Search

Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor originating in the nasopharynx and has a high incidence in Southeast Asia and North Africa. To develop these comprehensive guidelines for the diagnosis and management of NPC, the Chinese Society of Clinical Oncology (CSCO) arranged a multi‐disciplinary team comprising of experts from all sub‐specialties of NPC to write, discuss, and revise the guidelines. Based on the findings of evidence‐based medicine in China and abroad, domestic experts have iteratively developed these guidelines to provide proper management of NPC. Overall, the guidelines describe the screening, clinical and pathological diagnosis, staging and risk assessment, therapies, and follow‐up of NPC, which aim to improve the management of NPC.

OBJECTIVE Salvage endoscopic nasopharyngectomy (ENPG) is a reasonable choice for resectable recurrent nasopharyngeal carcinoma (rNPC). However, in past decades, complete removal of the tumor was not feasible when the recurrent lesion was adjacent to the internal carotid artery (ICA). The present article introduces innovative strategies to ensure sufficient surgical margins while avoiding accidental injury to the ICA. STUDY DESIGN Retrospective study. SETTING Tertiary care center. METHODS We retrospectively reviewed rT2-3 rNPC patients with tumor lesions adjacent to the ICA (

Background Surgical access for retropharyngeal lymph node (RPLN) dissection is difficult. We aimed to examine the efficacy of transcervical endoscopic RPLN dissection (TSE-RPLND) for recurrent RPLN in nasopharyngeal carcinoma (NPC). Methods From April 2013 to February 2019, a total of 31 patients with NPC diagnosed with RPLN recurrence underwent TSE-RPLND. The clinical characteristics, complications, and survival outcomes were retrospectively analyzed. Results The mean duration of surgery, quantity of bleeding and postoperative hospitalization stay were 347.9 minutes, 107.7 mL, and 8.7 days, respectively. After a median follow-up of 31.0 months, the 2-year locoregional relapse-free survival, distant metastasis-free survival, progression-free survival, and overall survival rates were 63.9%, 95.2%, 59.9%, and 83.3%, respectively. The long-term incidences of swallowing problems, permanent nutrient tube, tongue atrophy, and shoulder problems were 6 (19.4%), 3 (9.7%), 3 (9.7%), and 3 (9.7%), respectively. Conclusions TSE-RPLND is an effective method to treat RPLN recurrence in NPC, but nerve injury-related complications should not be ignored.

This paper proposes that the corporate governance structure and financial constraints determine the willingness and ability of firms to implement labor hoarding, and thus influence the speed of employment adjustment. Using Taiwanese manufacturing firms in the decade after the 2008 financial crisis as the sample and conducting a mixed‐effects analysis, our results confirm the presence of labor hoarding. The willingness of hoarding labor is higher for firms having a governance structure focusing less on shareholders’ interests, which leads to lower adjustment speeds. The ability of hoarding labor is stronger, so the adjustment is slower, for firms facing less pressure from financial constraints. Moreover, financial constraints have more impact than the governance structure, and impel firms to accelerate the adjustment throughout the decade. There is also evidence of asymmetric adjustment. The firms with job destruction have higher adjustment speeds than those with job creation, and the connections of adjustment speeds to corporate governance and financial constraints are more applicable to job destruction. We suggest that encouraging firms to adopt a governance structure of less shareholder concern, or more importantly helping them to obtain sufficient funds for retaining talent may be an effective policy to deal with brain drain in Taiwan.

We analyzed the number of circulating tumor cells (CTCs) and Epstein-Barr virus DNA (EBV DNA) for diagnosis, monitoring and prognosis of patients with metastatic nasopharyngeal carcinoma (mNPC). The levels of CTCs and EBV DNA were measured at baseline and after first-line chemotherapy in 148 mNPC patients prospectively enrolled between December 2014 and August 2016. We also collected 122 non-mNPC cases within the same time frame for examining CTCs and EBV DNA at baseline. In 270 NPC patients, we observed improved specificity (86.0% vs. 41.0%) and inferior sensitivity (42.3% vs. 81.3%) of CTCs as compared to EBV DNA for diagnosis of distant metastasis. mNPC patients were stratified into unfavorable and favorable prognostic groups, respectively, based on CTC of 12 at baseline and 1 after first-line chemotherapy and EBV DNA of 10,000 at baseline and 4,000 after first-line chemotherapy. Conversion of baseline unfavorable CTCs and EBV DNA to favorable after first-line chemotherapy was associated with significantly longer progression-free survival (PFS) and overall survival (OS) compared to patients with unfavorable CTCs and EBV DNA at both time points. Among patients with a complete/partial response as per imaging evaluation, favorable CTCs and EBV DNA levels after first-line chemotherapy were associated with significantly longer PFS and OS. In conclusion, our data demonstrated the number of CTCs and EBV DNA before, after and during first-line chemotherapy were strong predictive markers for mNPC patients. When utilized in conjunction with imaging studies, CTCs and EBV DNA could provide additional prognostic information.

Objective To compare survival effects of comprehensive neck dissection (CND) and selective neck dissection (SND) for patients with nasopharyngeal carcinoma (NPC) with only regional failure. Methods A total of 294 recurrent T0N1-3M0 NPC patients who underwent neck dissection in Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China, between January 1984 and February 2014, were enrolled in the survival and interaction analyses. Using propensity scores to adjust for potential prognostic factors, an additional well-balanced cohort of 210 patients was constructed by matching each patient who received SND with one patient who underwent CND (1:1); the differences were then compared between SND and CND in terms of overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), and distant metastasis-free survival (DMFS). Results Both univariate and multivariate analyses showed that SND was not inferior to CND (P > 0.05) but demonstrated that extracapsular spread (ECS) (hazard ratio [HR] 3.49, 95% confidence interval [CI] 2.30-5.29, P 0.05). Furthermore, no survival differences were found between SND and CND in the case-matched cohort in terms of OS, LRFS, RRFS, or DMFS (P = 0.550, 0.930, 0.214, and 0.146, respectively). Conclusion With a similar radical dissection extent around the tumor rather than dissection of extensive lymph region distal to the lesion, SND is not inferior to CND for patients with NPC with only cervical failure. ECS, rN stage, and positive margins were adverse independent prognostic factors for patients with NPC. Level of evidence 4 Laryngoscope, 129:387-395, 2019.

Background Due to the occult anatomic location of the nasopharynx and frequent presence of adenoid hyperplasia, the positive rate for malignancy identification during biopsy is low, thus leading to delayed or missed diagnosis for nasopharyngeal malignancies upon initial attempt. Here, we aimed to develop an artificial intelligence tool to detect nasopharyngeal malignancies under endoscopic examination based on deep learning. Methods An endoscopic images-based nasopharyngeal malignancy detection model (eNPM-DM) consisting of a fully convolutional network based on the inception architecture was developed and fine-tuned using separate training and validation sets for both classification and segmentation. Briefly, a total of 28,966 qualified images were collected. Among these images, 27,536 biopsy-proven images from 7951 individuals obtained from January 1st, 2008, to December 31st, 2016, were split into the training, validation and test sets at a ratio of 7:1:2 using simple randomization. Additionally, 1430 images obtained from January 1st, 2017, to March 31st, 2017, were used as a prospective test set to compare the performance of the established model against oncologist evaluation. The dice similarity coefficient (DSC) was used to evaluate the efficiency of eNPM-DM in automatic segmentation of malignant area from the background of nasopharyngeal endoscopic images, by comparing automatic segmentation with manual segmentation performed by the experts. Results All images were histopathologically confirmed, and included 5713 (19.7%) normal control, 19,107 (66.0%) nasopharyngeal carcinoma (NPC), 335 (1.2%) NPC and 3811 (13.2%) benign diseases. The eNPM-DM attained an overall accuracy of 88.7% (95% confidence interval (CI) 87.8%–89.5%) in detecting malignancies in the test set. In the prospective comparison phase, eNPM-DM outperformed the experts: the overall accuracy was 88.0% (95% CI 86.1%–89.6%) vs. 80.5% (95% CI 77.0%–84.0%). The eNPM-DM required less time (40 s vs. 110.0 ± 5.8 min) and exhibited encouraging performance in automatic segmentation of nasopharyngeal malignant area from the background, with an average DSC of 0.78 ± 0.24 and 0.75 ± 0.26 in the test and prospective test sets, respectively. Conclusions The eNPM-DM outperformed oncologist evaluation in diagnostic classification of nasopharyngeal mass into benign versus malignant, and realized automatic segmentation of malignant area from the background of nasopharyngeal endoscopic images.

Background Enlarged retropharyngeal lymph nodes (RLNs) are very common in patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy. The most suitable treatment option for enlarged RLNs depends on the pathological results. However, RLN sampling is difficult and imminent in the clinic setting. We recently developed a novel minimally invasive technique termed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for sampling RLN tissues sufficient for pathological or cytological diagnosis. Methods We enrolled 30 post-radiotherapy patients with NPC with suspected RLN metastasis detected via magnetic resonance imaging (MRI). The EUS probe was introduced into the nasopharynx via the nostrils, and EUS was then used to scan the retropharyngeal space and locate the RLN in the anterior carotid sheath. EUS-FNA was subsequently performed. The safety and efficacy of using EUS-FNA to sample the RLN tissues were assessed. Results Strips of tissue were successfully sampled from all patients using EUS-FNA. Of the 30 patients, 23 were confirmed to have cancer cells in the biopsied tissues via pathology or cytology examinations with 1 EUS-FNA biopsy session. The seven cases without confirmed cancer cells were subsequently reanalyzed by using another EUS-FNA biopsy session, and two more cases were confirmed possessing cancer cells. The other five patients without confirmed cancer cells were closely followed with MRI every month for 3 months. After follow-up for 3 months, three patients were still considered cancer-free due to the presence of RLNs with stable or shrinking diameters. The rest two patients who showed progressive disease underwent a third EUS-FNA biopsy procedure and were further confirmed to be cancer cell-positive. In the whole cohort reported here, the EUS-FNA procedure was not associated with any severe complications. Conclusion EUS-FNA is a safe and effective diagnostic approach for sampling tissues from the RLNs in patients with suspected recurrent NPC.

To compare intensity-modulated radiotherapy (IMRT) with cisplatin (CDDP) versus cetuximab (CTX) and nimotuzumab (NTZ) for Stage II-IVb Nasopharyngeal Carcinoma (NPC). A total of 1,837 patients with stage II - IVb NPC who received IMRT plus CTX or NTZ, or CDDP between January 2009 and December 2013 were included in the current analysis. Using propensity scores to adjust for potential prognostic factors, a well-balanced cohort of 715 patients was created by matching each patient who underwent IMRT plus concomitant NTZ/CTX with four patients who underwent IMRT plus concomitant CDDP (1:4). Efficacy and safety were compared between the CTX/NTZ and CDDP groups of this well-balanced cohort. Furthermore, we conducted multivariate analysis and subgroup analysis based on all the 1,837 eligible cases. There was no significant difference between CTX/NTZ group and CDDP group in terms of DFS (3-year, 86.7% vs. 86.2%, P>0.05), LRRFS (96.2% vs. 96.3%, P>0.05), DMFS (91.1% vs. 92.3%, P>0.05), and OS (91.7% vs. 91.9%, P>0.05). Subgroup analysis demonstrated a significant interaction effect between patients with IMRT plus CTX/NTZ and N3 node stage on LRRFS with the highest risk of loco-regional relapse (HR 8.85, P=0.001). Significantly increased hematologic toxicities, gastrointestinal reactions were observed in the CDDP group (P

Background Although endoscopic nasopharyngectomy and intensity-modulated radiotherapy (IMRT) have been reported to be useful in treating isolated local recurrent nasopharyngeal carcinoma (NPC), their efficacy needs to be revaluated with comparison to 2D conventional radiotherapy (RT). Methods Four hundred ten patients with recurrent NPC were retrospectively analyzed, among whom the patients underwent IMRT, endoscopic nasopharyngectomy, and 2D conventional RT. Results The 5-year overall survival (OS) and distant metastasis-free survival were significantly higher in endoscopic nasopharyngectomy and IMRT groups than in 2D conventional RT group both in the entire series and in the subgroup of patients with recurrent T1 to 2 NPC (p

The choice of whether to expense broad-based stock incentives has been a highly controversial debate in both academic research and practice circles. We provide insightful findings to reconcile certain debates regarding the effectiveness of non-expensed, broad-based stock incentives. Using a unique longitudinal dataset from Taiwanese high-tech firms over the 1997–2008 period, our results indicate that non-expensed employee stock bonus incentives exerted positive effects on short-term organizational value added creation. The dilution effects of broad-based stock incentives in Taiwan, however, exerted a negative influence on profitability and eroded share return. The negative effects were even more severe in the following year, and overexploitation of employee stock bonus also damaged the long-term organizational performance of Taiwanese high-tech firms. This negative aspect of non-expensed employee stock incentives resulted in more evidence for changing the regulatory context of broad-based stock incentives in Taiwan.

Previously, we and others showed that hypoxia‐inducible factor‐1α (HIF‐1α) and transcriptionally upregulated Aurora‐A were required for disease progression in several tumors. Here, we address the clinicopathologic value of Aurora‐A and HIF‐1α in locally advanced nasopharyngeal carcinoma (NPC). Aurora‐A and HIF‐1α expression was semiquantitatively evaluated by immunohistochemistry staining in 144 cases from a randomized controlled trial. Of these patients, 69 received neoadjuvant chemotherapy plus concurrent chemoradiotherapy, and acted as the training set, and 75 cases treated with neoadjuvant chemotherapy plus radiotherapy were used as the testing set to validate the prognostic effect of Aurora‐A and HIF‐1α. We found that Aurora‐A and HIF‐1α were highly expressed in NPC, but were deficient in normal adjacent epithelia. In the testing set, Aurora‐A overexpression predicted a shortened 5‐year overall survival (59.1% vs 82.5%, P = 0.024), progression‐free survival (44.8% vs 79.8%, P = 0.004), and distant metastasis‐free survival (43.0% vs 17.3%, P = 0.016). Multivariate regression analysis confirmed that Aurora‐A was indeed an independent prognostic factor for death, recurrence, and distant metastasis both in the testing set and overall patients. Moreover, a positive correlation between Aurora‐A and HIF‐1α was detected (P = 0.037). Importantly, although HIF‐1α did not show any prognostic effect for patient outcome, the subset with Aurora‐A and HIF‐1α co‐overexpression had the poorest overall, progression‐free, and distant metastasis‐free survival (all P

Background Endoscopic nasopharyngectomy is a new salvage treatment for locally recurrent nasopharyngeal carcinoma (NPC). However, how to resurface the nasopharyngeal defects in endoscopic endonasal approaches to avoid persistent postoperative headache, to the best of our knowledge, has not been reported. Methods From September 2009 to August 2010, we used a modified posterior pedicle nasal septum and floor mucoperiosteum flap (nasal septum and floor flap, NSFF) after endoscopic nasopharyngectomy in 12 patients with locally recurrent NPC. Most of the nasal septum and floor mucoperiosteum, except for the posterior pedicle, was harvested to cover the nasopharyngeal defects. Results All NSFFs successfully covered the entire nasopharyngeal defects and relined the nasopharynx with good functional recovery. The nasopharyngeal wounds recovered in 28 days (range, 14 to 56 days), and the donor-site wounds recovered in 46.5 days (range, 24–84 days). No reconstruction-related complications or disease recurrences were observed. Conclusion The NSFF is a safe and promising reconstructive option to resurface the nasopharyngeal defect after endoscopic nasopharyngectomy in patients with locally recurrent NPC. © 2011 Wiley Periodicals, Inc. Head Neck, 2011

From December 2009 to April 2010, six patients with caesarean scar pregnancies (CSPs) underwent the transvaginal removal of ectopic pregnancy tissue and repair of a uterine defect. Transvaginal surgery was performed uneventfully in all cases. The operating time ranged from 45 to 80 minutes. Blood loss ranged from 50 to 150 ml. Serum β-hCG (β-subunit of human chorionic gonadotrophin) levels declined to normal levels within a month for all patients, and all patients recovered without complications. Our results show that the transvaginal removal of ectopic pregnancy tissue and repair of the uterine defect is effective, safe, and minimally invasive for patients with CSP.

This paper examines the impact of managerial pay adjustments on firm performance using Taiwanese data. Pay adjustments are decomposed into three components: adjustments derived from external labor market comparisons, adjustments based on changes in firm and manager characteristics, and transitory adjustments. Panel regression models are used to test how pay adjustments affect subsequent firm performance. Evidence shows that the relation between pay adjustments and performance is related to performance measures, as different measures capture the incentive effect and managerial entrenchment effect in different ways. The relative strength of these two effects also explains the diverse impacts of the three adjustment components on firm performance.

Objectives: Nasopharyngectomy is the primary treatment for locally recurrent nasopharyngeal carcinoma (rNPC). However, oncological nasopharyngectomy is difficult to achieve, even using extranasal surgical approaches, with potential risks of severe functional disabilities and serious complications. This report introduces an innovative, minimally invasive, oncological, endoscopic nasopharyngectomy. Methods: Between October 2004 and January 2008, 37 rNPC patients received endoscopic nasopharyngectomy, with 17, 4, 14, and 2 cases of rT1N0M0, rT2aN0M0, rT2bN0M0, and rT3N0M0, respectively. Tumors in all patients were confined to the nasopharyngeal cavity, postnaris, nasal septum, superficial parapharyngeal space, or the base of the sphenoid sinus. Nasopharyngeal malignancies and adequate surgical margin (>0.5–1.0 cm) were required for continuous en bloc resection. Results: Among the 37 endoscopic nasopharyngectomies, 35 achieved en bloc tumor resection with negative surgical margins. In the remaining two cases, the tumors were dissected into small blocks, and one had positive surgical margins. No patient received postoperative radiotherapy and no severe complication was observed. During the 6–45 months of follow-up (median, 24 months), five patients experienced in situ residual or recurrence with 1 submaxillary lymphatic metastasis. One patient developed distant metastases and died, one died of intracranial infection, and one died of another cancer. The 2-year overall survival rate, local relapse-free survival rate, and progression-free survival rate were 84.2%, 86.3%, and 82.6%, respectively. Conclusions: Appropriate endoscopic nasopharyngectomy is a minimally invasive, safe, and promising surgical modality for the en bloc excision of rNPCs with encouraging short-term outcome. Long-term patient follow-up is ongoing. Laryngoscope, 119:516–522, 2009

Aerobic granules effectively degrade phenol at high concentrations. This work cultivated aerobic granules that can degrade phenol at a constant rate of 49 mg-phenol/g·VSS/h up to 1,000 mg/L of phenol. Fluorescent staining and confocal laser scanning microscopy (CLSM) tests demonstrated that an active biomass was accumulated at the granule outer layer. A strain with maximum ability to degrade phenol and a high tolerance to phenol toxicity isolated from the granules was identified as Candida tropicalis via 18S rRNA sequencing. This strain degrades phenol at a maximum rate of 390 mg-phenol/g·VSS/h at pH 6 and 30°C, whereas inhibitory effects existed at concentrations >1,000 mg/L. The Haldane kinetic model elucidates the growth and phenol biodegradation kinetics of the C. tropicalis. The fluorescence in situ hybridization (FISH) and CLSM test suggested that the Candida strain was primarily distributed throughout the surface layer of granule; hence, achieving a near constant reaction rate over a wide range of phenol concentration. The mass transfer barrier provided by granule matrix did not determine the reaction rates for the present phenol-degrading granule. Biotechnol. Bioeng. 2007;96:844–852. © 2006 Wiley Periodicals, Inc.

Mineral filler dispersion is important information for the production of mineral-charged polymers. In order to achieve timely control of product quality, a technique capable of providing real-time information on filler dispersion is highly desirable. In this work, ultrasound, temperature, and pressure sensors as well as an amperemeter of the extruder motor drive were used to monitor the extrusion of mineral-filled polymers under various experimental conditions in terms of filler type, filler concentration, feeding rate, screw rotation speed, and barrel temperature. Then, neural network relationships were established among the filler dispersion index and three categories of variables, namely, control variables of the extruder, extruder-dependent measured variables, and extruder-independent measured variables (based on ultrasonic measurement). Of the three categories of variables, the process control variables and extruder-independent ultrasonically measured variables performed best in inferring the dispersion index through a neural network model. While the neural network model based on control variables could help determine the optimal experimental conditions to achieve a dispersion index, the extruder-independent network model based on ultrasonic measurement is suitable for in-line measurement of the quality of dispersion. This study has demonstrated the feasibility of using ultrasound and neural networks for in-line monitoring of dispersion during extrusion processes of mineral-charged polymers. POLYM. ENG. SCI., 45:764–772, 2005. © 2005 Society of Plastics Engineers

Objectives:Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma (mNPC) at diagnosis; however, the impact of locoregional radiotherapy (lrRT) targeting the primary and regional lymph nodes on the survival of mNPC patients remains unknown and will be evaluated here retrospectively.Methods:A total of 408 mNPC patients were included in this study. The mortality risks were compared between the untreated patients and the patients who underwent chemotherapy and lrRT delivered alone or in combination. Univariate and multivariate analyses were conducted. The contributions of independent factors were adjusted by other covariates with significant prognostic association (P < .05).Results:Both lrRT and systemic chemotherapy were found to be significant independent prognostic factors of overall survival (OS). The group receiving lrRT alone exhibited similar mortality risk compared to the group who underwent systemic chemotherapy alone (multiadjusted hazard ratio [HR], 0.9; P =...

Objective: Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma at diagnosis (mNPC), but radiotherapy for primary tumor and its regional lymph nodes (loco-regional radiotherapy, LR-RT) is not routinely advocated. In current study, we evaluate the impact of LR-RT on survival of patients with mNPC.Method: A retrospective review of 385 mNPC patients at diagnosis recorded at San Yat-Sen University Cancer Center between 2001 and 2009. We compared mortality risks between patients who underwent different anticancer treatments including systemic chemotherapy, LR-RT, and local treatment of metastasis, alone or in combination, adjusted these risks for prognostic factors.Results: However, it presented a 50% reduced risk of death compared to those without any anticancer treatment (HR, 0.5; 95% CI, 0.2 to 1.0; P = .044) and 140% increase of death risk compared with those who underwent combination treatment of systemic chemotherapy and LR-RT (HR, 2.4; 95% CI, 1.3 to 4.5; P = ....

Objective: Salvage surgery and radiotherapy showed positive and similar survival outcomes in rT1/2 local recurrent nasopharyngeal carcinoma (rNPC) but no curative value in rT3/4 ones in the past. We will evaluate new techniques such as endoscopic surgery and intensity-modulated radiotherapy (IMRT) to compare with conventional radiotherapy (CRT) and chemotherapy in rNPC.Method: We did a retrospective review of 493 rNPC patients from January 2000 to December 2009. IMRT, CRT, and/or chemotherapy were suitable to all rT stage cases, but endoscopic surgery was applied to rT1 and some selected rT2/T3 cases. The 5-year overall survival rate (OS) and other oncological outcomes were summarized.Results: Among 493 cases, 120, 82, 132, and 159 were restaged in rT1N0M0, rT2N0M0, rT3N0M0, and rT4N0M0 according to AJCC/UICC 2002 TNM stage system. The 5-year OS was 73.0%, 37.0%, 17.3%, and 16.5% in rT1, rT2, rT3, and rT4 patients (P < .05). Adjusted for rT stages, the salvage surgery and IMRT showed a better survival cur...