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Supraglottic laryngectomy has evolved from open to transoral endoscopic approaches with advancements in surgical techniques and instruments such as lasers, endoscopes, ultrasonic devices, and robotics. Transoral laser‐assisted microsurgery has emerged as an effective treatment option, offering faster functional recovery and serving as an alternative to partial laryngectomy or non‐surgical therapies. Traditional endoscopic supraglottic laryngectomy involves resection of both suprahyoid and infrahyoid supraglottic structures. However, in cases where the tumor is limited to the infrahyoid epiglottis, a new technique known as transoral laser‐assisted infrahyoid supraglottic laryngectomy allows for tumor removal while preserving the suprahyoid epiglottis, aryepiglottic folds, and vallecula, ensuring optimal preservation of laryngopharyngeal function. This procedure enables patients to swiftly return to their daily routines with minimal complications. This article discusses the surgical technique, potential indications, and advantages and disadvantages of the new approach for infrahyoid epiglottic cancer. [ABSTRACT FROM AUTHOR]

Background: This study compared the complete closure versus the exposure of remnant parotid parenchyma in sialocele formation. Methods: This study included 151 patients with benign parotid lesions who underwent partial parotidectomy plus the complete closure or exposure of remnant parotid parenchyma. Two surgical methods of closed or exposed parenchyma were alternatively allocated to consecutive patients without randomization and blinding processes. Results: Complete closure and exposure of the remnant parotid parenchyma were performed in 81 and 70 patients. Early postoperative complications occurred with temporary events: transient facial weakness, 24 (16%); hematoma, 9 (6%); wound infection, 1 (0.7%) without statistical difference between the two groups (p > 0.1). Postoperative sialocele was more frequently found in the exposure group (n = 15) than the closure group (n = 4; p = 0.003). Conclusions: The complete closure of remnant parotid parenchyma is preferred over the exposure of injured parenchymal parenchyma to prevent postparotidectomy sialocele. [ABSTRACT FROM AUTHOR]

Objective: Deep lobe parotid tumour is commonly removed with the covering superficial lobe of parotid gland. Total or subtotal parotidectomy leads to an increase in surgical morbidity. This study evaluated recurrence and function after selective deep lobe parotidectomy via retroauricular hairline (Roh's) incision for pleomorphic adenoma. Materials and methods: Twenty‐eight patients with deep lobe parotid pleomorphic adenomas underwent selective deep lobe parotidectomy with preservation of the superficial lobe and the facial lobe via Roh's incision. Each patient was evaluated with any complications, cosmetic and salivary functions and local recurrence. Results: Superficial lobe‐preserving surgery via Roh's incision was successfully applied to all patients without injury to the facial nerve and the Stensen's duct for a median operation time of 65 min. Facial nerve paralysis was found only temporarily in 9 (32%) patients, and other complications were minimal. None of the patients had postoperative Frey's syndrome. Salivary secretory function in the operated side was well preserved. No recurrence was found in the patients for a median follow‐up of 94 months. Conclusions: Selective deep lobe parotidectomy via Roh's incision is a reliable option of treatment for deep lobe parotid pleomorphic adenoma. [ABSTRACT FROM AUTHOR]

Objectives: Plunging ranula is a pseudocyst of saliva extravasated from the sublingual gland (SLG) to the submandibular space. This is treated by transoral excision of the SLG or transcervical cyst excision that might differently affect surgical morbidity and recurrence. This study compared the clinical outcomes of complete vs partial excision of the SLG for plunging ranula. Study Design: A nonrandomized comparative study. Setting: Academic medical center. Methods: This study included 42 patients with plunging ranula who underwent complete or partial excision of the SLG with the evacuation of cystic content. Two surgical methods of complete or partial SLG resection were alternatively allocated to consecutive patients without randomization. The primary outcome was a postoperative recurrence. Secondary outcomes were operation time and complications. Results: Complete and partial excision of the SLG was performed in 22 and 20 patients, respectively, without injury to the Wharton's duct or the lingual nerve. Postoperative complications in 42 patients were minor with temporary events: hematoma, 1 (5%); tongue numbness, 2 (5%); dysgeusia, 4 (9%); and dysphagia, 2 (5%), which did not differ between patients with complete and partial excision of the SLG (P >.1). However, recurrence occurred in only 5 of 20 patients with partial SLG excision but none of 22 patients with complete SLG excision for a median follow-up of 36 months. Conclusions: Complete SLG excision is preferred over partial SLG excision to treat plunging ranula for reducing postsurgical risks of complications and recurrence. [ABSTRACT FROM AUTHOR]

Background: Thyroglossal duct cyst (TGDC) is the most common congenital cyst in the neck and is removed by the Sistrunk procedure. This surgery involves a horizontal skin incision over the cyst that may leave a noticeable scar on the front of the neck. Therefore, this study examined the clinical outcomes and cosmetic benefits of the Sistrunk procedure by an incision in the submental area that is not easily visible from the front. Materials and methods: This observational study was performed on 152 patients who underwent the Sistrunk procedure by a submental approach to remove TGDC at a university medical center. Intraoperative findings, postoperative complications, subjective pain levels, and satisfaction with incision scars and neck and facial deformities, and recurrence were prospectively evaluated. Results: The length of the submental incision was about 3 cm and the median total operation time was 36 min. Postoperative complications were minimal. Hematoma occurred in two cases (1.3%), surgical site infection in 1 case (0.7%), and dysphagia for more than 1 week occurred in 1 case (0.7%). On a 0–10 visual analogue scale, the pain had a median value of 2 on the first day after surgery, and satisfaction with incision scars and neck and facial deformities showed median values of 8 and 10 at 6 months after surgery, respectively. Recurrence occurred in one patient (0.7%) during the median follow-up period of 68 months. Conclusions: The submental approach for TGDC excision may be a reliable new surgical method that is safe and has cosmetic advantages. This observational study evaluated the clinical outcomes and cosmetic benefits of the Sistrunk procedure by a submental incision for thyroglossal duct cyst in 152 patients. The surgical procedure showed no increased operation time, no need for wide flap elevation, easy suprahyoid dissection, and an invisible scar in a natural position of the neck. [ABSTRACT FROM AUTHOR]

Background: This study compared our proposed N classification including the addition of the number of positive lymph node (LN+) and extranodal extension (ENE) with the current and previous American Joint Committee on Cancer (AJCC) N classifications in salivary gland cancer (SGC). Methods: This study involved 172 SGC patients who underwent surgery. Cox proportional hazard regression analyses were used to identify factors associated with overall survival (OS) and disease‐free survival (DFS). Results: In multivariate analyses, LN+ number, LN ratio, and ENE were associated with OS and DFS outcomes (all P <.05). Our new N classification proposed three categories: N0 (0 LN+), N1 (1 LN+), and N2 (≥2 LN+ or ENE). The C‐index of our N classification showed improvement in OS prediction (0.768) compared with the AJCC seventh (0.743) and eighth (0.756) edition N classifications. Conclusions: Our proposed N classification incorporating LN+ number and ENE may improve prediction of post‐treatment survival and recurrence in patients with SGC. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prognostic values of tumor‐related leukocytosis (TRL) as a reliable biomarker predictive of recurrence and survival after definitive surgery for oral cavity squamous cell carcinoma (OSCC). Materials and methods: This retrospective study involved 322 patients who underwent tumor extirpation combined with neck dissection for treatment‐naïve OSCC between 2006 and 2014. Multivariate binary logistic regression analyses were used to analyze the relationship between TRL and pathological variables. Cox proportional hazard regression analyses were used to find associations between factors and disease‐free survival (DFS) or overall survival (OS). Results: TRL was significantly related to advanced disease status, tumor size, invasion depth, poor differentiation, and T and N classifications, resulting in increased post‐treatment recurrence rate, particularly in the distant site. Multivariate logistic regression analyses showed that only the T classification was significantly associated with baseline TRL (p = 0.018). Multivariate analyses also showed that the tumor depth of invasion, pathological N classification, extranodal extension, and TRL remained the independent variables predictive of DFS and OS (all p < 0.05). TRL was related to a more than twofold increased risk of post‐treatment recurrence and mortality. Conclusions: TRL is associated with advanced tumor disease and increased recurrence and mortality in OSCC patients. [ABSTRACT FROM AUTHOR]

Background: This study examined the risk factors of pharyngocutaneous fistula development and poor survival after salvage laryngectomy. Methods: Binary logistic regression analyses were carried out to analyze the relationship between post‐salvage fistula development and variables. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate prognostic factors associated with disease‐free survival (DFS) and overall survival (OS) after salvage laryngectomy. Results: Multivariate analyses showed that previous radiotherapy and pre‐salvage tracheostomy were the independent variables predictive of post‐salvage fistula development (all P < .05). The 5‐year DFS and OS rates were 58.8% and 45.9%, respectively. Multivariate analyses showed that nodal positivity at salvage remained the independent factor predictive of both DFS (hazard ratio [HR] 2.83, P = .002) and OS (HR 2.22, P = .006). Conclusions: Fistula development after salvage laryngectomy might be predicted by a history of radiotherapy or tracheostomy. Post‐salvage survival is associated with nodal positivity at salvage. This study examined the risk factors of pharyngocutaneous fistula development and survival in 103 patients who underwent salvage laryngectomy. Previous radiotherapy and tracheostomy were the independent variables predictive of post‐salvage fistula development, and nodal positivity at salvage was the independent factor predictive of both disease‐free survival and overall survival. [ABSTRACT FROM AUTHOR]

The current use of steroids or pharmacological immunomodulators for the treatment of intractable oral ulceration is ineffective, necessitating newer cell‐based therapeutic approaches. We examined the potential efficacy of an oral mucosa equivalent developed in this study in an in vivo model of repeat major oral ulceration mimicking the intractable oral ulceration observed clinically. Oral mucosal samples and plasma fibrin were obtained from Sprague–Dawley rats. The oral mucosa equivalents were prepared with cultured mucosal keratinocytes and plasma fibrin mixed with cultured fibroblasts. Ulcers were chemically induced on the rat buccal mucosa thrice in 3 weeks and covered with or without mucosa equivalents. Gross and microscopic findings and mRNA expression levels were compared between the ulcer control and mucosa equivalent groups. Oral mucosal keratinocytes and fibroblasts were cultured in vitro to achieve high viability and colony‐forming efficiency. The equivalents showed epithelial and subepithelial structures similar to those of oral mucosa and exhibited high p63 positivity. In the in vivo study, ulceration was resolved earlier without significant granulation or scarring in the equivalent group than in control group (p < 0.05). Microscopic examinations revealed rapid re‐epithelialization and less fibrosis in the equivalent group than in the control group (p < 0.05). Mucosa equivalent‐covered ulcers showed histological characteristics similar to those of the normal buccal mucosa and exhibited lower expression of TGFB1, ACTA2, and FN1 mRNAs than the control group. The in vitro‐engineered oral mucosa equivalent promotes ulcer healing without scarring and functional deficits. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1779–1785, 2019. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the prognostic role of Fluorine 18‐fluorodeoxyglucose positron emission tomography/CT (18F‐FDG PET/CT) parameters quantitatively measured in patients with recurrent oral cavity cancer. Methods: Cox proportional hazards regression analyses were used to assess the associations between quantitative 18F‐FDG PET/CT parameters and other clinicopathological factors and progression‐free survival (PFS) and overall survival (OS). Results: All of the 18F‐FDG PET parameters (SUVmax, SUVmean, SUVpeak, metabolic tumor volume [MTV], and total lesion glycolysis [TLG]) were significantly associated with poor PFS and OS outcomes after salvage treatment (P < .01). In multivariate analyses, Karnofsky performance score, recurrence site, MTV, and TLG were independent variables predictive of both PFS and OS (P < .05). High MTV (>8.8 mL) or TLG (>29.4 g) values at recurrent lesions were associated with >5‐fold increased risk for tumor progression and mortality after salvage surgery. Conclusions: The PET parameters of MTV and TLG measured at recurrent lesions may predict tumor progression and survival after salvage treatment. This study examined the role of 18F‐FDG PET/CT at recurrent staging for predicting tumor progression and survival in 71 consecutive patients with recurrent oral cavity squamous cell carcinomas. Of 18F‐FDG parameters, metabolic tumor volume and total lesion glycolysis were independent factors predictive of tumor progression and survival after salvage treatment. [ABSTRACT FROM AUTHOR]

Background: This study examined the potential use of our newly developed prevascularized oral mucosal cell sheet for the treatment of skin wounds. Methods: Mucosal cell sheets containing cultured keratinocytes and plasma fibrin without (K sheet) or with a mixture of fibroblasts and endothelial progenitor cells (PV sheet) were transplanted into full‐thickness skin excisional wounds of nude mice. Results: This technique was successful for in vitro culture; expanding keratinocytes, fibroblasts, and endothelial progenitor cells; and generating prevascularized mucosal cell sheets. Cell sheets promoted in vivo wound healing with rapid wound closure and less scarring compared to controls. This result was more apparent in the PV than the K sheet (P < .05). Wounds covered with cell sheets showed less expression of TGFB1, ACTA2, and FN1 mRNAs than the controls (P < .05). Conclusion: The prevascularized mucosal cell sheet showed in vivo efficacy and tissue plasticity in cutaneous wounds by promoting accelerated healing. [ABSTRACT FROM AUTHOR]

Background: This study analyzed the expression of CD44 and cystine‐glutamate transporter SLC7A11 (xCT) in primary oral cavity squamous cell carcinoma (SCC) and the relationships of expression to tumor recurrence and patient survival. Methods: Associations between CD44 and xCT expression and clinicopathologic results were analyzed in 231 patients with oral cavity SCC. Cox proportional hazard analyses were used to identify factors associated with recurrence‐free survival (RFS), disease‐specific survival (DSS), and overall survival (OS). Results: Overexpression of CD44 and/or xCT was associated with advanced T classification, perineural invasion, and lymphovascular invasion (P <.05 each). High expression of xCT was also associated with nodal metastasis and depth of invasion (P <.01 each). Multivariate analysis indicated that high expression of xCT and both xCT and CD44 were independent predictors of poor RFS, DSS, and OS (P <.05 each). Conclusion: Overexpression of xCT or xCT plus CD44 may predict posttreatment recurrence and survival in patients with oral cavity SCC. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Patients with head and neck cancer (HNC) can die of index tumor progression and second tumor or non‐cancer causes. Here, we investigated the risk factors for competing non‐cancer mortality (NCM) in a prospective cohort of patients with advanced‐stage HNC. Materials and Methods: A prospective observational study was conducted with 604 patients who underwent definitive treatment for advanced‐stage HNC between 2010 and 2015. Main outcomes were NCM and cancer mortality (CM) defined as death from non‐cancer causes and HNC or second cancers, respectively. Cumulative incidence and cause‐specific hazard functions were used to analyze the risk factors of NCM and CM. Results: Age, smoking, Charlson comorbidity index (CCI), performance status, body mass index, rural residence, education and hemoglobin level at diagnosis, and chemotherapy were significantly associated with NCM (all p < 0.05). Multivariate analyses showed that age, CCI, and hemoglobin were independent factors of NCM. Age (≥65 years), CCI (≥2), and hemoglobin (<11 g/dl) were related to 4.5‐, 3.2‐, and 2.7‐fold increased adjusted risk of NCM, respectively. Conclusions: Old age, comorbidity, and hemoglobin at diagnosis were independent predictors of NCM. The risk factors could be used to predict non‐cancer death after definitive treatment for advanced‐stage HNC. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare the diagnostic accuracy of 18F‐FDG PET/CT and conventional contrast‐enhanced CT for the re‐staging of recurrent salivary gland carcinoma (SGC). Materials and Methods: This study included 58 consecutive patients who underwent recurrent SGCs after definitive treatment. The recurrences were evaluated by 18F‐FDG PET/CT and contrast‐enhanced CT of the neck and chest. McNemar's test was used to compare the diagnostic accuracy of 18F‐FDG PET/CT with standard neck and chest CT imaging, and a Cox proportional hazards model was used to assess the prognostic value of PET/CT. Results: Of 58 patients with recurrent SGCs, 17 (29%) had a local recurrence, 17 (29%) had a regional recurrence, and 38 (66%) had a distant metastasis, with these classifications showing overlap. The sensitivity and accuracy of 18F‐FDG PET/CT for the detection of distant metastases were significantly higher than those of CT (p < 0.05), whereas, for detection of loco‐regional recurrences, they did not differ (p > 0.1). The 18F‐FDG PET/CT‐positive findings at distant sites were predictors of poor progression‐free and overall survival outcome (all p < 0.05). Conclusions: 18F‐FDG PET/CT is a more effective method than CT for detecting distant site recurrences of SGC. This may lead to prognostic prediction for recurrent SGCs. [ABSTRACT FROM AUTHOR]

Abstract: Background: Surgical site infection is a complication of surgery for patients with head and neck cancer. We examined the risk factors for surgical site infection in patients undergoing surgery for head and neck cancer. Methods: The study involved 369 patients who underwent surgery for head and neck cancer. Hematological and nutritional parameters were measured preoperatively and postoperatively. Univariate and multivariate analyses were used to determine the risk factors for surgical site infection. Results: Of the 369 patients, 104 (28.2%) had surgical site infections: 45 (12.2%) superficial incisional; 6 (1.6%) deep incisional; and 53 (14.4%) organ/space infections. Multivariate analyses showed that history of radiotherapy, weight loss at diagnosis (>5%), preoperative hypoalbuminemia, neutrophil/lymphocyte ratio (NLR), reconstructive surgery, and tracheostomy were the independent factors predictive of surgical site infection. Patients with preoperative low serum albumin levels (<3.3 g/L) had a 3‐fold higher risk of surgical site infection. Conclusion: Our study shows that patient nutritional and hematological markers are associated with the risk of surgical site infection after major surgery for head and neck cancer. [ABSTRACT FROM AUTHOR]

Abstract: Background: We developed a highly efficient in vitro‐engineered mucosa equivalent using completely autologous mucosa and blood and investigated its feasibility and efficacy for oral surgical wound healing. Methods: Small oral mucosa samples were obtained from surgical patients, and keratinocytes and fibroblasts were primarily grown in media without animal products for generating 3D cell sheets. Results: Morphological characteristics of the cell sheets were comparable to those of human mucosa, although p63‐positive cells were more numerous in cell sheets. In addition, cell sheets were flexible, expandable, and easy to handle or transfer. In further in vivo rat experiments with deep wounding of the buccal mucosa and soft tissues, controls had significantly thinner epithelium and thicker collagen densities than those with cell sheets. Conclusion: Autologous cell sheets can be engineered in vitro from oral keratinocytes, fibroblasts, and fibrin, and can be used clinically to accelerate healing of oral soft tissue defects. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Poor nutritional status in patients with head and neck squamous cell carcinoma (HNSCC) is associated with tumor progression and survival. This study examined the prognostic value of nutritional and hematological markers in patients with HNSCC who received definitive treatments.Study Design: A prospective observational cohort study.Methods: This study included 338 consecutive patients who underwent surgery and/or radiotherapy/chemoradiotherapy for treatment-naïve HNSCC. Body weight and nutritional and hematological parameters were regularly measured before and after treatment. Univariate and multivariate analyses using Cox proportional hazards models were performed to identify factors associated with disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS).Results: Body weight, serum total protein and albumin levels, and hematological variables significantly decreased after treatment. Univariate analyses illustrated that age, tumor site, T and N classifications, overall stage, pretreatment serum albumin (<3.5 g/dL) and hemoglobin (<12 g/dL) levels, and neutrophil-lymphocyte ratio were significantly associated with DFS, CSS, and OS (all P < .05). Multivariate analyses identified age, tumor site, N classification, and pretreatment albumin levels as independent predictors of DFS, CSS, and OS (all P < .05). Patients with low serum albumin levels prior to treatment experienced approximately sixfold increases in the risks of tumor progression and cancer-specific and overall mortality compared to the findings in their counterparts.Conclusions: Our results suggest that pretreatment serum albumin levels predict DFS, CSS, and OS in patients who received definitive treatment for HNSCC. These findings might help to predict treatment outcome and guide nutritional intervention in patients with HNSCC.Level Of Evidence: 2b. Laryngoscope, 127:E437-E442, 2017. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to identify the prevalence of cancer cachexia and its prognostic impact in patients with advanced head and neck squamous cell carcinoma (HNSCC). Methods The prevalence of cancer cachexia was analyzed according to the follow-up periods during the first year after curative initial treatment. Recurrences, noncancer health events (NCHEs), and cause-specific survival outcomes were also analyzed according to the incidence of cancer cachexia during follow-up. Results Cancer cachexia was identified in 22 (6.1%), 148 (41%), 66 (18.4%), and 65 (18.7%) of 361 enrolled patients at pretreatment, immediately after treatment, 6-months after treatment, and 12-months after treatment, respectively. Sustained or newly developed cachexia at 6 and 12 months showed a significant association with recurrence and NCHE occurrence ( p < .05). In cause-specific survival analysis, patients with cachexia had a higher probability of cancer-specific death, noncancerous death, and overall death ( p < .05). Conclusion Cachexia prevalence at 6 and 12 months after treatment for HNSCC indicates a higher chance of recurrence, NCHE, and death. © 2016 Wiley Periodicals, Inc. Head Neck 39: 716-723, 2017 [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma of unknown primary of the head and neck (SCCUP) is a heterogeneous disease entity that requires careful examination to locate the occult primary. We examined the diagnostic value of expression of biomarkers, such as human papillomavirus (HPV), p16 and Epstein-Barr virus (EBV), in metastatic lymph nodes vs. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT). We prospectively enrolled 54 consecutive SCCUP patients who received HPV, p16 and EBV analyses of lymph node fine-needle aspirates and 18F-FDG PET/CT scans and subsequently underwent examinations and biopsies under general anesthesia to detect primary tumors. The diagnostic performance of the biomarkers and 18F-FDG PET/CT were compared by using receiver operating characteristics (ROC) curve analyses with histopathological results for identification of primary tumors. Primary tumors were identified in 28 (51.9%) of 54 patients: the palatine tonsil in 24, base of the tongue in 1, nasopharynx in 2, and hypopharynx in 1. The sensitivity of p16 (85.7%) and accuracy of HPV (85.2%) were higher than those (42.9% and 68.5%) of 18F-FDG PET/CT ( p < 0.05). The area under the ROC curve of HPV was higher than that of 18F-FDG PET/CT (0.857 vs. 0.666, p = 0.007). The disease-free survival rates were higher in the patients with primary tumor detection or p16 nodal immunopositivity than in the other patients ( p < 0.05). The results showed that HPV and p16 detection in metastatic lymph nodes can help locate hidden primary tumors, guide definitive treatment and predict patient survival. [ABSTRACT FROM AUTHOR]

Objective To investigate the prognostic significance of lysyl oxidase (LOX) expression in laryngeal cancer. Study Design Retrospective chart review and histologic analysis. Setting Tertiary referral academic center. Subjects and Methods Patients (N = 100) underwent surgical treatment for laryngeal cancer and had tissue specimens available. Immunohistochemical staining for LOX was performed on laryngeal cancer tissue microarrays, and the proportion and intensity of staining were evaluated. Patients with LOX scores ≤6 were classified into the low LOX group, while those with scores >6 were classified into the high LOX group. We analyzed the correlation between LOX expression and clinical factors as well as prognosis. Results LOX was predominantly expressed in the cytoplasm and nuclei of tumor cells. Kaplan-Meier analysis revealed that the high LOX group had worse overall survival and recurrence-free survival rates than the low LOX group ( P < .05). LOX expression exhibited marginally significant correlation with lymph node metastasis. In the Cox regression analysis, LOX expression and lymph node metastasis were significant factors correlated with overall survival rate (odds ratio [OR] = 3.92, 95% confidence interval [95% CI]: 1.35-11.37, P = .012; OR = 1.96, 95% CI: 0.93-1.43, P = .024, respectively). LOX expression was related to distant metastasis free survival rate (OR = 7.72, 95% CI: 1.02-19.18, P = .048). Conclusion A high expression level of LOX is associated with lymph node and distant metastasis as well as poor prognosis among patients with laryngeal cancer. [ABSTRACT FROM AUTHOR]

Background: The emotional status of cancer patients is associated with disease course and treatment outcomes. In this study, the authors evaluated associations between the presence of pretreatment depression and pretreatment quality of life (QOL), nutritional status, and survival outcomes in patients with head and neck squamous cell carcinoma (HNSCC).Methods: For this prospective study, 241 patients with previously untreated HNSCC who underwent curative treatments were enrolled. Patients completed the Beck Depression Inventory (BDI)-II, the European Organization for Research and Treatment of Cancer (EORTC) 30-item Core QOL Questionnaire (QLQ-C30), and the EORTC QLQ Head and Neck Cancer module (QLQ-H&N35). EORTC QLQ scores were compared between depressive and nondepressive patients, as determined according to pretreatment BDI-II scores ≥ 14 and <14, respectively. Univariate and multivariate analyses were performed to assess whether the presence of depression was associated with overall survival, disease-free survival (DFS), or posttreatment changes in nutritional status and laboratory data.Results: Pretreatment depression was present in 60 patients (24.9%). In depressive and nondepressive patients, the 3-year overall survival rates were 70.8% and 82.7%, respectively (P = .045), and the 3-year DFS rates were 63.5% and 79.1%, respectively (P = .015). After controlling for clinical factors, the presence of depression was predictive of 3-year DFS (P = .032). EORTC QLQ-C30 and QLQ-HN35 scores on all items except feeding tube, nutritional supplement, and problem with mouth opening differed between depressive and nondepressive patients (P < .05). Depressive patients had lower pretreatment serum albumin levels than nondepressive patients (P < .05).Conclusions: There was a significant correlation between pretreatment depression and pretreatment QOL, nutritional status, and survival outcomes in patients with HNSCC. [ABSTRACT FROM AUTHOR]

Background We examined the prognostic value of lymph node density in predicting cancer-specific mortality (CSM) for patients with lymph nodes positive (pN+) laryngeal squamous cell carcinoma (SCC) after laryngectomy. Methods The records of 156 patients with laryngeal SCC who initially underwent curative resection of the primary tumor combined with neck dissection were reviewed. Results The 5-year cumulative incidence of CSM was 20.4%. N classification and extralaryngeal spread (ELS) were independent variables for CSM in all patients. Univariate analyses in 71 pN+ patients showed that ELS, number of positive lymph nodes >4, and lymph node density >0.044 were significantly associated with increased CSM, whereas pN classification was not ( p = .218). On multivariate analysis, lymph node density ≥0.044 remained an independent predictor of CSM ( p = .001). Conclusion Among the pN+ patients with laryngeal SCC, no pN classification but lymph node density was noted to have an independent impact on CSM. © 2014 Wiley Periodicals, Inc. Head Neck 37: 1319-1325, 2015 [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid carcinoma (PTC) is generally an indolent tumor indicative of favorable prognosis. However, post-treatment recurrences may be problematic, and management strategies for recurrent disease have not been established. This study investigated risk factors associated with re-recurrence of PTC after reoperative surgery. Materials and methods: This study included 151 patients with pathologically confirmed recurrent/persistent PTC who underwent reoperation. Clinical factors, operative and pathologic findings, serum thyroglobulin levels, postoperative complications, and recurrences were examined. Univariate and multivariate analyses were performed to identify factors associated with re-recurrence-free survival (RFS) after reoperative surgery. Results: Recurrent tumors were found in thyroid remnants or previous resection bed ( n = 28), central nodes ( n = 48), and lateral neck nodes ( n = 102). Biochemical complete remission (stimulated thyroglobulin <1 ng/mL) was achieved in 69 (51.5 %) patients after reoperative surgery. Permanent vocal fold paralysis and hypoparathyroidism developed in 6 (4.1 %) and 4 (2.8 %) patients, respectively. Vocal fold paralysis occurred primarily due to intentional nerve resection following tumor invasion. During a median follow-up of 57.5 months, 41 (27.2 %) patients had re-recurrences. Univariate analyses showed that extranodal extension ( p = 0.028), recurrent laryngeal nerve invasion ( p = 0.037), as well as stimulated ( p = 0.001) and unstimulated ( p = 0.015) serum thyroglobulin were significant predictors of RFS. Multivariate analyses showed that postoperative biochemical remission independently predicted RFS ( p = 0.014). Conclusions: Postoperative thyroglobulin after reoperative surgery predicted re-recurrence. Careful follow-up of these patients after reoperation is recommended. [ABSTRACT FROM AUTHOR]

Objectives To estimate the prevalence of dysphonia and the effect of several risk factors on vocal quality in a representative population of older adults. Design Cross-sectional. Setting Korea. Participants Individuals aged 65 and older who underwent laryngoscopy from 2008 to 2010 (N = 3,759). Measurements The prevalence of dysphonia and the effect of potential risk factors on voice quality in elderly adults were measured. Results The mean age of participants was 72.4. The prevalence of dysphonia was 8.5% (95% confidence interval ( CI) = 7.4-9.8). There was no significant difference in prevalence according to age. Multivariable analysis after adjusting for age, sex, vocal fold disease, and all variables that were identified in the univariate analysis revealed that urban residence (odds ratio ( OR) = 1.83, 95% CI = 1.11-3.04), underweight ( OR = 2.79, 95% CI = 1.45-5.38) or normal weight ( OR = 1.63, 95% CI = 1.03-2.59), poor ( OR = 2.00, 95% CI = 1.19-3.34) or intermediate ( OR = 2.08, 95% CI = 1.15-3.78) subjective health status, asthma ( OR = 2.08, 95% CI = 1.12-3.86), chronic obstructive pulmonary disease ( OR = 2.49, 95% CI = 1.10-5.62), thyroid disease ( OR = 3.08, 95% CI = 1.50-6.34), and vocal fold disease ( OR = 3.72, 95% CI = 2.16-6.42) were independently associated with dysphonia in elderly adults. Conclusion This study provides valuable information regarding the prevalence of dysphonia and the risk factors that contribute to vocal quality in older adults. These factors are mostly associated with social, behavioral, and underlying health status variables. Multidisciplinary treatment should be considered to improve voice conditions in elderly adults. [ABSTRACT FROM AUTHOR]

BACKGROUND Securing negative surgical margins is a critical goal for head and neck surgery. Local recurrence develops even in some patients who have histologically negative surgical margins. Minimal residual tumor cells may lead to locoregional recurrence despite clear histologic margins reported at the time of resection of head and neck squamous cell carcinoma (HNSCC). To identify subclinical residual disease, the authors analyzed deep margin imprint samples collected on 1-layer nitrocellulose sheets. METHODS Bisulfite-treated DNA samples from 73 eligible patients were amplified by quantitative methylation-specific polymerase chain reaction (QMSP) targeting 6 genes (deleted in colorectal cancer [ DCC], endothelin receptor type B [ EDNRB], homeobox protein A9 [ HOXA9], kinesin family member 1A [ KIF1A], nidogen-2 [ NID2], and N-methyl D-aspartate receptor subtype 2B [ NR2B]). QMSP values were dichotomized as positive or negative. Associations between the QMSP status of deep margin samples and clinical outcomes were evaluated. RESULTS Two-gene methylation combinations among the genes DCC, EDNRB, and HOXA9 were associated with decreased locoregional recurrence-free survival, recurrence-free survival, and overall survival. The methylated gene combination of EDNRB and HOXA9 in margin imprints was the most powerful predictor of poor locoregional recurrence-free survival (hazard ratio [HR], 3.31; 95% confidence interval [CI], 1.30-8.46; P = .012) independent of standard histologic factors. In addition, methylation of both EDNRB and HOXA9 indicated a trend toward reduced recurrence-free survival (HR, 2.74; 95% CI, 0.90-8.33; P = .075) and reduced OS (HR, 5.78; 95% CI, 0.75-44.7; P = .093) in multivariable analysis. CONCLUSIONS A panel of gene methylation targets in deep surgical margin imprints provides a potential predictive marker of postoperative locoregional recurrence. Intraoperative use of molecular margin imprint analysis may assist surgeons in obtaining rigorously negative surgical margins and improve the outcome of head and neck surgery. Cancer 2015;121:1957-1965. © 2015 American Cancer Society. [ABSTRACT FROM AUTHOR]

BACKGROUND The prognostic role of swallowing-related, pretreatment subjective and objective findings has not been investigated in detail. The authors evaluated the association between pretreatment MD Anderson Dysphagia Inventory (MDADI) or videofluorographic swallowing study (VFSS) results and standard outcomes, including early recurrence and survival, in patients with treatment-naïve head and neck squamous cell carcinoma (HNSCC). METHODS Patients with HNSCC (n = 191) who received treatment at the authors' institution and were examined by self-administered MDADI questionnaires and VFSS were prospectively enrolled. MDADI and VFSS findings were analyzed in correlation with clinicopathologic variables, and factors that predicted 2-year disease-free survival (DFS) and overall survival (OS) were identified using a Cox proportional-hazards regression model. RESULTS The 2-year OS and DFS rates were 80.1% and 77.5%, respectively. Clinical tumor (T) and lymph node (N) classifications, overall TNM stage, sex, tumor site, and educational level were significantly associated with specific MDADI subdomains, whereas Karnofsky performance score was significantly associated with all MDADI subdomains. After controlling for clinical factors, total scores, global assessment scores, and emotional and physical MDADI subscores were significantly predictive of 2-year OS and DFS ( P < .05 for each). VFSS findings were not significantly associated with survival ( P > .05). CONCLUSIONS The current results provide evidence of the prognostic role of the MDADI in predicting early survival outcomes in patients with HNSCC. The MDADI may be a practical and noninvasive method for the identification of patients at risk who would benefit from close follow-up. Cancer 2015;121:1588-1598. © 2015 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Although lymph node (LN) metastasis (LNM) of papillary thyroid carcinoma (PTC) is common, routine prophylactic LN dissection (LND) is still controversial. The purpose of this study was to investigate risk factors for recurrence of PTC with clinically node-negative lateral neck to determine the utility of intraoperative LN biopsy. Materials and methods: This study involved 185 patients with pathologically confirmed PTC and clinically node-negative lateral neck. All patients underwent thyroidectomy with or without ipsilateral or bilateral central LND after intraoperative central LN biopsy. Routine lateral neck LND was not performed. Clinicopathologic and intraoperative findings and post-treatment recurrences were recorded. Univariate and multivariate analyses with Cox-proportional hazards model were used to identify factors associated with recurrence. Results: During a follow-up of 50-96 months, six (3.2 %) patients had recurrences in lateral cervical LNs at a median 28 months (range 7-57 months) after surgery. Overall, 2- and 5-year RFS rates were 98.4 and 96.7 %, respectively. Univariate analyses revealed that tumor size ( P = 0.005), bilaterality ( P = 0.033), T4 disease ( P < 0.001), and intraoperative diagnosis of central LNM ( P = 0.001) were significantly predictive of recurrence. Multivariate analyses showed that T4 disease ( P = 0.049) and intraoperative diagnosis of central LNM ( P = 0.027) were independently predictive of recurrence. Conclusions: Prophylactic lateral neck LND is not advocated for PTC with clinically node-negative lateral neck. Intraoperative LN biopsy may help identify patients at risk for recurrence and those who would benefit from LND. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid carcinoma (PTC) is associated with an excellent prognosis but frequently spreads to regional lymph nodes. The extent of neck dissection, particularly routine level II or V lymphadenectomy, is still controversial as it may lead to spinal accessory nerve injury and associated postoperative morbidities. We assessed the diagnostic value of preoperative ultrasonography (US) plus computed tomography (CT) for detecting metastatic lymph nodes and for identifying predictors of level II or V metastasis in patients with PTC. Methods: The results of US and CT were compared with histopathologic findings at various neck levels in 209 previously untreated PTC patients with lateral cervical nodal metastases who underwent total thyroidectomy with central and lateral neck dissection. Clinicopathologic predictors for level II or V metastases were identified. Results: Pathologic metastases to level II and V were observed in 53.6 and 25.4 % of patients, respectively. Occult metastases were found in 34.5 and 16.8 %, respectively. The sensitivities of US plus CT for levels II and V were 64.6 and 50.9 %, respectively. Image-based, isolated lateral level IV involvement and macroscopic extranodal extension were independently associated with level II metastasis or either level II or V metastasis ( p < 0.01). Macroscopic extranodal extension was also independently associated with level V metastasis ( p = 0.001). Conclusions: Patients with image-based, isolated lateral level IV involvement and no macroscopic extranodal extension are potential candidates for limited level III-IV dissection or prophylactic level II lymphadenectomy omission. Level V lymphadenectomy may be omitted in patients without macroscopic extranodal extension. [ABSTRACT FROM AUTHOR]

Background We compared clinical outcomes between patients with salivary gland carcinomas preoperatively misdiagnosed as benign lesion and properly diagnosed as malignant lesion. Methods The outcomes were compared between patients with benign lesion and malignant lesion (44 each) on preoperative fine-needle aspiration cytology diagnosis who underwent conservative or radical surgery. Results Five-year lesion-free survival (DFS) rates were 86.8% for benign lesion and 76.3% for malignant lesion ( p = .128). Surgical extent did not significantly affect locoregional recurrence and DFS ( p = .360). Univariate analysis showed that sublingual gland tumor, positive resection margin, and extraparenchymal extension (EPE) were significantly associated with DFS ( p < .05 each). On multivariate analysis, EPE remained an independent variable ( p = .047, hazard ratio = 6.621, 95% confidence interval = 1.393-31.474). Conclusions The clinical outcomes of patients with salivary gland carcinomas misdiagnosed as benign are relatively favorable. Conservative surgery may be sufficient for patients with low-grade and T1-2 salivary gland carcinomas. © 2013 Wiley Periodicals, Inc. Head Neck 35: 1764-1770, 2013 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Visualization of the vocal folds is essential when reaching a primary diagnosis of laryngeal disease. However, the examination is subjective and highly dependent on the experience of the treating physician. The present study is the development of objective tools for the diagnosis of laryngeal malignancy based on laryngeal texture analysis. Study Design Texture analysis using gray-level co-occurrence matrix (GLCM) in vocal fold images of 198 patients. Methods Vocal-fold images were subjected to texture analysis using gray-level co-occurrence matrix (GLCM)-based parameters, which were computed by a novel digital image-processing program. Patients were divided into two groups: those with benign-looking lesions and those with malignant-looking lesions. Textural irregularities were compared using GLCM-based parameters. The relationship between the texture-analysis parameters and the diagnosis was then statistically evaluated. Results Texture irregularity was negatively correlated with energy and the inverse difference moment (IDM) and positively correlated with entropy, variance, contrast, dissimilarity, and mean values. All of the GLCM-based parameters evaluated differed significantly according to the degree of differentiation of the benign- or malignant-looking lesion ( P < 0.001). Entropy had a sensitivity of 82.9% and a specificity of 82.2% at a cutoff value of 5.94; for variance, the sensitivity was 82.9% and the specificity was 84.5% at a cutoff value of 167. Conclusion GLCM-based texture analysis of vocal-fold lesions, especially in association with a differential diagnosis of benign and malignant-looking diseases, contributes to achieving an objective image-based analysis of vocal-fold lesions. In addition, this approach can be used to create algorithms permitting a reproducible classification of laryngeal pathologies. Level of Evidence NA. Laryngoscope, 123:E45-E50, 2013 [ABSTRACT FROM AUTHOR]

Background: Unilateral vocal fold paralysis (UVFP) may present as an uncommon complication of extralaryngeal neoplasms, requiring diagnostic scrutiny to seek occult tumors or diseases. The aim of this study was to examine the utility of computed tomography (CT) in evaluating adult UVFP of unknown etiology. Methods: From January 2010 to December 2011, UVFP was diagnosed in 822 patients at our tertiary-care center. In 634 patients, a readily identifiable cause of the UVFP was evident and therefore there was no need for any imaging; in the remaining 188 patients, the etiology could not be determined. Among this latter group, 153 patients underwent chest radiography (CXR) and contrast-enhanced CT imaging from the skull base to the midchest. Results: In 36 of the 153 (23.5 %) patients, CT revealed the cause of the UVFP: lung cancer in 12 patients, thyroid carcinoma in 7 patients, skull-base tumor in 4 patients, aortic aneurysm in 4 patients, esophageal cancer in 3 patients, thymus tumor in 2 patients, pericardial effusion in 1 patient, and other neck lesions in 3 patients. CXR and neck ultrasonography also identified the etiology in 14 and 12 patients, respectively. During follow-up after the initial CT, none of the patients with idiopathic UVFP was determined to have an underlying disease that would have explained the paralysis. Conclusion: CT is a useful single-imaging method for evaluating the etiology of adult UVFP. This approach may reveal occult tumors or previously undiagnosed diseases as the cause of the paralysis, thus improving patient care. [ABSTRACT FROM AUTHOR]

Background We investigated whether the addition of narrow band imaging (NBI) to standard diagnostic workups could enhance the detection of primary lesions in patients with carcinoma of unknown primary (CUP). Methods Thirty patients with CUP underwent NBI endoscopy and fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) after thorough conventional diagnostic workups between 2009 and 2011. Sites suspected of harboring primary tumors, as determined by NBI and/or FDG-PET/CT, were biopsied for histologic confirmation. Results Occult primary tumors were identified in 33.3% (10/30), including 13.3% (4/30) by NBI and 20.0% (6/30) by FDG-PET/CT. All of diagnosed lesions by NBI were confirmed histologically as squamous cell carcinomas with T1 classification and identified at 2 supraglottis, 1 hypopharynx, and 1 esophagus, respectively. Conclusions NBI endoscopy may be a useful method for detecting primary tumors, especially for small and superficial squamous cell carcinomas of the upper aerodigestive tract, after conventional workup in patients with CUP. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]

Background Tissue imprinting can generate molecular marker maps of tumor cells at deep surgical margins. The purpose of this study was to evaluate the feasibility of this method for detection of residual head and neck squamous cell carcinoma (HNSCC). Methods Paired fresh tissue and nitrocellulose membrane imprints of tumor and deep margins were collected from 17 HNSCC resections. DNA was amplified using quantitative methylation-specific polymerase chain reaction (qMSP) for p16, DCC, KIF1A, and EDNRB. Levels of methylation in tumors and deep margins were compared. Results DNA from imprints was adequate for qMSP. Hypermethylation of target genes was present in 12 of 17 tumors and in 8 deep margins. Methylation level was better from margin imprints than tissue. During follow-up (median, 13 months), local or regional recurrences occurred in 6 cases of which 5 had molecularly positive margins. Conclusion Tissue imprinting is feasible for molecular detection of residual tumor at deep surgical margins and may correlate with locoregional recurrence. © 2012 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

The article presents a study on identification of risk factors related to distant metastases (DM) and survival of patients with head and neck squamous cell carcinoma (HNSCC) which is presented through a database analysis and chart review. The study used univariate and multivariate analyses for the risk factors of DM. The study concluded that patients with advanced tumors, nodal involvement, or locoregional recurrences may require more frequent surveillance for the development of DMs.

Background To determine whether 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) could serve as a useful technique predicting tumor hypoxia and prognosis in tongue cancer, we assessed the relationship between FDG uptake and the levels of hypoxia-related markers. Methods Tumor uptake of FDG in 33 patients with T2 tongue cancer was assessed by measuring maximum standardized uptake values (SUVmax). Expression of hypoxia-inducible factor (HIF)-1α, carbonic anhydrase (CA)-9, glucose transporter (GLUT)-1, and erythropoietin receptor (EPOR), was determined by immunohistochemical staining. Correlation between SUVmax and the expression of hypoxia-related markers was assessed and multivariate analysis was performed to determine what parameters affected clinical outcomes. Results We observed strong correlations between SUVmax and expression of HIF-1α ( p < .05), CA-9 ( p < .01), and GLUT-1 ( p < .01). SUVmax, HIF-1α expression, and tumor grade were significant independent predictors of disease-free survival (DFS). Conclusion SUVmax may be a good noninvasive biomarker for prediction of hypoxic status and prognosis of patients with T2 tongue cancer. © 2011 Wiley Periodicals, Inc. Head Neck, 2011 [ABSTRACT FROM AUTHOR]