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With the increasing proportion of human papilloma virus (HPV) infection in the pathogenic factors of oropharyngeal cancer, a series of changes have occurred in the surgical treatment. While the treatment mode has been improved, there are still many problems, including the inconsistency between diagnosis and treatment modes, the lack of popularization of reconstruction technology, the imperfect post-treatment rehabilitation system, and the lack of effective preventive measures. Especially in terms of treatment mode for early oropharyngeal cancer, there is no unified conclusion whether it is surgery alone or radiotherapy alone, and whether robotic minimally invasive surgery has better functional protection than radiotherapy. For advanced oropharyngeal cancer, there is greater controversy over the treatment mode. It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy, or a treatment mode of surgery combined with postoperative chemoradiotherapy. In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer, this expert consensus, based on the characteristics and treatment status of oropharyngeal cancer in China and combined with the international latest theories and practices, forms consensus opinions in multiple aspects of preoperative evaluation, surgical indication determination, primary tumor resection, neck lymph node dissection, postoperative defect repair, postoperative complication management prognosis and follow-up of oropharyngeal cancer patients. The key points include: ① Before the treatment of oropharyngeal cancer, the expression of P16 protein should be detected to clarify HPV status; ② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resection of oropharyngeal cancer. Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction; ③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months, it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment; ④ Early-stage oropharyngeal cancer patients may opt for either surgery alone or radiation therapy alone. For intermediate and advanced stages, HPV-related oropharyngeal cancer generally prioritizes radiation therapy, with concurrent chemotherapy considered based on tumor staging. Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma (including primary and recurrent) and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy; ⑤ For primary exogenous T1-2 oropharyngeal cancer, direct surgery through the oral approach or da Vinci robotic surgery is preferred. For T3-4 patients with advanced oropharyngeal cancer, it is recommended to use temporary mandibulectomy approach and lateral pharyngotomy approach for surgery as appropriate; ⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth >3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients, selective neck dissection of levels IB to IV is recommended. For cN+ HPV unrelated oropharyngeal cancer patients, therapeutic neck dissection in regions I-V is advised; ⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node, or imaging suggests continuous enlargement of lymph nodes, the patient should undergo neck dissection; ⑧ For patients with suspected extracapsular invasion preoperatively, lymph node dissection should include removal of surrounding muscle and adipose connective tissue; ⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps, with priority given to adjacent flaps, followed by distal pedicled flaps, and finally free flaps. The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Background and purpose: Programmed death-1 (PD-1) monoclonal antibody therapy plays an increasingly important role in the treatment of head and neck squamous cell carcinoma (HNSCC). However, low response rate and lack of predictive biomarkers are still the challenging problems. This study aimed to confirm that programmed death ligand-2 (PD-L2) is a predictive biomarker for the outcome of HNSCC anti-PD-1 immunotherapy. Methods: The samples and clinical data of 50 HNSCC patients undergoing PD-1 monoclonal antibody immunotherapy were collected. Immunohistochemical staining was used to analyze the level of programmed death ligand-1 (PD-L1) and PD-L2. Kaplan-Meier overall survivals were analyzed using SPSS 26.0 software, grouped by the basic clinical characteristics and the PD-L1 and PD-L2 levels. Survival curves were plotted using GraphPad Prism. Results: HNSCC had a relatively high expression rate of PD-L2 with more than 80% of cases detected as PD-L2 positive. The expression of PD-L2 significantly correlated with the clinical outcome of immunotherapy, with a mean survival of 18.8 (16.0-21.7) months for patients with high PD-L2 expression and 11.0 (9.1-12.8) months for patients with low PD-L2 expression, this difference being statistically significant. Conclusion: PD-L2 has the potential to be used as a predictive biomarker for HNSCC anti-PD-1 immunotherapy.

Background and purpose: Oral mucosal malignant melanoma (OMM) is a highly malignant solid tumor with a distant metastasis rate of about 40%. The lung is the most common metastatic site. This study aimed to investigate the characteristics and prognostic analysis of OMM with lung metastasis, in order to find the best treatment mode for OMM with lung metastasis. Methods: The data of the patients with lung metastasis diagnosed in the Ninth People’s Hospital Affiliated to the Medical College of Shanghai Jiao Tong University from January 2017 to January 2021 were retrospectively analyzed. The imaging characteristics of chest computed tomography (CT) were summarized, and Kaplan-Meier method was used for survival analysis. Results: In this study, 88% of patients with OMM were diagnosed with lung metastasis within 2 years after operation, including 22 cases (52%) in the first year and 15 cases (36%) in the second year; 71% of patients showed multiple, round or oval nodules of different sizes on chest CT, and few single metastases (10%). Non-scheduled follow-up (P = 0.009), concurrent local recurrence (P = 0.037), concurrent pleural effusion (P = 0.042) and no immunotherapy (P = 0.000) could significantly reduce the survival time of patients. The response of patients with relapse to programmed death-1 (PD-1) immunotherapy was significantly reduced (P = 0.009), and the median overall survival (OS) of PD-1 single drug was only 10 months. After combination therapy with PD-1 and anti-vascular targeted drugs, the median OS could be increased to about 19 months (P = 0.019). Conclusion: OMM is prone to lung metastasis, and even tiny nodules less than 1cm can be metastatic foci. The metastasis of OMM most often occurs within 1-2 years after operation. Regular follow-up can detect early metastasis and significantly prolong the survival. The efficacy of immunotherapy alone for recurrent and metastatic OMM is also poor, and immunotherapy combined with anti-vascular targeted therapy is required.

Patients with locally advanced head and neck squamous cell carcinoma (LA‐HNSCC) have poor survival outcomes. The real‐world efficacy of nimotuzumab plus intensity modulated radiotherapy (IMRT)‐based chemoradiotherapy in patients with LA‐HNSCC remains unclear. A total of 25,442 HNSCC patients were screened, and 612 patients were matched by propensity score matching (PSM) (1:1). PSM was utilized to balance known confounding factors. Patients who completed at least five doses of nimotuzumab were identified as study group. The primary end point was 3‐year overall survival (OS) rate. Log‐rank test examined the difference between two survival curves and Cloglog transformation test was performed to compare survival at a fixed time point. The median follow‐up time was 54.2 (95% confidence interval [CI]: 52.7–55.9) months. The study group was associated with improved OS (hazard ratio [HR] = 0.75, 95% CI: 0.57–0.99, p = 0.038) and progression‐free survival (PFS) (HR = 0.74, 95% CI: 0.58–0.96, p = 0.021). Subgroup analysis revealed that aged 50–60 year, IV, N2, radiotherapy dose ≥ 60 Gy, without previous surgery, and neoadjuvant therapy have a trend of survival benefit with nimotuzumab. Nimotuzumab showed favorable safety, only 0.2% had nimotuzumab‐related severe adverse events. Our study indicated the nimotuzumab plus chemoradiotherapy provides survival benefits and safety for LA‐HNSCC patients in an IMRT era. [ABSTRACT FROM AUTHOR]

Background: Recent evidence suggested a potential correlation between BMI and the efficacy of immune checkpoint inhibitors in cancer patients. This study aimed to evaluate the prognostic value of the body mass index (BMI) in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) patients treat with pembrolizumab. Methods: The current retrospective cohort study enrolled 49 R/M HNSCC patients underwent at least one cycle of pembrolizumab as second‐line treatment from June 2018 to October 2020. Survival analysis of immunotherapy prognosis and risk factor analysis of age, gender, BMI, ECOG‐PS, CPS, rT‐stage, tumor site, and tube feeding. Results: Among the 49 patients, the BMI at the time of immunotherapy ranged from 14.5 to 32.0 kg/m2. The Kaplan–Meier analysis showed that the BMI was significantly correlated with overall survival time (OS, p = 0.0007) and progression‐free survival time (PFS, p = 0.0012). BMI, gender, prior treatment, serum albumin level, ECOG‐PS, CPS and rT‐stage were analyzed in multivariate Cox regression model analysis after adjusted for potential confounding clinical variables. Patients with underweight (OS:HR = 6.862, 95% CI:1.566–30.064, p = 0.011; PFS:HR = 5.672, 95% CI:1.364–23.586, p = 0.017);ECOG≥2 (OS:HR = 0.250, 95% CI:0.086–0.731, p = 0.011;PFS:HR = 0.284, 95% CI:0.101–0.805, p = 0.018); CPS <1(OS: HR = 4.34, 95% CI:1.271–15.464, p = 0.019; PFS:HR = 3.859, 95% CI:1.180–12.618, p = 0.025) and rT4‐stage(OS:HR = 4.380, 95% CI:1.452–13.209, p = 0.009;PFS: HR = 3.799, 95% CI:1.240–11.638, p = 0.019) suffered higher risk of mortality. Conclusions: The BMI at the time of clinical diagnosis was showed to be an independent predictive factor for R/M HNSCC patients receiving pembrolizumab. Compared with normal weight patients, underweight patients have worse clinical prognosis. [ABSTRACT FROM AUTHOR]

Immune checkpoint inhibitors (ICIs) present significant efficacy in the treatment of malignant tumors, and they have been approved as the first-line of treatment for various cancers. Pembrolizumab monotherapy or combined with chemotherapy has been recommended by domestic and foreign guidelines for the first-line treatment of recurrent/ metastatic head and neck squamous cell carcinoma. Although ICIs represent a milestone in the treatment of head and neck squamous cell carcinoma, potential problems still need to be addressed, such as the selection of the efficacy predictors for ICIs, the evaluation of the tumor response to ICIs, and the treatment of immune hyperprogression and immune-related adverse events. Therefore, to form a relatively unified understanding of ICIs treatment for head and neck squamous cell carcinoma, we integrated the clinical experience of multi-disciplinary experts of head and neck cancers on the basis of current clinical hot issues and finally developed this consensus. [ABSTRACT FROM AUTHOR]

The Na+ superionic conductor (NASICON)‐type Na3V2(PO4)3 cathodes have attracted extensive interest due to their high structural stability and fast Na+ mobility. However, the substitution of vanadium with low‐cost active elements remains imperative due to high cost of vanadium, to further boost its application feasibility. Herein, a novel ternary NASICON‐type Na4VMn0.5Fe0.5(PO4)3/C cathode is designed, which integrates the advantages of large reversible capacity, high voltage, and good stability. The as‐obtained Na4VMn0.5Fe0.5(PO4)3/C composite can deliver an excellent rate capacity of 96 m Ah g‐1 at 20 C and decent cycling durability of 94% after 3000 cycles at 20 C, which is superior to that of Na4VFe(PO4)3/C and Na4VMn(PO4)3/C. The synergetic contributions of multimetal ions and facilitated Na+ migration of the Na4VMn0.5Fe0.5(PO4)3/C cathode are confirmed by the first‐principles calculations. The processive reduction/oxidation involved in Fe2+/Fe3+, Mn2+/Mn3+, V3+/V4+/V5+ redox couples are also revealed upon the charging/discharging process by ex situ soft X‐ray absorption spectroscopy. The reversible structure evolution and small volume change during the electrochemical reaction is demonstrated by in situ X‐ray diffraction characterization. The rational design of NASICON‐type cathodes by regulating composition with substitution of multimetal ions can provide new perspectives for high‐performance Na‐ion batteries. [ABSTRACT FROM AUTHOR]

Background: Extranodal marginal zone B‐cell lymphoma of mucosa‐associated lymphoid tissue (MALT lymphoma) in the oromaxillofacial head and neck region is rare, with limited data available. This retrospective study explored the clinical features, stage, treatment, and prognosis of this disease. Methods: Overall, 105 patients with MALT lymphomas in the oromaxillofacial head and neck region were included in this retrospective analysis. SPSS 22.0 software package was used for data analysis and a two‐tailed P value of ≤.05 was considered statistically significant. Primary endpoints of the study were the complete response (CR) rate, overall survival (OS), and progression‐free survival (PFS). Results: About 52% of the patients had long‐term xerostomia, autoimmune diseases, or chronic parotitis and 81% had diseases involving the large salivary glands. Ann Arbor staging of the patients was as follows: stages I/II, 73 patients and stages III/IV, 32 patients. In the 97 patients followed up, CR rate after initial treatment was 80%. Tumor progression was observed in 12 patients and 14 patients died. There was a significant difference between the rate of CR in localized (87%) and disseminated (67%) lymphoma patients (P =.02). The 5‐ and 10‐year PFS of the localized lymphoma patients were both 91%, whereas those of the disseminated lymphoma patients were 83% and 65%, respectively (P =.03). The 5‐year PFS rates of the chemotherapy and non‐chemotherapy groups in the disseminated lymphoma patients were 85% and 73% (P =.04). Meanwhile, the 5‐year PFS rates of the rituximab and non‐rituximab groups in the disseminated lymphoma patients were 100% and 70% (P =.03). In multivariate analysis, MALT Lymphoma International Prognostic Index (MALT‐IPI) was an independent prognostic factor affecting OS, whereas Ann Arbor staging affected PFS. Conclusions: This study suggests that the outcome after initial treatment of MALT lymphomas in the oromaxillofacial head and neck region is satisfactory and that this disease progresses slowly. The CR rate and PFS of localized lymphoma patients are better than those of disseminated lymphoma patients. Systemic treatment (chemotherapy or rituximab) may improve PFS in disseminated disease patients. MALT‐IPI and Ann Arbor staging are independent prognostic factors. [ABSTRACT FROM AUTHOR]