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Arboleda LPA, Neves AB, Kohler HF, Vartanian JG, Candelária LM, Borges MF, Fernandes GA, de Carvalho GB, Kowalski LP, Brennan P, Santos‐Silva AR, Curado MP. Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022. Cancer Rep (Hoboken) 2023; 6:e1837. [PMID: 37288471 PMCID: PMC10432469 DOI: 10.1002/cnr2.1837] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision-making about this treatment according to the tumor site, clinical stage, and patient medical status. AIM The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period. METHODS AND RESULTS Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta-analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early-stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised. CONCLUSION NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non-surgical techniques. The guidelines support decision-making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences.
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Affiliation(s)
| | | | - Hugo Fontan Kohler
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
| | - José Guilherme Vartanian
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
| | | | - Matheus Ferraz Borges
- Group of Epidemiology and Statistics on CancerA.C. Camargo Cancer CenterSão PauloSPBrazil
| | | | | | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology DepartmentA.C. Camargo Cancer CenterSão PauloBrazil
- Head and Neck Surgery Department, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Paul Brennan
- International Agency for Research on CancerGenomic Epidemiology BranchLyonFrance
| | | | - Maria Paula Curado
- Group of Epidemiology and Statistics on CancerA.C. Camargo Cancer CenterSão PauloSPBrazil
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2
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Song Z, Chen Z, Sun X, Zou L. Competing risk models versus traditional Cox models for prognostic factors' prediction and care recommendation in patients with advanced laryngeal squamous carcinoma: a population-based study. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-07983-1. [PMID: 37115325 DOI: 10.1007/s00405-023-07983-1] [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: 12/05/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To explore the prognostic factors and the optimal treatment modalities for patients with stage IVA laryngeal squamous cell carcinoma (LSCC), so as to improve the survival rate of patients. METHODS Patients with stage IVA LSCC between 2004 and 2019 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. We used competing risk models to build nomograms for predicting cancer-specific survival (CSS). The effectiveness of the model was assessed using the calibration curves and the concordance index (C-index). The above results were compared with the nomogram established by Cox regression analysis. The patients were grouped into low-risk and high-risk groups by competing risk nomogram formula. And the Kaplan-Meier (K-M) method and log-rank test were used to make sure that these groups had a survival difference. RESULTS Overall, 3612 patients were included. Older age, black race, a higher N stage, a higher pathological grade, and a larger tumor size were independent risk factors for CSS; married marital status, total/radical laryngectomy, and radiotherapy were protective factors. The C-index was 0.663, 0.633, and 0.628 in the train set and 0.674, 0.639, and 0.629 in the test set of the competing risk model, and 0.672, 0.640, and 0.634 in the traditional Cox nomogram for 1, 3, and 5 years. In overall survival and CSS, the prognosis of the high-risk group was poorer than that of the low-risk group. CONCLUSION For patients with stage IVA LSCC, a competing risk nomogram was created to help screen risk population and guide clinical decision-making.
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Affiliation(s)
- Zhuo Song
- Department of Radiation Oncology, The Second Affiliated Hospital of Dalian Medical University, No. 467 Zhongshan Road, Dalian, 116023, Liaoning, China
| | - Zewen Chen
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Dalian Medical University, No. 467 Zhongshan Road, Dalian, 116023, Liaoning, China
| | - Xiuzhen Sun
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Dalian Medical University, No. 467 Zhongshan Road, Dalian, 116023, Liaoning, China.
| | - Lijuan Zou
- Department of Radiation Oncology, The Second Affiliated Hospital of Dalian Medical University, No. 467 Zhongshan Road, Dalian, 116023, Liaoning, China.
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Mattioli F, Serafini E, Lo Manto A, Mularoni F, Abeshi A, Lionello M, Ferrari M, Paderno A, Lancini D, Mattavelli D, Confuorto G, Marchi F, Ioppi A, Sampieri C, Mercante G, De Virgilio A, Petruzzi G, Crosetti E, Pellini R, Giuseppe S, Giorgio P, Piazza C, Molteni G, Bertolin A, Succo G, Nicolai P, Alicandri-Ciufelli M, Marchioni D, Presutti L, Fermi M. The role of adjuvant therapy in pT4N0 laryngectomized patients: Multicentric observational study. Head Neck 2023; 45:197-206. [PMID: 36250285 PMCID: PMC10092371 DOI: 10.1002/hed.27225] [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: 08/09/2022] [Revised: 09/20/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To retrospectively evaluate oncological outcomes in two groups of patients with pT4aN0 glottic SCC treated with total laryngectomy (TL) and neck dissection (ND) who underwent postoperative radiotherapy or exclusive clinical and radiological follow-up. METHODS It includes patients with pT4N0 glottic SCC who underwent TL and unilateral or bilateral ND with or without PORT. Divided in two comparison groups: the first group underwent adjuvant RT (TL-PORT); the second group referred to clinical and radiological follow-up (TL). RESULTS PORT was associated with a better OS while no differences were found in terms of DSS. A better local control is achieved when PORT is administered while no differences in terms of regional and distant control rates were found. Bilateral ND positively impacts on the regional control while the PNI negatively impact the regional control. CONCLUSIONS A tailored PORT protocol might be considered for pT4N0 glottic SCC treated with TL and ND, both considering the ND's extent and presence of PNI.
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Affiliation(s)
- Francesco Mattioli
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Edoardo Serafini
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Alfredo Lo Manto
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Francesca Mularoni
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - Azienda Ospedale Università di Padova, Padua, Italy
| | - Andi Abeshi
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Marco Lionello
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - Azienda Ospedale Università di Padova, Padua, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gennaro Confuorto
- Otolaryngology Unit, Department of Surgery, Dentistry and Paediatrics, University of Verona, Verona, Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Ioppi
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Claudio Sampieri
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giuseppe Mercante
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Armando De Virgilio
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Erika Crosetti
- ENT Unit, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital Orbassano, Turin, Italy
| | - Raul Pellini
- Department of Otolaryngology - Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Spriano Giuseppe
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Peretti Giorgio
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Gabriele Molteni
- Otolaryngology Unit, Department of Surgery, Dentistry and Paediatrics, University of Verona, Verona, Italy.,Department of Otolaryngology - Head and Neck Surgery, University Hospital Policlinico, Verona, Italy
| | - Andy Bertolin
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, Italy
| | | | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - Azienda Ospedale Università di Padova, Padua, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.,Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.,Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
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Heng Y, Xu C, Lin H, Zhu X, Zhou L, Zhang M, Li J, Tao L. Recurrence risk stratification and treatment strategies of patients with stage IVa-b hypopharyngeal squamous cell carcinoma. Head Neck 2022; 44:2030-2039. [PMID: 35915863 DOI: 10.1002/hed.27074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Optimal treatment strategies for patients with stage IVa-b hypopharyngeal squamous cell carcinoma (HSCC) remain controversial. This study aimed to examine the high-risk factors of postoperative tumor recurrence after surgical resection of HSCC and devise individualized postoperative adjuvant treatment (POAT). METHODS Overall, 218 patients with stage IVa-b HSCC who received surgery as initial treatment and with negative surgical margins were evaluated. Independent risk factors of recurrence were identified, and survival outcomes were compared according to recurrence risk and POAT use. RESULTS POAT significantly improved recurrence-free survival (RFS) and overall survival (OS) only in the high-risk patients (p = 0.003 and 0.018, respectively). Compared with postoperative radiotherapy alone, postoperative chemoradiotherapy (pCRT) achieved significantly better RFS (p = 0.035) and OS (p = 0.048). CONCLUSIONS POATs are recommended for high-risk patients with stage Iva-b HSCC, with pCRT achieving superior outcomes. Regular re-examination after tumor resection is sufficient for low-risk patients.
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Affiliation(s)
- Yu Heng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chengzhi Xu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Hanqing Lin
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Xiaoke Zhu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ming Zhang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ji Li
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Lei Tao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
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5
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Santos A, Santos IC, Dos Reis PF, Rodrigues VD, Peres WAF. Impact of Nutritional Status on Survival in Head and Neck Cancer Patients After Total Laryngectomy. Nutr Cancer 2021; 74:1252-1260. [PMID: 34278898 DOI: 10.1080/01635581.2021.1952446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Malnutrition is an important prognostic indicator of laryngeal squamous cell carcinoma. Retrospective study with head and neck cancer patients who underwent total laryngectomy. 243 patients of both sex were evaluated. The univariate analyses demonstrated an increased risk of death for the patients with greater weight loss, hypoalbuminemia, radiotherapy as an initial treatment, salvage surgery, and radical neck dissection. In a Multivariate Cox regression, older age (p = 0.03, 95% confidence interval [CI] 1.003-1.06, hazard ratio [HR] 1.029), Nutritional Risk Index ≤100 (p = 0.008, 95% CI 1.18-3.12, HR 1.921) and adjuvant radiotherapy (p = 0.029, 95% CI 0.31-3.12, HR 0.544) demonstrated prognostic significance in survival. Nutritional status is a modifiable variable and these findings highlight the need to adoption of simple nutritional assessment methods routinely during the treatment of head and neck cancer patients, in order to help improve prognosis after surgery.
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Affiliation(s)
- Adriana Santos
- Nutrition and Dietetic Section, Cancer Hospital Unit 1, National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Izabella Costa Santos
- Head and Neck Surgery Section, Cancer Hospital Unit 1, National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia Fonseca Dos Reis
- Nutrition and Dietetic Section, Cancer Hospital Unit 1, National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Viviane Dias Rodrigues
- Nutrition and Dietetic Section, Cancer Hospital Unit 1, National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wilza Arantes Ferreira Peres
- Department of Nutrition and Dietetics, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Muscatello L, Piazza C, Peretti G, Marchi F, Bertolin A, Crosetti E, Leopardi G, Lenzi R, Manca L, Matteucci J, Pellini R, Petruzzi G, Presutti L, Sarno A, Succo G, Valerini S, Rizzotto G. Open partial horizontal laryngectomy and adjuvant (chemo)radiotherapy for laryngeal squamous cell carcinoma: results from a multicenter Italian experience. Eur Arch Otorhinolaryngol 2021; 278:4059-4065. [PMID: 33599842 DOI: 10.1007/s00405-021-06651-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/27/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the functional and oncologic outcomes of adjuvant (chemo)radiation [(C)RT] after open partial horizontal laryngectomies (OPHLs). METHODS Multicenter retrospective evaluation of 130 patients (116 males, 14 females) submitted between 1995 and 2017 to OPHL Types II and III for laryngeal cancer and receiving adjuvant (C)RT for one or more of the following risk factors at histopathologic examination of the surgical specimen: pT4a and/or > pN2a categories, close/positive resection margins, or presence of both perineural (PNI) and lympho-vascular invasion (LVI). The primary study endpoints were evaluation of the presence of tracheostomy and/or gastrostomy at last follow-up, and calculation of laryngo-esophageal dysfunction-free survival (LEDFS). RESULTS Mean age of the study cohort was 60.8 ± 8.9 years (median, 62; interquartile range [IQR], 13). Mean follow-up was 50.7 ± 39.4 months (range 24-188; median, 38; IQR, 51). Adjuvant therapy consisted of CRT in 53 (41%) patients, and RT alone in 77 (59%). Five-year LEDFS was 85%. Overall survival was 71.5%, while 13% of patients remained tracheostomy- and 3% gastrostomy-dependent at the last follow-up. The only significant variable in predicting survival (p = 0.020) was tracheostomy dependence: it was maintained in 7.5% of subjects after OPHL Type II and in 34% of those submitted to OHPL Type III (p < 0.001). CONCLUSIONS In selected patients affected by advanced laryngeal cancer, OPHLs Type II and III have a relatively good laryngeal safety profile and provide favorable oncologic outcomes even in case of need for adjuvant (C)RT.
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Affiliation(s)
- Luca Muscatello
- Unit of Otorhinolaryngology, Azienda USL Toscana Nord Ovest, Versilia Hospital, Camaiore (LU), Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, Milan, Italy
- Department of Oncology and Oncohematology, University of Milan, Milan, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Andy Bertolin
- Otolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy
| | - Erika Crosetti
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Gianluca Leopardi
- Unit of Otorhinolaryngology, Azienda USL Toscana Centro, San Giuseppe Hospital, Empoli (FI), Italy
| | - Riccardo Lenzi
- Unit of Otorhinolaryngology, Azienda USL Toscana Nord Ovest, Apuane Hospital, Via E. Mattei 31, 54100, Massa, Italy.
| | - Laura Manca
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Mathematics, University of Pisa, Pisa, Italy
| | - Jacopo Matteucci
- Unit of Otorhinolaryngology, Azienda USL Toscana Nord Ovest, Apuane Hospital, Via E. Mattei 31, 54100, Massa, Italy
| | - Raul Pellini
- Department of Otolaryngology, Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology, Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Livio Presutti
- Department of Otolaryngology, Head and Neck Surgery, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Antonio Sarno
- Unit of Otorhinolaryngology, Azienda USL Toscana Centro, Santo Stefano Hospital, Prato, Italy
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy
| | - Sara Valerini
- Department of Otolaryngology, Head and Neck Surgery, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Giuseppe Rizzotto
- Otolaryngology Service, Vittorio Veneto Hospital, Vittorio Veneto (TV), Italy
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Heng Y, Zhu X, Zhou L, Zhang M, Li J, Tao L. A prognostic nomogram for predicting the long-term survival outcome of hypopharyngeal squamous cell carcinoma patients after tumour resection to assist the decision-making of postoperative adjuvant treatment. Eur J Surg Oncol 2019; 46:245-251. [PMID: 31537404 DOI: 10.1016/j.ejso.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/18/2019] [Accepted: 09/11/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Surgery remains the most common therapeutic strategy for Chinese patients with hypopharyngeal squamous cell carcinoma (HSCC), yet the indications for postoperative adjuvant treatment (POAT) remain unclear. METHODS We retrospectively analysed 385 patients with primary HSCC in our hospital between 2003 and 2014. Patients that received pharyngectomy without POAT were enrolled in this study for developing a nomogram that predicts their survival outcome. RESULTS Multivariate analyses showed that the tumour size, oesophagal invasion, extracapsular spread or internal jugular vein adhesion, thyroid gland invasion, and the number of lymph node metastases (≤3 or >3) were significantly correlated to the overall survival (OS) of the patient and were included as risk factors in the nomogram. The C-index was 0.768 (95% CI, 0.719-0.817) in development cohort and 0.767 (95% CI, 0.753-0.781) in validation cohort. A calibration curve was also conducted and was found favourable. The patients were stratified into three groups based on their nomogram scores. In the high-risk group, patients that received POAT had a better OS than those that received only surgery. In the moderate-risk group, POAT did not show any significant association with the OS. However, patients in the low-risk group that received POAT showed a worse OS than those without. CONCLUSION The newly-developed nomogram can effectively predict the survival outcome of patients with HSCC. According to the novel stratification criteria created, patients stratified as high-risk could benefit from POAT, while those in the low-risk group are advised not to receive POAT as this correlates with a worse OS.
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Affiliation(s)
- Yu Heng
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China; Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, PR China.
| | - Xiaoke Zhu
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China; Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, PR China.
| | - Liang Zhou
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Ming Zhang
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Ji Li
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China.
| | - Lei Tao
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China.
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8
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Zhu X, Heng Y, Zhou L, Tao L, Zhang M. A prognostic nomogram for predicting risk of recurrence in laryngeal squamous cell carcinoma patients after tumor resection to assist decision making for postoperative adjuvant treatment. J Surg Oncol 2019; 120:698-706. [PMID: 31273803 DOI: 10.1002/jso.25614] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to create a nomogram for postoperative prediction of the risk of recurrence in laryngeal squamous cell carcinoma patients who received laryngectomy alone and to assess indications for postoperative adjuvant treatments (POAT). METHODS A retrospective analysis of 1571 newly diagnosed laryngeal carcinoma patients was conducted. Those patients were divided into two groups-the development cohort (n = 1102) and the validation cohort (n = 469). Patients were classified into three subgroups according to their individual points calculated from the nomogram. The efficiency of POAT was examined among various subgroups. RESULTS Five variables, including pT classification, pN classification, surgical margin, tumor differentiation, and primary location, were included in the nomogram. The C-index was 0.753 in development cohort and 0.744 in validation cohort. Patients were classified into three subgroups with incremental risks of recurrence. In the high-risk group, patients receiving POAT showed significantly better recurrence-free survival (RFS) than did those receiving surgery alone, while POAT was not significantly associated with RFS in either the low- or moderate-risk groups. CONCLUSIONS The risk of tumor recurrence in patients with laryngeal carcinoma was quantified by our newly constructed nomogram. Patients categorized as high-risk were found to benefit from POAT in RFS.
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Affiliation(s)
- Xiaoke Zhu
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Yu Heng
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Lei Tao
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Ming Zhang
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
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