Search

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]

Copyright of Acta Oto-Laryngologica is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

Introduction. Frailty refers to a decreased physiologic reserve in geriatric patients and its importance in terms of treatment planning and outcome prediction has been emphasized in oncologic practices for older patients with cancer. We investigated the clinical implications of a head and neck cancer (HNC)-specific frailty index suggested by prospective clinical and functional evaluations of HNC patients. Materials and Methods. We analyzed data on 165 elderly patients with HNC who were prospectively enrolled in our hospital from 2010 to 2013. Pretreatment functional evaluations were performed according to all comprehensive geriatric assessment (CGA) domains. We additionally evaluated the patients' respiratory and swallowing functions using pulmonary function tests, voice handicap index (VHI), MD Anderson Dysphagia Inventory (MDADI), and other associated tests. Factors affecting the 2-year morbidity and mortality were also analyzed. Results. Respiratory and swallowing problems were major causes of 2-year morbidity. Pretreatment performance status, VHI ≥8, MDADI,70, dental problems, and chemotherapy were significantly associated with early morbidity and mortality (all p < .05). CGA-assessed frailty was found in 72 patients (43.6%) and was significantly associated with 2-year mortality (p = .027) but not with morbidity (p = .716). The high-risk group according to our new HNC-specific frailty index that included functional evaluations of respiration and swallowing showed significantly higher 2-year morbidity (p = .043) and mortality (p < .001). Conclusion. Pretreatment functional disabilities related to respiration and swallowing were significantly associated with early morbidity and mortality. The suggested index would be more useful for assessing frailty in elderly HNC patients. [ABSTRACT FROM AUTHOR]

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

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. This study aimed to investigate the effect of metformin on progression of head and neck cancers, occurrence of second primary cancers, and cause-specific survival. Methods. This study analyzed a retrospective cohort of 1,151 consecutive patients with head and neck squamous cell carcinoma who were treated at our hospital. Patients were divided into three groups: nondiabetic, nonmetformin, and metformin. Clinical characteristics, recurrence of index head and neck cancer, occurrence of second primary cancer, and survival were compared among the different groups. Results. Of 1,151 patients, 99 (8.6%) were included in the metformin group, 79 (6.8%) were in the nonmetformin group, and 973 (84.5%) were in the nondiabetic group. Diabetic status and metformin exposure had no significant impact on index head and neck cancer recurrence or second primary cancer development (p > .2). The nonmetformin group showed relatively lower overall (p = .017) and cancer-specific (p = .054) survival rates than the other groups in univariate analyses, but these results were not confirmed in multivariate analyses. Conclusion. Metformin use did not show beneficial effects on index tumor progression, second primary cancer occurrence, and cause-specific survival in patients with head and neck cancer compared with nonmetformin users and nondiabetic patients. [ABSTRACT FROM AUTHOR]

Objectives: Current guidelines recommend chest computed tomography (CT) with locoregional CT/magnetic resonance imaging for patients with head and neck squamous cell carcinoma (HNSCC), and 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/CT is suggested for stage III-IV patients. However, whole body screening with 18F-FDG PET/CT may provide better detection of distant metastases and synchronous cancer than conventional imaging. We evaluated the utility of 18F-FDG PET/CT in detecting distant metastasis and synchronous cancer.Methods: This prospective study enrolled 740 consecutive patients with previously untreated HNSCC diagnosed between September 2010 and December 2015. Synchronous cancer was histologically confirmed and distant metastases were confirmed by biopsy or serial imaging follow-ups. McNemar test was used to compare the true-positive detection rates of chest radiography (CXR) + head and neck CT (hnCT) (A) versus 18F-FDG PET/CT (C) and chest CT + hnCT (B) versus 18F-FDG PET/CT.Results: Distant metastases and synchronous cancer were found in 23 (3.1%) and 55 (7.4%) patients, respectively. A, B, and C detected distant metastases in 10 (1.3%), 19 (2.6%), and 21 (2.8%) patients, respectively. The absolute differences were 1.5% (A versus C, P = 0.003) and 0.3% (B versus C, P = 0.687). A, B, and C detected synchronous cancer in 15 (2.0%), 22 (2.9%), and 36 (4.9%) patients, respectively. The absolute differences were 2.8% (A versus C, P < 0.001) and 1.4% (B versus C, P = 0.013).Conclusions: 18F-FDG PET/CT detected more distant metastases and synchronous cancer than CXR + hnCT and more synchronous cancer than chest CT + hnCT. [ABSTRACT FROM AUTHOR]

Background Circulating biomarker (CB) is a convenient, emerging predictive tool for treatment response and outcomes in human cancers. Therefore, we examined the prognostic value of pre-treatment and early post-treatment CBs and their summated scores in patients with head and neck squamous cell carcinoma (HNSCC). Methods This study prospectively included 310 consecutive patients who underwent definitive treatment for previously untreated advanced-stage HNSCC between 2010 and 2015. The CB score was determined by complete blood counts (CBCs) and blood chemistry before and 2 months after the treatment, and the number of abnormal CB was counted from 0 to 10. Univariate and multivariate analyses with Cox proportional hazards models were used to find factors associated with disease-free survival (DFS) and overall survival (OS). Results Most CBC profiles were significantly changed at 2-months post-treatment compared with those at pre-treatment. Univariate analyses showed that hypoalbuminemia, leucocytosis, C-reactive protein, high CB scores (≥6), age, performance status and comorbidity and tumour site were significantly associated with DFS and OS (all P < 0.05). Both pre- and post-treatment CB scores were independent factors predictive of DFS and OS outcomes in the multivariate analyses ( P < 0.05). High CB scores at pre-treatment were associated with 7–10-fold increased risk of unfavourable DFS and OS outcomes, and those at 2-months post-treatment were associated with 2 to 4-fold increased risk of poor survival outcomes (all P < 0.05). Conclusions CB scores at pre-treatment and early post-treatment are useful for predicting survival outcomes in patients with advanced-stage HNSCC. [ABSTRACT FROM AUTHOR]

Background Posttreatment detection of recurrence may lead to salvage treatment and prognostic prediction in patients with head and neck squamous cell carcinoma (HNSCC). We evaluated the diagnostic and prognostic values of 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET)/computed tomography (CT) after definitive treatment of HNSCC. Methods This prospective study included 278 consecutive patients who underwent curative surgery ( n = 143, 51.4%) or definitive radiotherapy/chemoradiotherapy ( n = 135, 48.6%) for previously untreated HNSCC. The patients were regularly followed up and evaluated by 18 F-FDG PET/CT, head and neck CT/magnetic resonance imaging (MRI), and chest CT at regular intervals after treatment. The imaging interpretations were compared with the histological results for recurrence. Receiver operating characteristics curves analysis, McNemar's test and logistic regression using generalised estimating equations were used to compare the diagnostic accuracy of 18 F-FDG PET/CT and standard imaging of CT/MRI or chest CT, and a Cox proportional hazards model was used to assess the prognostic value of PET/CT. Results During a median follow-up of 44 months (range, 24–62 months), 73 patients (26.3%) had recurrence or persistent diseases. The area under curves for 18 F-FDG PET/CT and CT/MRI were 0.975 (0.964–0.992) and 0.789 (0.713–0.874), respectively ( P < 0.001). 18 F-FDG PET/CT detected 65 of 66 recurrences (98.5%) not suggested by physical examination and endoscopy. Positive findings on 18 F-FDG PET/CT scans were independent predictors of poorer cancer-specific and overall survival outcomes ( P < 0.01). Conclusions Posttreatment 18 F-FDG PET/CT surveillance helps to properly detect recurrence and to predict the survival following treatment of HNSCC. [ABSTRACT FROM AUTHOR]

Background Accurate assessment of the extent of cancer is essential for appropriate treatment planning and outcome prediction. This study prospectively evaluated whether adding 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography (PET)/computed tomography (CT) to the routine initial staging practice in head and neck squamous cell carcinoma (HNSCC) improved management and prognosis. Methods All consecutive patients with newly diagnosed HNSCC who presented in October 2010 – December 2012 underwent conventional workups (CWU) followed by PET/CT. The clinical stage and management plans before and after PET/CT were compared. PET/CT was deemed to have no/low, moderate, and high impact on management planning depending on whether PET/CT changed the treatment modality or goal. The appropriateness of PET/CT staging and management impact was confirmed by histopathology and clinical follow-up, and its association with survival was analysed. Findings Of the 248 patients, PET/CT changed the Tumour Node Metastasis (TNM) classification in 79 (31.9%). In the patients with discordant staging, PET/CT staging was significantly more sensitive and accurate than CWU staging (both P < 0.001). PET/CT had high or moderate impact on management in 39 (15.7%) patients. Patients with PET/CT upstaged disease had significantly worse progression-free survival (PFS) and overall survival (OS) than patients with no CWU-stage changes (3-year PFS = 56.8% versus 74.5%, P = 0.043; 3-year OS = 61.3% versus 85.3%, P = 0.006). Multivariate analyses revealed that PET/CT staging and second primary cancer were independent predictive factors for both PFS and OS ( P < 0.05, each). Interpretations 18 F-FDG PET/CT added important staging information that improved management and prognostic stratification in HNSCC. [ABSTRACT FROM AUTHOR]

Summary: In order to determine the efficacy and proper timing of routine PET scans for surveillance of recurrent head and neck squamous cell carcinoma (HNSCC), we evaluated the diagnostic performance of routine PET scans in relation to time interval from completion of treatment. Amongst 206 retrospectively evaluated post-treatment PET scans of 159 patients with HNSCC, 156 were performed for routine surveillance in subclinical cases. Diagnostic performance of PET scan and follow-up outcome were evaluated in relation to the time interval (2–6months, 6–12months, 12–24months, and >24months) of PET scan from the completion of treatment. Overall sensitivity and NPV of these PET scans for recurrence were 92.5% and 94.8%, compared with 55.0% and 76.9% for conventional evaluation methods. In the 156 routine scans, the diagnostic sensitivity, specificity, and NPV for locoregional recurrence were 90%, 91% and 97%, respectively, and the values for distant metastases and second primary cancers were 100%, 97% and 100%, respectively. The diagnostic accuracy of routine PET scans was not significantly altered by the time interval. Most (97%) of true negative cases on routine PET scans had no recurrence during a median 14months follow-up. PET scan may be a useful tool in routine surveillance for detection of recurrence in subclinical patients. For routine surveillance, the initial PET scan should be performed within 6months after completion of treatment and the proper timing of next routine PET scan for subclinical patient with initial negative PET result might be 1year after initial PET scan. [Copyright &y& Elsevier]

Objectives: Soft tissue sarcomas of the head and neck (HNSTS) show various histological types and clinical behaviour. Recently, the 8th edition of the American Joint Committee on Cancer (AJCC) proposed a staging system for HNSTS independent of other body soft tissue sarcomas, which requires validation. Therefore, we evaluated the prognostic factors for the survival of HNSTS patients through a comparison between previous and current AJCC staging systems.Materials and Methods: This study involved 135 consecutive HNSTS patients who underwent primary surgery, chemoradiotherapy or chemotherapy. Patients were grouped into staged (S) and not staged (NS) cancer according to the AJCC 8th edition staging. Cox proportional-hazard regression analyses were used to identify factors associated with overall survival (OS), and progression-free survival (PFS) in all, S or NS patients.Results: Median follow-up period was 75 months and the 5-year OS and PFS rates of all patients were 67.8% and 53.4%, respectively, which was similar between S and NS groups. Age, tumour size and grade, overall stage (7th edition) and resection margin were the significant prognostic factors for OS and PFS in all patients and NS group (all P < 0.05), whereas positive resection margin was the only significant factor for OS and PFS in the S group (P < 0.001). While OS was poorly discriminated among different 8th edition T-categories, different 7th edition showed good discrimination among overall stages in all patients and the NS group.Conclusion: The revised staging system may not provide an improved risk stratification for survival of HNSTS patients. [ABSTRACT FROM AUTHOR]