Natural history of untreated squamous cell carcinoma of the head and neck

Impact of Oral Hygiene on Prognosis in Patients With Squamous Cell Carcinoma of the Lower Gingiva

Objective: We aimed to analyze the significance of oral hygiene in patients with squamous cell carcinoma of the lower gingiva.

Methods: Oral hygiene was assessed using a questionnaire by calculating the oral health (OH) score and the dental care (DC) score. The association of oral hygiene with clinical pathologic variables, disease free survival (DFS), and overall survival (OS) was analyzed.

Results: Four out of 53 non-smokers and 19 out of 90 current or former smokers had an OH score of 6 (statistically significant difference, p = 0.036). Fifteen out of 63 patients with a T3/T4 tumor and 8 out of 80 patients with a T1/T2 tumor had an OH score of 6 (statistically significant difference, p = 0.026). Similar statistically significant findings were noted with respect to the DC scores, smoking status, and tumor stage. Among patients with an OH score of 0–5, the 5-year DFS and OS rates were 55 and 50%, respectively, and among patients with an OH score >5, they were 46 and 43%, respectively (both differences statistically significant, p < 0.05). Among patients with a DC score of 0–2, the 5-year DFS and OS rates were 69 and 51%, respectively and among patients with a DC score >2, they were 50 and 47%, respectively (both differences statistically significant, p < 0.05). Cox model confirmed OH and DC scores as independent factors affecting the DFS and OS.

Conclusion: Poor oral hygiene was associated with decreased DFS and OS.

Induction chemotherapy combined with immunotherapy in locally advanced head and neck squamous cell carcinoma

Background

This study aimed to explore the efficacy and safety of sintilimab combined with induction chemotherapy (IC) in locally advanced head and neck squamous cell carcinoma (HNSCC) patients.

Methods

A total of 163 patients were prospectively enrolled; 98 patients received IC only, and 65 patients received IC with sintilimab. Following neoadjuvant therapy, patients either underwent surgery (31.9%) or chemoradiotherapy (68.1%). Objective response rate (ORR), progression free survival (PFS), overall survival (OS), and toxicities between the two groups were compared.

Results

The ORR in the IC group was significantly lower than that in the IC with sintilimab group (68.4% vs 84.6%, P = 0.019). Grade 3 or higher acute toxicity occurred in 15 (15.3%) and 12 (18.5%) patients in the IC and IC with sintilimab groups, respectively. However, this difference was not significant (P = 0.596). After follow-up with a median time of 28.0 months, the IC group had a 2-year PFS rate of 27% (95%CI: 18–36%), whereas the IC with sintilimab group had a 2-year PFS rate of 44% (95%CI: 32–56%), and this difference was significant (P = 0.041). The 2-year OS rates in the IC and IC with sintilimab groups were 61% (95%CI: 52–70%) and 70% (95%CI: 60–80%), respectively, the difference was not significant (P = 0.681).

Conclusions

Addition of sintilimab to IC could provide longer PFS time than traditional chemotherapy regimen, without increasing the toxicity events.

Significance of depth of invasion determined by MRI in cT1N0 tongue squamous cell carcinoma

Depth of invasion (DOI) can be calculated preoperatively by MRI, and whether MRI-determined DOI can predict prognosis as well as whether it can be used as an indicator of neck dissection in cT1N0 tongue squamous cell carcinoma (SCC) remains unknown. The main goal of the current study was to answer these unknowns. A total of 151 patients with surgically treated cT1N0 tongue SCC were retrospectively enrolled, and MRI-determined DOI was measured based on T1-weighted layers with a 3.0T scan. The Chi-square test was used to evaluate the association between clinical pathologic variables and neck lymph node metastasis, and the factors that were significant in the Chi-square test were then analyzed in a multivariate logistic regression analysis model to determine the independent predictors. The main study endpoints were locoregional control (LRC) and disease-specific survival (DSS), and the Kaplan-Meier method (log-rank test) was used to calculate the LRC and DSS rates. The factors that were significant in univariate analysis were then analyzed in the Cox model to determine the independent prognostic factors. A value of p < 0.05 was considered significant, and all statistical analyses were performed with SPSS 20.0. Occult neck lymph node metastasis was noted in 26 (17.2%) patients, and the ROC curve indicated that the optimal cutoff value of MRI-determined DOI was 7.5 mm for predicting neck lymph node metastasis, with a sensitivity of 86.9%. The factors of lymphovascular invasion, MRI-determined DOI, pathologic DOI, and pathologic tumor grade were significantly associated with the presence of neck lymph node metastasis in univariate analysis, and further logistic regression analysis confirmed the independence of lymphovascular invasion, MRI-determined DOI, and pathologic DOI in predicting neck lymph node metastasis. The 5-year LRC and DSS rates were 84% and 90%, respectively. Cox model analysis suggested the MRI-determined DOI was an independent prognostic factor for both LRC and DSS. Therefore, elective neck dissection is suggested if MRI-determined DOI is greater than 7.5 mm in cT1N0 tongue SCC, and MRI-determined DOI ≥ 7.5 mm indicates additional risk for disease recurrence and cancer-related death.

Significance of Pretreatment Neutrophil-to-Lymphocyte Ratio in Mucoepidermoid Carcinoma of Pediatrics: A Multicenter Study

Background: Our goal was to analyze the value of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in the prognosis of pediatrics with parotid mucoepidermoid carcinoma (MEC). Methods: Patients (≤ 18 years old) undergoing surgical treatment for primary parotid MEC were enrolled from multiple clinical centers retrospectively. The χ²-test was used to analyze the associations between clinicopathological variables and the NLR. The main study endpoints were recurrence-free survival (RFS) and disease-specific survival (DSS). The prognostic value of NLR was assessed by Kaplan-Meier method and Cox model analysis. Results: There were 88 patients included in total, with mean NLR of 2.32 (range, 1.8-6.0). Histologic tumor grade and tumor stage were associated with the NLR significantly. The 10-year RFS rates were 98 and 81% for patients with an NLR < 2.32 and patients with an NLR ≥ 2.32, respectively, the difference was significant (p = 0.010). The 10-year DSS rate was 97 and 81% for patients with an NLR < 2.32 and patients with an NLR ≥ 2.32, respectively; the difference was not significant (p = 0.072). The independence of NLR in predicting the RFS was further confirmed in Cox model analysis. Conclusion: The NLR significantly affects the prognosis in pediatrics with primary parotid MEC.

Oncologic Outcomes of Patients With Sarcomatoid Carcinoma of the Hypopharynx

Objectives: Sarcomatoid carcinoma (SaCa) of the hypopharynx is rare, and its clinical pathologic characteristics and prognosis remain unknown. Therefore, the study aimed to analyze the oncologic outcomes of patients with SaCa of the hypopharynx.

Methods: Patients with SaCa of the hypopharynx who were surgically treated in the period from January 1985 to December 2018 were enrolled from two clinical centers. A matched pair study was also performed, and each patient with SaCa of the hypopharynx was matched with one patient with squamous cell carcinoma (SCC) of the hypopharynx. The main study endpoint was disease-specific survival (DSS).

Results: A total of 62 patients (all male) were enrolled. Compared to patients with traditional SCC of the hypopharynx, patients with SaCa of the hypopharynx were older and had higher rates of perineural invasion, lymphovascular invasion and cancer cachexia. The 5-year DSS rate was 20% in patients with SaCa compared to 34% in patients in the matched group, and the difference was significant (p = 0.016). According to the univariate analysis, tumor stage, lymph node stage, disease stage, and cachexia were associated with DSS. According to the Cox model, neck lymph node metastasis and disease stage were independent predictors for worse DSS.

Conclusion: The prognosis of patients with SaCa of the hypopharynx is dismal, and this type of SaCa is associated with more aggressive biological behavior than traditional SCC of the hypopharynx; neck lymph neck node metastasis and disease stage were the most important predictors of DSS.

Significance of the neutrophil-to-lymphocyte ratio in young patients with oral squamous cell carcinoma

Background

The main goal of this study was to evaluate the prognosis of young patients with oral squamous cell carcinoma (SCC) with a focus on the value of the pretreatment neutrophil-to-lymphocyte ratio (NLR).

Materials and methods

Young (≤40 years old) patients with oral SCC were retrospectively enrolled, and each young patient was matched with an old (≥60 years old) oral SCC patient. Associations between the NLR and clinicopathological variables were analyzed by the chi-square test, and the Kaplan–Meier method was used to analyze recurrence-free survival (RFS) and disease-specific survival (DSS) rates.

Results

A total of 103 young patients were enrolled, and compared to the old group, the young group had a significantly lower NLR value (p=0.012). In the young group, the 5-year RFS and DSS rates were 82% and 85%, respectively. In the old group, the 5-year RFS and DSS rates were 65% and 71%, respectively, and the differences between the groups were significant (both p<0.05). In the young patients with an NLR≤2.56, the 5-year DSS rate was 93%, while in the young patients with an NLR >2.56, the 5-year DSS rate was 76%. This difference was significant (p=0.020). A further Cox model analysis confirmed that the NLR was an independent prognostic factor for DSS.

Conclusion

Young patients with oral SCC have a better prognosis than old oral SCC patients, and the NLR is significantly associated with DSS in young patients.

Oncologic outcome of marginal mandibulectomy in squamous cell carcinoma of the lower gingiva

Background

There is a large amount of controversy about the best management of the mandible in oral squamous cell carcinoma (SCC), mainly owing to the inability to acquire accurate bone invasion status. Therefore, our goal was to analyse the oncologic safety in patients undergoing marginal mandibulectomy (MM) for cT1-2 N0 SCC of the lower gingiva.

Methods

Patients undergoing MM for untreated cT1-2 N0 SCC of the lower gingiva were retrospectively enrolled. The main endpoints of interest were locoregional control (LRC) and disease-specific survival (DSS).

Results

A total of 142 patients were included in the analysis, and a pathologic positive node was noted in 27 patients. Cortical invasion was reported in 23 patients, and medullary invasion was reported in 9 patients. The 5-year LRC and DSS rates were 85 and 88%, respectively. Patients with bone invasion had a significantly higher risk for recurrence than patients without bone invasion. However, the DSS was similar in patients with versus without bone invasion. Patients with a high neutrophil lymphocyte ratio had a higher risk for worse prognosis.

Conclusions

The oncologic outcome in patients undergoing MM for cT1-2 N0 SCC of the lower gingiva was favourable; bone invasion was not uncommon, but it significantly decreased the prognosis in patients undergoing MM.

Prognostic Value of the Pretreatment Neutrophil-to-Lymphocyte Ratio in Pediatric Parotid Cancer

Objective: Our goal was to evaluate the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR) in pediatric patients with parotid cancer. Materials and Methods: Pediatric patients with primary parotid cancer were retrospectively enrolled from several clinical centers. The associations between the clinical-pathologic variables and NLR and the prognostic significance of NLR for recurrence-free survival (RFS) and disease-specific survival (DSS) were analyzed. Results: A total of 123 patients were included. The mean NLR was 2.51 and ranged from 1.7 to 6.1. The tumor stage and disease grade were significantly related to NLR. In patients with NLR < 2.51, the 10-year RFS rate was 97%, and in patients with NLR ≥ 2.51, the 10-year RFS rate was 84%; the difference was significant (p = 0.016). In patients with NLR < 2.51, the 10-year DSS rate was 98%, and in patients with NLR ≥ 2.51, the 10-year DSS rate was 83%; this difference was also significant (p = 0.035). Further Cox model analysis confirmed the independence of NLR in predicting the RFS and DSS rates. Conclusions: NLR is significantly associated with prognosis in pediatric patients with parotid cancer.