A prospective, single-arm, phase II clinical trial of intraoperative radiotherapy using a low-energy X-ray source for local advanced Laryngocarcinoma (ILAL): a study protocol

Machine learning model to preoperatively predict T2/T3 staging of laryngeal and hypopharyngeal cancer based on the CT radiomic signature

OBJECTIVES

To develop and assess a radiomics-based prediction model for distinguishing T2/T3 staging of laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) METHODS: A total of 118 patients with pathologically proven LHSCC were enrolled in this retrospective study. We performed feature processing based on 851 radiomic features derived from contrast-enhanced CT images and established multiple radiomic models by combining three feature selection methods and seven machine learning classifiers. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were used to assess the performance of the models. The radiomic signature obtained from the optimal model and statistically significant morphological image characteristics were incorporated into the predictive nomogram. The performance of the nomogram was assessed by calibration curve and decision curve analysis.

RESULTS

Using analysis of variance (ANOVA) feature selection and logistic regression (LR) classifier produced the best model. The AUCs of the training, validation, and test sets were 0.919, 0.857, and 0.817, respectively. A nomogram based on the model integrating the radiomic signature and a morphological imaging characteristic (suspicious thyroid cartilage invasion) exhibited C-indexes of 0.899 (95% confidence interval (CI) 0.843-0.955), fitting well in calibration curves (p > 0.05). Decision curve analysis further confirmed the clinical usefulness of the nomogram.

CONCLUSIONS

The nomogram based on the radiomics model derived from contrast-enhanced CT images had good diagnostic performance for distinguishing T2/T3 staging of LHSCC.

CLINICAL RELEVANCE STATEMENT

Accurate T2/T3 staging assessment of LHSCC aids in determining whether laryngectomy or laryngeal preservation therapy should be performed. The nomogram based on the radiomics model derived from contrast-enhanced CT images has the potential to predict the T2/T3 staging of LHSCC, which can provide a non-invasive and robust approach for guiding the optimization of clinical decision-making.

KEY POINTS

• Combining analysis of variance with logistic regression yielded the optimal radiomic model. • A nomogram based on the CT-radiomic signature has good performance for differentiating T2 from T3 staging of laryngeal and hypopharyngeal squamous cell carcinoma. • It provides a non-invasive and robust approach for guiding the optimization of clinical decision-making.

Clinical benefits of intraoperative radiotherapy for the recurrence of centrally located hepatocellular carcinoma with microvascular invasion

BACKGROUND

Although the efficacy and safety of intraoperative radiotherapy (IORT) in the treatment of malignant tumours, such as breast cancer, have been documented, it remains unclear whether this treatment is effective for centrally located hepatocellular carcinoma (HCC) with microvascular invasion (MVI).

AIMS

This study aimed to explore the efficacy and safety of IORT in the treatment of centrally located HCC with MVI.

METHODS AND RESULTS

Patients with centrally located HCC, who underwent surgery between January 2016 and January 2020, were enrolled. The patient cohort was then allocated to two groups: those who underwent IORT combined with liver resection (IORT+LR); or LR alone (LR). Propensity score matching and Cox proportional hazards regression analyses were performed. The Kaplan-Meier method was used to estimate recurrence-free survival (RFS), and the log-rank test was used to determine whether RFS differed between the groups. Subgroup analysis was performed to evaluate differences in RFS and early recurrence rates in patients with different MVI grades. E-values were generated to measure the sensitivity to unmeasured confounding factors. In total, 97 patients were enrolled, 27 of whom underwent IORT+LR and 70 underwent LR alone. The 1-, 3-, and 5-year RFS rates in the IORT+LR group were 66%, 50%, and 32%, respectively, whereas those in the LR group were 54%, 37%, and 26%, respectively. After matching analysis, 23 patients were successfully matched, and RFS was found to be significantly different between the two groups (p = .04). IORT was an independent prognostic factor for RFS (hazard ratio 0.46 [95% confidence interval 0.21-0.99]). In subgroup analysis, RFS between the IORT+LR and LR groups was significantly different in patients with MVI (M1 grade) (p = .0067). The postoperative early recurrence rate was significantly reduced with IORT (p < .05). No serious complications were reported in either group following surgery. Based on E-values, the results appeared to be robust against unmeasured confounding factors.

CONCLUSION

IORT+LR provided safe, feasible treatment for patients with centrally located HCC with MVI, along with an improvement in prognosis and lower early recurrence rates.

Prediction of network pharmacology, molecular docking-based strategy, and vitro assays to determine potential pharmacological mechanism of Dioscoreae bulbiferae and Bruceae fructus against laryngocarcinoma

BACKGROUND

Based on network pharmacology, molecular docking, and vitro assays, investigate the probable pharmacological mechanism of Dioscoreae bulbiferae and Bruceae fructus in the treatment of laryngocarcinoma.

METHODS

The active components and targets of Dioscoreae bulbiferae and Bruceae fructus were retrieved from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform database. Targets linked with laryngocarcinoma were gathered from the GeneCards, DisGeNET, and DrugBank databases. The String database was utilized to build a protein-protein interaction network of common medication and illness targets, after which the core targets were filtered out. The Metascape database served for gene ontology enrichment and Kyoto encyclopedia of genes and genomes pathway analysis of common targets. AutoDock then performed molecular docking between the essential component and the vital target. To investigate the biological effects of diosbulbin B, we assessed the viability of laryngocarcinoma cells after diosbulbin B therapy using the Mahalanobis Taguchi system technique. Following that, we looked at how diosbulbin B affected colony formation after 14 days of culture of treated cells. Flow cytometry was utilized to detect apoptosis in order to examine the influence of diosbulbin B on laryngocarcinoma cell apoptosis.

RESULTS

According to a study of the literature, the fundamental components of Dioscoreae bulbiferae and Bruceae fructus in the treatment of laryngocarcinoma include brusatol and diosbulbin B, which may operate on core targets such as cyclin D1, Cyclin Dependent Kinase Inhibitor 1A, and E2F Transcription Factor 1. The significant pathways discovered using Kyoto encyclopedia of genes and genomes enrichment analysis were the phosphoinositide 3-kinase-protein kinase B signaling route, the tumor necrosis factor signaling pathway, and so on. These pathways primarily influence the development and prognosis of laryngeal cancer by controlling cell growth, cell proliferation, angiogenesis, tumorigenesis, and metastasis. The molecular docking studies revealed that the affinity between the heart and crucial targets was robust. The results of vitro assays indicate that diosbulbin B suppressed Hep-2 cell activity in a concentration-dependent manner. Besides, diosbulbin B has powerful antiproliferative properties in Hep-2 cells. Flow cytometry results showed that diosbulbin B promoted laryngocarcinoma cell apoptosis in a concentration-dependent manner.

CONCLUSION

The article delivered a preliminary discussion of the probable mechanism of Dioscoreae bulbiferae and Bruceae fructus in the treatment of laryngocarcinoma, which can serve as a theoretical basis and evidence for subsequent experimental investigation.

The prognostic role of coagulation markers in the progression and metastasis of laryngeal squamous cell carcinoma

BACKGROUND

The application of coagulation-related markers in laryngeal squamous cell carcinoma(LSCC) remains unclear. This study explored the prognostic role of coagulation markers in the progression and metastasis of LSCC.

METHODS

Coagulation markers of patients with LSCC receiving surgery in the Second Affiliated Hospital of Fujian Medical University in China, from January 2013 to May 2022 were retrospectively analyzed and compared with those of contemporary patients with benign laryngeal diseases. The relationship between clinicopathological features of LSCC and coagulation markers was analyzed with the chi-square and rank sum tests. The ROC curve analysis was utilized to evaluate the diagnostic efficacy of seven coagulation markers for LSCC and its different clinicopathological features, and to find the optimal cutoff value of each coagulation marker.

RESULTS

303 patients with LSCC and 533 patients with benign laryngeal diseases were included in the present analysis. Compared to the control group, prothrombin time (PT) (p < 0.001), activated partial thromboplastin time (APTT) (p = 0.001), and Fib (p < 0.001) in patients with LSCC were significantly higher, while mean platelet volume (MPV) (p < 0.001) was significantly shorter. Significant increases were detected in PT (Z = 14.342, p = 0.002), Fib (Z = 25.985, p < 0.001), platelet count (PC) (Z = 12.768, p = 0.005), PCT (Z = 9.178, p = 0.027), MPV (F = 2.948, p = 0.033) in T4 stage. Fib had the highest prognostic value among the seven coagulation markers in different T stages (AUC = 0.676, p < 0.001), N stages (AUC = 0.717, p < 0.001), tumor stage (AUC = 0.665, p < 0.001), differentiation degree (AUC = 0.579, p = 0.022), and neurovascular invasion (AUC = 0.651, p = 0.007). Fib (Z = 25.832, p < 0.001), PC (Z = 23.842, p < 0.001), and PCT (Z = 20.15, p < 0.001) in N1 and N3 stages were significantly higher than in N0 stage. PT (Z = 12.174, p = 0.007), Fib (Z = 23.873, p < 0.001), PC (Z = 17.785, p < 0.001), and PCT (Z = 14.693, p = 0.002) were significantly higher in stage IV than in stage I and II. APTT (Z=-1.983, p = 0.047), Fib (Z=-2.68, p = 0.007), PC (Z=-2.723, p = 0.006), and PCT (Z=-2.592, p = 0.01) increased significantly when the tumor invaded neurovascular tissue.

CONCLUSIONS

Coagulation markers have the potential to act as biomarkers for predicting pathological features of LSCC. The high level of Fib was helpful for the diagnosis of LSCC and the detection of advanced LSCC.

TRIAL REGISTRATION

Not applicable.

Characteristics and impact of postoperative surgical site infection on increased antibiotic duration among patients with laryngocarcinoma: a retrospective cohort study

Background

Whether increased antibiotic duration is necessary for surgical site infection (SSI) in patients after neck surgery is unclear. We investigated the characteristics of SSI, and the impact of SSI on increased antibiotic duration among patients with laryngocarcinoma (LC).

Methods

A retrospective cohort study including consecutive LC patients ≥18 years, undergoing surgery without remote metastasis was conducted from October 2015 to February 2022 in the Department of Otolaryngology-Head and Neck Surgery, Chengdu Second People's Hospital. SSI was defined according to current guidelines. Patients were stratified into 3 groups including no-infection, lower respiratory tract infection (LRTI) and SSI. Patient characteristics was recorded. Patients were followed up until discharge. A multiple linear regression model including SSI and other factors including age, sex, comorbidity and antibiotic treatments was performed to explore the impact of SSI on increased antibiotic duration among LC patients with postoperative infection.

Results

A total of 88 patients were included, with 26 (29.5%) in no-infection group, 38 (43.2%) in LRTI group, and 24 (27.3%) in SSI group. Laryngocutaneous fistula occurred in 8 (33.3%) patients with SSI. Thirteen (34.2%) patients in LRTI group and 9 (37.5%) patients in SSI group experienced postoperative infection within 2 days after surgery, and antibiotic susceptibility tests were performed in 18 (47.4%) and 12 (50.0%) patients in LRTI and SSI group, respectively (P>0.05 for both). Levofloxacin and cefoperazone-sulbactam were the most commonly used antibiotics for postoperative infection in both LRTI and SSI groups (P>0.05 for both), irrespective of antibiotic susceptibility tests or not. The postoperative antibiotic duration in SSI group was significantly longer than that in LRTI group (13.62±4.28 days in SSI vs. 11.22±3.64 days in LRTI, P=0.021). A multiple linear regression analysis including SSI, age, sex, diabetes, antibiotic susceptibility test and hypoalbuminemia showed that, SSI was independently associated with increased antibiotic duration with LRTI as the reference among LC patients diagnosed [regression coefficient β=3.02, 95% confidence interval (CI): 1.01-5.03, P=0.004], whereas antibiotic susceptibility test was not (P=0.467).

Conclusions

SSI may be independently associated with increased postoperative antibiotic duration in patients with LC with or without antibiotic susceptibility test.

Effect of a refined nursing model based on nursing quality feedback on the postoperative mental state of patients with laryngeal cancer

OBJECTIVE

To evaluate the impact and effect of a refined nursing model based on nursing quality feedback on the postoperative mental state of patients with laryngeal cancer.

METHODS

According to the principle of a randomized controlled trial, 102 patients undergoing laryngeal cancer surgery were divided into two groups with 51 patients in each group. The control group received a conventional nursing model, and the research group received a refined nursing model based on nursing quality feedback. Patients' mental status, illness perception, finding of benefits, cancer-related fatigue, changes in quality of life before and 3 months after operation were observed, and postoperative complications and nursing satisfaction were collected.

RESULTS

The scores of the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), the Brief Illness perception Questionnaire (BIPQ), and Revised Piper Fatigue Scale in the research group were lower than those in the control group at 3 months after operation, and the scores of benefit finding, EORTC QLQ-C30, and La Monica-Oberst Patient Satisfaction Scale (LOPSS) were higher than those in the control group (P < 0.05); and the complication rate of the research group (7.84%) was lower than that of the control group (23.53%) (P < 0.05).

CONCLUSION

For patients undergoing laryngeal cancer surgery, the use of the refined nursing model based on nursing quality feedback can reduce patients' negative emotions, increase the benefits found, reduce their negative perceptions and cancer-related fatigue, improve their quality of life, reduce complications, and enhance the nurse-patient relationship.