Analysis of Trends in Mortality in Patients with Lymphoepithelial Carcinoma of the Head and Neck

The role of postoperative radiotherapy (PORT) in lymphoepithelial carcinoma of the salivary gland (LECSG) and the effect of postoperative EBV DNA on prognosis

BACKGROUND

Whether postoperative radiotherapy (PORT) could improve survival and the role of EBV DNA remains unclear for patients with lymphoepithelial carcinoma of the salivary glands (LECSG).

PATIENTS AND METHODS

360 patients were included. Independent prognostic factors were selected using a Cox proportional hazards model and incorporated into risk stratification.

RESULTS

The number of positive lymph nodes (PLNs) ≥ 3 and tumor size ≥ 3 cm were independent factors for PFS in patients with neck dissection (ND). Patients were divided into three groups: high-risk, size ≥ 3 cm&PLNs ≥ 3; intermediate-risk, size < 3 cm&PLNs ≥ 3 or size ≥ 3 cm&PLNs < 3; low-risk, size < 3 cm&PLNs < 3. The 5-year PFS rate of the low-, intermediate- and high-risk patients receiving non-PORT and PORT was 87.9% vs 93.5% (p = 0.12), 41.2% vs 81.1% (p < 0.001), 18.0% vs 51.1% (p = 0.034). N stage was an independent factor for PFS in patients with non-neck dissection (NND) and patients were divided into two groups: low-risk, N0; and high-risk, N1/2. The 5-year PFS rate of the low-risk, and high-risk patients receiving non-PORT and PORT was 77.9% vs 94.3% (p = 0.0019), 21.4% vs 71.3% (p = 0.015). Compared with EBV DNA = 0, the 5-year PFS rate of patients with EBV DNA > 0 was 19.9% vs 91.3% (p < 0.001). In patients with EBV DNA = 0, the 5-year PFS rate of patients with or without PORT was 95.1% vs 92.3% (p = 0.082); while in patients with EBV DNA > 0, the 5-year PFS rate was 37% vs 9.2% (p = 0.0056).

CONCLUSIONS

In patients with ND, PLNs < 3&size < 3 cm patients did not benefit from PORT. Detectable EBV DNA after surgery was a negative prognostic factor.

Intraoral salivary lymphoepithelial carcinoma: clinicopathologic and immunophenotypic characterization of 3 cases indicates elevated programmed death-ligand 1 expression

OBJECTIVE

Intraoral salivary lymphoepithelial carcinoma (ISLEC) is a rare malignancy with programmed death-ligand 1 (PD-L1) expression levels that have been greatly understudied. We examined the clinicopathologic and immunophenotypic characteristics, including PD-L1 levels, of 3 cases of ISLEC.

STUDY DESIGN

We searched the archives of 2 oral and maxillofacial pathology laboratories for specimens diagnosed as ISLEC between 1985 and 2022. We collected patient demographic and clinical data. Immunostaining for AE1/AE3, CK7, CD3, CD20, p16, p53, Ki67, and PD-L1 (SP263), as well as Epstein-Barr virus-encoded small RNAs (EBER) in situ hybridization (ISH) were performed.

RESULTS

All 3 cases affected males aged 42 to 84 years (median = 61y) and involved the floor of the mouth, soft palate/uvula, and tongue. The lesions showed diffuse infiltration by non-keratinizing sheets and islands of undifferentiated carcinoma cells with associated dense lymphoplasmacytic inflammation. Immunohistochemically, all tumors showed AE1/AE3 positivity, selective p53 staining, and negativity for CK7 and p16. Ki67 highlighted 20%-80% of lesional cells. The inflammatory infiltrate comprised a mixed population of T and B lymphocytes. EBER ISH was positive in one case. All ISLECs displayed membranous, focal-to-diffuse, PD-L1 staining with tumor proportion score > 95% in two and 40-50% in the third case.

CONCLUSIONS

The clinicopathologic and immunophenotypic characteristics of the cases we examined highlight the rarity of ISLEC and indicate overall high PD-L1 levels in this type of malignancy, rendering patients with ISLEC potential candidates for targeted α-PD-1/PD-L1 immunotherapy.

Is radical radiotherapy with/without surgery an effective treatment in the lymphoepithelial carcinoma of the salivary gland？

BACKGROUND

There is limited information of radical radiotherapy (RT) on lymphoepithelial carcinoma of salivary gland (LECSG) regarding to the rarity of the disease. We conducted this retrospective study that evaluated the feasibility and efficacy of radical RT with/without surgery in LECSG.

METHODS

We retrospectively reviewed patients that were pathologically diagnosed of LECSG and had definite or suspicious residual disease. The prescribed dose given to P-GTV and/or P-GTV-LN was 66 to 70.4 Gy. The clinical target volume (CTV) involved ipsilateral salivary gland and corresponding lymph node drainage area.

RESULTS

A total of 56 patients were included. With a median follow-up of 60 months (range: 8 to 151 months), the 1-, 5-, and 10-year progression-free survival (PFS) rates were 94.6%, 84.7% and 84.7%; locoregional progression-free survival (LRPFS) rates were 98.2%, 87.4% and 87.4%; distance metastasis-free survival (DMFS) rates were 94.6%, 86.7% and 86.7%; and overall survival (OS) rates were 98.2%, 92.4% and 89.0%, respectively. A total of 7 patients without surgery were included. All patients were alive and only one patient experienced failure of distant metastasis four months after RT. The results of univariate analysis showed that compared with N stage, the number of positive lymph nodes (2 positive lymph nodes) was better prognostic predictor especially in PFS. There were no treatment-related deaths and most toxicities of RT were mild.

CONCLUSIONS

Radical RT with/without surgery in LECSG for definite or suspicious residual disease is feasibility and efficacy. Most toxicities of RT were mild due to the target volume involved ipsilateral area.

Clinical Informatics Approaches to Understand and Address Cancer Disparities

OBJECTIVES

Disparities in cancer incidence and outcomes across race, ethnicity, gender, socioeconomic status, and geography are well-documented, but their etiologies are often poorly understood and multifactorial. Clinical informatics can provide tools to better understand and address these disparities by enabling high-throughput analysis of multiple types of data. Here, we review recent efforts in clinical informatics to study and measure disparities in cancer.

METHODS

We carried out a narrative review of clinical informatics studies related to cancer disparities and bias published from 2018-2021, with a focus on domains such as real-world data (RWD) analysis, natural language processing (NLP), radiomics, genomics, proteomics, metabolomics, and metagenomics.

RESULTS

Clinical informatics studies that investigated cancer disparities across race, ethnicity, gender, and age were identified. Most cancer disparities work within clinical informatics used RWD analysis, NLP, radiomics, and genomics. Emerging applications of clinical informatics to understand cancer disparities, including proteomics, metabolomics, and metagenomics, were less well represented in the literature but are promising future research avenues. Algorithmic bias was identified as an important consideration when developing and implementing cancer clinical informatics techniques, and efforts to address this bias were reviewed.

CONCLUSIONS

In recent years, clinical informatics has been used to probe a range of data sources to understand cancer disparities across different populations. As informatics tools become integrated into clinical decision-making, attention will need to be paid to ensure that algorithmic bias does not amplify existing disparities. In our increasingly interconnected medical systems, clinical informatics is poised to untap the full potential of multi-platform health data to address cancer disparities.

Is postoperative radiotherapy an essential treatment for nonmetastatic lymphoepithelial carcinoma of the salivary gland?

BACKGROUND

Lymphoepithelial carcinoma of salivary gland (LECSG) is a rare malignant tumor. Whether postoperative radiotherapy (PORT) can improve locoregional control and which patients can benefit from PORT are unknown. This study aimed to evaluate the role of PORT and provide individualized suggestions for postoperative therapy in patients with LECSG.

PATIENTS AND METHODS

We retrospectively reviewed patients with nonmetastatic LECSG who underwent surgery with or without PORT. Recursive partitioning analysis (RPA) was performed to categorize the patients and predict progression-free survival (PFS).

RESULTS

A total of 223 patients were included, 34 (15.2%) received surgery alone, whereas the remaining 189 (84.8%) underwent PORT in the initial treatment. Although patients in the PORT group were with advanced T stage and N stage, the PORT group had an advantage over the non-PORT group on 1-year, 5-year and 10-year PFS and locoregional control (LRC). PORT was an independent prognostic factor for PFS and LRC. Furthermore, compared with T stage and N stage, the size of the primary tumor and the number of positive lymph nodes were better prognostic predictors. The RPA model was generated according to the endpoint of PFS and categorized patients into 3 prognostic groups: low-risk (maximum diameter of primary lesion (≤3cm) and number of positive lymph nodes (≤2)), intermediate-risk (maximum diameter of primary lesion (>3cm) and number of positive lymph nodes (≤2)), and high-risk (number of positive lymph nodes (>2)), with corresponding 5-year PFS rates of 90.0%, 75.0%, and 51.0%, respectively. Significant improvement in PFS was observed in the PORT group among intermediate-risk (P=0.000) and high-risk patients (P=0.000).

CONCLUSIONS

PORT was shown to be a positive prognostic factor for PFS and LRC of LECSG. PORT was an essential treatment especially for patients with >3cm maximum diameter of primary lesion and/or >2 positive lymph nodes.