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Dong A, Zhu S, Ma H, Wei X, Huang W, Ruan G, Liu L, Mo Y, Ai F. Matted Lymph Nodes on MRI in Nasopharyngeal Carcinoma: Prognostic Factor and Potential Indication for Induction Chemotherapy Benefits. J Magn Reson Imaging 2024; 59:1976-1990. [PMID: 37706438 DOI: 10.1002/jmri.29012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Lymph node characteristics markedly affect nasopharyngeal carcinoma (NPC) prognosis. Matted node (MN), an important characteristic for lymph node, lacks explored MRI-based prognostic implications. PURPOSE Investigate MRI-determined MNs' prognostic value in NPC, including 5-year overall survival (OS), distant metastasis-free survival (DMFS), local recurrence-free survival (LRFS), progression-free survival (PFS), and its role in induction chemotherapy (IC). STUDY TYPE Retrospective cohort survival study. POPULATION Seven hundred ninety-two patients with non-metastatic NPC (female: 27.3%, >45-year old: 50.1%) confirmed by biopsy. FIELD STRENGTH/SEQUENCE 5-T/3.0-T, T1-, T2- and post-contrast T1-weighted fast spin echo sequences acquired. ASSESSMENT MNs were defined as ≥3 nodes abutting with intervening fat plane replaced by extracapsular nodal spread (ENS). Patients were observed every 3 months for 2 years and every 6 months for 5 years using MRI. Follow-up extended from treatment initiation to death or final follow-up. MNs were evaluated by three radiologists with inter-reader reliability calculated. A 1:1 matched-pair method compared survival differences between MN-positive patients with or without IC. Primary endpoints (OS, DMFS, LRFS, PFS) were calculated from therapy initiation to respective event. STATISTICAL TESTS Kappa values assessed inter-reader reliability. Correlation between MN, ENS, and LNN was studied through Spearman's correlation coefficient. Clinical characteristics were calculated via Fisher's exact, Chi-squared, and Student's t-test. Kaplan-Meier curves and log-rank tests analyzed all time-to-event data. Confounding factors were included in Multivariable Cox proportional hazard models to identify independent prognostic factors. P-values <0.05 were considered statistically significant. RESULTS MNs incidence was 24.6%. MNs independently associated with decreased 5-year OS, DMFS, and PFS; not LRFS (P = 0.252). MN-positive patients gained significant survival benefit from IC in 5-year OS (88.4% vs. 66.0%) and PFS (76.4% vs. 53.5%), but not DMFS (83.1% vs. 69.9%, P = 0.145) or LRFS (89.9% vs. 77.8%, P = 0.140). DATA CONCLUSION MNs may independently stratify NPC risk and offer survival benefit from IC. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Annan Dong
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
| | - Siyu Zhu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
| | - Huali Ma
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
| | - Xiaoyu Wei
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Wenjie Huang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
| | - Guangying Ruan
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
| | - Lizhi Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
| | - Yunxian Mo
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
| | - Fei Ai
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
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Horakova Z, Starek I, Zapletalova J, Salzman R. Parotid Gland Metastases of Cutaneous Squamous Cell Carcinoma of the Head: Occult Metastases Occurrence and Their Late Manifestation. Int J Clin Pract 2024; 2024:5525741. [PMID: 38410673 PMCID: PMC10896655 DOI: 10.1155/2024/5525741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Cutaneous squamous cell carcinomas (cSCC) are malignant tumours with excellent prognosis unless nodal metastases develop. The aim of our study is to determine the prognostic significance of the clinical stage of parotid gland metastases and the incidence of occult cervical lymph node involvement in cSCC of the head. Our retrospective analysis includes 39 patients with cSCC parotid gland metastases, 15 of whom had concurrent cervical node involvement. In 32 patients, the lymph nodes manifested at stage N3b. A total of 26 patients were treated with parotidectomy, 9 patients received radiotherapy alone, and 4 received symptomatic therapy. The surgical treatment included either total conservative (21 cases) or superficial parotidectomy (5 cases) and neck dissection (therapeutic neck dissections in 11 cases and elective in 14 cases). In all cases, surgery was performed with sufficient tumour-free resection margins. Adjuvant radiotherapy was administered postoperatively in 16 patients. Occult metastases were present in 21% of cases after an elective neck dissection, but not in any case in the deep lobe of the parotid gland. The five-year overall survival and recurrence-free interval were 52% and 55%, respectively. Patients with the cN3b stage and G3 histological grade tend to have a worse prognosis, but not at a statistically significant level. The prognosis was not worse in patients with concurrent parotid and cervical metastases compared to those with metastases limited to the parotid gland only. The addition of adjuvant irradiation, in comparison to a single modality surgical treatment, was the only statistically significant prognostic factor that reduced the risk of death from this diagnosis (p=0.013). The extent of parotidectomy (partial vs. total) had no impact on either the risk of recurrence or patient prognosis. The combination of surgery with irradiation provides the best results and should be applied to all patients who tolerate the treatment. A partial superficial parotidectomy should be sufficient, with a minimum risk of occult metastasis in the deep lobe. Conversely, the relatively high incidence of occult neck metastases indicates that patients could likely benefit from elective neck dissection.
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Affiliation(s)
- Zuzana Horakova
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Zdravotniku 248/7, Olomouc 77900, Czech Republic
| | - Ivo Starek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Zdravotniku 248/7, Olomouc 77900, Czech Republic
| | - Jana Zapletalova
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University, Hnevotinska 3 77515, Olomouc, Czech Republic
| | - Richard Salzman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Zdravotniku 248/7, Olomouc 77900, Czech Republic
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Kang YJ, Park G, Park SY, Kim T, Kim E, Heo Y, Lee C, Jeong HS. Extra-Capsular Spread of Lymph Node Metastasis in Oral, Oropharyngeal and Hypopharyngeal Cancer: A Comparative Subsite Analysis. Cancers (Basel) 2024; 16:659. [PMID: 38339410 PMCID: PMC10854589 DOI: 10.3390/cancers16030659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The extra-capsular spread (ECS) of lymph node metastasis (LNM) is a hallmark of aggressive primary tumor phenotype in head and neck cancer (HNC); however, the factors influencing ECS are poorly understood. PATIENTS AND METHODS This was a retrospective study, including 190 cases of oral tongue cancer (OTC), 148 cases of oropharyngeal cancer (OPC) (118 HPV-positive and 30 HPV-negative), and 100 cases of hypopharyngeal cancer (HPC). Tumor dimension, tumor biological variables (lymphovascular/perineural invasion and histologic grade), and LNM variables (LNM number and size) were analyzed according to the presence of ECS using multivariable logistic regression and receiver operating characteristic (ROC) curve analyses. RESULTS LNM variables were significant factors for ECS in all subsites of HNC (p < 0.05), except HPV-positive OPC. In OTC, tumor dimensional variables were significantly related to ECS (p < 0.01). Meanwhile, in OPC and HPC, neither the primary tumor dimension nor the T status were significant factors for ECS occurrence. The predictability of ECS by ROC curve using multiple variables was 0.819 [95% confidence interval: 0.759-0.878] in OTC, 0.687 [0.559-0.815] in HPV-positive OPC, 0.823 [0.642-1.000] in HPV-negative OPC, and 0.907 [0.841-0.973] in HPC. CONCLUSION LNM variables were correlated with ECS occurrence for most HNC subsites, and site-dependent primary tumor characteristics might contribute differentially to the ECS development of LNM in HNC.
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Affiliation(s)
- Yung Jee Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Goeun Park
- Center for Biomedical Statistics, Samsung Medical Center, Seoul 06351, Republic of Korea;
| | - Sung Yool Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Taehwan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Eunhye Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Yujin Heo
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Changhee Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (Y.J.K.); (S.Y.P.); (T.K.); (E.K.); (Y.H.); (C.L.)
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Anto R, Riju J, Chinniah P, Tirkey AJ, Chamania G, Patil S, Bhandari S, Paulose A, Vidya K, Karuppusami R, Babu R, Micheal RC. Clinical, Radiological and Histological Features and Their Association with Extranodal Extension in Buccoalveolar Complex Squamous Cell Carcinoma. South Asian J Cancer 2023; 12:349-358. [PMID: 38130276 PMCID: PMC10733063 DOI: 10.1055/s-0043-1761439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Jeyashanth RijuObjectives The study was aimed to (1) evaluate the effectiveness of clinical examination, intraoperative finding, and contrast-enhanced computed tomography (CECT) to detect extranodal extension (ENE) in buccoalveolar complex squamous cell carcinoma (BAOSCC), (2) to know various factors influencing ENE, and (3) to evaluate survival outcome in patients with ENE. Materials and Methods This was a retrospective cohort study, which included 137 patients with BAOSCC who underwent curative treatment between May 2019 and April 2021. Collaborative findings suggestive of ENE were noted during preoperative clinical examination, CECT, and intraoperatively, and their efficacy was compared with postoperative histopathology. Also, the various factors associated with ENE were evaluated and compared. Statistical Analysis Univariate and multivariate analysis of parameters was done using multiple logistic regression analysis and significant correlation was determined using chi-square test between ENE positive and negative categories. Analysis of prognosis and survival was done by Kaplan-Meier curve plotting using regression analysis and its significance was compared. Results The overall prevalence of ENE was 18.98% and that of lymph node involvement was 40.88%. CECT (73.1%) was found to be more sensitive in detecting ENE compared to intraoperative examination (46.2%) and clinical examination (34.6%).In comparison with clinical examination (91.9%) or CECT (78.38%), intraoperative examination (93.7%) showed the highest specificity in detecting ENE. Clinical nodal size ≥ 3 cm ( p ≤ 0.001), fixity ( p ≤ 0.001), and clinical number of nodes ( p ≤ 0.001) had significant association with ENE. The presence of thick nodal walls on CECT increased the probability of predicting ENE 15 times ( p = 0.180, confidence interval: 0.3-765.4). After a mean follow-up of 18 months, subjects without nodal positivity had a survival advantage over patients with positive lymph nodes (86.4% vs. 53.3%) and those with ENE (86.4% vs. 23.2%), respectively. Conclusion The results demonstrated that clinical examination can be used as an adjuvant to radiological imaging for prediction of ENE preoperatively. Clinical finding suggesting size of node ≥ 3 cm and ≥ 2 nodes are strong predictor of ENE, in addition to other known predictors. Patients with ENE had an unfavorable prognosis when compared with subjects with metastatic nodes without ENE. Presence of ENE remains one of the strongest factors predicting recurrence and thus poor prognosis.
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Affiliation(s)
- Ronald Anto
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jeyashanth Riju
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Praveen Chinniah
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amit Jiwan Tirkey
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gaurav Chamania
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shruthi Patil
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Subhan Bhandari
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Antony Paulose
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Konduru Vidya
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rekha Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramesh Babu
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv C. Micheal
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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Henson CE, Abou-Foul AK, Morton DJ, McDowell L, Baliga S, Bates J, Lee A, Bonomo P, Szturz P, Nankivell P, Huang SH, Lydiatt WM, O’Sullivan B, Mehanna H. Diagnostic challenges and prognostic implications of extranodal extension in head and neck cancer: a state of the art review and gap analysis. Front Oncol 2023; 13:1263347. [PMID: 37799466 PMCID: PMC10548228 DOI: 10.3389/fonc.2023.1263347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Extranodal extension (ENE) is a pattern of cancer growth from within the lymph node (LN) outward into perinodal tissues, critically defined by disruption and penetration of the tumor through the entire thickness of the LN capsule. The presence of ENE is often associated with an aggressive cancer phenotype in various malignancies including head and neck squamous cell carcinoma (HNSCC). In HNSCC, ENE is associated with increased risk of distant metastasis and lower rates of locoregional control. ENE detected on histopathology (pathologic ENE; pENE) is now incorporated as a risk-stratification factor in human papillomavirus (HPV)-negative HNSCC in the eighth edition of the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) TNM classification. Although ENE was first described almost a century ago, several issues remain unresolved, including lack of consensus on definitions, terminology, and widely accepted assessment criteria and grading systems for both pENE and ENE detected on radiological imaging (imaging-detected ENE; iENE). Moreover, there is conflicting data on the prognostic significance of iENE and pENE, particularly in the context of HPV-associated HNSCC. Herein, we review the existing literature on ENE in HNSCC, highlighting areas of controversy and identifying critical gaps requiring concerted research efforts.
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Affiliation(s)
- Christina E. Henson
- Department of Radiation Oncology and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ahmad K. Abou-Foul
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Daniel J. Morton
- Department of Pediatrics and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sujith Baliga
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - James Bates
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Anna Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Petr Szturz
- Department of Oncology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - William M. Lydiatt
- Department of Surgery, Creighton University, and Nebraska Methodist Health System, Omaha, NE, United States
| | - Brian O’Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
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Lin C, Sharbel DD, Topf MC. Surgical clinical trials for HPV-positive oropharyngeal carcinoma. Front Oncol 2022; 12:992348. [PMID: 36439459 PMCID: PMC9682030 DOI: 10.3389/fonc.2022.992348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/21/2022] [Indexed: 07/22/2023] Open
Abstract
The treatment of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) continues to evolve as multiple ongoing and recently completed clinical trials investigate the role of surgery, radiation therapy, chemotherapy, and immunotherapy. Current trials are investigating transoral robotic surgery (TORS) in treatment de-escalation protocols in an effort to optimize quality of life, while maintaining historical survival rates. The advantage of TORS is its minimally invasive approach to primary resection of the tumor as well as valuable pathologic staging. The ORATOR trial reported poorer quality of life in patients treated with TORS compared to primary radiotherapy though this was not a clinically meaningful difference. The recently published ECOG 3311 trial showed that surgery can be used to safely de-escalate the adjuvant radiation dose to 50 Gy in intermediate-risk patients. In this review, we summarize and discuss the past and current clinical trials involving surgery in the treatment of HPV-positive OPSCC.
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Affiliation(s)
- Chen Lin
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Otolaryngology – Head and Neck Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Daniel D. Sharbel
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Michael C. Topf
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
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Xu B, Saliba M, Alzumaili B, Alghamdi M, Lee N, Riaz N, Patel SG, Ganly I, Dogan S, Ghossein RA, Katabi N. Prognostic impact of extranodal extension (ENE) in surgically managed treatment-naive HPV-positive oropharyngeal squamous cell carcinoma with nodal metastasis. Mod Pathol 2022; 35:1578-1586. [PMID: 35690646 PMCID: PMC10368196 DOI: 10.1038/s41379-022-01120-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/12/2022] [Accepted: 05/28/2022] [Indexed: 11/09/2022]
Abstract
Extranodal extension (ENE) is a significant prognostic factor for human papilloma virus (HPV)-negative head and neck squamous cell carcinoma and is incorporated into AJCC 8th edition pN stage. It remains controversial whether ENE or the degree of ENE is prognostically relevant in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). A detailed clinicopathologic review was conducted in a large retrospective cohort of 232 surgically treated patients with HPV-positive OPSCC and nodal metastasis. Fifty-six patients (24%) had nodal metastasis with ENE. The median vertical extent of ENE was 2.9 mm (range 0.2-20.3 mm), and the median horizontal span of ENE was 2.5 mm (range: 0.3-14.0 mm). Comparing with patients without ENE, those with ENE were associated with a higher number of positive lymph nodes, lymphovascular invasion, perineural invasion, adjuvant chemotherapy, larger primary tumor size, and shorter follow up period. Patients with ENE had shortened overall survival (OS), disease specific survival (DSS), disease free survival (DFS), distant metastasis free survival (DMFS), and regional recurrence free survival (RRFS) on univariate survival analysis. The 5-year OS, DSS, and DFS were 95%, 97%, and 90% respectively for the group without ENE, and 64%, 71%, and 65% respectively for the group with ENE. On Multivariate survival analysis, the presence of ENE was an independent adverse prognostic factor for OS, DSS, and DFS. Additionally, major ENE defined as a vertical extent of ≥4 mm or irregular soft tissue deposit independently predicted shortened OS, DSS, and RFS. In conclusion, the presence of ENE, in particular major ENE, is an independent prognostic factor in HPV-positive OPSCC. Therefore, we propose to document the presence and extent of ENE for these tumors. Consideration may be given for AJCC 9th edition to include ENE into pN stage of HPV-positive OPSCC.
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Affiliation(s)
- Bin Xu
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Maelle Saliba
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Bayan Alzumaili
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Mohammed Alghamdi
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Nancy Lee
- Department of Radiation Oncology, New York, NY, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, New York, NY, USA
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Snjezana Dogan
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Ronald A Ghossein
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA
| | - Nora Katabi
- Departmental of Pathology and Laboratory Medicine, New York, NY, USA.
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Abdel-Halim CN, Rohde M, Larsen SR, Green TM, Ulhøi BP, Woller NC, Gerke O, Høilund-Carlsen PF, Sørensen JA, Godballe C. Inter- and Intrarater Reliability and Agreement Among Danish Head and Neck Pathologists Assessing Extranodal Extension in Lymph Node Metastases from Oropharyngeal Squamous Cell Carcinomas. Head Neck Pathol 2022; 16:1082-1090. [PMID: 35829862 PMCID: PMC9729471 DOI: 10.1007/s12105-022-01468-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extranodal extension (ENE) in lymph node metastases is one of the most important prognostic factors in head and neck squamous cell carcinomas. Studies have shown inconsistency among pathologists in the assessment of ENE. The aims of this study were: (1) to determine the interrater and intrarater reliability and agreement in the assessment of ENE among Danish pathologists and (2) to test if a standardized assessment method may increase interrater agreement. METHODS Four Danish head and neck pathologists assessed ENE presence or absence in 120 histological slides from lymph nodes with oropharyngeal squamous cell carcinoma metastases (first round). Subsequently, guidelines were introduced to the pathologists and a new assessment was performed (second round). Finally, two of the pathologists assessed the slides to determine intrarater reliability and agreement (third round). RESULTS Interrater kappa coefficients varied between 0.57 and 0.67 in the first round and between 0.59 and 0.72 in the second round. The intrarater agreement between round 2 and 3 was 0.88 for pathologist 1 and 0.92 for pathologist 2 with resulting kappa coefficients of 0.76 (95% CI 0.64-0.88) and 0.84 (95% CI 0.74-0.94), respectively. CONCLUSION We found a moderate level of reliability and agreement among pathologists for ENE in lymph node metastases from oropharyngeal squamous cell carcinomas. The intrarater reliability and agreement was generally higher than interrater measures. Interrater agreement was slightly improved by standardized assessment.
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Affiliation(s)
- Chadi Nimeh Abdel-Halim
- Department of ORL – Head & Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark ,Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense, Denmark
| | - Max Rohde
- Department of ORL – Head & Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark ,Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense, Denmark
| | - Stine Rosenkilde Larsen
- Department of Pathology, Odense University Hospital, J. B. Winsløws Vej 15, 5000 Odense, Denmark
| | - Tina Marie Green
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense, Denmark ,Department of Pathology, Odense University Hospital, J. B. Winsløws Vej 15, 5000 Odense, Denmark
| | - Benedicte Parm Ulhøi
- Department of Pathology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Nina Claire Woller
- Department of Pathology, Copenhagen University Hospital, Inge Lehmanns Vej 14, Copenhagen, Denmark
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense, Denmark ,Department of Nuclear Medicine, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | | | - Jens Ahm Sørensen
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense, Denmark ,Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark ,University of Southern Denmark, Odense, Denmark
| | - Christian Godballe
- Department of ORL – Head & Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark ,Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, 5000 Odense, Denmark
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9
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Predictors of Extracapsular Spread in T1/T2 Oral Squamous Cell Carcinoma: A retrospective study. J Oral Biol Craniofac Res 2022; 12:449-453. [DOI: 10.1016/j.jobcr.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/21/2022] [Accepted: 05/21/2022] [Indexed: 11/18/2022] Open
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10
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Hussain T. Patient Benefit and Quality of Life after Robot-Assisted Head and Neck Surgery. Laryngorhinootologie 2022; 101:S160-S185. [PMID: 35605618 DOI: 10.1055/a-1647-8650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Robotic systems for head and neck surgery are at different stages of technical development and clinical application. Currently, robotic systems are predominantly used for transoral surgery of the pharynx and larynx. Robotic surgery of the neck, the thyroid, and the middle and inner ear is much less common; however, some oncological and functional outcomes have been reported. This article provides an overview of the current state of robot-assisted head and neck surgery with a special emphasis on patient benefit and postoperative quality of life (QoL). The focus is placed on the role of transoral robotic surgery (TORS) for the resection of oropharyngeal carcinomas. For this application, reported long-term outcomes show functional post-operative advantages for selected oropharyngeal cancer patients after TORS compared to open surgery and primary radiotherapy. Since TORS also plays a significant role in the context of potential therapy de-escalation for HPV-positive oropharyngeal cancer patients, ongoing trials are presented. Regarding the evaluation of the therapeutic benefit and the QoL of cancer patients, special attention has to be paid to the large degree of variability of individual patients' preferences. Influencing factors and tools for a detailed assessment of QoL parameters are therefore detailed at the beginning of this article. Notably, while some robotic systems for ear and skull base surgery are being developed in Europe, TORS systems are mainly used in North America and Asia. In Europe and Germany in particular, transoral laser microsurgery (TLM) is a well-established technology for transoral tumor resection. Future trials comparing TORS and TLM with detailed investigation of QoL parameters are therefore warranted and might contribute to identifying suitable fields for the application of the different techniques.
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Affiliation(s)
- Timon Hussain
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen
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11
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Caudell JJ, Gillison ML, Maghami E, Spencer S, Pfister DG, Adkins D, Birkeland AC, Brizel DM, Busse PM, Cmelak AJ, Colevas AD, Eisele DW, Galloway T, Geiger JL, Haddad RI, Hicks WL, Hitchcock YJ, Jimeno A, Leizman D, Mell LK, Mittal BB, Pinto HA, Rocco JW, Rodriguez CP, Savvides PS, Schwartz D, Shah JP, Sher D, St John M, Weber RS, Weinstein G, Worden F, Yang Bruce J, Yom SS, Zhen W, Burns JL, Darlow SD. NCCN Guidelines® Insights: Head and Neck Cancers, Version 1.2022. J Natl Compr Canc Netw 2022; 20:224-234. [PMID: 35276673 DOI: 10.6004/jnccn.2022.0016] [Citation(s) in RCA: 153] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Head and Neck Cancers address tumors arising in the oral cavity (including mucosal lip), pharynx, larynx, and paranasal sinuses. Occult primary cancer, salivary gland cancer, and mucosal melanoma (MM) are also addressed. The specific site of disease, stage, and pathologic findings guide treatment (eg, the appropriate surgical procedure, radiation targets, dose and fractionation of radiation, indications for systemic therapy). The NCCN Head and Neck Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel's most recent recommendations regarding management of HPV-positive oropharynx cancer and ongoing research in this area.
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Affiliation(s)
| | | | | | | | | | - Douglas Adkins
- 6Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | - David W Eisele
- 12The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Jessica L Geiger
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Debra Leizman
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Bharat B Mittal
- 20Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - James W Rocco
- 21The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - David Schwartz
- 24St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - David Sher
- 25UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | | | | | - Sue S Yom
- 30UCSF Helen Diller Family Comprehensive Cancer Center
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12
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Kowalchuk RO, Van Abel KM, Sauer AB, Yin LX, Garcia JJ, Harmsen WS, Moore EJ, Price DL, Chintakuntlawar AV, Price KR, Lester SC, Wittich MN, Patel SH, Foote RL, Ma DM, Nagelschneider AA, Routman DM. The number of radiographically positive lymph nodes further stratifies patient survival among clinical N1 patients with HPV-associated oropharyngeal cancer. Adv Radiat Oncol 2022; 7:100926. [PMID: 35814859 PMCID: PMC9260100 DOI: 10.1016/j.adro.2022.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/30/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Human papillomavirus–associated oropharyngeal squamous cell carcinoma (HPV[+]OPSCC) requires further study to optimize the existing clinical staging system and guide treatment selection. We hypothesize that incorporation of the number of radiographically positive lymph nodes will further stratify patients with clinical N1 (cN1) HPV(+)OPSCC. Methods and Materials A post hoc analysis from 2 prospective clinical trials at a high-volume referral center was conducted. Patients underwent primary tumor resection and lymphadenectomy, followed by either standard-of-care radiation therapy (60 Gy in 30 fractions) with or without cisplatin (40 mg/m2 weekly) or de-escalated radiation therapy (30 Gy in 20 twice-daily fractions) with concomitant 15 mg/m2 docetaxel once weekly. Imaging studies were independently reviewed by a blinded neuroradiologist classifying radiographic extranodal extension (rENE) and the number and maximal size of involved lymph nodes. Patients without pathologic data available for assessment were excluded. Results A total of 260 patients were included. Of these, 216 (83%) were cN1. Patients had a median of 2 radiographically positive lymph nodes (range, 0-12), and 107 (41%) had rENE. For cN1 patients, stratifying by radiographically positive lymph nodes (1-2 vs 3-4 vs >4) was predictive of progression-free survival (PFS) (P = .017), with 2-year PFS rates of 96%, 88%, and 81%, respectively. More than 2 radiographically positive lymph nodes was identified as a significant threshold for PFS (P = .0055) and overall survival (P = .029). Radiographic ENE and lymph node size were not predictive of PFS among cN1 patients. Conclusions The number of radiographically positive lymph nodes is predictive of PFS and overall survival and could be used to meaningfully subcategorize cN1 patients with HPV(+)OPSCC. We recommend further validation of our proposal that cN1 patients with 1 to 2 radiologically positive lymph nodes be categorized as cN1a, patients with 3 to 4 radiologically positive lymph nodes categorized as cN1b, and patients with >4 radiographically positive lymph nodes categorized as cN1c.
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Affiliation(s)
| | | | - Adam B. Sauer
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Linda X. Yin
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Eric J. Moore
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Daniel L. Price
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Scott C. Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Samir H. Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel M. Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - David M. Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
- Corresponding author: David M. Routman, MD.
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13
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Pilar A, O’Sullivan B, Huang SH. Risk Stratification of HPV-Associated Oropharyngeal Squamous Cell Carcinoma: Are All Tumors Created Equally? CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Fenlon JB, Hutten RJ, Weil CR, Lloyd S, Cannon DM, Kerrigan K, Cannon RB, Hitchcock YJ. Comparing adjuvant radiation to adjuvant chemoradiation in postsurgical p16+ oropharyngeal carcinoma patients with extranodal extension or positive margins. Head Neck 2021; 44:606-614. [PMID: 34931386 DOI: 10.1002/hed.26951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/02/2021] [Accepted: 12/02/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Adjuvant guidelines in surgically resected p16+ oropharyngeal carcinoma (OPC) with positive surgical margins (PSM) or extranodal extension (ENE) are based on randomized controlled trials predating p16 status. It remains unclear if adjuvant chemotherapy is necessary in p16+ patients with these features. METHODS The National Cancer Database was used to identify cases of nonmetastatic p16+ OPC diagnosed from 2010 to 2017. Patients treated with surgical resection followed by adjuvant radiation (aRT) or adjuvant chemoradiation (aCRT) were eligible for analysis. RESULTS A total of 14 071 patients were eligible for analysis. Overall survival (OS) was not statistically different between aRT and aCRT in patients with PSM (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.56-1.28), ENE (HR 0.93, 95% CI 0.69-1.27) or both (HR 0.73, 95% CI 0.41-1.31). CONCLUSIONS In patients with p16+ OPC with ENE, PSM, or both, adding chemotherapy to aRT was not associated with improved OS.
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Affiliation(s)
- Jordan B Fenlon
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Ryan J Hutten
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Christopher R Weil
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Donald M Cannon
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Kathleen Kerrigan
- Division of Medical Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
| | - Richard B Cannon
- Division of Otolaryngology - Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ying J Hitchcock
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah Health, Salt Lake City, Utah, USA
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15
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Kowalchuk RO, Van Abel KM, Yin LX, Garcia J, Harmsen WS, Moore EJ, Price DL, Chintakuntlawar AV, Price KR, Lester SC, Neben Wittich M, Patel SH, Foote RL, Ma DM, Nagelschneider AA, Routman DM. Correlation between radiographic and pathologic lymph node involvement and extranodal extension via CT and PET in HPV-associated oropharyngeal cancer. Oral Oncol 2021; 123:105625. [PMID: 34814068 DOI: 10.1016/j.oraloncology.2021.105625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/27/2021] [Accepted: 11/09/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE/OBJECTIVES Extranodal extension (ENE) and more than 4 pathologically involved lymph nodes (pN2) are critical prognostic factors in HPV-associated oropharyngeal cancer (HPV(+) OPSCC). We analyze a patient cohort with HPV(+) OPSCC to determine the sensitivity and specificity of CT and PET/CT in identifying involvement of more than 4 lymph nodes (rN2) compared to pN2 and radiographic ENE (rENE) compared to pathologic ENE (pENE). MATERIALS/METHODS The dataset consisted of 261 patients enrolled in two prospective clinical trials. All imaging studies were independently reviewed by a blinded neuroradiologist, classifying the presence or absence of rENE and rN2. Secondary analyses included correlations of imaging accuracy and pathologic size of the primary tumor. RESULTS CT demonstrated sensitivity of 59%, specificity of 92%, positive predictive value (PPV) of 53%, negative predictive value (NPV) of 94%, and accuracy of 88% for pN2. PET/CT showed similar results. Patients with up to 4 involved lymph nodes (rN0-1) had a 93-94% chance of remaining pN0-1. CT and PET/CT identified an equal number of involved nodes in 81% of patients. CT demonstrated sensitivity of 54%, specificity of 71%, PPV of 72%, NPV of 53%, and accuracy of 62% for pENE. PET/CT showed similar outcomes. Notably, when multiple radiographic criteria were used to identify rENE, PPV increased for both CT (84%) and PET/CT (79%). CONCLUSION Patients with rN0-1 had a 93-94% chance of remaining pN0-1, suggesting rN0-1 could effectively stratify patients for clinical trials and treatment de-escalation. While CT and PET/CT were highly correlated, both showed low sensitivity for identifying pENE.
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Affiliation(s)
- Roman O Kowalchuk
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN 55905, United States
| | - Kathryn M Van Abel
- Mayo Clinic, Department of Otolaryngology, Rochester, MN 55905, United States
| | - Linda X Yin
- Mayo Clinic, Department of Otolaryngology, Rochester, MN 55905, United States
| | - Joaquin Garcia
- Mayo Clinic, Department of Pathology, Rochester, MN 55905, United States
| | - William S Harmsen
- Mayo Clinic, Department of Statistics, Rochester, MN 55905, United States
| | - Eric J Moore
- Mayo Clinic, Department of Otolaryngology, Rochester, MN 55905, United States
| | - Daniel L Price
- Mayo Clinic, Department of Otolaryngology, Rochester, MN 55905, United States
| | | | - Katharine R Price
- Mayo Clinic, Department of Medical Oncology, MN 55905, United States
| | - Scott C Lester
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN 55905, United States
| | | | - Samir H Patel
- Mayo Clinic, Department of Radiation Oncology, Scottsdale, AZ 85259, United States
| | - Robert L Foote
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN 55905, United States
| | - Daniel M Ma
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN 55905, United States
| | | | - David M Routman
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN 55905, United States.
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16
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Valero C, Shah JP. Staging of human papilloma virus related cancers of the oropharynx. J Surg Oncol 2021; 124:931-934. [PMID: 34622962 DOI: 10.1002/jso.26584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 12/25/2022]
Abstract
For the past two decades an increasing number of oropharyngeal cancers have been found to be associated with the human papilloma virus (HPV). These tumors are a biologically distinct entity with better prognosis and excellent response to therapy. Therefore, a separate staging system has been introduced for HPV-related oropharyngeal tumors in the latest edition of the American Joint Committee on Cancer (AJCC eighth Ed).
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Affiliation(s)
- Cristina Valero
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
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17
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Saliba M, Ghossein R, Xu B. HPV-related head and neck cancers: Pathology and biology. J Surg Oncol 2021; 124:923-930. [PMID: 34582040 DOI: 10.1002/jso.26683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/12/2021] [Indexed: 12/16/2022]
Abstract
Discovering the key role HPV plays in head and neck carcinogenesis has revolutionized our approach to cancers such as oropharyngeal carcinomas. As the role of HPV expands beyond the oropharynx, there is a pursued need to understand the oncogenic mechanisms of HPV-driven tumorigenesis and their implications. Optimizing HPV detection methods all while acknowledging their limitations will ensure our ability to diagnose HPV-driven neoplasia wherever clinically relevant.
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Affiliation(s)
- Maelle Saliba
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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18
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Day AT, Yang AM, Tanamal P, Blackwell JM, Wang E, Sumer BD, Bishop JA, Hughes RS, Khan SA, Sher DJ. Extracapsular extension, pathologic node status, and adjuvant treatment in primary surgery patients with human papillomavirus-mediated oropharyngeal cancer: A national hospital-based retrospective cohort analysis. Head Neck 2021; 43:3345-3363. [PMID: 34331477 DOI: 10.1002/hed.26825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The significance of extracapsular extension (ECE) and adjuvant treatment paradigm in patients with surgically managed human papillomavirus-positive (HPV+) oropharyngeal cancer (OPC) is debated. METHODS National, hospital-based, retrospective cohort study of 2663 patients pN+ HPV+ OPC who underwent primary surgery. RESULTS Patients with ECE had a 1.74-times risk of death (95% confidence interval [CI]: 1.26-2.40, p = 0.001) compared to patients without ECE. Among patients with pN1, ECE-positive disease, risk of overall mortality was similar across treatment paradigms (surgery alone: ref; adjuvant radiation therapy [RT]: aHR: 0.81; 95% CI: 0.36-1.85; p = 0.62; adjuvant CRT: aHR: 0.66; 95% CI: 0.34-1.32; p = 0.24). Patients with pN2 ECE-positive disease treated with adjuvant RT alone exhibited similar risk of all-cause mortality (hazard ratio: 1.04, 95% CI: 0.24-4.47, p = 0.96) compared to adjuvant chemoradiation (CRT). In patients with advanced, ECE-positive disease (e.g., pT3-T4pN2), adjuvant CRT did not reduce the risk of overall mortality relative to adjuvant RT. CONCLUSION Although pathologic ECE negatively predicts for survival in patients with HPV+ OPC, our analyses support expansion of postoperative de-intensification clinical trial eligibility criteria in patients with ECE-positive disease.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Alex M Yang
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Priscilla Tanamal
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - James-Michael Blackwell
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ellen Wang
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Baran D Sumer
- Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Justin A Bishop
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Randall S Hughes
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Saad A Khan
- Department of Internal Medicine, Stanford Health Care, Palo Alto, California, USA
| | - David J Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
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Human Papillomavirus and Squamous Cell Carcinoma of Unknown Primary in the Head and Neck Region: A Comprehensive Review on Clinical Implications. Viruses 2021; 13:v13071297. [PMID: 34372502 PMCID: PMC8310239 DOI: 10.3390/v13071297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/02/2023] Open
Abstract
Squamous cell carcinoma of unknown primary (SCCUP) is a challenging diagnostic subgroup of oropharyngeal squamous cell carcinoma (OPSCC). The incidence of SCCUP is increasing in parallel with the well-documented increase in OPSCC and is likewise driven by the increase in human papillomavirus (HPV). The SCCUP patient often presents with a cystic lymph node metastasis and undergoes an aggressive diagnostic and treatment program. Detection of HPV in cytologic specimens indicates an oropharyngeal primary tumor origin and can guide the further diagnostic strategy. Advances in diagnostic modalities, e.g., transoral robotic surgery and transoral laser microsurgery, have increased the successful identification of the primary tumor site in HPV-induced SCCUP, and this harbors a potential for de-escalation treatment and increased survival. This review provides an overview of HPV-induced SCCUP, diagnostic modalities, and treatment options.
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20
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Lymph node extracapsular extension as a marker of aggressive phenotype: Classification, prognosis and associated molecular biomarkers. Eur J Surg Oncol 2021; 47:721-731. [DOI: 10.1016/j.ejso.2020.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/18/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
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21
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Sabiq F, Huang K, Patel A, Banerjee R, Debenham B, Lau H, Skarsgard D, Chen G, Lysack JT, Quon HC. Novel imaging classification system of nodal disease in human papillomavirus-mediated oropharyngeal squamous cell carcinoma prognostic of patient outcomes. Head Neck 2021; 43:1854-1863. [PMID: 33638232 DOI: 10.1002/hed.26657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Matted nodes in human papillomavirus (HPV)-mediated oropharyngeal squamous cell carcinoma (OPC) is an independent predictor of distant metastases and decreased overall survival. We aimed to classify imaging patterns of metastatic lymphadenopathy, analyze our classification system for reproducibility, and assess its prognostic value. METHODS The metastatic lymphadenopathy was classified based on radiological characteristics for 216 patients with HPV-mediated OPC. Patient outcomes were compared and inter-rater reliability was calculated. RESULTS The presence of ≥3 abutting lymph nodes with imaging features of surrounding extranodal extension (ENE), one subtype of matted nodes, was associated with worse 5-year overall survival, overall recurrence-free survival, regional recurrence-free survival, and distant recurrence-free survival (p ≤ 0.03). Other patterns were not significantly associated with outcome measures. Overall inter-rater agreement was substantial (κ = 0.73). CONCLUSION One subtype of matted nodes defined by ≥3 abutting lymph nodes with imaging features of surrounding ENE is the radiological marker of worst prognosis.
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Affiliation(s)
- Farahna Sabiq
- Department of Radiology, Division of Neuroradiology, University of Calgary, Calgary, Alberta, Canada
| | - Kitty Huang
- Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Adarsh Patel
- Department of Radiology, Division of Neuroradiology, University of Calgary, Calgary, Alberta, Canada
| | - Robyn Banerjee
- Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Brock Debenham
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Harold Lau
- Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - David Skarsgard
- Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Guanmin Chen
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - John T Lysack
- Department of Radiology, Division of Neuroradiology, University of Calgary, Calgary, Alberta, Canada
| | - Harvey C Quon
- Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
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22
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Yesensky J, Solis RN, Bewley A. Facial Nerve Sacrifice During Parotidectomy for Metastatic Cutaneous Squamous Cell Carcinoma. OTO Open 2021; 5:2473974X21996627. [PMID: 33718752 PMCID: PMC7917942 DOI: 10.1177/2473974x21996627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/08/2020] [Indexed: 12/02/2022] Open
Abstract
Objective We analyzed the incidence of facial nerve sacrifice during parotidectomy for
metastatic cutaneous squamous cell carcinoma (CSCC). Study Design We retrospectively reviewed the charts of patients with cutaneous squamous
cell carcinoma. Setting We used our CSCC institutional database, which includes patients treated at
the University of California–Davis from 2001 to 2018. Methods We evaluated patients who presented with biopsy-proven head and neck CSCC who
underwent parotidectomy as a part of surgical treatment. We assessed the
frequency of facial nerve sacrifice required in patients with normal
preoperative facial nerve function with metastatic disease to the parotid.
We evaluated the association between sacrifice and high-risk tumor variables
using multivariate analysis. Results We identified 53 patients with parotid metastasis and normal preoperative
facial nerve function. Thirteen percent of patients required sacrifice of
the main trunk of the facial nerve and 27% required sacrifice of a branch of
the facial nerve. All patients who underwent facial nerve sacrifice had
extracapsular spread (ECS). Perineural invasion (PNI) in the primary tumor
(odds ratio [OR], 9.11; P = .041) and location of
metastasis within the parotid body (OR, 6.6; P = .044) were
independently associated with facial nerve sacrifice. Conclusion Patients with regionally metastatic CSCC to the parotid gland frequently
require sacrifice of all or a component of the facial nerve despite normal
preoperative function. The likelihood of nerve sacrifice is highest for
tumors with PNI and metastatic disease within the body of the parotid.
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Affiliation(s)
- Jessica Yesensky
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Roberto N Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Arnaud Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
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23
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Ho AS, Luu M, Kim S, Tighiouart M, Mita AC, Scher KS, Mallen-St Clair J, Walgama ES, Lin DC, Nguyen AT, Zumsteg ZS. Nodal staging convergence for HPV- and HPV+ oropharyngeal carcinoma. Cancer 2021; 127:1590-1597. [PMID: 33595897 DOI: 10.1002/cncr.33414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Modern disease staging systems have restructured human papillomavirus (HPV)-negative (HPV-) and HPV-positive (HPV+) oropharyngeal carcinoma (OPC) into distinct pathologic nodal systems. Given that quantitative lymph node (LN) burden is the dominant prognostic factor in most head and neck cancers, we investigated whether HPV- and HPV+ OPC warrant divergent pathologic nodal classification. METHODS Multivariable Cox regression models of OPC surgical patients identified via U.S. cancer registry data were constructed to determine associations between survival and nodal characteristics. Nonlinear associations between metastatic LN number and survival were modeled with restricted cubic splines. Recursive partitioning analysis (RPA) was used to derive unbiased nodal schema. RESULTS Mortality risk escalated continuously with each successive positive LN in both OPC subtypes, with analogous slope. Survival hazard increased by 18.5% (hazard ratio [HR], 1.19 [95% CI, 1.16-1.21]; P < .001) and 19.1% (HR, 1.19 [95% CI, 1.17-1.21]; P < .001), with each added positive LN for HPV- and HPV+ OPC, respectively, up to identical change points of 5 positive LNs. Extranodal extension (ENE) was an independent predictor of HPV- OPC (HR, 1.55 [95% CI, 1.20-1.99]; P < .001) and HPV+ OPC (HR 1.73 [95% CI, 1.36-2.20]; P < .001) mortality. In RPA for both diseases, metastatic LN was the principal nodal covariate driving survival, with ENE as a secondary determinant. Given the similarities across analyses, we propose a concise, unifying HPV-/HPV+ OPC pathologic nodal classification schema: N1, 1-5 LN+/ENE-; N2, 1-5 LN+/ENE+; N3, >5 LN+. CONCLUSION HPV- and HPV+ OPC exhibit parallel relationships between nodal characteristics and relative mortality. In both diseases, metastatic LN number represents the principal nodal covariate governing survival, with ENE being an influential secondary element. A consolidated OPC pathologic nodal staging system that is based on these covariates may best convey prognosis. LAY SUMMARY The current nodal staging system for oropharyngeal carcinoma (OPC) has divided human papillomavirus (HPV)-negative (HPV-) and HPV-positive (HPV+) OPC into distinct systems that rely upon criteria that establish them as separate entities, a complexity that may undermine the core objective of staging schema to clearly communicate prognosis. Our large-scale analysis revealed that HPV- and HPV+ pathologic nodal staging systems in fact mirror each other. Multiple analyses produced conspicuously similar nodal staging systems, with metastatic lymph node number and extranodal extension delineating the highest risk groups that shape prognosis. We propose unifying HPV- and HPV+ nodal systems to best streamline prognostication and maximize staging accuracy.
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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
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Biostatistics and Bioinformatics Research Center, 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
| | - Mourad Tighiouart
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alain C Mita
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kevin S Scher
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Medical Oncology, Department of Medicine, 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
| | - Evan S Walgama
- 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
| | - De-Chen Lin
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Anthony T Nguyen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Radiation Oncology, 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
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24
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Abstract
This article outlines the ways that transoral robotic surgery and transoral laser microsurgery relate to treatment de-escalation in the treatment of head and neck cancer. Treatment de-escalation has particular importance in context of human papillomavirus-related oropharynx squamous cell carcinoma, which responds well to therapy but leaves many survivors with decades of treatment-related sequelae. We compare these less invasive transoral approaches with previously used open approaches to the oropharynx. We discuss the topic of treatment de-escalation in human papillomavirus-related disease and outline completed and ongoing clinical trials investigating the choice of primary treatment modality and de-escalation of adjuvant therapy.
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Affiliation(s)
- Benjamin Wahle
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St Louis, MO 63110, USA
| | - Jose Zevallos
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8115, St Louis, MO 63110, USA.
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25
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Jawad H, Ashaari SS, O'Shea R, Callanan D, Sheahan P, Feeley L. Prognostic performance of TNM8 staging rules in oral cavity squamous cell carcinoma. Oral Oncol 2020; 111:105021. [PMID: 33011675 DOI: 10.1016/j.oraloncology.2020.105021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/05/2020] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Two major changes to the staging of oral cavity squamous cell carcinoma (OCSCC) were adopted in TNM8: (1) depth of invasion is now used for T staging and (2) extranodal extension for N staging. The aim of this study was to evaluate if TNM8 stratifies OCSCC patients more accurately than TNM7 based on overall survival (OS) statistics and hazard discrimination. METHODS Retrospective study of 297 patients with OCSCC who underwent surgery at our institution. Clinical and pathological data were previously populated from review of medical charts and histological reports. Slides were re-reviewed for depth of invasion measurements. Patients were staged using both TNM7 and TNM8 with overall survival statistics analysed. RESULTS Overall 118 patients (39.7%) were upstaged using TNM8. Both TNM7 and TNM8 stage categories were highly significant for OS (all p values < 0.0001). Hazard discrimination analysis showed that TNM7 could only differentiate stage III from stage IV disease with significance (OS p = 0.01). In comparison TNM8 could distinguish between stage II and III disease (OS p = 0.047) and between stage III and IV disease (OS p = 0.004). Subsite analysis suggested that both editions of the staging system perform best for tongue primaries. CONCLUSIONS Although TNM8 showed improved hazard discrimination in comparison to TNM7, problems with discriminative ability persisted with 8th edition staging criteria. Large scale validation studies will be required to direct future refinement of the staging rules and to establish if the continued use of a single staging system for all oral cavity subsites is appropriate.
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Affiliation(s)
- Hadeel Jawad
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | | | - Ross O'Shea
- Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria, University Hospital, Cork, Ireland
| | - Deirdre Callanan
- Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria, University Hospital, Cork, Ireland; ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Patrick Sheahan
- Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria, University Hospital, Cork, Ireland; Department of Surgery, University College Cork, Cork, Ireland; ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Linda Feeley
- Department of Pathology, Cork University Hospital, Cork, Ireland; ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Ireland
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26
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Abstract
Transoral robotic surgery (TORS) is a rapidly growing diagnostic and therapeutic modality in otolaryngology-head and neck surgery, having already made a large impact in the short time since its inception. Cost-effectiveness analysis is complex, and a thorough cost-effectiveness inquiry should analyze not only financial consequences but also impact on the health state of the patient. The cost-effectiveness of TORS is still under scrutiny, but the early data suggest that TORS is a cost-effective method compared with other available options when used in appropriately selected patients.
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Affiliation(s)
- James Kenneth Byrd
- Otolaryngology - Head and Neck Surgery, Medical College of Georgia, Augusta University, 1120 15th Street BP 4132, Augusta, GA, USA.
| | - Rebecca Paquin
- Otolaryngology - Head and Neck Surgery, Medical College of Georgia, Augusta University, 1120 15th Street BP 4132, Augusta, GA, USA
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27
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Benchetrit L, Torabi SJ, Givi B, Haughey B, Judson BL. Prognostic Significance of Extranodal Extension in HPV-Mediated Oropharyngeal Carcinoma: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 164:720-732. [PMID: 32838649 DOI: 10.1177/0194599820951176] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the prognostic role of extranodal extension (ENE) among patients with human papilloma virus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) through a systematic review and meta-analysis of institutional studies. DATA SOURCES MEDLINE, Embase, Scopus, and PubMed. REVIEW METHODS Two independent authors searched the databases on December 3, 2019, to identify studies of HPV+ OPSCC comparing prognostic outcomes stratified by ENE. The I2 statistic was used to determine study heterogeneity. Fixed and random effects models were used to determine hazard ratios (HRs) with 95% CIs. RESULTS Eighteen observational studies met inclusion criteria, yielding 3603 patients with HPV+ OPSCC (1521 ENE+ and 2082 ENE-) with a median follow-up of 49 months. The presence of pathologic ENE (pENE) and radiologic ENE (rENE) was associated with decreased overall survival (pENE HR, 1.89 [95% CI, 1.15-3.13], I2 = 35%; rENE HR, 2.64 [95% CI, 1.46-4.78], I2 = 75%) and distant recurrence (pENE HR, 3.23 [95% CI, 1.25-8.33], I2 = 0%; rENE HR, 3.83 [95% CI, 1.88-7.80], I2 = 0%). Neither pENE nor rENE was associated with locoregional recurrence (pENE HR, 0.75 [95% CI, 0.20-2.84], I2 = 0%; rENE HR, 2.03 [95% CI, 0.86-4.79], I2 = 0%). pENE was not associated with disease-specific survival (pENE HR, 1.45 [95% CI, 0.84-2.49], I2 = 0%). CONCLUSION pENE and rENE are moderately associated with an increased risk of all-cause mortality and recurrence with distant metastasis in a cohort of patients with HPV+ OPSCC. These findings may be used to inform exclusion criteria for deintensification trials and assist in refined risk stratification.
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Affiliation(s)
| | - Sina J Torabi
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Babak Givi
- Department of Otolaryngology, School of Medicine, New York University, New York, New York, USA
| | - Bruce Haughey
- Otolaryngology-Head and Neck Surgery, Advent Health Celebration, Celebration, Florida, USA.,Department of Otolaryngology-Head and Neck Surgery (Collaborative), University of South Florida, Tampa, Florida, USA
| | - Benjamin L Judson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.,Yale Cancer Center, New Haven, Connecticut, USA
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28
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Beltz A, Zimmer S, Michaelides I, Evert K, Psychogios G, Bohr C, Künzel J. Significance of Extranodal Extension in Surgically Treated HPV-Positive Oropharyngeal Carcinomas. Front Oncol 2020; 10:1394. [PMID: 32850449 PMCID: PMC7433688 DOI: 10.3389/fonc.2020.01394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023] Open
Abstract
Squamous cell carcinomas of the head and neck are the subject of numerous current studies, especially in view of the increasing incidence of tumors induced by human papillomavirus (HPV) and the latest changes to the TNM classification of oropharyngeal squamous cell carcinoma (OPSCC). In addition to HPV status, the presence of extranodal extension of lymph node metastases represents an important risk and prognostic factor, which has now been integrated into the staging algorithm of the eighth edition of TNM classification for HPV-negative OPSCC. In the past numerous studies had shown a lack of prognostic significance of extranodal extension in HPV-associated tumors. However, extranodal extension–as a possible risk factor even in HPV-positive OPSCC–remains an important subject of current studies, which are now particularly characterized by high numbers of cases. In this paper, diagnostic methods and the prognostic significance of extranodal extension in surgically treated HPV-positive OPSCC are presented and discussed based on relevant literature, and the results of current publications are summarized. Further development of diagnostic criteria and procedures as well as international standardization of clinical diagnostics of extranodal extension should be encouraged. Several studies demonstrate that extranodal extension results in worse survival outcomes even in HPV-positive tumors, in contrast to results of previous studies. Consequently, whether the prognostic significance of extranodal extension is not actually relevant to outcome and the staging algorithm of HPV-positive OPSCC should be questioned and further analyzed.
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Affiliation(s)
- Anna Beltz
- Department of Otorhinolaryngology, University Medical Center Mainz, Mainz, Germany
| | - Stefanie Zimmer
- Institute of Pathology, Tissue Bank, University Medical Center Mainz, Mainz, Germany
| | - Ioannis Michaelides
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Georgios Psychogios
- Department of Otorhinolaryngology, University Hospital of Ioannina, Ioannina, Greece
| | - Christopher Bohr
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
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29
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Weinstein GS, Cohen R, Lin A, O'Malley BW, Lukens J, Swisher‐McClure S, Shanti RM, Newman JG, Parhar HS, Tasche K, Brody RM, Chalian A, Cannady S, Palmer JN, Adappa ND, Kohanski MA, Bauml J, Aggarwal C, Montone K, Livolsi V, Baloch ZW, Jalaly JB, Cooper K, Rajasekaran K, Loevner L, Rassekh C. Penn Medicine Head and Neck Cancer Service Line COVID-19 management guidelines. Head Neck 2020; 42:1507-1515. [PMID: 32584447 PMCID: PMC7362039 DOI: 10.1002/hed.26318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS Creation of consensus document. RESULTS The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature.
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Affiliation(s)
- Gregory S. Weinstein
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Roger Cohen
- Division of Medical Oncology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Alexander Lin
- Department of Radiation OncologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Bert W. O'Malley
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - John Lukens
- Department of Radiation OncologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Rabie M. Shanti
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Oral and Maxillofacial SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jason G. Newman
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Harman S. Parhar
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kendall Tasche
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Robert M. Brody
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ara Chalian
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Steven Cannady
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - James N. Palmer
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Nithin D. Adappa
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Michael A. Kohanski
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Joshua Bauml
- Division of Medical Oncology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Charu Aggarwal
- Division of Medical Oncology, Department of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kathleen Montone
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Virginia Livolsi
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Zubair W. Baloch
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jalal B. Jalaly
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kumarasen Cooper
- Department of PathologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Christopher Rassekh
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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30
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Hatten KM, Amin J, Isaiah A. Machine Learning Prediction of Extracapsular Extension in Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2020; 163:992-999. [PMID: 32600154 DOI: 10.1177/0194599820935446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether machine learning (ML) can predict the presence of extracapsular extension (ECE) prior to treatment, using common oncologic variables, in patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN Retrospective database review. SETTING National Cancer Database study. METHODS All patients with HPV-associated OPSCC treated surgically between January 1, 2010, and December 31, 2015, were selected from the National Cancer Database. Patients were excluded if surgical pathology reports did not include information regarding primary tumor stage, number of metastatic regional lymph nodes, size of largest metastatic regional lymph node, and tumor grade. The data were split into a random distribution of 80% for training and 20% for testing with ML methods. RESULTS A total of 3753 adults with surgically treated HPV-associated OPSCC met criteria for inclusion in the study. Approximately 38% of these patients treated with surgical management demonstrated ECE. ML models demonstrated modest accuracy in predicting ECE, with the areas under the receiver operating characteristic curves ranging from 0.58 to 0.68. The conditional inference tree model (0.66) predicted the metastatic lymph node number to be the most important predictor of ECE. CONCLUSION Despite a large cohort and the use of ML algorithms, the power of clinical and oncologic variables to predict ECE in HPV-associated OPSCC remains limited.
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Affiliation(s)
- Kyle M Hatten
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Julian Amin
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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31
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Treatment implications of postoperative chemoradiotherapy for squamous cell carcinoma of the oral cavity with minor and major extranodal extension. Oral Oncol 2020; 110:104845. [PMID: 32615441 DOI: 10.1016/j.oraloncology.2020.104845] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate adjuvant chemoradiotherapy (CRT) for patients with oral cavity squamous cell carcinoma (OSCC) with minor or major extranodal extension (ENE). MATERIALS AND METHODS Surgically resected OSCC with pathologically involved lymph node(s) (pN+) between 2006 and 2017. Sections of pN+ were re-reviewed and classified as no, minor (≤2 mm), or major (>2 mm) ENE. Patterns of failure and survival were compared between the groups and stratified by adjuvant treatment. Multivariable (MVA) analysis assessed the value of adjuvant treatment for minor and major ENE. RESULTS Total of 384 patients, 62 had minor and 114 had major ENE. Adjuvant CRT was delivered in 32(15%), 21(34%), and 45(39%) of patients with no, minor and major ENE, respectively. Patients with minor ENE had similar 5-year loco-regional control (LRC) and distant control (DC) but lower disease-free survival (DFS) (38% vs. 51%, p = 0·02) compared to patients with no ENE, while patients with major ENE had marginally lower LRC (59% vs 74%, p = 0·07), lower DC (58% vs 82%,p = 0·005) and DFS (13% vs. 38%, p=·001) compared to those with minor. On MVA, adjuvant chemotherapy was associated with improved DFS for major ENE (adjusted HR = 0·49; 95% CI 0·29-0·85, p = 0·01) but not for minor ENE after adjusting for age, ECOG status, T-, N-category, margin status, and radiotherapy. CONCLUSIONS Adjuvant chemoradiotherapy improves outcomes in patients with major ENE, but the benefit is unclear in patients with minor ENE. Future trials should focus on intensification of treatment for patients with major ENE and alternative adjuvant strategies for patients with minor ENE.
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32
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Zhao TC, Liang SY, Ju WT, Fu Y, Zhou ZH, Wang LZ, Li J, Zhang CP, Zhang ZY, Zhong LP. High-risk lymph node ratio predicts worse prognosis in patients with locally advanced oral cancer. J Oral Pathol Med 2020; 49:787-795. [PMID: 32449223 PMCID: PMC7540480 DOI: 10.1111/jop.13043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 12/24/2022]
Abstract
Background To investigate the prognostic value of lymph node ratio (LNR), as well as the correlation with docetaxel, cisplatin, and 5‐FU (TPF) induction chemotherapy, in patients with locally advanced oral squamous cell carcinoma (OSCC). Methods Two‐hundred and forty‐five patients from a phase 3 trial involving TPF induction chemotherapy in stage III/IVA OSCC patients (NCT01542931) were enrolled in this study between 2008 and 2010. The clinical and pathological data were collected and analyzed. The cutoff value for LNR was calculated on the receiver operating characteristic (ROC) curve. Univariate and multivariate Cox regression models, and Kaplan‐Meier method were used for survival analysis. Results According to the ROC curve, the cutoff value for LNR was 7.6%. With a median follow‐up period of 80 months, the OSCC patients with high‐risk LNR (> 7.6%), or positive extranodal extension (ENE) had significantly worse clinical outcomes than patients with low‐risk LNR (≤7.6%) or negative ENE. Multivariate analysis on pathological covariates showed that only high‐risk LNR was an independent negative predictive factor for survival (P < .05). The cutoff value of LNR of 7.6% was also verified with the similar results using an open TCGA database, high‐risk LNR indicating worse overall survival (P < .001) and disease‐free survival (P < .001). Conclusion Oral squamous cell carcinoma patients with high‐risk LNR have a worse clinical outcome than patients with low‐risk LNR. High‐risk LNR is an independent negative predictive factor for clinical outcome in patients with locally advanced OSCC.
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Affiliation(s)
- Tong-Chao Zhao
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Si-Yuan Liang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wu-Tong Ju
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Fu
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Hang Zhou
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li-Zhen Wang
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Li
- Department of Oral Pathology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen-Ping Zhang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Yuan Zhang
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lai-Ping Zhong
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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33
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Yan F, Byun YJ, Nguyen SA, Stalcup ST, Day TA. Predictive value of computed tomography in identifying extranodal extension in human papillomavirus-positive versus human papillomavirus-negative head and neck cancer. Head Neck 2020; 42:2687-2695. [PMID: 32484583 DOI: 10.1002/hed.26281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/02/2020] [Accepted: 05/12/2020] [Indexed: 01/26/2023] Open
Abstract
Pathologic extranodal extension (pENE) impacts treatment planning and is an important prognostic indicator for patients with head and neck squamous cell carcinoma (HNSCC). Computed tomography (CT) is a commonly used modality for assessment of radiographic ENE (rENE). To determine the predictive value of CT-identified rENE in predicting pENE, we performed a systematic review through a search of 4 databases (PubMed, Scopus, Cochrane, and OVID). Meta-analysis of diagnostic performance based on human papillomavirus (HPV) status was conducted. For HPV-negative HNSCC, pooled sensitivity, specificity, and accuracy were 60.6%, 93.3%, and 82.6%, respectively. Overall positive predictive value (PPV) was 82.7%. For HPV-positive HNSCC, pooled sensitivity, specificity, and accuracy were 77.7%, 72.2%, and 63.8%, respectively. Overall PPV was 68.6%. Significant differences were observed in diagnostic performance parameters between the two cohorts. The radiographic characteristics of HPV-positive and HPV-negative nodal metastases in HNSCC differ and radiographic evaluation of ENE in HPV-positive nodes is challenging. Development of refined imaging characteristics of HPV-positive nodes is needed to improve diagnostic performance.
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Affiliation(s)
- Flora Yan
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Young J Byun
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Shaun A Nguyen
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Seth T Stalcup
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Xie C, Li H, Yan Y, Liang S, Li Y, Liu L, Cui C, Liu Y. A Nomogram for Predicting Distant Metastasis Using Nodal-Related Features Among Patients With Nasopharyngeal Carcinoma. Front Oncol 2020; 10:616. [PMID: 32547935 PMCID: PMC7273517 DOI: 10.3389/fonc.2020.00616] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 04/03/2020] [Indexed: 01/05/2023] Open
Abstract
Distant metastasis is among the main reasons for treatment failure in nasopharyngeal carcinoma (NPC) patients. To identify patients with a high risk of distant metastasis is important to guide posttreatment surveillance, appropriate time treatments, and prolonging their long-term survival. In this study, we systematically examined the associations between a series of nodal-related characteristics and distant metastasis-free survival (DMFS) by detailed MRI reading and established a nomogram for DMFS in NPC patients. T-stage, age group, Epstein-Barr virus (EBV) level, central nodal necrosis, and nodal number were identified as independent risk factors for distant metastasis and were included into the final nomogram. The calibration plot showed a high agreement between the prediction by the nomogram and actual observations. Our established nomogram achieved a high C-index in predicting distant metastasis in both of the training cohort (0.737) and the validation cohort (0.718). This nomogram incorporated several readily available nodal features from the MR images, and it might be useful for guiding clinical decision and NPC patients' posttreatment surveillance. It also provides cues for how to redefine N-stage. Additional research is needed to confirm our conclusions.
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Affiliation(s)
- Chuanbo Xie
- Cancer Prevention Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Haojiang Li
- Department of Medical Imaging, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yue Yan
- Cancer Prevention Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shaobo Liang
- Department of Radiation Oncology, Cancer Center, First People's Hospital of Foshan Affiliated to Sun Yat-sen University, Foshan, China
| | - Yanhong Li
- Cancer Prevention Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lizhi Liu
- Department of Medical Imaging, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chunyan Cui
- Department of Medical Imaging, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuying Liu
- Cancer Prevention Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Cohen E, Coviello C, Menaker S, Martinez-Duarte E, Gomez C, Lo K, Kerr D, Franzmann E, Leibowitz J, Sargi Z. P16 and human papillomavirus in sinonasal squamous cell carcinoma. Head Neck 2020; 42:2021-2029. [PMID: 32149447 DOI: 10.1002/hed.26134] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 11/05/2022] Open
Abstract
Human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (SCC) is a well-known cause and prognostic indicator, and the utility of p16 as a surrogate marker for HPV status has been established. P16 and its relationship with HPV have not been defined in sinonasal malignancy nor has a link with outcomes been established. Patients with sinonasal SCC from 2011 to 2017 were identified from our pathology database. P16 immunohistochemistry and HPV RNA in situ hybridization were performed on tissue specimens. Forty-seven patients were included. Disease-free survival for p16+ patients was significantly higher than p16- patients (P = .043). Fewer HPV+ patients died (P = .052) or experienced recurrence (P = .0437). Odds ratio between p16 and HPV status was 14.19 (95% CI: 1.72, 442.03). Our findings demonstrate improved survival in both the p16+ and HPV+ groups and a positive association between p16 and HPV. There may be similar potential for modifying classification for HPV+ sinonasal SCC.
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Affiliation(s)
- Erin Cohen
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
| | - Caitlin Coviello
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
| | - Simon Menaker
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Carmen Gomez
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida
| | - Kaming Lo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Darcy Kerr
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida
| | - Elizabeth Franzmann
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
| | - Jason Leibowitz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
| | - Zoukaa Sargi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
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Sheppard SC, Giger R, Bojaxhiu B, Sachpekidis C, Dammann F, Dettmer MS, Arnold A, Wartenberg J, Nisa L. Multimodal Imaging With Positron Emission Tomography/Computed Tomography and Magnetic Resonance Imaging to Detect Extracapsular Extension in Head and Neck Cancer. Laryngoscope 2020; 131:E163-E169. [PMID: 32142169 DOI: 10.1002/lary.28602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/22/2020] [Accepted: 02/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the ability of specific positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) features to detect extracapsular extension (ECE) in head and neck squamous cell carcinoma (HNSCC) patients. STUDY DESIGN Retrospective study in a tertiary certified university cancer institute. METHODS We performed a review of patients with advanced HNSCC at Bern University Hospital between 2014 and 2018. Patients with pretherapeutic PET/CT and/or MRI who underwent neck dissection were included, with 212 patients fulfilling inclusion criteria. Blinded evaluation of specific PET/CT and MRI features with respect to presence of ECE was performed. Histopathological examination of neck dissection specimens was used as the gold standard to determine ECE status. RESULTS Out of the 212 included patients, 184 had PET/CT, 186 MRI, and 158 both modalities. Overall clinical stage IV (odds ratio [OR]: 2.26, 95% confidence interval [CI]: 2.25-11.74), ill-defined margins in both PET/CT and MRI (OR: 3.48, 95% CI: 1.21-9.98 and OR: 2.14, 95% CI: 0.94-4.89, respectively), and a maximum standardized uptake value ≥ 10 (OR: 5.44, 95% CI: 1.21-9.98) were all significant independent predictors of ECE. When combined, these four features led to a cumulative score able to predict ECE status with an accuracy of 91.43%. CONCLUSIONS The current findings indicate specific features in PET/CT and MRI are potential predictors of ECE status and may help in pretherapeutic stratification in HNSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E163-E169, 2021.
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Affiliation(s)
- Sean C Sheppard
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Beat Bojaxhiu
- Institute of Nuclear Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Christos Sachpekidis
- Institute of Nuclear Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Florian Dammann
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | - Andreas Arnold
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Jan Wartenberg
- Institute of Nuclear Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lluís Nisa
- Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Biomedical Research, University of Bern, Bern, Switzerland
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Freitag J, Wald T, Kuhnt T, Gradistanac T, Kolb M, Dietz A, Wiegand S, Wichmann G. Extracapsular extension of neck nodes and absence of human papillomavirus 16-DNA are predictors of impaired survival in p16-positive oropharyngeal squamous cell carcinoma. Cancer 2020; 126:1856-1872. [PMID: 32032442 DOI: 10.1002/cncr.32667] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/25/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinomas (OPSCCs) demonstrate superior outcome compared with HPV-negative OPSCCs. The eighth edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumor, lymph node, metastasis (TNM) classification (TNM 2017) modifies OPSCC staging based on p16 positivity as a surrogate for HPV-driven disease. In p16-negative OPSCCs, lymph node (N) categories include extracapsular/extranodal extension (ECE); and, in p16-positive OPSCCs, N categories are based on the number of positive neck lymph nodes omitting ECE status. The objective of the current study was to assess the prognostic impact of positive ECE status and the detection of HPV16 DNA in patients with p16-positive OPSCC. METHODS In a cohort of 92 patients with p16-positive, lymph node (N)-positive (stage III-IVB) OPSCC who underwent surgery and neck dissection, allowing for a pathologic examination of positive lymph nodes, 66 of 92 patients (71.4%) were p16-positive/HPV16 DNA-positive, 62 of 92 (67%) were ECE-positive, and 45 of 62 (72.6%) were ECE-positive, p16-positive, and HPV16 DNA-positive. Differences in outcome were assessed using Kaplan-Meier plots and Cox proportional hazard regression (CoxR) for tumor-specific survival and overall survival (OS). RESULTS The mean numbers of positive lymph nodes in ECE-positive patients (5.0 positive lymph nodes; 95% CI, 3.8-6.4 positive lymph nodes) and ECE-negative patients (2.4 positive lymph nodes; 95% CI, 1.8-2.9 positive lymph nodes) were different (P = .0007). ECE affected OS and tumor-specific survival in p16-positive patients (P = .007 and P = .047, respectively) and in p16-positive/HPV16 DNA-positive patients (P = .013 and P = .026, respectively). Related to the unequal distributions of ECE-positive/HPV16 DNA-negative tumors, the TNM 2017 failed to discriminate OS in patients with UICC stage I, II, and III disease (mean OS, 54.5, 73.4, and 45 months, respectively; median OS, 64.7 months, not reached, and 41.1 months, respectively). According to a univariate CoxR, the presence of ECE predicted impaired OS in patients with p16-positive OPSCC (hazard ratio, 3.40; 95% CI, 1.17-9.89; P = .025) and even greater impaired OS in those with p16-positive/HPV16 DNA-positive OPSCC (HR, 8.64; 95% CI, 1.12-66.40; P = .038). Multivariate CoxR confirmed ECE and HPV16 DNA detection as independent predictors. CONCLUSIONS ECE and HPV16 DNA status should be included in the prognostic staging of patients with p16-positive OPSCC because several lines of evidence demonstrate their impact on survival.
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Affiliation(s)
- Josefine Freitag
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Theresa Wald
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Kuhnt
- Department for Radiation Oncology, University Hospital Leipzig, Leipzig, Germany
| | - Tanja Gradistanac
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Marlen Kolb
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Dietz
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Wiegand
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Gunnar Wichmann
- Clinic for Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
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Liu Y, Chen S, Dong A, Ai F, Quan T, Cui C, Zhou J, Liang S, Wang J, Wang S, Hua L, Xu S, Chen M, Sun Y, Li H, Liu L. Nodal grouping in nasopharyngeal carcinoma: prognostic significance, N classification, and a marker for the identification of candidates for induction chemotherapy. Eur Radiol 2019; 30:2115-2124. [PMID: 31811429 DOI: 10.1007/s00330-019-06537-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/06/2019] [Accepted: 10/22/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study aimed to evaluate the value of nodal grouping (NG), defined as the presence of at least three contiguous lymph nodes (LNs) within one LN region, in staging and management of patients with non-metastatic nasopharyngeal carcinoma (NPC). METHODS MR images were reviewed to evaluate LN variables, including NG. The Kaplan-Meier method and multivariate Cox regression models evaluated the association between the variables and survival. Harrell's concordance index (C-index) was used to measure the performance of prognostic models. The outcome of induction chemotherapy (IC) in patients with and without NG was compared using matched-pair analysis. RESULTS In 1224 patients enrolled, NG was found to be an independent prognostic factor for overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and regional recurrence-free survival. The hazard ratio and 95% confidence interval (CI) of NG for OS (3.86, 2.09-7.12) were higher than those of stage N2 (3.54, 1.89-6.70). On upgrading patients with NG from stages N1 to N2, the revised N staging yielded a higher C-index compared to the American Joint Committee on Cancer system in predicting PFS (0.664 vs. 0.658, p = 0.022) and DMFS (0.699 vs. 0.690, p = 0.005). Results of the matched-pair analysis revealed that for patients with NG in stages N1 and N2, IC was correlated with improved OS (p = 0.022), PFS (p = 0.007), and DMFS (p = 0.021). CONCLUSIONS NG is a significant prognostic factor for patients with NPC. Patients with NG may be upgraded from stages N1 to N2. NG was also a marker for identifying patients who would benefit from IC. KEY POINTS • Nodal grouping, defined as the presence of at least three contiguous LNs within one LN region on MRI, was identified as a significant prognostic factor. • In patients with nasopharyngeal carcinoma, nodal grouping may influence lymph node staging. • Nodal grouping was a marker for identifying patients who may benefit from induction chemotherapy.
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Affiliation(s)
- Yifei Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Shenghuan Chen
- Department of Radiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, People's Republic of China
| | - Annan Dong
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Fei Ai
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Tingting Quan
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Chunyan Cui
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Jian Zhou
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Shaobo Liang
- Department of Radiation Oncology, First People's Hospital of Foshan, Foshan, People's Republic of China
| | - Jiamin Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shunxin Wang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ling Hua
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shuoyu Xu
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China
| | - Mingyuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Haojiang Li
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.
| | - Lizhi Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, People's Republic of China.
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Douglas C, Crosbie R, Young D, Montgomery J, O'Neill G, McArthur C. Accuracy of contrast-enhanced CT and predictive factors for extracapsular spread in unknown primary head and neck squamous cell cancer. Clin Radiol 2019; 75:77.e23-77.e28. [PMID: 31679816 DOI: 10.1016/j.crad.2019.09.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
AIM To determine the accuracy of contrast-enhanced computed tomography (CECT) for nodal extracapsular spread (ECS) and identify predictive radiological signs and clinicopathological features for ECS in unknown-primary head and neck squamous cell cancer (UPHNSCC). MATERIALS AND METHODS The CECT imaging of patients who underwent primary neck dissection for UPHNSCC during 2011-2015 was analysed. The largest pathological-looking node at each radiologically involved level was evaluated in consensus by two head and neck radiologists. Parameters included longest diameter, margin sharpness, haziness in adjacent fat, necrosis, and loss of fat plane with adjacent structures. Independent assessment was also made regarding the presence/absence of ECS. Findings and clinicopathological parameters were correlated with histopathology. RESULTS Thirty-one patients with 39 neck levels had metastatic nodal involvement determined on CECT. Confirmed ECS was found at 26 levels in 23 patients. Sensitivity of radiological assessment for ECS by nodal level was 81-85% (95% confidence interval [CI]=65-93%) and specificity 46-54% (95% CI=19-81%); kappa 0.87. On univariate analysis based on the largest involved node per patient, longest diameter being ≥30 mm (p=0.007), haziness in adjacent fat (p=0.023), increasing age (p=0.006), and more advanced pathological nodal status (p=0.027) were statistically significantly associated with ECS. Haziness and increasing age were independent predictors on multivariate analysis (odds ratio [OR]=26.4 and 1.24). CONCLUSION Expert assessment of ECS on CECT had good sensitivity with excellent interobserver agreement. A longest nodal diameter of ≥30 mm, haziness in the surrounding fat on CECT, advanced pathological nodal status, and advancing patient age were significantly associated with ECS in UPHNSCC patients, findings not previously reported.
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Affiliation(s)
- C Douglas
- Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow G51 4TF, UK
| | - R Crosbie
- Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow G51 4TF, UK
| | - D Young
- Department of Mathematics and Statistics, Strathclyde University, 16 Richmond Street, Glasgow G1 1XQ, UK
| | - J Montgomery
- Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow G51 4TF, UK
| | - G O'Neill
- Department of Radiology - Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK
| | - C McArthur
- Department of Radiology - Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
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Tumour Cell Anaplasia and Multinucleation as Prognosticators in Oropharyngeal Squamous Cell Carcinoma. Head Neck Pathol 2019; 14:606-615. [PMID: 31552619 PMCID: PMC7413948 DOI: 10.1007/s12105-019-01081-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 09/16/2019] [Indexed: 01/23/2023]
Abstract
Human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinomas (OPSCC) tend to have good outcomes, however a subset does not share this favourable prognosis. The aim of this paper is to investigate the utility of tumour cell anaplasia and multinucleation as prognostic markers in oropharyngeal squamous cell carcinoma. Retrospective review of 104 patients with OPSCC or squamous cell carcinoma of unknown primary site (SCCUP) who underwent primary resection and/or lymph node dissection. Slides of both primary and nodal metastatic disease were assessed for the presence of anaplasia and multinucleation. 53 patients were HPV-positive. Anaplasia was more frequent in males (p = 0.005), smokers (p = 0.003), and HPV-negative disease (p = 0.04). HPV status and > 10 pack-year smoking history were independent predictors of recurrence-free survival (RFS) and disease-specific survival (DSS). Neither anaplasia, nor multinucleation, at the primary site or in cervical metastases, had any significant impact on RFS or DSS. We did not find either anaplasia or multinucleation to have any significant prognostic impact in OPSCC. However, given the small number of adverse events in the HPV-positive cohort, we may have lacked sufficient power to detect significance in what was the subgroup of primary interest. Our study highlights the challenge of identifying markers of poor prognosis in HPV-positive OPSCC.
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Faraji F, Aygun N, Coquia SF, Gourin CG, Tan M, Rooper LM, Eisele DW, Fakhry C. Computed tomography performance in predicting extranodal extension in HPV‐positive oropharynx cancer. Laryngoscope 2019; 130:1479-1486. [DOI: 10.1002/lary.28237] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/20/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Farhoud Faraji
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryUniversity of California San Diego Health San Diego California U.S.A
| | - Nafi Aygun
- The Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins Hospital Baltimore Maryland U.S.A
| | - Stephanie F. Coquia
- The Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins Hospital Baltimore Maryland U.S.A
| | - Christine G. Gourin
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Marietta Tan
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Lisa M. Rooper
- Department of PathologyJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - David W. Eisele
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Carole Fakhry
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Bloomberg‐Kimmel Institute for Cancer Immunotherapy at Johns Hopkins Baltimore Maryland U.S.A
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public Health Baltimore Maryland U.S.A
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McMullen CP, Garneau J, Weimar E, Ali S, Farinhas JM, Yu E, Som PM, Sarta C, Goldstein DP, Su S, Xu W, Smith RV, Miles B, de Almeida JR. Occult Nodal Disease and Occult Extranodal Extension in Patients With Oropharyngeal Squamous Cell Carcinoma Undergoing Primary Transoral Robotic Surgery With Neck Dissection. JAMA Otolaryngol Head Neck Surg 2019; 145:701-707. [PMID: 31219521 DOI: 10.1001/jamaoto.2019.1186] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Importance The historically reported rates of subclinical cervical nodal metastases in oropharyngeal squamous cell carcinoma (OPSCC) predate the emergence of human papillomavirus as the predominant causative agent. The rate of occult nodal disease with changing etiology of OPSCC is not known, and it is challenging to anticipate which patients will be upstaged postoperatively and will require adjuvant therapy. Objective To assess the rate of nodal upstaging and occult extranodal extension (ENE) in a multi-institutional population of patients with pathologic (p)T1-2 OPSCC treated by transoral robotic surgery and neck dissection. Design, Setting and Participants This retrospective, multicenter cohort study of 92 participants at 2 US institutions (Albert Einstein College of Medicine, Bronx, New York [n = 38], and Icahn School of Medicine at Mount Sinai, New York, New York [n = 39]) and 1 Canadian institution (Princess Margaret Hospital, Toronto [n = 15]) examined the rate of postoperative pathologic upstaging for 92 patients with pT1-2 OPSCC undergoing transoral robotic surgery with neck dissection from August 2007 to December 2016. A neuroradiologist at each site blinded to final pathologic diagnosis reviewed preoperative imaging; these findings were compared with operative pathology and applied for tumor staging using the eighth edition of the American Joint Committee on Cancer Cancer Staging Manual. The statistical analysis was performed on December 18, 2018. Main Outcomes and Measures Occult pathologic nodal disease and change in nodal category postoperatively. Results Of 92 patients who met the inclusion criteria, 76 (83%) were male, and they had a mean (SD) age at surgery of 59.5 (10.5) years; 70 patients (84%) with available p16 status were positive. Five of 18 patients (28%) who had no evidence of nodal disease on imaging had occult pathologic nodal disease. Seven of 32 patients (22%) presenting with no nodal disease or with a single metastatic node on imaging received pathologic upstaging because of multiple positive nodes, indicating implementation of additional adjuvant treatment not anticipated after a priori imaging. Changes included 12 patients (13%) who had pathologic nodal upstaging and 12 (13%) with pathologic nodal downstaging in the eighth edition of staging. In the cohort, 24 patients (27%) had pathologic ENE, and 5 of 39 patients (13%) had occult ENE in the absence of radiographic evidence. Conclusions and Relevance Predicting pathologic staging preoperatively for patients with OPSCC undergoing transoral robotic surgery and neck dissection remains a challenge. Although nodal size, tumor size, and location do not help predict ENE, the presence of nodes on imaging and nodal category may help predict ENE. Our findings suggest a small proportion of patients might benefit from further adjuvant therapies not predicted by preoperative imaging based on occult nodal upstaging and ENE.
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Affiliation(s)
- Caitlin P McMullen
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Garneau
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emillie Weimar
- Princess Margaret Cancer Center, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sana Ali
- Montefiore Medical Center, Department of Radiology, Albert Einstein College of Medicine, Bronx, New York
| | - Joaquim M Farinhas
- Montefiore Medical Center, Department of Radiology, Albert Einstein College of Medicine, Bronx, New York
| | - Eugene Yu
- Princess Margaret Cancer Center, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Peter M Som
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cathy Sarta
- Montefiore Medical Center, Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Susie Su
- Princess Margaret Cancer Centre and Dalla Lana School of Public Health, Biostatistics Department, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre and Dalla Lana School of Public Health, Biostatistics Department, University of Toronto, Toronto, Ontario, Canada
| | - Richard V Smith
- Montefiore Medical Center, Department of Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Rajappa S, Maheshwari U, Ram D, Koyyala V, Mandal G, Kumar R, Dewan A, Vishwakarma G. Extracapsular extension in oral cavity cancers—predictive factors and impact on recurrence pattern and survival. Int J Oral Maxillofac Surg 2019; 48:989-994. [DOI: 10.1016/j.ijom.2019.03.900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
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Billfalk-Kelly A, Yu E, Su J, O'Sullivan B, Waldron J, Ringash J, Bartlett E, Perez-Ordonez B, Weinreb I, Bayley A, Bratman SV, Cho J, Giuliani M, Hope A, Hosni A, Kim J, Hansen AR, de Almeida J, Tong L, Xu W, Huang SH. Radiologic Extranodal Extension Portends Worse Outcome in cN+ TNM-8 Stage I Human Papillomavirus–Mediated Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2019; 104:1017-1027. [DOI: 10.1016/j.ijrobp.2019.03.047] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/01/2019] [Accepted: 03/23/2019] [Indexed: 11/16/2022]
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Adelstein DJ, Ismaila N, Ku JA, Burtness B, Swiecicki PL, Mell L, Beitler JJ, Gross N, Jones CU, Kaufman M, Le QT, Semrad TJ, Siu LL, Ridge JA. Role of Treatment Deintensification in the Management of p16+ Oropharyngeal Cancer: ASCO Provisional Clinical Opinion. J Clin Oncol 2019; 37:1578-1589. [DOI: 10.1200/jco.19.00441] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE An ASCO provisional clinical opinion offers timely clinical direction to ASCO’s membership after publication or presentation of potentially practice-changing data from major studies. This provisional clinical opinion addresses the role of treatment deintensification in the management of p16+ oropharyngeal cancer (OPC). CLINICAL CONTEXT For patients with p16+ OPC, current treatment approaches are well established. In the good-prognosis subset of nonsmoking p16+ patients with early-stage disease, these treatments have been highly successful, albeit with significant associated acute and late toxicity. Deintensification of surgical, radiation, and medical treatment in an effort to reduce toxicity while preserving high survival rates is an appropriate therapeutic objective currently being explored in patients who are experiencing the best treatment results. However, careful delineation of this good-risk subset is essential. While the current eighth edition of the American Joint Committee on Cancer staging system is prognostically robust, it should not be interpreted as reason to alter therapeutic decisions or justify treatment deintensification. The development of transoral surgical techniques and the adoption of intensity-modulated radiation therapy planning have been transformative in disease management and suggest potentially beneficial approaches. Recent advances in systemic treatments have been notable. The optimal integration and modification of these modalities to ameliorate toxicity has not been defined and remains an important focus of current investigation. PROVISIONAL CLINICAL OPINION The hypothesis that de-escalation of treatment intensity for patients with p16+ OPC can reduce long-term toxicity without compromising survival is compelling and necessitates careful study and the analysis of well-designed clinical trials before changing current treatment standards. Treatment deintensification for these patients should only be undertaken in a clinical trial. Additional information is available at www.asco.org/head-neck-cancer-guidelines .
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Affiliation(s)
| | | | | | | | | | - Loren Mell
- University of California San Diego, La Jolla, CA
| | | | - Neil Gross
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Marnie Kaufman
- Adenoid Cystic Carcinoma Research Foundation, Needham, MA
| | | | | | - Lillian L. Siu
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Beltz A, Gösswein D, Zimmer S, Limburg I, Wünsch D, Gribko A, Deichelbohrer M, Hagemann J, Stauber RH, Künzel J. Staging of oropharyngeal squamous cell carcinoma of the head and neck: Prognostic features and power of the 8th edition of the UICC staging manual. Eur J Surg Oncol 2019; 45:1046-1053. [DOI: 10.1016/j.ejso.2019.02.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 02/05/2023] Open
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48
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Wirth LJ, Burtness B, Nathan CAO, Grégoire V, Richmon J. Point/Counterpoint: Do We De-escalate Treatment of HPV-Associated Oropharynx Cancer Now? And How? Am Soc Clin Oncol Educ Book 2019; 39:364-372. [PMID: 31099643 DOI: 10.1200/edbk_238315] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
HPV-positive (HPV+) oropharyngeal carcinoma (OPC) continues to increase in incidence across the globe. Multimodality treatment offers a high likelihood of cure in HPV+ OPC but comes at a high cost of treatment-related morbidity. As a result, de-escalation of treatment to limit toxicity without compromising high cure rates has emerged as a major trend in head and neck cancer clinical research. Primary surgery with minimally invasive resection of the primary disease may allow for the elimination of chemotherapy and decrease radiation dose intensity. Primary dose-reduced radiation, with or without systemic therapy, is also under study, as is replacing concurrent cisplatin with newer systemic agents. Numerous institutional series and phase II trials have been presented, and the first generation of de-escalation randomized phase III trials have now been published. The various combinatorial multimodality strategies to achieve less intensive and toxic therapy are many. Has the time come for de-escalation as a standard approach to HPV+ OPC? The pros and cons, as well as the best approaches for de-escalated treatment of HPV+ OPC, are debated here.
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Affiliation(s)
- Lori J Wirth
- 1 From the Massachusetts General Hospital Cancer Center, Harvard University, and Harvard Medical School, Boston, MA
| | - Barbara Burtness
- 2 Yale University School of Medicine, New Haven, CT.,3 Yale Cancer Center, New Haven, CT
| | - Cherie-Ann O Nathan
- 4 Louisiana State University Health Sciences Center Shreveport, Shreveport, LA
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Lee NCJ, Eskander A, Park HS, Mehra S, Burtness BA, Husain Z. Pathologic staging changes in oral cavity squamous cell carcinoma: Stage migration and implications for adjuvant treatment. Cancer 2019; 125:2975-2983. [DOI: 10.1002/cncr.32161] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Nicholas C. J. Lee
- Department of Therapeutic Radiology Yale School of Medicine New Haven Connecticut
| | - Antoine Eskander
- Sunnybrook Health Sciences Centre, Odette Cancer Centre Toronto Ontario Canada
- Department of Otolaryngology–Head and Neck Surgery University of Toronto Toronto Ontario Canada
| | - Henry S. Park
- Department of Therapeutic Radiology Yale School of Medicine New Haven Connecticut
| | - Saral Mehra
- Section of Otolaryngology, Department of Surgery Yale School of Medicine New Haven Connecticut
| | - Barbara A. Burtness
- Section of Medical Oncology, Department of Internal Medicine Yale School of Medicine New Haven Connecticut
- Yale Cancer Center New Haven Connecticut
| | - Zain Husain
- Department of Therapeutic Radiology Yale School of Medicine New Haven Connecticut
- Sunnybrook Health Sciences Centre, Odette Cancer Centre Toronto Ontario Canada
- Department of Radiation Oncology University of Toronto Toronto Ontario Canada
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50
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Tian S, Ferris MJ, Switchenko JM, Magliocca KR, Cassidy RJ, Jhaveri J, Aiken AH, Baugnon KL, Hudgins PA, Kendi ATK, Patel MR, Saba NF, Curran WJ, Beitler JJ. Prognostic value of radiographically defined extranodal extension in human papillomavirus-associated locally advanced oropharyngeal carcinoma. Head Neck 2019; 41:3056-3063. [PMID: 31046181 DOI: 10.1002/hed.25791] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/11/2019] [Accepted: 04/17/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Pathologic extranodal extension (ENE) has traditionally guided the management of head and neck cancers. The prognostic value of radiographic ENE (rENE) in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (HPV + OPX) is uncertain. METHODS Patients with HPV + OPX with adequate pretreatment radiographic nodal evaluation from a single institution were analyzed. rENE status was determined by neuroradiologists' at time of diagnosis. Distant metastasis-free survival (DMFS), overall survival (OS), and locoregional recurrence-free survival (LRFS) were estimated using Kaplan-Meier methods. Cox proportional hazards models were fit to assess the impact of rENE on survival endpoints. RESULTS Hundred sixty-eight patients with OPX + squamous cell carcinomas diagnosed between April 2008 and December 2014 were included for analysis with median follow-up of 3.3 years. Eighty-eight percent of patients received concurrent chemoradiotherapy. rENE was not prognostic; its presence in patients with HPV + OPX did not significantly impact OS, LRFS, or DMFS. CONCLUSIONS In patients with HPV + OPX, rENE was not significantly associated with OS, LRFS, or DMFS.
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Affiliation(s)
- Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Matthew J Ferris
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | | | - Kelly R Magliocca
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Richard J Cassidy
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Jaymin Jhaveri
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Ashley H Aiken
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kristen L Baugnon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Patricia A Hudgins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ayse T K Kendi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Mihir R Patel
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Jonathan J Beitler
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
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