1
|
Vilaseca I, Aviles-Jurado FX, Valduvieco I, Berenguer J, Grau JJ, Baste N, Muxí Á, Castillo P, Lehrer E, Jordana M, Ramírez-Ruiz RD, Costa JM, Oleaga L, Bernal-Sprekelsen M. Transoral laser microsurgery in locally advanced laryngeal cancer: Prognostic impact of anterior versus posterior compartments. Head Neck 2021; 43:3832-3842. [PMID: 34569120 DOI: 10.1002/hed.26878] [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: 05/14/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To evaluate the importance of larynx compartments in the prognosis of T3-T4a laryngeal cancer treated with transoral laser microsurgery. METHODS Two hundred and two consecutive pT3-T4a larynx carcinomas. Pre-epiglottic space involvement, anterior and posterior paraglottic space (PGS) involvement, vocal cord, and arytenoid mobility were determined. Local control with laser (LC), overall survival (OS), disease-specific survival (DSS), and laryngectomy-free survival (LFS) were evaluated. RESULTS The lowest LC was found in tumors with fixed arytenoid. In the multivariate analysis, positive margins (hazard ratio [HR] = 0.289 [0.085-0.979]) and anterior (HR = 0.278 [0.128-0.605]) and posterior (HR = 0.269 [0.115-0.630]) PGS invasion were independent factors of a reduced LC. Anterior (HR = 3.613 [1.537-8.495]) and posterior (HR = 5.195 [2.167-12.455]) PGS involvement were independent factors of total laryngectomy. Five-year OS, DSS, and LFS rates were 63.9%, 77.5%, and 77.5%, respectively. Patients with posterior PGS presented a reduced 5-year LFS. CONCLUSIONS Tumor classification according to laryngeal compartmentalization depicts strong correlation with LC and LFS.
Collapse
Affiliation(s)
- Isabel Vilaseca
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain
| | - Francesc Xavier Aviles-Jurado
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain
| | - Izaskun Valduvieco
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain.,Radiation Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Joan Berenguer
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Radiology Department, Hospital Clínic, Barcelona, Spain
| | - Juan José Grau
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca, Barcelona, Spain.,Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Neus Baste
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - África Muxí
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain
| | - Paola Castillo
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Pathology Department, Hospital Clínic, Barcelona, Spain
| | - Eduardo Lehrer
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain
| | - Marta Jordana
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,Rehabilitation Department, Hospital Clínic, Barcelona, Spain
| | | | - José Miguel Costa
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain
| | - Laura Oleaga
- School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain.,Radiology Department, Hospital Clínic, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Otorhinolaryngology Head Neck Surgery Department, Hospital Clínic, Barcelona, Spain.,School of Medicine, Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| |
Collapse
|
2
|
Paderno A, Lancini D, Bosio P, Del Bon F, Fior M, Berretti G, Alparone M, Deganello A, Peretti G, Piazza C. Transoral Laser Microsurgery for Glottic Cancer in Patients Over 75 Years Old. Laryngoscope 2021; 132:135-141. [PMID: 34233029 PMCID: PMC9291037 DOI: 10.1002/lary.29738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/16/2021] [Accepted: 06/28/2021] [Indexed: 12/22/2022]
Abstract
Objectives/Hypothesis Laryngeal squamous cell carcinoma (LSCC) has a non‐negligible incidence in elderly patients. However, there is still no clear indication on the ideal treatment for early‐intermediate glottic LSCC in this specific age group. Both surgical and nonsurgical approaches may be burdened by complications and sequelae that negatively impact patient's health. In this setting, carbon dioxide transoral laser microsurgery (CO2 TOLMS) is a promising minimally invasive treatment option. Study Design Retrospective case series in a single tertiary academic institution. Methods Patients who underwent CO2 TOLMS for Tis‐T3 glottic LSCC from 1997 to 2017 were reviewed. Demographic, clinical, and tumor characteristics, as well as postoperative complications were recorded. Overall (OS), disease‐specific (DSS), recurrence‐free (RFS), laryngo‐esophageal dysfunction free survivals (LEDFS), and organ preservation (OP) were calculated. Results A total of 134 patients (mean age, 80 ± 4 years; median, 79; range, 75–93) were included in the study. Seven lesions were classified as pTis, 65 as pT1a, 22 as pT1b, 35 as pT2, and 5 as pT3. No treatment‐related death was observed. Twenty‐eight (20.9%) patients reported 10 surgical and 19 medical complications. Five‐year OS, DSS, RFS, LEDFS, and OP were 68.9%, 95.4%, 79.5%, 66%, and 92.5%, respectively. Age and comorbidities were associated with OS and LEDFS. Advanced T categories were negatively correlated with OS, DSS, RFS, LEDFS, and OP. Age and comorbidities were not significant risk factors for complications. Conclusions CO2 TOLMS can be considered a valuable therapeutic approach for selected Tis‐T3 glottic LSCC even in the elderly given its favorable oncologic outcomes and minimal aggressiveness. Level of Evidence 4 Laryngoscope, 132:135–141, 2022
Collapse
Affiliation(s)
- Alberto Paderno
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | - Paolo Bosio
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy
| | - Milena Fior
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Berretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Alparone
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giorgio Peretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili, Brescia, Italy.,Department of Surgical and Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
3
|
Salvage carbon dioxide transoral laser microsurgery for laryngeal cancer after (chemo)radiotherapy: a European Laryngological Society consensus statement. Eur Arch Otorhinolaryngol 2021; 278:4373-4381. [PMID: 34226992 PMCID: PMC8486708 DOI: 10.1007/s00405-021-06957-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/23/2021] [Indexed: 12/11/2022]
Abstract
Purpose To provide expert opinion and consensus on salvage carbon dioxide transoral laser microsurgery (CO2 TOLMS) for recurrent laryngeal squamous cell carcinoma (LSCC) after (chemo)radiotherapy [(C)RT]. Methods Expert members of the European Laryngological Society (ELS) Cancer and Dysplasia Committee were selected to create a dedicated panel on salvage CO2 TOLMS for LSCC. A series of statements regarding the critical aspects of decision-making were drafted, circulated, and modified or excluded in accordance with the Delphi process. Results The expert panel reached full consensus on 19 statements through a total of three sequential evaluation rounds. These statements were focused on different aspects of salvage CO2 TOLMS, with particular attention on preoperative diagnostic work-up, treatment indications, postoperative management, complications, functional outcomes, and follow-up. Conclusion Management of recurrent LSCC after (C)RT is challenging and is based on the need to find a balance between oncologic and functional outcomes. Salvage CO2 TOLMS is a minimally invasive approach that can be applied to selected patients with strict and careful indications. Herein, a series of statements based on an ELS expert consensus aimed at guiding the main aspects of CO2 TOLMS for LSCC in the salvage setting is presented.
Collapse
|
4
|
Ronen O, Robbins KT, de Bree R, Guntinas-Lichius O, Hartl DM, Homma A, Khafif A, Kowalski LP, López F, Mäkitie AA, Ng WT, Rinaldo A, Rodrigo JP, Sanabria A, Ferlito A. Standardization for oncologic head and neck surgery. Eur Arch Otorhinolaryngol 2021; 278:4663-4669. [PMID: 33982178 DOI: 10.1007/s00405-021-06867-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
The inherent variability in performing specific surgical procedures for head and neck cancer remains a barrier for accurately assessing treatment outcomes, particularly in clinical trials. While non-surgical modalities for cancer therapeutics have evolved to become far more uniform, there remains the challenge to standardize surgery. The purpose of this review is to identify the barriers in achieving uniformity and to highlight efforts by surgical groups to standardize selected operations and nomenclature. While further improvements in standardization will remain a challenge, we must encourage surgical groups to focus on strategies that provide such a level.
Collapse
Affiliation(s)
- Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - K Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, IL, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Dana M Hartl
- Head and Neck Oncology Service, Gustave Roussy, Villejuif, France
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Avi Khafif
- Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Wai Tong Ng
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza Y Cuello, Medellín, Colombia
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
5
|
Piazza C, Paderno A, Del Bon F, Lancini D, Fior M, Berretti G, Bosio P, Deganello A, Peretti G. Long-term Oncologic Outcomes of 1188 Tis-T2 Glottic Cancers Treated by Transoral Laser Microsurgery. Otolaryngol Head Neck Surg 2021; 165:321-328. [PMID: 33400625 DOI: 10.1177/0194599820983727] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate long-term disease-specific survival (DSS) and organ preservation (OP) rates in patients affected by Tis-T2 glottic squamous cell carcinoma (SCC) treated by carbon dioxide transoral laser microsurgery (CO2 TOLMS). STUDY DESIGN Single-center retrospective cohort study. SETTING Tertiary academic hospital. METHODS The study included patients treated by CO2 TOLMS for Tis-T2 glottic SCC at the Department of Otorhinolaryngology-Head and Neck Surgery of the University of Brescia, Italy, from 1988 to 2018. The male:female ratio was 11.2:1, and the mean age was 64 years (range, 31-95). T categories were distributed as follows: 124 (10%) Tis, 646 (54%) T1a, 172 (15%) T1b, and 246 (21%) T2. RESULTS Ten- and 20-year DSS rates were 97.6% and 96.3%, respectively, and 10- and 20-year OP rates were 94.7% and 93%. During the follow-up, 91% of patients were treated by CO2 TOLMS alone, while the remaining needed adjunctive treatments. Assessing the impact of multiple sessions of CO2 TOLMS, DSS showed no significant difference in terms of patients treated by 1, 2, or >2 procedures. Conversely, patients treated by >2 sessions of CO2 TOLMS showed a significantly worse OP rate. CONCLUSIONS Our series validates CO2 TOLMS as a long-term treatment strategy for early glottic SCC. Salvage CO2 TOLMS provided optimal results in terms of DSS and OP in patients with recurrence after previous transoral surgery.
Collapse
Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Davide Lancini
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Milena Fior
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Giulia Berretti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Paolo Bosio
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Deganello
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
6
|
T1 Glottic Cancer: Does Anterior Commissure Involvement Worsen Prognosis? Cancers (Basel) 2020; 12:cancers12061485. [PMID: 32517265 PMCID: PMC7352716 DOI: 10.3390/cancers12061485] [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: 04/09/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Radiotherapy (RT) and transoral laser microsurgery (TLM) represent the main treatment modalities for early glottic carcinoma. Local failure is notoriously more frequent in T1b glottic cancer in comparison to T1a and T2 tumors. In this scenario, the role of anterior commissure (AC) involvement is still controversial. The aim of the present study was therefore to determine its potential prognostic power in worsening patients’ survival and outcomes. We categorized different tumor glottic fold locations with respect to the involvement of one (T1a) or both vocal cords, with or without AC involvement. We analyzed a retrospective cohort of 74 patients affected by Stage I glottic cancer, treated between 2011 and 2018 by TLM or RT at a single academic institution. There were 22 T1a (30%) and 52 T1b (70%) cases. The median follow-up period was 30 months (mean, 32.09 ± 18.738 months; range, 12–79). Three-year overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and laryngectomy-free survival (LFS) were compared according to tumor location, extension, and cT category. According to both uni- and multivariate analyses, an increased risk for recurrence in T1b with AC involvement and T1a tumors was 7.31 and 9.45 times, respectively (p-values of 0.054 and 0.030, respectively). Among the 17 recurrences, T1b with AC involvement experienced 15 tumor relapses (88.2%), thus significantly affecting both the RFS and LFS in comparison to the other two tumor subcategories (T1a, p = 0.028 and T1b without AC involvement, p = 0.043). The deteriorating prognosis in the presence of AC involvement likely reflects the need to power the hazard consistency and discrimination of the T1b category when associated with such a risk factor, thus deserving an independent T category.
Collapse
|
7
|
Mi WF, Chen XM, Fan TT, Tabarak S, Xiao JB, Cao YZ, Li XY, Bao YP, Han Y, Li LZ, Shi Y, Guo LH, Wang XZ, Liu YQ, Wang ZM, Chen JX, Wu FC, Ma WB, Li HF, Xiao WD, Liu FH, Xie W, Zhang HY, Lu L. Identifying Modifiable Risk Factors for Relapse in Patients With Schizophrenia in China. Front Psychiatry 2020; 11:574763. [PMID: 33061925 PMCID: PMC7518216 DOI: 10.3389/fpsyt.2020.574763] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Preventing relapse of schizophrenic patients is really a challenge. The present study sought to provide more explicit evidence and factors of different grades and weights by a series of step-by-step analysis through χ2 test, logistic regression analysis and decision-tree model. The results of this study may contribute to controlling relapse of schizophrenic patients. METHODS A total of 1,487 schizophrenia patients were included who were 18-65 years of age and discharged from 10 hospitals in China from January 2009 to August 2009 and from September 2011 to February 2012 with improvements or recovery of treatment effect. We used a questionnaire to collect information about relapse and correlative factors during one year after discharge by medical record collection and telephone interview. The χ2 test and logistic regression analysis were used to identify risk factors and high-risk factors firstly, and then a decision-tree model was used to find predictive factors. RESULTS The χ2 test found nine risk factors which were associated with relapse. Logistic regression analysis also showed four high-risk factors further (medication adherence, occupational status, ability of daily living, payment method of medical costs). At last, a decision-tree model revealed four predictors of relapse; it showed that medication adherence was the first grade and the most powerful predictor of relapse (relapse rate for adherence vs. nonadherence: 22.9 vs. 55.7%, χ2 = 116.36, p < 0.001). The second grade factor was occupational status (employment vs. unemployment: 19.7 vs. 42.7%, χ2 = 17.72, p < 0.001); the third grade factors were ability of daily living (normal vs. difficult: 28.4 vs. 54.3%, χ2 = 8.61, p = 0.010) and household income (household income ≥ 3000 RMB vs. <3000 RMB: 28.6 vs. 42.4%, χ2 = 6.30, p = 0.036). The overall positive predictive value (PPV) of the logistic regression was 0.740, and the decision-tree model was 0.726. Both models were reliable. CONCLUSIONS For schizophrenic patients discharged from hospital, who had good medication adherence, more higher household income, be employed and normal ability of daily living, would be less likely to relapse. Decision tree provides a new path for doctors to find the schizophrenic inpatient's relapse risk and give them reasonable treatment suggestions after discharge.
Collapse
Affiliation(s)
- Wei-Feng Mi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiao-Min Chen
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei, China
| | - Teng-Teng Fan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Serik Tabarak
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Jing-Bo Xiao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yong-Zhi Cao
- Key Laboratory of High Confidence Software Technologies (MOE), Department of Computer Science and Technology, Peking University, Beijing, China
| | - Xiao-Yu Li
- Key Laboratory of High Confidence Software Technologies (MOE), Department of Computer Science and Technology, Peking University, Beijing, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Ying Han
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Ling-Zhi Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ying Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Li-Hua Guo
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiao-Zhi Wang
- Department of Psychiatry, The Fourth People's Hospital of Dalian Jinzhou District, Dalian, China
| | - Yong-Qiao Liu
- Department of Psychiatry, The Sixth People's Hospital of Hebei Province, Baoding, China
| | - Zhan-Min Wang
- Department of Psychiatry, Rongjun Hospital of Hebei Province, Baoding, China
| | - Jing-Xu Chen
- Department of Psychiatry, Beijing HuiLongGuan Hospital, Beijing, China
| | - Feng-Chun Wu
- Department of Psychiatry, Guangzhou Psychiatric Hospital, Guangzhou, China
| | - Wen-Bin Ma
- Department of Psychiatry, Jinzhou Kangning Hospital, Jinzhou, China
| | - Hua-Fang Li
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai, China
| | - Wei-Dong Xiao
- Department of Psychiatry, The People's Hospital of Hubei Province, Wuhan, China
| | - Fei-Hu Liu
- Department of Psychiatry, The Mental Health Center of Xi'an, Xi'an, China
| | - Wen Xie
- Department of Psychiatry, Affiliated Psychological Hospital of Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei, China
| | - Hong-Yan Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.,Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China.,National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.,Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| |
Collapse
|
8
|
Tulli M, Re M, Bondi S, Ferrante L, Dajko M, Giordano L, Gioacchini FM, Galli A, Bussi M. The prognostic value of anterior commissure involvement in T1 glottic cancer: A systematic review and meta-analysis. Laryngoscope 2019; 130:1932-1940. [PMID: 31721216 DOI: 10.1002/lary.28395] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/29/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The anterior commissure is considered a laryngeal subsite, but it is not taken into account in the current T-staging system. The impact of anterior commissure involvement (ACI) on the oncologic outcomes of T1 glottic tumors has not been well defined and remains controversial. The aim of this study was to assess the influence of ACI in the prognosis of T1 glottic tumors. METHODS A systematic review and meta-analysis of observational studies was performed by including studies published up to July 2019. Studies were selected if they had investigated the local control rate (LCR) at 5 years of clinical stage I (T1 and N0) glottic squamous cell carcinoma with and without ACI. The difference in LCR at 5 years between T1 glottic tumors without and with ACI was evaluated. RESULTS The meta-analysis showed that the difference in LCR at 5 years between T1 glottic tumors without and with ACI is 12% (95% confidence interval: 8%-16%, p < 0,0001, I2 = 34.81%). CONCLUSIONS Our study pointed out that the anterior commissure involvement is a negative prognostic factor in LCR at 5 years for T1 glottic tumors. Our results suggest the need to consider ACI in the T staging of glottic tumors. Laryngoscope, 130:1932-1940, 2020.
Collapse
Affiliation(s)
- Michele Tulli
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Massimo Re
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Stefano Bondi
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Luigi Ferrante
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Science and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Marianxhela Dajko
- Center of Epidemiology, Biostatistics and Medical Information Technology, Department of Biomedical Science and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Leone Giordano
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Federico M Gioacchini
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Galli
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institutes of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| |
Collapse
|
9
|
Involvement of the Anterior Commissure in Early Glottic Cancer (Tis-T2): A Review of the Literature. Cancers (Basel) 2019; 11:cancers11091234. [PMID: 31450795 PMCID: PMC6769981 DOI: 10.3390/cancers11091234] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background: The impact of the anterior commissure (AC) involvement on prognosis in laryngeal cancer remains a topic of discussion with inconsistent results in the literature. This review examines AC involvement as a prognostic factor in patients with early glottic cancer (Tis-T2) treated with radiotherapy or transoral laser microsurgery (TLM). Methods: A systematic literature search was performed. Due to the heterogeneity of the data, no meta-analysis was implemented. Weighted averages were calculated if the appropriate data were extractable. Results: Thirty-four studies on radiotherapy and 23 on TLM fit the inclusion criteria. The majority of studies for both radiotherapy (67.7%) and TLM (75.0%) did not report a significant impact on oncological outcomes. Weighted averages were slightly lower in patients with AC involvement. The two studies that applied a more detailed classification showed a significant impact on the amount of AC involvement. Conclusions: Binary variables (yes/no) for AC involvement lead to inconsistent results. Studies that use more detailed classifications of the AC show that there is a significant impact on the outcome. To further elucidate the role of the AC, detailed stratification of tumors involving the AC need to be investigated in further studies for both treatment modalities.
Collapse
|