A roadmap of six different pathways to improve survival in laryngeal cancer patients

Regulation of Dihydroartemisinin on the pathological progression of laryngeal carcinoma through the periostin/YAP/IL-6 pathway

Objective

Laryngeal cancer (LC) is one of the most common squamous cell carcinomas of the head and neck in clinical practice, and its incidence has been increasing in recent years, but the prognosis of the patients is not favorable. Hence, it is critical to re-understand and deeply study the causes and mechanisms of LC and explore new effective treatment methods and strategies. In this study, we analyzed the effect of Dihydroartemisinin (DHA) on the pathological progression of LC through the periostin (POSTN)/Yes-associated protein (YAP)/interleukin (IL)-6 pathway, which can provide new clinical references and guidelines.

Methods

POSTN, YAP, and IL-6 levels in 18 pairs of fresh LC tissues and adjacent counterparts in our hospital were detected. Additionally, LC TU686 cell line was purchased for DHA treatment of various concentrations to detect changes in cell biological behavior. Finally, we built a tumor-bearing mouse model with C57BL/6 mice and intragastrically administrated DHA to the animals to observe the growth of living tumors and to measure POSTN, YAP, and IL-6 expression in tumor tissues.

Results

As indicated by PCR, Western blotting, and immunohistochemistry, POSTN, YAP, and IL-6 presented higher expression in LC tissues than in adjacent counterparts. In cell experiments, the cloning rate of LC cells decreased and the apoptosis rate increased after DHA intervention, with 160 μmol/L DHA contributing to the most significant effect on LC activity inhibition. Furthermore, DHA-intervened cells exhibited markedly reduced POSTN, YAP, and IL-6 levels. Finally, the tumorigenesis experiment in nude mice showed inhibited tumor growth after DHA administration. And consistently, the expressions of POSTN, YAP, and IL-6 in living tumors decreased.

Conclusions

DHA can inhibit POSTN/YAP/IL-6 transduction, accelerate LC cell apoptosis, and alleviate the malignant progression of LC.

A Novel Framework of Manifold Learning Cascade-Clustering for the Informative Frame Selection

Narrow band imaging is an established non-invasive tool used for the early detection of laryngeal cancer in surveillance examinations. Most images produced from the examination are useless, such as blurred, specular reflection, and underexposed. Removing the uninformative frames is vital to improve detection accuracy and speed up computer-aided diagnosis. It often takes a lot of time for the physician to manually inspect the informative frames. This issue is commonly addressed by a classifier with task-specific categories of the uninformative frames. However, the definition of the uninformative categories is ambiguous, and tedious labeling still cannot be avoided. Here, we show that a novel unsupervised scheme is comparable to the current benchmarks on the dataset of NBI-InfFrames. We extract feature embedding using a vanilla neural network (VGG16) and introduce a new dimensionality reduction method called UMAP that distinguishes the feature embedding in the lower-dimensional space. Along with the proposed automatic cluster labeling algorithm and cost function in Bayesian optimization, the proposed method coupled with UMAP achieves state-of-the-art performance. It outperforms the baseline by 12% absolute. The overall median recall of the proposed method is currently the highest, 96%. Our results demonstrate the effectiveness of the proposed scheme and the robustness of detecting the informative frames. It also suggests the patterns embedded in the data help develop flexible algorithms that do not require manual labeling.

Artificial Intelligence and Laryngeal Cancer: From Screening to Prognosis: A State of the Art Review

OBJECTIVE

This state of the art review aims to examine contemporary advances in applications of artificial intelligence (AI) to the screening, detection, management, and prognostication of laryngeal cancer (LC).

DATA SOURCES

Four bibliographic databases were searched: PubMed, EMBASE, Cochrane, and IEEE.

REVIEW METHODS

A structured review of the current literature (up to January 2022) was performed. Search terms related to topics of AI in LC were identified and queried by 2 independent reviewers. Citations of selected studies and review articles were also evaluated to ensure comprehensiveness.

CONCLUSIONS

AI applications in LC have encompassed a variety of data modalities, including radiomics, genomics, acoustics, clinical data, and videomics, to support screening, diagnosis, therapeutic decision making, and prognosis. However, most studies remain at the proof-of-concept level, as AI algorithms are trained on single-institution databases with limited data sets and a single data modality.

IMPLICATIONS FOR PRACTICE

AI algorithms in LC will need to be trained on large multi-institutional data sets and integrate multimodal data for optimal performance and clinical utility from screening to prognosis. Out of the data types reviewed, genomics has the most potential to provide generalizable models thanks to available large multi-institutional open access genomic data sets. Voice acoustic data represent an inexpensive and accurate biomarker, which is easy and noninvasive to capture, offering a unique opportunity for screening and monitoring of LA, especially in low-resource settings.

Defining the Performance of Clinician's Ability to Screen for Laryngeal Mass From Voice

OBJECTIVE

Defining a clinician's ability to perceptually identify mass from voice will inform the feasibility, design priorities, and performance standards for tools developed to screen for laryngeal mass from voice. This study defined clinician ability of and examined the impact of expertise on screening for laryngeal mass from voice.

STUDY DESIGN

Task comparison study between experts and nonexperts rating voices for the probability of a laryngeal mass.

SETTING

Online, remote.

METHODS

Experts (voice-focused speech-language pathologists and otolaryngologists) and nonexperts (general medicine providers) rated 5-s/i/voice samples (with pathology defined by laryngoscopy) for the probability of laryngeal mass via an online survey. The intraclass correlation coefficient (ICC) estimated interrater and intrarater reliability. Diagnostic performance metrics were calculated. A linear mixed effects model examined the impact of expertise and pathology on ratings.

RESULTS

Forty clinicians (21 experts and 19 nonexperts) evaluated 344 voice samples. Experts outperformed nonexperts, with a higher area under the curve (70% vs 61%), sensitivity (49% vs 36%), and specificity (83% vs 77%) (all comparisons p < .05). Interrater reliability was fair for experts and poor for nonexperts (ICC: 0.48 vs 0.34), while intrarater reliability was excellent and good, respectively (ICC: 0.9 and 0.6). The main effects of expertise and underlying pathology were significant in the linear model (p < .001).

CONCLUSION

Clinicians demonstrate inadequate performance screening for laryngeal mass from voice to use auditory perception for dysphonia triage. Experts' superior performance indicates that there is acoustic information in a voice that may be utilized to detect laryngeal mass based on voice.

Elemental Analysis of Laryngeal Cancer Patients in Comparison with Controls Using Scalp Hair as an Analytical Tool

Laryngeal cancer, a rare form of head and neck cancer, is more common in men, and various factors play important roles in its etiology. In the current study, trace elemental contents in the scalp hair of laryngeal cancer patients and healthy subjects were evaluated. Selected essential and toxic elements were measured using flame atomic absorption spectrophotometry after the hair samples were digested with HNO₃-HClO₄. The mean/median levels of Pb in the scalp hair of patients were significantly higher than the healthy donors, but Sr, Zn, and Co exhibited comparatively lower levels in the laryngeal cancer patients. In comparison to healthy donors, the correlation pattern among the elements in the hair of the patients exhibited diverse mutual relationships. The multivariate apportionment of the elemental levels in the scalp hair of both donor groups was significantly divergent. The average elemental levels varied significantly among the cancer types (glottic, supraglottic, transglottic, and subglottic) as well as the cancer stages (I, II, III, IV). The average levels of the elements also exhibited considerable variations depending on the donors' habitat, gender, food, and smoking habits. Overall, the study revealed significantly divergent disparities among the elemental contents in the scalp hair of the laryngeal cancer patients in comparison with counterpart controls.

Reliability of a Multidisciplinary Multiparametric Approach in the Surgical Planning of Laryngeal Squamous Cell Carcinomas: A Retrospective Observational Study

(1) Background: Endoscopy and morphological imaging are the mainstay of the diagnostic work up of laryngeal squamous cell carcinomas (LSCCs), which can be integrated in a multidisciplinary discussion to obtain a shared pretreatment staging. (2) Methods: A retrospective evaluation of patients, managed at a tertiary university hospital in Italy and submitted to major laryngeal surgery, has been performed. Four different stagings have been defined and compared: epTN (based on endoscopy and physical ENT examination); radTN (based on CT scan); cTN (based on multidisciplinary integration of the two above); pTN based on pathology on surgical samples. Oncological outcomes have been assessed. (3) Results: Three-year relapse free and disease specific survival were 88% and 92.5%, respectively, without significant differences between partial surgeries (n = 13) and total laryngectomies (n = 32). As for the pretreatment staging, and in particular the T classification, the cTN has been revealed as more reliable than epTN and radTN alone in predicting the final pT (Cohen kappa coefficient: 0.7 for cT, 0.44 for radT, 0.32 for epT). In the partial surgery group, we did not record any positive margin nor local recurrence, with a 100% overall and disease-specific survival. (4) Conclusions: The multidisciplinary approach is fundamental in the definition of the primary lesion in LSCC, in particular in order to safely perform surgical preservation of laryngeal function, which is associated with a higher laryngectomy-free survival than irradiation but to a lower salvageability in case of recurrence.

Functional Outcomes Following Total Laryngectomy and Pharyngolaryngectomy: A 20-Year Single Center Study

BACKGROUND

Laryngeal cancer accounts for 1% of all cancers in men and 0.3% of all cancers in women. Pharyngolaryngectomy (TPL) and total laryngectomy (TL) are central surgical techniques in the management of advanced laryngeal malignancies but are associated with significant morbidity. In addition, optimal reconstruction following TPL remains an area of active research.

METHODS

Here, we compared speech and swallowing outcomes following circumferential and partial pharyngeal resection alongside total laryngectomy in patients with laryngeal and hypolaryngeal tumors. We performed a systemic analysis of patient demographics, tumor characteristics, treatment modality, and pharyngeal reconstruction technique following TPL and TL, leveraging data collected over a 20-year period at a large tertiary referral center.

RESULTS

Analyzing 155 patients the results show circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications.

CONCLUSION

Pharyngeal resection carries a substantial risk of incurring impaired speech and swallowing in patients. Moreover, our results support poorer functional outcomes with more radical pharyngeal resections and show a clear trend toward worse swallowing outcomes in salvage surgery.

Laryngeal cancers in paediatric and young adult patients: epidemiology, biology and treatment

PURPOSE OF REVIEW

The aim of thi study was to review the recent literature on epidemiology, biology and treatment of laryngeal cancer in paediatric and young adult patients.

RECENT FINDINGS

Epidemiological studies reported that 2-10% of patients with laryngeal cancer are younger than 40-year-old, while the prevalence of laryngeal cancer remains unknown in the paediatric population. The development of laryngeal cancer in young adults is multifactorial and may be linked to common carcinogens (tobacco and alcohol), occupational factors, laryngopharyngeal reflux, immunosuppression, human papillomavirus infection and genetic polymorphism. A substantial number of cohort studies reported a significant lower proportion of drinkers and smokers in young populations with laryngeal cancer, supporting the higher prevalence of chromosomal losses or abnormalities predisposing to cancer in this group. The development of laryngeal cancer in paediatric patients is strongly associated with genetic syndromes with DNA repair abnormalities. The pathological, clinical and survival outcome differences between young and old patient groups vary significantly between studies, depending on epidemiological, genetic features and therapeutic strategies used.

SUMMARY

Paediatric and adult populations with laryngeal cancer present different clinical, pathological and survival outcomes. In the adult population, the patient age at the time of disease development underlies genetic and etiological differences with different mutation patterns between young and old patients, the latter being more frequently individuals with a history of tobacco and alcohol abuse. The differences between age groups regarding stage of cancer at initial presentation, as well as clinical and survival outcomes, are unclear, which may be due to demographic, ethnicity and population genetic differences.

Transoral Laser Microsurgery for Glottic Cancer in Patients Over 75 Years Old

Objectives/Hypothesis

Laryngeal squamous cell carcinoma (LSCC) has a non‐negligible incidence in elderly patients. However, there is still no clear indication on the ideal treatment for early‐intermediate glottic LSCC in this specific age group. Both surgical and nonsurgical approaches may be burdened by complications and sequelae that negatively impact patient's health. In this setting, carbon dioxide transoral laser microsurgery (CO₂ TOLMS) is a promising minimally invasive treatment option.

Study Design

Retrospective case series in a single tertiary academic institution.

Methods

Patients who underwent CO₂ TOLMS for Tis‐T3 glottic LSCC from 1997 to 2017 were reviewed. Demographic, clinical, and tumor characteristics, as well as postoperative complications were recorded. Overall (OS), disease‐specific (DSS), recurrence‐free (RFS), laryngo‐esophageal dysfunction free survivals (LEDFS), and organ preservation (OP) were calculated.

Results

A total of 134 patients (mean age, 80 ± 4 years; median, 79; range, 75–93) were included in the study. Seven lesions were classified as pTis, 65 as pT1a, 22 as pT1b, 35 as pT2, and 5 as pT3. No treatment‐related death was observed. Twenty‐eight (20.9%) patients reported 10 surgical and 19 medical complications. Five‐year OS, DSS, RFS, LEDFS, and OP were 68.9%, 95.4%, 79.5%, 66%, and 92.5%, respectively. Age and comorbidities were associated with OS and LEDFS. Advanced T categories were negatively correlated with OS, DSS, RFS, LEDFS, and OP. Age and comorbidities were not significant risk factors for complications.

Conclusions

CO₂ TOLMS can be considered a valuable therapeutic approach for selected Tis‐T3 glottic LSCC even in the elderly given its favorable oncologic outcomes and minimal aggressiveness.

Level of Evidence

4 Laryngoscope, 132:135–141, 2022