-
Clinical Oral Investigations May 2024Surgical resection is a key component of the treatment of head and neck cancer and the achievement of free surgical margins are essential for the patients' outcome in...
OBJECTIVES
Surgical resection is a key component of the treatment of head and neck cancer and the achievement of free surgical margins are essential for the patients' outcome in terms of survival. While there is a general recommendation for a free resection range of 5 mm, up to date, there is a lack of investigations on the quality of tumor resection in dependence of affected subsite and tumor stage. In the presented study, predictors for the achieved resection margins in surgically treated oral squamous cell carcinomas were analyzed.
MATERIALS AND METHODS
A cohort of 567 patients was included in a retrospective analysis and resection status with exact margin ranges were analysed. Tumor stage, affected subsite and the results of the intraoperative frozen section analysis were assessed. Primary endpoint was the achieved resection margin in mm, secondary endpoints were overall and progression-free survival.
RESULTS
The observed mean values of minimal resection margins differed significantly between the investigated subsites (p = 0.042),pathological tumor stages (p < 0.001) and in tumors which demonstrated perineural infiltration (Pn1, p = 0.002). Furthermore, there was a significant impact of the results of the intraoperative frozen section analysis on progression-free and overall survival (p < 0.001).
CONCLUSIONS
Our data clearly indicate that resection status differs between tumors of different subsites and tumor stages.
CLINICAL RELEVANCE
Clinical procedures should be adapted in order to achieve similar certainty in all resections, and, thus to improve patients' outcome.
Topics: Humans; Margins of Excision; Retrospective Studies; Mouth Neoplasms; Female; Male; Middle Aged; Neoplasm Staging; Aged; Frozen Sections; Adult; Aged, 80 and over; Carcinoma, Squamous Cell
PubMed: 38764079
DOI: 10.1007/s00784-024-05711-5 -
Cureus Apr 2024This study aimed to determine the oncologic outcomes and identify prognostic factors in patients undergoing salvage glossectomy for recurrent oral tongue squamous cell...
OBJECTIVE
This study aimed to determine the oncologic outcomes and identify prognostic factors in patients undergoing salvage glossectomy for recurrent oral tongue squamous cell carcinoma (OTSCC).
METHODS
A retrospective chart review was conducted encompassing all patients who underwent salvage oral glossectomy out of 259 individuals undergoing oral glossectomy at a tertiary academic center. Inclusion criteria comprised patients who met the following conditions: 1) biopsy-proven oral tongue recurrence, 2) salvage glossectomy performed with curative intent, 3) availability of imaging records, and 4) comprehensive documentation. Cases involving base of tongue tumors and second primaries were excluded from the analysis. Categorical data were expressed as proportions, and continuous data as medians/quartiles. Univariate analysis used Fisher's exact test for categorical variables and Student's t-test for continuous ones. Survival analysis employed Kaplan-Meier estimates and the log-rank test.
RESULTS
High-risk histopathological risk factors were significantly more common with recurrence compared to initial presentation. The mean locoregional disease-free interval was 35 months. Kaplan-Meier estimates for one- and three-year disease-free survival (DFS) were 62.7% and 33.4%, while disease-specific survival (DSS) rates were 73% and 38.9%, respectively. Recurrent T-stage was a predictor for DFS, while margin status was a strong predictor for both LR control (p = 0.024) and DSS (p = 0.030), as was perineural invasion (p = 0.001 and p = 0.030). Alcohol use was associated with worse overall survival (p = 0.024). In contrast to other reports, nodal status was not a predictor in this series.
CONCLUSIONS
Upon recurrence, histopathological analysis unveils detrimental changes in tumor biology, which significantly influence disease control. Notably, consistent with findings from other studies, factors, such as recurrent T-stage, presence of perineural invasion, and, most importantly, margin status, play pivotal roles in determining oncologic outcomes. Consequently, the imperative for aggressive salvage surgery becomes evident in achieving sufficient disease control. This underscores the necessity for proactive management strategies aimed at addressing these factors to enhance patient outcomes.
PubMed: 38756252
DOI: 10.7759/cureus.58403 -
Postoperative radiotherapy versus surgery alone in pN1 oral cavity cancer patients: A meta-analysis.Laryngoscope Investigative... Jun 2024The aim of this meta-analysis is to evaluate the potential benefits of postoperative radiotherapy (PORT) in patients with pN1 oral cavity squamous cell carcinoma.
OBJECTIVES
The aim of this meta-analysis is to evaluate the potential benefits of postoperative radiotherapy (PORT) in patients with pN1 oral cavity squamous cell carcinoma.
METHODS
A literature search through major databases was conducted until January 2023. The adjusted hazard ratio (aHR) or risk ratio (RR) with 95% confidence intervals (CIs) of different survival outcomes were extracted and pooled.
RESULTS
Ten studies published between 2005 and 2022, with a pooled patient population of 2888, were included in this meta-analysis. Due to differences in study design and reported outcomes, the studies were categorized into distinct groups. In pN1 patients without extranodal extension (ENE), PORT was associated with a significant improvement in overall survival (OS) (aHR 0.76, 95% CI: 0.61-0.94). In pN1 patients without ENE and positive margins, PORT improved OS (aHR 0.71, 95% CI: 0.56-0.89) and was associated with a lower regional recurrence rate (RR 0.35, 95% CI: 0.15-0.83). However, in pN1 patients without ENE, positive margins, perineural invasion, and lymphovascular invasion, there were no significant differences observed between the PORT and observation groups in either 5-year OS (RR 0.48, 95% CI: 0.07-3.41) or 5-year disease-free survival (RR 0.37, 95% CI: 0.07-2.06).
CONCLUSIONS
The current study demonstrated that PORT has the potential to improve OS in pN1 disease. However, the decision of whether to administer PORT still hinges on diverse clinical scenarios, and additional research is necessary to furnish a more conclusive resolution.
LEVEL OF EVIDENCE
2.
PubMed: 38751691
DOI: 10.1002/lio2.1260 -
International Journal of Surgery... May 2024
Noninvasive prediction of perineural invasion in intrahepatic cholangiocarcinoma by clinicoradiological features and computed tomography radiomics based on interpretable machine learning: a multicenter cohort study: erratum.
Topics: Humans; Cholangiocarcinoma; Machine Learning; Tomography, X-Ray Computed; Bile Duct Neoplasms; Neoplasm Invasiveness; Cohort Studies; Male; Radiomics
PubMed: 38748504
DOI: 10.1097/JS9.0000000000001624 -
Clinical Oral Investigations May 2024This study aimed to evaluate the diagnostic accuracy of contrast-enhanced computed tomography (CT) in detecting bone invasion in oral squamous cell carcinoma (OSCC)...
OBJECTIVES
This study aimed to evaluate the diagnostic accuracy of contrast-enhanced computed tomography (CT) in detecting bone invasion in oral squamous cell carcinoma (OSCC) patients and to explore clinicopathological factors associated with its reliability.
MATERIALS AND METHODS
417 patients underwent preoperative contrast-enhanced CT followed by radical surgery. The presence or absence of bone invasion served as the outcome variable, with histopathologic examination of the resection specimen considered the gold standard. Statistical analyses, comprising correlation analyses and the determination of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were conducted.
RESULTS
CT exhibited 76.85% sensitivity, 82.20% specificity, 47.14% PPV, and 89.67% NPV. False-positive and false-negative rates were 11.27% and 5.99%, respectively. Artifacts affected assessment in 44 patients, but not in those with bone invasion. Tumor size, depth of invasion (DOI), tumor localization at the upper jaw, lymphatic invasion, and perineural invasion correlated with incorrect identification of bone invasion (Chi-square, p < 0.05).
CONCLUSIONS
Despite utilizing thin-section CT, notable false-positive and false-negative results persisted. Patients with T3 tumors, DOI ≥ 10 mm, or upper jaw tumors are at higher risk for misidentification of bone invasion. Combining multiple methods may enhance diagnostic accuracy, and the integration of artificial intelligence or tracking electrolyte disturbances by tumor depth profiling shows promise for further assessment of bone invasion before histopathology.
CLINICAL RELEVANCE
Surgeons should consider these insights when planning tumor resection. Supplementary imaging may be warranted in cases with high risk factors for misidentification. Further methodological advancements are crucial for enhancing diagnostic precision.
Topics: Humans; Female; Male; Neoplasm Invasiveness; Mouth Neoplasms; Middle Aged; Tomography, X-Ray Computed; Contrast Media; Carcinoma, Squamous Cell; Aged; Sensitivity and Specificity; Adult; Reproducibility of Results; Predictive Value of Tests; Aged, 80 and over; Neoplasm Staging; Retrospective Studies; Bone Neoplasms
PubMed: 38748270
DOI: 10.1007/s00784-024-05705-3 -
European Journal of Dentistry May 2024A 5-year survival rate is a predictor for the assessment of oral cancer prognosis. The purpose of this study is to analyze oral cancer data to discover and rank the...
OBJECTIVE
A 5-year survival rate is a predictor for the assessment of oral cancer prognosis. The purpose of this study is to analyze oral cancer data to discover and rank the prognostic factors associated with oral cancer 5-year survival using the association rule mining (ARM) technique.
MATERIALS AND METHODS
This study is a retrospective analysis of 897 oral cancer patients from a regional cancer center between 2011 and 2017. The 5-year survival rate was assessed. The multivariable Cox proportional hazards analysis was performed to determine prognostic factors. ARM was applied to clinicopathologic and treatment modalities data to identify and rank the prognostic factors associated with oral cancer 5-year survival.
RESULTS
The 5-year overall survival rate was 35.1%. Multivariable Cox proportional hazards analysis showed that tumor (T) stage, lymph node metastasis, surgical margin, extranodal extension, recurrence, and distant metastasis of tumor were significantly associated with overall survival rate ( < 0.05). The top associated death within 5 years rule was positive extranodal extension, followed by positive perineural and lymphovascular invasion, with confidence levels of 0.808, 0.808, and 0.804, respectively.
CONCLUSION
This study has shown that extranodal extension, and perineural and lymphovascular invasion were the top ranking and major deadly prognostic factors affecting the 5-year survival of oral cancer.
PubMed: 38744326
DOI: 10.1055/s-0043-1777050 -
Oncotarget May 2024The main goal of the present study was to analyze the expression profile of cyclin D1 in patients with PC, and to determine possible correlations with clinical and...
The main goal of the present study was to analyze the expression profile of cyclin D1 in patients with PC, and to determine possible correlations with clinical and histopathological features. A survey was conducted with 100 patients diagnosed with PC, who were treated at two reference hospitals in São Luís, Maranhão, Brazil, between 2013 and 2017. A review of clinical, epidemiological, and histopathological data was performed, Human Papillomavírus (HPV) DNA was detected using polymerase chain reaction (PCR) and cyclin D1 expression analysis was performed using immunohistochemical techniques. The data revealed that the absence of cyclin D1 expression was significantly associated with HPV-positive histological subtypes ( = 0.001), while its expression was associated with high-grade tumors ( = 0.014), histological subtype ( = 0.001), presence of sarcomatoid transformation ( = 0.04), and perineural invasion ( = 0.023). Patients with cyclin D1 expression exhibited lower disease-free survival compared to the cyclin D1-negative group, although the difference was not statistically significant. The results suggest that cyclin D1 may be a potential biomarker for PC, especially for poorer prognosis.
Topics: Humans; Cyclin D1; Male; Penile Neoplasms; Middle Aged; Aged; Biomarkers, Tumor; Prognosis; Adult; Brazil; Papillomavirus Infections; Immunohistochemistry; Aged, 80 and over; Disease-Free Survival
PubMed: 38742684
DOI: 10.18632/oncotarget.28584 -
Morphometric analysis of the foramen ovale in the Mexican population using computed tomography scan.Surgical Neurology International 2024The assessment of cranial foramina is an important part of the objective diagnostic and therapeutic study relevant to pathologies involving structures of the skull base....
BACKGROUND
The assessment of cranial foramina is an important part of the objective diagnostic and therapeutic study relevant to pathologies involving structures of the skull base. The study of the foramen ovale not only holds significance for anatomical development but also bears profound surgical importance, such as in trigeminal neuralgia, and diagnostic importance in tumors and various types of epilepsy. It becomes relevant in fine-needle aspiration techniques in perineural tumor procedures, for electroencephalographic analysis in seizures, and therapeutic procedures such as percutaneous trigeminal rhizotomy for trigeminal neuralgia.
METHODS
A cross-sectional study at the Department of Neurosurgery, Specialties Hospital, La Raza National Medical Center, Mexico City, involved 70 patients aged >18 years who underwent a single skull computed tomography scan between July 2023 and March 2024. Patients with sufficient scan quality and optimal visualization of skull base foramina were included in the study. Measurements of tomographic images were taken using Inobitec's DICOM file viewer. Data analysis in Microsoft Excel yielded mean, standard deviation, and 95% confidence interval (CI) for morphometric parameters of the foramen ovale.
RESULTS
Analysis of tomographies from 70 patients revealed a total of 140 foramen ovale, evenly split between 25 males (35.7%) and 45 females (64.3%). The measurements for the maximum anteroposterior diameter, transverse diameter, and surface area of all foramina were as follows: 6.61 ± 0.25 mm (95% CI), 3.97 ± 0.21 mm (95% CI), and 20.84 ± 1.58 mm (95% CI), respectively. Specific measurements for the right and left sides were obtained: for the right side, 6.59 ± 0.26 mm (95% CI) and 3.89 ± 0.21 mm (95% CI) for the maximum anteroposterior and transverse diameters, respectively, and 20.38 ± 1.62 mm 95% CI) for the surface area. For the left side, the measurements were 6.63 ± 0.24 mm (95% CI), 4.05 ± 0.21 mm (95% CI), and 21.31 ± 1.55 mm 95% CI) for the maximum anteroposterior diameter, transverse diameter, and surface area, respectively. The maximum and minimum dimensions for anteroposterior and transverse diameters were 10.67 mm, 4.41 mm, 7.09 mm and 2.36 mm, respectively, with a corresponding range for the surface area of 10.16 mm-44.13 mm. The average minimum distance between the foramen ovale and the foramen spinosum was 2.32 ± 0.24 mm (95% CI). In males, the average size of the foramen ovale was 23.66 ± 1.61, which was 22% larger than the average size in females (19.28 ± 1.45) ( 0.0001).
CONCLUSION
The foramen ovale is one of the main anatomical structures of the skull base, and besides that, it is complex and not directly accessible for clinical evaluation, useful information can be obtained through morphometric analysis. The present study provides specific anatomical data with morphological patterns to increase the understanding of the characteristics of the foramen ovale in the Mexican population. These are intended to be helpful in the pursuit of acknowledging the morphometrics and thus being able to plan neurosurgical procedures in the middle cranial fossa.
PubMed: 38741999
DOI: 10.25259/SNI_227_2024 -
Surgical Neurology International 2024Perineural Tarlov cysts are extrathecal cerebrospinal fluid-filled cavities in the perineural recesses around dorsal spinal nerve roots. They are mostly asymptomatic but...
Symptomatic lumbar Tarlov cyst resolution after computed tomography-guided percutaneous trans-sacral fibrin glue intracystic injection: A case report and literature review.
BACKGROUND
Perineural Tarlov cysts are extrathecal cerebrospinal fluid-filled cavities in the perineural recesses around dorsal spinal nerve roots. They are mostly asymptomatic but may occasionally cause back pain, radiculopathy, neurological deficits, and idiopathic intracranial hypotension.
CASE DESCRIPTION
A 40-year-old female presented with a partial left foot drop attributed to a symptomatic L5 Tarlov cyst with an extension anterior to the sacrum. Following a computed tomography (CT)-guided percutaneous trans-sacral fibrin glue intracystic injection, the cyst was markedly reduced in size, and the patient's symptoms resolved.
CONCLUSION
Rarely, patients may present with symptomatic lumbar Tarlov cysts located anterior to the sacrum. Here, we present a patient whose left-sided foot drop resolved following the percutaneous trans-sacral CT-guided L5 intracyst injection of fibrin glue.
PubMed: 38741984
DOI: 10.25259/SNI_139_2024 -
International Journal of General... 2024Colorectal cancers (CRC) are one of the most common tumors that are being researched for new biomarkers worldwide. In this context, studies are being carried out to...
BACKGROUND
Colorectal cancers (CRC) are one of the most common tumors that are being researched for new biomarkers worldwide. In this context, studies are being carried out to estimate whether various hematological parameters can be used for predicting prognosis. In this study, our aim was to evaluate the relation between platelet (PLT) levels as well as neutrophil-to-lymphocyte ratio (NLR), platelet (PLT)-to-lymphocyte ratio (PLR), and Lymphocyte-to-CRP ratio (LCR) which are easily accessible inflammatory response indicators.
METHODS
In this retrospective cross-sectional study, 111 patients diagnosed as colorectal adenocarcinoma were included. Patients with clinical evidence of an infection, recurrent colorectal cancer, previous history of a hematological disease, and a neoadjuvant chemo/radiotherapy were excluded. Demographic features such as age, gender, and histopathologic parameters such as tumor size, surgical margin status (proximal, distal, and radial), the presence of serosal inflammation, lymphovascular invasion (LVI), perineural invasion (PNI), lymph node metastasis (LNM) and distant metastasis, preoperative blood sample analysis, and CRP levels were noted. Statistical analysis for the association between hematologic parameters platelet (PLT) levels as well as neutrophil-to-lymphocyte ratio (NLR), platelet (PLT)-to-lymphocyte ratio (PLR), and Lymphocyte-to-CRP ratio (LCR) and histopathological features were done.
RESULTS
Among 111 patients, the mean age was 65.37, and the mean tumor size was 5.41 cm. Lymphovascular invasion, perineural invasion, radial surgical margin positivity, lymph node metastasis, localization, and stage were statistically significantly related to the number of platelets. For NLR, PNI (p=0.001), LNM (p=0.048), and stage (early/advanced) (p=0.045) were significantly related. None of the parameters were related to PLR and LCR.
CONCLUSION
Perineural invasion, lymph node metastasis, and the stage of the tumor could be the major histopathological features that could be related to hematologic parameters; however, this should be researched by larger studies as if they can be used as prognostic markers.
PubMed: 38741678
DOI: 10.2147/IJGM.S463588