1
|
Pak KY, Hsue VB, Lee MK, Chen MM, Balzer B, Wu AW, Tang DM. Sinonasal Tumors Masquerading as Invasive Fungal Sinusitis (IFS). Ann Otol Rhinol Laryngol 2024:34894241238864. [PMID: 38491860 DOI: 10.1177/00034894241238864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
OBJECTIVES Fungal tissue invasion in the setting of sinonasal malignancy has been rarely described in the literature. Only a handful of studies have discussed cases of suspected chronic and acute IFS (CIFS and AIFS, respectively), having an underlying undifferentiated sinonasal carcinoma, sinonasal teratocarcinosarcoma, and NK/T-cell lymphoma. METHODS Here, we describe 3 cases of carcinoma mimicking IFS from a single institution. RESULTS Each of our patients presented with sinonasal complaints as an outpatient in the setting of immunosuppression. Intranasal biopsies consistently were predominated by necrotic debris, with and without fungal elements, ultimately leading to a delay of oncologic care. The final pathologies included NK/T-cell lymphoma and SNEC. All patients were followed by radiation and chemotherapy, with 1 case of mortality. CONCLUSIONS We aim to emphasize the importance of obtaining viable tissue as pathology specimens as the presence of necrosis with fungal elements may limit the diagnosis and ultimately delay the care of an underlying sinonasal carcinoma.
Collapse
Affiliation(s)
- Kaitlynne Y Pak
- Division of Otolaryngology, Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Victor B Hsue
- Division of Otolaryngology, Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew K Lee
- Division of Otolaryngology, Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michelle M Chen
- Department of Otolaryngology, Head and Neck Surgery, Stanford Medical Center, Palo Alto, CA, USA
| | - Bonnie Balzer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Arthur W Wu
- Division of Otolaryngology, Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dennis M Tang
- Division of Otolaryngology, Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
2
|
Zhou FY, Zhang X, Cai LY, Chen MM, Tao ZY, Zhu XW, Gao WY. [Effect of accurately localized mini anterolateral thigh perforator flap in repairing medium-sized skin and soft tissue defects in fingers]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2024; 40:165-171. [PMID: 38418178 DOI: 10.3760/cma.j.cn501225-20231030-00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Objective: To explore the effect of accurately localized mini anterolateral thigh perforator flap in repairing medium-sized skin and soft tissue defects in fingers. Methods: The study was a retrospective observational study. From December 2019 to September 2022, 15 patients with medium-sized skin and soft tissue defects who met the inclusion criteria in fingers were admitted to the Second Affiliated Hospital of Wenzhou Medical University, including 12 males and 3 females, aged 23 to 62 years. After debridement, the wounds were all accompanied by exposed tendons, bones, vessels and nerves, with an area from 4.0 cm×3.0 cm to 8.0 cm×3.5 cm. Computed tomography angiography and color Doppler ultrasonography examinations were performed on both lower limbs of the patient before surgery to accurately locate the anterolateral thigh perforators. When the flap with area from 6.0 cm×3.0 cm to 11.0 cm×4.0 cm was harvested, the flap was thinned. The artery and vein perforators of the flap were anastomosed respectively with the digital artery and dorsal metacarpal vein. If there was avulsion injury, infection, or burn in the recipient area, the main arterial and veinous vessels carried by the skin flap was anastomosed with the radial artery and accompanying vein. The lateral thigh cutaneous nerve carried by the flap was anastomosed with the stump of the digital nerve. The types of perforators of the lateral thigh artery were observed during operation and compared with the location of the vessels before operation. After operation, the survival and adverse complication of the flap were closely observed. During follow-up, the skin flap color, texture, and shape were observed; the wound healing in donor area was observed. At the last follow-up, the two-point discriminative distance of the affected finger pulp was measured, and the function of the affected finger was evaluated using the trial standard for the evaluation of functions of upper limbs of Hand Surgery Society of Chinese Medical Association, and the interphalangeal joint movement of the affected finger was observed; the patients' complaints about the adverse effects of flap resection on lower limbs were recorded. Results: During the operation, it was observed that the perforators of the flaps in 11 patients were the descending branch of the lateral circumflex thigh artery, in two patients, the perforators of skin flaps were the oblique branch of the lateral thigh artery, and the perforators in another two patients were the transverse branch of the lateral circumflex thigh artery, which were consistent with the preoperative vascular localization. After operation, all flaps survived without vascular crisis and infection. The patients were followed up for 6-12 months, the flaps had excellent color, texture, and appearance; only linear scars remained on the donor wound. At the last follow-up, the two-point discrimination distance in the finger pulp was 7-11 mm; the affected finger function was rated as excellent in 6 cases, good in 6 cases, and fair in 3 cases; the flexion and extension function of the finger was not affected; two patients complained of numbness in the lateral thigh after excision of the skin flap, and the other 13 patients had no complain of adverse complaints. Conclusions: The perforating branch in lateral thigh region can be accurately located by computed tomography angiography and color Doppler ultrasonography, accurate positioning of perforators before operation can reduce the damage to the donor area during the incision of the flap, the appearance and function of the affected finger can be restored to the maximum extent by thinning the transplanted flap and rebuilding the finger sensation. Therefore, it is an effective and reliable way to repair the medium-sized skin and soft tissue defects of fingers with the mini thigh anterolateral perforator flap.
Collapse
Affiliation(s)
- F Y Zhou
- Department of Wound Repair, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - X Zhang
- Department of Wound Repair, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - L Y Cai
- Department of Wound Repair, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - M M Chen
- Department of Wound Repair, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Z Y Tao
- Department of Wound Repair, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - X W Zhu
- Department of Wound Repair, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - W Y Gao
- Department of Wound Repair, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| |
Collapse
|
3
|
Zumsteg ZS, Luu M, Rosenberg PS, Elrod JK, Bray F, Vaccarella S, Gay C, Lu DJ, Chen MM, Chaturvedi AK, Goodman MT. Global epidemiologic patterns of oropharyngeal cancer incidence trends. J Natl Cancer Inst 2023; 115:1544-1554. [PMID: 37603716 PMCID: PMC10699798 DOI: 10.1093/jnci/djad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/10/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The emergence of human papillomavirus (HPV)-positive oropharyngeal cancer and evolving tobacco use patterns have changed the landscape of head and neck cancer epidemiology internationally. We investigated updated trends in oropharyngeal cancer incidence worldwide. METHODS We analyzed cancer incidence data between 1993 and 2012 from 42 countries using the Cancer Incidence in Five Continents database volumes V through XI. Trends in oropharyngeal cancer incidence were compared with oral cavity cancers and lung squamous cell carcinomas using log-linear regression and age period-cohort modeling. RESULTS In total, 156 567 oropharyngeal cancer, 146 693 oral cavity cancer, and 621 947 lung squamous cell carcinoma patients were included. Oropharyngeal cancer incidence increased (P < .05) in 19 and 23 countries in men and women, respectively. In countries with increasing male oropharyngeal cancer incidence, all but 1 had statistically significant decreases in lung squamous cell carcinoma incidence, and all but 2 had decreasing or nonsignificant net drifts for oral cavity cancer. Increased oropharyngeal cancer incidence was observed both in middle-aged (40-59 years) and older (≥60 years) male cohorts, with strong nonlinear birth cohort effects. In 20 countries where oropharyngeal cancer incidence increased for women and age period-cohort analysis was possible, 13 had negative or nonsignificant lung squamous cell carcinoma net drifts, including 4 countries with higher oropharyngeal cancer net drifts vs both lung squamous cell carcinoma and oral cavity cancer (P < .05 for all comparisons). CONCLUSIONS Increasing oropharyngeal cancer incidence is seen among an expanding array of countries worldwide. In men, increased oropharyngeal cancer is extending to older age groups, likely driven by human papillomavirus-related birth cohort effects. In women, more diverse patterns were observed, suggesting a complex interplay of risks factors varying by country, including several countries where female oropharyngeal cancer increases may be driven by HPV.
Collapse
Affiliation(s)
- Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Julia K Elrod
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Department of Statistics and Data Science, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Salvatore Vaccarella
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Christopher Gay
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
| | - Diana J Lu
- Department of Radiation Oncology, The Queen’s Medical Center, Honolulu, HI, USA
| | - Michelle M Chen
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Anil K Chaturvedi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Marc T Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Cancer Prevention and Control, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
4
|
Zhang Y, Chen L, Jiang JN, Ma T, Liu JY, Yuan W, Guo TJ, Chen MM, Wang RL, Dong YH, Song Y, Ma J. [Research on the association between ambient PM 2.5 and its components and psychological distress among Chinese children and adolescents aged 9-18 years]. Zhonghua Liu Xing Bing Xue Za Zhi 2023; 44:1575-1582. [PMID: 37875444 DOI: 10.3760/cma.j.cn112338-20230504-00276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Objective: To analyze the association between exposure to ambient PM2.5 and its components [sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), organic matter (OM), and black carbon (BC)] and psychological distress among school children and adolescents aged 9 to 18 years in China. Methods: Based on data from the 2019 Chinese National Survey on Students' Constitution and Health, 130 808 children and adolescents aged 9 to 18 years were included. Scoring and determination of higher psychological distress were based on the Kessler Psychological Distress Scale (K10), and annual average exposure data for air pollution were matched by survey location and time. We used a restricted cubic spline approach based on logistic regression to fit the associations between PM2.5, SO42-, NO3-, NH4+, organic matter, black carbon concentrations, and psychological distress. Logistic regression models were used to analyse different age, gender, BMI and physical activity subgroups to estimate the association between exposure to high levels of pollution and high levels of psychological distress in different subgroups. Results: The proportion of children and adolescents with high levels of psychological distress in China was 30.4%, with girls being higher than boys at 31.6% and 29.1%, respectively (P<0.05). A non-linear positive association existed between exposure to PM2.5, SO42-, NO3- and organic matter concentrations and higher psychological distress. As PM2.5, NO3-, NH4+, organic matter, and black carbon concentrations continued to rise, the increase in the risk of higher psychological distress slowed, while SO42- showed little change in the OR of psychological distress at lower concentrations but continued to rise at higher concentrations. PM2.5 and its components were statistically associated with psychological distress in the physically inactive group but not in the physically active group. The association between high levels of pollutants and high psychological distress was stronger among students aged 9 to 12 years compared with students aged 13 to 15 years and 16 to 18 years. Conclusions: The ambient pollutant PM2.5 and its components are associated with psychological distress in children and adolescents aged 9 to 18 years in China. High pollutant exposure is a risk factor for high psychological distress among physically inactive children and adolescents, and there are age differences in the association between PM2.5 and components and psychological distress.
Collapse
Affiliation(s)
- Y Zhang
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| | - L Chen
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| | - J N Jiang
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| | - T Ma
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| | - J Y Liu
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| | - W Yuan
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| | - T J Guo
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| | - M M Chen
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| | - R L Wang
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| | - Y H Dong
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| | - Y Song
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| | - J Ma
- Institute of Child and Adolescent Health, Peking University/School of Public Health, Peking University, Beijing 100191, China
| |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
6
|
Fang RL, Leng Q, Wang Y, Chen MM, Cui Y, Wu XL, Ju Y. [A comparative analysis of the clinical symptoms of benign paroxysmal positional vertigo between older and young and middle-aged patients]. Zhonghua Nei Ke Za Zhi 2023; 62:802-807. [PMID: 37394849 DOI: 10.3760/cma.j.cn112138-20221225-00956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Objective: To compare the differences in clinical symptoms and the time required for diagnosis of benign paroxysmal positional vertigo (BPPV) between older patients and young and middle-aged patients in the structured inquiry of dizziness history. Methods: The medical records of 6 807 patients diagnosed with BPPV from the Vertigo Database of Vertigo Clinical Diagnosis, Treatment, and Research Center of Beijing Tiantan Hospital, Capital Medical University, between January 2019 and October 2021 were retrospectively analyzed. The data included basic demographic information, clinical symptoms in a structured medical history questionnaire, and the time interval from the appearance of BPPV symptoms to diagnosis consultation. The patients were divided into the young and middle-aged group (<65 years old) and the older group (≥65 years old). The differences in clinical symptoms and consultation time were compared between these two groups. Categorical variables were represented by numbers (%), and compared using Chi-squared tests or Fisher's exact probability test for analysis; whereas, continuous variables conforming to normal distribution were represented by mean±standard deviation. Both data groups were compared and analyzed by Student's t-test. Results: The mean age of the older group was 65-92 (71±5) years, while the mean age of the middle-aged group was 18-64 (49±12) years. The incidence of vertigo (42.5% vs. 49.1%, χ2=23.69, P<0.001); vertigo triggered by changes in position of the head or body (52.4% vs. 58.7%, χ2=22.31, P<0.001); and autonomic symptoms (10.1% vs. 12.4%, χ2=7.09, P=0.008) were lower, but hearing loss (11.8% vs. 7.8%, χ2=27.36, P<0.001) and sleep disorders (18.5% vs. 15.2%, χ2=11.13, P=0.001) were higher in the older group than in the young and middle-aged group. The time from the appearance of dizziness to diagnosis was commonly longer in the older patient group than the other group (55.0% vs. 38.5%, χ2=55.95, P<0.001). Conclusions: Older patients with BPPV have more atypical symptoms and complex concomitant symptoms than young and middle-aged patients. For older patients with dizziness, positional testing is needed to confirm the possibility of BPPV even if the clinical symptoms are atypical.
Collapse
Affiliation(s)
- R L Fang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Q Leng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Y Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - M M Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Y Cui
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - X L Wu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Y Ju
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| |
Collapse
|
7
|
Yuan W, Zhang Y, Chen L, Jiang JN, Chen MM, Liu JY, Ma T, Ma Q, Cui MJ, Guo TJ, Wang XX, Dong YH, Ma J. [Association of body fat distribution with depression and social anxiety in children and adolescents: A cross-sectional study based on dual-energy X-ray detection]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:429-435. [PMID: 37291917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the status of depression and social anxiety in children and adolescents, and to analyze the association between body fat distribution and depression, social anxiety in children and adolescents. METHODS A total of 1 412 children aged 7 to 18 years in Beijing were included by stratified cluster random sampling method. Body fat distribution, including total body fat percentage (total BF%), Android BF%, Gynoid BF% and Android-to-Gynoid fat ratio (AOI), were obtained by dual-energy X-ray absorption method. Depression and social anxiety were evaluated by Children Depression Inventory and Social Anxiety Scale for Children. Multivariate linear regression and restricted cubic spline analysis were used to estimate the linear and non-linear correlation between body fat distribution and depression and social anxiety. RESULTS 13.1% and 31.1% of the children and adolescents had depressive symptoms and social anxiety symptoms respectively, and the detection rate of depression and social anxiety in the boys and young groups was significantly lower than those in the girls and old groups. There was no significant linear correlation between total BF%, Android BF%, Gynoid BF%, AOI and depression and social anxiety in the children and adolescents. However, total BF% and Gynoid BF% had significant nonlinear correlation with depression, showing an inverted U-shaped curve relationship with the tangent points of 26.8% and 30.9%, respectively. In terms of the nonlinear association of total BF%, Android BF%, Gynoid BF% and AOI with depression and social anxiety, the change trends of the boys and girls, low age group and high age group were consistent. The overall anxiety risk HR of body fat distribution in the boys was significantly higher than that in the girls, and the risk HR of depression and social anxiety were significantly higher in the high age group than those in the low age group. CONCLUSION There was no significant linear correlation between body fat distribution and depression and social anxiety in children and adolescents. Total BF% and depression showed an inverted U-shaped curve, mainly manifested in Gynoid BF%, and this trend was consistent in different genders and different age groups. Maintaining children and adolescents' body fat distribution at an appropriate level is the future direction of the prevention and control of depression and social anxiety in children and adolescents.
Collapse
Affiliation(s)
- W Yuan
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - Y Zhang
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - L Chen
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - J N Jiang
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - M M Chen
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - J Y Liu
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - T Ma
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - Q Ma
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - M J Cui
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - T J Guo
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - X X Wang
- School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China
| | - Y H Dong
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - J Ma
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| |
Collapse
|
8
|
Itamura K, Hsue VB, Barbu AM, Chen MM. Diagnostic Assessment (Imaging) and Staging of Laryngeal Cancer. Otolaryngol Clin North Am 2023; 56:215-231. [PMID: 37030936 DOI: 10.1016/j.otc.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
Diagnosis of larynx cancer relies on a detailed history and physical and objective assessment with endoscopy and imaging. Endoscopy is needed to assess for vocal fold function that directly affects staging. Computed tomography and MRI can be used to assess for tumor extent in relation to intra- and extra-laryngeal structures, especially paraglottic and pre-epiglottic space involvement as well as cartilage invasion. Accurate staging is critical for subsequent treatment decision-making regarding larynx preservation.
Collapse
Affiliation(s)
- Kyohei Itamura
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA
| | - Victor B Hsue
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA
| | - Anca M Barbu
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA
| | - Michelle M Chen
- Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, 8635 West Third Street #590W, Los Angeles, CA 90048, USA; Department of Otolaryngology-Head and Neck Surgery, Stanford University, 900 Blake Wilbur Drive Rm W3045, Stanford, CA 94305, USA.
| |
Collapse
|
9
|
Benjamin WJ, Yalamanchi P, Taylor JMG, Lenze N, Worden FP, Chinn SB, Chen MM. Impact of monoclonal antibody therapy for head and neck cancer on end-of-life care utilization and costs. Head Neck 2023; 45:1468-1475. [PMID: 36976786 DOI: 10.1002/hed.27359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The impact of monoclonal antibody therapy (mAB) for advanced head and neck cancer on end-of-life health care utilization and costs has yet to be adequately studied. METHODS Retrospective cohort study of patients aged 65 and over with a diagnosis of head and neck cancer between 2007 and 2017 within the SEER-Medicare registry assessing the impact of mAB therapy (i.e., cetuximab, nivolumab, or pembrolizumab) on end-of-life health care utilization (ED visits, inpatient admissions, ICU admissions, and hospice claims) and costs. RESULTS Of 12 544 patients with HNC, 270 (2.2%) utilized mAB therapy at the end-of-life period. On multivariable analyses adjusting for demographic and clinicopathologic characteristics, there was a significant association between mAB therapy and emergency department visits (OR: 1.38, 95% CI: 1.1-1.8, p = 0.01) and healthcare costs (β: $9760, 95% CI: 5062-14 458, p < 0.01). CONCLUSIONS mAB use is associated with higher emergency department utilization and health care costs potentially due to infusion-related and drug toxicity expenses.
Collapse
Affiliation(s)
| | - Pratyusha Yalamanchi
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jeremy M G Taylor
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Nicholas Lenze
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Francis P Worden
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michelle M Chen
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA
| |
Collapse
|
10
|
Dong YH, Chen L, Liu JY, Ma T, Zhang Y, Chen MM, Zhong PL, Shi D, Hu PJ, Li J, Dong B, Song Y, Ma J. [Epidemiology and prediction of overweight and obesity among children and adolescents aged 7-18 years in China from 1985 to 2019]. Zhonghua Yu Fang Yi Xue Za Zhi 2023; 57:11-19. [PMID: 36854438 DOI: 10.3760/cma.j.cn112150-20220906-00881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Objective: To analyze and predict the epidemic trend of overweight and obesity among children and adolescents aged 7-18 years in China from 1985 to 2019. Methods: Data were collected from the Chinese National Survey on Students Constitution and Health in 1985, 1995, 2000, 2005, 2010, 2014, and 2019 with the sample size of 409 945, 204 931, 209 209, 234 420, 215 317, 214 353, and 212 711, respectively. Overweight and obesity were evaluated according to the "classification standard of the weight index value of overweight and obesity screening for Chinese school-age children and adolescents" of the Working Group on Obesity in China (WGOC). The detection rate and average annual growth rate of overweight and obesity, and single obesity among children and adolescents aged 7-18 years were calculated, and ArcGis10.6 software was used to analyze the difference in the prevalence of overweight and obesity among children and adolescents in different regions in 2019. Polynomial regression function was used to fit the prevalence and average annual growth rate of overweight and obesity, and single obesity among children and adolescents from 1985 to 2019, and to predict the prevalence of overweight and obesity and single obesity among children and adolescents in China. Results: In 2019, the total prevalence of overweight and obesity among children and adolescents aged 7-18 years in China was 23.4%, and the prevalence of single obesity was 9.6%. The prevalence of overweight and obesity among urban children and adolescents was higher than that in rural areas (25.4% vs. 21.5%), and the prevalence in boys was higher than that in girls (28.4% vs. 18.4%) (both P values<0.001). In 2019, there was a large regional disparity in the prevalence of overweight and obesity in different provinces, with the lowest in Guangdong (12.2%) and the highest in Shandong (38.9%), and the high epidemic areas were mainly concentrated in North China and Northeast China. From 1985 to 2019, the prevalence of overweight and obesity among children and adolescents aged 7-18 years in China increased from 1.2% to 23.4%, with an increase of 18.1 times, while the prevalence of obesity alone increased from 0.1% to 9.6%, with an increase of 75.6 times. The prevalence of overweight and obesity in urban boys, urban girls, rural boys and rural girls increased from 1.3%, 1.5%, 0.5%, and 1.6% in 1985 to 31.2%, 19.4%, 25.6%, and 17.4% in 2019, with an increase of 22.3, 11.7, 54.2, and 10.1 times, respectively. According to the prediction model, the prevalence of overweight and obesity among children and adolescents aged 7-18 years in China will increase from 23.4% in 2019 to 32.7% in 2030, and the prevalence of obesity alone will increase from 9.6% in 2019 to 15.1% in 2030. The growth of rural children and adolescents is obvious. By 2025, the prevalence of overweight and obesity among rural children and adolescents in China will comprehensively exceed that of urban, and there will be an "urban-rural reversal" phenomenon. At the same time, the prevalence of children's obesity in China's low, medium and high epidemic areas will also continue to increase. By 2035, the prevalence of overweight and obesity among children and adolescents in medium epidemic areas will exceed that in high epidemic areas, and there will be a "provincial reversal" phenomenon. Conclusion: From 1985 to 2019, the overweight and obesity of children and adolescents in China will continue to grow rapidly with large regional differences.
Collapse
Affiliation(s)
- Y H Dong
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - L Chen
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - J Y Liu
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - T Ma
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - Y Zhang
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - M M Chen
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - P L Zhong
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - D Shi
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - P J Hu
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - J Li
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - B Dong
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - Y Song
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - J Ma
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| |
Collapse
|
11
|
Mattingly AS, Chen MM, Divi V, Holsinger FC, Saraswathula A. Minimally Invasive Surgery in the United States, 2022: Understanding Its Value Using New Datasets. J Surg Res 2023; 281:33-36. [PMID: 36115146 PMCID: PMC9691544 DOI: 10.1016/j.jss.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/09/2022] [Accepted: 08/17/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION While minimally invasive surgery (MIS) has transformed the treatment landscape of surgical care, its utilization is not well understood. The newly released Nationwide Ambulatory Surgery Sample allows for more accurate estimates of MIS volume in the United States-in combination with inpatient datasets. MATERIALS AND METHODS Multiple nationwide databases from the Healthcare Cost and Utilization Project (HCUP) were used: the Nationwide Ambulatory Surgery Sample and National Inpatient Sample. The volume of MIS and robotic procedures were calculated from 2016 to 2018. An online query system, HCUPNet, was queried for inpatient stays from 1993 to 2014. RESULTS In 2017, 9.8 million inpatient major operating room procedures were analyzed, of which 11.1% were MIS and 2.5% were robotic-assisted, compared with 9.6 million inpatient operating room procedures (11.2% MIS and 2.9% robotic-assisted) in 2018. There were 10.6, 10.6, and 10.7 million ambulatory procedures in 2016, 2017, and 2018, respectively. Ambulatory MIS procedures showed an increasing trend across years, representing 16.9%, 17.4%, and 18%, respectively. HCUPNet data revealed an increase in inpatient MIS cases from 529,811 (8.9%) in 1993 to 1,443,446 (20.7%) in 2014. CONCLUSIONS This study is the first to estimate national MIS volume across specialties in both inpatient and ambulatory hospital settings. We found a trend toward a higher proportion of MIS and robotic cases from 1997 to 2018. These data may help contribute to a more comprehensive understanding of MIS value within surgery and highlight limitations of current databases, especially when categorizing robotic cases on a national scale.
Collapse
Affiliation(s)
- Aviva S Mattingly
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Michelle M Chen
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Vasu Divi
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California.
| | - Anirudh Saraswathula
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
12
|
Chen L, Zhang Y, Chen MM, Ma T, Ma Q, Liu JY, Dong YH, Song Y, Ma J. [Prevalence of unhealthy lifestyle among children and adolescents of Han nationality in China]. Zhonghua Xin Xue Guan Bing Za Zhi 2022; 50:1177-1185. [PMID: 36517438 DOI: 10.3760/cma.j.cn112148-20220826-00648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Objective: To explore the epidemiological characteristics and geographical distribution of unhealthy lifestyle among children and adolescents of Han nationality in China and obtain evidence for proposing the related strategies to improve the well-being of this population. Methods: Students aged 6-22 years old were selected from the Chinese National Survey on Students Constitution and Health in 2019. The prevalence of unhealthy lifestyles (physical inactivity, lack of outdoor activity, sedentary behavior, excessive screen time, sleep insufficiency, unhealthy eating behavior) between sex, residence, and age groups was calculated and compared. Multilevel logistic regression was used to explore the influencing factors of unhealthy lifestyle. Results: The prevalence of moderate-to-vigorous physical activity less than 1 h/d or 30 min/d were 82.06% and 54.69%, respectively. The prevalence of less than 2 h/d or 3 h/d of outdoor activities were 95.20% and 83.26%, respectively. The prevalence of more than 2 h/d or 3 h/d of sitting time were 50.64% and 31.92%, respectively. The prevalence of more than 2 h/d or 3 h/d of screen time were 42.02% and 27.79%, respectively. The prevalence of sleep insufficiency, excessive sugary beverages consumption (≥ 1 time/d), and insufficient consumption of eggs, milk, and breakfast (<7 d/week) were 66.49%, 20.97%, 83.36%, 70.71%, and 34.34%, respectively. The prevalence of severe sleep insufficiency, excessive sugary beverages consumption (≥ 3 times/d), and insufficient consumption of eggs, milk, and breakfast (≤2 d/week) were 27.77%, 8.21%, 47.21%, 32.36% and 9.73%, respectively. Conclusion: In 2019, unhealthy lifestyle is common among Han students aged 6-22 years in China. It is of importance to propose policies to strengthen the health education and initiatives to support healthy behaviors in Han children and adolescents. Jointly promotion on the creation of a healthy environment for Han children and adolescents, and formulation of targeted improvement measures in accordance with the epidemic characteristics in various regions are essential to improve the healthy lifestyle of this population.
Collapse
Affiliation(s)
- L Chen
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - Y Zhang
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - M M Chen
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - T Ma
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - Q Ma
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - J Y Liu
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - Y H Dong
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - Y Song
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| | - J Ma
- School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
| |
Collapse
|
13
|
Ma T, Li YH, Chen MM, Ma Y, Gao D, Chen L, Ma Q, Zhang Y, Liu JY, Wang XX, Dong YH, Ma J. [Associations between early onset of puberty and obesity types in children: Based on both the cross-sectional study and cohort study]. Beijing Da Xue Xue Bao Yi Xue Ban 2022; 54. [PMID: 36241240 PMCID: PMC9568395 DOI: 10.19723/j.issn.1671-167x.2022.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To explore and analyze the relationship between early onset of puberty and different types of obesity in children, by combining large sample cross-sectional survey data with long-term longitudinal cohort data, so as to provide clues for further clarifying the health hazards of early onset of puberty and obesity prevention and control. METHODS The research data were from the cross-sectional survey data of seven provinces(autonomous regions, municipalities) in China and the cohort data of adolescent development in Xiamen. The study first found the association between early onset of puberty and obesity by Logistic regression on the cross-sectional data, and then used Poisson regression to analyze the association between early puberty initiation and various types of obesity risk. RESULTS In the study, 43 137 and 1 266 children were included in the cross-sectional survey and cohort survey respectively. The cross-sectional study found that among the girls aged 10-13 years, compared with the girls of the same age who did not start puberty, the body mass index (BMI)-Z score of the girls in the puberty start group was 0.5-0.8 higher, and the waist circumference Z score was 0.4-0.7 higher, and the risk of various types of obesity was higher. At the same time, the early onset of puberty was positively correlated with simple obesity, central obesity and compound obesity, the OR (95%CI) were 1.86 (1.42-2.44), 1.95 (1.65-2.32) and 1.86 (1.41-2.45), respectively. No significant association was found in boys. According to the cohort data, in girls, the risk of simple obesity was 6.00 times [RR (95%CI): 6.00 (1.07-33.60)], the risk of central obesity was 3.30 times [RR (95%CI): 3.30 (1.22-8.92)], and the risk of compound obesity was 5.76 times [RR (95%CI): 5.76 (1.03-32.30)], compared with the group without early puberty initiation, while no association between early puberty initiation and obesity was found in boys. CONCLUSION Based on the cross-sectional survey and longitudinal cohort survey, it is confirmed that the early onset of puberty in girls may increase the risk of simple obesity, central obesity and compound obesity, while there is no significant correlation between puberty onset and obesity in boys.
Collapse
Affiliation(s)
- T Ma
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - Y H Li
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - M M Chen
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - Y Ma
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - D Gao
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - L Chen
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - Q Ma
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - Y Zhang
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - J Y Liu
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - X X Wang
- School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China
| | - Y H Dong
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| | - J Ma
- Institute of Child and Adolescent Health, Peking University School of Public Health, Beijing 100191, China
| |
Collapse
|
14
|
Ho AS, Kim S, Zalt C, Melany ML, Chen IE, Vasquez J, Mallen-St. Clair J, Chen MM, Vasquez M, Fan X, van Deen WK, Haile RW, Daskivich TJ, Zumsteg ZS, Braunstein GD, Sacks WL. Expanded Parameters in Active Surveillance for Low-risk Papillary Thyroid Carcinoma: A Nonrandomized Controlled Trial. JAMA Oncol 2022; 8:2796440. [PMID: 36107411 PMCID: PMC9478884 DOI: 10.1001/jamaoncol.2022.3875] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/08/2022] [Indexed: 08/28/2023]
Abstract
Importance Unlike for prostate cancer, active surveillance for thyroid cancer has not achieved wide adoption. The parameters by which this approach is feasible are also not well defined, nor is the effect of patient anxiety. Objective To determine if expanded size/growth parameters for patients with low-risk thyroid cancer are viable, as well as to assess for cohort differences in anxiety. Design, Setting, and Participants This prospective nonrandomized controlled trial was conducted at a US academic medical center from 2014 to 2021, with mean [SD] 37.1 [23.3]-month follow-up. Of 257 patients with 20-mm or smaller Bethesda 5 to 6 thyroid nodules, 222 (86.3%) enrolled and selected treatment with either active surveillance or immediate surgery. Delayed surgery was recommended for size growth larger than 5 mm or more than 100% volume growth. Patients completed the 18-item Thyroid Cancer Modified Anxiety Scale over time. Interventions Active surveillance. Main Outcomes and Measures Cumulative incidence and rate of size/volume growth. Results Of the 222 patients enrolled, the median (IQR) age for the study population was 46.8 (36.6-58) years, and 76.1% were female. Overall, 112 patients (50.5%) underwent treatment with active surveillance. Median tumor size was 11.0 mm (IQR, 9-15), and larger tumors (10.1-20.0 mm) comprised 67 cases (59.8%). One hundred one (90.1%) continued to receive treatment with active surveillance, 46 (41.0%) had their tumors shrink, and 0 developed regional/distant metastases. Size growth of more than 5 mm was observed in 3.6% of cases, with cumulative incidence of 1.2% at 2 years and 10.8% at 5 years. Volumetric growth of more than 100% was observed in 7.1% of cases, with cumulative incidence of 2.2% at 2 years and 13.7% at 5 years. Of 110 patients who elected to undergo immediate surgery, 21 (19.1%) had equivocal-risk features discovered on final pathology. Disease severity for all such patients remained classified as stage I. Disease-specific and overall survival rates in both cohorts were 100%. On multivariable analysis, immediate surgery patients exhibited significantly higher baseline anxiety levels compared with active surveillance patients (estimated difference in anxiety scores between groups at baseline, 0.39; 95% CI, 0.22-0.55; P < .001). This difference endured over time, even after intervention (estimated difference at 4-year follow-up, 0.50; 95% CI, 0.21-0.79; P = .001). Conclusions and Relevance The results of this nonrandomized controlled trial suggest that a more permissive active surveillance strategy encompassing most diagnosed thyroid cancers appears viable. Equivocal-risk pathologic features exist in a subset of cases that can be safely treated, but suggest the need for more granular risk stratification. Surgery and surveillance cohorts possess oppositional levels of worry, elevating the importance of shared decision-making when patients face treatment equivalence. Trial Registration ClinicalTrials.gov Identifier: NCT02609685.
Collapse
Affiliation(s)
- Allen S. Ho
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sungjin Kim
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Cynthia Zalt
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michelle L. Melany
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Irene E. Chen
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joan Vasquez
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jon Mallen-St. Clair
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michelle M. Chen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Missael Vasquez
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Xuemo Fan
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Welmoed K. van Deen
- Center for Outcomes Research and Education, Division of Health Sciences Research, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert W. Haile
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Timothy J. Daskivich
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zachary S. Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Glenn D. Braunstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Wendy L. Sacks
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| |
Collapse
|
15
|
Nguyen AT, Luu M, Nguyen VP, Lu DJ, Shiao SL, Kamrava M, Atkins KM, Mita AC, Scher KS, Spratt DE, Faries MB, Daskivich TJ, Lin DC, Chen MM, Clair JMS, Sandler HM, Ho AS, Zumsteg ZS. Quantitative Nodal Burden and Mortality Across Solid Cancers. J Natl Cancer Inst 2022; 114:1003-1011. [PMID: 35311991 PMCID: PMC9275768 DOI: 10.1093/jnci/djac059] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/10/2022] [Accepted: 03/16/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nodal staging systems vary substantially across solid tumors, implying heterogeneity in the behavior of nodal variables in various contexts. We hypothesized, in contradiction to this, that metastatic lymph node (LN) number is a universal and dominant predictor of outcome across solid tumors. METHODS We performed a retrospective cohort analysis of 1 304 498 patients in the National Cancer Database undergoing surgery between 2004 and 2015 across 16 solid cancer sites. Multivariable Cox regression analyses were constructed using restricted cubic splines to model the association between nodal number and mortality. Recursive partitioning analysis (RPA) was used to derive nodal classification systems for each solid cancer based on metastatic LN count. The reproducibility of these findings was assessed in 1 969 727 patients from the Surveillance, Epidemiology, and End Results registry. Two-sided tests were used for all statistical analyses. RESULTS Consistently across disease sites, mortality risk increased continuously with increasing number of metastatic LNs (P < .001 for all spline segments). Each RPA-derived nodal classification system produced multiple prognostic groups spanning a wide spectrum of mortality risk (P < .001). Multivariable models using these RPA-derived nodal classifications demonstrated improved concordance with mortality compared with models using American Joint Committee on Cancer staging in sites where nodal classification is not based on metastatic LN count. Each RPA-derived nodal classification system was reproducible in a large validation cohort for all-cause and cause-specific mortality (P < .001). High quantitative nodal burden was the single strongest tumor-intrinsic variable associated with mortality in 12 of 16 disease sites. CONCLUSIONS Quantitative metastatic LN burden is a fundamental driver of mortality across solid cancers and should serve as a foundation for pathologic nodal staging across solid tumors.
Collapse
Affiliation(s)
- Anthony T Nguyen
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Biostatistics and Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Vina P Nguyen
- Department of Medicine, Division of Hematology & Oncology, UCLA School of Medicine, Los Angeles, CA, USA
| | - Diana J Lu
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen L Shiao
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Katelyn M Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alain C Mita
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kevin S Scher
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals, Case Western Reserve, Cleveland, OH, USA
| | - Mark B Faries
- Cedars-Sinai Medical Center, The Angeles Clinic and Research Institute, Los Angeles, CA, USA
| | - Timothy J Daskivich
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - De-Chen Lin
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michelle M Chen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Howard M Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zachary S Zumsteg
- Correspondence to: Zachary S. Zumsteg, MD, Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA (e-mail: )
| |
Collapse
|
16
|
Zhong PL, Liu YF, Ma N, Dang JJ, Dong YH, Chen MM, Ma T, Ma Y, Chen L, Shi D, Song Y. [Effect of outdoor time on the incidence of myopia among primary school students in 9 provinces of China]. Zhonghua Liu Xing Bing Xue Za Zhi 2022; 43:1099-1106. [PMID: 35856206 DOI: 10.3760/cma.j.cn112338-20211111-00876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: We aimed to assess the effects of outdoor time in preventing incident myopia among primary school students and evaluate its differences among different grades to provide evidence for policy formulation related to myopia prevention. Methods: This study is a cohort study. We investigated 6 046 grade 1 to 5 students in 9 provinces, Jiangsu, Shanghai, Fujian, Shanxi, Henan, Hunan, Gansu, Chongqing, and Guangxi. In 2019, we measured their myopia on site. In 2020, we did a follow-up visit on those students to detect the myopia incidence rate. Information regarding outdoor time and myopia-related behaviors were obtained from a questionnaire within one week of visual acuity measurement in 2020. The chi-square test and Cochran-Armitage trend test compared the differences between groups. The Cox proportional hazards risk model was used to test the relationship between outdoor time and myopia. Results: In 2020, the overall myopia incidence rate of grade 1 to 5 students in the baseline was 27.5%; while 23.0% in grades 1 and 2 students and 31.7% in grades 3 to 5 students, respectively. After controlling for covariates, for students in grade 1 to 2, those with ≥1 hour of outdoor time per day were at 0.76 (95%CI: 0.62-0.93, P=0.008) times risk of being myopia than that of students with <1 hour of outdoor time per day; while for students in grades 3 to 5, an average of ≥3 hours of outdoor time per day was required to have a significant protective effect on myopia. The students with ≥3 hours of outdoor time per day were less likely to be myopia (OR=0.75, 95%CI: 0.61-0.93, P=0.007) than those students with <3 hours of outdoor time per day. Conclusions: For grade 1 and 2 students, 1 hour of outdoor time per day could reduce the incidence of myopia, whereas for grade 3 to 5 students, 3 hours of outdoor time per day could effectively reduce the incidence of myopia. Therefore, the recommendations for outdoor time as myopia prevention should be different for different grades. The higher the grade is, the more outdoor time should be spent to reduce myopia incidence. Moreover, other factors that affect myopia's incidence should be also paid attention to, and a comprehensive approach should be adopted to prevent and control the incidence of myopia.
Collapse
Affiliation(s)
- P L Zhong
- School of Public Health & Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China
| | - Y F Liu
- School of Public Health & Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China
| | - N Ma
- School of Public Health & Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China
| | - J J Dang
- School of Public Health & Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China
| | - Y H Dong
- School of Public Health & Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China
| | - M M Chen
- School of Public Health & Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China
| | - T Ma
- School of Public Health & Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China
| | - Y Ma
- School of Public Health & Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China
| | - L Chen
- School of Public Health & Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China
| | - D Shi
- School of Public Health & Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China
| | - Y Song
- School of Public Health & Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing 100191, China
| |
Collapse
|
17
|
Mott NM, Mierzwa ML, Casper KA, Shah JL, Mallen-St Clair J, Ho AS, Zumsteg ZS, Prince ME, Dossett LA, Chen MM. Financial Hardship in Patients With Head and Neck Cancer. JCO Oncol Pract 2022; 18:e925-e937. [PMID: 35167324 PMCID: PMC9797234 DOI: 10.1200/op.21.00683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Financial hardship is a growing concern for patients with cancer. Patients with head and neck cancer (HNC) are particularly vulnerable, given that a third leave the workforce following treatment. The goal of our study was to characterize financial hardship in the psychologic response (response to increased expenses) and coping behaviors (behaviors patients adopt to manage their care in the setting of increased expenses) domains in patients with HNC compared with patients with other cancers. METHODS This was a retrospective cohort study of nationally representative public survey data from 2013 to 2018 in the National Health Interviews Survey, an annual cross-sectional household survey. We included respondents age ≥ 18 years who reported a diagnosis of cancer and identified a subset of patients with HNC. Our main outcomes were financial hardship in the psychologic response and coping behaviors domains. RESULTS Our sample included a weighted population of 357,052 patients with HNC and 21.4 million patients with other cancers. Compared with patients with other cancers, patients with HNC reported greater levels of coping behaviors hardship (31% v 23%, P = .015), but similar levels of psychologic financial hardship (73% v 72%, P = .787). Medicaid or uninsured patients more often reported coping behaviors hardship. On multivariable analysis, HNC (odds ratio, 1.51; 95% CI, 1.01 to 2.24) was independently associated with coping behaviors hardship. CONCLUSION To our knowledge, this is the first study to evaluate financial hardship in patients with HNC compared with patients with other cancers that includes Medicaid and uninsured patients, who are more often to have financial hardship. Patients with HNC have greater levels of hardship in the coping behaviors domain compared with patients with other cancers, but similar levels in the psychologic response domain.
Collapse
Affiliation(s)
| | | | - Keith A. Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI
| | - Jennifer L. Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Allen S. Ho
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Zachary S. Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark E.P. Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI
| | - Lesly A. Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI,Center for Bioethics and Social Sciences in Medicine (CBSSM), University of Michigan, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Michelle M. Chen
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA,Michelle M. Chen, MD, MHS, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 8635 West Third St, Suite 590W, Los Angeles, CA 90048; e-mail:
| |
Collapse
|
18
|
Chang CM, Chen MM, Bellile EL, Rozek LS, Carey TE, Spector ME, Wolf GT, Taylor JM, Chinn SB. Impact of Nodal Metastases in HPV-negative Oropharyngeal Cancer. Cancer Epidemiol Biomarkers Prev 2022; 31:1554-1563. [PMID: 35579907 DOI: 10.1158/1055-9965.epi-21-0776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/06/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The updated American Joint Committee on Cancer (AJCC) 8th Edition staging manual restructured nodal classification and staging by placing less prognostic emphasis on nodal metastases for HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). However, there was no change for HPV-negative OPSCC. The purpose of our study is to examine the impact of nodal metastases on survival in HPV-negative OPSCC. METHODS HPV-negative OPSCC were queried from the NCDB and SEER databases. Univariable and multivariable models were utilized to determine the impact of nodal status on overall survival. These patients were reclassified according to AJCC 8 HPV-positive criteria (TNM8+) and risk stratification was quantified with C-statistics. RESULTS There were 11,147 cases of HPV-negative OPSCC in the NCDB and 3,613 cases in SEER that were included in the nodal classification analysis. Unlike non-oropharyngeal malignancies, increased nodal stage is not clearly associated with survival for patients with OPSCC independent of HPV status. When the TNM8+ was applied to HPV-negative patients, there was improved concordance in the NCDB cohort, 0.561 {plus minus} 0.004 to 0.624 {plus minus} 0.004 (difference +0.063) and the SEER cohort, 0.561 {plus minus} 0.008 to 0.625 {plus minus} 0.008 (difference +0.065). CONCLUSIONS We demonstrated a reduced impact of nodal metastasis on OPSCC survival, independent of HPV-status and specific to OPSCC. IMPACT We demonstrate, that when nodal staging is de-emphasized as a part of overall staging, we see improved concordance and risk stratification for HPV-negative OPSCC. The exact mechanism of this differential impact remains unknown but offers a novel area of study.
Collapse
Affiliation(s)
- Clifford M Chang
- New York University Langone Health, New York, New York, United States
| | | | - Emily L Bellile
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | - Laura S Rozek
- University of Michigan-Ann Arbor, Ann Arbor, United States
| | - Thomas E Carey
- University of Michigan-Ann Arbor, Ann Arbor, Michigan, United States
| | - Matthew E Spector
- University of Michigan-Ann Arbor, Ann Arbor, Michigan, United States
| | - Gregory T Wolf
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| | | | - Steven B Chinn
- University of Michigan-Ann Arbor, Ann Arbor, MI, United States
| |
Collapse
|
19
|
Chen MM, Ho AS. Leveraging Molecular Assays to Aid Decision-making in Large Indeterminate Thyroid Nodules-A Minimalist Approach. JAMA Otolaryngol Head Neck Surg 2022; 148:383. [PMID: 35175281 DOI: 10.1001/jamaoto.2021.4433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michelle M Chen
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Allen S Ho
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| |
Collapse
|
20
|
Chen MM, Hughes TM, Dossett LA, Pitt SC. Peace of Mind: A Role in Unnecessary Care? J Clin Oncol 2022; 40:433-437. [PMID: 34882501 PMCID: PMC8824400 DOI: 10.1200/jco.21.01895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/05/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Michelle M. Chen
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Tasha M. Hughes
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Susan C. Pitt
- Department of Surgery, University of Wisconsin, Madison, WI
| |
Collapse
|
21
|
Chen JL, Zhang JY, Chen MM, Wang XZ. [Conservative management of Oehlers type Ⅲ dens invaginatus in maxillary lateral incisors with periapical periodontitis: a report of three cases]. Zhonghua Kou Qiang Yi Xue Za Zhi 2022; 57:182-185. [PMID: 35152655 DOI: 10.3760/cma.j.cn112144-20210823-00380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- J L Chen
- Department of Conservative and Endodontic Dentistry, Xiangya School and Hospital of Stomatology, Central South University & Hunan Key Laboratory of Oral Health Research, Changsha 410008, China
| | - J Y Zhang
- Department of Conservative and Endodontic Dentistry, Xiangya School and Hospital of Stomatology, Central South University & Hunan Key Laboratory of Oral Health Research, Changsha 410008, China
| | - M M Chen
- Department of Conservative and Endodontic Dentistry, Xiangya School and Hospital of Stomatology, Central South University & Hunan Key Laboratory of Oral Health Research, Changsha 410008, China
| | - X Z Wang
- Department of Conservative and Endodontic Dentistry, Xiangya School and Hospital of Stomatology, Central South University & Hunan Key Laboratory of Oral Health Research, Changsha 410008, China
| |
Collapse
|
22
|
Ho AS, Robinson A, Shon W, Laury A, Raedschelders K, Venkatraman V, Holewinski R, Zhang Y, Shiao SL, Chen MM, Mallen-St Clair J, Lin DC, Zumsteg ZS, Van Eyk JE. Comparative Proteomic Analysis of HPV(+) Oropharyngeal Squamous Cell Carcinoma Recurrence. J Proteome Res 2021; 21:200-208. [PMID: 34846153 DOI: 10.1021/acs.jproteome.1c00757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Deintensification therapy for human papillomavirus-related oropharyngeal squamous cell carcinoma (HPV(+) OPSCC) is under active investigation. An adaptive treatment approach based on molecular stratification could identify high-risk patients predisposed to recurrence and better select for appropriate treatment regimens. Collectively, 40 HPV(+) OPSCC FFPE samples (20 disease-free, 20 recurrent) were surveyed using mass spectrometry-based proteomic analysis via data-independent acquisition to obtain fold change and false discovery differences. Ten-year overall survival was 100.0 and 27.7% for HPV(+) disease-free and recurrent cohorts, respectively. Of 1414 quantified proteins, 77 demonstrated significant differential expression. Top enriched functional pathways included those involved in programmed cell death (73 proteins, p = 7.43 × 10-30), apoptosis (73 proteins, p = 5.56 × 10-9), β-catenin independent WNT signaling (47 proteins, p = 1.45 × 10-15), and Rho GTPase signaling (69 proteins, p = 1.09 × 10-5). PFN1 (p = 1.0 × 10-3), RAD23B (p = 2.9 × 10-4), LDHB (p = 1.0 × 10-3), and HINT1 (p = 3.8 × 10-3) pathways were significantly downregulated in the recurrent cohort. On functional validation via immunohistochemistry (IHC) staining, 46.9% (PFN1), 71.9% (RAD23B), 59.4% (LDHB), and 84.4% (HINT1) of cases were corroborated with mass spectrometry findings. Development of a multilateral molecular signature incorporating these targets may characterize high-risk disease, predict treatment response, and augment current management paradigms in head and neck cancer.
Collapse
|
23
|
Chen MM, Mott NM, Miller J, Kazemi R, Stover M, Graboyes EM, Divi V, Malloy KM, Wallner LP, Pitt SC, Dossett LA. Clinician Attitudes and Beliefs About Deintensifying Head and Neck Cancer Surveillance. JAMA Otolaryngol Head Neck Surg 2021; 148:43-51. [PMID: 34734995 DOI: 10.1001/jamaoto.2021.2824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Surveillance imaging and visits are costly and have not been shown to improve oncologic outcomes for patients with head and neck cancer (HNC). However, the benefit of surveillance visits may extend beyond recurrence detection. To better understand surveillance and potentially develop protocols to tailor current surveillance paradigms, it is important to elicit the perspectives of the clinicians who care for patients with HNC. Objective To characterize current surveillance practices and explore clinician attitudes and beliefs on deintensifying surveillance for patients with HNC. Design, Setting, and Participants This qualitative study was performed from January to March 2021. Guided by an interpretive description approach, interviews were analyzed to produce a thematic description. Data analysis was performed from March to April 2021. Otolaryngologists and radiation oncologists were recruited using purposive and snowball sampling strategies. Main Outcomes and Measures The main outcomes were current practice, attitudes, and beliefs about deintensifying surveillance and survivorship as well as patients' values and perspectives collected from interviews of participating physicians. Results Twenty-one physicians (17 [81%] men) were interviewed, including 13 otolaryngologists and 8 radiation oncologists with a median of 8 years (IQR, 5-20 years) in practice. Twelve participants (57%) stated their practice comprised more than 75% of patients with HNC. Participants expressed that there was substantial variation in the interpretation of the surveillance guidelines. Participants were open to the potential for deintensification of surveillance or incorporating symptom-based surveillance protocols but had concerns that deintensification may increase patient anxiety and shift some of the burden of recurrence monitoring to patients. Patient and physician peace of mind, the importance of maintaining the patient-physician relationship, and the need for adequate survivorship and management of treatment-associated toxic effects were reported to be important barriers to deintensifying surveillance. Conclusions and Relevance In this qualitative study, clinicians revealed a willingness to consider altering cancer surveillance but expressed a need to maintain patient and clinician peace of mind, maintain the patient-clinician relationship, and ensure adequate monitoring of treatment-associated toxic effects and other survivorship concerns. These findings may be useful in future research on the management of posttreatment surveillance.
Collapse
Affiliation(s)
- Michelle M Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
| | | | - Jacquelyn Miller
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Ruby Kazemi
- University of Michigan Medical School, Ann Arbor
| | | | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Vasu Divi
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Lauren P Wallner
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Susan C Pitt
- Department of Surgery, University of Wisconsin, Madison
| | | |
Collapse
|
24
|
Ho AS, Luu M, Shafqat I, Mallen-St Clair J, Chen MM, Chen Y, Jain M, Ali N, Patio C, Filarski CF, Lin DC, Bankston H, Braunstein GD, Sacks WL, Zumsteg ZS. Predictive Impact of Metastatic Lymph Node Burden on Distant Metastasis Across Papillary Thyroid Cancer Variants. Thyroid 2021; 31:1549-1557. [PMID: 34470466 DOI: 10.1089/thy.2021.0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: While numerous factors determine prognosis in papillary thyroid carcinoma (PTC), distant metastasis (M1) represents one of the most dire. Escalating nodal burden and aggressive histology may contribute to higher metastatic risk, but this relationship is poorly defined and challenging to anticipate. We evaluate the predictive impact of these histological features on predicting distant metastases at initial presentation. Methods: Univariate and multivariable logistic regression models of conventional and aggressive thyroid cancer variants (well-differentiated papillary thyroid carcinoma [WDPTC], diffuse sclerosing variant [DSV], tall cell variant [TCV], poorly differentiated thyroid cancer [PDTC], and anaplastic thyroid carcinoma [ATC]) identified via U.S. cancer registry data were constructed to determine associations between M1 status and quantitative nodal burden. Associations between metastatic lymph node (LN) number and M1 disease were modeled using univariate and multivariable logistic regression with interaction terms, as well as a linear continuous probability model. Results: Overall, M1 prevalence at disease presentation was 3.6% (n = 1717). When stratified by subtype, M1 prevalence varied significantly by histology (WDPTC [1.0%], DSV [2.3%], TCV [4.1%], PDTC [17.4%], ATC [38.4%] [p < 0.001]). For WDPTC, M1 prevalence escalated with metastatic LN number (0 LN+ [0.5%], 1-5 LN+ [2.0%], 6-10 LN+ [3.4%], >10 LN+ [5.5%] [p < 0.001]) and LN ratio (p < 0.001). A statistically significant interaction was observed between histology and increasing nodal burden for M1 risk. On multivariable analysis, each successive metastatic LN conferred increased M1 risk for WDPTC (odds ratio [OR] 1.06 [1.05-1.08], p < 0.001) and TCVs (OR 1.04 [1.02-1.07], p < 0.001). In contrast, other aggressive variants had a higher baseline M1 risk, but this did not vary based on the number of positive LN (DSV, OR 1.02 [0.95-1.10], p = 0.52; PDTC, OR 1.00 [0.98-1.02], p = 0.66; ATC, 1.00 [0.98-1.02], p = 0.97). Conclusions: Progressive nodal burden independently escalates the risk of distant metastasis in WDPTC and TCVs of PTC. Conversely, aggressive variants such as PDTC and ATC have substantial M1 risk at baseline and appear to be minimally affected by metastatic nodal burden. Consideration of these factors after surgery may help tailor clinical decision-making for treatment and surveillance. Further studies are warranted to calibrate the ideal management approach for these higher risk patient groups.
Collapse
Affiliation(s)
- Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Biostatistics and Bioinformatics Research Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Iram Shafqat
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michelle M Chen
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yufei Chen
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Monica Jain
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nabilah Ali
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Chrysanta Patio
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Carolyn F Filarski
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - De-Chen Lin
- Department of Medicine, and Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hakimah Bankston
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Glenn D Braunstein
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wendy L Sacks
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Cedars-Sinai Medical Center, California, USA
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
25
|
Chen MM, Chang CM, Dermody S, Rosko AJ, Mierzwa ML, Swiecicki PL, Spector ME, Worden FP, Prince MEP, Chinn SB. A Consideration for Surgical Management in Select T4b Oral Cavity Squamous Cell Carcinoma. Ann Otol Rhinol Laryngol 2021; 131:609-616. [PMID: 34365858 DOI: 10.1177/00034894211038213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The role of surgery for conventionally "unresectable" (cT4b) oral cavity squamous cell carcinoma is unclear. We analyzed factors associated with overall survival in cT4b relative to cT4a oral cavity squamous cell carcinoma. METHODS We identified 6830 cT4a and 522 cT4b oral cavity squamous cell carcinoma chemoradiation or surgery + adjuvant therapy patients in the National Cancer Data Base from 2004 to 2016. The main outcome was overall survival. Statistical analysis was performed using chi-squared tests, univariable and multivariable regression analysis. RESULTS The cT4b group had a higher rate of positive margins (30.4% vs 21.3%, P = .009) and downstaging (41.2% vs 13.1%; P < .001) compared to cT4a, while only 1.7% were upstaged. cT4b surgery + chemoradiation patients had similar survival to cT4a surgery + radiation (HR 0.93; 95% CI, 0.70-1.25) and cT4a surgery + chemoradiation patients (HR, 0.92; 95% CI, 0.69-1.23), while cT4b surgery + radiation patients had worse OS (HR, 1.55; 95% CI, 1.05-1.47). CONCLUSIONS Clinical T4b staging is a poor predictor of pathologic staging given a high rate of downstaging on final pathology. Surgical resection with adjuvant chemoradiation is an option in select cT4b oral cavity squamous cell carcinoma patients.
Collapse
Affiliation(s)
- Michelle M Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Sarah Dermody
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michelle L Mierzwa
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Paul L Swiecicki
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Department of Medical Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Francis P Worden
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.,Department of Medical Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
26
|
Jiang RX, Cao ZT, Chen MM, Wang Y, Ju Y, Zhao XQ. [Influence of vascular risk factors on seasonality of benign paroxysmal positional vertigo]. Zhonghua Yi Xue Za Zhi 2021; 101:2310-2315. [PMID: 34333947 DOI: 10.3760/cma.j.cn112137-20201201-03234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the seasonal changes of benign paroxysmal positional vertigo (BPPV) onset, and explore the relationship between vascular risk factors and the seasonal patterns of BPPV. Methods: Data of 3 886 patients subjected to vestibular function examination and diagnosed with BPPV who underwent manipulation or instrumental repositioning from January 1, 2016 to December 31, 2019 in the Department of Neurology, Beijing Tiantan Hospital were retrospectively analyzed. Demographic information and medical history of the patients were recorded. Weather temperature data of Beijing were obtained and monthly averages were calculated. The relationship between the BPPV onset and temperature and seasonality was investigated. Meanwhile, the influence of vascular risk factors on the seasonal patterns of BPPV was determined. Results: BPPV is more common in women (n=2 667). The male to female ratio of patients was approximately 1∶2, with a mean age of (55±13) years. The cases of BPPV in spring (March-May), summer (June-August), autumn (September-November) and winter (December-February) were 1 000 (25.7%), 911 (23.4%), 808 (20.8%) and 1 167 (30.0%), respectively. The peak incidence of BPPV occurred in December (n=491) and the lowest occurred in September (n=251). The number of BPPV cases diagnosed monthly was inversely correlated with mean temperature (R2=0.317; P<0.001). Patients with ≥2 vascular risk factors were at higher risk of developing BPPV in spring or winter than those without risk factors (OR=1.32, 95%CI: 1.13-1.53,P<0.001). Proportion of onset in spring or winter increased with each additional risk factor (P trend<0.001). Conclusions: BPPV often occurs in the months with low temperature (spring and winter) and the number of cases is inversely correlated with temperature. Compared with those with no vascular risk factors, patients with more vascular risk factors are more likely to develop BPPV in spring and winter.
Collapse
Affiliation(s)
- R X Jiang
- Department of Neurology, Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070,China
| | - Z T Cao
- Department of Neurology, Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070,China
| | - M M Chen
- Department of Neurology, Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070,China
| | - Y Wang
- Department of Neurology, Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070,China
| | - Y Ju
- Department of Neurology, Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070,China
| | - X Q Zhao
- Department of Neurology, Clinical Center for Vertigo and Balance Disturbance, China National Clinical Research Center for Neurological Diseases; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070,China
| |
Collapse
|
27
|
Gharzai LA, Burger N, Li P, Jaworski EM, Henderson C, Spector M, Rosko A, Chen MM, Prince ME, Bradford CR, Malloy KM, Stucken CL, Swiecicki P, Worden F, Schipper MJ, Schonewolf CA, Shah J, Jagsi R, Chinn S, Shuman A, Casper K, Mierzwa ML. Patient Burden with Current Surveillance Paradigm and Factors Associated with Interest in Altered Surveillance for Early Stage HPV-Related Oropharyngeal Cancer. Oncologist 2021; 26:676-684. [PMID: 33823077 DOI: 10.1002/onco.13784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Optimal surveillance paradigms for survivors of early stage human papillomavirus (HPV)-related oropharyngeal cancer are not well defined. This study aimed to characterize patient interest in and factors associated with an altered surveillance paradigm. MATERIALS AND METHODS We surveyed patients with Stage I or II HPV-related oropharyngeal cancer treated at a tertiary care institution from 2016 to 2019. Primary outcomes were descriptive assessment of patient knowledge, interest in altered surveillance, burdens of in-person appointments, and priorities for surveillance visits. Ordinal regression was used to identify correlates of interest in altered surveillance. RESULTS Sixty-seven patients completed surveys from February to April 2020 at a median of 21 months since completing definitive treatment. A majority (61%) of patients were interested in a surveillance approach that decreased in-person clinic visits. Patients who self-identified as medical maximizers, had higher worry of cancer recurrence, or were in long-term relationships were less likely to be interested. Patients reported significant burdens associated with surveillance visits, including driving distance, time off work, and nonmedical costs. Patients were most concerned with discussing cancer recurrence (76%), physical quality of life (70%), mortality (61%), and mental quality of life (52%) with their providers at follow-up visits. CONCLUSION Patients with early stage HPV-related oropharyngeal cancers are interested in altered surveillance approaches, experience significant burdens related to surveillance visits, and have concerns that are not well addressed with current surveillance approaches, including physical and mental quality of life. Optimized surveillance approaches should incorporate patient priorities and minimize associated burdens. IMPLICATIONS FOR PRACTICE The number of patients with HPV-related oropharyngeal cancers is increasing, and numerous clinical trials are investigating novel approaches to treating these good-prognosis patients. There has been limited work assessing optimal surveillance paradigms in these patients. Patients experience significant appointment-related burdens and have concerns such as physical and mental quality of life. Additionally, patients with early stage HPV-related oropharyngeal cancers express interest in altered surveillance approaches that decrease in-person clinic visits. Optimization of surveillance paradigms to promote broader survivorship care in clinical practice is needed.
Collapse
Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas Burger
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Pin Li
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth M Jaworski
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Caitlin Henderson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Spector
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andy Rosko
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle M Chen
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Swiecicki
- Department of Medical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis Worden
- Department of Medical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Caitlin A Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Steve Chinn
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Shuman
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
28
|
Abstract
This study uses data from the 2010-2018 National Health Interview Survey to characterize trends in human papillomavirus (HPV) vaccination rates, ages at vaccination, and numbers of doses received among young adults in the US between 2010 and 2018.
Collapse
Affiliation(s)
- Michelle M. Chen
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Nicole Mott
- University of Michigan Medical School, Ann Arbor
| | - Sarah J. Clark
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor
| | - Diane M. Harper
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Andrew G. Shuman
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Mark E. P. Prince
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | | |
Collapse
|
29
|
|
30
|
Smith JD, Chen MM, Balakrishnan K, Sidell DR, di Stadio A, Schechtman SA, Brody RM, Kupfer RA, Rassekh CH, Brenner MJ. The Difficult Airway and Aerosol-Generating Procedures in COVID-19: Timeless Principles for Uncertain Times. Otolaryngol Head Neck Surg 2020; 163:934-937. [PMID: 32571147 DOI: 10.1177/0194599820936615] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The impact of the COVID-19 pandemic on otolaryngology practice is nowhere more evident than in acute airway management. Considerations of preventing SARS-CoV-2 transmission, conserving personal protective equipment, and prioritizing care delivery based on acuity have dictated clinical decision making in the acute phase of the pandemic. With transition to a more chronic state of pandemic, heightened vigilance is necessary to recognize how deferral of care in patients with tenuous airways and COVID-19 infection may lead to acute airway compromise. Furthermore, it is critical to respect the continuing importance of flexible laryngoscopy in diagnosis. Safely managing airways during the pandemic requires thoughtful multidisciplinary planning. Teams should consider trade-offs among aerosol-generating procedures involving direct laryngoscopy, supraglottic airway use, fiberoptic intubation, and tracheostomy. We share clinical cases that illustrate enduring principles of acute airway management. As algorithms evolve, time-honored approaches for diagnosis and management of acute airway pathology remain essential in ensuring patient safety.
Collapse
Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michelle M Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | | | - Samuel A Schechtman
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Robert M Brody
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Christopher H Rassekh
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
31
|
Wang KY, Hirsch JA, Nicola GN, Golding LP, Lee RK, Chen MM. Implications of the Revisions and Revaluation of Office/Outpatient Evaluation and Management Codes for Neuroradiology Reimbursement. AJNR Am J Neuroradiol 2020; 41:1160-1164. [PMID: 32554420 DOI: 10.3174/ajnr.a6619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/21/2020] [Indexed: 11/07/2022]
Abstract
In the 2020 Final Rule, the Center for Medicare & Medicaid Services adopted a new coding structure and accepted the substantial increase in valuation for office/outpatient Evaluation and Management codes set to begin in 2021. Given budget neutrality requirements, the projected increase in reimbursement will require a reduction in the conversion factor to offset such increases. The aim is to inform neuroradiologists the impact of these proposed changes on reimbursement and the profession.
Collapse
Affiliation(s)
- K Y Wang
- From the Department of Radiology (K.Y.W.), Baylor College of Medicine, Houston, Texas
| | - J A Hirsch
- Department of Radiology (J.A.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - G N Nicola
- Hackensack Radiology Group (G.N.N.), River Edge, New Jersey
| | - L P Golding
- Triad Radiology Associates (L.P.G.), Winston Salem, North Carolina
| | - R K Lee
- Department of Radiology (R.K.L.), Einstein Healthcare Network, Sydney Kimmel College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - M M Chen
- Department of Neuroradiology (M.M.C.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
32
|
Chen MM, Zhao RC, Chen KF, Huang Y, Liu ZJ, Wei YG, Jian Y, Sun AM, Qin L, Li B, Qin Y. Hypomethylation of CTCFL promoters as a noninvasive biomarker in plasma from patients with hepatocellular carcinoma. Neoplasma 2020; 67:909-915. [PMID: 32386482 DOI: 10.4149/neo_2020_190819n789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023]
Abstract
Hepatocellular carcinoma (HCC) is the third deadliest cancer in the world with high morbidity and poor prognosis. CTCFL (CCCTC-binding factor like) is a member of the cancer testis antigen (CTA) family with oncogenic properties. To demonstrate whether the hypomethylation of CTCFL promoters in plasma could be used as a noninvasive biomarker to predict poor prognosis of HCC, we extracted cell-free DNA from the plasma and detected the methylation status of CTCFL in 43 HCC, 5 liver cirrhosis and 6 benign lesion samples using methylation specific PCR (MSP). Our study indicated that the hypomethylation of CTCFL promoters in HCC plasma samples (60.4%) was significantly different from that in benign lesion plasma samples (16.7%) with a p-value of 0.043. Analysis of clinicopathological data showed that the methylation status of CTCFL promoters was significantly correlated with microvascular involvement (MVI) (p=0.001) and postoperative recurrence (p=0.031). Furthermore, clinical prognosis data of 347 HCC patients from The Cancer Genome Atlas (TCGA) database displayed that the hypomethylated group had worse overall survival than the hypermethylated group (p=0.0056). In conclusion, we provide evidence that the hypomethylation of CTCFL promoters in cell-free DNA is a biomarker for monitoring HCC patients, which can be used as a noninvasive prediction index for tumor recurrence and provide the individualized decision-making for clinicians.
Collapse
Affiliation(s)
- M M Chen
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - R C Zhao
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, China
| | - K F Chen
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, China
| | - Y Huang
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Z J Liu
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Y G Wei
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, China
| | - Y Jian
- Digestive System Department, Chengdu Second People's Hospital, Chengdu, China
| | - A M Sun
- Analytical and Testing Center, Sichuan University, Chengdu, China
| | - L Qin
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - B Li
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, China
| | - Y Qin
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| |
Collapse
|
33
|
Saraswathula A, Chen MM, Colevas AD, Divi V. Assessing Care Value for Older Patients Receiving Radiotherapy With or Without Cisplatin or Cetuximab for Locoregionally Advanced Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2019; 145:1160-1167. [PMID: 31621810 PMCID: PMC6802372 DOI: 10.1001/jamaoto.2019.2381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/02/2019] [Indexed: 12/23/2022]
Abstract
Importance Clinicians frequently use radiotherapy with cetuximab over radiotherapy only or radiotherapy with cisplatin because of a perceived survival and tolerability advantage, but scant data are available to support this perception. Objective To measure the 3 aspects of value (quality, outcomes, and cost) in older patients receiving radiotherapy only, radiotherapy with cisplatin, or radiotherapy with cetuximab for locoregionally advanced head and neck cancer. Design, Setting, and Participants For this cohort study, patient records were obtained from the Surveillance, Epidemiology, and End Results Program (SEER)-Medicare outcomes and claims database from January 1, 2004, to December 31, 2014. Participants were 65 years or older; received a diagnosis between 2006 and 2013 of stages III to IVB head and neck cancer; had only 1 cancer on record; and did not undergo surgical intervention. Data analysis was conducted from February 5, 2018, to March 27, 2019. Exposures Patients were divided into exposure arms on the basis of their first-line therapy or identified chemoradiotherapy and radiotherapy regimen. Main Outcomes and Measures Overall survival was analyzed by propensity score matching Cox proportional hazards regression models, quality by measuring 90-day emergency department (ED) visit and inpatient admission rates, and costs by assessing 90-day total Medicare spending. Results The overall cohort included 1091 patients, of whom 815 (74.7%) were male; the mean (SD) age was 73.9 (6.6) years. Patients receiving radiotherapy with cisplatin had higher overall survival compared with those receiving radiotherapy only (adjusted hazard ratio [HR], 0.64; 95% CI, 0.47-0.87). This finding was not seen in patients receiving radiotherapy with cetuximab (adjusted HR, 0.95; 95% CI, 0.75-1.20), compared with the radiotherapy only group, and it persisted after stratifying patients by age. The ED visit (adjusted incidence rate ratio [IRR], 1.72; 95% CI, 1.30-2.30) and inpatient admission (adjusted IRR, 1.48; 95% CI, 1.12-1.98) rates in the 90 days after treatment start were higher in patients receiving radiotherapy with cisplatin compared with those treated with radiotherapy only. Patients receiving radiotherapy with cetuximab had a higher rate of ED visits (adjusted IRR, 1.38; 95% CI, 1.05-1.82) compared with those in the radiotherapy only group. The 90-day after-treatment spending for patients receiving radiotherapy with cetuximab was $48 620 (95% CI, $46 466-$50 775) compared with $33 009 (95% CI, $31 499-$34 519) for radiotherapy with cisplatin and $27 622 (95% CI, $25 118-$30 126) for radiotherapy only. Conclusions and Relevance In this cohort study, no survival difference, a higher rate of ED visits but not of inpatient admissions, and higher spending were observed in patients receiving radiotherapy with cetuximab compared with patients receiving radiotherapy only. The findings suggest that radiotherapy alone should be maintained as a treatment arm in evaluation of novel therapeutics for locoregionally advanced head and neck cancer in older and sicker patients.
Collapse
Affiliation(s)
| | - Michelle M. Chen
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - A. Dimitrios Colevas
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Vasu Divi
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
34
|
Vu TH, Kwon M, Ahmed S, Gule-Monroe M, Chen MM, Sun J, Fornage BD, Debnam JM, Edeiken-Monroe B. Diagnostic Accuracy and Scope of Intraoperative Transoral Ultrasound and Transoral Ultrasound-Guided Fine-Needle Aspiration of Retropharyngeal Masses. AJNR Am J Neuroradiol 2019; 40:1960-1964. [PMID: 31582388 DOI: 10.3174/ajnr.a6236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/12/2019] [Indexed: 11/07/2022]
Abstract
The use of transoral sonography-guided fine-needle aspiration for intraoperative localization of retropharyngeal masses has been described by Fornage et al. The purpose of this study was to assess the accuracy of this technique. We reviewed the images and medical records of 26 patients with a retropharyngeal lesion suspicious for a metastatic lymph node of Rouviere identified on CT and/or PET/CT. There were 14 patients with a history of thyroid cancer, 7 with mucosal squamous cell carcinoma, 1 with renal cell carcinoma, 1 with parotid acinic cell cancer, 1 with metastatic colon adenocarcinoma, and 2 with no history of cancer. Intraoperative transoral sonography was performed using a commercially available endovaginal transducer. A transoral sonography-guided fine-needle aspiration was performed with a 25-cm-long 20-ga Chiba needle through a needle guide attached to the transducer shaft. Cytopathologic results were categorized as malignant, benign, or nondiagnostic. Transoral sonography and transoral sonography-guided fine-needle aspiration were performed in all patients. A diagnostic specimen was obtained in 25 of 26 (96%) patients with a 100% overall accuracy. Twelve patients underwent subsequent transoral resection of the retropharyngeal mass. In each patient, surgical pathology confirmed the fine-needle aspiration biopsy result. In 4 patients, transoral sonography-guided injection of methylene blue was used to facilitate intraoperative localization of the metastatic retropharyngeal mass. Transoral sonography and transoral sonography-guided fine-needle aspiration of suspicious masses in the retropharyngeal space are highly accurate procedures for identification and cytologic evaluation of benign and metastatic lymph nodes of Rouviere and for presurgical localization.
Collapse
Affiliation(s)
- T H Vu
- From the Section of Neuroradiology (T.H.V., M.K., S.A., M.G.-M., M.M.C., J.M.D., B.E.-M.)
| | - M Kwon
- From the Section of Neuroradiology (T.H.V., M.K., S.A., M.G.-M., M.M.C., J.M.D., B.E.-M.)
| | - S Ahmed
- From the Section of Neuroradiology (T.H.V., M.K., S.A., M.G.-M., M.M.C., J.M.D., B.E.-M.)
| | - M Gule-Monroe
- From the Section of Neuroradiology (T.H.V., M.K., S.A., M.G.-M., M.M.C., J.M.D., B.E.-M.)
| | - M M Chen
- From the Section of Neuroradiology (T.H.V., M.K., S.A., M.G.-M., M.M.C., J.M.D., B.E.-M.)
| | - J Sun
- Department of Biostatistics (J.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - B D Fornage
- Section of Breast Imaging (B.D.F.), Department of Diagnostic Radiology
| | - J M Debnam
- From the Section of Neuroradiology (T.H.V., M.K., S.A., M.G.-M., M.M.C., J.M.D., B.E.-M.)
| | - B Edeiken-Monroe
- From the Section of Neuroradiology (T.H.V., M.K., S.A., M.G.-M., M.M.C., J.M.D., B.E.-M.)
| |
Collapse
|
35
|
D'Anna G, Chen MM, McCarty J, Radmanesh A, Kotsenas AL. Reply. AJNR Am J Neuroradiol 2019; 40:E57. [PMID: 31515209 DOI: 10.3174/ajnr.a6215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- G D'Anna
- Radiology Unit Humanitas Mater Domini Castellanza (Varese), Italy
| | - M M Chen
- Department of Radiology University of Texas MD Anderson Cancer Center Houston, Texas
| | - J McCarty
- Department of Diagnostic and Interventional Imaging University of Texas Health Sciences Center at Houston Houston, Texas
| | - A Radmanesh
- Department of Radiology New York University School of Medicine New York, New York
| | - A L Kotsenas
- Department of Radiology Mayo Clinic Rochester, Minnesota
| |
Collapse
|
36
|
D'Anna G, Chen MM, McCarty J, Radmanesh A, Kotsenas AL. Reply. AJNR Am J Neuroradiol 2019; 40:E55. [PMID: 31537521 DOI: 10.3174/ajnr.a6214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- G D'Anna
- Radiology Unit Humanitas Mater Domini Castellanza (Varese), Italy
| | - M M Chen
- Department of Radiology University of Texas MD Anderson Cancer Center Houston, Texas
| | - J McCarty
- Department of Diagnostic and Interventional Imaging University of Texas Health Sciences Center at Houston Houston, Texas
| | - A Radmanesh
- Department of Radiology New York University School of Medicine New York, New York
| | - A L Kotsenas
- Department of Radiology Mayo Clinic Rochester, Minnesota
| |
Collapse
|
37
|
Shi HP, Wang ZQ, Fan ZY, Zang MD, Pan JM, Dai QQ, Zheng YN, Zhu ZL, Sah RD, Liu WT, Yang ZY, Feng RH, Yao XX, Chen MM, Yan C, Yan M, Zhu ZG, Li C. [Analysis and comparison of the clinical features and prognosis between extra - gastrointestinal stromal tumors and duodenal gastrointestinal stromal tumors]. Zhonghua Wei Chang Wai Ke Za Zhi 2019; 22:856-860. [PMID: 31550825 DOI: 10.3760/cma.j.issn.1671-0274.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the differences of clinicopathological features, diagnosis, treatment and prognosis between patients with extra-gastrointestinal stromal tumors (EGIST) and duodenal gastrointestinal stromal tumors (DGIST). Methods: A retrospective case - control study was performed. Case inclusion criteria: (1) tumor confirmed by histology and pathology; (2) primary tumor locating in the extra - gastrointestinal tract or duodenum; (3) without other synchronous tumors; (4) complete clinical and pathological data. Clinical data of 20 EGIST patients and 32 DGIST patients from March 2011 to September 2016 at Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine were retrospectively collected and analyzed. The observational parameters included clinicopathological characteristics, treatment and prognosis conditions. Continuous data of abnormal distribution were expressed as median (range) and compared using the Mann-Whitney U-test. Survival curves were drawn by the Kaplan-Meier method and compared with the Log-rank test. Results: Of the 20 EGIST patients, 8 were males and 12 were females with age of 61.0 (30.0 to 86.0) years and of the 32 DGIST patients, 12 were males and 20 were females with age of 55.5 (27.0 to 70.0) years. Compared with DGIST patients, EGIST patients were older (U=188.000, P=0.012], had larger tumor size [10.0 (3.0 to 29.0) cm vs. 4.0 (1.5 to 10.0) cm, U=98.500, P<0.001] and higher ratio of high risk classification [85.0% (17/20) vs. 12.5% (4/32), χ(2)=26.870, P<0.001]. Among the 20 EGIST patients, 5 were diagnosed with distal metastasis and received imatinib (400 mg/d), and the other 15 patients underwent radical resection who were included in survival analysis. All the 32 DGIST patients underwent radical resection. The median follow-up of whole group was 43 (14 to 76) months. The 3-year recurrence/metastasis-free survival rate of 15 cases undergoing radical resection in the EGIST group was 85.6%, which was lower than that of the DGIST group (88.6%), and the difference was not statistically significant (P=0.745). There was no significant difference in the 3-year overall survival rate between the EGIST group (92.9%) and the DGIST group (100%) (P=0.271). Conclusions: As compared to DGIST, EGIST mostly occurs in those with older age, larger tumor size and higher risk grade. The prognosis of EGIST patients after radical resection is similar to that of DGIST patients.
Collapse
Affiliation(s)
- H P Shi
- Department of Gastrointestinal Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Harris JP, Chen MM, Orosco RK, Sirjani D, Divi V, Hara W. Association of Survival With Shorter Time to Radiation Therapy After Surgery for US Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2019. [PMID: 29522072 DOI: 10.1001/jamaoto.2017.3406] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Shortening the time from surgery to the start of radiation (TS-RT) is a consideration for physicians and patients. Although the National Comprehensive Cancer Network recommends radiation to start within 6 weeks, a survival benefit with this metric remains controversial. Objective To determine the association of delayed TS-RT with overall survival (OS) using a large cancer registry. Design, Setting, and Participants In this observational cohort study, 25 216 patients with nonmetastatic stages III to IV head and neck cancer were identified from the National Cancer Database (NCDB). Exposures Patients received definitive surgery followed by adjuvant radiation therapy, with an interval duration defined as TS-RT. Main Outcomes and Measures Overall survival as a function of TS-RT and the effect of clinicopathologic risk factors and accelerated fractionation. Results We identified 25 216 patients with nonmetastatic squamous cell carcinoma of the head and neck. There were 18 968 (75%) men and 6248 (25%) women and the mean (SD) age of the cohort was 59 (10.9) years. Of the 25 216 patients, 9765 (39%) had a 42-days or less TS-RT and 4735 (19%) had a 43- to 49-day TS-RT. Median OS was 10.5 years (95% CI, 10.0-11.1 years) for patients with a 42-days or less TS-RT, 8.2 years (95% CI, 7.4-8.6 years; absolute difference, -2.4 years, 95% CI, -1.5 to -3.2 years) for patients with a 43- to 49-day TS-RT, and 6.5 years (95% CI, 6.1-6.8 years; absolute difference, -4.1 years, 95% CI, -3.4 to -4.7 years) for those with a 50-days or more TS-RT. Multivariable analysis found that compared with a 42-days or less TS-RT, there was not a significant increase in mortality with a 43- to 49-day TS-RT (HR, 0.98; 95% CI, 0.93-1.04), although there was for a TS-RT of 50 days or more (HR, 1.07; 95% CI, 1.02-1.12). A significant interaction was identified between TS-RT and disease site. Subgroup effect modeling found that a delayed TS-RT of 7 days resulted in significantly worse OS for patients with tonsil tumors (HR, 1.22; 95% CI, 1.05-1.43) though not other tumor subtypes. Accelerated fractionation of 5.2 fractions or more per week was associated with improved survival (HR, 0.93; 95% CI, 0.87-0.99) compared with standard fractionation. Conclusions and Relevance Delayed TS-RT of 50 days or more was associated with worse overall survival. The multidisciplinary care team should focus on shortening TS-RT to improve survival. Unavoidable delays may be an indication for accelerated fractionation or other dose intensification strategies.
Collapse
Affiliation(s)
- Jeremy P Harris
- Department of Radiation Oncology, Stanford University, Stanford, California.,Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Michelle M Chen
- Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Ryan K Orosco
- Department of Head and Neck Surgery, University of California San Diego, San Diego
| | - Davud Sirjani
- Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Vasu Divi
- Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California
| | - Wendy Hara
- Department of Radiation Oncology, Stanford University, Stanford, California
| |
Collapse
|
39
|
Qian ZJ, Chen MM, Divi V, Megwalu UC. Impact of lymph node sampling on survival in cN0 major salivary gland adenoid cystic carcinoma. Head Neck 2019; 41:1903-1907. [PMID: 30620437 PMCID: PMC7202936 DOI: 10.1002/hed.25628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/27/2018] [Accepted: 12/13/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The role of elective neck dissection in the management of major salivary gland adenoid cystic carcinoma is unclear. METHODS Data were retrospectively extracted from the National Cancer Center Database. The study cohort included 1504 patients with adenoid cystic carcinoma of major salivary glands with clinical N0 necks who were treated with surgery between 2004 and 2014. The cohort was divided into four groups based on number of lymph nodes (LNs) examined on pathology: 0, 1-8, 9-17, and ≥18 LNs. RESULTS The rate of occult nodal metastasis was 9.0%. Number of LNs removed was not associated with survival (Reference, 0 LNs; HR = 0.98, 95% CI 0.73-1.32 for 1-8 LNs; HR = 1.22, 95% CI 0.80-1.88 for 9-17 LNs; HR = 0.94, 95% CI 0.61-1.46 for ≥18 LNs) after adjusting for important covariates. CONCLUSIONS LN sampling is not associated with survival in cN0 major salivary gland ACC.
Collapse
Affiliation(s)
- Zhen Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Michelle M Chen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Vasu Divi
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
40
|
D'Anna G, Chen MM, McCarty JL, Radmanesh A, Kotsenas AL. The Continued Rise in Professional Use of Social Media at Scientific Meetings: An Analysis of Twitter Use during the ASNR 2018 Annual Meeting. AJNR Am J Neuroradiol 2019; 40:935-937. [PMID: 31072973 DOI: 10.3174/ajnr.a6064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/04/2019] [Indexed: 12/15/2022]
Abstract
Professional use of social media continues to increase. We analyzed Twitter use of our own American Society of Neuroradiology (ASNR) 2018 annual meeting, reviewing all Twitter posts (3020 tweets from 523 participants) containing the hashtag #ASNR18 from May 21, 2018, to June 12, 2018, extracting the transcripts from Symplur. Then, each tweet was categorized by the role of user, type of tweet, and topic. The dominant user category was neuroradiologist/radiologist (63%). The keynote address, "The Radiology Renaissance: Shaping the Future of Healthcare," presented by Andy DeLao @Cancergeek was the most frequently tweeted topic (10%). Comment on a session was the major type of tweet. When we compared the data with a similar analysis in 2014, our data analysis showed a growth in the use of Twitter in only 4 years.
Collapse
Affiliation(s)
- G D'Anna
- From the Neuroradiology Unit (G.D.A.), Azienda Socio Sanitaria Territoriale Monza Ospedale San Gerardo, Monza, Italy
| | - M M Chen
- Department of Radiology (M.M.C.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J L McCarty
- Department of Diagnostic and Interventional Imaging (J.L.M.), University of Texas Health Sciences Center at Houston, Houston, Texas
| | - A Radmanesh
- Department of Radiology (A.R.), New York University School of Medicine, New York, New York
| | - A L Kotsenas
- Department of Radiology (A.L.K.), Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
41
|
Abstract
The Quality Oncology Practice Initiative has several metrics related to end-of life (EOL) care, including hospice enrollment ≤3 days, with lower scores signaling better performance. Of privately insured patients with head and neck cancer, 3.5% were enrolled in hospice prior to death and 21.3% spent ≤3 days in hospice, indicating aggressive EOL care. Patients with late hospice enrollment had higher spending in the last 30 days of life (DOL). Patients in hospice ≤3 days spent $37,426, while those in hospice >3 days spent $24,418 ( P = .002). The largest portion of this difference was attributable to inpatient services. Patients in hospice ≤3 days spent $22,089 on inpatient services in the last 30 DOL, while those in hospice >3 days spent $8361 ( P < .001). Further research is needed to determine if more high-value care can be provided with earlier hospice enrollment and to ensure that goal concordance is included in defining high-value care.
Collapse
Affiliation(s)
- Michelle M. Chen
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Eben L. Rosenthal
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Vasu Divi
- Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California, USA
| |
Collapse
|
42
|
Chen SZ, Lin KN, Xiao M, Luo XF, Li Q, Ren JH, Huang RY, Chen MM, Ally ZZ, Chen T, Yang JD, Hu J. [Distribution and drug resistance of pathogens of blood stream infection in patients with hematological malignancies after chemotherapy]. Zhonghua Xue Ye Xue Za Zhi 2019; 38:951-955. [PMID: 29224318 PMCID: PMC7342781 DOI: 10.3760/cma.j.issn.0253-2727.2017.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the distribution and resistance of pathogens isolated from blood cultures in patients with hematological malignancies after chemotherapy in Union Hospital of Fujian Medical University so as to understand the real situation of blood stream infection (BSI) and provide the basis for rational use of antibiotics in clinic. Methods: The data of 657 strains isolated from blood culture specimens of patients with hematological malignancies from January 2013 to December 2016 were collected analyzed. Results: A total of 657 cases of blood culture positive bacterial strains were included in the study, involving 410 cases (62.4%) with single Gram-negative bacteria (G(-) bacteria) , 163 cases (24.8%) with single Gram-positive bacteria (G(+) bacteria) , 50 cases (7.6%) with single fungi. The most common 5 isolates in blood culture were Klebsiella pneumoniae (17.5%) , Escherichia coli (17.2%) , Coagulase negative staphylococci (CNS) (14.9%) , Pseudomonas aeruginosa (14.2%) and Staphylococcus aureus (3.5%) . The extended-spectrum beta-lactamase (ESBL) production rates of Klebsiella pneumoniae and Escherichia coli were 25.2% and 55.8%, respectively. ESBL producing strains were almost more resistant than non-ESBL producing strains. The resistance rates of Enterobacteriaceae to carbapenems, piperacillin/tazobactam and tigecycline were lower than 14.0%. The resistance rates of Pseudomonas aeruginosa to a variety of drugs were lower than 12.0%. Tigecycline-resistant Acinetobacter baumannii bacteria were not detected, and the resistance rates of Acinetobacter baumannii to cefixime and cefotaxime were 7.1%. Methicillin-resistant strains in CNS (MRCNS) and in Staphylococcus aureus (MRSA) accounted for 84.7% and 43.5%, respectively. Vancomycin, linezolid and tigecycline-resistant G(+) bacteria were not detected. Conclusion: The pathogens isolated from blood culture were widely distributed. Most of them were G(-) bacteria, and the resistance to antibiotics was quite common. Furhermore, vancomycin, linezolid and tigecycline can be chosen empirically to treat patiens who ar suspected to have G(+) bacterial BSI.
Collapse
Affiliation(s)
- S Z Chen
- Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Union Hospital of Fujian Medical University, Fuzhou 350001, China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Liu ZG, Zheng AF, Chen MM, Lian YX, Zhang XK, Zhang SZ, Yu D, Li JK. Isolation and identification of pathogenic Aeromonas veronii from a dead Yangtze finless porpoise. Dis Aquat Organ 2018; 132:13-22. [PMID: 30530927 DOI: 10.3354/dao03288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Diseases caused by Aeromonas veronii in freshwater fish have been widely reported, but other species such as aquatic mammals have probably been overlooked. Here, we identified one isolate of A. veronii from a Yangtze finless porpoise Neophocaena asiaeorientalis asiaeorientalis exhibiting disease and mortality, and subsequently confirmed its virulence in artificial infection of BALB/c mice. The bacterial isolate was identified as A. veronii based on physiological, biochemical, and phenotypic features, and homology of the 16S rRNA, cpn60, rpoB, dnaJ and gyrB genes. Our results expand the known host spectrum of A. veronii, which is of great importance for the etiology of porpoise, dolphin, and other cetacean diseases.
Collapse
Affiliation(s)
- Z G Liu
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, PR China
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Xiang M, Holsinger FC, Colevas AD, Chen MM, Le QT, Beadle BM. Survival of patients with head and neck cancer treated with definitive radiotherapy and concurrent cisplatin or concurrent cetuximab: A Surveillance, Epidemiology, and End Results-Medicare analysis. Cancer 2018; 124:4486-4494. [PMID: 30332498 DOI: 10.1002/cncr.31708] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cisplatin and cetuximab are both systemic therapies commonly used in combination with radiation (RT) for the definitive treatment of head and neck cancers, but their comparative efficacy is unclear. METHODS Patients with locoregionally advanced (American Joint Committee on Cancer stage III-IVB) squamous cell carcinomas of the oropharynx, larynx, or hypopharynx were identified in the Surveillance, Epidemiology, and End Results-Medicare database. Patients received either cisplatin or cetuximab concurrent with RT, as determined by Medicare claims. The primary study outcome was head and neck cancer-specific mortality (CSM) analyzed with competing risks. Filtering, propensity score matching, and multivariable Fine-Gray regression were used to adjust for differences between the cisplatin and cetuximab cohorts, including age, comorbidity, and cycles of systemic therapy received. RESULTS The total cohort consisted of 1395 patients, of whom 786 (56%) received cisplatin and 609 (44%) received cetuximab; the median follow-up was 3.5 years in the patients who remained alive. In the cetuximab cohort, CSM was significantly higher than in the cisplatin cohort (39% vs 25% at 3 years; P < .0001). In the matched cohorts (n = 414), the adjusted hazard ratio of CSM for cetuximab was 1.65 (95% confidence interval, 1.30-2.09; P < .0001) relative to cisplatin, corresponding to an absolute difference of approximately 10% in both CSM and overall survival at 3 years. Cetuximab was associated with less dysphagia, more dermatitis, and a similar incidence of mucositis. CONCLUSIONS In this sizeable, national patient population, treatment with cetuximab was associated with significantly higher CSM than cisplatin. These results suggest that cisplatin may be the preferred chemotherapeutic agent in this setting.
Collapse
Affiliation(s)
- Michael Xiang
- Department of Radiation Oncology, Stanford University, Stanford, California, United States
| | - F Christopher Holsinger
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University, Stanford, California, United States
| | - A Dimitrios Colevas
- Department of Medicine, Division of Oncology, Stanford University, Stanford, California, United States
| | - Michelle M Chen
- Department of Otolaryngology, Division of Head and Neck Surgery, Stanford University, Stanford, California, United States
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California, United States
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University, Stanford, California, United States
| |
Collapse
|
45
|
Chen MM, Megwalu UC, Liew J, Sirjani D, Rosenthal EL, Divi V. Regionalization of head and neck cancer surgery may fragment care and impact overall survival. Laryngoscope 2018; 129:1413-1419. [DOI: 10.1002/lary.27440] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/31/2018] [Accepted: 06/20/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Michelle M. Chen
- Department of Otolaryngology–Head and Neck SurgeryStanford University Palo Alto California
- Department of OtolaryngologyPalo Alto Veterans Administration Palo Alto California
| | - Uchechukwu C. Megwalu
- Department of Otolaryngology–Head and Neck SurgeryStanford University Palo Alto California
| | - Jazmine Liew
- New York Medical College School of Medicine Valhalla New York U.S.A
| | - Davud Sirjani
- Department of Otolaryngology–Head and Neck SurgeryStanford University Palo Alto California
- Department of OtolaryngologyPalo Alto Veterans Administration Palo Alto California
| | - Eben L. Rosenthal
- Department of Otolaryngology–Head and Neck SurgeryStanford University Palo Alto California
| | - Vasu Divi
- Department of Otolaryngology–Head and Neck SurgeryStanford University Palo Alto California
- Department of OtolaryngologyPalo Alto Veterans Administration Palo Alto California
| |
Collapse
|
46
|
Saraswathula A, Chen MM, Mudumbai SC, Whittemore AS, Divi V. Persistent Postoperative Opioid Use in Older Head and Neck Cancer Patients. Otolaryngol Head Neck Surg 2018; 160:380-387. [DOI: 10.1177/0194599818778276] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Despite the epidemic of opioid overuse among American patients, there are limited data regarding the prevalence of such use among patients with head and neck cancer (HNC). Here, we report on the prevalence of persistent postoperative opioid (PPO) use and its risk factors among older patients with HNC undergoing surgery. Study Design Retrospective cohort study. Setting Surveillance, Epidemiology, and End Results (SEER)–Medicare linked cancer registry-claims database. Subjects and Methods We identified patients aged 66 years or older who were diagnosed with HNC from 2008 to 2013, underwent primary surgical resection for their cancers, and met certain insurance and discharge criteria. The primary outcome was PPO use, defined as new opioid prescriptions 90 to 180 days postoperatively. We used multivariable logistic regression to evaluate associations between PPO use and factors such as demographics and postoperative treatment. Results Of the 1190 eligible patients with HNC, 866 (72.8%) received opioid prescriptions attributable to their surgery. Among these 866 patients, the prevalence of PPO use was 33.3% overall; it was 48.3% among the 428 patients with preoperative opioid use compared to 18.5% among the 438 opioid-naive patients (adjusted odds ratio [OR], 3.96; 95% confidence interval [CI], 2.80-5.59). Other factors associated with PPO use include postoperative radiotherapy (OR, 1.99; 95%, CI 1.33-2.98) and Charlson comorbidity index (OR, 1.20; 95% CI, 1.03-1.41). Postoperative chemotherapy (OR, 1.19; 95% CI, 0.73-1.95) was not significantly associated with PPO use. Conclusions PPO use is a substantial problem in older surgical patients with HNC, one that warrants consideration of alternative treatment strategies and continued examination of prescription guidelines for patients with HNC.
Collapse
Affiliation(s)
| | - Michelle M. Chen
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Seshadri C. Mudumbai
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alice S. Whittemore
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
| | - Vasu Divi
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
47
|
Abstract
Fibroblast growth factor 21 (FGF21) is a potent regulator of glucose and lipid homeostasis in vivo; its most closely related subfamily member, FGF19, is known to be a critical negative regulator of bile acid synthesis. To delineate whether FGF21 also plays a functional role in bile acid metabolism, we evaluated the effects of short- and long-term exposure to native FGF21 and long-acting FGF21 analogs on hepatic signal transduction, gene expression and enterohepatic bile acid levels in primary hepatocytes and in rodent and monkey models. FGF21 acutely induced ERK phosphorylation and inhibited Cyp7A1 mRNA expression in primary hepatocytes and in different rodent models, although less potently than recombinant human FGF19. Long-term administration of FGF21 in mice fed a standard chow diet resulted in a 50-60% decrease in bile acid levels in the liver and small intestines and consequently a 60% reduction of bile acid pool size. In parallel, colonic and fecal bile acid was decreased, whereas fecal cholesterol and fatty acid excretions were elevated. The long-acting FGF21 analog showed superiority to recombinant human FGF21 and FGF19 in decreasing bile acid levels with long duration of effect action in mice. Long-term administration of the long-acting FGF21 analogs in obese cynomolgus monkeys suppressed plasma total bile acid and 7α-hydroxy-4-cholesten-3-one levels, a biomarker for bile acid synthesis. Collectively, these data reveal a previously unidentified role of FGF21 in bile acid metabolism as a negative regulator of bile acid synthesis.
Collapse
Affiliation(s)
| | | | | | | | - Murielle M Véniant
- Department of Cardiometabolic DisordersAmgen Inc., Thousand Oaks, California, USA
| |
Collapse
|
48
|
Divi V, Chen MM, Hara W, Shah D, Narvasa K, Segura Smith A, Kelley J, Rosenthal EL, Porter J. Reducing the Time from Surgery to Adjuvant Radiation Therapy: An Institutional Quality Improvement Project. Otolaryngol Head Neck Surg 2018; 159:158-165. [PMID: 29631478 DOI: 10.1177/0194599818768254] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The National Comprehensive Cancer Network guidelines recommend an interval between surgery and adjuvant radiation therapy of less than 6 weeks, but only 44% of patients meet this metric nationally. We sought to identify key components of an improvement process focused on starting adjuvant radiation therapy within 6 weeks of surgery. Methods This project used an A3 model to improve a defined process measure. We studied a consecutive sample of 56 patients with oral cavity carcinoma who were treated at our institution with upfront surgical resection followed by adjuvant radiation therapy. Twelve proposed interventions tested during the study period focused on 3 key drivers of delays: delayed dental evaluation and teeth extraction, delayed radiation oncology consults, and inadequate patient engagement. The primary outcome measure was the number of days from surgery to the start of radiation therapy. Results Prior to the intervention, 62% of patients received adjuvant radiation within 6 weeks of surgery. Following the intervention, 73% of patients achieved this metric. The percentage of patients with avoidable delays decreased from 24% to 9%. The percentage of patients with unavoidable delays was relatively constant before and after the intervention (15% and 18%, respectively). Discussion Defining disease-specific metrics is critical to improving care in our head and neck cancer patient population. We demonstrate several key components to develop and improve self-defined metrics. Implications for Practice As we transition to a system of value-based care, structured quality improvement projects can have a measurable impact on cancer patient process measures.
Collapse
Affiliation(s)
- Vasu Divi
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.,2 Stanford Health Care, Stanford University, Stanford, California, USA
| | - Michelle M Chen
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Wendy Hara
- 3 Department of Radiation Oncology, Stanford Cancer Center, Stanford University, Stanford, California, USA
| | - Deepa Shah
- 2 Stanford Health Care, Stanford University, Stanford, California, USA
| | - Kristina Narvasa
- 2 Stanford Health Care, Stanford University, Stanford, California, USA
| | | | - Jennifer Kelley
- 2 Stanford Health Care, Stanford University, Stanford, California, USA
| | - Eben L Rosenthal
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.,2 Stanford Health Care, Stanford University, Stanford, California, USA
| | - Julie Porter
- 2 Stanford Health Care, Stanford University, Stanford, California, USA
| |
Collapse
|
49
|
Chen MM, Harris JP, Orosco RK, Sirjani D, Hara W, Divi V. Association of Time between Surgery and Adjuvant Therapy with Survival in Oral Cavity Cancer. Otolaryngol Head Neck Surg 2018; 158:1051-1056. [PMID: 29313448 DOI: 10.1177/0194599817751679] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The National Cancer Center Network recommends starting radiation therapy within 6 weeks after surgery for oral cavity squamous cell carcinoma (OCSCC), but there is limited evidence of the importance of the total time from surgery to completion of radiation therapy (package time). We set out to determine if there was an association between package time and survival in OCSCC and to evaluate the impact of treatment location on outcomes. Study Design Retrospective cohort study. Setting Tertiary academic medical center. Subjects and Methods We reviewed the records of patients with OCSCC who completed postoperative radiation therapy at an academic medical center from 2008 to 2016. The primary endpoints were overall survival and recurrence-free survival. Statistical analysis included χ2 tests and Cox proportional hazards regressions. Results We identified 132 patients with an average package time of 12.6 weeks. On multivariate analysis, package time >11 weeks was independently associated with decreased overall survival (hazard ratio, 6.68; 95% CI, 1.42-31.44) and recurrence-free survival (hazard ratio, 2.94; 95% CI, 1.20-7.18). Patients who received radiation therapy at outside facilities were more likely to have treatment delays (90.2% vs 62.9%, P = .001). Conclusions Prolonged package times are associated with decreased overall and recurrence-free survival among patients with OCSCC. Patients who received radiation therapy at outside facilities are more likely to have prolonged package times.
Collapse
Affiliation(s)
- Michelle M Chen
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Jeremy P Harris
- 2 Department of Radiation Oncology, Stanford Cancer Center, Stanford University, Stanford, California, USA
| | - Ryan K Orosco
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Davud Sirjani
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Wendy Hara
- 2 Department of Radiation Oncology, Stanford Cancer Center, Stanford University, Stanford, California, USA
| | - Vasu Divi
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| |
Collapse
|
50
|
Schoppy DW, Rhoads KF, Ma Y, Chen MM, Nussenbaum B, Orosco RK, Rosenthal EL, Divi V. Measuring Institutional Quality in Head and Neck Surgery Using Hospital-Level Data: Negative Margin Rates and Neck Dissection Yield. JAMA Otolaryngol Head Neck Surg 2017; 143:1111-1116. [PMID: 28983555 DOI: 10.1001/jamaoto.2017.1694] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Negative margins and lymph node yields (LNY) of 18 or more from neck dissections in patients with head and neck squamous cell carcinomas (HNSCC) have been associated with improved patient survival. It is unclear whether these metrics can be used to identify hospitals with improved outcomes. Objective To determine whether 2 patient-level metrics would predict outcomes at the hospital level. Design, Setting, and Participants A retrospective review of records from the National Cancer Database (NCDB) was used to identify patients who underwent primary surgery and concurrent neck dissection for HNSCC between 2004 and 2013. The percentage of patients at each hospital with negative margins on primary resection and an LNY 18 or more from a neck dissection was quantified. Cox proportional hazard models were used to define the association between hospital performance on these metrics and overall survival. Main Outcomes and Measures Margin status and lymph node yield at hospital level. Overall survival (OS). Results We identified 1008 hospitals in the NCDB where 64 738 patients met inclusion criteria. Of the 64 738 participants, 45 170 (69.8%) were men and 19 568 (30.2%) were women. The mean SD age of included patients was 60.5 (12.0) years. Patients treated at hospitals attaining the combined metric of a 90% or higher negative margin rate and 80% or more of cases with LNYs of 18 or more experienced a significant reduction in mortality (hazard ratio [HR] 0.93; 95% CI, 0.89-0.98). This benefit in survival was independent of the patient-level improvement associated with negative margins (HR, 0.73; 95% CI, 0.71-0.76) and LNY of 18 or more (HR, 0.85; 95% CI, 0.83-0.88). Including these metrics in the model neutralized the association of traditional measures of hospital quality (volume and teaching status). Conclusions and Relevance Treatment at hospitals that attain a high rate of negative margins and LNY of 18 or more is associated with improved survival in patients undergoing surgery for HNSCC. These surgical outcome measures predicted outcomes independent of traditional, but generally nonmodifiable characteristics. Tracking of these metrics may help identify high-quality centers and provide guidance for institution-level quality improvement.
Collapse
Affiliation(s)
- David W Schoppy
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
| | | | - Yifei Ma
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
| | - Michelle M Chen
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
| | - Brian Nussenbaum
- Division of Head and Neck Surgery, Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ryan K Orosco
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
| | - Eben L Rosenthal
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
| | - Vasu Divi
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University School of Medicine, Stanford, Palo Alto, California
| |
Collapse
|