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Robbins KT, Ferlito A, Silver CE, Takes RP, Strojan P, Snyderman CH, de Bree R, Haigentz M, Langendijk JA, Rinaldo A, Shaha AR, Hanna EY, Werner JA, Suárez C. Contemporary management of sinonasal cancer. Head Neck 2010; 33:1352-65. [PMID: 20737500 DOI: 10.1002/hed.21515] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Sinonasal cancer is a relatively uncommon entity encountered by head and neck oncologists, rhinologists, and skull base surgeons. Recent innovations in surgical and nonsurgical therapeutic modalities raise the question of whether there has been any measurable improvement for treatment outcomes. METHODS A retrospective review of data from recent studies that focus on surgery, radiation, and chemotherapy, or combinations thereof, was conducted. RESULTS Surgery continues to be the preferred treatment and provides the best results, albeit with an inherent bias based on patient selection. For advanced disease (T4 lesions), the survival rate remains only modest. Complications of treatment, including both surgical and radiation therapy, have been reduced. CONCLUSIONS There is a need to improve the efficacy of treatment for this disease. Recommendations for the future direction of therapeutic investigations are outlined.
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de Bree R, Leemans CR, Silver CE, Robbins KT, Rodrigo JP, Rinaldo A, Takes RP, Shaha AR, Medina JE, Suárez C, Ferlito A. Paratracheal lymph node dissection in cancer of the larynx, hypopharynx, and cervical esophagus: The need for guidelines. Head Neck 2010; 33:912-6. [DOI: 10.1002/hed.21472] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2010] [Indexed: 11/08/2022] Open
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253
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Pfister DG, Cassileth BR, Deng GE, Yeung KS, Lee JS, Garrity D, Cronin A, Lee N, Kraus D, Shaha AR, Shah J, Vickers AJ. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol 2010; 28:2565-70. [PMID: 20406930 DOI: 10.1200/jco.2009.26.9860] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To determine whether acupuncture reduces pain and dysfunction in patients with cancer with a history of neck dissection. The secondary objective is to determine whether acupuncture relieves dry mouth in this population. PATIENTS AND METHODS Patients at a tertiary cancer center with chronic pain or dysfunction attributed to neck dissection were randomly assigned to weekly acupuncture versus usual care (eg, physical therapy, analgesia, and/or anti-inflammatory drugs, per patient preference or physician recommendation) for 4 weeks. The Constant-Murley score, a composite measure of pain, function, and activities of daily living, was the primary outcome measure. Xerostomia, a secondary end point, was assessed using the Xerostomia Inventory. RESULTS Fifty-eight evaluable patients were accrued and randomly assigned from 2004 to 2007 (28 and 30 patients on acupuncture and control arms, respectively). Constant-Murley scores improved more in the acupuncture group (adjusted difference between groups = 11.2; 95% CI, 3.0 to 19.3; P = .008). Acupuncture produced greater improvement in reported xerostomia (adjusted difference in Xerostomia Inventory = -5.8; 95% CI, -0.9 to -10.7; P = .02). CONCLUSION Significant reductions in pain, dysfunction, and xerostomia were observed in patients receiving acupuncture versus usual care. Although further study is needed, these data support the potential role of acupuncture in addressing post-neck dissection pain and dysfunction, as well as xerostomia.
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Iyer NG, Shaha AR. Management of thyroid nodules and surgery for differentiated thyroid cancer. Clin Oncol (R Coll Radiol) 2010; 22:405-12. [PMID: 20381323 DOI: 10.1016/j.clon.2010.03.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 03/16/2010] [Indexed: 11/19/2022]
Abstract
The incidence of well-differentiated thyroid cancer has seen a worldwide increase in the last three decades. Whether this is due to a 'true increase' in incidence or simply increased detection of otherwise subclinical disease remains unclear. The treatment of thyroid cancer revolves around appropriate surgical intervention, minimising complications and the use of adjuvant therapy in select circumstances. Prognostic features and risk stratification are crucial in determining the appropriate treatment. There continues to be considerable debate in several aspects of management in these patients. Level 1 evidence is lacking, and there are limited prospective data to direct therapy, hence limiting decision-making to retrospective analyses, treatment guidelines based on expert opinion and personal philosophies. This overview focuses on the major issues associated with the investigation of thyroid nodules and the extent of surgery. As overall survival in well-differentiated thyroid cancer exceeds 95%, it is important to reduce over-treating the large majority of patients, and focus limited resources on high-risk patients who require aggressive treatment and closer attention. The onus is on the physician to avoid treatment-related complications from thyroid surgery and to offer the most efficient and cost-effective therapeutic option.
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Ferlito A, Corry J, Silver CE, Shaha AR, Thomas Robbins K, Rinaldo A. Planned neck dissection for patients with complete response to chemoradiotherapy: a concept approaching obsolescence. Head Neck 2010; 32:253-61. [PMID: 19572281 DOI: 10.1002/hed.21173] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The question of efficacy of "planned" neck dissection following complete response to chemoradiation of head and neck cancer is discussed. There is general agreement that preemptive neck dissection in patients who present initially with low volume (N1) neck disease is not necessary. However, routine performance of planned neck dissection for patients who present initially with high volume (> or =N2) disease remains controversial. The authors reviewed a large number of studies reported in the recent literature and discuss how they affect this debate.Twenty-four of the reviewed studies indicate a benefit in regional control obtained by "planned" neck dissection among patients who had bulky neck disease pretreatment. All these studies are retrospective, they do not assess treatment response prior to surgery, although they do show very good regional control rates. Twenty-six studies demonstrate no benefit from "planned" neck dissection after complete clinical response. The reasons for these different conclusions include the development of more effective chemoradiation regimens which have improved the initial locoregional control rates of patients undergoing primary chemoradiation treatment, and improvements in diagnostic technology which have increased ability to detect low volume persistent tumor in the post treatment period. When neck dissection is necessary for persistent or recurrent disease, recent studies have shown that selective or superselective neck dissection may produce results therapeutically equivalent to those obtained with more extensive procedures, with less morbidity.There is now a large body of evidence, based on long-term clinical outcomes, that patients who have achieved a complete clinical (including radiologic) response to chemoradiation have a low rate of isolated neck failure, and the continued use of planned neck dissection for these patients cannot be justified.
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Ganly I, Patel SG, Matsuo J, Singh B, Kraus DH, Boyle J, Wong RJ, Lee N, Pfister DG, Shaha AR, Shah JP. Predictors of outcome for advanced-stage supraglottic laryngeal cancer. Head Neck 2010; 31:1489-95. [PMID: 19408292 DOI: 10.1002/hed.21113] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The objective of this study was to report our experience in the management of patients with advanced-stage supraglottic laryngeal carcinoma and to identify factors predictive of outcome. METHODS In total, 181 patients with advanced-stage supraglottic laryngeal carcinoma were treated at Memorial Sloan-Kettering Cancer Center between 1984 and 1998. Sixty-nine (38%) patients were treated by surgery +/- postoperative radiotherapy (SRT), 93 (52%) by chemoradiotherapy (CTRT), and 19 (10%) by radiotherapy alone (RT). Survival outcomes were calculated using the Kaplan-Meier method. Predictors of outcome were identified using multivariate analysis. RESULTS The-5 year overall survival (OS) and disease-specific survival (DSS) were 53% and 71%, respectively. Patients treated with SRT and CTRT had comparable outcomes. The main independent predictors of OS and DSS were age greater than 60 years and stage of the neck at presentation. CONCLUSION Regardless of index treatment, age over 60 years and clinical stage of the neck at presentation were the main independent predictors of OS and DSS.
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Gil Z, Carlson DL, Boyle JO, Kraus DH, Shah JP, Shaha AR, Singh B, Wong RJ, Patel SG. Lymph node density is a significant predictor of outcome in patients with oral cancer. Cancer 2010; 115:5700-10. [PMID: 19691095 DOI: 10.1002/cncr.24631] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The impact of lymph node metastases on prognosis in patients with oral cavity squamous cell carcinoma (OSCC) has been well recognized. However, accurate stratification of risk for recurrence among patients with lymph node metastases is difficult based on the existing staging systems. In the current study, the utility of lymph node density (LND) was evaluated as an alternative method for predicting survival. METHODS Three hundred eighty-six patients who underwent neck dissection were included. The median follow-up was 67 months. Five-year overall survival (OS), disease-specific survival (DSS), and locoregional failure (LRF) rates were calculated using the Kaplan-Meier method. LND (number of positive lymph nodes/total number of excised lymph nodes) and tumor-node-metastasis (TNM) staging variables were subjected to multivariate analysis. RESULTS Using the median (LND=0.06) as the cutoff point, LND was found to be significantly associated with outcome. For patients with LND<or=0.06, the OS was 58 percent versus 28 percent for patients with LND>0.06 (P<.001). Similarly, the DSS for patients with LND<or=0.06 was 65 percent and was 34 percent for those with LND>0.06 (P<.001). On univariate analysis, pathologic T and N classification, extracapsular spread, and LND were found to be significant predictors of outcome (P<.001). However, on multivariate analysis, LND remained the only independent predictor of OS (P=.02; hazards ratio, 2.0), DSS (P=.02; hazards ratio, 2.3), and LRF (P=.005; hazards ratio, 4.1). LND was also found to be the only significant predictor of outcome in patients receiving adjuvant radiotherapy (P<.05). Within individual subgroups of pN1 or pN2 patients, LND reliably stratified patients according to their risk of failure (P<.05). CONCLUSIONS After surgery for OSCC, pathologic evaluation of the neck using LND was found to reliably stratify the risk of disease recurrence and survival.
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Morris LG, Shaha AR, Tuttle RM, Sikora AG, Ganly I. Tall-cell variant of papillary thyroid carcinoma: a matched-pair analysis of survival. Thyroid 2010; 20:153-8. [PMID: 20151822 PMCID: PMC3714453 DOI: 10.1089/thy.2009.0352] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The tall-cell variant (TCV) of papillary thyroid carcinoma (PTC) is considered a more aggressive variant of PTC, with a poor prognosis. This is largely due to the tendency for TCV to present at an older age and with extrathyroidal extension (ETE). When these two variables are controlled for, it is unclear whether tall-cell histology alone portends a poor prognosis. Because previous studies have been underpowered to adequately answer this question, we hypothesized that TCV may have poorer prognosis than PTC. Our objective was to utilize a large cancer registry to obtain sufficient power to differentiate between outcomes in cases of TCV and PTC. METHODS Using the National Cancer Institute's Surveillance, Epidemiology, and End Results database, we identified 278 TCV patients and 2522 classical PTC patients with sufficient information for a detailed matched-pair analysis. Each TCV patient was matched with a PTC patient for age, sex, extent of ETE, regional and distant metastases, surgical and adjuvant therapy, and year of diagnosis. The TCV cohort was then compared against all PTC cases and matched PTC cases. RESULTS Compared with classical PTC, TCV patients presented at an older age (54.3 years vs. 46.3 years, p < 0.0001) had a higher rate of ETE (53.6% vs. 30.2%, p < 0.0001) and poorer 5-year disease-specific survival (81.9% vs. 97.8%, p < 0.0001). In the matched-pair analysis comparing TCV patients to the matched PTC cohort, 5-year disease-specific survival was poorer in the TCV cohort (81.9% vs. 91.3%, p = 0.049). The number of deaths in the TCV cohort was higher than in the matched PTC cohort (p = 0.043). CONCLUSIONS TCV exhibits poorer survival than classical PTC. When the major prognostic factors for thyroid cancer are controlled for, including age and ETE, tall-cell histology alone remains a significant prognostic factor for disease-specific death.
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259
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Shaha AR. Substernal goiter: What is in a definition? Surgery 2010; 147:239-40. [DOI: 10.1016/j.surg.2009.10.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 10/26/2009] [Indexed: 11/25/2022]
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260
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Gopalakrishna Iyer N, Shaha AR. Complications of thyroid surgery: prevention and management. MINERVA CHIR 2010; 65:71-82. [PMID: 20212419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The essentials of thyroid surgery include intimate knowledge of thyroid gland anatomy, sound understanding of thyroid pathology and meticulous technique. While mortality due to thyroid surgery is rare, complications can result in debilitating sequelae. Thyroid surgeons need to understand and anticipate situations when these may occur, and actively take steps to prevent them, as treatment of these complications is often difficult and frustrating. Surgeons also need to maintain an audit of their own complication rates and convey these to patients instead of quoting data from published literature, which is biased towards high-volume specialized units rather than "real world data". This review addresses the common complications that occur during thyroid surgery and the issues therein.
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Shaha AR. Prophylactic central compartment dissection in thyroid cancer: a new avenue of debate. Surgery 2009; 146:1224-7. [PMID: 19958952 DOI: 10.1016/j.surg.2009.10.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 10/05/2009] [Indexed: 01/05/2023]
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262
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Shaha AR, Michael Tuttle R. Author reply: Management of mild elevation of calcitonin after thyroidectomy. Ann Surg Oncol 2009; 17:329-30. [PMID: 19809854 DOI: 10.1245/s10434-009-0744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Indexed: 11/18/2022]
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Abstract
Fletcher et al have described a single case in their article of needle localization for recurrent thyroid cancer in the paratracheal region (“Ultrasound-Guided Needle Localization of Recurrent Paratracheal Thyroid Cancer”). This is an intriguing report of a truly challenging problem recently seen in the management of paratracheal and central compartment recurrence in thyroid cancer.
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Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009; 266:1333-52. [PMID: 19597837 DOI: 10.1007/s00405-009-1028-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 06/18/2009] [Indexed: 11/24/2022]
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265
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Ferlito A, Kowalski LP, Byers RM, Pellitteri PK, Bradley PJ, Rinaldo A, Silver CE, Wei WI, Shaha AR, Medina JE. Is the Standard Radical Neck Dissection no Longer Standard? Acta Otolaryngol 2009. [DOI: 10.1080/003655402_000028042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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266
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Ferlito A, Shaha AR, Rinaldo A, Pellitteri PK, Mondin V, Byers RM. "Skip Metastases" from Head and Neck Cancers. Acta Otolaryngol 2009. [DOI: 10.1080/003655402_000028056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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267
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Ferlito A, Robbins KT, Medina JE, Shaha AR, Som PM, Rinaldo A. Is it Time to Eliminate Confusion Regarding Cervical Lymph Node Levels According to the Scheme Originated at the Memorial Sloan-Kettering Cancer Center? Acta Otolaryngol 2009. [DOI: 10.1080/003655402_000028043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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268
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Rinaldo A, Shaha AR, Wei WI, Silver CE, Ferlito A. Microvascular Free Flaps: a Major Advance in Head and Neck Reconstruction. Acta Otolaryngol 2009. [DOI: 10.1080/003655402_000028041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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269
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León X, Ferlito A, III CMM, Saffiotti U, Shaha AR, Bradley PJ, Brandwein MS, Anniko M, Elluru RG, Rinaldo A. Second Primary Tumors in Head and Neck Cancer Patients. Acta Otolaryngol 2009. [DOI: 10.1080/003655402_000028048] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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270
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Pillarisetty VG, Katz SC, Ghossein RA, Tuttle RM, Shaha AR. Micromedullary Thyroid Cancer: How Micro Is Truly Micro? Ann Surg Oncol 2009; 16:2875-81. [DOI: 10.1245/s10434-009-0595-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 06/10/2009] [Accepted: 06/11/2009] [Indexed: 11/18/2022]
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271
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Forastiere AA, Shaha AR. Chemotherapy alone for laryngeal preservation--is it possible? J Clin Oncol 2009; 27:1933-4. [PMID: 19289612 DOI: 10.1200/jco.2008.20.9445] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Miller SJ, Alam M, Andersen J, Berg D, Bichakjian CK, Bowen G, Cheney RT, Glass LF, Grekin RC, Hallahan DE, Kessinger A, Lee NY, Liegeois N, Lydiatt DD, Michalski J, Morrison WH, Nehal KS, Nelson KC, Nghiem P, Olencki T, Oseroff AR, Perlis CS, Rosenberg EW, Shaha AR, Urist MM, Wang LC. Merkel Cell Carcinoma. J Natl Compr Canc Netw 2009; 7:322-32. [DOI: 10.6004/jnccn.2009.0024] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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273
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Ganly I, Patel SG, Matsuo J, Singh B, Kraus DH, Boyle J, Wong R, Shaha AR, Shah JP. Analysis of postoperative complications of open partial laryngectomy. Head Neck 2009; 31:338-45. [PMID: 19073010 DOI: 10.1002/hed.20975] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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274
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Estilo CL, O-charoenrat P, Talbot S, Socci ND, Carlson DL, Ghossein R, Williams T, Yonekawa Y, Ramanathan Y, Boyle JO, Kraus DH, Patel S, Shaha AR, Wong RJ, Huryn JM, Shah JP, Singh B. Oral tongue cancer gene expression profiling: Identification of novel potential prognosticators by oligonucleotide microarray analysis. BMC Cancer 2009; 9:11. [PMID: 19138406 PMCID: PMC2649155 DOI: 10.1186/1471-2407-9-11] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 01/12/2009] [Indexed: 12/18/2022] Open
Abstract
Background The present study is aimed at identifying potential candidate genes as prognostic markers in human oral tongue squamous cell carcinoma (SCC) by large scale gene expression profiling. Methods The gene expression profile of patients (n=37) with oral tongue SCC were analyzed using Affymetrix HG_U95Av2 high-density oligonucleotide arrays. Patients (n=20) from which there were available tumor and matched normal mucosa were grouped into stage (early vs. late) and nodal disease (node positive vs. node negative) subgroups and genes differentially expressed in tumor vs. normal and between the subgroups were identified. Three genes, GLUT3, HSAL2, and PACE4, were selected for their potential biological significance in a larger cohort of 49 patients via quantitative real-time RT-PCR. Results Hierarchical clustering analyses failed to show significant segregation of patients. In patients (n=20) with available tumor and matched normal mucosa, 77 genes were found to be differentially expressed (P< 0.05) in the tongue tumor samples compared to their matched normal controls. Among the 45 over-expressed genes, MMP-1 encoding interstitial collagenase showed the highest level of increase (average: 34.18 folds). Using the criterion of two-fold or greater as overexpression, 30.6%, 24.5% and 26.5% of patients showed high levels of GLUT3, HSAL2 and PACE4, respectively. Univariate analyses demonstrated that GLUT3 over-expression correlated with depth of invasion (P<0.0001), tumor size (P=0.024), pathological stage (P=0.009) and recurrence (P=0.038). HSAL2 was positively associated with depth of invasion (P=0.015) and advanced T stage (P=0.047). In survival studies, only GLUT3 showed a prognostic value with disease-free (P=0.049), relapse-free (P=0.002) and overall survival (P=0.003). PACE4 mRNA expression failed to show correlation with any of the relevant parameters. Conclusion The characterization of genes identified to be significant predictors of prognosis by oligonucleotide microarray and further validation by real-time RT-PCR offers a powerful strategy for identification of novel targets for prognostication and treatment of oral tongue carcinoma.
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Shaha AR. Missing Neck Nodes. Laryngoscope 2009. [DOI: 10.1002/lary.20320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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