Search

Patients with locally advanced HPV-positive tonsil cancer would benefit from prophylactic contralateral neck dissection (pCND).The aim of this study was to analyze rates of contralateral lymph node metastases (LNM) and their prognostic effects on locally advanced HPV-positive tonsillar squamous cell carcinoma.Medical records of 54 patients who underwent upfront primary surgery and pCND were retrospectively reviewed.Six (11.1%) patients had contralateral LNM in 54 locally advanced HPV-positive tonsil cancer. Of these, five patients had contralateral level II LNM and one patient had contralateral level II and III LNM. Contralateral LNM showed significant positive correlations with advanced T stage (This study demonstrated no advantage in performing pCND in early stage HPV-positive tonsil cancer.

Factors that affected prognosis were T stage and extracapsular spread in patients that underwent primary surgery with postoperative radiotherapy for pN2 head and neck carcinoma.The purpose of this study was to examine treatment outcomes and define prognostic factors for pN2 head and neck carcinoma.A total of 209 patients underwent surgery with postoperative radiotherapy between 1994 and 2011. Primary tumor sites were the oropharynx (n = 70), hypopharynx (n = 48), larynx (n = 47), and oral cavity (n = 44). There were 21, 83, 60, and 45 patients with stage T1 to T4 cancers, respectively. The N stages were 20 N2a, 129 N2b, and 60 N2c.The recurrence rate was 40% (83/209) over a mean observation period of 39 months. The 5-year disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS) rates in our cohort were 44%, 60%, and 56%, respectively. The presence of advanced T stage or extracapsular spread had a significant adverse effect on 5-year DFS, DSS, and OS rates according to Kaplan-Meier survival curves. Multivariate Cox regression analysis confirmed the significant association between 5-year DSS rate and advanced T stage (hazard ratio (HR), 2.20; 95% confidence interval (CI), 1.26-3.82; p = 0.005) and extracapsular spread (HR, 2.29; 95% CI, 1.24-4.21; p = 0.008).

Our findings show that copy number loss of FHIT is associated with lymph node metastasis (LNM) and suggest that the down-regulation of Fhit indicates poor prognosis in early oral squamous cell carcinoma (OSCC).The purpose of this study was to identify alterations in genetic markers related to LNM in early OSCC.Genome-wide copy number alterations were analyzed in 14 early OSCCs with (n = 7) or without (n = 7) cervical LNM using 180K array-comparative genomic hybridization. To explore the prognostic implications of the most significantly associated genetic alteration with cervical LNM, immunohistochemical analysis was conducted in 30 OSCCs.A total of 11 recurrently altered regions (RARs) were identified in the 14 OSCC cases. Six RARs on chromosomes 3p26-3p14, 5q22, and 9p21 were found to be significantly more common in early OSCC with LNM (p0.05). Among these, loss of 3p14.2 (where the FHIT gene is located) was the most frequent (five of seven patients with LNM, and none of seven without LNM), and most significantly associated with cervical LNM (p = 0.005). Fhit immunohistochemical staining of 30 OSCCs showed that Fhit negativity was associated with cervical LNM (p = 0.032) and poor disease-specific survival (p = 0.045).

The aim of this study was to evaluate the role of PNI in HPSCC.The medical records of 105 patients who underwent surgery-based treatment for HPSCC were reviewed. Clinicopathologic parameters including disease-specific survival were correlated with PNI.PNI was identified in 27 of the 105 (25.7%) cases of HPSCC. Correlation analysis demonstrated that PNI in HPSCC was significantly correlated with pN classification (10.3% in N0/N1 vs 34.8% in N2/N3, p = 0.006). Patients with PNI had decreased 5-year disease-specific survival with borderline significance (p = 0.065). In a sub-set of 31 patients who did not receive post-operative radiotherapy, PNI was determined to be a significant prognostic predictor (p = 0.033). In multivariate analysis, extracapsular invasion was the only independent prognostic factor for disease-specific survival (p = 0.001).Perineural invasion (PNI) should be considered an independent predictor for cervical lymph node involvement. PNI status in primary hypopharyngeal squamous cell carcinoma (HPSCC) specimens should be considered in decisions concerning adjuvant radiotherapy.

Median (18)F-FDG PET/CT maximum standardized uptake values (SUV max) cut-off values of 7.9 or greater were associated with high-risk human papillomavirus (HPV) negativity in patients with hypopharyngeal squamous cell carcinoma (HPSCC). Furthermore, median (18)F-FDG PET/CT SUV max cut-off values of 7.9 or greater and high-risk HPV negativity were associated with adverse outcomes.We studied the association and the potential prognostic significance of (18)F-FDG PET/CT and high-risk HPV status in HPSCC.The medical records of 45 patients who underwent (18)F-FDG PET/CT for HPSCC before surgery were reviewed. High-risk HPV in situ hybridization was performed to detect HPV infection.The median SUV max was 9.91 ± 4.91 (range 1.9-22.1) and the positive rate of high-risk HPV in situ hybridization was 11% (5 of 45). The SUV max values of negativity for the high-risk HPV subtypes (10.47 ± 4.87) and positivity (5.48 ± 2.45) were found to be significantly different (p = 0.030). The SUV max cut-off value for differentiating negativity for the high-risk HPV subtypes from positivity was 7.9, with a sensitivity of 65% and a specificity of 80%. The 5-year disease-specific survival rate (DSSR) in our cohort was 57%. Patients with an SUV max value higher than 7.9 (p = 0.005) and high-risk HPV negativity (p = 0.047) had decreased 5-year DSSR.

High-risk human papillomavirus (HPV) infection was significantly related to lymph node size in patients with single node metastasis of oral and oropharyngeal cancer.The purpose of this study was to examine the relationship between high-risk HPV infection and lymph node size in patients with single node metastasis of oral and oropharyngeal carcinoma.This study included 48 patients with oral and oropharyngeal carcinoma. Pathologic lymph node stages comprised 36 N1 and 12 N2a.High-risk HPV in situ hybridization was positive in 29% of patients (14/48). Of those patients with high-risk HPV, there was a significant difference (p = 0.008) between oral (9.5%) and oropharyngeal (44.4%) cancers. Average lymph node diameter was 20.7 ± 12.6 mm (range 5-54 mm). We found a positive correlation between high-risk HPV status and lymph node size (p = 0.018). Mean lymph node diameter in high-risk HPV-positive cases was 27.3 ± 13.1 mm and 18.0 ± 11.5 mm in high-risk HPV-negative cases. Extracapsular spread (p = 0.030) and cystic nodal metastases (p = 0.019) were also significantly related to lymph node size. High-risk HPV negative status (p = 0.043), advanced tumor stage (p = 0.009), and extracapsular spread (p = 0.038) all had significant adverse effects on 5-year disease-specific survival.

(18)F-FDG PET/CT is a useful technique for the evaluation of paraglottic space invasion and lymph node metastasis in patients with supracricoid partial laryngectomy (SCPL). Primary SUVmax values (using 7.0 as a cut-off) and nodal SUVmax values (using 2.2 as a cut-off) are important for recurrence and poor prognosis.The purpose of this study was to evaluate the usefulness of (18)F-FDG PET/CT for paraglottic space invasion and lymph node metastasis and the prognostic significance in SCPL.The medical records of 42 patients who underwent (18)F-FDG PET/CT for SCPL before surgery were reviewed.The median primary SUVmax was 6.63 ± 5.07 and the median nodal SUVmax was 1.25 ± 1.86. The primary SUVmax values with paraglottic space invasion (8.34 ± 5.92) and without (4.57 ± 2.74) were significantly different (p = 0.015). The (18)F-FDG PET/CT had an accuracy of 87% for the identification of cervical metastases on a level-by-level basis. A median primary SUVmax value of 7.0 and nodal SUVmax of 2.2 were associated with recurrence (p = 0.022 and p = 0.009, respectively) and 5-year disease-specific survival (p = 0.021 and p = 0.041, respectively).

Median maximum standardized uptake (SUVmax) cut-off values of FDG PET/CT higher than 3.85 were found to be associated with a greater risk cervical lymph node metastasis with extracapsular spread (ECS) in patients with oropharyngeal squamous cell carcinoma (OPSCC).The purpose of this study was to evaluate the use of FDG PET/CT for the identification of ECS and to establish its histologic correlates in OPSCC.The medical records of 78 patients who underwent FDG PET/CT for OPSCC before surgery were reviewed.ECS was present in 42% (42/69) of dissected necks and in 51% (54/106) of dissected cervical levels. The SUVmax values of cervical lymph nodes with and without ECS were found to be significantly different (6.73 ± 3.78 vs 3.02 ± 2.24, p0.001). The SUVmax cut-off value for differentiating necks with ECS from those without ECS was 3.85. The presence of ECS (p = 0.036) and median SUVmax (using 3.85 as a cut-off) (p = 0.037) were found to have a significant adverse effect on 5-year disease-specific survival by univariate analysis. The multivariate analysis showed a significant association of 5-year disease-specific survival with ECS (hazard ratio (HR) = 32.3 in cervical metastasis with ECS, p = 0.012; and HR = 19.6 in cervical metastasis without ECS, p = 0.024).