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

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

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

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

Objective: Conservative parotidectomy is known to reduce morbidity, but has been rarely examined in patients with clinically node-negative (cN0) parotid cancers. We evaluated the clinicopathological variables influencing the outcomes of these patients and the efficacy of conservative parotidectomy. Methods: We reviewed the clinical and pathological data of 256 patients with cN0 parotid carcinomas who underwent curative surgery at our institution. Of these, 110 and 146 underwent conservative and total parotidectomy, respectively, with 83 undergoing elective neck dissection and 135 receiving postoperative radiotherapy. Univariate and multivariate analyses of variables predicting recurrence-free survival (RFS) and overall survival (OS) were performed. Morbidity, survival, and recurrence rates were compared between the conservative and total parotidectomy groups. Results: The 5-year RFS and OS rates in all patients were 85.7 and 91.4%, respectively. Multivariate analysis showed that advanced T classification, positive resection margin, and high-histologic grade were independent prognostic factors for both RFS and OS. Among the 201 patients with low- or intermediate-grade parotid cancers, those who underwent total parotidectomy had a greater chance of facial nerve paralysis than those who underwent conservative parotidectomy (p < 0.001). The 5-year RFS and OS after conservative parotidectomy (93.7 and 100%, respectively) were not worse than those after total parotidectomy (85.5 and 90.9%, respectively). Conclusion: Patients with cN0 parotid cancers may be stratified by histological grade and T classification. Conservative parotidectomy may be suitable for early T1–2 low- or intermediate-grade tumors if a resection margin is secured. [ABSTRACT FROM AUTHOR]

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

Background: The accurate detection of distant metastases can facilitate appropriate treatment planning for patients with recurrent head and neck squamous cell carcinoma (HNSCC). Objectives: We evaluated the role of 18F-FDG PET/CT for distant metastasis diagnosis and survival prediction in patients with recurrent HNSCC. Materials and methods: This study included 95 consecutive patients with recurrent HNSCC and salvage treatments. McNemar's test was used to compare the detection of distant metastasis at recurrence using 18F-FDG PET/CT and contrast-enhanced chest and neck CT, and bone scintigraphy. Results: Thirty-two patients (34%) had distant metastases at recurrence. The sensitivity, specificity, accuracy, and positive and negative predictive values of 18F-FDG PET/CT for detecting chest and bone metastases were comparable to those of conventional imaging (p >.1). However, 18F-FDG PET/CT detected two additional distant metastatic lesions. After controlling for clinicopathological factors, a recurrent lesion with maximum standardized uptake value (SUVmax) >8.7 was identified as an independent predictor of poor overall survival (p =.001). Conclusions and significance:18F-FDG PET/CT or conventional imaging is comparable with regard to detecting distant metastases of recurrent HNSCC. However, 18F-FDG PET/CT may detect additional metastatic lesions in unusual distant sites and the recurrent lesion SUVmax may predict patient survival after salvage treatments. [ABSTRACT FROM AUTHOR]

Objectives: Diminished skeletal muscle mass (SMM) is a reliable marker of poor survival outcomes in patients with cancer. SMM or body composition is generally assessed at the third lumbar vertebra (L3) by abdominal computed tomography (CT) scans, not routinely evaluated in patients with head and neck squamous cell carcinoma (HNSCC). Therefore, we evaluated the effectiveness of head and neck CT images to assess SMM in patients with HNSCC for predicting their overall survival.Materials and Methods: SMM was assessed in 305 consecutive patients with stage III-IV HNSCC by measuring the cross-sectional area (CSA) at the third lumbar and cervical (C3) vertebrae levels. A formula for predicting the L3 SMM was established using linear regression analysis obtained from C3 CSA and other clinical factors. The actual SMM CSAs measured at L3 level and those obtained from the prediction model were compared using correlation analysis. The predictive power of our formula for estimating overall survival was compared using C-index.Results: Median SMM CSAs at the L3 and C3 levels were 174.5 cm2 and 56.3 cm2, respectively, and were not strongly correlated (adjusted R2 = 0.421). Prediction model 2 included the strongest predictive factors including sex, age, weight, and C3 SMM CSA, and significantly increased the L3 SMM correlation power (adjusted R2 = 0.721). The C-index of the prediction model was 0.713 (95% confidence interval 0.692-0.747).Conclusions: Head and neck CT imaging might be useful to estimate L3 SMM and predict overall survival in HNSCC patients. [ABSTRACT FROM AUTHOR]

Head and neck squamous cell carcinoma (HNSCC) is commonly associated with a high risk of malnutrition and sarcopenia, related to adverse clinical outcomes. This study evaluated the prognostic values of body composition on recurrence and survival in patients with advanced-stage HNSCC. This study prospectively enrolled 258 consecutive patients with definitive treatments for advanced-stage HNSCC. For the determination of sarcopenia, the cross-sectional area of the skeletal muscles (SMs) was measured at the level of the third lumbar vertebra on the computed tomography images of whole-body 18F-fluorodeoxyglucose positron-emission tomography/computed tomography before and after treatments. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify the prognostic factors of disease-free survival (DFS) and overall survival (OS). Pretreatment and post-treatment diminished SM masses (sarcopenia) were found in 17 (6.6%) and 32 (12.4%) of 258 included patients, respectively. All values of body composition, SM index, visceral fat area, lean body mass, fat mass and body mass index significantly decreased after treatment (all P < 0.05). Multivariable analyses showed that age, Charlson comorbidity index, pretreatment and post-treatment sarcopenia, pretreatment hypoalbuminaemia, p16 status and tumour site remained the independent variables predictive of DFS and OS outcomes (all P < 0.05). Patients with sarcopenia before or after treatment had about threefold increased risk of overall recurrence or death. Diminished SM mass may predict recurrence and survival after definitive treatments in patients with advanced-stage HNSCC. • Skeletal muscle mass was measured from computed tomography images at L3 before and after treatment. • Pretreatment and post-treatment sarcopenia were found in 6.6% and 12.4%, respectively. • Most body composition parameters significantly decreased after treatment. • Sarcopenia is the independent risk factor for disease-free and overall survival after treatment. • Sarcopenia was associated with about threefold increased risk of overall recurrence or death. Condensed Abstract : This study evaluated the prognostic values of body composition on recurrence and survival in 258 patients with advanced-stage head and neck squamous cell carcinoma. Sarcopenia was the independent risk factor for poorer disease-free and overall survival outcomes after definitive treatments, showing about threefold increased risk of overall recurrence or death. [ABSTRACT FROM AUTHOR]

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

Objectives: The recently published 8th edition of the American Joint Committee on Cancer (AJCC) tumour-node-metastasis (TNM) staging system was significantly updated following the thyroid cancer-related guidelines to provide better predictability of survival but not focus on recurrence. Therefore, we compared the predictive values of the 7th and 8th editions of the AJCC staging systems for recurrence-free survival (RFS) and overall survival (OS) after thyroidectomy for papillary thyroid carcinoma (PTC).Methods: This retrospective study included 2930 patients who underwent thyroidectomy and neck dissection for previously untreated PTC between 2006 and 2014. TNM stage was defined according to 7th and 8th editions. Univariate and multivariate Cox proportional hazard regression analyses were used to identify associations between variables and RFS or OS. Multivariate models for the AJCC TNM stages were adjusted for clinical and pathological variables.Results: A significant number of patients classified as T3 with overall TNM stages II-IV in the AJCC 7th edition were down-staged in the 8th edition. Unadjusted T classification and overall TNM staging in both the 7th and 8th editions were significantly associated with RFS and OS rates (P < 0.001). After adjustment for clinicopathological factors, the overall TNM stage according to the AJCC 8th edition, but not the 7th edition, remained significantly associated with RFS and OS (P < 0.05), with better predictability of recurrence and survival, in patients with PTC.Conclusions: The 8th edition AJCC staging system down-staged a large proportion of PTC patients, resulting in better predictability of recurrence and survival compared to the previous staging system.Condensed Abstract: This study compared the abilities of the 7th and 8th edition AJCC staging systems to predict recurrence and overall survival in 2930 patients with papillary thyroid carcinoma. The updated guidelines down-staged a large proportion of patients, resulting in better prediction of recurrence and survival than the previous staging system. [ABSTRACT FROM AUTHOR]

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

Objectives: Radiological extranodal extension (rENE) upon CT is obtained before concurrent chemoradiation therapy (CCRT) for head and neck squamous cell carcinoma (HNSCC). We evaluated the prognostic value of rENE, rather than pathologically proven ENE, in patients who received CCRT for HNSCC. Materials and methods: We reviewed 117 patients. We divided the patients into rENE(+) and rENE(-) groups and evaluated overall survival (OS) and disease-specific survival (DSS), and factors affecting these outcomes. Results: Median follow-up was 37.4 months; 31 patients (26.2%) died and 26 (22.2%) had recurrence. Thirty patients were rENE(+) and these had worse 5-year OS (74% vs. 94%, p<.01) and DSS (42% vs. 84%, p<.01) rates compared with the rENE(-) group (n=87). rENE (hazard ratio [HR] 3.57, p<.05) and complete response (HR 3.55, p<.05) affected OS. Clinical T stage (HR 2.86, p<.05), rENE (HR 2.88, p<.05), and complete response (HR 7.03, p<.01) affected DSS. rENE(+) increased risk of incomplete response (IR) compared with the rENE(-) group (p<.05). Conclusions: CT findings suggesting ENE predicts treatment response to CCRT and prognosis, and could be used to determine the treatment modality for HNSCC. [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]

Objective: Histological grade is the most important factor for defining treatment strategies and predicting prognosis for salivary gland carcinoma (SGC). We examined factors affecting long-term recurrence and survival among intermediate-grade SGC (IGSGC) patients to define optimal treatment modalities and outcomes. Methods: We reviewed the clinical and pathological data on 108 IGSGC patients who underwent definitive surgery with or without postoperative radiotherapy. We compared treatment outcomes by treatment strategies such as surgical extent for the primary tumor, neck dissection, or postoperative radiotherapy. Results: During a 103-month median follow-up, local, regional, and distant recurrences were detected in 14 (13.0%), 3 (2.8%), and 21 (19.4%) patients, respectively. The 10-year locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 83.1, 76.0, and 80.1%, respectively. Multivariate analyses identified a nonparotid primary site as an independent prognostic factor for LRC (p = 0.018). Adenoid cystic carcinoma and a positive pN classification were significantly unfavorable prognostic factors for DMFS (p = 0.025 and p = 0.030, respectively); overall advanced stage was an independent prognostic factor for OS (p = 0.020). Surgical extent, elective neck dissection, and postoperative adjuvant radiotherapy did not significantly affect treatment outcomes. Conclusion: Patients with early-stage IGSGC of parotid origin can achieve favorable treatment outcomes with conservative surgery alone. [ABSTRACT FROM AUTHOR]

Purpose: Intracellular antioxidant enzymes are commonly upregulated in various cancer types and are associated with treatment outcomes. Because the relationship has rarely been examined in oral squamous cell carcinoma (OSCC), we aimed to evaluate the association between the levels of glutathione peroxidase (GPX)1, GPX4, and thioredoxin reductase (TrxR)1 expression and prognosis in patients with OSCC who underwent curative surgical resection. Methods: This study included 233 patients who underwent curative surgery for previously untreated OSCC between 2000 and 2012. Tumour GPX1, GPX4, and TrxR1 expression was evaluated by immunohistochemistry and was dichotomised to low and high values according to defined expression levels. The association between GPX1, GPX4, and TrxR1 expression and clinicopathological results was analysed. Univariate and multivariate analyses using the Cox proportional hazards model were conducted to assess the significance of differences in recurrence or survival outcomes between variables. Results: High GPX1, GPX4, and TrxR1 expression was observed in 99 (42.5%), 133 (57.1%), and 46 (19.7%) patients, respectively. GPX1 overexpression was significantly correlated with nodal metastasis, advanced overall stage, depth of invasion of >10 mm, high grade and perineural invasion ( P < 0.05). High GPX4 expression was also related to nodal metastasis, overall advanced stage and high grade ( P < 0.05). Univariate and multivariate analyses showed that increased GPX1 expression was significantly associated with poor disease-free, cancer-specific and overall survival (all P < 0.05), while increased GPX4 or TrxR1 expression was not (all P > 0.1). Conclusions: Tumour GPX1 expression is a useful biomarker predictive of recurrence and survival in OSCC patients. [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]

ConclusionThe application of adjuvant RT to reduce recurrence should be tailored in cases of pathologically negative node metastasis.ObjectivesThe treatment modality following surgical resection of advanced laryngeal cancer is determined by adverse factors. Aside from lymph node metastasis (LNM) or positive margins, definite risk factors supporting adjuvant radiation therapy (RT) have not been clearly suggested. The aim of this study was to analyze the risk factors for advanced laryngeal cancer without LNM and the role of RT.Materials and methodsPathologically T3 and T4-staged laryngeal squamous cell carcinoma without LNM were reviewed. The patients were classified into RT (+) (n = 22) and RT (−) (n= 38) groups.ResultsFive-year overall survival (OS) of the RT (+) and RT (−) groups was 84.4% and 83.8%, respectively. Five-year disease-specific survival of the RT (+) and RT (−) groups was 88.4% and 93.9%. Five-year local control rate of the RT (+) and RT (−) groups was 94.7% and 91.3%. The factors affecting OS were smoking history and recurrence history (p = 0.02). By multivariate analysis, smoking history and recurrence history were determining factors for 5-year OS (p = 0.024 andp = 0.047, respectively). [ABSTRACT FROM PUBLISHER]

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

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

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

Background Interleukin-4 (IL-4) and interleukin-13 (IL-13) are anti-inflammatory and immunomodulatory cytokines that play crucial roles in cancer progression. However, the clinical significance of the expression of these cytokines and their receptors (IL-4R) in oral cavity squamous cell carcinoma (OSCC) is unknown. Therefore, we evaluated the expression of IL-4R in OSCC specimens by immunohistochemistry (IHC) and analysed its relationship to recurrence and survival. Methods A total of 186 patients with OSCC were enrolled, and the expression of IL-4Rα and IL-13Rα1 on their primary tumour specimens was evaluated by IHC and correlated to clinicopathologic parameters, recurrence and survival. Findings High expression of IL-4Rα and IL-13Rα1 was observed in 60 (32.3%) and 165 (88.7%) patients, respectively. IL-4Rα expression was inversely correlated with parameters reflecting primary tumour burden, including tumour size, tumour stage and depth of invasion at the initial diagnosis ( P < 0.05). High expression of IL-4Rα also correlated with a greater risk of recurrence ( P = 0.002), but was unrelated to cancer-specific survival (CSS, P = 0.118). Conversely, high IL-13Rα1 expression correlated with reduced recurrence ( P < 0.001) and increased CSS ( P < 0.001) in OSCC patients. Interpretations High expression of IL-4Rα correlated with increased recurrence, while high IL-13Rα1 expression had an inverse relationship to recurrence and CSS in OSCC patients. [ABSTRACT FROM AUTHOR]

Significant loss of body weight (SLW) by patients treated for squamous cell carcinomas of the oral cavity and oropharynx (OSCC) may affect treatment completion and results. We assessed factors predicting SLW and its correlation with disease-free survival (DFS) in these patients. We evaluated 226 consecutive patients with previously untreated, operable OSCC whose body weight was recorded before, during, and for up to 1 year after treatment. SLW was defined as ≥10% reduction in pretreatment body weight. Clinicopathologic parameters were compared in patients with and without SLW. Of the 226 patients, 94 (41.6%) experienced SLW and 132 (58.4%) did not. Univariate analyses showed that factors significantly associated with SLW included T3–4, N+, stage III–IV, and oropharyngeal tumors, nonsurgical (radiotherapy or chemotherapy) vs. surgical treatment, posttreatment recurrence, histologic differentiation, involved resection margin, and number of metastatic lymph nodes (pLNs) ≥ 3 (P< 0.05). Multivariate analyses showed that radiotherapy, recurrence, and number of pLNs were significant independent predictors of SLW (P< 0.005). DFS rate was significantly higher in patients without than with SLW (P< 0.01). OSCC patients with multiple pLNs, those undergoing radiotherapy, and those with posttreatment recurrences may require close nutritional monitoring and support. [ABSTRACT FROM PUBLISHER]

Introduction: Morbidity and mortality rates following gastric cancer surgery are still high. The present study documented complications requiring reoperation after gastrectomy for gastric cancer and described surgical management for each complication.Materials and Methods: Between 1987 and 2004, 8,033 patients underwent gastrectomy at the Department of Surgery, College of Medicine, Yonsei University, and the records were reviewed.Results and Discussion: The most frequent complication was intestinal obstruction (88 patients, 54.3%), followed by intraabdominal bleeding (15, 9.3%), wound dehiscence or evisceration (15, 9.3%), incisional hernia (15, 9.3%), anastomotic leakage (seven, 4.2%), acalculous cholecystitis (five, 3.1%), duodenal stump leakage (five, 3.1%), intraabdominal abscess without leakage (five, 3.1%), bowel perforation (five, 3.1%), bile peritonitis due to hepatic duct injury (one, 0.6%), and biliary stricture (one, 0.6%). There were ten cases of hospital mortality (6.2%) from intraabdominal bleeding (four patients), intestinal obstruction (four patients), and anastomotic leakage (two patients). The most common long-term complication requiring reoperation was intestinal obstruction (69, 75.8%) due to adhesive formation rather than technical failure, while short-term complications were surgery-related and associated with high hospital mortality (14.1%).Conclusion: Proper preoperative preparation and faultless surgical skills are required during initial surgery to reduce complications and the need for reoperation. [ABSTRACT FROM AUTHOR]

Summary: Tumor hypoxia is associated with poorer outcome in patients with head and neck carcinomas, but little is known about hypoxia biomarkers in oral tongue cancer. We evaluated whether hypoxia biomarkers and clinicopathologic variables were prognostic predictors in patients with T2-staged squamous cell carcinoma (SCC) of the oral tongue. Tissue microarrays were constructed from formalin-fixed tumor blocks of 43 patients with T2-staged tongue SCCs treated by surgical resection and neck dissection. Tissue samples were stained with monoclonal antibodies to hypoxia-inducible factor (HIF)-1α, HIF-2α, carbonic anhydrase (CA)-9, glucose transporter (GLUT)-1, and erythropoietin receptor (EPOR). Locoregional control and survival rates were calculated by the Kaplan-Meier method, and prognostic factors were calculated from uni- and multivariate analyses. Tumor thickness was correlated with expression of CA-9 and GLUT-1 and nodal classification was correlated with GLUT-1 expression. The nodal metastasis rate was 51%, and the 5-year locoregional control and disease-specific survival (DSS) rates were 59% and 69%, respectively. Univariate analysis showed that HIF-1α and EPOR expression were significantly related to DSS. Multivariate analysis showed that EPOR expression was an independent predictor of DSS (P =0.030). EPOR expression may be an independent predictor for DSS in patients with T2-staged SCC of the oral tongue. [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]