLA specificities associated with familial NPC. HLA-A, -B, and -DRB1 typing was successful for 36 NPC patients, 72 unaffected family members, and 130 community controls, and the chi square or Fisher exact test was used to compare allele frequencies between cases and controls. We observed a consistent protective effect of HLA-DRB1*10 on NPC development. However, none of the NPC patients or their family members had a positive result for this HLA marker (0% vs 9.2% in controls, P = 0.047). In addition, HLA-A*26 was probably an induction marker, as its allelic frequency was significantly higher among NPC patients than among controls (P = 0.003) and among NPC patients than among at-risk family members (P = 0.067). Logistic regression analysis of the joint effect of selected HLA specificities showed that HLA-A*26 and HLA-A*30 were co-associated and have an important effect on NPC risk. Despite the small size of our cohort, we showed that HLA-A*26-A*30 and HLA-DRB1*10 might be predictive markers for NPC screening of Tunisian families with a high risk of NPC.

Nasopharyngeal carcinoma: A review of current updates

Nasopharyngeal carcinoma (NPC) is a rare malignancy worldwide, but it is endemic in a few areas including Southern China, Southeast Asia, North Africa and the Arctic. The underlying mechanisms behind this remarkable geographic distribution remain unclear. Although Epstein-Barr virus (EBV) infection has been suggested as a necessary cause of undifferentiated NPC, EBV itself is not sufficient to cause this malignancy. Other co-factors, such as environmental risk factors, and/or genetic susceptibility, may interact with EBV to play a role in the carcinogenesis of NPC. Survival rates differ significantly between NPC patients in early stages and late stages. Due to the close associations between EBV infection and NPC risk, EBV-related biomarkers have been used for early detection and screening for NPC in a few high-incidence areas. In the present review article the latest updates are discussed.

The incidence and prognosis of nasopharyngeal carcinoma patients with family history

Purpose

Epidemiological data showed that nasopharyngeal carcinoma (NPC) was a regional malignancy. It suggested that genetic factor may play an important role in tumorigenesis of NPC. The aim was to investigate the incidence and the prognosis of NPC patients with family history.

Methods

The clinical data of patients with NPC treated in Fudan University Shanghai Cancer Center from January 2008 to December 2012 were reviewed, and the patients with family history were selected. The prognosis of patients with family history was follow-up. The 5-year overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were analyzed by Kaplan-Meier and log-rank test. Cox proportional hazard model was used for multivariate analysis.

Results

There were 3.64% (135/3706) NPC patients with family history of NPC. Eighty-three percent (112/135) patients had only one family member suffering from NPC previously, and 74.1% (100/135) patients who had family history only in first-degree family members. Excluding five patients lost to follow-up, 130 patients were eventually used to analyze the prognosis. The 5-year OS, LRFS, and DMFS rates of all patients with family history were 84.1%, 83.4%, and 83.8%, respectively. There were no significant differences of OS, LRFS and DMFS between one relative group and at least two relatives group. In addition, the degree of NPC had no association with OS, LRFS and DMFS, respectively.

Conclusion

Our results showed that there was an incidence rate of 3.64% NPC patients with family history. These patients had a satisfied prognosis, and the prognosis of NPC patients with family history in different degree or numbers of relatives had no significant differences.

Outcomes of adding induction chemotherapy to concurrent chemoradiotherapy for stage T3N0-1 nasopharyngeal carcinoma: a propensity-matched study

OBJECTIVE

Our objective was to examine whether adding induction chemotherapy to concurrent chemoradiotherapy improved survival in stage III nasopharyngeal carcinoma (NPC) patients, especially in low-risk patients at stage T3N0-1.

MATERIALS AND METHODS

We retrospectively analyzed 687 patients with stage T3N0-1 NPC treated with intensity-modulated radiation therapy (IMRT) plus concurrent chemotherapy (CC) with or without induction chemotherapy (IC). Propensity score matching (PSM) method was used to select 237 pairs of patients from two cohorts. Overall survival (OS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS) were assessed by using the Kaplan-Meier method, log-rank test, and Cox regression analysis.

RESULTS

No significant survival differences were observed between IC plus CC and CC cohorts with similar 4-year OS (91.7% vs 92.6%, P=0.794), LRFS, (92.7% vs 96.8%, P=0.138), DMFS (93.5% vs 94.3%, P=0.582), and PFS (87.5% vs 91.1%, P=0.223). In a univariate analysis, lower Epstein-Barr virus deoxyribonucleic acid (EBV DNA; <4,000 copies/mL) significantly improved 4-year DMFS (95.5% vs 91.6%, P=0.044) compared with higher EBV DNA (≥4,000 copies/mL). No factors were associated with 4-year OS, LRFS, DMFS, and PFS in a multivariate analysis. IC plus CC group experienced higher rates of grade 3-4 leucopenia (P<0.001) and neutropenia (P<0.001).

CONCLUSION

The addition of IC to CC in stage T3N0-1 NPC patients treated with IMRT did not significantly improve their survival. The IC group experienced higher rates of grade 3-4 hematological toxicities. Therefore, further investigation is required.

Site-specific familial risk and survival of familial and sporadic head and neck cancer

The vast majority of head and neck cancers (HNCs) are sporadic squamous cell carcinomas, smoking and heavy drinking being the main risk factors. However, little is known about the possible role of family history and the importance of inherited factors versus shared environment. We used Swedish population-based registries to study the family history of HNC. In order to estimate the risk for family members to get the same cancer, and the risk for cancer-specific death in patients with a family history of HNC compared with patients without a family history, multivariate Cox proportional hazards analyses were performed. A 1.43-fold increased risk for developing HNC in the first-degree relatives (FDRs) of HNC patients [hazard ratio (HR), 1.43; 95% CI, 1.28-1.61] was found, when compared with relatives of healthy controls. In spouses of patients with HNC, the risk for developing any HNC was moderately increased (HR, 1.25; 95% CI, 1.01-1.53), compared with spouses of healthy controls. In addition, a 1.34-fold increased risk for death of HNC was found in HNC patients with a family history of HNC (HR, 1.34; 95% CI, (1.03-1.73) compared with HNC patients without a family history. We found an increased risk for HNC in relatives and spouses of HNC patients, when compared with family members of healthy controls. This suggests that in addition to inherited factors, shared environmental factors have a significant role in the development of the cancer. Family history of HNC was associated with worse survival in a newly diagnosed HNC patient.

Effects of gene polymorphisms in the endoplasmic reticulum stress pathway on clinical outcomes of chemoradiotherapy in Chinese patients with nasopharyngeal carcinoma

There is considerable inter-individual variabil¬ity in chemoradiotherapy responses in nasopharyngeal carcinoma (NPC) patients receiv¬ing the same or similar treatment protocols. In this study we evaluated the association between the gene polymorphisms in endoplasmic reticulum (ER) stress pathway and chemoradiation responses in Chinese NPC patients. A total of 150 patients with histopathologically conformed NPC and treated with concurrent chemoradiotherapy were enrolled. Genotypes in ER stress pathway genes, including VCP (valosin-containing protein) rs2074549, HSP90B1 rs17034943, CANX (calnexin) rs7566, HSPA5 [heat shock protein family A (Hsp70) member 5] rs430397, CALCR (calcitonin receptor) rs2528521, and XBP1 (X-box binding protein 1) rs2269577 were analyzed by Sequenom MassARRAY system. The short-term effects of primary tumor and lymph node after radiotherapy were assessed based on the Response Evaluation Criteria in Solid Tumors (RECIST) of WHO. And acute radiation-induced toxic reactions were evaluated according to the Radiation Therapy Oncology Group or European Organization for Research and Treatment of Cancer (RTOG/EORTC). The effects of gene polymorphisms on clinical outcomes of chemoradiotherapy were assessed by chi-square test, univariate and multivariate logistic regression analyses. We found that CT and CT+CC genotypes of CANX rs7566 was significantly correlated with primary tumor treatment efficacy at 3 months after chemoradiotherapy and with occurrence of radiation-induced myelosuppression in Chinese NPC patients. CT and CT+CC genotypes of CALCR rs2528521 were significantly correlated with cervical lymph node efficacy at 3 months after chemoradiotherapy. And CC and CT+CC genotypes of VCP rs2074549 were significantly associated with occurrence of myelosuppression. In conclusion, SNPs of VCP rs2074549, CANX rs7566 and CALCR rs2528521 in ER stress pathway genes may serve as predictors for clinical outcomes of chemoradiotherapy in Chinese NPC patients.

Pretreatment anemia and survival in nasopharyngeal carcinoma

Due to the low incidence of pretreatment anemia in nasopharyngeal carcinoma (NPC), the true prognostic impact of pretreatment anemia may be underestimated before. We retrospectively analyzed the association of pretreatment anemia with disease-specific survival (DSS), distant-metastasis-free survival (DMFS), and locoregional-relapse-free survival (LRFS) by Cox regression in a cohort of 5830 patients, stratifying by midtreatment anemia, smoking, body mass index (BMI), etc. Pretreatment anemia was significantly associated with adverse DSS (hazard ratio (HR) = 2.15, 95 % confidence interval (CI) 1.62-2.85, P < 0.001) and DMFS (HR = 1.53, 95 % CI 1.08-2.17, P = 0.018), comparing to patients with normal hemoglobin, after adjusting for covariates. Moreover, the association with DSS remained unchanged regardless of smoking status and clinical stage, whereas it was limited in the subgroups of above 45 years, male sex, and BMI <25 kg/m(2). With restriction to midtreatment anemic patients, pretreatment anemia was still strongly correlated with inferior DSS and DMFS. This study, in the largest reported cohort, is the first to show the adverse prognostic impact of pretreatment anemia on DSS and DMFS in NPC.

Pretreatment Serum Lactate Dehydrogenase and N Classification Predict Long-Term Survival and Distant Metastasis in Patients With Nasopharyngeal Carcinoma Who Have A Positive Family History of Cancer

The purpose of the present study was to evaluate prognostic factors in patients with nasopharyngeal carcinoma (NPC) from the endemic area of southern China who have a positive family history (FH) of cancer. Retrospective analysis of 600 patients with nondisseminated NPC and a positive FH was conducted. The prognostic value of different factors for overall survival (OS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and local relapse-free survival (LRFS) were assessed using Cox regression models. The 3-year OS, DMFS, DFS, and LRFS rates were 93.8%, 91.3%, 86.3%, and 93.8%, respectively. The FH tumor type was NPC for 226/600 (37.7%) patients and other cancers for 374/600 (62.3%) patients. The 3-year OS and DMFS rates for patients with an FH of NPC were 91.2% and 89.8%, respectively. Thirty of 600 (5.0%) patients had elevated pretreatment serum lactate dehydrogenase (LDH >245.0 IU/L). In multivariate analysis, N classification (HR 4.56, 95% CI 2.13-9.74, P < 0.0001) and elevated pretreatment serum LDH (HR 2.87, 95% CI 1.08-7.62, P = 0.034) were independent prognosticators for OS. Female patients (HR 0.42, 95% CI 0.19-0.95, P = 0.037) and patients with normal pretreatment serum LDH (HR 2.42, 95% CI 1.02-5.78, P = 0.046) had better DMFS. Elevated pretreatment serum LDH and N classification are independent prognostic factors for poorer survival in patients with NPC who have a positive FH of cancer.

Familial nasopharyngeal carcinomas possess distinguished clinical characteristics in southern China

OBJECTIVE

To compare clinical characteristics between familial nasopharyngeal carcinomas (NPCs) and sporadic NPCs in Guangdong province, China, a high-risk area.

METHODS

Between 1991 and 2001, 993 NPC patients treated at the Cancer Center of Sun Yat-Sen University in Guangdong were randomly selected as probands. Information about NPC among the probands' relatives and other information were obtained from a retrospective review of the patients' medical records. The patients were divided into sporadic NPC, low-frequency familial NPC (one NPC patient in addition to the proband in three generations), and high-frequency familial NPC (2 or more additional NPC patients in three generations) groups. Pathological and clinical characteristics were compared among these groups.

RESULTS

Of the 993 patients, 131 (13.2%) had a familial history of NPC. The average age at diagnosis was the lowest in the high-frequency familial NPC group (39 years; P=0.048). Although the overall survival (OS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) rates did not differ between familial and sporadic NPCs, the locoregional recurrence-free survival (LRFS) rate increased in the order sporadic NPCs, low-frequency familial NPCs, and high-frequency familial NPCs (P=0.009), with 5-year rates of 70%, 83%, and 87%, respectively. Multivariate analysis showed that family history of NPC was an independent favorable prognostic factor for LRFS, with adjusted hazard ratio (aHR) of 0.548, 95% CI (0.342-0.878). The high LRFS for familial NPCs was mainly noted among young, advanced-stage patients who received continuous radiation treatment.

CONCLUSIONS

Genetic factors may play an important role in the etiology of high-frequency familial NPC and underlie the early age of onset and sensitivity to radiotherapy.

Diabetes, prediabetes and the survival of nasopharyngeal carcinoma: a study of 5,860 patients

BACKGROUND

The incidence of diabetes is increasing. But the impact of diabetes and prediabetes on survival of patients with nasopharyngeal carcinoma (NPC) has received little evaluation.

METHODS

In a cohort of 5,860 patients, we compared the disease specific survival (DSS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival (DMFS) of patients with diabetes, prediabetes and normoglycemia defined by pretreatment fasting plasma glucose (FPG) using Kaplan-Meier method, log-rank test and Cox proportional hazards model.

RESULTS

Comparing to normoglycemic patients, the diabetic and the prediabetic were generally older, fatter, had hypertension, heart diseases and hyperlipaemia and usually received radiotherapy alone. But both the diabetic and the prediabetic had similar DSS, LRFS and DMFS to normoglycemic patients, even adjusting for such important factors as age, gender, smoking, drinking, hypertension, heart diseases, body mass index, hyperlipaemia, titer of VCA-IgA and EA-IgA, pathology, T-stage, N-stage, chemotherapy and radiotherapy (P>0.05 for all). Additionally, the findings remained unchanged in sensitivity analysis by excluding patients with known diabetes history and in subgroups of the various factors.

CONCLUSIONS

The diabetic and prediabetic NPC patients had similar survival to normoglycemic NPC patients. These data, in the largest reported cohort, are the first to evaluate the association between diabetes, prediabetes and the survival in NPC. The findings are relevant to patient management and provided evidence of the effect on this disease exerted by comorbidities.