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For: Kim C, Yu H, Kim DK. The Risk of Ischemic and Hemorrhagic Stroke in Head and Neck Cancer: A Longitudinal Cohort Study. Cancers (Basel) 2023;15:3503. [PMID: 37444613 DOI: 10.3390/cancers15133503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open

For:	Kim C, Yu H, Kim DK. The Risk of Ischemic and Hemorrhagic Stroke in Head and Neck Cancer: A Longitudinal Cohort Study. Cancers (Basel) 2023;15:3503. [PMID: 37444613 DOI: 10.3390/cancers15133503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open

Number

Cited by Other Article(s)

Tsai YT, Tsai MH, Kudva A, Vito AD, Lai CH, Liao CT, Kang CJ, Tsai YH, Hsu CM, Huang EI, Chang GH, Tsai MS, Fang KH. The Prognostic Value of Preoperative Total Cholesterol in Surgically Treated Oral Cavity Cancer. Biomedicines 2024;12:2898. [PMID: 39767804 PMCID: PMC11726739 DOI: 10.3390/biomedicines12122898] [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: 12/06/2024] [Revised: 12/17/2024] [Accepted: 12/18/2024] [Indexed: 01/16/2025] Open

Abstract

BACKGROUND

With growing evidence linking lipid profile changes to tumor development and cancer prognosis, we investigated the prognostic significance of preoperative serum total cholesterol (TC) levels in patients with oral cavity squamous cell carcinoma (OSCC) undergoing surgical treatment.

METHODS

We conducted a retrospective observational study involving 310 patients with primary OSCC who received surgery at our hospital from January 2009 to December 2018. Receiver operating characteristic curve analysis was performed to determine the optimal preoperative TC cutoff value, with the Youden Index employed as the optimization criterion to maximize the sum of sensitivity and specificity. Variables with p < 0.1 in the univariable analysis were included in the multivariable Cox regression model, and stepwise selection was used to identify the optimal subset of prognostic factors for overall survival (OS) and disease-free survival (DFS).

RESULTS

An optimal TC cutoff of 157 mg/dL was established. Patients with TC < 157 mg/dL exhibited significantly lower 5-year rates of OS and DFS (p < 0.001 and p = 0.006, respectively). Multivariable analysis confirmed that TC < 157 mg/dL represented an independent prognostic factor for reduced OS and DFS rates. Subgroup analyses reinforced the consistent prognostic significance of TC. We also constructed a nomogram (concordance index: 0.74) to provide personalized OS predictions, enhancing the clinical utility of TC.

CONCLUSIONS

Preoperative TC appears to be a significant prognostic factor for OS and DFS after OSCC surgery. Routine TC assessment facilitates the development of nomograms for personalized survival predictions, supports clinicians in tailoring treatment strategies, and guides nutritional or metabolic interventions to enhance patient outcomes. Further multicenter prospective studies are needed to validate our findings.

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Affiliation(s)

Yao-Te Tsai Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan; (Y.-T.T.); (C.-M.H.); (E.I.H.); (G.-H.C.); (M.-S.T.) College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (M.-H.T.); (C.-H.L.); (C.-T.L.); (C.-J.K.); (Y.-H.T.)
Ming-Hsien Tsai College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (M.-H.T.); (C.-H.L.); (C.-T.L.); (C.-J.K.); (Y.-H.T.) Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kaohsiung 833253, Taiwan
Adarsh Kudva Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal 576104, India;
Andrea De Vito Ear Nose Throat (ENT) Unit, Department of Surgery, Forli Hospital Health Local Agency of Romagna, 47121 Forli, Italy;
Chia-Hsuan Lai College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (M.-H.T.); (C.-H.L.); (C.-T.L.); (C.-J.K.); (Y.-H.T.) Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
Chun-Ta Liao College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (M.-H.T.); (C.-H.L.); (C.-T.L.); (C.-J.K.); (Y.-H.T.) Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
Chung-Jan Kang College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (M.-H.T.); (C.-H.L.); (C.-T.L.); (C.-J.K.); (Y.-H.T.) Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan
Yuan-Hsiung Tsai College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (M.-H.T.); (C.-H.L.); (C.-T.L.); (C.-J.K.); (Y.-H.T.) Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan
Cheng-Ming Hsu Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan; (Y.-T.T.); (C.-M.H.); (E.I.H.); (G.-H.C.); (M.-S.T.) College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (M.-H.T.); (C.-H.L.); (C.-T.L.); (C.-J.K.); (Y.-H.T.)
Ethan I. Huang Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan; (Y.-T.T.); (C.-M.H.); (E.I.H.); (G.-H.C.); (M.-S.T.) College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (M.-H.T.); (C.-H.L.); (C.-T.L.); (C.-J.K.); (Y.-H.T.)
Geng-He Chang Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan; (Y.-T.T.); (C.-M.H.); (E.I.H.); (G.-H.C.); (M.-S.T.) College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (M.-H.T.); (C.-H.L.); (C.-T.L.); (C.-J.K.); (Y.-H.T.)
Ming-Shao Tsai Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi 613016, Taiwan; (Y.-T.T.); (C.-M.H.); (E.I.H.); (G.-H.C.); (M.-S.T.) College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (M.-H.T.); (C.-H.L.); (C.-T.L.); (C.-J.K.); (Y.-H.T.)
Ku-Hao Fang College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan; (M.-H.T.); (C.-H.L.); (C.-T.L.); (C.-J.K.); (Y.-H.T.) Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan 333423, Taiwan

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Yip PL, Zheng H, Cheo T, Tan TH, Lee SF, Leong YH, Wong LC, Tey J, Ho F, Soon YY. Stroke Risk in Survivors of Head and Neck Cancer. JAMA Netw Open 2024;7:e2354947. [PMID: 38349657 PMCID: PMC10865145 DOI: 10.1001/jamanetworkopen.2023.54947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/13/2023] [Indexed: 02/15/2024] Open

Abstract

Importance

Survivors of head and neck cancers (HNC) have increased risk of stroke. A comprehensive report using standardized methods is warranted to characterize the risk and to inform on survivorship strategy.

Objective

To determine the stroke risk in subpopulations of survivors of HNC in Singapore.

Design, Setting, and Participants

This national, registry-based, cross-sectional study aimed to estimate stroke risk in subgroups of the HNC population between January 2005 and December 2020. Participants were identified from the Singapore Cancer Registry, the Singapore Stroke Registry, and the Registry of Birth and Deaths using relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes. HNC subgroups were defined based on patient demographic, disease, and treatment factors. Data were analyzed from September 2022 to September 2023.

Exposure

Diagnosis of HNC.

Main Outcomes and Measures

Both ischemic and hemorrhagic stroke were studied. The age-standardized incidence rate ratio (SIRR) and age-standardized incidence rate difference (SIRD) were reported. The Singapore general population (approximately 4 million) served as the reference group for these estimations.

Results

A total of 9803 survivors of HNC (median [IQR] age at diagnosis, 58 [49-68] years; 7166 [73.1%] male) were identified. The most common HNC subsites were nasopharynx (4680 individuals [47.7%]), larynx (1228 individuals [12.5%]), and tongue (1059 individuals [10.8%]). A total of 337 individuals (3.4%) developed stroke over a median (IQR) follow-up of 42.5 (15.0-94.5) months. The overall SIRR was 2.46 (95% CI, 2.21-2.74), and the overall SIRD was 4.11 (95% CI, 3.37-4.85) strokes per 1000 person-years (PY). The cumulative incidence of stroke was 3% at 5 years and 7% at 10 years after HNC diagnosis. The SIRR was highest among individuals diagnosed at younger than 40 years (SIRR, 30.55 [95% CI, 16.24-52.35]). All population subsets defined by age, sex, race and ethnicity, HNC subsites (except tongue), stage, histology, and treatment modalities had increased risk of stroke compared with the general population. The SIRR and SIRD were significantly higher among individuals who had a primary radiation treatment approach (SIRR, 3.01 [95% CI, 2.64-3.43]; SIRD, 5.12 [95% CI, 4.18-6.29] strokes per 1000 PY) compared with a primary surgery approach (SIRR, 1.64 [95% CI, 1.31-2.05]; SIRD, 1.84 [95% CI, 0.923.67] strokes per 1000 PY).

Conclusions and Relevance

In this cross-sectional study of survivors of HNC, elevated stroke risks were observed across different age, subsites, and treatment modalities, underscoring the importance of early screening and intervention.

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