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Hashmi AA, Mudassir G, Rashid K, Malik UA, Zia S, Zia F, Irfan M. Risk Factors of Oral Squamous Cell Carcinoma with Special Emphasis on Areca Nut Usage and Its Association with Clinicopathological Parameters and Recurrence. Int J Surg Oncol 2024; 2024:9725822. [PMID: 39233744 PMCID: PMC11374421 DOI: 10.1155/2024/9725822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/20/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction Oral squamous cell carcinoma (OSCC) is the most prevalent type of head and neck cancer and is associated with high mortality, particularly in Southeast Asian countries. Areca nut usage, smoking, and alcohol consumption are the most common risk factors for OSCC. Areca nut chewing is highly prevalent in Pakistan and has been attributed to an increase in OSCC cases. This study aimed to determine the association between areca nut usage and various clinicopathological features of OSCC and further evaluate the association of clinicopathological parameters of OSCC with tumor recurrence. Materials and Methods The study was conducted using the data of 228 patients with OSCC resected at Liaquat National Hospital, Karachi, Pakistan, over 5 years between 2018 and 2022. Clinicopathological data were collected from hospital archives, and associations between various risk factors and clinicopathological parameters were determined. Results Males were more commonly affected (77.2%), and the most common age group was <50 years (54.4%). Areca nut usage was reported in 59.6% of cases, and the buccal mucosa was the most common site (62.7%). Areca nut usage was significantly associated with male gender, greater tumor size, greater depth of invasion (DOI), higher tumor stage, nodal stage, presence of perineural invasion (PNI), and recurrence. In addition, multivariate analysis revealed that OSCC recurrence was significantly associated with older age, larger tumor size and DOI, nodal metastasis, and areca nut usage. Conclusion Areca nut-related OSCCs were associated with poor prognosis and recurrence in our study population. Furthermore, OSCC recurrence was associated with various clinicopathological parameters, such as larger tumor size, a higher DOI, and nodal metastasis.
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Affiliation(s)
- Atif Ali Hashmi
- Department of Histopathology Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Ghazala Mudassir
- Department of Pathology Shifa College of Dentistry Shifa Tameer-e-Millat University, Rawalpindi, Pakistan
| | - Khushbakht Rashid
- Department of Nephrology Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | | | - Shamail Zia
- Department of Pathology Jinnah Sindh Medical University, Karachi, Pakistan
| | - Fazail Zia
- Department of Pathology Jinnah Sindh Medical University, Karachi, Pakistan
| | - Muhammad Irfan
- Department of Biostatistics Liaquat National Hospital and Medical College, Karachi, Pakistan
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Gupta I, Badrzadeh F, Tsentalovich Y, Gaykalova DA. Connecting the dots: investigating the link between environmental, genetic, and epigenetic influences in metabolomic alterations in oral squamous cell carcinoma. J Exp Clin Cancer Res 2024; 43:239. [PMID: 39169426 PMCID: PMC11337877 DOI: 10.1186/s13046-024-03141-5] [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: 05/20/2024] [Accepted: 07/28/2024] [Indexed: 08/23/2024] Open
Abstract
Oral squamous cell carcinoma (OSCC) accounts for around 90% of all oral cancers and is the eighth most common cancer worldwide. Despite progress in managing OSCC, the overall prognosis remains poor, with a survival rate of around 50-60%, largely due to tumor size and recurrence. The challenges of late-stage diagnosis and limitations in current methods emphasize the urgent need for less invasive techniques to enable early detection and treatment, crucial for improving outcomes in this aggressive form of oral cancer. Research is currently aimed at unraveling tumor-specific metabolite profiles to identify candidate biomarkers as well as discover underlying pathways involved in the onset and progression of cancer that could be used as new targets for diagnostic and therapeutic purposes. Metabolomics is an advanced technological approach to identify metabolites in different sample types (biological fluids and tissues). Since OSCC promotes metabolic reprogramming influenced by a combination of genetic predisposition and environmental factors, including tobacco and alcohol consumption, and viral infections, the identification of distinct metabolites through screening may aid in the diagnosis of this condition. Moreover, studies have shown the use of metabolites during the catalysis of epigenetic modification, indicating a link between epigenetics and metabolism. In this review, we will focus on the link between environmental, genetic, and epigenetic influences in metabolomic alterations in OSCC. In addition, we will discuss therapeutic targets of tumor metabolism, which may prevent oral tumor growth, metastasis, and drug resistance.
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Affiliation(s)
- Ishita Gupta
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Marlene & Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Fariba Badrzadeh
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Marlene & Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Yuri Tsentalovich
- International tomography center CB RAS, Institutskaya str. 3a, Novosibirsk, 630090, Russia
| | - Daria A Gaykalova
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
- Department of Otorhinolaryngology-Head and Neck Surgery, Marlene & Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA.
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
- Institute for Genome Sciences, 670 West Baltimore Street, Baltimore, MD, 21201, USA.
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Khalil C, Khoury M, Higgins K, Enepekides D, Karam I, Husain ZA, Bayley A, Poon I, Truong T, Chan KKW, Smoragiewicz M, Fu R, Eskander A. Lymph node yield: Impact on oncologic outcomes in oral cavity cancer. Head Neck 2024; 46:1965-1974. [PMID: 38344842 DOI: 10.1002/hed.27656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Lymph node metastases are associated with poor prognosis in oral cavity squamous cell carcinoma (OCSCC). In other cancers, clinical guidelines on the number of lymph nodes removed during primary surgery, lymph node yield (LNY), exist. Here, we evaluated the prognostic capacity of LNY on regional failure, locoregional recurrence, and disease-free survival (DFS) in patients with OCSCC treated by primary neck surgery. METHODS This retrospective cohort study took place at Sunnybrook Health Sciences Centre in Toronto, Canada and involved a chart review of all adult patients with treatment-naive OCSCC undergoing primary neck dissection. For each outcome, we first used the maximally selected rank statistics and an optimism-corrected concordance to identify an optimal threshold of LNY. We then used a multivariable Cox proportional hazards model to assess the association between high LNY (>threshold) and each outcome. RESULTS Among the 579 patients with OCSCC receiving primary neck dissection, 61.7% (n = 357) were male with a mean age of 62.9 years (standard deviation: 13.1) at cancer diagnosis. When adjusting for sociodemographic and clinical factors, LNY >15 was significantly associated with improved DFS (adjusted HR [aHR]: 0.73, 95% CI: 0.54-0.98), locoregional recurrence (aHR: 0.68, 95% CI: 0.49-0.95), and regional failure (aHR: 0.61, 95% CI: 0.39-0.93). CONCLUSIONS Our study findings suggested high LNY to be a strong independent predictor of various patient-level quality of surgical care metrics. The optimal LNY we found (15) was lower than the conventionally recommended (18), which calls for further research to establish validity in practice.
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Affiliation(s)
- Carlos Khalil
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Khoury
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Zain Ali Husain
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Andrew Bayley
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ian Poon
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Tra Truong
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Martin Smoragiewicz
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rui Fu
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Pinto JV, Pedrosa S, Vales F, Rodrigues Pereira P, Silveira H, Moura CP. Nodal Yield in Level II-IV Neck Dissections in Head and Neck Squamous Cell Carcinoma. Cureus 2024; 16:e63310. [PMID: 39070387 PMCID: PMC11283326 DOI: 10.7759/cureus.63310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVES The main objective of this study is to analyze factors associated with nodal yield in level II-IV selective neck dissections (NDs) and the secondary objective is to assess its impact on overall and disease-free survival. METHODS Observational retrospective study including adult patients submitted to level II-IV ND from January 2015 to December 2021 in the otorhinolaryngology department of a tertiary hospital center. RESULTS A total of 44 patients and 78 level II-IV NDs (34 bilateral and 10 unilateral) were included. The median age at diagnosis was 60 (22-74) years, and 93.2% of the patients were male. A lower nodal yield was significantly associated with previous radiotherapy (p = 0.042) and extranodal invasion (p < 0.001) and was non-significantly associated with older age (p = 0.065). Furthermore, on a Cox analysis adjusted to the cN status and age, the nodal yield was not associated with five-year disease-free survival (HR = 0.986; 95% CI = 0.922-1.054; p = 0.681) nor with five-year overall survival (HR = 1.006; 95% CI = 0.925-1.095; p = 0.888). CONCLUSION A reduced nodal yield in level II-IV NDs was significantly associated with previous radiotherapy and extranodal extension and non-significantly associated with age. There was no association between the nodal yield and five-year overall survival or disease-free survival.
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Affiliation(s)
- João V Pinto
- Otorhinolaryngology Department, Unidade Local de Saúde de São João, Porto, PRT
- Otorhinolaryngology Department, Faculdade de Medicina da Universidade do Porto, Porto, PRT
- Research, Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto, PRT
| | - Sofia Pedrosa
- Pathology and Laboratory Medicine Department, Unidade Local de Saúde de São João, Porto, PRT
| | - Fernando Vales
- Otorhinolaryngology Department, Unidade Local de Saúde de São João, Porto, PRT
- Otorhinolaryngology Department, Faculdade de Medicina da Universidade do Porto, Porto, PRT
| | - Pedro Rodrigues Pereira
- Pathology and Laboratory Medicine Department, Unidade Local de Saúde de São João, Porto, PRT
| | - Helena Silveira
- Otolarhinoryngology Department, Unidade Local de Saúde de São João, Porto, PRT
| | - Carla P Moura
- Otorhinolaryngology Department, Unidade Local de Saúde de São João, Porto, PRT
- Genetics Department, Porto Medical School, University of Porto, Porto, PRT
- Research, i3S - Instituto de Investigação e Inovação em Saúde, Porto, PRT
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Pinto JV, Sousa MM, Silveira H, Vales F, Moura CP. Comparison of Clinical and Pathological Staging in Patients with Head and Neck Cancer After Neck Dissection. Int Arch Otorhinolaryngol 2023; 27:e571-e578. [PMID: 37876699 PMCID: PMC10593535 DOI: 10.1055/s-0042-1758208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 06/30/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Clinical and pathological staging plays an important role on the prognosis of head and neck cancer (HNC) patients. Objective The present study aims to compare clinical and pathological T, N and overall staging in patients with HNC, to identify factors associated with these discrepancies, and to analyze and compare survival or disease-free survival in staging disagreements. Methods Retrospective cohort including every patient submitted to neck dissection from January 2010 to December 2020 in the department of Otorhinolaryngology of a tertiary hospital center. Results A total of 79 patients were analyzed; their mean age was 58.52 ± 13.15 years old and 88.9% were male. Assessing overall staging, discrepancies were noted in 53% (36.4% upstaging and 16.6% downstaging) and were significantly associated with clinical overall staging ( p = 0.006). Regarding T staging, differences were noted in 45.5% (30.3% upstaging and 15.2% downstaging) and were significantly associated with imaging modality ( p = 0.016), clinical T staging ( p = 0.049), and histology ( p = 0.017). Discrepancies in N staging were noted in 38% (25.3% upstaging and 12.7% downstaging) and were significantly associated with age ( p = 0.013), clinical N staging ( p < 0.001), and presence of extranodal invasion ( p < 0.001). Both in Overall, T, and N staging, the aforementioned disagreements were not associated with either higher mortality or higher disease relapse. Conclusion Overall, T, and N staging disagree in an important number of cases, and the overall stage can disagree in up to 53% of the cases. These disagreements do not seem to influence overall and disease-free survival.
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Affiliation(s)
- João Viana Pinto
- Otorhinolaryngology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Otorhinolaryngology, Surgery and Physiology Department, Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
- Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Porto University, Portugal
| | - Mafalda Martins Sousa
- Otorhinolaryngology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Otorhinolaryngology, Surgery and Physiology Department, Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
| | - Helena Silveira
- Otorhinolaryngology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Otorhinolaryngology, Surgery and Physiology Department, Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
| | - Fernando Vales
- Otorhinolaryngology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Otorhinolaryngology, Surgery and Physiology Department, Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
| | - Carla Pinto Moura
- Otorhinolaryngology Department, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
- Department of Medical Genetics, Centro Hospitalar Universitário S. João, Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal
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Tan Y, Wang Z, Xu M, Li B, Huang Z, Qin S, Nice EC, Tang J, Huang C. Oral squamous cell carcinomas: state of the field and emerging directions. Int J Oral Sci 2023; 15:44. [PMID: 37736748 PMCID: PMC10517027 DOI: 10.1038/s41368-023-00249-w] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023] Open
Abstract
Oral squamous cell carcinoma (OSCC) develops on the mucosal epithelium of the oral cavity. It accounts for approximately 90% of oral malignancies and impairs appearance, pronunciation, swallowing, and flavor perception. In 2020, 377,713 OSCC cases were reported globally. According to the Global Cancer Observatory (GCO), the incidence of OSCC will rise by approximately 40% by 2040, accompanied by a growth in mortality. Persistent exposure to various risk factors, including tobacco, alcohol, betel quid (BQ), and human papillomavirus (HPV), will lead to the development of oral potentially malignant disorders (OPMDs), which are oral mucosal lesions with an increased risk of developing into OSCC. Complex and multifactorial, the oncogenesis process involves genetic alteration, epigenetic modification, and a dysregulated tumor microenvironment. Although various therapeutic interventions, such as chemotherapy, radiation, immunotherapy, and nanomedicine, have been proposed to prevent or treat OSCC and OPMDs, understanding the mechanism of malignancies will facilitate the identification of therapeutic and prognostic factors, thereby improving the efficacy of treatment for OSCC patients. This review summarizes the mechanisms involved in OSCC. Moreover, the current therapeutic interventions and prognostic methods for OSCC and OPMDs are discussed to facilitate comprehension and provide several prospective outlooks for the fields.
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Affiliation(s)
- Yunhan Tan
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
- West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhihan Wang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Mengtong Xu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Bowen Li
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Zhao Huang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Siyuan Qin
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Edouard C Nice
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, Australia
| | - Jing Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Canhua Huang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China.
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Martins Sousa M, Guimarães J, Monteiro E. Comparison Between Clinical and Pathological Staging After Elective Neck Dissection in Head and Neck Cancer. Cureus 2023; 15:e40881. [PMID: 37492826 PMCID: PMC10363934 DOI: 10.7759/cureus.40881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION Head and neck squamous cell carcinomas (HNSCC) are the most common malignancies in the head and neck. Previous studies have shown discrepancies in clinical and pathological staging, with a significant number of head and neck cancer patients who were not correctly staged. This has important implications regarding the treatment and prognosis of these patients. The aim of this study was to analyze potential disagreements in clinical and pathological staging in patients with head and neck cancer who underwent elective neck dissection. METHODS A retrospective study of patients with squamous cell carcinoma of the head and neck, who underwent elective neck dissection, between January 2018 and December 2020. RESULTS We analyzed 87 patients, with an average age of 64 ± 10.05 years, of whom 96.6% were male. The primary tumor location was the glottis (31%), oropharynx (26.4%), hypopharynx (19.5%), supraglottis (11.5%), and oral cavity (11.5%). In 87.3% there was a history of smoking and/or drinking. Pathological N (pN) staging was higher than clinical staging in 34.3% of patients (N1 in 22.9%; N2 in 8%; N3 in 3.4%). There were no significant differences between the number of nodes removed and the pN staging. However, there was a significant survival difference in patients with>15 nodes removed (p=0.05). There was also a significant difference in patients with pN up-staging regarding survival (p=0.005). Pathological T staging was different from clinical T staging (p<0.05), with an up-staging in 18.4% of the patients and a down-staging in 14.9%, without significant differences regarding survival or recurrence (p>0.05). Adjuvant treatment with radiotherapy was performed in 41.4% and with chemo-radiotherapy in 13.8% of the patients. Locoregional recurrence occurred in 17.5%. CONCLUSION This study revealed that clinical and pathological N staging after elective neck dissection disagreed in a substantial number of patients, with pathological upstaging and significant differences regarding survival. With relation to T staging, there were no significant differences regarding survival. We should be aware of staging disagreements since they can have significant implications on the treatment and prognosis of cancer patients.
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Affiliation(s)
- Mafalda Martins Sousa
- Otolaryngology - Head and Neck Surgery, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Joana Guimarães
- Otolaryngology - Head and Neck Surgery, Instituto Português de Oncologia do Porto, Porto, PRT
| | - Eurico Monteiro
- Otolaryngology - Head and Neck Surgery, Instituto Português de Oncologia do Porto, Porto, PRT
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Li J, Xu Y, Zhang J, Wang S, Wang X, Guo H, Miao G. Prognostic value of the nodal yield in oral squamous cell carcinoma: a systematic review and meta-analysis. Expert Rev Anticancer Ther 2023; 23:339-345. [PMID: 36645663 DOI: 10.1080/14737140.2023.2168648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To systematically evaluate the prognostic value of the nodal yield in oral squamous cell carcinoma by meta-analysis. METHODS The meta-analysis was adherence to PRISMA. We searched MEDLINE, Embase, and Cochrane for studies published up to 20 April 2022. We collected evidences from observational studies regarding nodal yield in oral squamous cell carcinoma, and investigated its prognostic value by the routine methods of meta-analysis. RESULTS From seven studies, there was no significant impact of the lymph node yield on overall survival among patients with oral squamous cell carcinoma cases and <18 lymph nodes (hazard ratio (HR) = 1.019, 95% confidence interval (CI) = 0.786-1.320, p = 0.887), with significant heterogeneity (I2 = 80%). The pooled result indicated that a > 18-lymph node yield was a favorable prognostic factor (HR = 0.786, 95%CI = 0.646-0.956, p = 0.016; I2 = 39%). The lymph node yield was not associated with disease-specific survival (HR = 1.594, 95%CI = 0.996-2.552, p = 0.052; I2 = 81%) or disease-free survival (HR = 1.508, 95%CI = 0.924-2.460, p = 0.100; I2 = 41%). CONCLUSION A lymph node yield of ≥18 lymph nodes might be a favorable prognostic factor for the overall survival of patients with oral squamous cell carcinoma.
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Affiliation(s)
- Jiajia Li
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Yubo Xu
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Shaohai Wang
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Xiaoyu Wang
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Huayan Guo
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
| | - Guojun Miao
- Department of Oral and Maxillofacial Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, Tongji, China
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Liu XC, Ma SR, Shi S, Zhao YF, Jia J. Prognostic significance of lymph node ratio in patients with squamous cell carcinoma of the floor of the mouth. Int J Oral Maxillofac Surg 2021; 51:307-313. [PMID: 34281747 DOI: 10.1016/j.ijom.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/21/2021] [Accepted: 07/01/2021] [Indexed: 11/19/2022]
Abstract
The lymph node ratio (LNR) has been proposed as an independent prognostic factor for survival in patients with oral squamous cell carcinoma (OSCC). However, little attention has been paid to its role in the specific subsite of the floor of the mouth (FOM). The purpose of this study was to evaluate the prognostic significance of the LNR in patients with FOM SCC. A retrospective analysis of 92 patients with FOM SCC who were treated with primary curative resection and neck dissection was conducted. Overall survival (OS) and disease-free survival (DFS) were used to evaluate the prognostic significance of the LNR. Both of these parameters were significantly worse (P < 0.001) in patients with neck metastases. The mean LNR was 0.145 in patients with positive lymph nodes. A LNR <0.145 was predictive of longer DFS, while the receiver operating characteristic curve analysis demonstrated that a LNR ≥0.175 indicated a significantly lower OS. This study confirms that metastatic cervical lymph nodes correlate with an adverse prognosis in patients with FOM SCC, and specifically, a LNR ≥0.145 is predictive. Therefore, the LNR in patients with FOM SCC may be a predictor of survival in these patients.
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Affiliation(s)
- X C Liu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine - Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - S R Ma
- Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - S Shi
- Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Y F Zhao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine - Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - J Jia
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine - Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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Prognostic value of the nodal yield in elective neck dissections in patients with head and neck carcinomas. Eur Arch Otorhinolaryngol 2021; 279:883-889. [PMID: 33938992 DOI: 10.1007/s00405-021-06819-0] [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: 01/19/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The objective of this study is to assess the prognostic capacity of the nodal yield in elective neck dissections performed in patients with head and neck squamous cell carcinomas (HNSCC) without clinical or radiological evidence of regional involvement (cN0) at the time of diagnosis. METHODS Retrospective study including 647 patients with HNSCC treated with an elective neck dissection. RESULTS Patients with < 15 dissected nodes (n = 172, 26.6%) had a 5-year disease-specific survival of 64.9% (95% CI: 57.3-72.5%), while for patients with ≥ 15 dissected nodes (n = 475, 73.4%), it was of 81.9% (95% CI: 78.4-85.4%) (P = 0.0001). The nodal yield category had prognostic capacity on the disease-specific survival in patients with tumors located in the oral cavity (P = 0.001), the oropharynx (P = 0.023) and the hypopharynx (P = 0.034), while for patients with tumors located in the larynx, no significant differences appeared (P = 0.779). Differences in regional recurrence-free survival were also observed based on the nodal yield category in patients with extra-laryngeal tumors (5-year regional recurrence-free survival of 81.0% in patients with < 15 dissected nodes vs 89.0% in patients with ≥ 15 dissected nodes; P = 0.046). CONCLUSION The nodal yield in elective neck dissections in patients without evidence of lymph node disease (cN0) had prognostic capacity depending on the location of the primary tumor. For tumors located in the larynx, the number of dissected nodes did not significantly influence the prognosis. For tumors located in the oral cavity, oropharynx or hypopharynx, patients with < 15 dissected nodes had a disease-specific mortality 2.9 times higher than patients with ≥ 15 dissected nodes.
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A preoperative prognostic nutritional index is a prognostic indicator in oral squamous cell carcinoma patients undergoing radical surgery. Int J Oral Maxillofac Surg 2021; 50:1413-1421. [PMID: 33663900 DOI: 10.1016/j.ijom.2021.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/17/2020] [Accepted: 01/19/2021] [Indexed: 12/23/2022]
Abstract
The purpose of this study was to investigate the prognostic value of prognostic nutritional index (PNI) in oral squamous cell carcinoma (OSCC) patients and to undertake a comparative evaluation of the prognostic value of comparing PNI, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in terms of prognostic utility. A retrospective study was conducted involving 203 consecutive patients with OSCC who were treated with radical surgery with curative intent. The PNI and systemic inflammatory response were developed, and their prognostic utility was evaluated. Kaplan-Meier curve analysis and log-rank testing showed that PNI (P< 0.001), NLR (P=0.011), PLR (P=0.013), and LMR (P=0.014) were significantly associated with overall survival. Multivariate analysis identified PNI as an independent prognostic factor for OSCC patients (P=0.029). In time-dependent receiver operating characteristic curve analysis, PNI was continuously superior to that of NLR, PLR, and LMR. In conclusion, this study suggested that PNI offered an independent prognostic biomarker in OSCC patients undergoing radical surgery. However, this study was small and retrospective, thus further investigations are needed to clarify the utility of PNI for tailor-made treatments in clinical settings.
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Roy P, Mallick I, Arun I, Zameer L, Dey D, Singh A, Chatterjee S, Jain P, Manikantan K, Sharan R, Pattatheyil A. Nodal yield and topography of nodal metastases from oral cavity squamous cell carcinoma - An audit of 1004 cases undergoing primary surgical resection. Oral Oncol 2020; 113:105115. [PMID: 33341004 DOI: 10.1016/j.oraloncology.2020.105115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Nodal metastasis is an important prognostic factor in oral squamous cell carcinoma (OSCC). Detailed topographic study of metastasis can guide surgical and adjuvant radiation treatment protocols. METHODS Retrospective analysis of distribution of nodal spread was done by auditing pathology records of 1004 patients who underwent primary surgical management at our center. RESULTS The median nodal yield was 41 (range of 9-166) nodes, per patient. Metastasis was present in 42.9% patients, of which 52.3% demonstrated extranodal extension. Reclassification by AJCC8 criteria resulted in up-staging in 35.6% patients (pN1, pN2a, pN2b, pN2c, pN3a and pN3b in 13.1%, 3.7%, 6.9%, 0.9%, 0%, 18.1% respectively). Ipsilateral levels Ib and IIa were involved in a quarter of patients each, while IIb, IV and V were involved in < 4%, 3% and 1% of patients, respectively. Contralateral nodal metastasis was present in 5.4%. Skip metastases to level IV were 2.2% and 1.2% for tongue and gingivobuccal primaries. Tongue primaries had a lower likelihood of involving level Ib, but higher of level IIa and III, compared to gingivobuccal primaries, and a lower likelihood of extranodal extension. Primary site did not influence nodal metastasis to levels IIb, IV or V, but other factors like lymphovascular invasion, pT stage and margin status had an influence. CONCLUSION This large series with high nodal yield, shows low level of metastasis to level IIb, IV and V, which can help modify future guidelines for extent of surgery and avoid targeted adjuvant radiation to specific levels.
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Affiliation(s)
- Paromita Roy
- Oncopathology, Tata Medical Center, Kolkata, India.
| | | | - Indu Arun
- Oncopathology, Tata Medical Center, Kolkata, India
| | | | - Debdeep Dey
- Oncopathology, Tata Medical Center, Kolkata, India
| | - Angad Singh
- Oncopathology, Tata Medical Center, Kolkata, India
| | | | - Prateek Jain
- Head and Neck Surgery, Tata Medical Center, Kolkata, India
| | | | - Rajeev Sharan
- Head and Neck Surgery, Tata Medical Center, Kolkata, India
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Holcomb AJ, Perryman M, Goodwin S, Penn J, Villwock MR, Bur AM, Shnayder Y, Tsue TT, Woodroof J, Kakarala K. Pathology protocol increases lymph node yield in neck dissection for oral cavity squamous cell carcinoma. Head Neck 2020; 42:2872-2879. [PMID: 32578921 DOI: 10.1002/hed.26343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/11/2020] [Accepted: 05/30/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Lymph node yield (LNY) is a proposed quality indicator in neck dissection for oral cavity squamous cell carcinoma (OCSCC). METHODS Retrospective series including 190 patients with OCSCC undergoing neck dissection between 2016 and 2018. A change in pathologic grossing protocol was initiated during the study period to assess residual adipose tissue. A generalized linear model was used to assess the impact of multiple variables on LNY. RESULTS Mean LNY was 28.59 (SD = 17.65). The protocol identified a mean of 10.32 lymph nodes per case. Multivariable analysis identified associations between LNY and use of the pathology protocol (P = .02), number of dissected lymph node levels (P < .001), presence of pathologic lymph nodes (P = .002), body mass index (P = .02), prior neck surgery (P = .001), and prior neck radiation (P = .001). CONCLUSIONS Assessment of residual adipose tissue within neck dissection specimens improves accuracy of LNY. LNY in neck dissection is influenced by multiple factors including methods of pathologic assessment.
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Affiliation(s)
- Andrew J Holcomb
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mollie Perryman
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sara Goodwin
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph Penn
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mark R Villwock
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrés M Bur
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Terance T Tsue
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Janet Woodroof
- Department of Pathology and Lab Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiran Kakarala
- Department of Otolaryngology, Head and Neck Surgery, The University of Kansas Medical Center, Kansas City, Kansas, USA
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14
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Yu Y, Sultana R, Rangabashyam MS, Mohan N, Hwang JSG, Soong YL, Tan NC, Iyer GN, Tan HK. Impact of Radiotherapy on Neck Dissection Nodal Count in Patients With Head and Neck Cancer. Laryngoscope 2020; 130:1947-1953. [PMID: 32401396 DOI: 10.1002/lary.28620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/05/2020] [Accepted: 02/25/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Our study aimed to review the impact of preoperative radiotherapy (RT) and other factors on the lymph node count of neck dissection (ND) specimens from patients with head and neck cancer (HNC). A retrospective study was conducted on all patients with head and neck cancers who had undergone NDs in Singapore General Hospital between 1992 and 2013. STUDY DESIGN Retrospective study. METHODS Patients were categorized into two groups: patients treated with RT with or without chemotherapy before ND and patients who had undergone ND surgery without previous history of RT. The primary endpoint for this study would be the lymph node count from ND. RESULTS The study cohort consists of 1,024 NDs on 829 patients. There were 597 (58.3%) radical/modified radical NDs involving levels I-V. Within this group, 75 (12.6%) NDs had preoperative RT. Preoperative RT and age were found to significantly reduce nodal yield in both univariate and multivariate analysis in the radical/modified radical ND subgroup. In our multivariate analysis, preoperative RT was shown to decrease the nodal yield by 7.464 (P = .0002, 95% confidence interval [CI]: -11.35 to -3.58). Advanced age independently decreases nodal yield, even after accounting for the effect of RT (P = .0002, 95% CI: -0.27 to -0.08). In addition, preoperative RT has a more pronounced effect in reducing lymph node count in the older age group. CONCLUSIONS Preoperative RT and advanced age are independent and synergistic factors that reduce nodal count from NDs in patients with head and neck cancers. LEVEL OF EVIDENCE 4 Laryngoscope, 130: 1947-1953, 2020.
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Affiliation(s)
- Yue Yu
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Mahalakshmi S Rangabashyam
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore
| | - Niraj Mohan
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore
| | | | - Yoke-Lim Soong
- SingHealth Duke-NUS Head and Neck Centre, Singapore.,Division of Radiation Oncology, National Cancer Centre, Singapore
| | - Ngian-Chye Tan
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Gopalakrishna N Iyer
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Hiang-Khoon Tan
- Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre, Singapore.,SingHealth Duke-NUS Head and Neck Centre, Singapore.,Duke-NUS Medical School, Singapore
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Maymone MB, Greer RO, Kesecker J, Sahitya PC, Burdine LK, Cheng AD, Maymone AC, Vashi NA. Premalignant and malignant oral mucosal lesions: Clinical and pathological findings. J Am Acad Dermatol 2019; 81:59-71. [DOI: 10.1016/j.jaad.2018.09.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 01/20/2023]
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16
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Zenga J, Stadler M, Massey B, Campbell B, Shukla M, Awan M, Schultz CJ, Wong S, Jackson RS, Pipkorn P. Lymph node yield from neck dissection in HPV‐associated oropharyngeal cancer. Laryngoscope 2019; 130:666-671. [DOI: 10.1002/lary.28102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/10/2019] [Accepted: 05/20/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology and Communication SciencesMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Michael Stadler
- Department of Otolaryngology and Communication SciencesMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Becky Massey
- Department of Otolaryngology and Communication SciencesMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Bruce Campbell
- Department of Otolaryngology and Communication SciencesMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Monica Shukla
- Department of Radiation OncologyMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Musaddiq Awan
- Department of Radiation OncologyMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | | | - Stuart Wong
- Department of Medical OncologyMedical College of Wisconsin Milwaukee Wisconsin U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine Saint Louis Missouri U.S.A
| | - Patrick Pipkorn
- Department of Otolaryngology–Head and Neck SurgeryWashington University School of Medicine Saint Louis Missouri U.S.A
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A novel histopathological scoring system for patients with oral squamous cell carcinoma. Clin Oral Investig 2019; 23:3759-3765. [DOI: 10.1007/s00784-019-02804-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/11/2019] [Indexed: 01/08/2023]
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18
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Safi AF, Kauke M, Jung H, Timmer M, Borggrefe J, Persigehl T, Nickenig HJ, Zinser M, Maintz D, Kreppel M, Zöller J. Does volumetric measurement of cervical lymph nodes serve as an imaging biomarker for locoregional recurrence of oral squamous cell carcinoma? J Craniomaxillofac Surg 2018; 46:1013-1018. [DOI: 10.1016/j.jcms.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/13/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022] Open
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19
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The importance of lymph node ratio for patients with mandibular infiltration of oral squamous cell carcinoma. J Craniomaxillofac Surg 2018; 46:1007-1012. [DOI: 10.1016/j.jcms.2018.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/05/2018] [Accepted: 03/28/2018] [Indexed: 12/19/2022] Open
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20
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Comparative Analysis of Clinical and Pathological Lymph Node Staging Data in Head and Neck Squamous Cell Carcinoma Patients Treated at the General Hospital Vienna. Radiol Oncol 2018; 52:173-180. [PMID: 30018521 PMCID: PMC6043886 DOI: 10.2478/raon-2018-0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/04/2018] [Indexed: 12/28/2022] Open
Abstract
Background Results from publications evaluating discrepancies between clinical staging data in relation to pathological findings demonstrate that a significant number of head and neck squamous cell carcinoma (HNSCC) patients are not correctly staged. The aim of this retrospective study was to analyze potential discrepancies of radiological assessment versus pathological data of regional lymph node involvement and to compare the results with data published in the literature. Patients and methods In a retrospective analysis we focused on patients with HNSCC routinely treated by surgery plus postoperative radiotherapy between 2002 and 2012. For inclusion, complete pre-operative clinical staging information with lymph node status and patho-histological information on involved lymph node regions as well as survival outcome data were mandatory. We included 87 patients (UICC stage III-IV 90.8%) for which the aforementioned data obtained by CT or MRI were available. Overall survival rates were estimated by the Kaplan-Meier method. The Pearson correlation coefficient and Spearman's rank correlation coefficient (non-linear relationship) was calculated. Results Discrepancies at the level of overall tumour stage assessment were noticed in 27.5% of all cases. Thereof, 5.7% were assigned to patho-histological up-staging or down-staging of the primary tumour. At the lymph node level, 11.5% of the patients were downstaged, and 10.3% were upstaged. Conclusions The study showed that in approximately one-fifth (21.8%) of the patients, lymph node assessment by CT or MRI differs from the pathologic staging, an outcome that corresponds well with those published by several other groups in this field.
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