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Dysphagia and feeding tube dependency commonly occur in patients with laryngeal or hypopharyngeal cancer (LHC) during and after treatment, often leading to poor functional outcomes. Therefore, we examined the factors related to feeding tube dependency among advanced-stage LHC patients undergoing curative surgery. This study included 69 consecutive patients who underwent conservative surgery for previously untreated, advanced-stage LHC (squamous cell carcinoma) between 2006 and 2016. Persistent feeding tube dependency was defined as 1 year or more after treatment completion. Binary logistic regression analysis was used to determine the factors associated with reactive prolonged and persistent feeding tube dependency. Cox proportional hazard regression analysis was used to determine the association between feeding tube dependency and survival. None of the study patients had a prophylactic feeding tube, but 15 (21.7%) patients had reactive feeding tube placement for 3 months or more. A total of 9 (13.0%) patients had persistent feeding tube dependency. Univariate analysis showed that age, tracheostomy, and common terminology criteria for adverse events (CTCAE) ≥ 3 were significantly associated with reactive prolonged and persistent feeding tube dependency (all P < 0.05). In the multivariate analysis, advanced age and CTCAE ≥ 3 remained the independent factors of reactive prolonged and persistent feeding tube dependency (all P < 0.05). Feeding tube dependency was not associated with overall survival or disease-free survival (P > 0.1). Feeding tube dependency might be related to clinical factors, such as age and severe adverse events, in the patients undergoing function-preserving surgery for advanced-stage LHC. [ABSTRACT FROM AUTHOR]

Background: Thyroid lobectomy is recommended as the primary treatment for low-risk thyroid cancer. However, recurrence and hypothyroidism may develop after lobectomy, necessitating thyroid hormone supplementation. The 2015 American Thyroid Association (ATA) guidelines recommended post-lobectomy thyroid-stimulating hormone (TSH) suppression. This study examined the need for TSH suppression and recurrence after lobectomy for unilateral papillary thyroid carcinoma (PTC). Methods: This study involved 369 patients who underwent thyroid lobectomy and ipsilateral central neck dissection for PTC between 2007 and 2015. Thyroid function tests were performed before and regularly after lobectomy. Binary logistic regression analyses were used to find factors predictive of the post-lobectomy need for TSH suppression that was defined by the 2015 ATA guidelines. Results: Serum TSH concentrations gradually increased after lobectomy: proportions with TSH >2 mIU/L at post-lobectomy 1, 3–6, 12, and 24 months were found in 77.0%, 82.3%, 66.7%, and 59.9%, respectively. After lobectomy, 168 (45.5%) patients received levothyroxine (T4) supplementation. Multivariate logistic regression analyses showed that pre-TSH level >2 mIU/L was the sole independent variable predictive of the need for post-lobectomy TSH suppression (P = 0.003). During the median follow-up of 72 months, recurrence was found in 4 (1.1%) patients who never received T4 supplementation and had post-lobectomy TSH levels >2 mIU/L. Conclusions: Our data show that thyroid lobectomy for unilateral PTC is associated with a low recurrence rate, but a significant risk of hypothyroidism. Preoperative TSH level can predict the need for post-lobectomy TSH suppression compliant with the 2015 ATA guidelines. [ABSTRACT FROM AUTHOR]

Purpose: Oral cavity squamous cell carcinoma (OCC) can spread to the neck without apparent lymphadenopathy. Pretreatment detection or prediction of occult metastasis might contribute to proper management of clinically node-negative (cN0) OCC. We examined the role of tumour quantitative 18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) measurements for predicting OCC occult metastasis and survival. Methods: This study included 130 cN0 OCC patients who underwent 18F-FDG PET/CT scanning and subsequent curative surgery and neck dissection. Maximum, peak, and mean standardized uptake value (SUVmax, SUVpeak, and SUVmean), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were measured on pretreatment 18F-FDG PET/CT. Binary logistic regression was used to identify factors predicting occult cervical metastasis. Univariate and multivariate Cox proportional hazard regression were used to find factors associated with overall survival (OS). Results: Pathological cervical metastasis (pN +) was found in 29 (22.3%) patients. Age, tumour differentiation, lymphovascular invasion, and T classification were significantly associated with pN + (all P < 0.05). After adjustment for these factors, MTV and TLG independently predicted pN + (P < 0.05). Invasion depth, lymphovascular invasion, T and N classifications, and overall TNM stage were significantly associated with OS. After adjustment for these factors, SUVmax and TLG independently predicted OS (all P < 0.05). Patients with TLG > 9.3 g had a 5.7-fold increased risk of overall mortality. Conclusions: Tumour 18F-FDG PET/CT parameters might predict occult metastasis and survival in cN0 OCC patients. [ABSTRACT FROM AUTHOR]

Purpose: Adenoid cystic carcinoma (AdCC) is generally slow growing but has highly metastatic potential to distant organs. Several factors and biomarkers are associated with metastasis and treatment outcomes, although further definition is needed. Therefore, this study aimed to evaluate the risk factors for survival and distant metastasis in patients with head and neck AdCC. Methods: This study included 125 patients with previously untreated AdCC who underwent primary surgery with or without radiotherapy in our tertiary referral centre. Univariate and multivariate Cox proportional hazard regression analyses were used to identify risk factors associated with overall survival (OS), cause-specific survival (CSS), disease-free survival (DFS), and distant metastasis-free survival (DMFS). Factors associated with OS in patients with distant metastasis were separately analysed. Results: During a median follow-up of 9.8 years (range 3.0–22.6 years), 58 patients (46.4%) had distant metastasis and 29 (23.2%) died of disease. Multivariate analyses showed that lymphovascular invasion, lymph node metastasis, and distant metastasis were independent factors of OS and CSS outcomes (all P < 0.05). The T classification and extranodal extension were independent factors of DFS and DMFS outcomes (P < 0.05). After patients presented with distant metastasis, the median survival was 5.8 years. Multivariate analyses showed that extranodal extension and regional recurrence were independent factors of survival after occurrence of distant metastasis (P < 0.05). Conclusion: Several clinicopathological factors can predict distant metastasis and survival of patients with AdCC treated with primary surgery. This may promote post-treatment surveillance in patients with AdCC. [ABSTRACT FROM AUTHOR]

Purpose: Cervical metastasis from unknown primary (CUP) is commonly classified as an advanced overall stage. P16 or human papillomavirus (HPV) positivity in metastatic lymph nodes (LN) might be associated with a favorable survival outcome of CUP. Therefore, we evaluated the prognostic values of p16 immuno-positivity in LN and other clinicopathological factors in patients with squamous cell carcinoma CUP (SCCUP). Methods: This study involved 83 patients who underwent therapeutic neck dissection and panendoscopic examination and biopsy for suspected CUP. P16 immunostaining and HPV typing in LN were performed in 56 patients. Cox proportional hazard regression analyses were used to identify factors associated with overall survival (OS) and disease-free survival (DFS). Results: Postoperatively, primary tumors (PT) were found in 32 (38.6%) patients, mainly (90.6%) in the oropharynx, and not found in 51 (61.4%) patients. The clinicopathological data (except for histological grade) and 5-year OS and DFS rates did not significantly differ between patients with and without PT identification (all P > 0.05). P16 positivity was associated with favorable OS and DFS outcomes in the patients with PT (P < 0.05) but not in those without PT (P > 0.1). Multivariate analyses showed that age (> 60 years) and LN ratio (≥ 0.1) were the independent predictors of OS and DFS outcomes (all P < 0.05). P16 positivity or other factors were not independent factors. Conclusion: Age and LN ratio are significant risk factors of survival and recurrence after primary surgery for SCCUP. Prognostic significance of LN p16 positivity should be further studied. [ABSTRACT FROM AUTHOR]

Purpose: Subclinical lymph node (LN) metastasis is associated with poor survival outcome in oral cavity squamous cell carcinoma (OCC), which alleges elective neck LN dissection. Preoperative detection of metastatic LNs may improve prognosis and proper management of OCC. We examined the clinical usefulness of fluorine 18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for the detection of occult neck LN metastasis in OCC patients in comparison with conventional CT/magnetic resonance (MR) imaging. Methods: A total of 178 OCC patients with negative neck palpation findings were assessed prospectively with 18F-FDG PET/CT and CT/MR imaging. Histopathological analyses of neck dissection samples served as reference. Diagnostic values of 18F-FDG PET/CT versus CT/MR imaging were compared with the McNemar test and logistic regression with generalized estimating equations. Results: Forty-two patients (23.6%) had metastasis in 44 sides and 58 levels of the neck. The sensitivity for detection of occult metastasis was higher for 18F-FDG PET/CT than that for CT/MR imaging on a per-patient (69.1% vs 35.7%), per-side (70.5% vs 36.4%), and per-level (62.1% vs 29.3%) basis (all P ≤ 0.001). However, the specificity for metastatic detection was higher for CT/MR imaging than that for 18F-FDG PET/CT (all P < 0.005). 18F-FDG PET/CT improved detection of occult metastasis up to 33.4% in these patients compared to CT/MR imaging. Conclusions: 18F-FDG PET/CT can better detect occult neck metastasis than CT/MR imaging, which may potentially impact the clinical management of OCC patients. [ABSTRACT FROM AUTHOR]

Purpose: Metastatic lymph node (LN) burden is one of the most important prognosticators in human solid cancers, but has rarely been examined in laryngeal and hypopharyngeal cancers (LHC). We evaluated the nodal factors predictive of recurrence and survival in patients with LHC. Methods: This study included 141 consecutive patients who underwent primary surgery and neck dissection for previously untreated LHC at our tertiary referral centre. Nodal factors included the presence of pathological LN metastasis, number of positive LNs, LN ratio, and extra-nodal extension (ENE). Our proposed N classification was analysed by recursive partitioning analysis and compared with the AJCC and other N classifications using the c-index. Univariate and multivariate Cox proportional hazard regression analyses were used to define significant predictors of post-treatment disease-free survival (DFS) and overall survival (OS). Results: Of the 141 patients, 66 (46.8%) had positive LNs, and 27 (19.1%) had ENE. In multivariate analyses, the number of positive LNs was strongly associated with DFS and OS outcomes (P < 0.01). Our new N classification was proposed with four categories, such as N0 (0 LN +), N1 (1 LN +), N2 (2–4 LN + or ENE) and N3 (≥ 5 LN +). The C-index of our new N classification improved the OS prediction (0.718) compared with the AJCC and the other N classifications (0.704–0.713). Conclusion: Metastatic LN burden is an important predictor of survival in patients with LHC. A proposed N classification using the number of positive LNs and ENE might improve the LHC survival prediction. [ABSTRACT FROM AUTHOR]

Purpose: Submandibular gland (SMG) carcinoma has an unfavorable clinical course and a low survival rate. Specific tumor and nodal findings might help predict posttreatment recurrence and survival in SMG carcinoma patients. This study evaluated factors predictive of posttreatment recurrence and survival in SMG carcinoma patients. Methods: This study enrolled 99 consecutive patients with previously untreated SMG carcinoma. All patients underwent tumor and metastatic lymph node resection along with or without radiation/chemo-radiation. The predictive clinical and pathological factors for disease-free survival (DFS), distant metastasis–free survival (DMFS), disease-specific survival (DSS), and overall survival (OS) were determined using univariate and multivariate Cox proportional hazards regression analyses. Results: The median tumor size was 2.7 cm and 53 patients (53.5%) had high-grade tumors. The rates of initial nodal and distant metastasis at initial presentation or follow-up were 45.5% and 42.4%, respectively. The actuarial 5-year DFS, DMFS, DSS, and OS rates were 46.4%, 55.9%, 61.5%, and 59.7%, respectively. The independent factors associated with poor DFS, DMFS, DSS, and OS outcomes (all p < 0.05) were T3–T4 classification and lymph node ratio. A histological high-grade tumor was an independent prognostic factor predictive of poor DMFS, DSS, and OS outcomes (all p < 0.05). Conclusions: A high rate of distant site failure is associated with SMG carcinoma, resulting in a poor survival rate. Lymph node ratio might help predict recurrence, distant metastasis, and death due to SMG carcinoma. [ABSTRACT FROM AUTHOR]

Purpose: High-grade salivary gland carcinoma (SGC) shows a high rate of metastasis and post-treatment recurrence, resulting in poor patient survival. Therefore, we evaluated the utility of pre-treatment 18F-FDG PET/CT parameters in predicting metastasis, tumor progression, and survival of high-grade SGC patients.Methods: This observational study included 75 patients with previously untreated high-grade SGC who underwent pre-treatment 18F-FDG PET/CT scanning and subsequent treatment. Standardized uptake values (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured on pre-treatment 18F-FDG PET/CT. Logistic regression analysis was used to identify the relationship of these factors with metastasis. Cox proportional hazard regression analyses were used to identify associations between PET parameters and both progression-free survival (PFS) and overall survival (OS).Results: A total of 36 (48%) patients had neck or distant metastases at initial staging. After controlling for clinical factors, MTV (> 8.8 mL) was an independent factor for initial metastasis (adjusted odds ratio 4.80, 95% confidence interval 1.09-21.20; P = 0.039). All PET parameters of SUVmax (> 4.3), SUVmean (> 3.0), SUVpeak (3.9), MTV (> 8.8 mL), and TLG (> 31.1 g) were significant variables for PFS (all P < 0.05), while MTV and TLG were significant factors for OS. After controlling for clinicopathological factors, MTV (adjusted hazard ratio 4.36, 95% confidence interval 1.69-11.26; P = 0.002) and TLG (3.41, 1.47-7.91; P = 0.004) were significantly associated with PFS, but not OS.Conclusions: MTV is useful among quantitative PET measurements for predicting initial metastasis and PFS in patients with high-grade SGC. [ABSTRACT FROM AUTHOR]

Objectives: Despite the excellent prognosis of early glottic cancer (T1-T2), the significance of preoperatively measured tumor thickness has not been elucidated. We evaluated the role of tumor thickness measured using computed tomography (CT) as a predictive factor for recurrence of early glottic cancer after transoral laser microsurgery (TLM). Methods: The medical records of 134 patients who were diagnosed with early glottic squamous cell carcinoma and underwent TLM were reviewed. Age, sex, clinical stage, preoperative biopsy, anterior commissure involvement, CT findings, recurrence, and overall survival were evaluated. Results: Seventy-three patients (54 T1a, 2 T1b, and 17 T2) were enrolled. Tumor thickness on pathology increased proportionally with increased tumor thickness on CT. The recurrence-free survival (RFS) and overall survival rates were 82.2 and 91.2%, respectively. Upon univariate analysis, RFS was affected by the type of cordectomy, tumor differentiation, margin involvement, anterior commissure involvement, impaired vocal fold mobility, and tumor thickness (> 4 mm) on CT scan (all p < 0.01). Among the relevant covariates, an involved or close resection margin [hazard ratio (HR) 19.2; 95% confidence interval (CI) 3.5-105.6; p < 0.01], impaired vocal cord mobility (HR 8.5; 95% CI 1.45-49.2; p = 0.02), and pathological tumor thickness (> 4 mm) (HR 6.0; p = 0.02) were predictive of RFS. Conclusion: Tumor thickness may be another predictive factor for recurrence in early glottic cancer. Before TLM, reviewing the extent of tumor thickness will help to improve local control in cases of early glottic cancer. [ABSTRACT FROM AUTHOR]

Objective: We aimed to identify the clinical implications of nonspecific pulmonary nodules (NPNs) detected in the initial staging workup for patients with head and neck squamous cell carcinoma (HNSCC).Methods: Medical records of patients who had been diagnosed and treated in our hospital were retrospectively analysed. After definite treatment, changes of NPNs detected on initial evaluation were monitored via serial chest computed tomography. The associations between NPNs and the clinicopathological characteristics of primary HNSCC were evaluated. Survival analyses were performed according to the presence of NPNs.Results: The study consisted of 158 (49.4%) patients without NPNs and 162 (50.6%) patients with NPNs. The cumulative incidence of probabilities of pulmonary malignancy (PM) development at 2 years after treatment were 9.0% and 6.2% in NPN-negative and NPN-positive patients, respectively. Overall and PM-free survival rates were not significantly different according to NPN status. Cervical lymph node (LN) involvement and a platelet-lymphocyte ratio (PLR) ≥126 increased the risk of PMs (both P <0.05).Conclusions: NPNs detected in the initial evaluation of patients with HNSCC did not predict the risk of pulmonary malignancies. Cervical LN involvement and PLR ≥126 may be independent prognostic factors affecting PM-free survival regardless of NPN status.Key Points: • We aimed to identify the clinical implications of nonspecific pulmonary nodules (NPNs). • NPNs in head and neck cancer patients do not lead to pulmonary malignancies (PMs). • NPNs are not associated with overall or PM-free survival (PMFS). • Cervical lymph node involvement is an independent prognostic factor affecting PMFS. • Platelet-lymphocyte ratio ≥126 is another predictor of PMFS regardless of NPN presence. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and safety of ethanol ablation (EA) for thyroglossal duct cyst (TGDC) against surgery.Methods: This study included 345 patients (289, surgery; 56, EA) treated for TGDC at four institutions between May 2005 and June 2014. Surgery (whole surgery and Sistrunk operation which is the current standard surgical method) and EA were compared with respect to the treatment failure and complication rates. The cost of EA and surgery was also compared. The Cox regression hazard model and linear regression were used for the adjustment of covariates.Results: EA demonstrated higher treatment failures (19.6% vs. 2.4%, p < 0.001[whole surgery] and 1.2%, p = 0.004 [Sistrunk operation]), but fewer complications (1.8% vs. 10.0%, p = 0.04 [whole surgery] and 10.2%, p = 0.06 [Sistrunk operation]), and lower cost (₩423,801 vs. ₩1,435,707 [whole surgery]) than surgery. EA achieved 85.7% of treatment success up to second session. The mean volume reduction rate after EA was 82.3% at last follow-up. Young age and EA were correlated with treatment failure (p = 0.01 and 0.001, respectively).Conclusion: Both surgery and EA had acceptable treatment efficacy in the management of TGDC. Although there is a higher likelihood of treatment failure with EA, it has a better safety profile than surgery.Key Points: • Both surgery and ethanol ablation show acceptable treatment efficacy for TGDC. • Considering treatment failure, surgery manages TGDC more effectively than EA. • EA is safer than surgery and presents no major complications. • EA could be an alternative treatment for TGDC in selected patients. [ABSTRACT FROM AUTHOR]

Objectives: To identify the clinical significance of primary tumour thickness (TT) and its direction in patients with oral tongue squamous cell carcinoma (OTSCC), we measured TT in all axial/coronal/sagittal views on magnetic resonance imaging (MRI) and evaluated their meaning.Methods: A total of 53 OTSCC patients were analysed who had undergone preoperative three-dimensional MRI and had been surgically treated. TT measured on axial (mediolateral direction), coronal (superoinferior direction), and sagittal (anteroposterior direction) views was compared to that in pathologic specimens. The association between TT on MRI and other pathologic parameters was also evaluated.Results: TT on MRI in each plane showed relatively high concordance rates with the histological measurements. TT in all three planes was significantly correlated with lymph node (LN) metastasis. Occult LN metastasis was found in 15 of 39 (38.5%) patients, and the cutoff value of TT in axial/coronal/sagittal MRI predicting occult LN metastasis was 6.7 mm, 7.2 mm, and 12.3 mm, respectively. TT on MRI did not show any significant association with recurrence and survival.Conclusions: TT on MRI in all three planes showed relatively high coincidence with TT on histopathology and presented a potential cut-off value as a predictive indicator for occult LN metastasis.Key Points: Three-dimensional measurement of tumour thickness (TT) is important for oral cancer treatment. Magnetic resonance imaging (MRI) is a useful diagnostic tool for oral cancer. TT on MRI has a high coincidence with TT on histopathology. TT on MRI is a predictive marker for occult lymph node metastasis. [ABSTRACT FROM AUTHOR]

Purpose: Quality of life (QOL) scores in cancer patients are associated with disease course and treatment outcomes. The aim of this study was to prospectively evaluate the associations between pretreatment QOL scores and survival or functional outcomes in patients with head and neck squamous cell carcinoma (HNSCC).Methods: This prospective study enrolled a total of 141 patients with previously untreated HNSCC who underwent curative treatments from October 2010 to March 2012. Patients completed questionnaires on QOL including the European Organization of Research and Treatment of Cancer 30-item Core QOL questionnaire (EORTC QLQ-C30) and EORTC QOL questionnaire Head and Neck Cancer module (QLQ-H&N35). Univariate and multivariate analyses were used to identify QOL scores significantly associated with overall survival (OS), disease-free survival (DFS), and functional outcomes of gastrostomy or tracheostomy dependence.Results: The 2-year OS and DFS rates were 82.3 and 78.0%, respectively. The rates of gastrostomy and tracheostomy dependence were 9.2 and 14.9%, respectively. After controlling for clinical factors, specific QOL indices of 'dyspnea' (hazard ratio 1.023 [95% confidence interval 1.006-1.039]) and 'appetite loss' (1.020 [1.005-1.034]) were significantly associated with OS, while 'insomnia' (1.013 [1.002-1.025]) and 'appetite loss' (1.014 [1.001-1.026]) scores were significantly predictive of DFS (P < 0.05). Global health status score (0.967 [0.935-1.000]) and fatigue (1.048 [1.010-1.086]) were significantly associated with the dependence of tracheostomy (P < 0.05). There was no relationship between gastrostomy dependence and QOL indices.Conclusion: This study provides evidence of significant relationships between certain pretreatment QOL measures and survival or functional outcomes in HNSCC patients. [ABSTRACT FROM AUTHOR]