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Metsäniitty M, Hasnat S, Öhman C, Salo T, Eklund KK, Oscarsson J, Salem A. Zebrafish larvae as a model for studying the impact of oral bacterial vesicles on tumor cell growth and metastasis. Hum Cell 2024:10.1007/s13577-024-01114-6. [PMID: 39138804 DOI: 10.1007/s13577-024-01114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024]
Abstract
Oral bacteria naturally secrete extracellular vesicles (EVs), which have attracted attention for their promising biomedical applications including cancer therapeutics. However, our understanding of EV impact on tumor progression is hampered by limited in vivo models. In this study, we propose a facile in vivo platform for assessing the effect of EVs isolated from different bacterial strains on oral cancer growth and dissemination using the larval zebrafish model. EVs were isolated from: wild-type Aggregatibacter actinomycetemcomitans and its mutant strains lacking the cytolethal distending toxin (CDT) or lipopolysaccharide (LPS) O-antigen; and wild-type Porphyromonas gingivalis. Cancer cells pretreated with EVs were xenotransplanted into zebrafish larvae, wherein tumor growth and metastasis were screened. We further assessed the preferential sites for the metastatic foci development. Interestingly, EVs from the CDT-lacking A. actinomycetemcomitans resulted in an increased tumor growth, whereas EVs lacking the lipopolysaccharide O-antigen reduced the metastasis rate. P. gingivalis-derived EVs showed no significant effects. Cancer cells pretreated with EVs from the mutant A. actinomycetemcomitans strains tended to metastasize less often to the head and tail compared to the controls. In sum, the proposed approach provided cost- and labor-effective yet efficient model for studying bacterial EVs in oral carcinogenesis, which can be easily extended for other cancer types. Furthermore, our results support the notion that these nanosized particles may represent promising targets in cancer therapeutics.
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Affiliation(s)
- Marjut Metsäniitty
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, 00014, Helsinki, Finland
| | - Saika Hasnat
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, 00014, Helsinki, Finland
| | - Carina Öhman
- Oral Microbiology, Department of Odontology, Umeå University, 90187, Umeå, Sweden
| | - Tuula Salo
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, 00014, Helsinki, Finland
| | - Kari K Eklund
- Department of Rheumatology, University of Helsinki and Helsinki University Hospital, 00014, Helsinki, Finland
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, 00014, Helsinki, Finland
| | - Jan Oscarsson
- Oral Microbiology, Department of Odontology, Umeå University, 90187, Umeå, Sweden
| | - Abdelhakim Salem
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, 00014, Helsinki, Finland.
- Translational Immunology Research Program (TRIMM), Research Program Unit (RPU), University of Helsinki, 00014, Helsinki, Finland.
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Khunteta N, Makkar A, Badwal JS, Katta P, Choudhary D, Viswanath M, Malhotra H. Patterns of Neck Nodal Metastasis from Oral Cavity Carcinoma. South Asian J Cancer 2023; 11:326-331. [PMID: 36756101 PMCID: PMC9902093 DOI: 10.1055/s-0041-1733348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Nitin KhuntetaObjectives The aim is to study the patterns of lymph node metastasis from various sites in oral cavity cancer and determine the risk factors for metastasis. Materials and Methods It is a prospective observational study. The inclusion criteria were-245 patients of carcinoma buccal mucosa, anterior two-thirds of tongue, hard palate, oral surface of soft palate, floor of mouth, vestibule, and alveolus. The exclusion criteria were-patients who had received preoperative chemotherapy or radiotherapy and patients with recurrent disease. Statistical Methods All data were analyzed using SPSS 18.0 and Graphpad prism 7 software for statistical analysis. Count data have been expressed as percentages (%). The χ 2 test was used for univariate analysis of the risk factors of cervical lymph node metastasis. The odds ratio value (with 95% confidence interval) was used to express the risk of cervical lymph node metastasis. p -Value of <0.05 was considered as the difference with statistical significance. Results The most common site involved was buccal mucosa. Patterned lymph node metastasis was seen in 93.5% cases. Skip metastasis was seen in 4.31% cases. Level I b was the most common site of nodal involvement for all primary subsites of oral cavity cancer. The incidence of positive nodes on histopathological analysis was highest in cases of lower alveolus (63.15%), followed by tongue. Conclusion In our study, patterns of lymph node metastasis for oral cavity cancer were comparable to other studies with large number of subjects. The incidence of skip metastasis or aberrant status was low. On multivariate analysis, depth of invasion of tumor, pathologic grade, pathologic T stage, and morphologic type of growth were found to be independent predictors of risk for metastasis.
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Affiliation(s)
- Nitin Khunteta
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India,Address for correspondence Nitin Khunteta, MBBS, MS, MCh, DNB Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and TechnologyJaipur 302022, RajasthanIndia
| | - Ayush Makkar
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Jaspreet Singh Badwal
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Prakhar Katta
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Dinesh Choudhary
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Mohinder Viswanath
- Department of Surgical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Hemant Malhotra
- Department of Medical Oncology, Sri Ram Cancer Centre, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
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Bera RN, Singh AK, Tripathi R, Sharma NK. Influence of Site, Size, Depth of Invasion and Histologic Grading on the Occurrence of Cervical Level IIb Metastasis and Extranodal Extension in Clinically N0 Neck of Patients with OSCC: A Single Center Retrospective Analysis. J Maxillofac Oral Surg 2022; 21:1078-1087. [PMID: 36896054 PMCID: PMC9989099 DOI: 10.1007/s12663-022-01776-5] [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: 06/09/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022] Open
Abstract
Background Depth of Invasion ≥ 4 mm, T stage and primary site with more than 20% chances for occult metastasis are currently the accepted indications for elective neck dissection. Nodal metastasis decreases survival by 50%. ENE further reduces the prognosis. Dissection of level IIb lymph nodes in clinically N0 neck does not improve survival. Methods A total of 320 patients were evaluated. Binary and multiple logistic regression and chi-square test were used for data analysis. ROC curve with Youden's J index was used to set up a cutoff value for DOI. The predictor variables were site, size, grading and depth of invasion of primary tumor. Incidence of level IIb metastasis and ENE were the outcomes. Results The study revealed a significant association and risk stratification between primary tumor characteristics with the occurrence of ENE. The cutoff value for DOI predicting ENE was 12.5 mm. Tumors of the oral tongue were an independent risk factor for level IIb metastasis. Discussion Size of primary tumor, DOI, tumors of the mandibular alveolus and poor grading are independent risk factors for ENE. Isolated metastasis to level IIb rarely occurs in the absence of concomitant level IIa metastasis. Size, DOI and grading were significantly associated with level IIb metastasis. However, only tumors of the oral tongue were independent risk factor.
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Affiliation(s)
- Rathindra Nath Bera
- Senior Resident Department of Oral and Maxillofacial Surgery, Dental College Rajendra Institute of Medical Sciences, Ranchi, India
| | - Akhilesh Kumar Singh
- Department of Oral and Maxillofacial Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Richik Tripathi
- Department of Oral and Maxillofacial Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Naresh Kumar Sharma
- Department of Oral and Maxillofacial Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
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Global microRNA expression profile in laryngeal carcinoma unveils new prognostic biomarkers and novel insights into field cancerization. Sci Rep 2022; 12:17051. [PMID: 36224266 PMCID: PMC9556831 DOI: 10.1038/s41598-022-20338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/12/2022] [Indexed: 12/30/2022] Open
Abstract
Laryngeal carcinoma is still a worldwide burden that has shown no significant improvement during the last few decades regarding definitive treatment strategies. The lack of suitable biomarkers for personalized treatment protocols and delineating field cancerization prevents further progress in clinical outcomes. In the light of this perspective, MicroRNAs could be promising biomarkers both in terms of diagnostic and prognostic value. The aim of this prospective study is to find strong prognostic microRNA biomarkers for advanced laryngeal carcinoma and molecular signatures of field cancerization. Sixty patients were enrolled and four samples were collected from each patient: tumor surface and depth, peritumor normal mucosa, and control distant laryngeal mucosa. Initially, a global microRNA profile was conducted in twelve patients from the whole cohort and subsequently, we validated a selected group of 12 microRNAs with RT-qPCR. The follow-up period was 24 months (SD ± 13 months). Microarray expression profile revealed 59 dysregulated microRNAs. The validated expression levels of miR-93-5p (χ2(2) = 4.68, log-rank p = 0.03), miR-144-3p (χ2(2) = 4.53, log-rank p = 0.03) and miR-210-3p (χ2(2) = 4.53, log-rank p = 0.03) in tumor samples exhibited strong association with recurrence-free survival as higher expression levels of these genes predict worse outcome. Tumor suppressor genes miR-144-3p (mean rank 1.58 vs 2.14 vs 2.29, p = 0.000) and miR-145-5p (mean rank 1.57 vs 2.15 vs 2.28, p = 0.000) were significantly dysregulated in peritumor mucosa with a pattern of expression consistent with paired tumor samples thus revealing a signature of field cancerization in laryngeal carcinoma. Additionally, miR-1260b, miR-21-3p, miR-31-3p and miR-31-5p were strongly associated with tumor grade. Our study reports the first global microRNA profile specifically in advanced laryngeal carcinoma that includes survival analysis and investigates the molecular signature of field cancerization. We report two strong biomarkers of field cancerization and three predictors for recurrence in advance stage laryngeal cancer.
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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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Contrera KJ, Huang AT, Shenson JA, Tang C, Roberts D, Myers JN, Weber RS, Lai SY, Williams M, El-Hallal M, Jacob D, Zafereo M. Primary and recurrent regional metastases for lateralized oral cavity squamous cell carcinoma. Surg Oncol 2022; 44:101804. [DOI: 10.1016/j.suronc.2022.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/17/2022] [Accepted: 07/03/2022] [Indexed: 10/16/2022]
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Farrokhian N, Holcomb AJ, Dimon E, Karadaghy O, Ward C, Whiteford E, Tolan C, Hanly EK, Buchakjian MR, Harding B, Dooley L, Shinn J, Wood CB, Rohde SL, Khaja S, Parikh A, Bulbul MG, Penn J, Goodwin S, Bur AM. Development and Validation of Machine Learning Models for Predicting Occult Nodal Metastasis in Early-Stage Oral Cavity Squamous Cell Carcinoma. JAMA Netw Open 2022; 5:e227226. [PMID: 35416990 PMCID: PMC9008495 DOI: 10.1001/jamanetworkopen.2022.7226] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Given that early-stage oral cavity squamous cell carcinoma (OCSCC) has a high propensity for subclinical nodal metastasis, elective neck dissection has become standard practice for many patients with clinically negative nodes. Unfortunately, for most patients without regional metastasis, this risk-averse treatment paradigm results in unnecessary morbidity. OBJECTIVES To develop and validate predictive models of occult nodal metastasis from clinicopathological variables that were available after surgical extirpation of the primary tumor and to compare predictive performance against depth of invasion (DOI), the currently accepted standard. DESIGN, SETTING, AND PARTICIPANTS This diagnostic modeling study collected clinicopathological variables retrospectively from 7 tertiary care academic medical centers across the US. Participants included adult patients with early-stage OCSCC without nodal involvement who underwent primary surgical extirpation with or without upfront elective neck dissection. These patients were initially evaluated between January 1, 2000, and December 31, 2019. EXPOSURES Largest tumor dimension, tumor thickness, DOI, margin status, lymphovascular invasion, perineural invasion, muscle invasion, submucosal invasion, dysplasia, histological grade, anatomical subsite, age, sex, smoking history, race and ethnicity, and body mass index (calculated as weight in kilograms divided by height in meters squared). MAIN OUTCOMES AND MEASURES Occult nodal metastasis identified either at the time of elective neck dissection or regional recurrence within 2 years of initial surgery. RESULTS Of the 634 included patients (mean [SD] age, 61.2 [13.6] years; 344 men [54.3%]), 114 (18.0%) had occult nodal metastasis. Patients with occult nodal metastasis had a higher frequency of lymphovascular invasion (26.3% vs 8.1%; P < .001), perineural invasion (40.4% vs 18.5%; P < .001), and margin involvement by invasive tumor (12.3% vs 6.3%; P = .046) compared with those without pathological lymph node metastasis. In addition, patients with vs those without occult nodal metastasis had a higher frequency of poorly differentiated primary tumor (20.2% vs 6.2%; P < .001) and greater DOI (7.0 vs 5.4 mm; P < .001). A predictive model that was built with XGBoost architecture outperformed the commonly used DOI threshold of 4 mm, achieving an area under the curve of 0.84 (95% CI, 0.80-0.88) vs 0.62 (95% CI, 0.57-0.67) with DOI. This model had a sensitivity of 91.7%, specificity of 72.6%, positive predictive value of 39.3%, and negative predictive value of 97.8%. CONCLUSIONS AND RELEVANCE Results of this study showed that machine learning models that were developed from multi-institutional clinicopathological data have the potential to not only reduce the number of pathologically node-negative neck dissections but also accurately identify patients with early OCSCC who are at highest risk for nodal metastases.
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Affiliation(s)
- Nathan Farrokhian
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Andrew J. Holcomb
- Department of Otolaryngology, Nebraska Methodist Health System, Omaha
| | - Erin Dimon
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Omar Karadaghy
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Christina Ward
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Erin Whiteford
- Department of Otolaryngology, Nebraska Methodist Health System, Omaha
| | - Claire Tolan
- Department of Otolaryngology, Nebraska Methodist Health System, Omaha
| | - Elyse K. Hanly
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa, Iowa City
| | - Marisa R. Buchakjian
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa, Iowa City
| | - Brette Harding
- Department of Otolaryngology–Head and Neck Surgery, University of Missouri, Columbia
| | - Laura Dooley
- Department of Otolaryngology–Head and Neck Surgery, University of Missouri, Columbia
| | - Justin Shinn
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee
| | - C. Burton Wood
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee
| | - Sarah L. Rohde
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee
| | - Sobia Khaja
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis
| | - Anuraag Parikh
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston
| | - Mustafa G. Bulbul
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston
| | - Joseph Penn
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Sara Goodwin
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Andrés M. Bur
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
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Distribution of Metastases in Ent Area – Comparison of Theory and Practice. ACTA MEDICA MARTINIANA 2021. [DOI: 10.2478/acm-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
In head and neck cancers the occurrence of nodal metastases is the most important prognostic factor. Their early diagnosis is crucial for proper treatment. Detection of early metastases is still very difficult. Predictive diagnostic methods such as the sentinel lymph node detection is limited by the occurrence of skip metastases. At our Clinic we prefer a selective neck dissection based on a surgical treatment of predilected lymphatic spread area for each type of head and neck tumor with a preservation of non-lymphatic structures of the neck. The main objective of this article is to analyze the distribution of neck metastases and to study the frequency of skip metastases in head and neck cancer.
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Chen YW, Chang WC, Yang CY, Lin YC, Lin CS, Kuo CS, Li YH. Pretreatment body mass index and serum uric acid and albumin levels as prognostic predictors in patients with oral squamous cell carcinoma. JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/jmedsci.jmedsci_325_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Hoda N, Bc R, Ghosh S, Ks S, B VD, Nathani J. Cervical lymph node metastasis in squamous cell carcinoma of the buccal mucosa: a retrospective study on pattern of involvement and clinical analysis. Med Oral Patol Oral Cir Bucal 2021; 26:e84-e89. [PMID: 33340086 PMCID: PMC7806357 DOI: 10.4317/medoral.24016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/16/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The study was performed with an aim to map the pattern of metastasis of squamous cell carcinomas of buccal mucosa to various cervical lymph node levels and analyze its correlation with primary tumor size and histo-pathological grading. MATERIAL AND METHODS 254 patients with squamous cell carcinoma of the buccal mucosa treated with surgery first approach were analyzed retrospectively. The tumor size was noted from pre-operative CT Scans and were divided into early and advanced tumors. The resected specimen was studied to note the histo-pathological grading of the squamous cell carcinoma and the metastatic deposits at various lymph node levels. RESULTS Out of 254 patients (149 females, 105 males), 145 patients showed histo-pathologically proven metastatic deposits in one or more lymph nodes out of which there were 56 patients showing occult metastasis. 78/145 patients showed metastatic involvement of level IB and/or IA lymph nodes, 31 showed involvement of level II and/or I lymph nodes, 27 showed involvement of level III with or without involvement of level I and II and 9 showed metastasis to level IV and V lymph nodes with or without level I, II or III lymph nodes. Cervical lymph node metastasis had statistically significant association with tumor size with advanced tumors showing worse pattern of metastatic spread beyond level I and II lymph nodes. As the degree of differentiation of squamous cell carcinoma reduced, they were more prone for cervical metastasis with moderately and poorly differentiated squamous cell carcinoma showing higher involvement of level III, IV and V lymph nodes. CONCLUSIONS The majority of buccal mucosa cases showed metastasis to level I, II and III lymph nodes out of which level IB and/or IA was most frequently involved. Metastasis to level IV and V lymph nodes was rare and was seen especially in patients with advanced primary tumor and poor histo-pathologic differentiation.
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Affiliation(s)
- N Hoda
- Department of Oral Oncology, Kidwai Memorial Institue of Oncology, Dr. Mh Marigowda Road, Bengaluru, Karnataka-560029
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Jangir N, Singh A, Jain P, Khemka S. The predictive value of depth of invasion and tumor size on risk of neck node metastasis in squamous cell carcinoma of the oral cavity: A prospective study. J Cancer Res Ther 2021; 18:977-983. [DOI: 10.4103/jcrt.jcrt_783_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Jović A, Fila J, Gršić K, Ivkić M, Ozretić D. Diffusion-weighted MRI: impact of the size of the ROI in detecting metastases in subcentimeter lymph nodes in head and neck squamous cell carcinoma. Neuroradiology 2020; 62:987-994. [PMID: 32418025 DOI: 10.1007/s00234-020-02449-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/28/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Our aim is to determine the impact of the size of ROI in detecting subcentimeter metastatic lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC). Secondary aim is to determine the impact of the histopathologic grade of the primary cancer on the ADC value of the metastatic nodes. METHODS The prospective study included 51 patients with histopathologically proven HNSCC at the primary site. Primary site includes oral cavity, oropharynx, larynx, and hypopharynx. ADC values of the lymph nodes were measured on ADC maps by placing two ROIs in the lymph nodes (0.2 cm2 in the center of the node and the whole node). Lymph nodes were dissected by levels, marked by the surgeon, and sent to the pathologist. RESULTS By applying a smaller ROI, ADC values have greater sensitivity, specificity, NPV, PPV, and AUC in detecting metastasis compared to the ADC value of the entire node (88.0%, 80.73%, 90.7%, 75.9%, 0.912% versus 80.0%, 77.98%, 85% ,71.4%, and 0.819%, respectively) p < 0.001. Statistically significant negative correlation was established between the tumor grade and the ADC of lymph node at ROI 0.2 cm2and ROI of the whole lymph node (rho = - 0.425; p = 0.002, and rho = - 0.298; p = 0.038, respectively). CONCLUSION ROI size affects the ADC value of the nodes. The higher histopathological grade of the primary tumor is inversely correlated with the ADC value of the lymph nodes.
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Affiliation(s)
- Andrijana Jović
- Department of Neuroradiology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Jana Fila
- Department of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Krešimir Gršić
- Department of Head and Neck Surgery and Otorhinolaryngology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Mirko Ivkić
- School of Medicine, University of Rijeka, Braće Branchetta 20/1, 51000, Rijeka, Croatia
| | - David Ozretić
- Department of Neuroradiology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
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Chang WC, Yang CY, Lin CS, Lin CK, Chen YW. Pretreatment body mass index as a prognostic predictor in patients with oral squamous cell carcinoma. Clin Oral Investig 2019; 24:2781-2788. [DOI: 10.1007/s00784-019-03141-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/30/2019] [Indexed: 01/06/2023]
Abstract
Abstract
Objectives
To evaluate whether low body mass index (BMI) is a potential adverse prognostic factor in patients with oral squamous cell carcinoma (OSCC).
Material and methods
This cross-sectional study included 320 patients with OSCC who underwent therapeutic surgical treatment in Taiwan. The pretreatment BMI was measured as a common indicator of the pretreatment nutritional status to calculate the overall survival in Kaplan-Meier method. The adverse histopathological features of margin status, depth of invasion (DOI), lymphovascular invasion (LVSI), perineural invasion (PNI), and extranodal extension (ENE) were analyzed using the Cox regression model.
Results
Low BMI (underweight), DOI > 5 mm, and ENE were identified as detrimental prognostic factors. On multivariate Cox regression analysis, the low BMI group (odds ratio [OR] = 1.683; 95% confidence interval [95% CI] 1.116–2.539; P = 0.022), DOI > 5 mm (OR = 2.399; 95% CI 1.459–3.943; P = 0.001), and ENE (OR = 2.467; 95% CI 1.540–3.951; P = 0.000) yielded reduced survival rate.
Conclusions
The lower BMI had an important and significant effect on the survival of patients with oral cancer and their surgical outcomes. In addition to the adverse histopathological features, a DOI > 5 mm and positive ENE were also identified as the most important prognostic factors.
Clinical relevance
Underweight patients with low BMI, DOI of > 5 mm, and positive ENE should receive more intensive nutritional supplementation and postoperative adjuvant therapy.
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Jiang Q, Tang A, Long S, Qi Q, Song C, Xin Y, Zhang C, Cao Z, Zhang J. Development and validation of a nomogram to predict the risk of occult cervical lymph node metastases in cN0 squamous cell carcinoma of the tongue. Br J Oral Maxillofac Surg 2019; 57:1092-1097. [PMID: 31677799 DOI: 10.1016/j.bjoms.2019.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 09/21/2019] [Indexed: 12/09/2022]
Abstract
We have explored the relations between clinicopathological features and cervical lymph node metastases (LNM) in patients with cN0 squamous cell carcinoma (SCC) of the tongue, and developed and validated a nomogram for predicting the risk of their development. Clinical data on 230 patients with cN0 SCC of the tongue who had had primary extended excision and lymph node dissection of the neck were collected retrospectively. They were divided into a development cohort and a validation cohort in a 4:1 ratio. Logistic regression analysis was used to assess the risk factors of cervical LNM in patients in the development cohort, and a nomogram was established to predict the risk of such nodes. In the validation cohort, the predictive performance and compliance of the model were evaluated using the consistency index (C-index) and calibration curve, and the clinical value was evaluated by decision curve analysis. Of the 230 patients, 60 had cervical LNM, of which 60 were invaded (26%). Analysis of the development cohort showed that the site of the primary lesion, depth of invasion, size of the tumour, and histopathological grade were included in the prediction model, which was validated in the validation cohort. Consistency was high (C-index=0.846), calibration good, and it was clinically valuable. The nomogram could be used to predict the probability of occult cervical LNM before operation in patients with stage cN0 SCC of the tongue. It could also be used as a reference tool for dissection of cervical nodes and a communication tool between the doctor and the patient.
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Affiliation(s)
- Q Jiang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - A Tang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - S Long
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Q Qi
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - C Song
- Department of Oral and Maxillofacial Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Y Xin
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - C Zhang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Z Cao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China.
| | - J Zhang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China.
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Li Y, Liu K, Ke Y, Zeng Y, Chen M, Li W, Liu W, Hua X, Li Z, Zhong Y, Xie C, Yu H. Risk Factors Analysis of Pathologically Confirmed Cervical Lymph Nodes Metastasis in Oral Squamous Cell Carcinoma Patients with Clinically Negative Cervical Lymph Node: Results from a Cancer Center of Central China. J Cancer 2019; 10:3062-3069. [PMID: 31281484 PMCID: PMC6590044 DOI: 10.7150/jca.30502] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/27/2019] [Indexed: 12/30/2022] Open
Abstract
Objective: To explore the risk factors of cervical lymph node metastasis in oral squamous cell carcinoma (OSCC) patients with clinical negative cervical lymph nodes(cN0) and provide a reference for clinical treatment. Methods: The clinical data of 161 OSCC patients with cN0 were retrospectively analyzed. All patients underwent extended primary resection combined with cervical lymph node dissection. The level and number of cervical lymph node metastasis were confirmed by postoperative pathology. The risk factors of cervical lymph node metastasis in patients were analyzed by univariate and multivariate Logistic regression analysis. Results: Thirty-one out of 161 cases (19%) were confirmed cervical lymph node metastasis. Among them, there were 28 cases of lymph node metastasis in one cervical level and 3 cases in two cervical levels. A total of 42 positive lymph nodes were detected in 34 cervical levels. The level number of positive areas in the IA, IB, IIA, IIB, III, IV and V levels was 2, 15, 12, 1, 4,0, and 0, respectively. The corresponding regional metastasis rates were 5.9%, 44.1%, 35.3%, 2.9%, 11.8%, 0% and 0%, respectively. The number of positive lymph node metastases in the corresponding levels were 2, 17, 17, 1, 5, 0, and 0 respectively. Univariate analysis showed that gender, age, lesion location, T stage, and perineural invasion/lymphvascular invasion (PNI/PVI) had no significant effect on cervical lymph node metastasis (P>0.05). The growth pattern, degree of differentiation, depth of invasion, neutrophil/lymphocyte ratio (NLR) and the short/long axis diameter ratio (S/L ratio) of lymph nodes were important factors influencing the cervical lymph node metastasis in cN0 OSCC patients (P<0.05). Multivariate Logistic regression analysis indicated that the growth pattern, degree of differentiation, depth of invasion, NLR, and the S/L ratio of lymph nodes were independent risk factors for cervical lymph node metastasis (P<0.05). Conclusion: The growth pattern, degree of differentiation, depth of invasion, neutrophil/lymphocyte ratio, and the short/long axis diameter ratio of lymph nodes were the independent risk factors for pathological cervical lymph node metastasis in oral squamous cell carcinoma patients with cN0. If patients with the above risk factors receive nonstandard radical neck dissection or no dissection, it may be necessary for them to receive the corresponding regional postoperative radiotherapy.
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Affiliation(s)
- Yonghong Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China.,Department of Oncology and Surgery, The First Hospital of Tianmen City of Hubei Province, Tianmen, Hubei, China
| | - Ke Liu
- Department of Oromaxillofacial and Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yuan Ke
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Yifei Zeng
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Mengge Chen
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Wei Li
- Department of Oncology and Surgery, The First Hospital of Tianmen City of Hubei Province, Tianmen, Hubei, China
| | - Wenming Liu
- Department of Oncology and Surgery, The First Hospital of Tianmen City of Hubei Province, Tianmen, Hubei, China
| | - Xinying Hua
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Zheng Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Yahua Zhong
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Haijun Yu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
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Perinerural, lymphovascular and depths of invasion in extrapolating nodal metastasis in oral cancer. Clin Oral Investig 2019; 24:747-755. [DOI: 10.1007/s00784-019-02921-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
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Comparison of the hospitalization period after microvascular reconstruction flap in trismus patients: free anterolateral thigh flap versus free forearm flap. Clin Oral Investig 2019; 23:2951-2957. [PMID: 30617585 DOI: 10.1007/s00784-018-02799-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 12/20/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The primary strategy for treating oral squamous cell carcinoma (OSCC) is therapeutic resection, with the trismus resection defect reconstructed via free flap. The most popular free flaps include the radial forearm free flap (RFFF) and anterolateral thigh free flap (ALT). This study investigated the relationships between the hospitalization period and a variety of surgical outcomes, as well as maximum inter-incisor distance (IID), in trismus patients who chewed betel nuts. MATERIALS AND METHODS Forty-nine primary OSCC patients who chewed betel nuts and underwent surgical resection and reconstruction between 2010 and 2016 were enrolled in this retrospective study. The data were from a single center in Taiwan. The outcome variable after flap recovery surgery was the duration of postoperative hospitalization. Other factors that were analyzed comprised correlations between hospitalization and a variety of factors, including postoperative inter-incisor distances (IIDs), operative time, gender, and WBC count, upon stratification into two reconstruction groups. RESULTS The mean postoperative hospitalization duration in the ALT group was 22.9 ± 7.2 days, which was significantly shorter than that in the RFFF group (27.8 ± 7.0 days; p = 0.019). Two-week postoperative IID (ALT group: 16.1 ± 0.8 mm; RFFF group: 7.0 ± 0.6 mm) was inversely related to the duration of hospitalization (p = 0.022, r = - 0.372). CONCLUSIONS The ALT flap is more effective than the RFFF flap to reduce the length of hospitalization in trismus patients. CLINICAL RELEVANCE The ALT flap should be considered as a first-line technique in OSCC reconstruction in trismus patient reconstruction.
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Gill A, Vasan N, Givi B, Joshi A. AHNS Series: Do you know your guidelines? Evidence-based management of oral cavity cancers. Head Neck 2017; 40:406-416. [PMID: 29206324 DOI: 10.1002/hed.25024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/13/2017] [Indexed: 12/22/2022] Open
Abstract
Oral cavity squamous cell carcinoma (OCSCC) is the most common nonmelanoma head and neck cancer in the world, with an estimated 405 000 new cases expected each year. Subsites of the oral cavity include the alveolar ridge, buccal mucosa, anterior tongue, tonsillar pillar, retromolar trigone, hard palate, gingiva, and floor of the mouth. In this issue of the AHNS "Do you know your guidelines?" series, we review the evidence-based approach to the management of oral cavity carcinomas based on the framework provided by the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology.
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Affiliation(s)
- Amarbir Gill
- Division of Otolaryngology - Head and Neck Surgery, The University of California, Davis, Sacramento, California
| | - Nilesh Vasan
- Department of Otorhinolaryngology - University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Babak Givi
- Department of Otolaryngology - New York University Langone Medical Center, New York, New York
| | - Arjun Joshi
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University, Washington, DC
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Lymph node density as a prognostic predictor in patients with betel nut-related oral squamous cell carcinoma. Clin Oral Investig 2017; 22:1513-1521. [PMID: 29038963 PMCID: PMC5866838 DOI: 10.1007/s00784-017-2247-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/10/2017] [Indexed: 11/04/2022]
Abstract
Objectives Lymph node metastasis in oral squamous cell carcinoma (OSCC) is a poor prognostic factor. The histopathologic stage (e.g., pN) is used to evaluate the severity of lymph node metastasis; however, the current staging system insufficiently predicts survival and recurrence. We investigated clinical outcomes and lymph node density (LND) in betel nut-chewing individuals. Material and methods We retrospectively analyzed 389 betel nut-exposed patients with primary OSCC who underwent surgical resection in 2002–2015. The prognostic significance of LND was evaluated by overall survival (OS) and disease-free survival (DFS) using the Kaplan-Meier method. Results Kaplan-Meier analyses showed that the 5-year OS and DFS rates in all patients were 60.9 and 48.9%, respectively. Multivariate analysis showed that variables independently prognostic for OS were aged population (hazard ratio [HR] = 1.6, 95% confidence interval [95% CI] = 1.1–2.5; P = .025), and cell differentiation classification (HR = 2.4, 95% CI = 1.4–4.2; P = .002). In pathologic N-positive patients, a receiver operating characteristic (ROC) curve for OS was used and indicated the best cutoff of 0.05, and the multivariate analysis showed that LND was an independent predictor of OS (HR = 2.2, 95% CI = 1.3–3.7; P = .004). Conclusions Lymph node density, at a cutoff of 0.05, was an independent predictor of OS and DFS. OS and DFS underwent multiple analyses, and LND remained significant. The pathologic N stage had no influence in the OS analysis. Clinical relevance LND is a more reliable predictor of survival in betel nut-chewing patients for further post operation adjuvant treatment, such as reoperation or adjuvant radiotherapy.
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Dass A, Singhal SK, Punia R, Gupta N, Verma H, Budhiraja S, Salaria M. Role of Neck Dissection in Clinical T 3N 0M 0 Lesion of Oral Cavity: Changing Trend. J Clin Diagn Res 2017; 11:XC12-XC14. [PMID: 28969257 DOI: 10.7860/jcdr/2017/28192.10521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/16/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Neck dissection is an important part in the management of head and neck malignancies especially in terms of control of nodal metastasis. The study is focused on evaluating the profile of lymph nodes in T3N0M0 lesion of different subsides of oral cavity. AIM To evaluate the utility of neck dissection in T3N0M0 stage of carcinomas of the different region of oral cavity. MATERIALS AND METHODS Ninety patients aged 20 to 70 years underwent treatment for carcinoma of the oral cavity at our center between 2005 and 2013. Of these, 39 patients were stage T3N0M0 and underwent excision of the primary lesion with neck dissection. The data were collected retrospectively from hospital record library. These patients were evaluated clinically, radiologically and compared with intra operative finding. Addition of radiotherapy was decided on final histopathology. RESULTS Out of 39 patients, the site of primary tumour in 21 patients was tongue, in 13 patients was Buccal Mucosa (BM), in 2 patients was lip and in 3 patients was Floor of Mouth (FOM) with tongue. In patients with clinically negative neck nodes, ultrasonography and intra-operative examination revealed the presence of suspicious nodes in 35.9% and 30.7% cases respectively. Occult metastasis in the nodes was identified on histopathological examination in 15 patients (38.5%). A total of 14 patients of carcinoma of tongue and one patient of BM showed positive nodes on histopathology. These patients with positive neck nodes on histopathology, were sent for postoperative radiotherapy. At follow up examination, four patients showed local and distal recurrence and they were managed accordingly. Out of 39 patients, 11 patients of BM, 2 patients of lip, 1 patient of FOM and 6 patients of tongue were disease free in last follow up. CONCLUSION Selective neck dissection is an effective therapeutic intervention in patients without clinically involved neck nodes. It can upstage the tumour and additional treatment may be advised. In patients with carcinoma of buccal mucosa and lip, the patients can be kept under regular follow up when biopsy report showed excision with adequate margin and no nodal metastasis.
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Affiliation(s)
- Arjun Dass
- Professor, Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Surinder K Singhal
- Associate Professor, Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Rps Punia
- Professor, Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Nitin Gupta
- Assistant Professor, Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Hitesh Verma
- Assistant Professor, Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Delhi, India
| | - Shilpi Budhiraja
- Senior Resident, Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Delhi, India
| | - Minakshi Salaria
- Senior Resident, Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College and Hospital, Chandigarh, India
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Gender differences in prognostic factors for oral cancer. Int J Oral Maxillofac Surg 2015; 44:1205-11. [DOI: 10.1016/j.ijom.2015.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/23/2022]
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Metastatic neck disease. Atlas Oral Maxillofac Surg Clin North Am 2015; 23:95-104. [PMID: 25707568 DOI: 10.1016/j.cxom.2014.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Burusapat C, Jarungroongruangchai W, Charoenpitakchai M. Prognostic factors of cervical node status in head and neck squamous cell carcinoma. World J Surg Oncol 2015; 13:51. [PMID: 25889704 PMCID: PMC4336753 DOI: 10.1186/s12957-015-0460-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical nodal status is one of prognostic factors in head and neck squamous cell carcinoma (HNSCC). The objective of this study was to identify prognostic factors of cervical node status including site and size of primary tumors, presence of lymphovascular invasion, and size of cervical node for appropriate further treatment in HNSCC. METHODS A 5-year retrospective review of patients with HNSCC in Phramongkutklao Hospital from 2009 to 2013 was conducted. Histopathologic data on primary tumors and cervical nodes were reviewed. Cervical nodes were divided into five groups: 1-3, 4-6, 7-9, 10-30, and >30 mm. Numbers of positive and negative nodes were compared in different sizes and sites and the presence of extracapsular extension. RESULTS In all, 165 patients and 1,472 nodes were reviewed. The mean age was 52.6 years and 77.58% were male. The most frequent primary site was oral tongue (50.91%). In sum, 52.72% showed lymphovascular invasion. Thirty-five patients (81.40%) in therapeutic neck dissections and 18 patients (69.23%) in prophylactic neck dissections showed nodal metastasis. The mean size of metastatic nodes was 3.89 mm (range, 2-45 mm) and 3.53 mm (range, 2-23 mm), respectively. Significant associations were found between the size of cervical nodes and the site of primary tumor of the oral tongue, lip, base of the tongue, and floor of the mouth (p < 0.05). Metastatic lymph nodes showed extracapsular extension 69.55%. No significance was found between extracapsular extension and clinical staging, size of primary tumor, pathologic differentiation, and size of cervical nodes. Sizes of cervical lymph node of squamous cell carcinoma (SCC) of the oral tongue and lip were statistically significant with the size of tumor and tumor grading (p < 0.05). CONCLUSIONS A statistical significance was found between the size of cervical nodes and the site of primary tumor of the oral tongue and lip. Herein, we recommended performing neck dissection in all cases of SCC of the base of the tongue, floor of the mouth, buccal mucosa, and retromolar trigone.
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Affiliation(s)
- Chairat Burusapat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Thung Phayathai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Weerawut Jarungroongruangchai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Thung Phayathai, Ratchathewi, Bangkok, 10400, Thailand.
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Haksever M, Akduman D, Demir M, Aslan S, Yanılmaz M, Solmaz F. The treatment of neck and parotid gland in cutaneous squamous cell carcinoma of face and forehead and the review of literature. Ann Med Surg (Lond) 2015; 4:48-52. [PMID: 25905014 PMCID: PMC4405003 DOI: 10.1016/j.amsu.2015.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/06/2015] [Accepted: 01/27/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction The treatment of cervical lymph node metastases have a significant prognostic effect on the face and forehead skin cancers. We aimed to point out the importance of loco-regional treatment in cutaneous squamous cell carcinoma of face and forehead. Presentation of case We present our experience with four cases that had squamous cell carcinoma of face and forehead skin. All cases had regional recurrence following 1–3 years after the primary treatment, but did not have local recurrence. Discussion Loco-regional lymphatic treatment for face and forehead skin squamous carcinomas has vital importance especially in the cases with high-risk factors for lymph node metastasis. Conclusion Elective lymph node dissection of appropriate region(s) should be included in the treatment plan for cases which have one or more of high-risk factors for lymph node metastases and long-term follow-up should not be ignored. Elective node dissection should be performed in high-risk of lymphatic metastasis. Long-term follow-up of treated face and forehead skin cancers should not be ignored. Face skin cancer patients should be informed about possible future metastases. Atypical recurrences should be kept in mind in case of regional lymph node dissection.
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Affiliation(s)
- Mehmet Haksever
- Bursa Sevket Yilmaz Training and Research Hospital, Department of Otorhinolaryngology, Yıldırım, 16800, Bursa, Turkey
| | - Davut Akduman
- Bursa Sevket Yilmaz Training and Research Hospital, Department of Otorhinolaryngology, Yıldırım, 16800, Bursa, Turkey
| | - Mustafa Demir
- Bursa Sevket Yilmaz Training and Research Hospital, Department of Otorhinolaryngology, Yıldırım, 16800, Bursa, Turkey
| | - Sündüs Aslan
- Bursa Sevket Yilmaz Training and Research Hospital, Department of Otorhinolaryngology, Yıldırım, 16800, Bursa, Turkey
| | - Muhammed Yanılmaz
- Fatih University, Medical Faculty Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Fevzi Solmaz
- Bursa Sevket Yilmaz Training and Research Hospital, Department of Otorhinolaryngology, Yıldırım, 16800, Bursa, Turkey
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Akdeniz O, Akduman D, Haksever M, Ozkarakas H, Muezzinoglu B. Relationships Between Clinical Behavior of Laryngeal Squamous Cell Carcinomas and Expression of VEGF, MMP-9 and E-Cadherin. Asian Pac J Cancer Prev 2013; 14:5301-10. [DOI: 10.7314/apjcp.2013.14.9.5301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Guo XH, Wang JY, Gao Y, Gao M, Yu GY, Xiang RL, Li L, Yang NY, Cong X, Xu XY, Li SL, Peng X, Wu LL. Decreased adiponectin level is associated with aggressive phenotype of tongue squamous cell carcinoma. Cancer Sci 2013. [PMID: 23181352 DOI: 10.1111/cas.12077] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Circulating adiponectin levels are inversely associated with risk of various obesity-related cancers. However, the effect of adiponectin on carcinogenesis and progression of tongue squamous cell carcinoma (TSCC) remains unknown. We measured serum adiponectin levels in 59 patients with TSCC and 50 healthy controls. Expression of adiponectin and its receptors in paired tumor and paracancerous specimens were determined by immunohistochemical staining (n = 37) and western blot (n = 30), respectively. Serum adiponectin level was lower in patients than in controls (5.0 ± 2.4 vs 8.4 ± 3.5 μg/mL, P < 0.01), and was inversely associated with histological grade and lymph node metastasis but not tumor size. Local adiponectin levels in tumor tissue gradually decreased as tumor-node-metastasis stage increased, while the expression of adiponectin receptors was unchanged. In addition, serum adiponectin levels in the TSCC patients without metabolic and cardiovascular diseases, or without smoking and drinking habits, were still lower than in controls. Furthermore, adiponectin inhibited the migration, but not proliferation, of SCC15 cells in vitro. These results indicate that a decreased adiponectin level is associated with risk of TSCC. Hypoadiponectinemia might be used as a biomarker to predict an aggressive phenotype of TSCC.
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Affiliation(s)
- Xiao-Hong Guo
- Center for Salivary Gland Diseases of Peking University School and Hospital of Stomatology, Department of Physiology and Pathophysiology, Peking University Health Science Center and Key Laboratory of Molecular Cardiovascular Sciences, Beijing, China
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