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Hsu C, Wen Y, Wang H, Hsieh C, Liao C, Lee L, Ng S, Lin C, Chen W, Lin J, Tsai Y, Lee S, Chien C, Hua C, Wang CP, Chen T, Terng S, Tsai C, Fan K, Yeh C, Lin C, Tsao C, Cheng N, Fang T, Huang S, Kang C, Lee L, Fang K, Wang Y, Lin W, Hsin L, Yen T, Liao C. Prognostic impact of bridge or neoadjuvant induction chemotherapy in patients with resected oral cavity cancer: A nationwide cohort study. Cancer Med 2024; 13:e70061. [PMID: 39101462 PMCID: PMC11299076 DOI: 10.1002/cam4.70061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/18/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND While surgery remains the primary treatment for oral squamous cell carcinoma (OCSCC), induction chemotherapy (IC) can be used as a bridging or neoadjuvant therapy. This nationwide study in Taiwan examines the survival outcomes of OCSCC patients who received IC before surgery. METHODS We analyzed data from 29,891 patients with OCSCC. Of these, 29,058 initially underwent surgery (OP group), whereas 833 received IC before surgery (IC + OP group). A propensity score (PS)-matched analysis (4, 1 ratio, 3260 vs. 815 patients) was performed considering tumor subsite, sex, age, Charlson comorbidity index, clinical T1-T4b tumors, clinical N0-3 disease, and clinical stage I-IV. RESULTS In the PS-matched cohort, the 5-year disease-specific survival (DSS) and overall survival (OS) rates were 65% and 57%, respectively. When comparing the OP and IC + OP groups, the 5-year DSS rates were 66% and 62%, respectively (p = 0.1162). Additionally, the 5-year OS rates were 57% and 56%, respectively (p = 0.9917). No significant intergroup differences in survival were observed for specific subgroups with cT4a tumors, cT4b tumors, cN3 disease, pT4b tumors, and pN3 disease. However, for patients with pT4a tumors, the OP group demonstrated superior 5-year outcomes compared to the IC + OP group, with a DSS of 62% versus 52% (p = 0.0006) and an OS of 53% versus 44% (p = 0.0060). Notably, patients with cT2-3, cN1, and c-Stage II disease in the IC + OP group were significantly more likely to achieve pT0-1 status (p < 0.05). CONCLUSIONS Following PS matching, the IC + OP group generally exhibited similar prognosis to the OP group. However, for pT4a tumors, the OP group showed superior 5-year outcomes. While IC may not universally improve survival, it could be advantageous for patients who respond positively to the treatment.
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Affiliation(s)
- Cheng‐Lung Hsu
- Department of Medical OncologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Yu‐Wen Wen
- Clinical Informatics and Medical Statistics Research CenterChang Gung UniversityTaoyuanTaiwan
- Division of Thoracic SurgeryChang Gung Memorial HospitalTaoyuanTaiwan
| | - Hung‐Ming Wang
- Department of Medical OncologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Chia‐Hsun Hsieh
- Department of Medical OncologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Chi‐Ting Liao
- Department of Medical OncologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Li‐Yu Lee
- Department of PathologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Shu‐Hang Ng
- Department of Diagnostic RadiologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Chien‐Yu Lin
- Department of Radiation OncologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Wen‐Cheng Chen
- Department of Radiation OncologyChang Gung Memorial HospitalChiayiTaiwan
| | - Jin‐Ching Lin
- Department of Radiation OncologyChanghua Christian HospitalChanghuaTaiwan
| | - Yao‐Te Tsai
- Department of Otorhinolaryngology‐Head and Neck SurgeryChang Gung Memorial HospitalChiayiTaiwan
| | - Shu‐Ru Lee
- Research Service Center for Health InformationChang Gung UniversityTaoyuanTaiwan
| | - Chih‐Yen Chien
- Department of Otolaryngology, Chang Gung Memorial Hospital Kaohsiung Medical CenterChang Gung University College of MedicineKaohsiungTaiwan
| | - Chun‐Hung Hua
- Department of OtorhinolaryngologyChina Medical University HospitalTaichungTaiwan
| | - Cheng Ping Wang
- Department of OtolaryngologyNational Taiwan University Hospital and College of MedicineTaipeiTaiwan
| | - Tsung‐Ming Chen
- Department of OtolaryngologyShuang Ho Hospital, Taipei Medical UniversityNew Taipei CityTaiwan
| | - Shyuang‐Der Terng
- Department of Head and Neck SurgeryKoo Foundation Sun Yat‐Sen Cancer CenterTaipeiTaiwan
| | - Chi‐Ying Tsai
- Department of Oral and Maxillofacial SurgeryChang Gung Memorial Hospital, Chang Gung UniversityTaoyuanTaiwan
| | - Kang‐Hsing Fan
- Department of Radiation OncologyNew Taipei Municipal TuCheng HospitalNew Taipei CityTaiwan
| | - Chih‐Hua Yeh
- Department of Diagnostic RadiologyChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Chih‐Hung Lin
- Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Chung‐Kan Tsao
- Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Nai‐Ming Cheng
- Department of Nuclear Medicine and Molecular Imaging CenterChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Tuan‐Jen Fang
- Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Shiang‐Fu Huang
- Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Chung‐Jan Kang
- Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Li‐Ang Lee
- Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Ku‐Hao Fang
- Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Yu‐Chien Wang
- Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Wan‐Ni Lin
- Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Li‐Jen Hsin
- Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Tzu‐Chen Yen
- Department of Nuclear Medicine and Molecular Imaging CenterChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
| | - Chun‐Ta Liao
- Department of Otorhinolaryngology, Head and Neck SurgeryChang Gung Memorial Hospital and Chang Gung UniversityTaoyuanTaiwan
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Patel AM, Haleem A, Choudhry HS, Brody RM, Brant JA, Carey RM. Elective Neck Dissection in cT1-4 N0M0 Head and Neck Basaloid Carcinoma. Otolaryngol Head Neck Surg 2024; 171:457-470. [PMID: 38613196 DOI: 10.1002/ohn.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To investigate the survival benefit of elective neck dissection (END) over neck observation in surgically resected cT1-4 N0M0 head and neck basaloid carcinoma (HNBC). STUDY DESIGN Retrospective cohort study. SETTING The 2006 to 2017 hospital-based National Cancer Database. METHODS Patients with surgically resected cT1-4 N0M0 HNBC were selected. Linear, binary logistic, Kaplan-Meier, and Cox proportional hazards regression models were implemented. RESULTS Of 857 patients satisfying inclusion criteria, the majority were male (77.0%) and white (88.1%) with disease of the oral cavity (21.5%) or oropharynx (42.9%) classified as high grade (76.9%) and cT1-2 (72.9%). 389 (45.4%) patients underwent END. END utilization between 2006 and 2017 increased for cT1-2 disease (33.3% vs 56.9%, R2 = .699) but remained relatively constant for cT3-4 disease (66.7% vs 57.9%, R2 = .062). One-hundred and fifteen (29.6%) ENDs detected occult nodal metastases (ONMs). The 5-year overall survival (OS) of patients undergoing neck observation and END was 65.6% and 66.8%, respectively (P = .652). END was not associated with improved OS in survival analyses stratified by patient demographics, clinicopathologic features, and adjuvant therapy. Compared with surgery alone, adjuvant radiotherapy (adjusted hazard ratio: 0.74, 95% confidence interval [CI]: 0.57-0.97, P = .031) was associated with improved OS. END (hazard ratio [HR]: 0.96, 95% CI: 0.71-1.28, P = .770) and ONM (HR: 1.12, 95% CI: 0.78-1.61, P = .551) were not associated with OS. CONCLUSION END is performed in nearly half of patients with HNBC but is not associated with improved OS, even after stratifying survival analyses by patient demographics, clinicopathologic features, and adjuvant therapy. The rate of ONM approaching 30%, however, justifies inclusion of END in the surgical management of HNBC.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hassaam S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Patel AM, Haleem A, Maxwell R, Lukens JN, Lin A, Brody RM, Brant JA, Carey RM. Choice of Adjuvant Radiotherapy Facility in Major Salivary Gland Cancer. Laryngoscope 2024; 134:3620-3632. [PMID: 38400788 DOI: 10.1002/lary.31352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Undergoing surgery and adjuvant radiotherapy (aRT) at the same facility has been associated with higher overall survival (OS) in head and neck squamous cell carcinoma. Our study investigates whether undergoing surgery and aRT at the same academic facility is associated with higher OS in major salivary gland cancer (MSGC). METHODS The 2006-2018 National Cancer Database was queried for patients with MSGC undergoing surgery at an academic facility and then aRT. Multivariable binary logistic and Cox proportional hazards regression models were implemented. RESULTS Of 2801 patients satisfying inclusion criteria, 2130 (76.0%) underwent surgery and aRT at the same academic facility. Residence in a less populated area (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.16-2.45), treatment without adjuvant chemotherapy (aOR 1.97, 95% CI 1.41-2.76), and aRT duration (aOR 1.02, 95% CI 1.01-1.04) were associated with undergoing surgery and aRT at different facilities on multivariable logistic regression adjusting for patient demographics, clinicopathologic features, and adjuvant therapy (p < 0.01). Five-year OS was higher in patients undergoing surgery and aRT at the same academic facility (68.8% vs. 61.9%, p < 0.001). Undergoing surgery and aRT at different facilities remained associated with worse OS on multivariable Cox regression (aHR 1.41, 95% CI 1.10-1.81, p = 0.007). CONCLUSION Undergoing surgery and aRT at the same academic facility is associated with higher OS in MSGC. Although undergoing surgery and aRT at the same academic facility is impractical for all patients, academic physicians should consider same-facility treatment for complex patients who would most benefit from clear multidisciplinary communication. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3620-3632, 2024.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Afash Haleem
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Russell Maxwell
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
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Patel AM, Haleem A, Choudhry HS, Povolotskiy R, Roden DF. Patterns and Trends in Adjuvant Therapy for Major Salivary Gland Cancer. Otolaryngol Head Neck Surg 2024; 171:155-171. [PMID: 38482915 DOI: 10.1002/ohn.715] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/16/2024] [Accepted: 02/17/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To investigate adjuvant therapy indications, utilization, and associated survival disparities in major salivary gland cancer (MSGC). STUDY DESIGN Retrospective cohort study. SETTING The 2006 to 2017 National Cancer Database. METHODS Patients with surgically resected MSGC were included (N = 11,398). pT3-4 classification, pN2-3 classification, lymphovascular invasion, pathologic extranodal extension (pENE), and positive surgical margin (PSM) were considered indications for adjuvant radiotherapy (aRT). pENE and PSM were considered possible indications for adjuvant chemotherapy. Multivariable logistic and Cox regression models were implemented. RESULTS Among 6694 patients with≥ $\ge $ 1 indication for aRT, 1906 (28.5%) received no further treatment and missed aRT. Age, race, comorbidity status, facility type, and distance to reporting facility were associated with missed aRT (P < .025). Among 4003 patients with ≥1 possible indication for adjuvant chemoradiotherapy (aCRT), 914 (22.8%) received aCRT. Patients with pENE only (38.5%) and both pENE and PSM (44.0%) received aCRT more frequently than those with PSM only (17.0%) (P < .001). Academic facility was associated with aCRT utilization (P < .05). aCRT utilization increased between 2006 and 2017 in both academic (14.8% vs 23.9%) and nonacademic (8.8% vs 13.5%) facilities (P < .05). Among 2691 patients with ≥1 indication for aRT alone, missed aRT portended poorer OS (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.28-2.03, P < .001). Among 4003 patients with ≥1 possible indication for aCRT, aRT alone (HR: 1.02, 95% CI: 0.89-1.18, P = .780) and aCRT were associated with similar OS. CONCLUSION Missed aRT in MSGC occurs frequently and portends poorer OS. Further studies clarifying indications for aCRT are required.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hassaam S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Roman Povolotskiy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Dylan F Roden
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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5
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Taylor KJ, Amdal CD, Bjordal K, Astrup GL, Herlofson BB, Duprez F, Gama RR, Jacinto A, Hammerlid E, Scricciolo M, Jansen F, Verdonck-de Leeuw IM, Fanetti G, Guntinas-Lichius O, Inhestern J, Dragan T, Fabian A, Boehm A, Wöhner U, Kiyota N, Krüger M, Bonomo P, Pinto M, Nuyts S, Silva JC, Stromberger C, Specenier P, Tramacere F, Bushnak A, Perotti P, Plath M, Paderno A, Stempler N, Kouri M, Grégoire V, Singer S. Long-term health-related quality of life in head and neck cancer survivors: A large multinational study. Int J Cancer 2024; 154:1772-1785. [PMID: 38312044 DOI: 10.1002/ijc.34861] [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: 06/16/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 02/06/2024]
Abstract
Head and neck cancer (HNC) patients suffer from a range of health-related quality of life (HRQoL) issues, but little is known about their long-term HRQoL. This study explored associations between treatment group and HRQoL at least 5 years' post-diagnosis in HNC survivors. In an international cross-sectional study, HNC survivors completed the European Organization for Research and Treatment of Cancer (EORTC) quality of life core questionnaire (EORTC-QLQ-C30) and its HNC module (EORTC-QLQ-H&N35). Meaningful HRQoL differences were examined between five treatment groups: (a) surgery, (b) radiotherapy, (c) chemo-radiotherapy, (d) radiotherapy ± chemotherapy and neck dissection and (e) any other surgery (meaning any tumour surgery that is not a neck dissection) and radiotherapy ± chemotherapy. Twenty-six sites in 11 countries enrolled 1105 survivors. They had a median time since diagnosis of 8 years, a mean age of 66 years and 71% were male. After adjusting for age, sex, tumour site and UICC stage, there was evidence for meaningful differences (10 points or more) in HRQoL between treatment groups in seven domains (Fatigue, Mouth Pain, Swallowing, Senses, Opening Mouth, Dry Mouth and Sticky Saliva). Survivors who had single-modality treatment had better or equal HRQoL in every domain compared to survivors with multimodal treatment, with the largest differences for Dry Mouth and Sticky Saliva. For Global Quality of Life, Physical and Social Functioning, Constipation, Dyspnoea and Financial Difficulties, at least some treatment groups had better outcomes compared to a general population. Our data suggest that multimodal treatment is associated with worse HRQoL in the long-term compared to single modality.
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Affiliation(s)
- Katherine J Taylor
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre Mainz, Mainz, Germany
| | - Cecilie D Amdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Research Support Service, Oslo University Hospital, Oslo, Norway
| | - Kristin Bjordal
- Research Support Service, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Guro L Astrup
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Bente B Herlofson
- University of Oslo, Faculty of Dentistry, Oslo, Norway
- Department of Otorhinolaryngology, Oslo University Hospital, Oslo, Norway
| | - Fréderic Duprez
- Department of Radiotherapy-Oncology, Ghent University Hospital, Faculty of Medicine and Health Sciences-Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Ricardo R Gama
- Department of Head and Neck Surgery, Barretos Cancer Hospital, Barretos, Brazil
| | - Alexandre Jacinto
- Department of Radiation Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - Eva Hammerlid
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Femke Jansen
- Department Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Giuseppe Fanetti
- Division of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Johanna Inhestern
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Department of Otorhinolaryngology, Oberhavelkliniken Hennigsdorf, Hennigsdorf, Germany
| | - Tatiana Dragan
- Department of Radiation Oncology, Head and Neck Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Andreas Boehm
- Department of Otorhinolaryngology, St. Georg Hospital, Leipzig, Germany
| | - Ulrike Wöhner
- Department of Otorhinolaryngology, St. Georg Hospital, Leipzig, Germany
| | - Naomi Kiyota
- Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Maximilian Krüger
- Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Centre Mainz, Mainz, Germany
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Monica Pinto
- Rehabilitation Medicine Unit, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italy
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Joaquim Castro Silva
- Department of Otolaryngology, Head and Neck Surgery, Instituto Português de Oncologia Francisco Gentil Do Porto, Porto, Portugal
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Pol Specenier
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | | | - Ayman Bushnak
- Department of Otorhinolaryngology, University Hospital Gießen und Marburg, Giessen, Germany
| | - Pietro Perotti
- Department of Otorhinolaryngology - Head and Neck Surgery, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Michaela Plath
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Noa Stempler
- Oral Medicine Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Maria Kouri
- Dental Oncology Unit, Department of Oral Medicine and Pathology and Hospital Dentistry, Dental School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vincent Grégoire
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre Mainz, Mainz, Germany
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Patel AM, Haleem A, Choudhry HS, Brant JA, Brody RM, Carey RM. Surgical Resection Improves Overall Survival in cT4b Major Salivary Gland Cancer. Otolaryngol Head Neck Surg 2024; 170:1349-1363. [PMID: 38426575 DOI: 10.1002/ohn.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/09/2024] [Accepted: 01/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To compare surgical and nonsurgical definitive treatment in cT4b major salivary gland cancer (MSGC). STUDY DESIGN Retrospective cohort study. SETTING The 2004 to 2019 National Cancer Database. METHODS The NCDB was queried for patients with cT4b MSGC (N = 976). Patients undergoing definitive treatment with (1) surgical resection + adjuvant therapy, (2) radiotherapy (RT) alone, or (3) chemoradiotherapy (CRT) were included in Kaplan-Meier and Cox survival analyses. RESULTS Of 219 patients undergoing definitive treatment, 148 (67.6%) underwent surgical resection + adjuvant therapy and 71 (32.4%) underwent RT or CRT. There were no documented mortalities within 90 days of surgical resection. Tumor diameter and nodal metastasis were associated with decreased odds of undergoing definitive treatment (P < 0.025). Patients with positive surgical margins (PSM) had higher 5-year overall survival (OS) than those undergoing definitive RT or CRT (48.5% vs 30.1%, P = 0.018) and similar 5-year OS as those with negative margins (48.5% vs 54.0%, P = 0.205). Surgical resection + adjuvant therapy (adjusted hazard ratio: 0.55, 95% confidence interval [CI]: 0.37-0.84) was associated with higher OS than definitive RT or CRT (P < 0.025). A separate cohort of 961 patients with cT4a tumors undergoing surgical resection + adjuvant therapy was created; cT4a and cT4b (hazard ratio: 1.02, 95% CI: 0.80-1.29, P = 0.896) tumors had similar OS. CONCLUSION A minority of patients with cT4b MSGC undergo definitive treatment. Surgical resection + adjuvant therapy was safe and associated with higher OS than definitive RT or CRT, despite high rate of PSM. In the absence of clinical trial data, appropriately selected patients with cT4b MSGC may benefit from surgical resection.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hassaam S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology-Head and Neck Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology-Head and Neck Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology-Head and Neck Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Raab G, Babu C, Yu Y, Givi B, Wong RJ, Lee NY, Zakeri K. Higher Rates of Inadequate Adjuvant Radiation Dose Among Older Adults with Head and Neck Cancer. Laryngoscope 2024; 134:2206-2211. [PMID: 37983853 DOI: 10.1002/lary.31188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To determine the rate of inadequate radiotherapy and identify risk factors associated with inadequate adjuvant radiotherapy for head and neck cancer among older adults. METHODS A retrospective review of the National Cancer Database (NCDB) was performed to identify patients diagnosed with squamous cell cancer of the head and neck between 2004 and 2017. Patients with a single malignancy, negative surgical margins, no extranodal extension, and receipt of adjuvant radiation without systemic therapy were included in the study cohort. The main outcome of interest was the adjuvant radiation dose received. Participant data were compared using univariable, multivariable, and correlation analyses to evaluate risk factors for inadequate radiation therapy (RT) dosing. RESULTS Among 7608 patients, 1010 patients (13.3%) received an inadequate radiation dose and 6598 (86.7%) received an adequate dose. Patients living in a higher income zip-code, younger age, and those who received intensity-modulated RT (IMRT) were more likely to receive an adequate radiation dose (p < 0.05). Patients older than 70 and 80 years old had a greater likelihood of receiving an inadequate radiation dose (≥70 vs. <70: 16.9% vs. 12.5%; p < 0.05 and ≥80 vs. <80: 20.6% vs. 13.0%%; p < 0.05). Similarly, increasing age was negatively correlated with radiation dose (correlation coefficient: -0.05; p < 0.001). CONCLUSION A substantial proportion of older patients receiving adjuvant radiation do not complete the full treatment. Older age, year of diagnosis, non-IMRT, and living in a lower-income zip code were associated with early termination of RT. Future studies should examine strategies to improve tolerance of adjuvant RT so that more patients complete the full treatment. LEVEL OF EVIDENCE 3; Cohort Study Laryngoscope, 134:2206-2211, 2024.
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Affiliation(s)
- Gabriel Raab
- Weill Cornell Medical College, New York, New York, USA
| | | | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Babak Givi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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8
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Zarate Rodriguez JG, Raper L, Sanford DE, Trikalinos NA, Hammill CW. Race and Odds of Surgery Offer in Small Bowel and Pancreas Neuroendocrine Neoplasms. Ann Surg Oncol 2024; 31:3249-3260. [PMID: 38294612 DOI: 10.1245/s10434-024-14906-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Despite existing society guidelines, management of pancreatic (PanNEN) and small bowel (SBNEN) neuroendocrine neoplasms remains inconsistent. The purpose of this study was to identify patient- and/or disease-specific characteristics associated with increased odds of being offered surgery for PanNEN and SBNEN. PATIENTS AND METHODS The Surveillance, Epidemiology, and End Results (SEER) Program database and the National Cancer Database (NCDB) were queried for patients with PanNEN/SBNEN. Demographic and pathologic data were compared between patients who were offered surgery and those who were not. Multivariate logistic regression was performed to identify factors independently associated with being offered surgery. RESULTS In SEER, there were 3641 patients with PanNEN (54.7% were offered surgery) and 5720 with SBNEN (86.0% were offered surgery). On multivariate analysis of SEER, non-white race was associated with decreased odds of surgery offer for SBNEN [odds ratio (OR) 0.58, p < 0.001], but not PanNEN (p = 0.187). In NCDB, there were 28,483 patients with PanNEN (57.5% were offered surgery) and 42,675 with SBNEN (86.9% were offered surgery). On multivariate analysis of NCDB, non-white race was also associated with decreased odds of surgery offer for SBNEN (OR 0.61, p < 0.001) but not PanNEN (p = 0.414). CONCLUSIONS This study's findings suggest that, in addition to previously reported disparities in surgical resection and surgery refusal rates, racial/ethnic disparities also exist earlier in the course of treatment, with non-white patients being less likely to be offered surgery for SBNEN but not for PanNEN; this is potentially due to discrepancies in rates of referral to academic centers for pancreas and small bowel malignancies.
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Affiliation(s)
- Jorge G Zarate Rodriguez
- Division of Hepatobiliary, Pancreatic & Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Lacey Raper
- Division of Hepatobiliary, Pancreatic & Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- University of Missouri-Columbia School of Medicine, Columbia, MO, USA
| | - Dominic E Sanford
- Division of Hepatobiliary, Pancreatic & Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Nikolaos A Trikalinos
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Chet W Hammill
- Division of Hepatobiliary, Pancreatic & Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
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9
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Danstrup CS, Andersen M, Lundbye-Christensen S, Sommer M, Lyhne NM. Survey of Danish Head and Neck Cancer Patients' Positions on Personalized Medicine, Gene Tests, and Personalized Follow-Up. J Pers Med 2024; 14:404. [PMID: 38673031 PMCID: PMC11051027 DOI: 10.3390/jpm14040404] [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: 03/19/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
The field of personalized medicine (PM) has grown rapidly because of the "omics revolution", but PM may be difficult for patients to comprehend. This study sought to explore head and neck cancer (HNC) patients' positions and knowledge of PM, gene tests, and follow-up and to compare HNC patients' positions to a sample from a national Danish questionnaire. To do this, patients with prior HNC were invited to participate in a questionnaire. Initial interviews revealed a heterogenic understanding of PM between patients. A total of 226 patients were included in the survey and 177 patients with complete data were included for analysis. Most patients were more positive than negative towards gene tests and gene research (83% and 93%, respectively), but 72% had little or no knowledge of the subject. Almost all patients, 98%, were satisfied with their follow-up. Significantly more patients with HNC were positive towards gene research compared to a sample from a national Danish questionnaire (p < 0.001). Patients with HNC were positive towards gene tests and PM, but patients may not understand or comprehend the information given, and it is important to inform and educate patients and health professionals to establish common ground in PM.
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Affiliation(s)
- Christian Sander Danstrup
- Department of Otorhinolaryngology-Head and Neck Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Maria Andersen
- Department of Clinical Oncology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
- Research Data and Biostatistics, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Mia Sommer
- Department of Hematology, Aalborg University Hospital, 9000 Aalborg, Denmark
- School of Nursing, University College Northern Denmark, 9000 Aalborg, Denmark
| | - Nina Munk Lyhne
- Department of Otorhinolaryngology-Head and Neck Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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Ahmed A, Whittington J, Shafaee Z. Impact of Commission on Cancer Accreditation on Cancer Survival: A Surveillance, Epidemiology, and End Results (SEER) Database Analysis. Ann Surg Oncol 2024; 31:2286-2294. [PMID: 38093167 DOI: 10.1245/s10434-023-14709-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/21/2023] [Indexed: 03/06/2024]
Abstract
INTRODUCTION To analyze the cancer burden in the United States, researchers are relying on the Surveillance, Epidemiology, and End Results (SEER) Program. Our objective was to analyze differences in cancer outcome between Commission on Cancer (CoC)-accredited and non-accredited facilities. METHODS The SEER database was queried for diagnosis years 2018 and 2019. Only analytic cases were included. Observed survival was calculated using the Kaplan-Meier method for all cancer sites, stratified by accreditation status. Univariate analyses were performed to quantify differences in survival between cancer cases in CoC-accredited and non-CoC-accredited facilities. Cancers of interest were chosen based on statistical significance (p < 0.01) and clinical significance (> 25% difference in end survival). Multivariate analyses were conducted on cancers of interest. RESULTS Overall, there were 602,185 cases from CoC-accredited facilities and 198,492 from non-CoC-accredited facilities. 5 of 59 solid organ cancers showed statistically and clinically significant reductions in survival in non-accredited facilities (lung and bronchus: 27.9%; liver: 41.1%; esophagus: 30.4%; pancreas: 32.7%; intrahepatic bile duct: 39.4%). Multivariate analysis on these 5 cancers was performed. CoC accreditation was a statistically significant variable decreasing the hazard in all 5 cancers (hazard ratio 0.86-0.91; all p-values <0.005). All these cancers demand resource-intensive treatment. CONCLUSION Accreditation has a significant impact on survival in 5/59 solid organ cancers. Although accredited facilities may be better apt to handle these cancer cases, the survival in most cancers is not significantly affected by accreditation. However, examining longer-term endpoints elucidate further nuances. Herein, CoC accreditation was found to be an independent variable impacting 2-year survival for a minority of cancers.
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Affiliation(s)
- Armaan Ahmed
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Biophysics, Johns Hopkins University, Baltimore, MD, USA
- Elmhurst Hospital, NYC Health + Hospitals, New York, NY, USA
| | - Jennifer Whittington
- Elmhurst Hospital, NYC Health + Hospitals, New York, NY, USA
- Department of Surgery, Icahn School of Medicine, New York, NY, USA
| | - Zahra Shafaee
- Elmhurst Hospital, NYC Health + Hospitals, New York, NY, USA.
- Department of Surgery, Icahn School of Medicine, New York, NY, USA.
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11
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Raab G, Yu Y, Sherman E, Wong R, Mell LK, Lee NY, Zakeri K. Nomogram to predict risk of early mortality following definitive or adjuvant radiation and systemic therapy for head and neck cancer. Clin Transl Radiat Oncol 2024; 45:100725. [PMID: 38304239 PMCID: PMC10832379 DOI: 10.1016/j.ctro.2024.100725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 02/03/2024] Open
Abstract
Purpose/Objectives We sought to create nomograms to predict individual risk of early mortality, which can identify patients who require interventions to prevent early death. Methods We included patients in the National Cancer Database with non-metastatic squamous cell carcinoma of the head and neck who received radiation and systemic therapy between 2004 and 2017 in the definitive or adjuvant setting. Early mortality was defined as any death less than 90 days after starting radiation. Multivariable logistic regression was used to assess the relationship between covariates and early mortality. Nomograms to predict the risk of early death were created for both the definitive and adjuvant settings. Results Among 84,563 patients in the definitive group and 18,514 patients in the adjuvant group, rates of early mortality were 3.5 % (95 % CI 3.4-3.7 %) and 2.2 %, (95 % CI 1.9-2.4 %), respectively. Patients above the age of 70 had an early mortality rate of 7.8 % (95 % CI 7.3-8.2 %) in the definitive group and 4.4 % (95 % CI 3.6-5.4 %) in the adjuvant group. In the multivariable analysis, age, comorbidity, T and N category, and tumor site were associated with early mortality in both cohorts (p < 0.05 for all). Nomograms including age, comorbidity, T and N category and tumor site performed better than age alone at predicting early mortality (AUC for definitive group: 0.70 vs 0.66; AUC for adjuvant group: 0.71 vs 0.61). Conclusion Nomograms including age, comorbidity, T and N category and tumor site were developed to predict the risk of early death following definitive or adjuvant chemoradiation.
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Affiliation(s)
- Gabriel Raab
- Weill Cornell Medical College, New York, NY, USA
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Loren K. Mell
- Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA, USA
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Patel AM, Vedula S, Haleem A, Choudhry HS, Tseng CC, Park RCW. Elective Neck Dissection for cT1-4 N0M0 Head and Neck Verrucous Carcinoma. Otolaryngol Head Neck Surg 2023; 169:1187-1199. [PMID: 37278222 DOI: 10.1002/ohn.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/21/2023] [Accepted: 04/29/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the survival benefit of elective neck dissection (END) over neck observation in cT1-4 N0M0 head and neck verrucous carcinoma (HNVC). STUDY DESIGN Retrospective cohort study. SETTING The 2006 to 2017 National Cancer Database. METHODS Patients with surgically resected cT1-4 N0M0 HNVC were selected. Linear, binary logistic, Kaplan-Meier, and Cox proportional hazards regression models were utilized. RESULTS Of 1015 patients satisfying inclusion criteria, 223 (22.0%) underwent END. The majority of patients were male (55.4%) and white (91.0%) with disease of the oral cavity (67.6%) classified as low grade (90.0%) and cT1-2 (81.8%). The minority of ENDs (4.0%) detected occult nodal metastases. The rate of END increased from 2006 to 2017 for both cT1-2 (16.3% vs 22.0%, p = .126, R2 = 0.405) and cT3-4 (41.7% vs 70.0%, p = .424, R2 = 0.232) disease but these trends were not statistically significant. Independent predictors of undergoing END included treatment at an academic facility (adjusted odds ratio [aOR]: 1.75, 95% confidence interval [CI]: 1.19-2.55), cT3-4 disease (aOR: 3.31, 95% CI: 2.16-5.07), and tumor diameter (aOR: 1.09, 95% CI: 1.01-1.19) (p < 0.05). The 5-year overall survival (OS) of patients treated with and without END was 71.3% and 70.6%, respectively (p = .661). END did not significantly reduce the 5-year hazard of death (adjusted hazard ratio: 1.25, 95% CI: 0.91-1.71, p = .172). END did not significantly improve 5-year OS in univariate and multivariate analyses stratified by several patient, facility, tumor, and treatment characteristics. CONCLUSION END does not confer an appreciable survival benefit in HNVC, even after stratifying univariate and multivariate analyses by several patient, facility, tumor, and treatment characteristics. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sudeepti Vedula
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hassaam S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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13
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Ho AS, Luu M, Balzer BL, Aro K, Jang JK, Mita AC, Scher KS, Mallen-St Clair J, Vasquez M, Bastien AJ, Epstein JB, Lin DC, Chen MM, Zumsteg ZS. Comparative impact of grade on mortality across salivary cancers: A novel, unifying staging system. Head Neck 2023; 45:2028-2039. [PMID: 37345665 DOI: 10.1002/hed.27429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND The comparative impact of histologic variants and grade has not been well described. METHODS Salivary cancer histologies were profiled using hospital and population-based cancer registries. Multivariable models were employed to assess relationships between histology, grade, and survival. RESULTS On univariate analysis, histologic variants exhibited a wide spectrum of mortality risk (5-year overall survival (OS): 86% (acinic cell carcinoma), 78% (mucoepidermoid carcinoma), 72% (adenoid cystic carcinoma), 64% (carcinoma ex-pleomorphic adenoma), 52% (adenocarcinoma NOS), and 47% (salivary duct carcinoma) (p < 0.001). However, on multivariable analysis these differences largely vanished. Worsening grade corresponded with deteriorating survival (5-year OS: 89% [low-grade], 81% [intermediate-grade], 45% [high-grade]; p < 0.001), which was upheld on multivariable analysis and propensity score matching. Recursive partitioning analysis generated TNM + G schema (c-index 0.75) superior to the existing system (c-index 0.73). CONCLUSION Grade represents a primary determinant of salivary cancer prognosis. Integrating grade into stage strengthens current staging systems.
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Affiliation(s)
- Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Biostatistics and Bioinformatics Research Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Bonnie L Balzer
- Samuel Oschin Comprehensive Cancer Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Pathology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Julie K Jang
- Samuel Oschin Comprehensive Cancer Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Alain C Mita
- Samuel Oschin Comprehensive Cancer Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kevin S Scher
- Samuel Oschin Comprehensive Cancer Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Missael Vasquez
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Amanda J Bastien
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - De-Chen Lin
- Herman Ostrow School of Dentistry, University of Southern California, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michelle M Chen
- Samuel Oschin Comprehensive Cancer Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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14
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Tripathi R, Larson K, Fowler G, Han D, Vetto JT, Bordeaux JS, Yu WY. A Clinical Decision Tool to Calculate Pretest Probability of Sentinel Lymph Node Metastasis in Primary Cutaneous Melanoma. Ann Surg Oncol 2023; 30:4321-4328. [PMID: 36840860 PMCID: PMC9961302 DOI: 10.1245/s10434-023-13220-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/24/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Although sentinel lymph node biopsy (SLNB) status is a strong prognostic indicator for cutaneous melanoma, unnecessary SLNBs have substantial cost and morbidity burden. OBJECTIVE This study was designed to develop, validate, and present a personalized, clinical, decision-making tool using nationally representative data with clinically actionable probability thresholds (Expected Lymphatic Metastasis Outcome [ELMO]). METHODS Data from the Surveillance, Epidemiology, and End Results (SEER) Registry from 2000 to 2017 and the National Cancer Database (NCDB) from 2004 to 2015 were used to develop and internally validate a logistic ridge regression predictive model for SLNB positivity. External validation was done with 1568 patients at a large tertiary referral center. RESULTS The development cohort included 134,809 patients, and the internal validation cohort included 38,518 patients. ELMO (AUC 0.85) resulted in a 29.54% SLNB reduction rate and greater sensitivity in predicting SLNB status for T1b, T2a, and T2b tumors than previous models. In external validation, ELMO had an accuracy of 0.7586 and AUC of 0.7218. Limitations of this study are potential miscoding, unaccounted confounders, and effect modification. CONCLUSIONS ELMO ( https://melanoma-sentinel.herokuapp.com/ ) has been developed and validated (internally and externally) by using the largest publicly available dataset of melanoma patients and was found to have high accuracy compared with other published models and gene expression tests. Individualized risk estimates for SLNB positivity are critical in facilitating thorough decision-making for healthcare providers and patients with melanoma.
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Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD, USA.
| | | | - Graham Fowler
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Dale Han
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - John T Vetto
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Wesley Y Yu
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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15
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Friedman AD, Gengler I, Altaye M, Tabangin ME. Early-Stage Glottic Carcinoma in the United States: Demographics and Treatment Choice. Laryngoscope 2023; 133:901-907. [PMID: 35852500 DOI: 10.1002/lary.30305] [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: 03/09/2022] [Revised: 06/10/2022] [Accepted: 07/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Limited investigation of factors potentially contributing to treatment choice in early-stage glottic carcinoma (EGC) has been performed with large-scale data. The National Cancer Database (NCDB) represents >72% of all new cancer cases in the United States. We hypothesized that NCDB variables may lend insight into treatment decisions between surgery and radiation for EGC. METHODS The NCDB was queried for all cases of T1-2 N0 M0 glottic carcinoma from 2004 to 2016. We used multivariable logistic regression analysis to examine factors associated with first-line treatment modality: radiation therapy (RT) versus surgery. All reported odds ratios (OR) were adjusted for age, gender, race, insurance, residence in a metropolitan area, region, and facility volume. RESULTS 34,991 EGC patients received treatment: 6,687 (19%) surgery; 20,289 (58%) RT; and 8,015 (23%) surgery and RT. OR for receiving RT (vs. surgery alone) were >2 for: more advanced T stage cancers (OR 2.5 [95%CI: 2.3, 2.7]), treatment at non-academic facilities (OR 2.8, [95%CI: 2.6, 3.0]), and shorter travel distances to treatment centers (OR 2.2, [95%CI: 2.0, 2.4]). Surgery was more likely with treatment in the western US, higher income, private insurance, living in a metropolitan (vs. non-metropolitan) area, female gender, older age, and low facility volume. Hispanic ethnicity, education level, and race were not associated with treatment type in the multivariable model. CONCLUSION Most patients in the NCDB receive first-line treatment with radiation for EGC, and this decision is associated with various tumor, patient, and treatment facility characteristics. LEVEL OF EVIDENCE 4 Laryngoscope, 133:901-907, 2023.
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Affiliation(s)
- Aaron D Friedman
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A
| | - Isabelle Gengler
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, U.S.A
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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16
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Rubenstein RN, Nelson JA, Azoury SC, Shamsunder MG, Haglich K, Yin S, Stern CS, Matros E. Breast Surgical Oncology Epidemiologic Research: A Guide and Comparison of Four National Databases. Ann Surg Oncol 2023; 30:2069-2084. [PMID: 36600098 PMCID: PMC10033365 DOI: 10.1245/s10434-022-12890-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/24/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND National databases are a rich source of epidemiologic data for breast surgical oncology research. However, these databases differ in the demographic, surgical, and oncologic variables provided. This study aimed to compare the strengths and limitations of four national databases in the context of breast surgical oncology research. METHODS The study comprised a descriptive analysis of four national databases (the National Surgical Quality Improvement Program [NSQIP], the Nationwide Inpatient Sample [NIS], the Surveillance, Epidemiology and End Results [SEER] program, and the National Cancer Database [NCDB]) to assess their strengths and limitations in the context of breast surgical oncology. The study assessed the data available in each database for female patients with a breast cancer diagnosis between 2007 and 2017, and compared patient age, ethnicity, and race distributions. RESULTS Data from 3.9 million female patients were examined, with most patients being between 60 and 69 years of age, non-Hispanic, and white. Age, ethnicity, and race distributions were similar in the databases. The NSQIP includes data on operative details, comorbidities, and postoperative outcomes. The NIS provides health services and inpatient utilization information, but does not evaluate outpatient procedures. The SEER program provides population-based oncologic detail including stage, histology, and neoadjuvant/adjuvant treatment. The NCDB offers hospital-based oncologic information and the largest population in the study period, with approximately 2.5 million breast cancer patients. CONCLUSION Epidemiologic datasets offer tremendous potential for the examination of oncologic breast surgery, with each database providing unique data useful for addressing different epidemiologic questions. Understanding the strengths and limitations of each database creates a more efficient and productive research environment.
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Affiliation(s)
- Robyn N Rubenstein
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Saïd C Azoury
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghana G Shamsunder
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathryn Haglich
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shen Yin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie S Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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17
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Patel AM, Choudhry HS, Desai AD, Shah VP, Patel P, Eloy JA, Roden DF, Fang CH. Prognostic significance of head and neck spindle cell carcinoma. Head Neck 2023; 45:685-696. [PMID: 36584171 DOI: 10.1002/hed.27285] [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: 09/25/2022] [Revised: 11/13/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Our study investigates the prognostic significance of spindle cell histology on overall survival (OS) of conventional head and neck squamous cell carcinoma (HNSCC). METHODS The 2004 to 2017 National Cancer Database was queried for patients with head and neck spindle cell carcinoma (HNSpCC) (n = 1572) or HNSCC (n = 242 697) of the oral cavity, major salivary glands, sinonasal tract, oropharynx, hypopharynx, and larynx treated with curative intent. RESULTS Patients with HNSpCC presented more frequently with higher-grade tumors and cN0 disease than those with HNSCC (p < 0.001). In the oral cavity, the HR for death for SpCC compared with SCC was 1.33 (p < 0.001). In the oropharynx, the HR for death for SpCC compared with SCC was 1.47 (p = 0.028). CONCLUSIONS After adjusting for patient, tumor, and treatment characteristics, SpCC histology had an independent adverse prognostic effect on OS in the oral cavity and oropharynx. SpCC histology does not necessarily portend poorer survival in all HNSCC. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hannaan S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Amar D Desai
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Vraj P Shah
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Prayag Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-Robert Wood Johnson Barnabas Health, Livingston, New Jersey, USA
| | - Dylan F Roden
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein School of Medicine/Montefiore Medical Center, Bronx, New York, USA
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18
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Zhu JQ, Wang ML, Li Y, Zhang W, Li LJ, Liu L, Zhang Y, Han CJ, Tie CW, Wang SX, Wang GQ, Ni XG. Convolutional neural network based anatomical site identification for laryngoscopy quality control: A multicenter study. Am J Otolaryngol 2023; 44:103695. [PMID: 36473265 DOI: 10.1016/j.amjoto.2022.103695] [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: 08/26/2022] [Revised: 09/26/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Video laryngoscopy is an important diagnostic tool for head and neck cancers. The artificial intelligence (AI) system has been shown to monitor blind spots during esophagogastroduodenoscopy. This study aimed to test the performance of AI-driven intelligent laryngoscopy monitoring assistant (ILMA) for landmark anatomical sites identification on laryngoscopic images and videos based on a convolutional neural network (CNN). MATERIALS AND METHODS The laryngoscopic images taken from January to December 2018 were retrospectively collected, and ILMA was developed using the CNN model of Inception-ResNet-v2 + Squeeze-and-Excitation Networks (SENet). A total of 16,000 laryngoscopic images were used for training. These were assigned to 20 landmark anatomical sites covering six major head and neck regions. In addition, the performance of ILMA in identifying anatomical sites was validated using 4000 laryngoscopic images and 25 videos provided by five other tertiary hospitals. RESULTS ILMA identified the 20 anatomical sites on the laryngoscopic images with a total accuracy of 97.60 %, and the average sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100 %, 99.87 %, 97.65 %, and 99.87 %, respectively. In addition, multicenter clinical verification displayed that the accuracy of ILMA in identifying the 20 targeted anatomical sites in 25 laryngoscopic videos from five hospitals was ≥95 %. CONCLUSION The proposed CNN-based ILMA model can rapidly and accurately identify the anatomical sites on laryngoscopic images. The model can reflect the coverage of anatomical regions of the head and neck by laryngoscopy, showing application potential in improving the quality of laryngoscopy.
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Affiliation(s)
- Ji-Qing Zhu
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mei-Ling Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Ying Li
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Wei Zhang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Li-Juan Li
- Department of Otorhinolaryngology, The People's Hospital of Wenshan Prefecture, Wenshan, Yunnan, China
| | - Lin Liu
- Department of Otolaryngology-Head and Neck Surgery, Dalian Municipal Friendship Hospital, Dalian, Liaoning, China
| | - Yan Zhang
- Department of Otorhinolaryngology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Cai-Juan Han
- Department of Otolaryngology-Head and Neck Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, China
| | - Cheng-Wei Tie
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shi-Xu Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gui-Qi Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xiao-Guang Ni
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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19
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Papazian MR, Chow M, Oliver J, Gordon AJ, Jacobson A, Vaezi A, Tam M, Givi B. Surgical Treatment in Very Advanced (T4b) Adenoid Cystic Carcinoma of the Head and Neck. Otolaryngol Head Neck Surg 2023; 168:1411-1419. [PMID: 36892056 DOI: 10.1002/ohn.203] [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: 08/26/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To compare treatment outcomes for T4b head and neck adenoid cystic carcinoma (ACC). STUDY DESIGN Historical cohort study. SETTING National Cancer Database (NCDB). METHODS Identified all T4b ACC of head and neck origin diagnosed 2004 to 2019 in the NCDB. Demographics, clinical characteristics, treatment details, and survival were analyzed. Treatment outcomes were analyzed using univariable and multivariable Cox regression. RESULTS We identified 606 cases of T4b ACC. Less than half (284, 47.0%) underwent curative-intent treatment. Among these, most were treated with primary surgery: surgery + radiotherapy (RT) (122, 43.0%) or surgery + chemoradiotherapy (CRT) (42, 14.8%). The positive margin rate was 78.7%, and 90-day postoperative mortality was zero. Nonsurgical patients were treated with definitive RT (60, 21.1%) or definitive CRT (60, 21.1%). The median follow-up was 51.5 months. Overall survival was 77.8% at 3 years. Three-year survival was higher for patients treated with surgery compared to those treated nonsurgically (84% vs 70%; p = .005). Surgical treatment remained associated with higher survival on multivariable analysis (hazard ratio [HR]: 0.47, p = .005). This effect was most pronounced for oral cavity tumors (HR: 0.17, p = .01). Among matched cohorts of surgically treated patients, there was no difference in 3-year survival between clinical T4a and T4b tumors (83.3% vs 83.0%, p = .99). CONCLUSION Long-term survival for T4b ACC of the head and neck could be expected. Primary surgical treatments can be performed safely and are associated with longer survival. A carefully selected subset of patients with very advanced ACC might benefit from the consideration of surgical treatments.
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Affiliation(s)
- Michael R Papazian
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Michael Chow
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Jamie Oliver
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, New York, USA
| | - Alex J Gordon
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Adam Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Alec Vaezi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Moses Tam
- Department of Radiation Oncology, NYU Langone Health, New York, New York, USA
| | - Babak Givi
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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20
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Plichta JK, Rushing CN, Lewis HC, Rooney MM, Blazer DG, Thomas SM, Hwang ES, Greenup RA. Implications of missing data on reported breast cancer mortality. Breast Cancer Res Treat 2023; 197:177-187. [PMID: 36334190 PMCID: PMC9912364 DOI: 10.1007/s10549-022-06764-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/06/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND National cancer registries are valuable tools to analyze patterns of care and clinical outcomes; yet, missing data may impact the accuracy and generalizability of these data. We sought to evaluate the association between missing data and overall survival (OS). METHODS Using the NCDB (National Cancer Database) and SEER (Surveillance, Epidemiology, End Results Program), we assessed data missingness among patients diagnosed with invasive breast cancer from 2010 to 2014. Key variables included demographic (age, race, ethnicity, insurance, education, income), tumor (grade, ER, PR, HER2, TNM stages), and treatment (surgery in both databases; chemotherapy and radiation in NCDB). OS was compared between those with and without missing data using Cox proportional hazards models. RESULTS Overall, 775,996 patients in the NCDB and 263,016 in SEER were identified; missing at least 1 key variable occurred for 29% and 13%, respectively. Of those, the overwhelming majority (NCDB 80%; SEER 88%) were missing tumor variables. When compared to patients with complete data, missingness was associated with a greater risk of death: NCDB HR 1.23 (99% CI 1.21-1.25) and SEER HR 2.11 (99% CI 2.05-2.18). Patients with complete tumor data had higher unadjusted OS estimates than that of the entire sample: NCDB 82.7% vs 81.8% and SEER 83.5% vs 81.7% for 5-year OS. CONCLUSIONS Missingness of select variables is not uncommon within large national cancer registries and is associated with a worse OS. Exclusion of patients with missing variables may introduce unintended bias into analyses and result in findings that underestimate breast cancer mortality.
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Affiliation(s)
- Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, DUMC 351327710, USA.
- Duke Cancer Institute, Durham, NC, USA.
| | - Christel N Rushing
- Duke Cancer Institute, Durham, NC, USA
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA
| | - Holly C Lewis
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
| | - Marguerite M Rooney
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
| | - Dan G Blazer
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Durham, NC, USA
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, DUMC 351327710, USA
- Duke Cancer Institute, Durham, NC, USA
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21
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Rana C, Bychkov A. NIFTP Statistics-Now You See It, Now You Don't. J Clin Endocrinol Metab 2022; 108:e5-e6. [PMID: 36181476 DOI: 10.1210/clinem/dgac569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Chanchal Rana
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba 296-0041, Japan
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22
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Dublin JC, Oliver JR, Tam MM, Persky MJ, Jacobson AS, Liu C, Hu KS, Vaezi AE, Morris LGT, Givi B. Nodal Metastases in Pediatric and Adult Acinic Cell Carcinoma of the Major Salivary Glands. Otolaryngol Head Neck Surg 2022; 167:941-951. [PMID: 35259039 DOI: 10.1177/01945998221083094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 02/07/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Acinic cell carcinoma (AciCC) is a rare, usually low-grade salivary malignancy. Evidence on rates of lymph node metastases (LNMs) is limited in pediatric patients and varies significantly (4%-45%) in adults. We set out to determine and compare rates of LNMs in pediatric and adult AciCC and to analyze their impact on survival, using the National Cancer Database. STUDY DESIGN Historical cohort study. SETTING National Cancer Database. METHODS All AciCCs of the major salivary glands with complete clinical and pathologic nodal staging were selected between 2010 and 2016. Patient demographics, tumor characteristics, treatment, and survival were analyzed. Univariable and multivariable regression were performed to determine factors associated with LNMs and survival. RESULTS We identified 57 (4.6%) pediatric patients (<18 years) and 1192 (95.4%) adults with AciCC. Clinical LNMs were rare in pediatric patients (n < 10) and adults (n = 88, 7.4%). Occult LNMs were uncommon in pediatric patients (n < 5) and adults (n = 41, 4.6%). Three-year overall survival for pediatric patients was 97.8%. Adults with LNM had worse 3-year overall survival than those without (66.0% vs 96.3%, P < .001). In multivariable regression, high-grade disease (hazard ratio, 10.15 [95% CI, 5.60-18.80]; P < .001) and T3-T4 tumors (hazard ratio, 2.80 [95% CI, 1.56-4.97]; P < .001) were associated with LNM in adult patients. CONCLUSION LNMs in AciCC of the major salivary glands are rare in children and adults. However, high-grade and T3-T4 tumors are associated with an increased risk of LNM. LNM is associated with worse survival.
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Affiliation(s)
- Jared C Dublin
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Jamie R Oliver
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Moses M Tam
- Department of Radiation Oncology, NYU Langone Health, New York, New York, USA
| | - Michael J Persky
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Adam S Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Cheng Liu
- Department of Pathology, NYU Langone Health, New York, New York, USA
| | - Kenneth S Hu
- Department of Radiation Oncology, NYU Langone Health, New York, New York, USA
| | - Alec E Vaezi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Luc G T Morris
- Department of Surgery, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Babak Givi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
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23
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Gordon AJ, Dublin JC, Patel E, Papazian M, Chow MS, Persky MJ, Jacobson AS, Patel KN, Suh I, Morris LGT, Givi B. American Thyroid Association Guidelines and National Trends in Management of Papillary Thyroid Carcinoma. JAMA Otolaryngol Head Neck Surg 2022; 148:1156-1163. [PMID: 36326739 PMCID: PMC9634599 DOI: 10.1001/jamaoto.2022.3360] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022]
Abstract
Importance Over time, the American Thyroid Association (ATA) guidelines have increasingly promoted more limited treatments for well-differentiated thyroid cancers. Objective To determine whether the 2009 and 2015 ATA guidelines were associated with changes in the management of low-risk papillary thyroid carcinomas on a national scale. Design, Setting, and Participants This historical cohort study used the National Cancer Database. All papillary thyroid carcinomas diagnosed from 2004 to 2019 in the National Cancer Database were selected. Patients with tumors of greater than 4 cm, metastases, or clinical evidence of nodal disease were excluded. Data were analyzed from August 1, 2021, to September 1, 2022. Main Outcomes and Measures The primary aim was to tabulate changes in the rates of thyroid lobectomy (TL), total thyroidectomy (TT), and TT plus radioactive iodine (RAI) therapy after the 2009 and 2015 ATA guidelines. The secondary aim was to determine in which settings (eg, academic vs community) the practice patterns changed the most. Results A total of 194 254 patients (155 796 [80.2%] female patients; median [range] age at diagnosis, 51 [18-90] years) who underwent treatment during the study period were identified. Among patients who underwent surgery, rates of TL decreased from 15.1% to 13.7% after the 2009 guidelines but subsequently increased to 22.9% after the 2015 changes. Among patients undergoing TT, rates of adjuvant RAI decreased from 48.7% to 37.1% after 2009 and to 19.3% after the 2015 guidelines. Trends were similar for subgroups based on sex and race and ethnicity. However, academic institutions saw larger increases in TL rates (14.9% to 25.7%) than community hospitals (16.3% to 19.5%). Additionally, greater increases in TL rates were observed for tumors 1 to 2 cm (6.8% to 18.9%) and 2 to 4 cm (6.6% to 16.0%) than tumors less than 1 cm (22.8% to 29.2%). Conclusions and Relevance In this cohort study among patients with papillary thyroid carcinomas up to 4 cm, ATA guideline changes corresponded with increased TL and reduced adjuvant RAI. These changes were primarily seen in academic institutions, suggesting an opportunity to expand guideline-based care in the community setting.
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Affiliation(s)
- Alex J. Gordon
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Jared C. Dublin
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Evan Patel
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California
| | - Michael Papazian
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Michael S. Chow
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Michael J. Persky
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Adam S. Jacobson
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Kepal N. Patel
- Division of Endocrine Surgery, Department of Surgery, NYU Langone Health, New York, New York
| | - Insoo Suh
- Division of Endocrine Surgery, Department of Surgery, NYU Langone Health, New York, New York
| | - Luc G. T. Morris
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak Givi
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
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24
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Nair AG, Giannakeas V, Semple JL, Narod SA, Lim DW. Contemporary Trends in Breast Reconstruction Use and Impact on Survival Among Women with Inflammatory Breast Cancer. Ann Surg Oncol 2022; 29:8072-8082. [PMID: 36074200 DOI: 10.1245/s10434-022-12408-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast reconstruction is generally discouraged in women with inflammatory breast cancer (IBC). Nevertheless, reconstruction rates are increasing in this population. OBJECTIVE We aimed to determine contemporary trends and predictors of breast reconstruction use and its impact on mortality among IBC patients. METHODS Demographic, clinicopathologic, and follow-up data for women with non-metastatic IBC having mastectomy between 2004 and 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) 18 registries database. Rates and predictors of immediate breast reconstruction, along with survival outcomes between the breast reconstruction and no reconstruction groups were calculated. To account for selection bias, a propensity score analysis matching one reconstruction patient to three no reconstruction patients was performed. RESULTS A total of 4076 women with non-metastatic IBC who underwent mastectomy (388 [9.5%] with breast reconstruction and 3688 [90.5%] without) were included. The proportion of women undergoing breast reconstruction and contralateral prophylactic mastectomy increased from 6.2 to 15.3% and 12.9 to 29.6%, respectively, between 2004 and 2015. Younger age, higher annual income, metropolitan residence, and bilateral mastectomy predicted breast reconstruction use. The 10-year breast cancer-specific survival was 62.9% for women having breast reconstruction and 47.6% for women not having breast reconstruction. After propensity-matched analysis, 10-year cancer-specific survival was similar between the reconstruction (56.6%) and no reconstruction (62.2%) groups (adjusted hazard ratio 0.96, 95% confidence interval 0.79-1.16; p = 0.65). CONCLUSIONS Breast reconstruction rates continue to rise among IBC patients, particularly young women and women with access to reconstruction. Breast reconstruction is not associated with inferior breast cancer-specific survival and can be an option for select patients.
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Affiliation(s)
| | - Vasily Giannakeas
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - John L Semple
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Department of Surgery, Women's College Hospital, Toronto, ON, Canada.,Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Steven A Narod
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - David W Lim
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. .,Department of Surgery, Women's College Hospital, Toronto, ON, Canada.
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Kashyap B, Mikkonen JJW, Bhardwaj T, Dekker H, Schulten EAJM, Bloemena E, Kullaa AM. Effect of smoking on MUC1 expression in oral epithelial dysplasia, oral cancer, and irradiated oral epithelium. Arch Oral Biol 2022; 142:105525. [PMID: 36027639 DOI: 10.1016/j.archoralbio.2022.105525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/01/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to assess the MUC1 expression in the oral epithelium of normal, oral epithelial dysplasia (OED), oral squamous cell carcinoma (OSCC), and irradiated oral epithelium (IROE) and its association with smoking habits in non-smokers and smokers. DESIGN Oral mucosal biopsies from controls, OED, OSCC, and IROE groups were obtained and categorized based on the smoking history as non-smokers, smoker I (25 pack-years), and smoker II (>25 pack-years). Immunohistochemical staining of MUC1 using human milk fat globule 1 (HMFG 1) antibody was performed, and the MUC1 score was calculated. The relation between MUC1 expression and clinicopathological findings was examined. RESULTS MUC1 staining of superficial oral epithelial cells with mild MUC1 score was detected in all control samples. The MUC1 staining extended from superficial to basal cell layer of oral epithelium with the increase in MUC1 score from moderate to strong in OED, OSCC, and IROE, and the difference was significant (p < 0.004, p < 0.002 and p < 0.004, respectively) compared to controls. A positive association between smoking and MUC1 score was observed within groups (p < 0.05). CONCLUSION The depolarization of MUC1 protein expression is associated with smoking habits in OED and OSCC. In the IROE, the radiation causes subcellular and molecular changes, observed as altered MUC1 expression and accelerated by smoking, furthermore, complicating the oral mucosal adaptation and progress to radiation-induced lesions as a delayed effect.
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Affiliation(s)
- Bina Kashyap
- Institute of Dentistry, University of Eastern Finland, Kuopio campus, Kuopio P.O. Box 1627, Kuopio 70211, Finland.
| | - Jopi J W Mikkonen
- Institute of Dentistry, University of Eastern Finland, Kuopio campus, Kuopio P.O. Box 1627, Kuopio 70211, Finland.
| | - Tulika Bhardwaj
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio campus, P.O. Box 1627, Kuopio 70211, Finland.
| | - Hannah Dekker
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Engelbert A J M Schulten
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Elisabeth Bloemena
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Arja M Kullaa
- Institute of Dentistry, University of Eastern Finland, Kuopio campus, Kuopio P.O. Box 1627, Kuopio 70211, Finland.
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Gao J, Tseng CC, Barinsky GL, Fang CH, Grube JG, Hsueh WD, Baredes S, Eloy JA. Analysis of the Treatment and Survival of Sinonasal Extramedullary Plasmacytoma. Am J Rhinol Allergy 2022; 36:591-598. [PMID: 35440217 DOI: 10.1177/19458924221092529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND While extramedullary plasmacytomas are infrequently encountered plasma cell malignancies, most cases occur in the head and neck, with a predilection for the sinonasal cavity. Due to the rarity of this disease, the majority of studies on sinonasal extramedullary plasmacytoma (SN-EMP) are case reports or small retrospective case series. OBJECTIVE To investigate the impact of patient, disease, and treatment factors on the survival of patients with SN-EMP. METHODS The National Cancer Database was queried for all patients with SN-EMP between 2004-2016 (N = 381 cases). Univariate and multivariate analyses were used to examine patient demographics, tumor characteristics, and survival. RESULTS The majority of SN-EMP patients were over 60 years old (57.0%), male (69.8%), and white (86.2%). The most common treatment modality was radiotherapy alone (38.6%), followed by surgery plus radiotherapy (37.8%). Five-year overall survival was 74.0% and median survival was 9.1 years. Accounting for patient demographics and tumor characteristics in a multivariate model, the following groups had worse prognosis: 60 and older (HR 1.99, p = 0.031) and frontal sinus primary site (HR 11.56, p = 0.001). Patients who received no treatment (HR 3.89, p = 0.013), chemotherapy alone (HR 5.57, p = 0.008) or radiotherapy plus chemotherapy (HR 2.82, p = 0.005) had significantly lower survival than patients who received radiotherapy alone. Patients who received surgery with radiotherapy (HR 0.57, p = 0.039) had significantly higher survival than patients who received radiotherapy alone. CONCLUSION In patients with SN-EMP five-year overall survival was found to be 74.0% with decreased survival associated with a frontal sinus primary site and being aged 60 or older. Patients receiving no treatment, chemotherapy alone, or radiotherapy with chemotherapy was associated with lower survival. Receiving surgery plus radiotherapy was associated with the highest five-year overall survival.
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Affiliation(s)
- Jeff Gao
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher C Tseng
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gregory L Barinsky
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christina H Fang
- Department of Otorhinolaryngology - Head and Neck Surgery, 2013Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jordon G Grube
- Division of Otolaryngology/ Head and Neck Surgery, Department of Surgery, 138207Albany Medical Center, Albany, New York, USA
| | - Wayne D Hsueh
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurological Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJBarnabas Health, Livingston, New Jersey, USA
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Prostate Cancer Disparities in Hispanics using the National Cancer Database. Urology 2022; 165:218-226. [DOI: 10.1016/j.urology.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/19/2022] [Accepted: 02/10/2022] [Indexed: 11/20/2022]
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Cheng J, Zhou X, Xu H, Dan H, Li J, Chen Q. Incidence and Survival of Oral Cavity and Oropharyngeal Cancer in the USA from 1975 to 2018. J Oral Maxillofac Surg 2022; 80:1294-1305. [DOI: 10.1016/j.joms.2022.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/24/2022]
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Davies JC, Husain Z, Day TA, Graboyes EM, Eskander A. Perioperative Mortality Risk in Patients Undergoing Transoral Robotic Surgery for T1-T2 Oropharyngeal Squamous Cell Carcinoma: A National Cancer Database Study. Front Oncol 2022; 11:808465. [PMID: 35071012 PMCID: PMC8770260 DOI: 10.3389/fonc.2021.808465] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
The National Cancer Database is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methods used or for the conclusions drawn from these data by the investigators.
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Affiliation(s)
- Joel C Davies
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Zain Husain
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Science Center, Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Terry A Day
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Evan M Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Antoine Eskander
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Science Center, Odette Cancer Center, University of Toronto, Toronto, ON, Canada
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30
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Kurago Z, Loveless J. Microbial Colonization and Inflammation as Potential Contributors to the Lack of Therapeutic Success in Oral Squamous Cell Carcinoma. FRONTIERS IN ORAL HEALTH 2022; 2:739499. [PMID: 35048056 PMCID: PMC8757816 DOI: 10.3389/froh.2021.739499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
This review discusses the microenvironment of evolving and established conventional oral squamous cell carcinoma, by far the most common oral cancer. The focus of this paper is mainly on the more recent data that describe the role of microorganisms, host-microbial interactions, and in particular, the contributions of cell-surface toll-like receptors on immune system cells and on normal and malignant epithelial cells to their functions that support carcinogenesis. Because carcinomas arising at various host surfaces share much in common, additional information available from studies of other carcinomas is included in the discussion. Accumulating evidence reveals the complex toll-like receptor-mediated tumor-supporting input into many aspects of carcinogenesis via malignant cells, stromal immune cells and non-immune cells, complicating the search for effective treatments.
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Affiliation(s)
- Zoya Kurago
- Augusta University Dental College of Georgia, Augusta, GA, United States.,Medical College of Georgia, Augusta, GA, United States.,Georgia Cancer Center, Augusta, GA, United States
| | - Jenni Loveless
- Augusta University Dental College of Georgia, Augusta, GA, United States
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31
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Lenze NR, Bensen JT, Farnan L, Sheth S, Zevallos JP, Yarbrough WG, Zanation AM. Evaluation of Patient-Reported Delays and Affordability-Related Barriers to Care in Head and Neck Cancer. OTO Open 2021; 5:2473974X211065358. [PMID: 34926976 PMCID: PMC8671675 DOI: 10.1177/2473974x211065358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To examine the prevalence and predictors of patient-reported barriers to care among survivors of head and neck squamous cell carcinoma and the association with health-related quality of life (HRQOL) outcomes. Study Design Retrospective cohort study. Setting Outpatient oncology clinic at an academic tertiary care center. Methods Data were obtained from the UNC Health Registry/Cancer Survivorship Cohort. Barriers to care included self-reported delays in care and inability to obtain needed care due to cost. HRQOL was measured with validated questionnaires: general (PROMIS) and cancer specific (FACT-GP). Results The sample included 202 patients with head and neck squamous cell carcinoma with a mean age of 59.6 years (SD, 10.0). Eighty-two percent were male and 87% were White. Sixty-two patients (31%) reported at least 1 barrier to care. Significant predictors of a barrier to care in unadjusted analysis included age ≤60 years ( P = .007), female sex ( P = .020), being unmarried ( P = .016), being uninsured ( P = .047), and Medicaid insurance ( P = .022). Patients reporting barriers to care had significantly worse physical and mental HRQOL on the PROMIS questionnaires ( P < .001 and P = .002, respectively) and lower cancer-specific HRQOL on the FACT-GP questionnaire ( P < .001), which persisted across physical, social, emotional, and functional domains. There was no difference in 5-year OS (75.3% vs 84.1%, P = .177) or 5-year CSS (81.6% vs 85.4%, P = .542) in patients with and without barriers to care. Conclusion Delay- and affordability-related barriers are common among survivors of head and neck cancer and appear to be associated with significantly worse HRQOL outcomes. Certain sociodemographic groups appear to be more at risk of patient-reported barriers to care.
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Affiliation(s)
- Nicholas R. Lenze
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeannette T. Bensen
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Siddharth Sheth
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jose P. Zevallos
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Wendell G. Yarbrough
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Pathology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Adam M. Zanation
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Hermanns I, Ziadat R, Schlattmann P, Guntinas-Lichius O. Trends in Treatment of Head and Neck Cancer in Germany: A Diagnosis-Related-Groups-Based Nationwide Analysis, 2005-2018. Cancers (Basel) 2021; 13:6060. [PMID: 34885170 PMCID: PMC8656765 DOI: 10.3390/cancers13236060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
Advances in head and neck cancer (HNC) treatment might have changed treatment strategies. This study determined, with focus on gender disparity, whether treatment rates have changed for inpatients in Germany between 2005 and 2018. Nation-wide population-based diagnosis-related groups (DRG) data of virtually all HNC cases (1,226,856 procedures; 78% men) were evaluated. Poisson regression analyses were used to study changes of annual treatment rates per German population. For surgery, the highest increase was seen for women with cancer of the oral cavity (relative risk (RR) 1.14, 95% confidence interval (CI) 1.11-1.18, p < 0.0001) and the highest decrease for men with laryngeal cancer (RR 0.90, CI 0.87-0.93). In women with oropharyngeal cancer, the highest increase of radiotherapy rates was seen (RR 1.18, CI 1.10-1.27, p < 0.0001). A decrease was seen in men for hypopharyngeal cancer (RR 0.93, CI 0.87-0.98, p = 0.0093). The highest increase for chemotherapy/immunotherapy was seen for women with oropharyngeal cancer (RR 1.16, CI 1.08-1.24, p < 0.0001), and a decrease in men with hypopharyngeal cancer (RR 0.93, CI 0.88-0.97, p = 0.0014). Treatment patterns had changed for nearly all subsites and therapy types. There were relevant gender disparities, which cannot be explained by the DRG data.
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Affiliation(s)
- Isabel Hermanns
- Department of Otorhinolaryngology, Jena University Hospital, D-07747 Jena, Germany; (I.H.); (R.Z.)
| | - Rafat Ziadat
- Department of Otorhinolaryngology, Jena University Hospital, D-07747 Jena, Germany; (I.H.); (R.Z.)
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, D-07743 Jena, Germany;
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, D-07747 Jena, Germany; (I.H.); (R.Z.)
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33
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Fan Q, Yao XA, Han X. Spatial variation and disparity in female breast cancer relative survival in the United States. Cancer 2021; 127:4006-4014. [PMID: 34265081 DOI: 10.1002/cncr.33801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer among women in the United States. However, data on spatial disparities in survival for breast cancer are limited in the country. This study estimated 5-year relative survival (RS) of female breast cancer and examined the spatial variations across the contiguous United States. METHODS Women newly diagnosed with breast cancer in 2003-2010 in the United States were identified from the National Cancer Database and followed up through 2016. The crude 5-year RS at the county level was estimated and adjusted for patients' key sociodemographic and clinical factors. To account for spatial effects, the RS estimates were smoothed using the Bayesian spatial survival model. A local spatial autocorrelation analysis with the Getis-Ord Gi* statistics was applied to identify geographic clusters of low or high RS. RESULTS Clusters of low RS were identified in more than 15 states covering 671 counties, mostly in the southeast and southwest regions, including Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Approximately 30% of these clusters can be explained by patients' characteristics: Race, insurance, and stage at diagnosis appeared to be the major attributable factors. CONCLUSIONS Significant spatial disparity in female breast cancer survival was found, with low RS clusters identified in Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Policies and interventions that focus on serving Black women, improvements in insurance coverage, and early detection in these areas could potentially mitigate the spatial disparities.
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Affiliation(s)
- Qinjin Fan
- Department of Geography, University of Georgia, Athens, Georgia
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Xiaobai A Yao
- Department of Geography, University of Georgia, Athens, Georgia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Yan F, Li H, de Almeida JR, Kaczmar JM, Pipkorn P, Zenga J, Richardson MS, Neskey DM, Sharma AK, Day TA, Graboyes EM. Microscopic Extranodal Extension in HPV-Negative Head and Neck Cancer and the Role of Adjuvant Chemoradiation. Otolaryngol Head Neck Surg 2021; 165:536-549. [PMID: 33618570 PMCID: PMC8380754 DOI: 10.1177/0194599821989637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Pathologic extranodal extension (ENE) is an important adverse feature for human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC), but the prognostic significance of microscopic ENE (ENEmi) and role of adjuvant concurrent chemoradiation (CRT) for ENEmi remain unclear. This study evaluates (1) the prognostic significance of ENEmi in HPV-negative HNSCC and (2) whether adjuvant CRT is associated with improved overall survival (OS) for these patients. STUDY DESIGN Retrospective cohort study. SETTING Commission on Cancer (CoC)-accredited facilities. METHODS This retrospective cohort study included patients in the National Cancer Database from 2009 to 2015 with pathologic node-positive (pN+) HPV-negative HNSCC with either pathologic ENEmi or no ENE who had undergone margin-negative surgery. The association of ENEmi with OS was evaluated using Cox proportional hazard analyses. Analyses were repeated in patients with ENEmi receiving adjuvant therapy to evaluate the association of adjuvant CRT with OS. RESULTS We included 5483 patients with pN+ HPV-negative HNSCC, of whom 24% had ENEmi. On multivariable analysis, ENEmi was associated with decreased OS relative to no ENE (adjusted hazard ratio [aHR], 1.43; 95% CI, 1.28-1.59). Among patients with ENEmi who received ≥60 Gy of adjuvant radiation therapy (RT) (n = 617), adjuvant CRT was not associated with improved OS relative to RT (aHR, 0.91; 95% CI, 0.66-1.27). CONCLUSION For patients with HPV-negative HNSCC, pN+ with ENEmi is associated with worse OS than pN+ without ENE. However, for patients with ENEmi, concurrent CRT is not associated with improved OS relative to RT. The optimal adjuvant paradigm for ENEmi requires additional investigation.
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Affiliation(s)
- Flora Yan
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Hong Li
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John R. de Almeida
- Department of Otolaryngology–Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John M. Kaczmar
- Division of Medical Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Patrik Pipkorn
- Department of Otolaryngology–Head and Neck Surgery, Washington University, St Louis, Missouri, USA
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mary S. Richardson
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David M. Neskey
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anand K. Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A. Day
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Evan M. Graboyes
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Dezube AR, Kucukak S, De Leon LE, Wiener D, Rochefort MM, Jaklitsch MT. Internal Staging Discordance in National Cancer Databases for Non-Small-Cell Lung Cancer. Ann Thorac Surg 2021; 114:1269-1275. [PMID: 34461072 DOI: 10.1016/j.athoracsur.2021.07.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/17/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Surveillance, Epidemiology and End Results (SEER) and the National Cancer Database (NCDB) are databases for cancer analysis which may be subject to error in data reporting. We examined rates and impact of discordant data for non-small cell lung cancer. METHODS NCDB and SEER were queried for non-small cell lung cancer pathologic Tumor, Node, Metastasis data (NCDB) or "derived" data (SEER). Discordancy between descriptors with stage and impact of outlier data were analyzed. RESULTS Incomplete staging was noted in 71.5% of NCDB and 10.3% of SEER. 174,829 patients from NCDB and 117,114 from SEER were analyzed. NCDB had 97 cases with ≥20 positive lymph nodes recorded vs. 27 in SEER (p<0.001). Mean and median sampled lymph nodes were skewed with inclusion of these data-points (p<0.001). NCDB misclassified 0.99% tumors >5cm as stage I vs. 0.04% in SEER (p<0.001). NCDB mis-staged positive lymph nodes as pathologic N0 (0.59%) or Stage 0/Stage I (0.65%). NCDB misclassified pathologic N1 as < Stage II (0.91%) or N2 as < Stage III (0.36%). NCDB misclassified Stage I with documentation of pathologic N1-N3 disease (0.24%) or Stage II with evidence of N2 or N3 disease (0.50%). NCDB misclassified pathologic M1 as pathologic Stage <IV in 0.9% of cases and misclassified 19.8% of stage IV as pathologic M0. SEER collaborative staging had no discordancy (p<0.001). CONCLUSIONS NCDB and SEER are two powerful cancer databases. However, cumulative discordancy rate was 4.9% for NCDB and 0.008% for SEER with more mistaging and outliers in NCDB.
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Affiliation(s)
- Aaron R Dezube
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Suden Kucukak
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Luis E De Leon
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel Wiener
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Division of Thoracic Surgery, Boston VA Healthcare System
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Hochfelder CG, Mehta V, Kabarriti R, McGinn AP, Castellucci E, Ow TJ. Survival analysis of patients with advanced hypopharyngeal cancer comparing patients who received primary surgery to those who received chemoradiation: An analysis of the NCDB. Oral Oncol 2021; 121:105470. [PMID: 34418696 DOI: 10.1016/j.oraloncology.2021.105470] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The objective of this study was to use the American College of Surgeons' National Cancer Database (NCDB) to examine the association between primary treatment and overall survival (OS) among patients with locoregionally advanced hypopharyngeal cancer. METHODS 6,055 adult patients diagnosed between 2004 and 2015 with stage III or IV, M0, hypopharyngeal squamous cell carcinoma were identified within the NCDB. Patients who received primary chemoradiation (CRT) were compared to those that received surgery with adjuvant radiation or chemoradiation (S + Adj). OS was compared between treatment groups using Kaplan-Meier analyses, propensity score adjustment, and Cox regression analyses. RESULTS The median survival was 22.7 months (IQR 11.0-49.0). The S + Adj group had a significantly higher comorbidity score, higher grade disease, and more advanced stage disease than the CRT group. S + Adj was associated with significantly improved survival when compared to CRT (p < 0.0001). A propensity score adjusting for facility type, facility location, care at multiple facilities, histology, and T stage was developed. S + Adj was associated with longer survival (HR: 0.72, 95% CI: 0.64-0.80) when compared to CRT in a multivariable Cox regression analysis (adjusting for age, race and ethnicity, insurance status, a comorbidity index, diagnosis year, treatment delay, N stage, and the propensity score). S + Adj was associated with significantly improved survival among those with T2 disease (p = 0.02), T3 disease (p = 0.02), and T4 disease (p < 0.0001) in sensitivity analyses examining these subcohorts independently. CONCLUSIONS Among patients with advanced hypopharyngeal cancer reported in NCDB, treatment with S + Adj was associated with longer survival compared to those treated with primary CRT.
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Affiliation(s)
- Colleen G Hochfelder
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI 48109, United States
| | - Vikas Mehta
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, United States
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY 10467, United States
| | - Aileen P McGinn
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Ave, Bronx, NY 10461, United States
| | - Enrico Castellucci
- Department of Medical Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY 10467, United States
| | - Thomas J Ow
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, United States; Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, United States.
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Lenze NR, Farquhar DR, Sheth S, Zevallos JP, Lumley C, Blumberg J, Patel S, Hackman T, Weissler MC, Yarbrough WG, Olshan AF, Zanation AM. Prognostic impact of socioeconomic status compared to overall stage for HPV-negative head and neck squamous cell carcinoma. Oral Oncol 2021; 119:105377. [PMID: 34161897 DOI: 10.1016/j.oraloncology.2021.105377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To estimate the relative prognostic ability of socioeconomic status (SES) compared to overall stage for HPV-negative head and neck squamous cell carcinoma (HNSCC) MATERIALS AND METHODS: Data were obtained from the Carolina Head and Neck Cancer Epidemiology Study (CHANCE). An empirical 4-category SES classification system was created. Cox proportional hazards models, survival gradients, Bayesian information criterion (BIC), and Harrell's C index were used to estimate the prognostic ability of SES compared to stage on overall survival (OS). RESULTS The sample consisted of 1229 patients with HPV-negative HNSCC. Patients with low SES had significantly increased risk of mortality at 5 years compared to patients with high SES (HR 3.11, 95% CI 2.07-4.67; p < 0.001), and the magnitude of effect was similar to overall stage (HR 3.01, 95% CI 2.35-3.86; p < 0.001 for stage IV versus I). Compared to overall stage, the SES classification system had a larger total survival gradient (35.8% vs. 29.1%), similar model fit (BIC statistic of 7412 and 7388, respectively), and similar model discriminatory ability (Harrell's C index of 0.61 and 0.64, respectively). The association between low SES and OS persisted after adjusting for age, sex, race, alcohol, smoking, overall stage, tumor site, and treatment in a multivariable model (HR 2.96, 95% CI 1.92-4.56; p < 0.001). CONCLUSION SES may have a similar prognostic ability to overall stage for patients with HPV-negative HNSCC. Future research is warranted to validate these findings and identify evidence-based interventions for addressing barriers to care for patients with HNSCC.
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Affiliation(s)
- Nicholas R Lenze
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
| | - Douglas R Farquhar
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Siddharth Sheth
- Division of Hematology and Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, United States
| | - Jose P Zevallos
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Catherine Lumley
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Jeffrey Blumberg
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Samip Patel
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Trevor Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Mark C Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Wendell G Yarbrough
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States; Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States
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38
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Jawad MU, Farhan S, Haffner MR, Le HV, Thorpe SW, Klineberg EO, Randall RL. Primary mobile vertebral column sarcomas: Prognostic factors vary by histologic subtypes. J Surg Oncol 2021; 124:635-645. [PMID: 34091907 DOI: 10.1002/jso.26530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/08/2021] [Accepted: 05/09/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Primary sarcomas originating from the mobile spine portends a particularly sinister outcome. Rarity of the disease process has resulted in inconsistent data due to small sample size and heterogeneity in patient selection and analytics. METHODS Surveillance, Epidemiology and End Result (SEER) database from 1975 to 2017 was queried to report incidence and survival data in 712 patients in the United States. Kaplan-Meier and Cox Regression were used to determine the prognostic factors affecting survival. RESULTS Incidence of spinal sarcoma was 0.019 per 100,000 persons in 2017 and has not significantly changed since 2000 (p > 0.05). Disease-specific 5-year survival for the entire cohort was 57%. Osteosarcoma has the worst 5-year survival (39%) and chondrosarcoma has the best 5-year survival (69%). Independent predictors of survival for the entire cohort included age, grade, and stage. Stage was an independent predictor of survival for every histologic subtype. Additional predictors of survival for spinal osteosarcoma, Ewing sarcoma, and chondrosarcoma included age, size, and grade, respectively. CONCLUSIONS The current study is an analysis of a population-based registry reporting incidence survival data for patients with sarcoma of mobile vertebral column. Survival and prognostic factors vary by histologic subtypes. There is lack of improvement in survival over the last three decades.
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Affiliation(s)
- Muhammad U Jawad
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Saif Farhan
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Max R Haffner
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Hai Van Le
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Steven W Thorpe
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - R Lor Randall
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
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Go CC, Kim DH, Briceño CA. A SEER analysis of survival and prognostic factors in merkel cell carcinoma of the head and neck region. Int J Oral Maxillofac Surg 2021; 51:314-322. [PMID: 34090757 DOI: 10.1016/j.ijom.2021.05.014] [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: 12/22/2020] [Revised: 03/29/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
While Merkel cell carcinoma (MCC) of the head and neck is highly malignant, it remains poorly characterized due to its rarity. The purpose of this study was to examine prognostic factors for overall survival (OS) and disease-specific survival (DSS) in patients with MCC of the head and neck region. The Surveillance, Epidemiology and End Results registry was reviewed for patients diagnosed between 1984 and 2016 with histologically confirmed, primary MCC of the head and neck region. A total of 2818 patients met the inclusion criteria, with a median age at diagnosis of 77 years. At five and 10 years, respectively, the OS was 42.4% and 25.1% and the DSS was 67.9% and 64.1%. Multivariate Cox analysis indicated that predictors of decreased DSS included age at diagnosis ≥75 years, white race, increasing tumor spread, lymph node involvement and either the lip or the scalp/neck as a primary site. When adjusting for the aforementioned factors, tumor depth was not found to be a prognostic factor for DSS. We anticipate these results will help clinicians to counsel patients regarding expectations and potential prognosis.
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Affiliation(s)
- C C Go
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - D H Kim
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Scheie Eye Institute, Philadelphia, PA, USA
| | - C A Briceño
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Scheie Eye Institute, Philadelphia, PA, USA.
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40
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Civantos AM, Prasad A, Carey RM, Bur AM, Mady LJ, Brody RM, Rajasekaran K, Cannady SB, Hartner L, Ibrahim SA, Newman JG, Brant JA. Palliative care in metastatic head and neck cancer. Head Neck 2021; 43:2764-2777. [PMID: 34018648 DOI: 10.1002/hed.26761] [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: 06/24/2020] [Revised: 01/10/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to inherent impact on quality of life, metastatic head and neck cancer patients are well-suited to benefit from palliative care (PC). Our objective was to examine factors that shape PC utilization and implications for overall survival in stage IVc head and neck cancer patients. METHODS A retrospective study of patients with stage IVc head and neck cancer in the National Cancer Database from 2004 and 2015 was conducted. RESULTS 7794 cases met inclusion criteria, of which 19.3% received PC. PC use was associated with more recent years of diagnosis, Northeast facility geography, and non-private insurances (p < 0.05). Compared to no PC, "interventional" PC, defined as palliative surgery, radiation, and/or chemotherapy, and "pain management only" PC were associated with lower overall survival (p < 0.05). CONCLUSIONS PC use increased over time and was associated with demographic and clinical factors. There remains opportunity for improvement in optimal implementation of palliative care.
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Affiliation(s)
- Alyssa M Civantos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aman Prasad
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrés M Bur
- Department of Otolaryngology: Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Leila J Mady
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert M Brody
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Steven B Cannady
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lee Hartner
- Department of Hematology, Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Said A Ibrahim
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Jason G Newman
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jason A Brant
- Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Lehrich BM, Abiri A, Goshtasbi K, Birkenbeuel J, Yasaka TM, Papagiannopoulos P, Tajudeen BA, Brem EA, Kuan EC. Treatment Modalities and Survival Outcomes for Sinonasal Diffuse Large B-Cell Lymphoma. Laryngoscope 2021; 131:E2727-E2735. [PMID: 33899946 DOI: 10.1002/lary.29584] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/25/2021] [Accepted: 04/14/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study utilizes a large population national database to comprehensively analyze prognosticators and overall survival (OS) outcomes of varying treatment modalities in a large cohort of sinonasal diffuse large B-cell lymphoma (SN-DLBCL) patients. STUDY DESIGN Retrospective database study. METHODS The National Cancer Database was queried for all SN-DLBCL cases diagnosed from 2004 to 2015. Kaplan-Meier log-rank test determined differences in OS based on clinical covariates. Cox proportional-hazards analysis was used to determine clinical and sociodemographic covariates predictive of mortality. RESULTS A total of 2,073 SN-DLBCL patients were included, consisting of 48% female with a mean age of 66.0 ± 16.2 years. Overall, 82% of patients were Caucasian, 74% had early-stage disease, and 49% had primary tumors in the paranasal sinuses. Early-stage patients were more likely to receive multi-agent chemoradiotherapy compared to multi-agent chemotherapy alone (P < .001). Multivariable Cox proportional-hazards analysis revealed chemoradiotherapy to confer significantly greater OS improvements than chemotherapy alone (hazard ratio [HR]: 0.61; P < .001). However, subset analysis of late-stage patients demonstrated no significant differences in OS between these treatment modalities (P = .245). On multivariable analysis of chemotherapy patients treated post-2012, immunotherapy (HR = 0.51; P = .024) demonstrated significant OS benefits. However, subset analysis showed no significant advantage in OS with administering immunotherapy for late-stage patients (P = .326). Lastly, for all patients treated post-2012, those receiving immunotherapy had significantly improved OS compared to those not receiving immunotherapy (P < .001). CONCLUSIONS Treatment protocol selection differs between early- and late-stage SN-DLBCL patients. Early-stage patients receiving chemotherapy may benefit from immunotherapy as part of their treatment paradigm. LEVEL OF EVIDENCE III Laryngoscope, 2021.
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Affiliation(s)
- Brandon M Lehrich
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A.,Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, U.S.A
| | - Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Jack Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Tyler M Yasaka
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Elizabeth A Brem
- Department of Hematology and Oncology, University of California, Irvine, California, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A
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Mirian C, Gerds TA, Pedersen MM, de Ridder M, Balm A, Mattavelli D, Piazza C, Jensen LR, Balasubramanian D, Subramaniam N, Dokhe Y, Thankappan K, Iyer S, Karam SD, Wiegand S, Feeley L, Milross C, Gao K, Palme CE, Low THH, Gupta R, Freudlsperger C, Moratin J, Sheahan P, Clark J, Ovesen T. Metrics of pN-staging in oral squamous cell carcinoma: An analysis of 1,905 patients. Eur J Cancer 2021; 150:33-41. [PMID: 33887515 DOI: 10.1016/j.ejca.2021.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/20/2021] [Accepted: 03/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND We aimed to compare the predictive performance of pN-categories in oral squamous cell carcinoma (OSCC) encompassing the most recent 8th edition (TNM8), its predecessor (TNM7), and a newly proposed algorithm (pN-N+), which classifies patients according to the number of positive lymph nodes and extranodal extension. METHODS Consecutive, primary OSCC patients from seven previously published cohorts were included and classified according to the three pN-classifications: TNM7, TNM8 and pN-N+. Overall survival probabilities were summarised with the Kaplan-Meier method. We added each of the three metrics to a Cox regression adjusted for pT-category, lymph nodal yield, age, sex, radiotherapy and chemotherapy, and trained these models in one institution. We evaluated the predictive performance in the remaining six institutions and assessed the predicted 5-year risk of death using the area under the receiver operating characteristics curve (AUC) and Brier scores. RESULTS All 1,905 included patients were classified according to TNM7 and pN-N+. A subset of 1,575 patients was additionally classified according to TNM8, leading to upstaging in 27.0%. The pN-N+ ranked overall best determined by the obtained AUC and Brier scores. In contrast to pN-N+, TNM7 and TNM8 both suffered from disproportionate patient distribution across pN-categories and poor pN-categorial discrimination on overall survival. CONCLUSIONS The TNM8 pN-classification designates a larger subset to more advanced disease stages but failed to show improvement of its predictive performance compared to TNM7. The pN-categories of TNM7/8 are disproportionate and inconsistently discriminated. The pN-N+ conveyed the best measures of prognosis and should be considered in future TNM iterations.
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Affiliation(s)
- Christian Mirian
- Department of Otorhinolaryngology, Region Hospital West Jutland, Holstebro, Denmark.
| | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Maria M Pedersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mischa de Ridder
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Alfons Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Lasse R Jensen
- Department of Otorhinolaryngology, Region Hospital West Jutland, Holstebro, Denmark
| | - Deepak Balasubramanian
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Narayana Subramaniam
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Yogesh Dokhe
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Sana D Karam
- Department of Radiation Oncology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Susanne Wiegand
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Linda Feeley
- Department of Pathology, Cork University Hospital, Cork, Ireland; ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Chris Milross
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia
| | - Carsten E Palme
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Ruta Gupta
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Sydney, Australia
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Julius Moratin
- Department of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Sheahan
- ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Ireland; Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria, University Hospital, Cork, Ireland; Department of Surgery, University College Cork, Cork, Ireland
| | - Jonathan Clark
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Therese Ovesen
- Department of Otorhinolaryngology, Region Hospital West Jutland, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
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Comparison of treatment modalities for selected advanced laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2021; 279:361-371. [PMID: 33864482 DOI: 10.1007/s00405-021-06780-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/22/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE The authors aimed to clarify the optimal treatment strategy and the indication of different treatments in managing advanced laryngeal squamous cell carcinoma (LSCC). METHODS A total of 9700 patients with advanced (T3-4aN0-3M0) LSCC who treated with (1) surgery alone, (2) surgery plus adjuvant radiation with or without chemotherapy (aCRT/RT), or (3) definitive CRT/RT was retrieved from the SEER database. The propensity score matching (PSM) was applied to balance confounding factors. Kaplan-Meier method and Cox proportional hazards regression were used to comparing the overall survival (OS) of patients. RESULTS After optimal matching, 907 patients were screened from each treatment cohort. Kaplan-Meier and multivariate analyses presented that patients treated with surgery plus aCRT/CT had significantly longer OS than those treated with either surgery alone or CRT/RT, even after PSM. However, significant interactions were tested in treatment effects in stratified analyses of the primary subsite, T stage, N stage, and insurance status (PInteraction < 0.05 for all). Specifically, surgery plus aCRT/CT significantly improved the OS of patients with supraglottic, T4a, and N + tumors (P < 0.001 for all), while three treatment modalities achieved equal OS rates for patients with glottic, T3, and N0 tumors (P > 0.05 for all). Besides, supraglottic tumors presented a poorer prognosis than glottic subsite. CONCLUSION Current study suggests that surgery with aCRT/RT is the preferred initial therapy for patients with T4a tumors, whereas patients with T3 tumors could be treated with either surgery (followed by aCRT/RT if it presents N +) or definitive CRT/RT for achieving laryngeal preservation. More-intense treatment should be emphasized for advanced supraglottic cancer.
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Graillon N, Iocca O, Carey RM, Benjamin K, Cannady SB, Hartner L, Newman JG, Rajasekaran K, Brant JA, Shanti RM. What has the National Cancer Database taught us about oral cavity squamous cell carcinoma? Int J Oral Maxillofac Surg 2021; 51:10-17. [PMID: 33840565 DOI: 10.1016/j.ijom.2021.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/19/2021] [Indexed: 11/17/2022]
Abstract
The wealth of data in the National Cancer Database (NCDB) has allowed numerous studies investigating patient, disease, and treatment-related factors in oral cavity squamous cell carcinoma (OCSCC); however, to date, no summation of these studies has been performed. The aim of this study was to provide a concise review of the NCDB studies on OCSCC, with the hopes of providing a framework for future, novel studies aimed at enhancing our understanding of clinical parameters related to OCSCC. Two databases were searched, and 27 studies published between 2002 and 2020 were included. The average sample size was 13,776 patients (range 356-50,896 patients). Four areas of research focus were identified: demographic and socioeconomic status, diagnosis, prognosis, and treatment. This review highlights the impact of age, sex, ethnicity, and socioeconomic status on the prognosis and management of OCSCC, describes the prognostic factors, and details the modalities and indications for neck dissection and adjuvant therapy in OCSCC. In conclusion, the NCDB is a very valuable resource for clinicians and researchers involved in the management of OCSCC, offering an incomparable perspective on a large dataset of patients. Future developments regarding hospital information management, review of data accuracy and completeness, and wider accessibility will help clinicians to improve the care of patients affected by OCSCC.
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Affiliation(s)
- N Graillon
- Department of Oral and Maxillofacial Surgery, CHU Conception, APHM, Marseille, France; Aix-Marseille Université, IFSTTAR, LBA UMR_T24, Marseille, France.
| | - O Iocca
- Division of Maxillofacial Surgery, Surgical Science Department, University of Torino, Italy
| | - R M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - K Benjamin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - S B Cannady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - L Hartner
- Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J G Newman
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - K Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - J A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - R M Shanti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA; Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Oliver JR, Patel KN, Chang CM, Baldwin CK, Brar PC, Morris LGT, Givi B. Lymph node metastases in pediatric medullary thyroid carcinoma. Surgery 2021; 170:736-742. [PMID: 33838880 DOI: 10.1016/j.surg.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/14/2021] [Accepted: 03/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Unlike medullary thyroid carcinoma in adults, the vast majority of pediatric medullary thyroid carcinoma is hereditary. Pediatric medullary thyroid carcinoma is known to have different genetic alterations driving tumorigenesis, but it is not known if pediatric medullary thyroid carcinoma has different clinicopathologic features. This study aims to identify which pediatric medullary thyroid carcinoma patients might warrant elective neck dissection. METHODS We selected all patients ages 0 to 19 diagnosed with clinically evident medullary thyroid carcinoma in the National Cancer Database between 2004 to 2016. Clinicopathologic factors, treatments, and outcomes were analyzed and compared between this cohort and adults (ages ≥20) with medullary thyroid carcinoma. RESULTS One hundred twenty-five pediatric medullary thyroid carcinoma (median age: 13) and 5,086 adult medullary thyroid carcinoma (median age: 57) patients were identified. Pediatric patients had smaller tumors (median diameter: 1.2 cm vs 2.0 cm; P < .001), lower rates of nodal metastases (n = 31, 36.9% vs 1,689, 50.4%; P = .02) but double the incidence of multifocal tumors (n = 70, 59.3%, vs 1,412, 29.9%; P < .001) compared with adults. Multifocal tumors conferred a significantly increased risk of nodal metastases in adult medullary thyroid carcinoma (64.4% vs 43.2%; P < .001) but not pediatric medullary thyroid carcinoma (37.7% vs 35.7%; P = .85). Nodal metastases were more frequent among older children (0-5 years: 0.0%, 6-12: 40.7%, 13-19: 41.7%; P = .04). However, rates of occult nodal metastases were similar between older children (6-19 years: n = 12, 21.4%) and adults (557, 25.8% P = .56). CONCLUSION Pediatric medullary thyroid carcinoma has lower rates of lymph node metastases compared with adults. The risk of nodal disease was low among the youngest children, but older children ages 6 to 19 were at considerable risk for occult metastases. These findings could guide clinicians in selecting pediatric patients considered for elective lymph node dissection.
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Affiliation(s)
| | - Kepal N Patel
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, NY
| | | | - Chelsey K Baldwin
- Division of Endocrinology, Department of Medicine, New York University Grossman School of Medicine, NY
| | - Preneet C Brar
- Division of Endocrinology and Diabetes, Department of Pediatrics, New York University Grossman School of Medicine, NY
| | - Luc G T Morris
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Babak Givi
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, NY.
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Hodges TR, Labak CM, Mahajan UV, Wright CH, Wright J, Cioffi G, Gittleman H, Herring EZ, Zhou X, Duncan K, Kruchko C, Sloan AE, Barnholtz-Sloan JS. Impact of race on care, readmissions, and survival for patients with glioblastoma: an analysis of the National Cancer Database. Neurooncol Adv 2021; 3:vdab040. [PMID: 33959715 PMCID: PMC8086235 DOI: 10.1093/noajnl/vdab040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The objective of this study was to explore racial/ethnic factors that may be associated with survival in patients with glioblastoma by querying the National Cancer Database (NCDB). Methods The NCDB was queried for patients diagnosed with glioblastoma between 2004 and 2014. Patient demographic variables included age at diagnosis, sex, race, ethnicity, Charlson-Deyo score, insurance status, and rural/urban/metropolitan location of zip code. Treatment variables included surgical treatment, extent of resection, chemotherapy, radiation therapy, type of radiation, and treatment facility type. Outcomes included 30-day readmission, 30- and 90-day mortality, and overall survival. Multivariable Cox regression analyses were performed to evaluate variables associated with race and overall survival. Results A total of 103 652 glioblastoma patients were identified. There was a difference in the proportion of patients for whom surgery was performed, as well as the proportion receiving radiation, when stratified by race (P < .001). Black non-Hispanics had the highest rates of unplanned readmission (7.6%) within 30 days (odds ratio [OR]: 1.39 compared to White non-Hispanics, P < .001). Asian non-Hispanics had the lowest 30- (3.2%) and 90-day mortality (9.8%) when compared to other races (OR: 0.52 compared to White non-Hispanics, P = .031). Compared to White non-Hispanics, we found Black non-Hispanics (hazard ratio [HR]: 0.88, P < .001), Asian non-Hispanics (HR: 0.72, P < .001), and Hispanics (HR: 0.69, P < .001) had longer overall survival. Conclusions Differences in treatment and outcomes exist between races. Further studies are needed to elucidate the etiology of these race-related disparities and to improve outcomes for all patients.
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Affiliation(s)
- Tiffany R Hodges
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Collin M Labak
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Uma V Mahajan
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - James Wright
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gino Cioffi
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Haley Gittleman
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Eric Z Herring
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Xiaofei Zhou
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kelsey Duncan
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Andrew E Sloan
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.,Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Jill S Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
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47
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Yan F, Li H, Kaczmar JM, Sharma AK, Day TA, Neskey DM, Pipkorn P, Zenga J, Graboyes EM. Evaluating Adjuvant Therapy With Chemoradiation vs Radiation Alone for Patients With HPV-Negative N2a Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 146:1109-1119. [PMID: 32790830 DOI: 10.1001/jamaoto.2020.2107] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance The American Joint Committee on Cancer staging system (Cancer Staging Manual, 8th Edition) for head and neck squamous cell carcinoma (HNSCC) now categorizes human papillomavirus (HPV)-negative HNSCC in a single positive lymph node smaller than 3 cm with pathologic extranodal extension (ENE) as N2a. The standard of care for pathologic ENE is adjuvant chemoradiation therapy (CRT). Whether adding chemotherapy concurrent with adjuvant radiation therapy improves survival in this clinical scenario is unknown. Objective To assess whether adjuvant CRT relative to radiation therapy alone is associated with improved survival among patients with pN2a HPV-negative HNSCC with ENE. Design, Setting, and Participants This retrospective cohort study included 504 patients with pN2a HPV-negative HNSCC with ENE who had undergone margin-negative surgery and adjuvant therapy. The patients were identified from the National Cancer Database from January 1, 2004, to December 31, 2015. Statistical analyses were conducted from September 1, 2019, to April 16, 2020. Main Outcomes and Measures The primary end point was overall survival. The association of adjuvant CRT with overall survival was analyzed using univariate and multivariate Cox proportional hazards regression analyses. Planned subset analyses were conducted in patients younger than 70 years with no comorbidities (the subset most likely to be eligible for a clinical trial of cisplatin-based chemoradiation) and in patients with pT3/T4 disease classification. Results Of 504 patients (mean [SD] age, 60.5 [12.7] years; 319 [63.3%] men; 434 [86.1%] White) with pN2a HPV-negative HNSCC with ENE who had undergone margin-negative surgery and adjuvant therapy, 298 patients (59.1%) received adjuvant CRT. For the overall cohort of patients with pN2a ENE, adjuvant CRT was not associated with improved overall survival relative to adjuvant radiation therapy alone in a multivariate analysis (adjusted hazard ratio, 0.98; 95% CI, 0.74-1.30). Adjuvant CRT was still not associated with improved overall survival in a subset analysis of 304 patients younger than 70 years with no comorbidities (adjusted hazard ratio, 0.98; 95% CI, 0.66-1.45) nor in a subset of 220 patients with pT3/T4 disease classification (adjusted hazard ratio, 1.03; 95% CI, 0.70-1.54). Conclusions and Relevance This study found that for patients with pN2a HPV-negative HNSCC with ENE who underwent margin-negative surgery and adjuvant therapy, adding chemotherapy concurrent with adjuvant radiation therapy was not associated with improved overall survival. Additional research is necessary to identify the optimal treatment paradigm for this clinical scenario.
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Affiliation(s)
- Flora Yan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Hong Li
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - John M Kaczmar
- Division of Medical Oncology, Department of Medicine, Medical University of South Carolina, Charleston
| | - Anand K Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - David M Neskey
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,Department of Cell & Molecular Pharmacology & Experimental Therapeutics, Medical University of South Carolina, Charleston
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St Louis, Missouri
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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Cui X, Song D, Li X. Construction and Validation of Nomograms Predicting Survival in Triple-Negative Breast Cancer Patients of Childbearing Age. Front Oncol 2021; 10:636549. [PMID: 33628740 PMCID: PMC7898905 DOI: 10.3389/fonc.2020.636549] [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: 12/01/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background Triple-negative breast cancer (TNBC) is one of the most aggressive subtypes of breast cancer with poorest clinical outcomes. Patients of childbearing age have a higher probability of TNBC diagnosis, with more demands on maintenance and restoration of physical and psychosocial function. This study aimed to design effective and comprehensive nomograms to predict survival in these patients. Methods We used the SEER database to identify patients with TNBC aged between 18 and 45 and randomly classified these patients into a training (n=2,296) and a validation (n=2,297) cohort. Nomograms for estimating overall survival (OS) and breast cancer-specific survival (BCSS) were generated based on multivariate Cox proportional hazards models and competing-risk models in the training cohort. The performances of the nomograms were quantified in the validation cohort using calibration curves, time-dependent receiver operating characteristic (ROC) curves and Harrell’s concordance index (C-index). Results A total of 4,593 TNBC patients of childbearing age were enrolled. Four prognostic factors for OS and six for BCSS were identified and incorporated to construct nomograms. In the validation cohort, calibration curves showed excellent agreement between nomogram-predicted and actual survival data. The nomograms also achieved relatively high Harrell’s C-indexes and areas under the time-dependent ROC curves for estimating OS and BCSS in both training and validation cohorts. Conclusions Independent prognostic factors were identified, and used to develop nomograms to predict OS and BCSS in childbearing-age patients with TNBC. These models could enable individualized risk estimation and risk-adapted treatment for these patients.
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Affiliation(s)
- Xiang Cui
- Department of Thyroid and Breast Surgery, The First People's Hospital of Shangqiu, Shangqiu, China
| | - Deba Song
- Department of Thyroid and Breast Surgery, The First People's Hospital of Shangqiu, Shangqiu, China
| | - Xiaoxu Li
- Department of Thyroid and Breast Surgery, The First People's Hospital of Shangqiu, Shangqiu, China
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49
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Sineshaw HM, Ellis MA, Yabroff KR, Han X, Jemal A, Day TA, Graboyes EM. Association of Medicaid Expansion Under the Affordable Care Act With Stage at Diagnosis and Time to Treatment Initiation for Patients With Head and Neck Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2021; 146:247-255. [PMID: 31944232 DOI: 10.1001/jamaoto.2019.4310] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Medicaid expansions as part of the Patient Protection and Affordable Care Act (ACA) are associated with decreases in the percentage of uninsured patients who have received a new diagnosis of cancer. Little is known about the association of Medicaid expansions with stage at diagnosis and time to treatment initiation (TTI) for patients with head and neck squamous cell carcinoma (HNSCC). Objective To determine the association of Medicaid expansions as part of the ACA with stage at diagnosis and TTI for patients with HNSCC. Design, Setting, and Participants A retrospective cohort study was conducted at Commission on Cancer-accredited facilities among 90 789 patients identified from the National Cancer Database aged 18 to 64 years with HNSCC that was diagnosed during the period from January 1, 2010, to December 31, 2016. Statistical analysis was conducted from February 18 to November 8, 2019. Main Outcomes and Measures Outcome measures included health insurance coverage, stage at diagnosis, and TTI. Absolute percentage change in health insurance coverage, crude and adjusted difference in differences (DD) in absolute percentage change in coverage, stage at diagnosis, and TTI before (2010-2013) and after (2014-2016) ACA implementation were calculated for Medicaid expansion and nonexpansion states. Results Of the 90 789 nonelderly adults with newly diagnosed HNSCC (mean [SD] age, 54.7 [7.0] years), 70 907 (78.1%) were men, 72 911 (80.3%) were non-Hispanic white, 52 142 (57.4%) were between 55 and 64 years of age, and 54 940 (60.5%) resided in states with an ACA Medicaid expansion. Compared with nonexpansion states, the percentage of patients with HNSCC with Medicaid increased more in expansion states after the implementation of the ACA (adjusted DD, 4.6 percentage points [95% CI, 3.7-5.4 percentage points]). The percentage of patients with localized disease (American Joint Committee on Cancer stage I-II) at diagnosis increased in expansion states compared with nonexpansion states for the overall cohort (adjusted DD, 2.3 percentage points [95% CI, 1.1-3.5 percentage points]) and for the subset of patients with nonoropharyngeal HNSCC (adjusted DD, 3.4 percentage points [95% CI, 1.5-5.2 percentage points]). The mean TTI did not differ between expansion and nonexpansion states for the cohort (adjusted DD, -12.7 percentage points [95% CI, -27.4 to 4.2 percentage points]) but improved for patients with nonoropharyngeal HNSCC (adjusted DD, -26.5 percentage points [95% CI, -49.6 to -3.4 percentage points]). Conclusions and Relevance This study suggests that Medicaid expansions were associated with a greater increase in the percentage of patients with HNSCC with Medicaid coverage, an increase in the percentage of patients with localized disease at diagnosis for the overall cohort of patients with HNSCC, and improved TTI for patients with nonoropharyngeal HNSCC.
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Affiliation(s)
- Helmneh M Sineshaw
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Mark A Ellis
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Terry A Day
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston.,Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Evan M Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston.,Hollings Cancer Center, Medical University of South Carolina, Charleston
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50
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Ho AS, Luu M, Barrios L, Chen I, Melany M, Ali N, Patio C, Chen Y, Bose S, Fan X, Mallen-St Clair J, Braunstein GD, Sacks WL, Zumsteg ZS. Incidence and Mortality Risk Spectrum Across Aggressive Variants of Papillary Thyroid Carcinoma. JAMA Oncol 2021; 6:706-713. [PMID: 32134428 DOI: 10.1001/jamaoncol.2019.6851] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance While well-differentiated papillary thyroid carcinoma (WDPTC) outcomes have been well characterized, the prognostic implications of more aggressive variants are far less defined. The rarity of these subtypes has led to their consolidation as intermediate risk for what are in fact likely heterogeneous diseases. Objective To analyze incidence, clinicopathologic characteristics, and outcomes for aggressive variants of papillary thyroid carcinoma (PTC). Design, Setting, and Participants This cohort study used data from 2000 to 2016 from hospital-based and population-based US cancer registries to analyze aggressive PTC variants, including diffuse sclerosing (DSV), tall-cell (TCV), insular, and poorly differentiated (PDTC) subtypes. These variants were compared against WDPTC and anaplastic cases. Data analysis was conducted from January 2019 to October 2019. Main Outcomes and Measures Age-adjusted incidence was calculated via annual percentage change (APC) using the weighted least-squares method. Overall survival and disease-specific survival were analyzed via Cox regression. Propensity-score matching was used to adjust survival analyses for clinical and demographic covariates. Results Collectively, 5447 aggressive PTC variants were identified (including 415 DSV, 3339 TCV, 362 insular, and 1331 PDTC cases), as well as 35 812 WDPTC and 2249 anaplastic cases. Over the study period, a substantial increase in aggressive variant incidence was observed (APC, 9.1 [95% CI, 7.33-10.89]; P < .001), surpassing the relative increases observed in WDPTC (APC, 5.1 [95% CI, 3.98-6.12]; P < .001) and anaplastic cases (APC, 1.9 [95% CI, 0.75-3.05]; P = .003; parallelism P < .007). Survival varied markedly based on histologic subtype, with a wide spectrum of mortality risk noted; 10-year overall survival was 85.4% (95% CI, 84.6%-86.3%) in WDPTC, 79.2% (95% CI, 73.6%-85.3%) in DSV, 71.9% (95% CI, 68.4%-75.6%) in TCV, 45.1% (95% CI, 40.2%-50.6%) in PDTC, 27.9% (95% CI, 20.0%-38.9%) in the insular variant, and 8.9% (95% CI, 7.5%-10.6%) in anaplastic cases (P < .001). These differences largely persisted even after adjusting for inherent differences in baseline characteristics by multivariable Cox regression and propensity-score matching. Conclusions and Relevance An upsurge in aggressive PTC incidence was observed at a rate beyond that seen in WDPTC or anaplastic thyroid carcinoma. Moreover, long-term survival outcomes for aggressive PTC subgroups exhibit heterogeneous clinical behavior and a wide range of mortality risk, suggesting that treatment should be tailored to specific histologic subtypes. Given increasing prevalence and disparate outcomes, further investigation to identify optimal therapeutic strategies is needed in these diverse, understudied populations.
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Affiliation(s)
- Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Biostatistics and Bioinformatics Research Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Laurel Barrios
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Irene Chen
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michelle Melany
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nabilah Ali
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chrysanta Patio
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yufei Chen
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Shikha Bose
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Xuemo Fan
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Glenn D Braunstein
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Wendy L Sacks
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California.,Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
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