Yuhei Matsuda, Tatsuo Okui, Masaaki Karino, Noriaki Aoi, Satoe Okuma, Kenji Hayashida, Tatsunori Sakamoto, Takahiro Kanno
Publication date 28-07-2021
Oral cancer treatment reportedly causes decreased oral function, but few studies have examined the effects of oral cancer treatment on oral function in depth. This study aimed to comprehensively evaluate the oral function after treatment and classify the conditions related to oral dysfunction in patients with oral cancer. We recruited participants, collected their background data, and evaluated their oral function from September 2019 to March 2021. Principal component analysis was used to identify the components of oral function measurement and oral health perception. Receiver operating characteristic analysis was performed to investigate the accuracy of oral function measurements in predicting oral intake and nutritional status. Fifty patients treated for oral cancer, including 33 (66.0%) males and 17 (34.0%) females, were included. Their median age was 71.0 years (interquartile range: 63.0-76.0). There were significant differences in oral dryness between males and females, occlusal force among different age groups, tongue pressure based on the tumor stage and performance of reconstructive procedures, and masticatory function and Eating Assessment Tool scores based on whether radiotherapy was performed (P < 0.05). The principal component analysis proposed that oral function measurements and subjective oral health perception could be divided into three main components (transport, oral hygiene, and occlusion type), which explain 61.5% of the variance of the phenomenon. A significant decrease in oral function after oral cancer treatment should be diagnosed as postoperative oral dysfunction. Postoperative oral dysfunction can be classified into three types, each of which may present with different pathologies.
Pubmed PDF WebCiro Gilvetti, Chandni Soneji, Brian Bisase, Andrew William Barrett
Publication date 25-07-2021
To determine the overall recurrence rate (RR) and malignant transformation rate (MTR) of high grade oral mucosal epithelial dysplasias (HGOED). A clinicopathological review of records of patients diagnosed with a unifocal HGOED between 2004 and 2016 on incisional biopsy who then underwent excision. The mean duration of follow-up was 47.7 months (±29.9 SD). Full demographic, historical and histopathological data were available for 120 patients. Six were lost to follow-up after excisional biopsy. Invasive squamous cell carcinoma (SCC) was present in 19 (18.3%) excisions. HGOED affected the lateral and ventral tongue in 58% of patients. Fourteen (11.7%) were not treated surgically but kept under surveillance. The overall RR was 34.7% (33 patients) and MTR 17.8% (17 patients). Four of the 14 (28.6%) patients who had not had the HGOED excised developed SCC, by contrast to the 13 of the 106 (12.3%) who had been treated. RR was significantly associated with positive excision margins (p = 0.007; OR = 3.6) and a clinical presentation of erythroplakia (p = 0.023; OR = 1.5). MTR was significantly associated with age (p = 0.034), clinical appearance (p = 0.030), site (p = 0.007), treatment received (p = 0.012) and positive excision margins (p = 0.007). The mean time for recurrence to develop was 62 months (±31.5 SD) (range 22-144 months), that for malignant transformation was 50 months (±32.5 SD) (range 8-97 months). Patients with HGOED require follow-up for at least 10 years after treatment. Younger age, homogeneous clinical appearance, complete excision, a larger excision specimen and clear margins all improve prognosis.
Pubmed PDF WebIrene H. Nauta, Thomas Klausch, Peter M. van de Ven, Frank J.P. Hoebers, Lisa Licitra, Tito Poli, Kathrin Scheckenbach, Ruud H. Brakenhoff, Johannes Berkhof, C. René Leemans
Publication date 27-07-2021
The prognostic advantage of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) resulted in the initiation of treatment de-intensification studies. Two randomized controlled trials (RCTs) reported inferior survival of HPV-positive OPSCC treated with radiotherapy plus cetuximab compared to standard of care radiotherapy plus cisplatin. In this study we investigated whether the important role of cisplatin in the treatment of HPV-positive OPSCCs would also emerge from causal inference analyses of real-world data. A retrospective cohort of 263 advanced-stage OPSCC-patients from 5 European clinics was studied, treated with radiotherapy (RT) alone or cisplatin-based chemoradiotherapy (CRT) based on standard clinical indications. Causal inference was applied to adjust for treatment assignment, thereby simulating a randomized setting. Average treatment effect of concurrent cisplatin on overall survival (OS) probability was estimated using Bayesian Additive Regression Trees (BART) and Bayesian logistic regression. Significantly better survival probabilities were found for HPV-positive OPSCC treated with CRT compared to RT alone (3-year OS probability 0.961 versus 0.798, p = 0.008). This study using causal inference of retrospective patient data confirms the important role of cisplatin in the treatment of HPV-positive OPSCC. Causal inference analyses of real-world data complements the evidence from the published RCTs.
Pubmed PDF WebCeleste Kim, Eduardo Martinez, Marta Kulich, Mark S. Swanson
Publication date 24-07-2021
Analyze how otolaryngologists approach HPV-related oropharyngeal cancer in terms of patient selection for transoral surgery, perceptions of treatment related risks and benefits, and adjuvant treatment decisions. A survey on HPV-related cancer management was distributed to otolaryngologists in the US through Red Cap. Differences in responses were analyzed using Pearson's chi-squared and Fisher's exact tests. A total of 111 out of 143 (77.6%) otolaryngologists completed the survey. Overall, most prefer treating T1/T2 tumors using transoral robotic surgery (TORS) and T3 tumors through primary radiation therapy (RT), though there were significant differences between cohorts. Non-fellowship-trained surgeons and those in community practices favored RT for T1/T2 more than their fellowship-trained and academic counterparts, respectively. For adjuvant treatment, non-fellowship-trained surgeons favored adjuvant CRT, whereas fellowship-trained surgeons preferred only adjuvant RT, for patients with lymphovascular or perineural invasion, >1 lymph node involvement, or close deep margins. TORS was viewed as having less adverse sequelae (i.e. dysphagia, dysphonia, xerostomia). Though the two modalities had similar oncologic outcomes, TORS was perceived as providing better quality of life (QOL). There are variations in HPV-related OPSCC management based on surgeon background and preferences across the US. TORS and primary RT are believed to offer similar oncologic control, but the former provides lesser adverse sequelae and better QOL. Additionally, surgeon demographics (i.e. fellowship status, practice type, and region) can affect management decisions, including patient selection for TORS and adjuvant therapy decisions. Further study is required to better understand and standardize appropriate HPV-positive OPSCC management.
Pubmed PDF WebVirginia Drake, Elaine Bigelow, Carole Fakhry, Melina Windon, Lisa M. Rooper, Patrick Ha, Brett Miles, Christine Gourin, Rajarsi Mandal, Wojciech Mydlarz, Nyall London, Peter S. Vosler, Siddhartha Yavvari, Tanya Troy, Tim Waterboer, David W. Eisele, Gypsyamber DSouza
Publication date 26-07-2021
Tumor HPV status is an established independent prognostic marker for oropharynx cancer (OPC). Recent studies have reported that tumor estrogen receptor alpha (ERα) positivity is also associated with prognosis independent of HPV. Little is known about the biologic and behavioral predictors of ERα positivity in head and neck squamous cell cancer (HNSCC). We therefore explored this in a multicenter prospective cohort study. Participants with HNSCC completed a survey and provided a blood sample. Tumor samples were tested for ERα using immunohistochemistry. ERα positivity was defined as ≥1%, standardized by the American Society of Clinical Oncology/College of American Pathologists in breast cancer. Characteristics were compared with χ Of 318 patients with HNSCC, one third had ERα positive tumors (36.2%, n = 115). Odds of ERα expression were significantly increased in those with HPV-positive tumors (OR = 27.5, 95% confidence interval[CI] 12.1-62), smaller tumors (≤T2, OR = 3.6, 95% CI 1.9-7.1), male sex (OR = 2.0, 95% CI 1.1-3.6), overweight/obesity (BMI ≥ 25, OR = 1.9, 95% CI 1.1-3.3), and those married/living with a partner (OR = 1.7, 95% CI 1.0-3.0). In a multivariate model, HPV-positivity (aOR = 27.5, 95% CI 11.4-66) and small tumor size (≤T2, aOR = 2.2, 95% CI 1.0-4.8) remained independently associated with ERα status. When restricted to OPC (n = 180), tumor HPV status (aOR = 17.1, 95% CI 2.1-137) and small tumor size (≤T2, aOR = 4.0 95% CI 1.4-11.3) remained independently associated with ERα expression. Tumor HPV status and small tumor size are independently associated with ERα expression in HNSCC.
Pubmed PDF WebYun Xu, Mengwei Chen, Qiaojuan Guo, Hewei Peng, Lanyan Guo, Jingfeng Zong, He Huang, Bijuan Chen, Hanchuan Xu, Jianji Pan, Shaojun Lin
Publication date 17-07-2021
Our previous study revealed that percutaneous endoscopic gastrostomy (PEG) and intensive nutritional support may minimize body weight loss, maintain nutritional status, and offer better treatment tolerance for patients with locally advanced nasopharyngeal carcinoma (LA-NPC) during concurrent chemoradiotherapy (CCRT). This study aimed to further explore the potential long-term survival benefits of PEG in LA-NPC. Between June 1, 2010 and June 30, 2014, a total of 133 consecutive LA-NPC patients who received prophylactic PEG (pPEG) feeding before the initiation of CCRT were included. Meanwhile, an additional 133 non-PEG patients, who were matched for age; sex; and tumor, node, and metastases stage, were selected as control cohort. The log-rank test was used to compare survival distributions between groups. Multivariate prognosis analysis was conducted using a Cox's proportional hazards regression model. After a median follow-up time of 81 months (range: 4-119 months), pPEG was not associated with significant survival benefits in the whole cohort. However, the N3 NPC patients who underwent PEG had significantly higher 5-year overall survival (OS) and progression-free survival (PFS) (84.0 and 76.0%, respectively) than those who did not undergo PEG (56.7 and 45.6%, respectively; p < 0.05). Univariate and multivariate analyses demonstrated that PEG was an independent factor for N3 survival. PEG can maintain the nutritional status and improve the rate of treatment completion for LA-NPC patients who underwent CCRT, and these advantages can transfer into survival benefits in N3 NPC. Further multicenter prospective clinical trials are warranted.
Pubmed PDF WebYuancheng Li, Linnan Gong, Na Qin, Xiaoyu Wei, Limin Miao, Hua Yuan, Cheng Wang, Hongxia Ma
Publication date 16-07-2021
CircRNAs are critical gene modulators in tumor initiation and progression. However, the expression pattern and molecular pathogenesis of circRNAs in oral squamous cell carcinoma (OSCC) are still poorly characterized. RNA sequencing with CIRCexplorer2 pipeline was performed to identify circRNAs in 46 tumor-normal paired tissues from OSCC patients. Another set of 48 head and neck squamous cell carcinoma samples from the Mi Onco Circ database were utilized as an independent validation. Of the 1276 identified high-confidence circRNAs, 154 were differentially expressed between tumor and normal tissues (log CircRNAs showed a global down-regulation pattern in OSCC tissues, and genes regulated by circRNAs primarily involved in immune and extracellular matrix pathways, which could also affect the OSCC prognosis, indicating that they may serve as potential prognostic biomarkers.
Pubmed PDF WebAtsumu Kouketsu, Hitoshi Miyashita, Ikuho Kojima, Maya Sakamoto, Takaki Murata, Shiro Mori, Shinnnosuke Nogami, Kensuke Yamauchi, Hirokazu Nagai, Hiroyuki Kumamoto, Tetsu Takahashi
Publication date 16-07-2021
To evaluate the ability of different imaging modalities to accurately detect bone invasion in oral squamous cell carcinomas. Patients with oral squamous cell carcinoma, who were scheduled for mandibulectomy or maxillectomy, underwent clinical evaluation using five preoperative imaging diagnosis methods-contrast-enhanced MRI, CT, Overall, 50 patients were enrolled in this study, and nine patients with pathological mandibular invasion were included in our subgroup analysis. MRI was found to be the most useful method in detecting bone invasion, showing the highest sensitivity (88.9%) and negative predictive values (92.3%). CT (87.5% specificity and 77.8% sensitivity) was more specific than MRI, though less sensitive. Combined PET/CT was more sensitive (83.3%) and less specific (71.9%) than CT. Tc scan had high sensitivity (88.9%); however, the specificity was relatively low (71.9%). MRI was the most useful method in detecting bone invasion. A negative MRI result definitively excludes bone marrow invasion. In patients with positive MRI findings, a negative CT may be useful in ruling out bone marrow invasion.
Pubmed PDF WebAlejandro Herreros-Pomares, Carlos Llorens, Beatriz Soriano, Feiyu Zhang, Sandra Gallach, Leticia Bagan, Judith Murillo, Eloísa Jantus-Lewintre, José Bagan
Publication date 06-07-2021
Oral microbiome plays an important role in oral diseases. Among them, proliferative verrucous leucoplakia (PVL) is an uncommon form of progressive multifocal leukoplakia with a worryingly rate of malignant transformation. Here, we aimed to characterize the oral microbiome of PVL patients and compare it with those of healthy controls. Oral biopsies from ten PVL patients and five healthy individuals were obtained and used to compare their microbial communities. The sequence of the V3-V4 region of 16S rRNA gene was used as the taxonomic basis to estimate and analyze the composition and diversity of bacterial populations present in the samples. Our results show that the oral microbial composition and diversity are significantly different among PVL patients and healthy donors. The average number of observed operational taxonomic units (OTUs) was higher for healthy donors than for PVL, proving a loss of diversity in PVL. Several OTUs were found to be more abundant in either group. Among those that were significantly enriched in PVL patients, potential protumorigenic pathogens like Oribacterium sp. oral taxon 108, Campylobacter jejuni, uncultured Eubacterium sp., Tannerella, and Porphyromonas were identified. Oral microbiome dysbiosis was found in patients suffering from PVL. To the best of our knowledge, this is the first study investigating the oral microbiome alterations in PVL and, due to the limited number of participants, additional studies are needed. Oral microbiota-based biomarkers may be helpful in predicting the risks for the development of PVL.
Pubmed PDF WebJi Won Kim, Tri Ho Minh, Jeong Mi Kim, Mi Eun Choi, Eun Jeong Jeon, Jin-Mi Park, Young-Mo Kim, Jeong-Seok Choi
Publication date 05-07-2021
We examined the regenerative efficacy of the activated platelet-rich plasma (PRP) concentrate administered by local injection in an animal model mimicking partial glossectomy for tongue cancer. Four-week-old mice were randomized to four groups; (1) a treatment-naïve control group, (2) a PRP group, (3) a hemiglossectomy group, and (4) a hemiglossectomy + PRP group. The activated PRP concentrate was injected into the deep layer of resected surfaces of mouse tongues immediately after excision, and tongue widths and lengths were measured on postoperative days (POD) 5 and 12. Gross tongue morphologies and microscopic findings were investigated. Inflammation and fibrous tissue areas were also measured, and immunohistochemical analysis was performed for c-kit, neurofilament, and S-100. The activated PRP concentrate reduced wound scar contracture, promoted wound healing, and reduced inflammation and wound fibrosis. On POD 12, histologic findings in the hemiglossectomy + PRP group were similar to those in the normal control group, and the intensity of stem cell factor receptor c-kit expression was also significantly greater in the PRP group than in the hemiglossectomy group on POD 12. Immunohistochemical staining revealed S100 and neurofilament expressions in the hemiglossectomy + PRP group were significantly more intense than in the hemiglossectomy group. Intralesional activated PRP concentrate injection has potential use for tongue regeneration, wound healing, and neural regeneration with minimal scarring after partial glossectomy.
Pubmed PDF WebFrancesco Merolla, Gennaro Ilardi, Gaetano Di Spigna, Daniela Russo, Francesco Martino, Silvia Varricchio, Giovanni Orabona Dell’Aversana, Massimo Mascolo, Bianca Covelli, Rosario Caltabiano, Giuseppe Broggi, Giovanni Audino, Angela Celetti, Loredana Postiglione, Stefania Staibano
Publication date 09-07-2021
To date, a very small number of serum biomarkers have been identified for clinical use in squamous carcinomas of the head and neck region. Chromatin Assembly Factor-1 (CAF-1) heterotrimeric complex subunit CAF1/p60 expression levels have been reported to be of prognostic value in Oral Squamous Cell Carcinoma (OSCC), as well as in other human solid tumors. Here our aim was to detect and quantify CAF1/p60 in the peripheral blood of Head and Neck Squamous Cell Carcinoma (HNSCC) patients, and to investigate the possible associations between serum concentration of CAF-1/p60 and HNSCC tumors. A total of 63 HNSCC patients (51 OSCC, 8 OPSCC, 3 laryngeal SCC, and 1 rhinopharynx SCC) and 30 healthy controls were enrolled. The serum levels of CAF-1/p60 were measured by ELISA assay before and after surgery. Serum CAF-1/p60 concentration resulted significantly higher in cancer patients, compared with healthy controls, in pre-surgery samples (P < 0.05). Serum levels of CAF-1/p60 significantly decreased in serum samples taken after surgery (P < 0.05). Our results demonstrated that CAF-1/p60 may be detected in serum, suggesting a role for CAF-1/p60 as potential soluble biomarkers in HNSCC tumors.
Pubmed PDF WebKrupal B. Patel, Edmund A. Mroz, William C Faquin, James W. Rocco
Publication date 02-07-2021
Previous work indicates that mutant-allele tumor heterogeneity (MATH), estrogen receptor alpha (ERα) expression, and human papillomavirus (HPV) status provide prognostic utility in head and neck squamous cell carcinoma (HNSCC). We sought to assess whether the combination of these three objective biomarkers could provide better prognostication for patients who receive chemoradiotherapy (CRT). 156 patients (75 oral cavity, 44 oropharyngeal and 37 laryngeal squamous cell carcinoma cancer patients) who received CRT as primary therapy or adjuvant to surgery were identified from The Cancer Genome Atlas (TCGA). MATH values were calculated from TCGA whole exome sequencing data, HPV status was determined by mapping RNA-seq reads, and ERα expression was determined from ESR1 mRNA expression data. Relationships among clinical characteristics were assessed by Fisher exact tests. Relationships of clinical characteristics and MATH, ERα and HPV to overall survival were evaluated with Cox proportional hazard analysis. The combination of poor-prognosis values for all 3 biomarkers (high MATH, low ERα and HPV-negative status) has a predicted hazard ratio of 28.2 (95% CI: 5.4-148, p = 0.0001) versus the combination of their good-prognosis values (low MATH, high ERα and HPV-positive status). Addition of N classification to the combination of these three biomarkers added further prognostic value. A combination of these three biomarkers, readily determined on pretreatment biopsy specimens, can stratify patients into prognostic groups. Their application potentially offers numerous opportunities to optimize treatment or explore de-intensification strategies in the clinical trial setting.
Pubmed PDF WebAugusto Bacelo Bidinotto, Natália Luiza Kops, Marina Bessel, Ana Goretti Kalume Maranhão, Flávia Moreno, Gérson Fernando Mendes Pereira, Luísa Lina Villa, Eliana Márcia Wendland, POP-Brazil Study Group
Publication date 29-06-2021
This study aimed to report the national prevalence of oral HPV infection among unvaccinated women and men aged 16-25 years who utilized the public primary care services. POP-Brazil is a cross-sectional, multicentric, nationwide survey conducted between September 2016 and November 2017. Recruitment was based in 119 public primary care practices in 26 state capitals and the Federal District of Brazil. Trained health professionals conducted face-to-face interviews. Oral samples were collected with mouthwash and gargle cycles. Genotyping was performed using the Roche PCR-based linear array genotyping test. Sampling weights by sex and age were applied. Valid oral HPV samples were collected from 5071 (96.88%) participants; 4005 women and 1066 men. Mean participant age was 21.63 years. Overall HPV prevalence was 1.69% (n = 73, 95% CI 1.05-2.32). Thirty individuals presented at least one high-risk HPV type [0.57% (95% CI, 0.29-0.85)]. There were no associations between age, sex, sociodemographic characteristics, drug use or sexual behavior and oral HPV prevalence. The prevalence of oral HPV infection in Brazilian teenagers and young adults is low, with no sociodemographic or behavioral correlates.
Pubmed PDF WebZhenning Li, Lixia Zhang, Fa-yu Liu, Peng Li, Jing He, Cameron L. Kirkwood, Jiho Sohn, Jon M. Chan, William J. Magner, Keith L. Kirkwood
Publication date 29-06-2021
Mitogen-activated protein kinases (MAPKs) require MAPK phosphatases (MKPs) for deactivation of MAPK intracellular signaling. MKP-1 (encoded by Dusp1) is a key negative regulator of MAPKs and prior reports have indicated that MKP-1 regulates oral cancer-associated inflammation and leukocyte infiltration. To determine the significance of myeloid-based expression of MKP-1 in oral cancer. The Cancer Genome Atlas (TCGA) was used to address DUSP1 expression in oral squamous cell carcinoma (OSCC). Syngeneic and carcinogen-induced mouse models using global and myeloid-specific Dusp-1 deficient mice with immunophenotypic, histologic, and transcriptomic analyses and in vitro migration assays. Data from TCGA indicates the DUSP1 expression is inversely related to oral cancer burden and nodal involvement. Using murine models of OSCC, the role of MKP-1 signaling in tumor associated macrophages (TAMs) was assessed. Dusp1-deficient mice had increased tumor burden and TAM infiltrate with increased M2 macrophage polarization. Transcriptomic signatures of TAMs from Dusp1-deficent mice indicated a pro-metastatic phenotype as well as concomitant differences in myeloid-associated genes, cytokine/chemokine signaling, and Notch signaling consistent with tumor progression. In vitro and in vivo assays revealed mouse OSCC cells had a higher migration rate using TAM cell-free supernatant from Dusp1 deficiency mice compared to controls with enhanced regional cervical lymph node metastasis, respectively. To validate TAM studies using implantable mouse models, an OSCC progression model with conditional myeloid-specific Dusp-1 deficient mice demonstrated enhanced OSCC disease progression, characterized by advanced onset, histological stage, and tumor burden. Myeloid-based Dusp1-deficiency increases OSCC burden and metastasis through alteration in TAM recruitment, gene profile, and polarity suggesting that MKP-1 could be a viable target to reprogram TAM to limit local/regional OSCC extension.
Pubmed PDF WebKristina R. Dahlstrom, Karen S. Anderson, Ming Guo, Michael C. Kwon, Craig A. Messick, Curtis A. Pettaway, Nancy Asomaning, Marika Hopper, Anthony Price, Li Xu, Andrew T. Day, Ann M. Gillenwater, Erich M. Sturgis
Publication date 29-06-2021
The Human papillomavirus (HPV)-related Oropharyngeal and Uncommon Cancers Screening Trial of Men (HOUSTON) was designed to determine the prevalence of IgG antibodies to HPV type 16 E proteins (HPV16EAbs), to screen for persistence of HPV and/or detect HPV-related premalignancies and cancers, and to assess acceptance of screening among middle-aged men. HOUSTON consists of a cross-sectional study and a longitudinal cohort study of men aged 50-64 years. Serologic HPV16EAb status and oral rinse HPV16 status were determined. All HPV16EAb-positive (HPV16EAb+) men and a matched cohort of HPV16EAb-negative (HPV16EAb-) men as well as all oral rinse HPV16-positive (HPV16+) men were included in the longitudinal study (blinded to their results) and underwent oropharyngeal screening every 6 months as well as one-time anal and penile screening. Of 553 men enrolled in the cross-sectional study, six (1.1%) were HPV16EAb+ (two were also oral rinse HPV16+), and 41 (7.4%) were HPV16EAb- but oral rinse HPV16+. These 47 men, along with five matched controls, were invited to participate in the longitudinal study, and 42 (81%) agreed and completed baseline in-person screening, with 93% and 90% completeing 6-month and 12-month follow-up visits. One HPV16EAb+ (also oral rinse HPV16+) man, who declined participation in the longitudinal study, presented 4 months after enrollment with an early-stage HPV16-related pharyngeal cancer. Additionally, one HPV16EAb+ (oral rinse HPV16-) man and two oral rinse HPV16+ (HPV16EAb-) men were diagnosed with oncogenic HPV-associated anal dysplasia. This biomarker panel deserves further prospective study to explore potential utility for HPV-related cancer screening among men.
Pubmed PDF WebShivakumar Gudi, Brian OSullivan, Ali Hosni, Jie Su, Andrew Hope, Jolie Ringash, Katrina Hueniken, Geoffrey Liu, Li Tong, David Goldstein, John de Almeida, Aaron R. Hansen, Scott V. Bratman, John Cho, Meredith Giuliani, Ezra Hahn, John Kim, Wei Xu, John Waldron, Shao Hui Huang
Publication date 28-06-2021
We compare clinical behaviour of East-Indians and White-Canadians with oral cavity squamous cell carcinoma (OSCC) treated at a Western institution within a uniform health care system. Newly diagnosed OSCC patients who underwent postoperative (chemo-)radiotherapy (PORT/POCRT) between 2005 and 2017 were included. Data on ethnicity and other variables were extracted from patient-questionnaires, a prospective database and supplemented by chart review. Baseline characteristics were compared between East-Indian versus White-Canadian groups. A propensity-matched (1:1 ratio) of East-Indian versus White-Canadian cohorts was generated to compare locoregional control (LRC), distant control (DC), overall survival (OS), and acute and late toxicities. A total of 53 East-Indian and 467 White-Canadian OSCC patients were identified. Compared to White-Canadians, East-Indian patients were younger, had less exposure to smoking and alcohol (p < 0.001), but more chewed betel (areca) nut /tobacco (43% vs 0.2%, p < 0.001). Buccal/retromolar-trigone/lower gingiva primaries were more common in East-Indians (49% vs 25%, p < 0.001). Median follow-up was 5.0 years. Propensity-score paired analysis revealed inferior 3-year LRC (68% vs 81%, p = 0.030), non-significantly lower OS (61% vs 75%, p = 0.257), but similar DC (81% vs 87%, p = 0.428) in East-Indian versus White-Canadian patients. Actuarial rate of toxicities was higher in East-Indians vs White-Canadians: acute toxicity at 6 weeks: 47% vs 30%, p = 0.012; chronic trismus at 5-years: 16% vs 2%, p = 0.013. East-Indian OSCC patients have a greater betel nut/ chewable tobacco exposure compared to White-Canadians and a different distribution of OSCC sites. Propensity-matched cohort analysis showed lower LRC and higher toxicities in East-Indian OSCC patients, suggesting a complicated interaction between genetic/biological and life-style factors.
Pubmed PDF WebChing-Mei Chen, Tian-Huei Chu, Chih-Chi Chou, Chih-Yen Chien, Jian-Shiang Wang, Chao-Cheng Huang
Publication date 27-06-2021
microRNA (miRNA) expression patterns have provided new insight as biomarkers of prognosis as well as novel therapeutic targets for several neoplasms. However, the role of exosomal miRNA in the prognosis of oral squamous cell carcinoma (OSCC) has not yet been completely clarified. Paired primary tumor and normal oral epithelial cells from OSCC patients were obtained, and the exosomal miRNA profiles between them were compared by miRNA microarray analysis. The miRNA levels in the serum exosomes of OSCC patients were verified by real-time quantitative reverse transcription PCR (qRT-PCR) analysis. Finally, the biological functions and the potential as a prognostic marker of the selected miRNA candidates were analyzed in the OSCC cells and patients, respectively. Exosomal miR-155 and miR-21 were significantly upregulated, and exosomal miR-126 was dramatically downregulated in the primary OSCC cells and the serum of OSCC patients. In the analysis of oncogenic behaviors, coculture with either miR-155-rich or miR-21-rich exosomes could promote cell proliferation and invasion accompanied with downregulation of PTEN and Bcl-6 tumor suppressors. Moreover, treatment with miR-126-rich exosomes inhibited oncogenic behaviors and oncogene EGFL7 expression in OSCC cells. Finally, exosomal miR-126 was reduced in the serum of the late-staged OSCC patients, and downregulation of blood exosomal miR-126 was associated with poor survival in OSCC patients. Exosomal miR-155 and miR-21 are oncogenic miRNAs which suppress PTEN and Bcl-6 expression, and exosomal miR-126 acts as a tumor suppressor which downregulates EGFL7 in OSCC. Furthermore, blood exosomal miRNAs may serve as biomarkers for the diagnosis and prognosis of OSCC.
Pubmed PDF WebMan-yi Zhu, Hai-jun Wu, Jing-jing Miao, Mu-ping Di, Bo-yu Chen, Hua-geng Huang, Hai-qiang Mai, Lin Wang, Chong Zhao
Publication date 27-06-2021
The aim of this study was to establish a nomogram for predicting radiation-induced hypothyroidism (RHT) based on an equivalent dose at 2 Gy per fraction (EQD Two hundred forty-four eligible patients with NPC were recruited for this study. Patients' clinical factors and dose-volume parameters of the thyroid gland were retrieved from medical records and the IMRT treatment planning system, respectively. The irradiation doses were converted into EQD With a median follow-up of 63.0 months, the cumulative incidence rates of RHT at 3 months and 1-, 2-, 3-, 4- and 5- year after IMRT were 10.2%, 36.2%, 47.6%, 54.2%, 58.8% and 69.4%, respectively. Four independent factors for predicting RHT, including gender, age, pretreatment volume of the thyroid gland and V The nomogram proposed in this study provides a reliable estimate of RHT risk in patients with NPC after IMRT and appears to have the potential to be a useful tool for widespread clinical applications.
Pubmed PDF WebSnehal Shah, Abhishek Mahajan, Shivakumar Thiagarajan, Nithyanand Chidambaranathan, Meena Sutar, Nilesh Sable, Devendra Chaukar
Publication date 26-06-2021
The description for T4a oral tongue cancer in the 8th edition AJCC staging can be improved further. In this article we attempted to identify the important radiological (MRI) findings that could possibly be included in the staging eventually. We included all oral tongue squamous cell carcinoma patients who underwent surgery at TMH between Jan 2012 to Dec 2018 and whose MRIs were available for review. The relation of the tumor to the neurovascular bundle (NVB) on MRI was classified as Type I to IV. The association of the type of NVB involvement with DFS and the presence of PNI in the final HPR was analyzed. Two-hundred and fifty-nine patients satisfied the eligibility criteria. The majority of them were men (82.6%), with a median age of 49 Yrs. Sixty-nine percent of patients had either abutment (Type III) or encasement (Type IV) of the NVB. The presence of Abutment/encasement of the NVB was significantly associated with the presence of PNI in the final HPR (p < 0.001). This abutment/encasement was seen in clinically advanced T-stage tumors. However, the presence of abutment/encasement of the NVB influenced the DFS in the univariate analysis only. Abutment/encasement of the NVB in patients with carcinoma oral tongue is often seen in advanced-stage tumors and is significantly associated with the presence of PNI in the final HPR. Hence, the relation of the tumor with the NVB should be further assessed to understand its importance and its possible inclusion in the AJCC T-staging.
Pubmed PDF WebJanice L. Farlow, J. Chad Brenner, Yu L. Lei, Steven B. Chinn
Publication date 05-07-2021
Immunotherapy revolutionized cancer treatment but has yet to elicit durable responses in the majority of patients with head and neck squamous cell carcinoma (HNSCC). HNSCC is generally characterized by a high tumor mutational burden, which has translated to a large neoantigen load that could prime the immune system to recognize and eliminate malignant cells. Studies are increasingly showing, however, that HNSCC is an "immune desert" tumor that can hijack multiple parts of the tumor immunity cycle in order to evade immune recognition and suppress immune system activation. Herein we will review how HNSCC tumors modulate their architecture, cellular composition, and cytokine milieu to maximize immunosuppression; as well as relevant therapeutic opportunities and emerging issues facing the field of HNSCC immuno-oncology.
Pubmed PDF WebMark D. Wilkie, Jeffrey Lancaster, Nicholas J. Roland, Terence M. Jones
Publication date 05-07-2021
Non-melanoma skin cancer (NMSC) is among the most common cancers worldwide, with an incidence that continues to rise. Although cutaneous squamous cell carcinoma (cSCC) constitutes only approximately 20% of such cases, it represents the most common cause of NMSC mortality, owing largely to the propensity for development of regional lymph node metastases (LNM), which, when present, carry a dismal prognosis. Whilst overall rates of LNM are low, there are a number of patient and tumour factors that likely confer considerably higher risks, which has led several investigators to propose more proactive elective management of regional nodal basins in selected high-risk cases. Current international guidelines, however, do not recommend any elective treatment or sampling of regional nodal basins in the absence of clinically apparent disease. The purpose of this review is to explore in detail the fundamental issues underlying this controversy, focusing specifically on cSCC of the head and neck (cSCCHN). In particular the rationale for more a proactive elective approach to regional nodal basins, including the evidence-base underlying identification of potentially high-risk factors for development of LNM is discussed, along with oncological outcomes for those patients that do go onto suffer LNM. We also provide contemporary perspectives and evidence for approaches to electively managing regional nodal basins, and offer insight into how these may develop both in the clinical and research arenas.
Pubmed PDF WebSoung Yung Kim, Meinrad Beer, Dechen W. Tshering Vogel
Publication date 05-07-2021
Head and neck cancer (HNC) is the fifth most frequent cancer worldwide and associated with significant morbidity. Along with clinical examination and endoscopic evaluation, imaging plays an important role in pre- and posttherapeutic evaluation of patients with HNC. Cross-sectional Imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography / computed tomography (PET/CT) are routinely used in the assessment of these patients. This review provides an overview of the various cross-sectional imaging modalities used in the evaluation of HNC and will give a short summary of the latest imaging technologies regarding head and neck cancer diagnosis.
Pubmed PDF WebBeatriz Zamboni Martins Panucci, Evânio Vilela Silva, Rafael Humberto Artero Arévalo, Ricardo Ernesto Rivera Miranda, Florence Juana Maria Cuadra Zelaya, Heitor Albergoni Silveira, Jorge Esquiche León
Publication date 29-07-2021
Chondromyxoid fibroma (CMF) is a benign chondroid/myxoid matrix-producing tumor that often develops in the long bones of young adults. CMF is rarely reported in the craniofacial skeleton, with most cases presenting with bone erosion or destruction, which may lead to a misdiagnosis. To date, approximately 129 cases of CMF in the craniofacial region have been reported, with only three cases in patients aged less than 1 year. Of these 129 cases, only 34 affected the jaws. A 1-year-old boy presented with a mass in the left anterior maxilla, extending and compressing the ipsilateral nasal cavity. After surgical excision of the lesion, microscopy revealed spindle-to-stellate tumor cells surrounded by a predominant myxoid stroma containing focal slit-like vascular channels and hemorrhagic areas. Immunohistochemistry showed positivity for vimentin, CD10, and α-SMA (focal). The Ki-67 labeling index was 6%. CFM should be included in the differential diagnosis when assessing maxillary tumors in pediatric patients.
Pubmed PDF WebLuca DAscanio, Gino Latini, Manlio Pandolfini, Luca Imperatori, Arianna Di Stadio
Publication date 29-07-2021
To understand the impact of COVID pandemic on the activity and patients' care of the Head and Neck regional Unit, temporary moved in a COVID-free hospital. We retrospectively analyzed the yearly activity of the "Head & Neck Cancer Unit" at the Azienda Ospedali Riuniti Marche Nord (Italy) during 2020 (COVID-19 pandemic) and we compared it with the one performed in 2019. Statistical analyses were performed using Chi-square. No significant differences were observed comparing the total number of patients treated for H&N squamous cell carcinoma (SCC) in 2019 with the ones in 2020. Moreover, no differences were identified in term of cancer stage at the moment of the surgery between 2019 and 2020. On the contrary, a significant reduction in the number of surgical procedures carried out for thyroid (p < 0.05) and skin (p < 0.001) malignancies was identified. Despite Covid-19 limitations, our institution was able to preserve the number of major oncologic procedures without negative impact on patients' care. We believe that the creation of specific COVID-free hospital can be the key preserve quality of care in epidemic emergency.
Pubmed PDF WebAlhadi Almangush, Rasheed Omobolaji Alabi, Antti A. Mäkitie, Ilmo Leivo
Publication date 17-07-2021
Yash P. Merchant, Akshay Kudpaje, Vishal U.S. Rao
Publication date 15-07-2021
Muhammad Shahid Iqbal, Josef Kovarik, Rahul Patil, Charles G. Kelly
Publication date 14-07-2021
Mohammed Imaduddin, Mahesh Sultania, B. Vigneshwaran, Dillip Kumar Muduly, Madhabananda Kar
Publication date 10-07-2021
Allen L. Feng, Hassan B. Nasser, Keith A. Casper, Kelly M. Malloy, Chaz L. Stucken, Mark E. Prince, Steven B. Chinn, Andrew J. Rosko, Matthew E. Spector
Publication date 07-07-2021
Tiantian Wu, Zhenmin Liu, Xiangzhi Yong, Guocheng Mei, Qiaozhi Jiang, Meifei Fang, Ping Li, Zhongming Zhang, Renchuan Tao
Publication date 05-07-2021
As a method to improve the survival rate of patients with hematological malignancies, allogeneic hematopoietic stem cell transplantation (allo-HSCT) has increasingly been used for treatment. However, some potentially serious complications after allo-HSCT, including graft-versus-host disease, graft failure, infection, end-organ toxicity, and secondary malignancies, will determine the success of hematopoietic reconstitution. Here, we describe a case of a patient with p16-positive tongue squamous cell carcinoma (TSCC) following allo-HSCT. A 62-year-old man who had previously received allo-HSCT due to acute lymphocytic leukemia (AML) presented with erosions on the back of the tongue surrounded by multiple white patches, which were compatible with oral chronic graft-versus-host disease (cGVHD). During follow-up, a circular-like erosive lesion appeared on the right dorsal surface of the tongue. Biopsy of this lesion confirmed early invasive TSCC (T2N0M0). Partial glossectomy and tongue reconstruction were performed after cessation of immunosuppressants. Immunohistochemical (IHC) staining was positive for p16 and ki-67, suggesting a probable active human papillomavirus (HPV) infection. Six months after surgery, the patient showed no signs of metastasis or recurrence nor progression of oral GVHD.
Pubmed PDF WebNada Al Masalmeh, Geetika Kukreja, Feras Zaiem, S. Naweed Raza, Harold Kim, Misako Nagasaka, Ammar Sukari
Publication date 01-07-2021
Extra-pulmonary small cell carcinomas (EPSCC) are rare malignancies. Like small cell lung cancer (SCLC), they are aggressive malignancies with dismal prognosis. We here report a case of a middle-aged man who presented with odynophagia and cervical lymphadenopathy. Diagnostic workup confirmed the diagnosis of locally-advanced p16-positive oropharyngeal cancer (OPC) with a surprising histology of small cell cancer, suggesting a human papilloma virus (HPV)-related oropharyngeal cancer with small cell differentiation. HPV oropharynx infection is a well-known risk factor for squamous cell carcinoma of the oropharynx, but it is unknown if it may increase the risk of other OPC histology.
Pubmed PDF WebIlda Patrícia Ribeiro, Teresa Lopes, Nicole Pedro, Leonor Barroso, Rui Costa, Isabel Marques Carreira, Fernando Ribeiro
Publication date 01-07-2021
Sachin Ambre, Mahesh Sultania, Sandhya Biswal, Suvradeep Mitra, Biswajit Sahoo, Dillip Kumar Muduly, Madhabananda Kar
Publication date 29-06-2021
Marcelo Cardoso Figueiredo, Mariana Chantre-Justino, Rafael Latini Ruback, Paulo Pires de Mello, Gilda Alves, Maria Helena Ornellas
Publication date 26-06-2021
Neoplasms induced by human papillomavirus (HPV) infection are generally associated to high-risk HPV types. Recurrent respiratory papillomatosis (RRP) is a rare and chronic HPV-related disease characterized by papillomatous lesions in the respiratory tract, usually affecting larynx. RRP rarely comprises malignant transformation since the low-risk HPV-6 and/or HPV-11 are the most commonly found in the disease. We described a case of one adult-onset RRP (29-year-old, female) with HPV-6 infection affecting vocal folds and extra-laryngeal sites. Computed tomographic scan of the chest revealed papillomatosis with pulmonary spread showing multiple nodules and cavities. Lung involvement later progressed to squamous cell carcinoma of the lung. Patient's pregnancy during investigations may have accelerated lung carcinoma development due to immunological changes. Immunohistochemistry revealed PD-L1 high expression in tumor biopsy and, after pregnancy, the oncology treatment included a combination of pembrolizumab (PD-L1 inhibitor) to chemotherapy and also radiotherapy, showing considerable results. Patient died due to lung cancer complications 15 months after cancer diagnosis. RRP management associated with lung involvement and poor prognostic outcome, such as lung carcinoma, is still a big challenge. In this report, we described the clinical and treatment course of RRP progression to highlight the need for attention to future patients.
Pubmed PDF WebDeepak Pandiar, Pratibha Ramani, Reshma Poothakulath Krishnan, K. Monica
Publication date 26-06-2021
Adarsh Kudva, Vasantha Dhara, BR Patil, Mridula Sankaran
Publication date 26-06-2021
Most aberrations in the cervical course of the internal carotid artery are generally encountered as incidental findings due to their asymptomatic nature. However these morphological variations if not identified intra operatively or pre operatively may lead to vascular accidents. It is essential to be aware of the existence of tortuosity, kinking, and coiling of these great vessels while considering patients for surgeries of head and neck cancer, pharyngeal resections, traumatic injury repair, etc. Our paper presents a case series of four patients in whom carotid dolichoarteriopathies were observed during the course of neck dissection. It aims to highlight the precautions required to avoid morbidity in such patients.
Pubmed PDF WebSachin C Sarode, Shailesh Gondivkar, Gargi S. Sarode, Amol Gadbail, Monal Yuwanati
Publication date 21-06-2021
Khanh Linh Tran, Edward Wang, Sidney Fels, Antony Hodgson, Eitan Prisman
Publication date 19-06-2021
Avinash Kavarthapu, Kaarthikeyan Gurumoorthy
Publication date 19-06-2021
The aim of this article is to survey the accessible writing on the pathogenetic systems engaged with the relationship between oral malignancy and periodontitis. Gingival tissue contains multiple microbiota, which can induce inflammatory reactions. This reaction plays a crucial role in assessing the susceptibility of patients to periodontal diseases. The link between chronic periodontitis and the risk of malignancy through this inflammation of the affected epithelium have been studied thoroughly. Many studies have reported that, chronic periodontitis has systemic influence which has high risk of developing different types of cancers. Also, various confounding factors such as consumption of alcohol, smoking, diet, age and gender have been found to be associated with both chronic periodontitis and oral cancer. An online quest for a wide range of articles distributed was started utilizing MEDLINE/Pub Med, with the keywords, for example, 'oral squamous cell carcinoma (OSCC)', 'oral microbiota,' 'microorganisms and malignancy and Porphyromonas gingivalis. This review aimed to study the current literature linking chronic periodontitis and oral cancer.
Pubmed PDF WebCatherine T. Haring, Collin Brummel, Chandan Bhambhani, Brittany Jewell, Molly Heft Neal, Apurva Bhangale, Keith Casper, Kelly Malloy, Scott McLean, Andrew Shuman, Chaz Stucken, Andrew Rosko, Mark Prince, Carol Bradford, Avraham Eisbruch, Michelle Mierzwa, Muneesh Tewari, Francis P. Worden, Paul L. Swiecicki, Matthew E. Spector
Publication date 19-06-2021
Kedar Vaidya, Gargi S. Sarode, Namrata Sengupta, Sachin C. Sarode, Kiran Gadre, Pushkar Gadre, Shankargouda Patil
Publication date 17-06-2021
Yan-li Wang, Yan Zhu, Shu-xian Jin
Publication date 17-06-2021
Chunyue Ma, Surui Sheng, Yi Shen, Weijin Gao, Thorsen Haugen, Liang Wang, Jian Sun
Publication date 16-06-2021
To introduce new superior thyroid artery perforator flaps (STAPF), and to compare the clinical outcomes with sternocleidomastoid myocutaneous flaps (SCMMF) for their intraoral applications. Between January 2013 and December 2020, forty-three oral cancer patients who received post-oncologic reconstructions with one of these two regional flaps were retrospectively collected. Their techniques and outcomes were compared. All the STAPFs were preprepared with radiologic evaluations. Despite the common arterial origins, the compositions and harvesting procedures of STAPF and SCMMF were different. Though SCMMFs (n = 23) were designed in rotational styles, most STAPFs (n = 20) were septocutaneous perforator flaps, with 2 chimeric ones. In addition, the sizes of STAPFs were generally larger than those of SCMMFs (p = 0.006). Success rate for STAPFs was much higher, with only three partial cutaneous necroses. Radiotherapy delay was more frequently found in those reconstructed with SCMMFs (P = 0.046), mostly due to fistula formations. Besides, incomplete level IIB dissections were also reported in 9 (20.9%) patients in SCMMF group. In our study, the overall survival was affected by both flap conditions (p = 0.014, 1.333-12.881) and postoperative surgical complications (except fistula) (P = 0.005, 2.240-84.134). Functionally speaking, post-reconstructive speech and neck mobility (p < 0.001) were better in the STAPF group. With accumulated experiences on the use of locoregional flaps in the neck, STAPF, when well-prepared, can provide superior reconstructive outcomes for various intraoral defects. As a comparison with SCMMF in the same middle region, STAPF is a viable option with higher success rates and oncological safety for oral cancer patients.
Pubmed PDF WebJia-ling Chen, Qian Wang, Liang-mei Huang, Yong-hui Xu, Dan-dan Dong, Yu-feng Lin, Rong-yi Chen, Jian-qiang Shi
Publication date 03-05-2021
Dong Hoon Lee, Sang Chul Lim
Publication date 30-04-2021
We analyzed clinical data of patients in which the suprastructure maxillectomy site was covered with nasal cavity mucosa flaps with or without free mucosa graft from the nasal septum, to determine the usefulness of this procedure. A total of four edentulous patients who had the suprastructure maxillectomy site covered using nasal cavity mucosa flaps with or without free mucosa graft from the nasal septum between 2014 and 2020, were analyzed. All patients underwent suprastructure maxillectomy using the external approach. There were no major complications resulting from surgical intervention. Radiotherapy (RT) was performed in all patients after surgery. All nasal cavity mucosa flaps survived after RT. There was mild cheek retraction, but to a degree that was cosmetically tolerable in all patients. Local recurrence and distant metastasis to the orbit occurred in one patient. Among four patients, two patients died during follow-up, including one tumor related death and one death from old age. We demonstrated that the use of nasal cavity mucosal flap to cover the suprastructure maxillectomy cavity was effective in improving the patient's quality of life by minimizing wound problems and facial contour changes such as cheek retraction despite postoperative RT.
Pubmed PDF WebAndrew Hartley, Margriet Vreugdenhil, Sara Meade, Charles Fong, Paul Sanghera
Publication date 26-04-2021
N. Ezgi Ozer, Betul Ilhan, Pelin Guneri
Publication date 26-04-2021
Li-Cheng Tan, Peng-Cheng Yu, Jian Wang, Xiao-Yan Zhou, Qing-Hai Ji, Yu-Long Wang
Publication date 24-04-2021
BCOR-rearranged sarcoma is the third common subtype of undifferentiated small round cell sarcoma and was first recognized in 2012 from bone sarcoma with a similar morphological manifestation with undifferentiated round cell but totally different molecular hallmark from Ewing sarcoma. Primary BCOR-rearranged sarcomas were mostly found in bone and soft tissue and were sporadically reported in viscera involving kidney, which add difficulties in differential diagnosis. Here we present a 21 years old male patient with BCOR-CCNB3 in neck, which first diagnosed as thyroid cancer.
Pubmed PDF WebReshika Dhakal, Benjamin J. Moeller, Roshan S. Prabhu, Catherine H. Frenkel, Daniel R. Carrizosa, Ashley L. Sumrall, Zvonimir L. Milas, Daniel S. Brickman, Matthew C. Ward
Publication date 23-04-2021
Kondamudi Dheeraj, Suresh Mani, Rajeev Kumar
Publication date 23-04-2021
Zaneta Ivy DSouza, Rajiv S. Desai, Pankaj M. Shirsat, Shivani Bansal, Pooja Prasad
Publication date 22-04-2021
Akihito Fujimi, Yasuhiro Nagamachi, Naofumi Yamauchi, Takuji Nishisato, Kazuyuki Murase, Kohichi Takada, Mitsuhiro Tsujiwaki, Shintaro Sugita, Tadashi Hasegawa, Junji Kato
Publication date 17-04-2021