Prognostic significance of head and neck spindle cell carcinoma

Elective Neck Dissection in cT1-4 N0M0 Head and Neck Spindle Cell Carcinoma

OBJECTIVE

To investigate the survival benefit of elective neck dissection (END) over neck observation in surgically resected cT1-4 N0M0 head and neck spindle cell carcinoma (HNSpCC).

STUDY DESIGN

Retrospective cohort study.

SETTING

The 2006 to 2018 hospital-based National Cancer Database (NCDB).

METHODS

Patients with surgically resected cT1-4 N0M0 HNSpCC were selected. Linear, binary logistic, Kaplan-Meier, and Cox proportional hazards regression models were implemented.

RESULTS

Of 815 patients satisfying inclusion criteria, a high proportion were male (72.4%) and white (86.0%) with disease of the larynx (43.8%) classified as high grade (87.7%) and cT1-2 (74.8%). In total, 235 (28.8%) patients underwent END. END utilization between 2006 and 2018 increased for cT1-2 disease (4.0% vs 30.5%, R2 = 0.731) and for cT3-4 disease (15.4% vs 84.6%, R2 = 0.606). In total, 58 (24.7%) ENDs detected occult nodal metastases (ONMs). The 5-year overall survival (OS) of patients undergoing neck observation and END was 62% and 54%, respectively (P = .215). Among patients undergoing END, patients with ONM had worse 5-year OS than those without ONM (38% vs 60%, P < .001). On multivariable Cox regression, END was not associated with OS (adjusted hazard ratio [aHR] 0.74, 95% CI 0.68-1.32, P = .735); ONM (hazard ratio [HR] 2.01, 95% CI 1.29-3.12, P = .002) was associated with worse OS.

CONCLUSION

END is performed in a high proportion (30%) of patients with cN0M0 HNSpCC but is not associated with higher OS. The rate of ONM approaching 25% and the association between ONM and worse OS, however, justify consideration of END in HNSpCC.

LEVEL OF EVIDENCE: 4

The impact of histopathology on prognosis of squamous cell carcinoma of the larynx: can we do better?

Despite decades of progress, laryngeal squamous cell carcinoma (SCC) is still associated with significant morbidity and mortality worldwide. Additional biomarkers are needed to apply precision medicine and predict the clinical course. We reviewed and summarised routinely reported histopathologic features (e.g. subtypes of laryngeal SCC) along with promising potential biomarkers not yet routinely assessed using international guidelines. These include extra- vs intratumoural vascular and perineural invasion, tumour budding, depth of invasion, and tumour-infiltrating lymphocytes. We also address the problem of specimen quality and type (open approach vs endoscopic surgery) and the related limitations. High-risk human papillomavirus infection is another controversial issue to be discussed, being rare in laryngeal SCC, with an indeterminate prognostic significance and less reliable p16 overexpression as a surrogate marker of HPV infection. Further studies are warranted to address the applicability and to see which of the described parameters may help to better stratify patients with laryngeal SCC and should therefore be included in the pathology report.

Prognostic implications across histological subtypes of head and neck squamous cell carcinoma: An update

BACKGROUND

Head and neck squamous cell carcinoma (HNSCC) is one of the most common malignancies worldwide, arising from the mucosal epithelium of the oral cavity, oropharynx, hypopharynx, nasopharynx, larynx, and sinuses. In addition to the conventional morphologic pattern characterized by the degree of cellular atypia and squamous differentiation, HNSCC is classified into eight histopathologic subtypes: basaloid, spindle cell, adenosquamous, cuniculatum, verrucous, lymphoepithelial, papillary, and acantholytic.

METHODS

This review provides a comprehensive review of the literature on the prognostic implications of the histological subtypes of HNSCC.

RESULTS

Although there is extensive literature on HNSCC, few studies specifically focus on the treatment and prognosis of its histopathologic subtypes. Among these subtypes, verrucous squamous cell carcinoma and carcinoma cuniculatum generally have a favorable prognosis, while others, such as basaloid and spindle cell squamous cell carcinoma, tend to follow a more aggressive clinical course.

CONCLUSION

In this review, we delve into the histopathological subtypes of HNSCC and explore their clinicopathological, molecular, and prognostic findings. Further molecular investigations aimed at identifying targeted therapies for these subtypes are necessary. Moreover, it is crucial to recognize the emerging histopathological variants documented in the literature, considering the ongoing limitations in prognostic assessment.

Choice of Adjuvant Radiotherapy Facility in Major Salivary Gland Cancer

OBJECTIVE

Undergoing surgery and adjuvant radiotherapy (aRT) at the same facility has been associated with higher overall survival (OS) in head and neck squamous cell carcinoma. Our study investigates whether undergoing surgery and aRT at the same academic facility is associated with higher OS in major salivary gland cancer (MSGC).

METHODS

The 2006-2018 National Cancer Database was queried for patients with MSGC undergoing surgery at an academic facility and then aRT. Multivariable binary logistic and Cox proportional hazards regression models were implemented.

RESULTS

Of 2801 patients satisfying inclusion criteria, 2130 (76.0%) underwent surgery and aRT at the same academic facility. Residence in a less populated area (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.16-2.45), treatment without adjuvant chemotherapy (aOR 1.97, 95% CI 1.41-2.76), and aRT duration (aOR 1.02, 95% CI 1.01-1.04) were associated with undergoing surgery and aRT at different facilities on multivariable logistic regression adjusting for patient demographics, clinicopathologic features, and adjuvant therapy (p < 0.01). Five-year OS was higher in patients undergoing surgery and aRT at the same academic facility (68.8% vs. 61.9%, p < 0.001). Undergoing surgery and aRT at different facilities remained associated with worse OS on multivariable Cox regression (aHR 1.41, 95% CI 1.10-1.81, p = 0.007).

CONCLUSION

Undergoing surgery and aRT at the same academic facility is associated with higher OS in MSGC. Although undergoing surgery and aRT at the same academic facility is impractical for all patients, academic physicians should consider same-facility treatment for complex patients who would most benefit from clear multidisciplinary communication.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:3620-3632, 2024.

Patterns and Trends in Adjuvant Therapy for Major Salivary Gland Cancer

OBJECTIVE

To investigate adjuvant therapy indications, utilization, and associated survival disparities in major salivary gland cancer (MSGC).

STUDY DESIGN

Retrospective cohort study.

SETTING

The 2006 to 2017 National Cancer Database.

METHODS

Patients with surgically resected MSGC were included (N = 11,398). pT3-4 classification, pN2-3 classification, lymphovascular invasion, pathologic extranodal extension (pENE), and positive surgical margin (PSM) were considered indications for adjuvant radiotherapy (aRT). pENE and PSM were considered possible indications for adjuvant chemotherapy. Multivariable logistic and Cox regression models were implemented.

RESULTS

Among 6694 patients with≥ $\ge $ 1 indication for aRT, 1906 (28.5%) received no further treatment and missed aRT. Age, race, comorbidity status, facility type, and distance to reporting facility were associated with missed aRT (P < .025). Among 4003 patients with ≥1 possible indication for adjuvant chemoradiotherapy (aCRT), 914 (22.8%) received aCRT. Patients with pENE only (38.5%) and both pENE and PSM (44.0%) received aCRT more frequently than those with PSM only (17.0%) (P < .001). Academic facility was associated with aCRT utilization (P < .05). aCRT utilization increased between 2006 and 2017 in both academic (14.8% vs 23.9%) and nonacademic (8.8% vs 13.5%) facilities (P < .05). Among 2691 patients with ≥1 indication for aRT alone, missed aRT portended poorer OS (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.28-2.03, P < .001). Among 4003 patients with ≥1 possible indication for aCRT, aRT alone (HR: 1.02, 95% CI: 0.89-1.18, P = .780) and aCRT were associated with similar OS.

CONCLUSION

Missed aRT in MSGC occurs frequently and portends poorer OS. Further studies clarifying indications for aCRT are required.

Surgical Resection Improves Overall Survival in cT4b Major Salivary Gland Cancer

OBJECTIVE

To compare surgical and nonsurgical definitive treatment in cT4b major salivary gland cancer (MSGC).

STUDY DESIGN

Retrospective cohort study.

SETTING

The 2004 to 2019 National Cancer Database.

METHODS

The NCDB was queried for patients with cT4b MSGC (N = 976). Patients undergoing definitive treatment with (1) surgical resection + adjuvant therapy, (2) radiotherapy (RT) alone, or (3) chemoradiotherapy (CRT) were included in Kaplan-Meier and Cox survival analyses.

RESULTS

Of 219 patients undergoing definitive treatment, 148 (67.6%) underwent surgical resection + adjuvant therapy and 71 (32.4%) underwent RT or CRT. There were no documented mortalities within 90 days of surgical resection. Tumor diameter and nodal metastasis were associated with decreased odds of undergoing definitive treatment (P < 0.025). Patients with positive surgical margins (PSM) had higher 5-year overall survival (OS) than those undergoing definitive RT or CRT (48.5% vs 30.1%, P = 0.018) and similar 5-year OS as those with negative margins (48.5% vs 54.0%, P = 0.205). Surgical resection + adjuvant therapy (adjusted hazard ratio: 0.55, 95% confidence interval [CI]: 0.37-0.84) was associated with higher OS than definitive RT or CRT (P < 0.025). A separate cohort of 961 patients with cT4a tumors undergoing surgical resection + adjuvant therapy was created; cT4a and cT4b (hazard ratio: 1.02, 95% CI: 0.80-1.29, P = 0.896) tumors had similar OS.

CONCLUSION

A minority of patients with cT4b MSGC undergo definitive treatment. Surgical resection + adjuvant therapy was safe and associated with higher OS than definitive RT or CRT, despite high rate of PSM. In the absence of clinical trial data, appropriately selected patients with cT4b MSGC may benefit from surgical resection.

Non-Squamous Cell Carcinoma of the Larynx: A State-of-the-Art Review

(1) Background: Non-squamous cell laryngeal carcinoma includes endothelial tumors, such as minor salivary gland tumors, lymphoepithelial tumors, neuroendocrine tumors, soft and hard tissue sarcomas, and malignant melanomas. (2) Methods: A state-of-the-art review using the MEDLINE/PUBMED, Google Scholar, Ovid Medline, Embase, and Scopus electronic databases was performed. (3) Conclusions: In order to optimize overall treatment outcomes, a multidisciplinary, patient-centered approach to the management of non-SCC of the larynx must be adopted universally; a national or international registry on non-SCC laryngeal cancer can be useful to improve understanding about the behavior of this kind of tumor.