To what extent has the last two decades seen significant progress in the management of older patients with head and neck cancer?

Nomogram for predicting early death in elderly patients with laryngeal squamous cell carcinoma: A population-based SEER study

BACKGROUND

The disease and mortality rates of patients with laryngeal squamous cell carcinoma (LSCC) stabilize after peaking at the age of 60 years. This study aimed to identify risk factors associated with early death (death within 6 months) in elderly (≥60 years) patients with LSCC and to establish predictive nomograms to aid clinicians in developing individualized treatment plans.

METHODS

Data pertaining to elderly patients with LSCC between 2004 and 2015 was obtained from the Surveillance, Epidemiology, and End Results database (version 8.4.0). Multiple logistic models were used to identify the independent risk factors associated with early mortality. The overall risk of early death was predicted using a web-based probability calculator and predictive nomogram. The cohort underwent decision curve analysis (DCA), calibration, and receiver operating characteristic curves to evaluate the clinical applicability and predictability of the models during the training and validation stages.

RESULTS

This study included 10,031 patients, of which 1,711 (17.0%) experienced all-cause early death, and 1,129 died from cancer-specific causes. Patients with LSCC who had overlapping laryngeal lesions, advanced age, unmarried status, high tumour and node stages, presence of distant metastases, and lack of treatment were at risk for early death. According to the nomograms, the risk of all-cause death and cancer-specific early death had an area under the curve of 0.796 and 0.790, respectively. Internal validation and DCA revealed that the prediction model was accurate and could be applied clinically.

CONCLUSION

The study provides an overview of the characteristics of early death in patients with LSCC. Among the prognostic factors, T stage and radiotherapy demonstrated the strongest predictive value for early mortality, while marital status and tumor grade had the worst prognostic value. Two nomogram plots were constructed to facilitate accurate prediction of all-cause and cancer-specific early mortality within 6 months in elderly patients with LSCC, thereby helping clinicians in providing more personalised treatment plans.

Oncologic Significance of Therapeutic Delays in Patients With Oral Cavity Cancer

Importance

Oral cavity cancer often requires multidisciplinary management, subjecting patients to complex therapeutic trajectories. Prolonged treatment intervals in oral cavity cancer have been associated with poor oncological outcomes, but there has yet to be a study investigating treatment times in Canada.

Objective

To report treatment delays for patients with oral cavity cancer in Canada and evaluate the outcomes of treatment delays on overall survival.

Design, Setting, and Participants

This multicenter cohort study was performed at 8 Canadian academic centers from 2005 to 2019. Participants were patients with oral cavity cancer who underwent surgery and adjuvant radiation therapy. Analysis was performed in January 2023.

Main Outcomes and Measures

Treatment intervals evaluated were surgery to initiation of postoperative radiation therapy interval (S-PORT) and radiation therapy interval (RTI). The exposure variables were prolonged intervals, respectively defined as index S-PORT greater than 42 days and RTI greater than 46 days. Patient demographics, Charlson Comorbidity Index, smoking status, alcohol status, and cancer staging were also considered. Univariate (log rank and Kaplan-Meier) and multivariate (Cox regression) analyses were performed to determine associations with overall survival (OS).

Results

Overall, 1368 patients were included; median (IQR) age at diagnosis was 61 (54-70) years, and 896 (65%) were men. Median (IQR) S-PORT was 56 (46-68) days, with 1093 (80%) patients waiting greater than 42 days, and median (IQR) RTI was 43 (41-47) days, with 353 (26%) patients having treatment time interval greater than 46 days. There were variations in treatment time intervals between institutions for S-PORT (institution with longest vs shortest median S-PORT, 64 days vs 48 days; η2 = 0.023) and RTI (institution with longest vs shortest median RTI, 44 days vs 40 days; η2 = 0.022). Median follow-up was 34 months. The 3-year OS was 68%. In univariate analysis, patients with prolonged S-PORT had worse survival at 3 years (66% vs 77%; odds ratio 1.75; 95% CI, 1.27-2.42), whereas prolonged RTI (67% vs 69%; odds ratio 1.06; 95% CI, 0.81-1.38) was not associated with OS. Other factors associated with OS were age, Charlson Comorbidity Index, alcohol status, T category, N category, and institution. In the multivariate model, prolonged S-PORT remained independently associated with OS (hazard ratio, 1.39; 95% CI, 1.07-1.80).

Conclusions and Relevance

In this multicenter cohort study of patients with oral cavity cancer requiring multimodal therapy, initiation of radiation therapy within 42 days from surgery was associated with improved survival. However, in Canada, only a minority completed S-PORT within the recommended time, whereas most had an appropriate RTI. An interinstitution variation existed in terms of treatment time intervals. Institutions should aim to identify reasons for delays in their respective centers, and efforts and resources should be directed toward achieving timely completion of S-PORT.

The relation between hypoxia and proliferation biomarkers with radiosensitivity in locally advanced laryngeal cancer

PURPOSE

Treatment decision-making in advanced-stage laryngeal squamous cell carcinoma (LSCC) is difficult due to the high recurrence rates and the desire to preserve laryngeal functions. New predictive markers for radiosensitivity are needed to facilitate treatment choices. In early stage glottic LSCC treated with primary radiotherapy, expression of hypoxia (HIF-1α and CA-IX) and proliferation (Ki-67) tumour markers showed prognostic value for local control. The objective of this study is to examine the prognostic value of tumour markers for hypoxia and proliferation on locoregional recurrent disease and disease-specific mortality in a well-defined cohort of patients with locally advanced LSCC treated with primary, curatively intended radiotherapy.

METHODS

In pre-treatment biopsy tissues from a homogeneous cohort of 61 patients with advanced stage (T3-T4, M0) LSCC primarily treated with radiotherapy, expression of HIF-1α, CA-IX and Ki-67 was evaluated with immunohistochemistry. Demographic data (age and sex) and clinical data (T- and N-status) were retrospectively collected from the medical records. Cox regression analysis was performed to assess the relation between marker expression, demographic and clinical data, and locoregional recurrence and disease-specific mortality.

RESULTS

Patients with high expression of HIF-1α developed significantly more often a locoregional recurrence (39%) compared to patients with a low expression (21%) (p = 0.002). The expression of CA-IX and Ki-67 showed no association with locoregional recurrent disease. HIF-1α, CA-IX and Ki-67 were not significantly related to disease-specific mortality. Clinical N-status was an independent predictor of recurrent disease (p < 0.001) and disease-specific mortality (p = 0.003). Age, sex and T-status were not related to locoregional recurrent disease or disease-specific mortality.

CONCLUSION

HIF-1α overexpression and the presence of regional lymph node metastases at diagnosis were independent predictors of locoregional recurrent disease after primary treatment with curatively intended radiotherapy in patients with locally advanced LSCC.

Optimal treatment strategy and prognostic analysis for hypopharyngeal squamous-cell carcinoma patients with T3-T4 or node-positive: A population-based study

PURPOSE

To explore the optimal treatment strategy and relevant prognostic analysis for hypopharyngeal squamous-cell carcinoma patients (HSCC) with T3-T4 or node-positive.

METHODS AND MATERIALS

From 2004 to 2018, data for 2574 patients from the Surveillance, Epidemiology, and End Results database (SEER) and 66 patients treated at our center from 2013 to 2022 with T3-T4 or N + HSCC were collected. Patients in the SEER cohort were randomly assigned to the training set or validation set at a 7:3 ratio. Variables with statistically significant (P < 0.05) in univariate COX regression analysis or clinical significance were included in the multivariate COX regression model and subsequently used to construct the nomogram.

RESULTS

The 3-year OS (52.9%vs44.4%, P < 0.01) and 3-year CSS rate (58.7%vs51.5%, P < 0.01) rates in the surgery combined with postoperative adjuvant therapy (S + ADT) group were superior to the radiotherapy combined with chemotherapy (CRT) group. The multivariate Cox regression analysis of the training group showed that age, race, marital status, primary site, T stage, N stage, and treatment modalities were correlated with OS and CSS. Based on those variables, we constructed nomograms for OS and CSS. Both the internal and external validation showed high prediction accuracy of the nomogram.

CONCLUSION

Among patients with T3-T4 or node-positive, S + ADT was associated with superior OS and CSS compared to those treated with primary CRT, while the survival rate in the CRT group was comparable to S + ADT group in T2-T3 disease. The internal and external verification shows that the prognostic model has good discrimination ability and accuracy.

Ultrasound and Microbubbles Mediated Bleomycin Delivery in Feline Oral Squamous Cell Carcinoma—An In Vivo Veterinary Study

To investigate the feasibility and tolerability of ultrasound and microbubbles (USMB)-enhanced chemotherapy delivery for head and neck cancer, we performed a veterinary trial in feline companion animals with oral squamous cell carcinomas. Six cats were treated with a combination of bleomycin and USMB therapy three times, using the Pulse Wave Doppler mode on a clinical ultrasound system and EMA/FDA approved microbubbles. They were evaluated for adverse events, quality of life, tumour response and survival. Furthermore, tumour perfusion was monitored before and after USMB therapy using contrast-enhanced ultrasound (CEUS). USMB treatments were feasible and well tolerated. Among 5 cats treated with optimized US settings, 3 had stable disease at first, but showed disease progression 5 or 11 weeks after first treatment. One cat had progressive disease one week after the first treatment session, maintaining a stable disease thereafter. Eventually, all cats except one showed progressive disease, but each survived longer than the median overall survival time of 44 days reported in literature. CEUS performed immediately before and after USMB therapy suggested an increase in tumour perfusion based on an increase in median area under the curve (AUC) in 6 out of 12 evaluated treatment sessions. In this small hypothesis-generating study, USMB plus chemotherapy was feasible and well-tolerated in a feline companion animal model and showed potential for enhancing tumour perfusion in order to increase drug delivery. This could be a forward step toward clinical translation of USMB therapy to human patients with a clinical need for locally enhanced treatment.

Effects of frailty on patients undergoing head and neck cancer surgery with flap reconstruction: a retrospective analysis

OBJECTIVES

To establish the implications of frailty as a predictor of outcome in patients with head and neck cancer requiring flap repair.

DESIGN

Retrospective cohort.

DATA SOURCE

We captured data from patients above 60 years old undergoing head and neck tumour resection and free flap reconstruction surgery between June 2019 and June 2020 at the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The data contain all treatment information.

OUTCOME VARIABLES

Surgery repeated in 30 days, postoperative complications, hospital length of stay, postoperative main biochemical standards.

EXPOSURE VARIABLES

Age, sex, smoking history, alcoholism history, American Society of Anesthesiologists score, National Nosocomial Infection Surveillance score and Clinical T staging were exposure variables. The frailty index is the main variable.

RESULT

A total of 254 patients were included in this study. Among them, 124 patients were classified as frail, while 130 patients were classified as non-frail. We found that frail patients stayed in the hospital longer than non-frail patients after surgery (p=0.018). According to the data of 26 frail patients who directly entered the intensive care unit (ICU), we found that these patients had a lower leucocyte count (p=0.005).

CONCLUSIONS

Frailty is a useful predictor of outcomes in patients undergoing head and neck cancer surgery with flap reconstruction. Frailty can be a clinical tool used to identify high-risk patients and guide perioperative care to optimise patient outcomes. Frail patients have better outcomes if they directly enter the ICU.

Genetic Variation in the ZNF208 Gene at rs8103163 and rs7248488 Is Associated With Laryngeal Cancer in the Northwestern Chinese Han Male

Background: Laryngeal cancer is more common in middle-aged and older men. We conducted an association analysis between ZNF208 polymorphisms and laryngeal cancer (LC) risk in the Northwestern Chinese Han male.

Methods: A total of 352 subjects (172 LC patients and 180 controls) were involved in this study. Agena MassARRAY was used to determine the genotypes. Unconditional logistic regression analysis was performed to explore the relevance.

Results: Two SNPs were associated with the risk of LC: rs8103163, OR = 1.41, p = 0.043; rs7248488, OR = 1.45, p = 0.025. Furthermore, rs8103163 was associated with an increased risk of LC under a log-additive model (OR = 1.40, p = 0.042), and rs7248488 was related to a higher risk of LC under a recessive model (OR = 2.33, p = 0.025) and a log-additive model (OR = 1.44, p = 0.026).

Conclusions: We first demonstrated that the rs8103163 A allele and the rs7248488 A allele in ZNF208 create susceptibility to laryngeal cancer in the Northwestern Chinese Han male.