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Background: Circular RNAs (circRNAs) can function as competing endogenous RNAs (ceRNAs) to impact the development of esophageal squamous cell cancer (ESCC). Human circ_0001946 has been identified as a potential anticancer factor in ESCC, yet our understanding of its molecular basis remains limited., Methods: Circ_0001946, microRNA (miR)-1290 and SRY-box transcription factor 6 (SOX6) were quantified by quantitative reasl-time PCR (qRT-PCR) or immunoblotting. Cell proliferation was assessed by CCK-8 and EDU assays. Cell apoptosis and invasion were evaluated by flow cytometry and transwell assays, respectively. Cell migration was detected by transwell and wound-healing assays. The direct relationship between miR-1290 and circ_0001946 or SOX6 was determined by dual-luciferase reporter and RNA immunoprecipitation (RIP) assays. Xenograft model assays were used to assess the role of circ_0001946 in tumor growth., Results: Circ_0001946 expression was attenuated in human ESCC, and circ_0001946 increase impeded cell proliferation, invasion, migration and enhanced apoptosis in vitro. Moreover, circ_0001946 increase diminished xenograft growth in vivo. Mechanistically, circ_0001946 bound to miR-1290, and re-expression of miR-1290 reversed circ_0001946-dependent cell properties. SOX6 was a miR-1290 target and it was responsible for the regulation of miR-1290 in cell properties. Furthermore, circ_0001946 functioned as a ceRNA to regulate SOX6 expression via miR-1290., Conclusion: Our findings uncover an undescribed molecular mechanism, the circ_0001946/miR-1290/SOX6 ceRNA crosstalk, for the anti-ESCC activity of circ_0001946., (© 2022 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.)

Chemotherapy regimens containing cisplatin remain the first-line treatments for patients with oral squamous cell cancer (OSCC); however, the treatment effect is often transient because of chemoresistance and recurrence. Understanding the mechanisms of chemoresistance in OSCC might provide novel targetable vulnerabilities. In the present study, we revealed that Forkhead box D1 (FOXD1) is upregulated in OSCC and predicted poor prognosis. Moreover, ectopic expression of FOXD1 promoted, while silencing of FOXD1 inhibited, the epithelial-mesenchymal transition (EMT) and chemoresistance of OSCC, both in vitro and in vivo. Mechanistically, FOXD1 binds to the promoter of long non-coding RNA Cytoskeleton Regulator RNA (CYTOR) and activates its transcription. CYTOR then acts as a competing endogenous RNA to inhibit miR-1252-5p and miR-3148, thus upregulating lipoma preferred partner (LPP) expression. Importantly, the CYTOR/LPP axis was proven to be essential for FOXD1-induced EMT and chemoresistance in OSCC. These findings reveal a novel mechanism for the chemotherapy resistance of OSCC, suggesting that FOXD1 might be a potential prognostic marker and anti-resistance therapeutic target., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Whether or not young patients with squamous cell carcinoma of oral cavity (OC-SCC) have a difference in prognosis remains a controversy. This study aimed to analyze the clinical characteristics and difference of survival rates between adult patients less than 40 years of age and those 40 years of age and older., Methods: A retrospective analysis was conducted using the database of patients diagnosed with OC-SCC between 1990 and 2013 in the Sun Yat-sen University Cancer Center, but patients older than 85 years, younger than 18 years, or died within 6 months of diagnosis were excluded. Patients were categorized into two groups: the young group (< 40 years of age) and the older group (≥ 40 years of age). Cox regression, survival and subgroups analyses were performed. The primary endpoints included the rates of 5-year overall survival (OS) and disease-specific survival (DSS)., Results: A total of 1902 OC-SCC patients were identified. The percentage of female in the young group was significantly higher than that in the older group (40.27% vs 31.03%, p < 0.001). This study failed to find the difference in TNM classification or tumor stage between the two groups (p > 0.05). The young group was more likely to receive adjuvant radiotherapy and/or chemotherapy (42.48% vs 26.91%, p < 0.001). The 5-year OS rate (71% vs. 57%, p < 0.001) and DSS rate (72% vs 58%, p < 0.001) in patients under 40 years were significantly higher than those for the older group., Conclusion: Our findings suggested that OC-SCC in younger patients did not present at a more advanced stage. In addition, young age is an independent predictor for better survival.

Laryngeal squamous cell carcinoma (LSCC) is a common head and neck cancer. Despite recently improved management of LSCC, chemotherapy resistance of patients remains a challenge. In this study, we identified that long noncoding RNA FOXD2-AS1 regulates LSCC therapeutic resistance by augmenting LSCC stemness. LSCC chemotherapy-resistant patients showed increased FOXD2-AS1 expression compared with that in chemotherapy-sensitive patients, which predicted poor prognosis. Gain- or loss-of-function experiments showed that upregulated FOXD2-AS1 maintained cancer stemness, reducing the response to chemotherapy, while FOXD2-AS1 downregulation had the opposite effects. FOXD2-AS1 acted as a scaffold for STAT3 and PRMT5, promoting STAT3 transcriptional activity, which is essential to maintain cancer stemness and promote chemotherapeutic resistance. Interfering with FOXD2-AS1 using short hairpin RNA rescued LSCC's chemotherapeutic sensitivity. Thus, FOXD2-AS1 promotes LSCC chemotherapeutic resistance and is an upstream activator of STAT3, making FOXD2-AS1 a potential therapeutic target to improve the chemotherapy effect in LSCC patients.

Objectives: Although the survival rate of laryngeal cancer is relatively high, some patients with laryngeal squamous cell carcinoma (LSCC) show the least benefit from laryngectomy, owing to few determining diagnostic tools. We aimed to identify high-risk patients according to a preoperatively determined signature of the platelet-to-lymphocyte ratio (PLR) of > 193.55, as an indicator of poor treatment outcome in LSCC patients., Methods: We retrospectively evaluated 899 patients who underwent laryngectomy for LSCC. The patients were stratified by PLR into three subgroups: low (≤ 119.55), moderate (> 119.55 and ≤ 193.55), and high (> 193.55). Kaplan-Meier curves were plotted to compare the intergroup cancer-specific survival (CSS)., Results: Patients with high PLR had significantly worse survival outcomes (5-year CSS, low vs. moderate vs. high: 75.3 vs. 68.4 vs. 53.9%; 10-year CSS, low vs. moderate vs. high: 65.0 vs. 56.0 vs. 38.6%, P < 0.001). Patients with PLR > 193.55 represented malnutrition and more advanced cancer stage.., Conclusion: Patients with PLR > 193.55 experience poor outcomes and represent malnutrition, more advanced cancer stage.

Pinato prognostic nutritional index (PNI) adequately predicts long-term outcomes of various malignancies. However, its value in predicting outcomes in laryngeal squamous cell carcinoma (LSCC) is unknown. All patients newly diagnosed with LSCC presenting to the Department of Head and Neck Oncology at Sun Yat-sen University Cancer Center between January 1, 1990 and July 31, 2010 were eligible. The PNI was calculated as serum albumin (g/L) + 5 × total lymphocyte count/L. The Cutoff Finder software program was used to classify the patients into 3 groups for which the PNI score was at least 70% sensitive, at least 70% specific, or equivocal. Cancer-specific survival was estimated using the Kaplan-Meier method, and predictors were assessed with Cox regression analysis. Median time between surgery and PNI administration for the 975 eligible patients was 83 months. Index score groups were significantly associated with age, T stage, TNM stage, and type of surgery. Five-year CSS and OS were 57.3% and 56.6% in patients with PNI scores below 48.65 (low-probability of survival), 72.8% and 71.3% with scores between 48.65 and 56.93 (moderate-probability of survival), and 77.6% and 75.3% with scores above 56.93 (high-probability of survival); 10-year CSS and OS were 44.2% and 42.7%, 61.6% and 55.6%, 68.3% and 63.5%, respectively. The PNI score groups significantly predicted CSS and OS (P < 0.001). The PNI is an inexpensive and readily available score that predicted survival in patients with LSCC after curative laryngectomy.

There is increasing evidence that the neutrophil-to-lymphocyte ratio (NLR) is a stage-independent predictor of poor outcome in patients with cancer. The purpose of this study was to investigate the association between cancer-specific survival (CSS), overall survival (OS), and the preoperative NLR in patients with advanced laryngeal squamous cell carcinoma (LSCC) undergoing total laryngectomy (TL).All patients with a new diagnosis of advanced laryngeal cancer (stages III and IV) presenting at the Department of Head and Neck Oncology, Sun Yat-sen University Cancer Center between January 1990 and July 2010 (n = 420) were included. To evaluate the independent prognostic relevance of the NLR, univariate and multivariate Cox regression models were used. CSS and OS were estimated using the Kaplan-Meier method.Four-hundred twenty patients were enrolled in this study. Patients with an NLR ≥2.59 showed a significantly lower CSS (P = .014) and OS (P = .032) than patients with an NLR <2.59. The Cox proportional multivariate hazard model showed that a higher preoperative NLR was independently correlated with a poor CSS and OS, with hazard ratios of 1.42 (95% confidence interval [CI] 1.06-1.91, P = .018) and 1.31 (95% CI 1.00-1.71, P = .046), respectively.The NLR may be an independent prognostic marker for CSS and OS in patients with advanced LSCC undergoing TL.

Background: Activating mutations in epidermal growth factor receptor (EGFR) and KRAS are important markers in non-small cell lung cancer. However, EGFR and KRAS gene mutations in lung squamous cell carcinoma are rarely reported. The aim of this study was to analyze EGFR and KRAS gene mutation rate and their relationship with clinical features in patients with lung squamous cell carcinomas., Methods: A total of 139 patients undergoing treatment for naïve lung squamous cell carcinomas with tumor tissue samples available for testing were recruited. EGFR and KRAS mutation statuses of the tumor samples were detected using a mutant enriched liquid chip., Results: Of the 139 cases of lung squamous cell carcinoma, EGFR mutations were detected in 25 cases (18%), KRAS mutations were detected in 7 cases (5%), and the presence of both EGFR and KRAS mutations was detected in 1 case (0.7%). EGFR mutations occurred more often in females than in males (33.3% vs 16.5%) and in patients that never smoked than in those who smoke (29.6% vs 16.1%). However, the difference did not reach statistical significance (P>0.05). No significant differences were observed in age, stage, and different biopsy type. KRAS mutations occurred more often in males than in females (5.5% vs 0%), but the difference did not reach statistical significance (P>0.05). No significant differences were observed in age, stage, different biopsy type, and smoking status (P>0.05)., Conclusions: EGFR and KRAS mutations were low in lung squamous cell carcinomas, and had no significant correlation with clinical features. Before using tyrosine kinase inhibitor targeted therapy, EGFR and KRAS mutations should be detected in patients with lung squamous cell carcinomas.

Purpose: To discuss the outcomes of primary squamous cell carcinoma (SCC) of the major salivary glands treated by surgery with or without postoperative adjuvant radiotherapy., Materials and Methods: We performed a retrospective analysis of 579 cases with malignancy originating in the major salivary glands. A total of 34 cases were eligible for the present study. The outcomes were analyzed in terms of disease failure patterns and survival rates between the 2 treatment groups., Results: The treatment was surgery alone in 16 patients and a combination of surgery and postoperative adjuvant radiotherapy in 18. The locoregional recurrence rate was 43.8% in the surgery group and 22.2% in the surgery plus radiotherapy group. The distant metastasis rate was 6.3% in the surgery group and 44.4% in the surgery plus radiotherapy group. The 5-year disease-specific survival and disease-free survival (DFS) rate for all patients was 50.3% and 35.3%, respectively. The 5-year disease-specific survival rate was 48.9% in the surgery group and 48.2% in the surgery plus radiotherapy group. The 5-year DFS rate was 25.0% in the surgery group and 31.2% in the surgery plus radiotherapy group. The log-rank test showed no significant differences in the disease-specific survival or DFS rates between the 2 groups (P = .724 for disease-specific survival and P = .269 for DFS)., Conclusion: Planned postoperative adjuvant radiotherapy is anticipated to be able to improve locoregional control rates and DFS for patients with primary SCC of the major salivary glands., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

ALK rearrangement is a very rare subset of squamous cell cancer of lung and the efficacy of crizotinib treatment for these patients is lack of data. Here we report a case with squamous cell cancer of lung that harbored the ALK rearrangement was given crizotinib in the second-line therapy. A 55-year-old female patient was diagnosed with squamous cell carcinoma of lung by bronchoscopy biopsy with stage IV. The patient was given two cycles of chemotherapy and the response was progressive disease. After failure to chemotherapy, genotype testing showed wild-type EGFR/KRAS and ALK rearrangement positive. The patient was administered with crizotinib and had a partial response, and the progression-free survival was 6 months. The side effects were tolerable.

Objective: This study aimed to compare the value of sentinel lymph node biopsy (SLNB) with that of elective neck dissection (END) for the prediction of cervical lymph node metastasis in patients with clinically diagnosed T1-2N0 (cT1-2N0) oral tongue squamous cell carcinoma (OTSCC), and it aimed to examine the prognostic value of individualized treatment in sentinel lymph node (SLN)-negative patients., Study Design: The study entailed a retrospective review of 82 patients with cT1-2N0 OTSCC. Thirty patients underwent SLNB, and 52 patients underwent END., Results: There was a significant difference between the SLNB and END groups in the incidence of occult cervical lymph node metastasis in initial specimens (30% vs 11.5%; P = .037). However, there were no significant differences between the groups for 10-year overall and cervical recurrence-free survival rates and 10-year overall survival rate., Conclusions: SLNB is superior to END for the prediction of cervical lymph node metastasis in patients with cT1-2N0 OTSCC. Neck dissection may be reduced for SLN-negative patients, owing to the comparable prognosis of SLNB., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To assess the values of color Doppler and magnetic resonance imaging (MRI) in the identification of cervical lymph node micrometastasis of tongue cancer., Methods: Totally 96 cases of tongue cancer with impalpable neck lymph node was examined with color Doppler and MRI within one week before surgery. Chi-square test was used to assess if the presence of regional lymph node micrometastasis, histopathological analysis as a golden standard lymph node micrometastasis., Results: For the diagnosis of cervical lymph node micrometastasis, color Doppler was significantly better than MRI in sensitivity (72.5% vs 50.0%, P = 0.039) and the accuracy (78.1% vs 64.6%, P = 0.038), but no significant difference in the specificity (82.1% vs 75.0%, P = 0.357), the positive predictive value (74.4% vs 58.8%, P = 0.159) and the negative predictive value (80.7% vs 67.7%, P = 0.108)., Conclusion: Color Doppler is better than MRI in the sensitivity and accuracy for the diagnosis of cervical lymph node micrometastasis of tongue cancer.

Objective: To investigate the clinical therapeutic outcomes and neck node control of a pretreatment neck dissection in the chemoradiation protocol of organ preservation for N2-N3 of supraglottic and hypopharyngeal carcinoma., Methods: Forty-six patients (group A) with untreated N2 or N3 squamous cell carcinoma of the supraglottis or hypopharynx underwent pretreatment neck dissection in a chemoradiation protocol, while 39 patients (group B) did not undergo pretreatment neck dissection in a chemoradiation protocol. Salvage surgeries were used for local or cervical node residual tumor or recurrence after chemoradiotherapy., Results: In group A, the mean time between neck dissection and chemoradiation was 21 days (range 15-29). Only 3 patients (6.5%) experienced wound complications. A 'boost' of radiation of 12 Gy was delivered after 33 neck dissections (64.8%) in patients with extracapsular spread. The Kaplan-Meier 5-year overall survival rate was 42.5%. The 5-year overall survival rate and disease-specific survival rate in group A was 42.5 and 46.4%. The rate of neck node control in group A was better than that in group B (86.3 vs. 65.9%, p = 0.02)., Conclusions: Pretreatment neck dissection in a chemoradiation protocol for supraglottic or hypopharyngeal carcinoma showed low complication rates, no delay for radiation, optimal radiation doses, and a high nodal disease control., (Copyright © 2012 S. Karger AG, Basel.)

Conclusion: The radial forearm free flap (RFFF) is one of the optimal choices for hypopharyngeal reconstruction. Our series demonstrates that the technique of an indicator flap for the monitoring of the buried flap is simple, reliable, and inexpensive. The condition of the indicator flap can be easily interpreted by the physicians and the nursing staff. Therefore, the success rate of this microsurgical reconstruction may be improved., Objectives: The RFFF is increasingly applied in reconstruction of the hypopharynx after radical resection for advanced hypopharyngeal cancer. However, postoperative monitoring of the buried free flap is extremely difficult. We designed a small external component as an indicator flap to monitor the perfusion of the buried vascular pedicle., Methods: Eight consecutive patients with hypopharyngeal cancer underwent radical surgery and hypopharyngeal reconstruction using RFFF at the Sun Yat-sen University Cancer Center between January 2005 and January 2007. The indicator flap was sutured to the surface of the neck for postoperative monitoring., Results: All of the indicator flaps remained viable. One patient experienced vascular compromise and was successfully salvaged. The success rate of the buried flaps was 100%. Pharyngocutaneous fistula occurred in one patient. All patients resumed an oral diet eventually.

Objective: To analyse the prognostic factors and the neck treatment strategy of early tongue squamous cell carcinoma (SCC)., Methods: Total of 152 cases of early tongue SCC underwent surgery between January 1994 December 2003 were reviewed. The patients, according to their neck managements, were divided into two groups, or wait-whach group (n = 32) and neck dissection group (n = 120), and the neck dissection group was subdivided into supraomohyoid neck dissection (SND) group and comprehensive neck dissection(CND) group (including radical neck dissection and modified radical neck dissection)., Results: All patients were followed up over 5 years or until death and the 5-year follow-up rate was 94.7%. The regional recurrence rates of wait-whach group and neck dissection group were 34.4% and 14.2% respectively (χ(2) = 6.865, P < 0.01) and 5-year overall survival rates of the two groups were 68% and 79% respectively (χ(2) = 1.699, P > 0.05). There were no significant difference in the regional recurrence rate or 5-year survival rate between SND group and CND group (P > 0.05). The patients with pathologically node positive had a low 5-year survival rate compared to those with node negative. The patients with regional recurrence had a significant low 5-year survival rate compared to patients without regional recurrence (P < 0.01)., Conclusions: Occult lymph node metastasis and regional recurrence were important prognostic factors for early tongue cancer. Supraomohyoid neck dissection can not improve the 5-year survival rate, but significantly reduce the rate of neck recurrence. The results suggest that the selective neck dissection for ipsilateral level I-III should be applied to the patients with early tongue carcinoma which does not cross the midline.

Objectives: To investigate the feasibility and efficacy of laryngeal framework reconstruction using titanium mesh in patients with glottic cancer after frontolateral vertical partial laryngectomy., Study Design: Prospective study., Methods: Defect of laryngeal framework, caused by frontolateral vertical partial laryngectomy in nine patients with T2 or T3 squamous cell carcinoma of glottic, were reconstructed with titanium mesh from 2007 to 2009. Computed tomography (CT) and fiberscopic examinations were performed at two weeks and three months postoperatively., Results: No aspiration and laryngeal stenosis was observed in the nine patients. CT scanning showed that titanium mesh was fastened well without displacement and deformity and that there was no laryngeal stenosis. Fiberscopic inspection showed that the larynx lumen was maintained well without stricture, shrinkage, and necrosis. No titanium mesh was exposed to the larynx lumen., Conclusions: Titanium mesh was a good alternative for reconstruction of the laryngeal framework. It provided adequate structural support to maintain airway patency.

Objective: To explore the relationship between the expression of excision repair cross-complementation group 1 (ERCC1) and class III ß-tubulin and the clinical characteristics and overall survival of patients with non-small cell lung cancer (NSCLC)., Methods: Immunohistochemical analysis was used to determine the protein expression of ERCC1 and class III ß-tubulin in 160 completely resected NSCLC primary tumor samples, 50 of which were paired with adjacent normal tissue samples and another 40 benign lung lesion tissue samples as controls. Clinical data at baseline, disease-free survival and overall survival were also collected. Univariate and multivariate Cox models were used to analyze the risk factors., Results: In 160 tumor samples, the ERCC1 and class III ß-tubulin positive rates obtained with immunohistochemistry were 46.9% and 49.4%, respectively. Both biomarkers had a higher positive rate in male patients. For patients who did not receive adjuvant chemotherapy, ERCC1 positivity was associated with longer survival (median survival time 73 vs 53 months, p=0.041), while in patients treated with platinum chemotherapy, ERCC1 positivity tended to be associated with poor survival (median survival time 41 vs 54 months, p=0.014). Class III ß-tubulin positivity was also associated with poor survival (median survival time 38 vs 58 months, p<0.001), but had no influence on the survival of patients who did not receive adjuvant chemotherapy., Conclusions: ERCC1 and class III ß-tubulin could be important survival predictors for completely resected NSCLC patients treated with adjuvant chemotherapy. Further prospective studies need to be performed to test this hypothesis in Chinese patients.

Background and Objective: Reconstructing buccal defects with proper flaps can expand the indications of surgery, improve quality of life and prolong survival. This study was to investigate the indications for such application, the selection of different kinds of flaps and the skills of the reconstructive operation., Methods: From September 2005 to August 2007, 26 patients underwent reconstructive operation after resection of buccal mucosa carcinoma: eight had simple buccal mucosa resection, 11 had resection of the bucca cavioris and facial skin, seven had resection of the bucca cavioris, facial skin and angulus oris; besides, seven patients underwent parotid duct resection. As for the reconstructive operation, pectoralis major myocutaneous flap was used in five patients, free radial forearm flap in 11 patients, free anterolateral thigh flap in six patients, and sternodeiceomastoid myocutaneous flap in four patients. Eight patients received postoperative radiotherapy at 66-70 Gy., Results: No perioperative death occurred. Necrosis happened in one patient who used free radial forearm flap; partial necrosis in one patient who used pectoralis major myocutaneous flap. The survival rate of the flaps was 96.2%. Hydrops of the operative wound happened in one patient with salivary fistula. During the follow-up of 1-3 years, seven patients had recurrence (four had recurrence in primary lesion and three in cervical lymph nodes), two died of recurrence in primary lesion., Conclusion: The free anterolateral thigh flap and free radial forearm flap are suitable for reconstruction of large buccal defects, and are first-choices for defects larger than 4 cm; the pectoralis major myocutaneous flap can be applied as the second-choice flap; the sternodeiceomastoid myocutaneous flap can be used for defects smaller than 4 cm.

Background and Objective: The therapeutic outcome of early stage squamous cell carcinoma of the oral tongue (SCCOT) is generally satisfactory. Recurrence is a major factor affecting the treatment efficacy of SCCOT. This study was to investigate the reasons for recurrence and prognostic factors of SCCOT, thus to decrease the recurrence rate and improve the therapeutic effect., Methods: In total 227 patients with SCCOT treated in Sun Yat-sen University Cancer Center from January 1992 to December 2003 were retrospectively reviewed. The Kaplan-Meier method was used to analyze the survival rate, the log-rank test was used to compare survival distributions, and the Chi-square test was adopted to compare different factors affecting recurrence. Multivariate analysis was performed using the Cox proportional hazard model., Results: The recurrence rate was significantly lower in patients with well differentiated SCCOT (19.3%) than in those with moderately-poorly differentiated SCCOT (39.2%) (P=0.004), and was significantly lower in patients receiving combined therapy (15%) than in those receiving surgery alone (28%) (P=0.014). The overall 3-year and 5-year survival rates in recurrent and non-recurrent groups were 40.7% vs. 87.3% and 25.9% vs. 80.3%, respectively(P=0.000). The overall 3-year and 5-year survival rates were also significantly different in patients > or =45 years and < 45 years (P=0.021), and in those with or without neck dissection (P=0.023)., Conclusions: The pathological classification and whether receiving combination therapy are the factors affecting recurrence of SCCOT. Age, neck dissection and recurrence are prognostic factors of SCCOT. Age and recurrence are independent factors of SCCOT.

Background and Objective: The prognosis of advanced squamous cell carcinoma of the larynx is poor Prognostic factors of this disease vary in different studies. This study was to analyze the most important factors affecting the prognosis of the patients with advanced (stage III and IV) squamous cell carcinoma (SCC) of the larynx., Methods: Clinical data of 221 patients with advanced SCC of the larynx were retrospectively analyzed. Survival analysis was performed by the life table method; comparison among/between groups was performed using the log-rank test; and multivariate analysis was carried out using the Cox proportional hazard model., Results: The two- and five-year overall survival rates of the 221 patients were 76.9% and 51.1%; while the 2-and 5-year disease free survival rates were 60.0% and 43.0%. Patients in stage III had better prognosis than those in stage IV. Post-operative radiotherapy improved the survival rate in patients with positive surgical margins. There was no difference in the survival rate between patients underwent partial laryngectomy and those underwent total laryngectomy. Multivariate analyses indicated that age, anatomic type, post-surgical stage, surgical margin and radiotherapy influenced the disease free survival (p<0.05), whereas, age, post-surgical stage and surgical margin affected the overall survival (p<0.05)., Conclusions: The prognosis of patients with advanced SCC of the larynx receiving surgery is poor. Age, post-surgical stage and surgical margin are the most important factors affecting the overall survival.

Background and Objective: Secreted protein acidic and rich in cysteine (SPARC) is expressed widely in malignant tumors. It is related to prognosis and biological behaviors of tumors. This study was to detect the expression of SPARC in stage II tongue squamous cell carcinoma and analyze its relationship with prognosis., Methods: Tongue carcinoma samples (T2N0M0) were obtained from 55 patients treated in Sun Yat-sen University Cancer Center from January 1999 to December 2003. Twenty-five squamous epithelium samples with tongue inflammation nearby were taken as control. Immunohistochemistry was used to detect the expression of SPARC. Its relationships with survival, occult lymph node metastasis and recurrence were analyzed., Results: The positive rate of SPARC was 49.1% in tongue cancer tissues and 0 in normal tissues (p < 0.001). The accumulative 5-year survival rate was significantly lower in SPARC-positive patients than in SPARC-negative patients (30.0% vs. 85.3%, p = 0.005). The positive rate of SPARC was significantly higher in tissues with occult lymph node metastasis than in those without metastasis (86.7% vs. 35.0%, p = 0.001), and higher in tissues with recurrence than in those without recurrence (100% vs. 31.5%, p < 0.001). The expression of SPARC was positively correlated to occult lymph node metastasis (r = 0.46, p < 0.001) and recurrence (r < 0.595, p < 0.001)., Conclusion: SPARC is highly expressed in stage II tongue squamous cell carcinoma, and positively correlated to survival, occult lymph node metastasis and recurrence.

Background & Objective: Postoperative relapse in tongue squamous cell carcinoma patients with pathologically negative cervical lymph node might be related to micrometastases. This study was to detect the lymph node micrometastases in cN0 tongue cancer patients, and explore its clinical significance., Methods: A total of 523 cervical lymph nodes taken from 49 tongue cancer patients were examined by routine HE staining and immunohistochemistry (IHC) with anti-cytokeratin antibody (CK19) staining. The follow-up period ranged from 9 to 83 (mean 56) months., Results: Metastases were detected in 7 (1.3%) lymph nodes from 5 patients with HE staining, and in 34 (6.5%) lymph nodes from 19 patients with CK19 staining. Micrometastases were detected in 27 (5.2%) lymph nodes from 14 patients. The difference in detecting lymph node metastases between two methods was significant (P=0.001). HE staining upstaged 3 cases from cN0 to pN1, and 2 cases from cN0 to pN2b; IHC staining upstaged 3 cases from cN0 to pN1, and 16 cases from cN0 to pN2b. Lymph node micrometastases showed no correlation to sex, age, T stage, differentiation, and depth of primary tumor invasion (P>0.05). The 5-year survival rates of the patients with and without micrometastases were 78.5% and 86.7%, respectively (P>0.05)., Conclusions: CK19 staining could increase the detection rate of cervical lymph node metastases and the accuracy of pathologic stage in tongue cancer. The results of our study showed that the presence of lymph node micrometastasis has no correlation to the prognosis. A further study is needed.

Background & Objective: The prognosis of stage IV glottic cancer is poor. This study was to explore the impacts of different treatment modalities, cervical lymph node status and surgical margin on the prognosis of stage IV glottic cancer., Methods: Clinical data of 88 patients with stage IV glottic cancer were reviewed. The correlations of different treatment modalities, cervical lymph node status, and surgical margin to the prognosis of stage IV glottic cancer were analyzed., Results: The overall 3-and 5-year survival rates of the 88 patients were 71.6% and 63.0%. There was no significant difference in survival rate among the patients received operation, operation plus postoperative radiotherapy, chemoradiotherapy, and operation plus chemotherapy (P=0.729). The overall survival rate was significant lower in patients with lymph node metastasis than in those without lymph node metastasis (P=0.015); for stage cN0 patients, there was no significant difference between the patients with and without occult lymph node metastasis (P=0.474). There was no significant difference between the patients with positive surgical margin and those with negative surgical margin (P=0.016)., Conclusions: N stage is the important prognostic factor for stage IV glottic cancer. The prognosis of patients with lymph node metastasis is poor. The survival rate of the patients with positive surgical margin is lower than that of those with negative surgical margin.

Background & Objective: Cervical lymph node metastasis rate of glottic carcinoma is low. How to deal with cervical adenopathy remains controversial. This study was to explore the factors relate to cervical lymphatic metastasis of glottic carcinoma., Methods: Clinical data of 333 patients with glottic carcinoma, treated at Cancer Center of Sun Yat-sen University from Jan. 1, 1992 to Dec. 31, 2000, were reviewed. Distribution of cervical adenopathy, prognosis, and neck management were analyzed., Results: The overall lymphatic metastasis rate was 9.61% (32/333); the occult lymphatic metastasis rate was 6.24% (20/321). Most metastatic lymph nodes located at ipsilateral levels II, III and IV (28/32). The pathologic grade had no correlation to the overall lymphatic metastasis rate (P=0.092), and occult lymphatic metastasis rate (P=0.067). The overall lymphatic metastasis rate (P=0.002) and occult lymphatic metastasis rate (P=0.015) rose up following with increased T stage. Neck selective radiotherapy for the patients at stage cN0 had no significant impact on occult lymph node metastasis rate (P=0.363). The 3-and 5-year survival rates were significantly lower in cN+ patients than in cN0 patients (56.25% vs. 88.70%, 46.67% vs. 85.37%, P<0.001), significantly lower in the cN+ patients with occult lymph node metastasis than in the cN+ patients without lymph node metastasis (68.18% vs. 89.00%, 63.31% vs. 85.55%, P=0.005), and significantly lower in naive cN+ patients than in the naive cN0 patients with occult lymph node metastasis (41.67% vs. 68.18%, 16.67% vs. 63.31%, P=0.004)., Conclusions: Most metastatic lymph nodes of glottic carcinoma locate at ipsilateral levels II, III and IV, especially at level II. Cervical lymphatic metastasis affects the prognosis of glottic carcinoma.

Background & Objective: At present, there is no clinical examination that can accurately assess the lymph node metastasis status of oral tongue carcinoma with clinically negative neck lymph node (cN0) before operation. Therefore, the treatment of cN0 neck is still controversial. Sentinel lymph node (SLN) biopsy may be the evidence for individual treatment of cN0 neck. This study was to explore the feasibility of SLN radiolocalization, and to investigate the clinical value of SLN detection in squamous cell carcinoma of the oral tongue., Methods: Twenty-one oral tongue squamous cell carcinoma patients with cN0 necks were recruited, among which 1 had received primary dissection before. 99mTc-SC, as the tracer, was injected into the submucosa around primary tumor before operation. Lymphoscintigraphy was performed immediately in 5 cases. The gamma probe was used to identify SLNs for all cases before and during operation. All patients received supraomohyoid neck lymph node dissection. The pathologic results were considered as golden standard to evaluate the effectiveness of SLN radiolocalization. SLNs that had been reported as negative by routine pathologic examination were examined by immunohistochemistry., Results: The detection rate of SLNs was 100%. Among the 21 patients, the pathologic results of SLNs for 21 patients accorded with the pathologic results of neck lymph node dissection; the accuracy rate was 95%. In 1 patient, the pathologic result of SLNs was negative, but that of neck lymph node dissection was positive. Micrometastases were found in 3 of 41 detected lymph nodes by immunohistochemstry., Conclusions: SLN radiolocalization in squamous cell carcinoma of the oral tongue is feasible. SLN biopsy can well predict the cervical lymph node metastasis status of oral tongue carcinoma, but further investigation is necessary to determine its clinical value.

Background & Objective: Subglottic cancer is rare. The subglottic region of the larynx is occult, which leads to misdiagnosis or missed diagnosis of subglottic cancer. It is usually advanced when initially presented. There is no large amount case-control study on subglottic cancer, and management of this tumor is still controversial. This study was to analyze the clinical features, treatments, and outcomes of subglottic cancer., Methods: Clinical records of 10 subglottic cancer patients, treated in Cancer Center of Sun Yat-sen University from Jan. 1981 to Oct. 2005, were reviewed., Results: Of the 10 patients, 4 had intralaryngeal invasion of more than half circle, 4 had extralaryngeal invasion, and 1 had lymph node metastasis. The patients were followed up for 1-15 years; 1 was lost. The overall 5-year survival rate was 55.5% (5/9). Excepted for the 2 patients denied treatment, the 5-year survival rate of the 7 treated patients was 71.4%, the 5-year disease-free survival rate was 42.9%. The 5-year disease-free survival was 0/2 for the patients received radiotherapy alone, 1/2 for those received operation alone, and 2/3 for those received both treatments., Conclusions: Subglottic cancer is usually advanced when diagnosed, and tends to extend within the larynx and infiltrate other organs. The prognosis is poor. Total laryngectomy is still the main operation for subglottic cancer, and operation combined with radiotherapy is better than single treatment.

Background & Objective: The cervical lymphatic metastasis rate of glottic cancer is low, and has seldom been reported. This study was to explore the factors related to cervical lymphatic metastasis of T3-T4 glottic cancer, and analyze its correlation to prognosis., Methods: Clinical data of 83 patients with T3-T4 glottic cancer, treated in Cancer Center of Sun Yat-sen University from 1992 to 2000, were reviewed retrospectively. The lymphatic metastasis rate, distribution of metastatic lymph nodes, influence factors of neck recurrence of cN0 glottic cancer, and correlation of cervical lymphatic metastasis to prognosis of T3-T4 glottic cancer were analyzed., Results: Overall lymphatic metastasis rate was 20.5%. The neck recurrence rate of cN0 patients was 14.3%. Most metastatic lymph nodes located at the ipsilateral levels II, III, and IV, while only 1 located at the contralateral level II. For cN0 patients, there was no difference in the neck recurrence rate between observation group and prophylactic cervical radiation group (P=0.772). Histopathologic differentiation affected the neck recurrence of cN0 patients (P=0.028); while T stage did not relate to the neck recurrence (P=0.217). The prognosis of cN+ patients was poorer than that of cN0 patients (P<0.001). The neck recurrence of CN0 patients did not affect the prognosis (P=0.460)., Conclusion: Most metastatic lymph nodes of T3-T4 glottic cancer locate at the ipsilateral levels II, III, and IV. Poor differentiation is significantly correlated to high risk of neck recurrence among cN0 patients. However, the recurrence does not affect the prognosis. Close observation should be done to the cervix of cN0 patients; while neck dissection should be done to cN+ patients.

Background & Objective: The occult lymph node metastasis rate of supraglottic cancer is high, and the treatment of occult lymph node metastasis is important. This study was to explore the related factors, treatment, and prognosis of occult lymph node metastasis of supraglottic cancer., Methods: Clinical data of 104 patients with cN0 supraglottic cancer, treated in Cancer Center of Sun Yat-sen University from 1992 to 1999, were retrospectively reviewed. The occult lymph node metastasis rate, distribution of metastatic lymph nodes, related factors, and treatment of the neck were analyzed., Results: The occult lymph node metastasis rates were 23.1% (24/104) in the whole group, and 23.9% (11/46) in stage T2 patients, 30.8% (8/26) in stage T3, 18.5% (5/17) in stage T4. The metastatic lymph nodes mainly located at lateral levels II-III(22/24). The prognosis of the patients with occult lymph node metastasis was poor (log-rank=10.66, P=0.001). Positive margin increased occult lymph node metastasis rate (Chi(2)=10.015, P=0.002), while pathologic differentiation (Chi(2)=3.349, P=0.175), T stage (Chi(2)=2.701, P=0.440), and treatment of primary lesion (Chi(2)=1.093, P=0.296) had no effects on it. Selective neck dissection reduced occult lymph node metastasis rate (Chi(2)=4.070,P=0.044)., Conclusions: The occult metastatic lymph nodes of cN0 supraglottic cancer mainly locate at lateral levels II-III. The prognosis of the patients with occult lymph node metastasis is poor. Positive margin increases occult lymph node metastasis rate. For patients at stage T1N0, observation is enough; for patients at stage T2-4N0, lateral neck dissection (levels II-IV) is effective.

Objective: To determine the value of elective neck dissection in patients with clinically stage I (cT1N0M0) squamous cell carcinoma of the tongue., Methods: This was a retrospective study of patients with surgical treatment between November 1984 and November 1999. A total of 130 patients were included in the study, all of whom received operation of the primary site, meanwhile, 99 of whom underwent elective neck dissection simultaneously including level I -III or level I -IV neck dissection in 20 patients and level I - V neck dissection in 79 patients. Results Among all these patients, the rate of occult metastasis to the neck were 12. 0%. Local failure rate in patients with only local treatment, level I II, II, III/IV neck dissection and level I - V neck dissection were 25. 8%, 15. 0% and 7. 6% respectively. There were significant difference in regional failure between patients with only local treatment and patients with elective neck dissection (P < 0.05). Also, no significant differences were noted in the survival rate between patients with only local treatment, elective neck dissection (level I -III or level I -IV) and level I -V neck dissection (P > 0.05)., Conclusions: Elective neck dissection significantly reduced regional control failure but was not able to reduce distant metastasis or increase the overall survival. A prospective randomized study is worthwhile to further evaluate the benefit of elective neck dissection in the treatment of clinically stage I squamous cell carcinoma of the tongue.

Background & Objective: Laryngeal squamous cell carcinoma (LSCC) is a common malignancy of the head and neck. Stage I-II LSCC patients have a favorable prognosis after operation or radiotherapy, but the curative effect and prognosis of stage III-IV LSCC are not satisfying, and its treatment is also controversial. This study was to summarize our experience in treating stage III-IV LSCC patients, evaluate the treatment results, and seek more reasonable therapeutic modality., Methods: Records of 202 stage III-IV LSCC patients, treated in Cancer Center of Sun Yat-sen University from Jan. 1, 1991 to Jan. 1, 2000, were retrospectively analyzed. Of the 202 patients, 64 received surgery alone, 83 received surgery and preoperative or postoperative radiotherapy, 41 received radiotherapy, and 14 received chemotherapy. The overall survival rate was estimated using life table method by SPSS10.0 software. Survival curves were compared with Wilcoxon method; relapse statuses were compared with Chi(2) test., Results: The 5- and 10-year overall survival rates of the 202 patients was (42.12+/-3.62)% and (33.20+/-4.32)%, and the median survival time was 48.5 months. The 5-year survival rates were 61.07% in glottic carcinoma group and 26.07% in supraglottic carcinoma group, and were 53.41% in surgery alone group, 51.04% in surgery plus radiotherapy group, 18.33% in radiotherapy group and 7.14% in chemotherapy group. There was no significant difference between surgery alone group and surgery plus radiotherapy group (P>0.05). Of the 147 patients received surgery, the 5-year survival rates were 56.15% for the 31 patients received partial laryngectomy and 52.08% for the 116 patients received total laryngectomy. Eleven patients had tumor relapsed after total laryngectomy within 5 years., Conclusions: Surgery, especially total laryngectomy, is the major treatment modality for stage III-IV LSCC. Partial laryngectomy may be performed with strict selection. Postoperative radiotherapy may be preformed on the patients with suspect of tumor residue or positive margin.

Background & Objective: Lymphoepithelial carcinoma of salivary gland is a rare and special kind of malignant tumor, and has seldom been reported. This study was to summarize the clinical features, treatment and curative effect of this disease according to our experiences., Methods: Clinical data of 16 patients with pathologically confirmed primary lymphoepithelial carcinoma of salivary gland, treated in Cancer Center of Sun Yat-sen University from Jan. 1990 to Sep. 2004, were retrospectively analyzed, and survival analysis was performed with Kaplan-Meier method., Results: The 16 patients with lymphoepithelial carcinoma of salivary gland accounted for 3.6% of all the patients diagnosed as malignant tumors of salivary gland simultaneously in our center. All patients had tumors occurred in unilateral gland, aged 15-57 years, with the female to male ratio of 1:1. All patients were from southern China. Except for 1 patient, the rest 15 had Epstein-Barr virus (EBV) serological tests. The positive rates of EBV-VCA-IgA, EBV-EA-IgA, and EBV-DNA enzyme were 93.3%, 66.7%, and 86.7%, respectively. All patients were treated with surgery, of which 9 received surgery only, 5 received surgery plus postoperative radiotherapy, 1 received surgery plus postoperative chemoradiotherapy, 1 received surgery plus chemotherapy. Four (25.0%) patients had postoperative pathology-proved ipsilateral cervical lymph node metastasis. The 1-, 3-, and 5-year survival rates of the 16 patients were 86.15%, 48.46%, and 24.23%., Conclusions: Although lymphoepithelial carcinoma of salivary gland is poorly differentiated, the prognosis of this disease is good. Complete resection plus postoperative radiotherapy is possibly accommodating.

Background & Objective: Dendritic cells (DCs) are the most important antigen-presenting cells, and can synthesize and secrete S100 protein. This study was designed to investigate the expression of S100-labeled DCs in glottic squamous cell carcinoma, and analyze its correlation to the prognosis., Methods: The expression of S100-labeled DCs in peritumoral tissues of 111 specimens of gllotic squamous cell carcinoma was detected by immunohistochemistry; 17 specimens of normal tissues were used as control. The correlation of S100-labeled DCs expression to prognosis of the 111 patients was evaluated., Results: The positive rates of S100-labeled DCs were 51.35% (57/111) in peritumoral tissues of gllotic squamous cell carcinoma, and 0 in normal tissues. The 5-year survival rate was significantly higher in S100-positive group than in S100-negative group (72.31% vs. 53.91%, P=0.030)., Conclusions: The glottic squamous cell carcinoma patients with obvious infiltration of S100-labeled DCs may achieve good prognosis.

Background & Objective: Dendritic cells (DCs) are the most important antigen-presenting cells. CD1a, a marker of immature DCs, plays a role in tumorigenesis. This study was designed to explore the correlation of CD1a(+) DCs to pathologic degree, T stage, local recurrence, and prognosis of glottic squamous cell carcinoma., Methods: Clinical and follow-up data of 111 patients with glottic squamous cell carcinoma were analyzed retrospectively. The expression of CD1a(+) DCs in the 111 specimens of glottic squamous cell carcinoma and 17 specimens of non-tumor tissue was detected by immunohistochemistry. Correlations of CD1a(+) DCs to pathologic degree, T stage, local recurrence, and prognosis of glottic squamous cell carcinoma were analyzed., Results: Positive rates of CD1a(+) DCs were 59.46% in glottic squamous cell carcinoma tissues, and 0 in non-tumor tissues; it was significantly higher in well-differentiated group than in moderately-and poorly-differentiated group [71.43% (55/77) vs. 28.57% (11/34), P<0.05], higher in T1-T2 group than in T3-T4 group [67.16% (45/67) vs. 47.73% (21/44), P<0.05], and higher in non-recurrence group than in local recurrence group [65.06% (54/83) vs. 42.86% (12/28), P<0.05]., Conclusions: The lower pathologic degree and higher T stage of glottic squamous cell carcinoma, the lower expression of CD1a(+) DCs. The positive rate of CD1a(+) DCs is low in recurrent glottic tumor. High expression of CD1a(+) DCs may indicate better prognosis of glottic squamous cell carcinoma.

Background & Objective: In oral tongue squamous cell carcinoma (SCC), the management for clinically negative (cN0) neck remains controversial. This study was to explore rational neck management for cN0 cases., Methods: Clinical data of 187 patients with oral tongue SCC of cN0, who received surgery alone, were retrospectively reviewed. Rules of occult nodal metastasis, factors that impact cervical node metastasis, and prognostic factors were analyzed. Neck recurrences of different treatment groups were compared., Result: Incidence of occult nodal metastasis in all patients was 23.0% (43/187). The most common site of occult nodal metastases was ipsilateral level II. About 83.0% of occult nodal metastases were found in ipsilateral levels I, II, and III. Pathologic grade was an independent influencing factor for occult neck metastases. Occult neck metastasis was an independent prognostic factor for oral tongue SCC. Supraomohyoid neck dissection (SOHND) was an effective therapeutic method for oral tongue SCC of cN0; the neck recurrence rate after SOHND was only 6.7%., Conclusions: SOHND is the effective and safe treatment for oral tongue SCC.

Objective: This study was designed to explore the optimal management option for cervical metastases in tongue squamous cell carcinoma (SCC) with clinically N0 neck in order to avoid excessive or inadequate treatment in clinical practice., Methods: Clinical data of 327 cases of tongue SCC with cN0 neck were retrospectively analyzed. Neck control rates affected by different pathoclinical parameters were compared. Prognosis analysis and death analysis were also performed., Results: Overall 3-year survival was 69.7% (228/327), 3-year survival of neck recurrent group and non-recurrent group was 39.1% (25/64) and 77.2% (203/263), and 51.5% (51/99) of the death related to neck failure. Overall neck control rate was 80.4% (263/327); neck control rate of wait and watch group, level I neck dissection, level I + II neck dissection, supraomohyoid neck dissection, radical neck dissection, functional neck dissection, was 67.5% (27/40), 72.7% (24/33), 60.0% (15/25), 84.9% (45/55), 86.8% (131/151), 84.0% (21/25), respectively. Treatment modality and cervical lymph node involvement were independent factors for neck control., Conclusions: Neck control is a key for prognosis of tongue SCC with cN0 neck. Supraomohyoid neck dissection is the first choice in management of cervical metastases in tongue SCC with cN0 neck, during which the suspected involved lymph nodes should be sent for frozen section to determine whether comprehensive neck dissection required. Multimodal metastasis and/or capsular spread are the indications for postoperative irradiation.

Background & Objective: Cervical lymph node metastasis and recurrence are the most common causes of treatment failure to patients with oral tongue carcinoma. The neck management for oral tongue carcinoma of early stages remains controversial. This study was to evaluate the effectiveness of elective neck dissection (END) in treating oral tongue squamous cell carcinoma (SCC) of stage I., Methods: A retrospective analysis of 95 patients with oral tongue SCC of stage I, undergone surgical treatment from 1988 through 1997, was performed to determine the impact of END on patients' outcomes,such as regional recurrence,and overall survival. Of the 95 patients, 24 (observation group) did not undergo END, while the rest 71 (END group) underwent END., Results: In observation group, the regional recurrence rate was 25.0% (6/24), and the recurrence-related mortality was 20.8% (5/24). END significantly reduced both the regional recurrence rate and the recurrence-related mortality to 7.0% (5/71) and 4.2% (3/71) respectively (Chi(2) test, P < 0.05). The overall survival rate of END group was also significantly higher than that of observation group (log-rank test, P < 0.05)., Conclusion: END may improve the neck control rate of oral tongue SCC of stage I, reduce the recurrence-related mortality, and increase the overall survival rate of patients.

Background & Objective: Survivin, a new described member of the family of apoptosis inhibitory proteins (IAP), is undetectable in normal tissue of adults, but abundantly expressed in a variety of human malignancies. This study was designed to examine the expression of Survivin in laryngeal squamous cell carcinoma, analyze the relationships between the expression of Survivin and prognostic factors including age, gender, clinical stage, T stage, N stage, classification, histology and recurrence, to investigate its significance on prognosis., Methods: Clinical information and paraffin- embedded tumor samples of 81 cases laryngeal squamous cell carcinoma (LSCC) patients, who were treated at Cancer Center of Sun Yat-sen University between 1997 and 1998, were collected. Tissue chip was made, and SP method was performed to analyze Survivin expression in tumor tissue and adjacent normal laryngeal mucosa. SPSS 10.0 software was used. Kaplan-Meier method was used for survival analysis, and log-rank test was used for data analysis; multivariate analysis was carried out using Cox proportional hazard model., Results: The overall 5-year survival rate for patients with laryngeal squamous cell carcinoma in this study was 58.33%. The over-expression rate of Survivin in tumor tissue and adjacent normal laryngeal tissue were 50.62%, 0%, respectively (P< 0.05). The positive Survivin expression group(5-year overall surivial rate: 22.06%) had a worse prognosis than that of negative group (5- year overall survival rate: 92.33%)(P< 0.05). The univariate analysis showed that clinical stage, T stage, N stage, histology grade, recurrence, and Survivin expression were the most important prognostic factors (P< 0.05). The Chi(2) test results showed that the expression of survivin was correlated with clinical stage, T stage, N stage, histology grade and recurrence (P< 0.05); Multivariate analysis results showed that clinical stage, survivin expression, and recurrence were independent prognosis factors on survival in LSCC patients., Conclusions: The expression of Survivin is an important biological factor affecting the prognosis; Tissue chip method can be simply and efficiently used in large scale of retrospective study in laryngeal squamous cell carcinoma.

Objective: To investigate the factors on distant metastases (DM) of laryngeal cancer., Methods: 277 cases of laryngeal cancer hospitalized in Cancer Center of Sun Yat-sen University from 1990 to 1995 were reviewed. 18 cases with DM were investigated to confirm the distant metastatic rate, target organ, time interval, and prognosis. Kaplan-Meier and Cox model analysis were used to find the significant indicators for DM in laryngeal cancer., Results: The overall incidence of DM in laryngeal cancer was 6.5% (18/277). The target site of DM was mainly in lung 83.3% (15/18), liver 16.7% (3/18). 3 cases with DM in lung also combined with bone metastases which occurred in vertebra 1, lib 1 and 1 in multi-sites. 2 patients were diagnosed DM when admitted, and the rest with time interval between 1 and 103 months (median 7 months). The 3-year and 5-year cumulative survival in laryngeal cancer with DM was 23.8% and 11.9% respectively. The time interval between the presentation of DM and death was 2.77 months (median 4.6 months). The worst prognosis is liver metastasis with which the patient could survive 4.6 months at most in our study. Kaplan-Meier analysis in 277 laryngeal cancers showed that pathology, pathological differentiation of squamous cell carcinoma, N stage, and clinical stage were significant indicators for DM from laryngeal cancer. Cox model analysis showed that only N stage was the significant prognostic factor for DM in laryngeal cancer (Wald = 7.889, P = 0.005)., Conclusion: Laryngeal cancer has certain percentage of DM, which is mainly in lung and their prognosis is usually poor. Non-squamous cell carcinoma, low pathological differentiation, cervical metastasis and advanced cancer are the possible indicators for DM, but our study shows that only N stage significantly predicts DM from laryngeal cancer.

Background & Objective: At present, whether neck dissection should be employed in squamous cell carcinoma (SCC) of the tongue with clinically node negative neck(cN0) is still controversial. This study was designed to explore the regularity of cervical lymph node metastasis in SCC of the mobile part of the tongue, and to discuss the theories and principles of employment of selective neck dissection in cN0 cases., Methods: A retrospective research was performed on clinical data of 214 cases of SCC of the tongue treated with surgery from 1991 to 1997. Distribution of cervical lymph node metastasis of cN0 pN(+)= (pathologically node positive) and cN(+) (clinically node positive) pN(+)= cases were analyzed; the survival rates of different groups were compared; the factors that impact the survival of SCC of the tongue were screened out by Cox regression analysis., Results: Cervical lymph node metastases were found in 69 cases. The metastatic rate was 32.2%. Metastases occurred in level I, II, III, IV, V of the ipsilateral neck were 22.3%, 33.5%, 22.3%, 4.6%, 1.0%, in level I,II,III, IV,V of the contralateral neck were 6.6%, 3.6%, 3.0%, 2.0%, 0.5%, respectively. The 5-year survival rates of the pN(+)= group and the pN0 group were 47% and 83%, respectively(P< 0.001). T stage and N stage were independent factors that impact the long-term outcome of SCC of the tongue., Conclusion: Level I,II,III of the ipsilateral neck tend to be involved when cervical lymph node metastases occur. Selective neck dissection can be used to treat the cervical metastasis in cN0 cases, as well as to evaluate the cervical lymph node status in order to determine whether comprehensive neck dissection should be employed.

Background & Objective: There is controversy in therapy strategy for the cN0 squamous cell carcinoma of the tongue. The aim of this study was to explore the relative factors of prognosis for the cN0 squamous cell carcinoma of the tongue and to identify the risk population., Methods: Cox regression model was used to analyze the clinical data of 109 patients with cN0 tongue cancer treated in Cancer Center, Sun Yat-sen University from January 1990 to March 1998. The prognostic index (PI) of the patients was calculated on basis of the results of multivariate analysis. According to the individualized PI, the patients were classified to different hazard groups., Results: The 3, 5 years survival rates were 74.40%and 69.31%, respectively. Multivariate analysis showed the prognosis statistically correlated with T grade, therapy manner of primary tumor, differentiation grade, age, and occult neck lymph node metastasis. T stage was found to be the most important prognostic factor. The prognosis of the patients in comprehensive therapy group is better than that in surgery alone group, chemotherapy alone,or radiotherapy alone group. The patients with tongue carcinoma in low differentiation group, the older group, or occult neck lymph node metastasis group showed a poor prognosis. The patients were divided into high-risk group,moderate-risk group, and low-risk group according to the PI value and there was significant difference in the survival rates between each two groups of the three groups (P< 0.05), and the 5-year survival rates were 83.33%, 64.12%, and 27.65%, respectively., Conclusion: The prognosis of cN0 squamous cell carcinoma of the tongue is associated with T grade, therapy manner of primary tumor, differentiation grade, age, and occult neck lymph node metastasis. PI value could be used to predict the prognosis of the patients with the cN0 squamous cell carcinoma of the tongue.

Background & Objective: There was few report about the protection of oral function of microwave coagulation in treatment of cancer of floor of the mouth. This study was designed to systematically clarify the principle, operation, treatment of the primary cancer and lymph nodes, efficiency, function of the mouth, complications and indications of the microwave coagulation in treatment of the cancer of the oral cavity. Based on this, the significance of the two special methods and prevention of bleeding during the cause were discussed., Methods: Ninety-six cases with cancer of oral cavity who were treated with microwave coagulation were analyzed retrospectively. The survival rates and the recurrent rates of those with the coagulated tissue be resected or unresected, and of the positive margin group and the negative margin group were compared for analyzing the complications and prevention of them., Results: The difference of the survival rates of those whose coagulated tissue pathologically positive and negative was insignificant (Log Rank = 0.70, P = 0.4033), and the differences of the recurrent rates of the primary site, secondary site and the uncertain site of them were also insignificant (chi 2 = 1.65, 0.837, 0.003; P = 0.684, 0.36, 0.959). The overall survival rate of the patients with negative margin was better than those of with positive margin (Log Rank = 6.08, P = 0.0136). However, the difference of the recurrent rates of them was insignificant (chi 2 = 0.327, P = 0.567). The total complication rate of 96 patients was 9.6% and all of them were acceptable. The complication rate of those with the coagulated tissue be resected was lower than that of the unresected (P = 0.013)., Conclusion: Ligating the tongue artery, resecting the coagulated tissue, and packing the wound margin were effective methods to prevent the bleeding. The pathological result of the coagulated tissue could not be used to predict the prognosis. It is best to hold enough treatment range for microwave coagulation. Application of microwave coagulation in treatment of cancer of oral cavity has the advantage of less and slight complications.

Background & Objective: p53 expression was a marker to predict the poor prognosis of laryngeal cancer. Detection of p53 in the pathological negative margin can be used to find more patients with poor prognosis. The aim of this study was to reveal the correlation between p53 expression and prognosis in primary cancer and surgical margin of laryngeal squamous cell carcinoma (SCC)., Methods: The clinical data of 67 laryngeal SCC with pathological negative margin were analyzed retrospectively. The expression of p53 protein in the margin and primary cancer was detected by immunohistochemistry. The survival rates and the recurrent rates were compared between p53 positive and negative group both in surgical margin and primary cancer., Results: (1) The positive rates of p53 in surgical margin and primary cancer were 19.4% (13/67) and 50.7% (34/67), respectively. (2) The recurrent rate of positive margin group was higher than that of negative margin group (69.2% vs. 33.3%, P = 0.018). The survival rate of positive margin group was lower than that of negative margin group (24.62% vs. 75.69%, P = 0.0012). The recurrent rate of p53 positive primary cancer was higher than that of p53 negative primary cancer (64.7% vs. 15.2%, P = 0.0000). The survival rate of p53 positive primary cancer was lower than that of p53 negative primary cancer (42.86% vs. 90.86%, P = 0.0000)., Conclusion: The prognosis of those with p53 protein positive in the pathological margin or the primary cancer were worse than that of the negative group.

Background & Objective: Some clinical and histopathological features of squamous cell carcinoma of tongue (TSCC) were closely associated with occult cervical lymph node metastasis (OCLNM). This study was designed to investigate the correlation between occult cervical lymph node metastasis in squamous cell carcinoma of tongue and the clinicopathological indexes of primary tumor tissue., Methods: Thirty-five TSCC patients with OCLNM treated in Cancer Center, Sun Yat-sen University from 1988 to 1996 were enrolled. According to random principle, 35 TSCC patients without OCLNM at the same period were selected. Tumor deepness was measured and pathological parameters were assessed under microscope., Results: The rates of OCLNM in group of infiltrative plus ulcerative type, group of infiltrative type, group of ulcerative type and group of exogenous type were 70.37%, 41.67%, 40.00%, and 27.27%, respectively; the rates of OCLNM in T1, T2, and T4 were 44.00%, 43.48%, and 62.64%, respectively. The rates of OCLNM in groups of tumor deepness < 4 mm, 4-7.9 mm, and > or = 8 mm were 14.29%, 61.54%, and 88.89%, respectively. The rates of OCLNM in groups of response of peritumoral lymphocyte +, ++ and +++ were 73.68%, 58.62%, and 18.18%, respectively. The rates of OCLNM in groups of with vascular invasion and without vascular invasion were 85.71% and 46.03%, respectively. The rates of OCLNM in groups of well, moderate, and poor differentiation were 52.63%, 42.31%, and 66.67%, respectively. The rates of OCLNM in groups of invasive patterns of type I, type II, type III, and type IV were 40.90%, 50.00%, 52.00%, and 80.00%, respectively. Univariate analysis indicated that OCLNM in TSCC was closely associated with gross appearance of primary tumor, tumor deepness, response degree of peritumoral lymphocyte and vascular invasion (P < 0.05), but was not associated with T stage, pathological differentiation, and invasion way (P > 0.05); Logistic multivariate analysis manifested that only tumor deepness and response degree of peritumoral lymphocyte significantly correlated with OCLNM in TSCC., Conclusion: There was significant correlation between gross appearance of primary tumor, tumor deepness, response degree of peritumoral lymphocyte and vascular invasion and OCLNM in TSCC. These parameters can be used to predict occult cervical lymph node metastasis in TSCC.

Background & Objective: Induction chemotherapy play an important role in treatment of the patients with tongue squamous cell carcinoma. This study was designed to evaluate the role of induction chemotherapy with single agent bleomycin A5 in treating stage T2 tongue squamous cell carcinoma., Methods: The authors retrospectively analyzed the influence of surgery and induction chemotherapy with single agent bleomycin A5 plus surgery on survival rate and locoregional control among 72 patients with tongue squamous cell carcinoma., Results: The 5-year survival rates were 81.46% and 57.14% respectively for the group of surgery alone and the group of induction chemotherapy plus surgery, the difference between the two groups were significant (P = 0.0229). The rates of locoregional recurrence were 22.2%, 33.3% and the medial time of recurrence was 20, 24 months respectively in the two groups. For the patients in stage II and stage III plus stage IV, there was no difference between the two groups for the 5-year survival rate (P = 0.0949; P = 0.0739). For the patients in stage III plus stage IV, the rates of locoregional recurrence were 12.5%, 35.7% and the medial time of recurrence was 12, 12.8 months, respectively, in the two groups., Conclusions: It has no significant role in treatment of the patients with stage T2 tongue squamous cell carcinoma for single agent bleomycin A5. Induction chemotherapy using single agent bleomycin A5 did not improve the 5-year survival rate for early or late primary lesions. The impact on the control rate of locoregional recurrence would be studied further for single agent bleomycin A5.

Background & Objective: This study was designed to investigate the factors associated with the primary recurrence in laryngeal squamous cell carcinomas after treatment., Methods: A total of 166 cases of laryngeal squamous cell carcinomas hospitalized in Cancer Center of Sun Yat-sen University from 1990 to 1995 were reviewed retrospectively. It was considered primary recurrence that pathologically confirmed recurrence after 6 months of follow-up. The correlative factors which included age, pathological differentiation, diseased site, stage, treatment modality, surgical procedures, surgical margin, and radiotherapy with primary recurrence were investigated., Results: The primary recurrence in this group after treatment was 16.3% (27/166). The primary recurrence rates in different treatment modalities of definitive radiotherapy, definitive surgery, and combined management were 50%, 8.9%, and 14.1%, respectively, which had statistical significance (P < 0.05). The primary recurrence rates in surgical and non-surgical(radiotherapy and radiochemotherapy) treatment were 11.3% and 44%, respectively, which had statistical significance(P < 0.05). The comparison of T stage in different treatment modalities showed definitive radiotherapy had earlier T stage than definitive surgery and combined therapy(P < 0.05). The primary recurrence rates in positive and negative surgical margin were 34.8% and 6.1%, respectively, which had statistical significance (P < 0.05)., Conclusions: The treatment of primary site influences directly the primary relapse. Surgical treatment has better primary control than non-surgical treatment. Definitive radiotherapy has more probability of primary recurrence. The surgical clearance of the primary site influences directly the primary control.

Background & Objective: Induction chemotherapy is important in comprehensive care of patients with oral tongue squamous cell carcinoma. However, the effect of induction chemotherapy on the long-time effect was not clearly known. This study was designed to investigate the relationship between pathological negativity of primary lesion after induction chemotherapy and long-time effect in tongue squamous cell carcinoma., Methods: The 3 year survival rate, the 5 year survival rate, survival rate with tumor free, and reasons of treatment failure of 25 patients with tongue squamous cell carcinoma which primary lesion was pathologically negative were analyzed retrospectively., Results: The 3 year survival rate and the 5 year survival rate of the patients which primary lesion (91.75% and 91.66%) was pathologically negative were both higher than the patients with residual tumor (64.52% and 57.0%). The survival rate with tumor free in the former was also higher than that in the latter. The main reasons for treatment failure were local recurrence and/or regional lymph node metastasis/recurrence., Conclusion: Induction chemotherapy could increase the long-time survival rate of the patients with tongue squamous cell carcinoma whose primary lesion was pathologically negative.

Background & Objective: There was little report on the rule of lymph node metastasis in the cancer of mouth floor. The aim of this study was to investigate the rule of lymph node metastasis and investigate the reasonable treatment., Methods: A total of 79 cases with squamous carcinoma of mouth floor were included into this study retrospectively. The distributive difference of clinical and pathological positive lymph node was compared. The recurrent rate of the patients who were performed with radical neck dissection and supra-half-neck dissection in clinical positive lymph node group were compared with the recurrent rate of the patients who were preformed with radical neck dissection, supra-half-neck dissection, submandibular triangle dissection, and clinical observational group., Results: Clinical and pathological positive lymph node was found mainly in II region (61.8% and 40.0%, respectively), secondly in I and/or III region, and rarely in IV, V, and VI region. In clinical positive lymph node group, the recurrent rate of the patients who performed with radical cervical neck dissection was lower than supra-half-neck dissection, but without statistical significance (chi 2 = 3.403, P = 0.065). In clinical cervical negative lymph node group, the recurrent rates of the patients performed with supra-half-neck, submandibular triangle dissection, and in clinical observational group were 11.1% (1/9), 40.0% (2/5), and 23.5% (4/17), without statistical significance (chi 2 = 1.554, P = 0.46)., Conclusion: Lymph node metastasis of cancer of floor of mouth mainly distributes in I, II, III region; The patients with negative cervical lymph node should be performed lymph node dissection in I, II, III region (supra-half-neck).