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Acta Medica Okayama Dec 2021The long-term changes in tissues implanted in the oral cavity and pharynx after head and neck reconstruction have not been fully evaluated. This study aimed to clarify...
Morphological Changes and Durability of Skin and Mucosal Flaps in Intraoral and Pharyngeal Reconstructions: Long-term Follow-up and Literature Review for Potential Second Carcinomas.
The long-term changes in tissues implanted in the oral cavity and pharynx after head and neck reconstruction have not been fully evaluated. This study aimed to clarify the morphological changes, long-term durability, and potential for secondary carcinogenesis in such tissues. In our single-center study, the rough morphological changes in 54 cases of intraoral and pharyngeal skin and mucosal flaps were evaluated more than 10 years after flap transfer. In addition, the literature on the development of second carcinomas from skin flaps was reviewed. The mean follow-up period for transferred flaps was 148 months. The reconstruction areas and the probability of morphological changes were significantly correlated (p=0.006), especially in cases with tongue, lower gingiva, and buccal mucosal reconstruction. Free jejunal flap surfaces were well maintained, whereas tubed skin flaps showed severe morphological changes in cases with pharyngeal reconstruction. None of the flaps in our series developed second primary carcinomas. Skin flaps generally had good durability for > 10 years in intraoral environments, while mucosal flaps had better durability for pharyngeal reconstruction. Second squamous carcinomas arising from skin flaps are extremely rare; however, surgeons should take this possibility into consideration and conduct meticulous and long-term follow-up.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Female; Follow-Up Studies; Free Tissue Flaps; Humans; Male; Middle Aged; Neoplasms, Second Primary; Pharynx; Plastic Surgery Procedures; Retrospective Studies; Young Adult
PubMed: 34955541
DOI: 10.18926/AMO/62813 -
Chinese Journal of Cancer Nov 2014Although the Epstein-Barr virus (EBV) has spread to all populations in the world, EBV-associated nasopharyngeal carcinoma (NPC) is prevalent only in South China and... (Review)
Review
Although the Epstein-Barr virus (EBV) has spread to all populations in the world, EBV-associated nasopharyngeal carcinoma (NPC) is prevalent only in South China and Southeast Asia. The role of EBV in the malignant transformation of nasopharyngeal epithelium is the main focus of current researches. Radiotherapy and chemoradiotherapy have been successful in treating early stage NPC, but the recurrence rates remain high. Unfortunately, local relapse and metastasis are commonly unresponsive to conventional treatments. These recurrent and metastatic lesions are believed to arise from residual or surviving cells that have the properties of cancer stem cells. These cancer stem-like cells (CSCs) have the ability to self-renew, differentiate, and sustain propagation. They are also chemo-resistant and can form spheres in anchorage-independent environments. This review summarizes recent researches on the CSCs in EBV-associated NPC, including the findings regarding cell surface markers, stem cell-related transcription factors, and various signaling pathways. In particular, the review focuses on the roles of EBV latent genes [latent membrane protein 1 (LMP1) and latent membrane protein 2A (LMP2A)], cellular microRNAs, and adenosine triphosphate (ATP)-binding cassette chemodrug transporters in contributing to the properties of CSCs, including the epithelial-mesenchymal transition, stem-like transition, and chemo-resistance. Novel therapeutics that enhance the efficacy of radiotherapy and chemoradiotherapy and inhibitors that suppress the properties of CSCs are also discussed.
Topics: Carcinoma; Cell Transformation, Neoplastic; China; Drug Resistance, Neoplasm; Epithelial-Mesenchymal Transition; Herpesvirus 4, Human; Humans; MicroRNAs; Multidrug Resistance-Associated Proteins; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharynx; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplastic Stem Cells; Signal Transduction; Viral Matrix Proteins
PubMed: 25223912
DOI: 10.5732/cjc.014.10081 -
Cancer Cytopathology Feb 2019
Topics: Carcinoma, Neuroendocrine; Carcinoma, Small Cell; Head and Neck Neoplasms; Humans; Lung Neoplasms; Oropharynx; Papillomavirus Infections
PubMed: 30661306
DOI: 10.1002/cncy.22094 -
Clinical Oral Investigations Mar 2022This study aims to evaluate the usefulness of liquid-based brush cytology for malignancy diagnosis and HPV detection in patients with suspected oropharyngeal and oral...
OBJECTIVES
This study aims to evaluate the usefulness of liquid-based brush cytology for malignancy diagnosis and HPV detection in patients with suspected oropharyngeal and oral carcinomas, as well as for the diagnosis of tumoral persistence after treatment.
MATERIAL AND METHODS
Seventy-five patients with suspicion of squamous cell carcinoma of the oropharynx or oral cavity were included. Two different study groups were analyzed according to the date of the sample collection: (1) during the first endoscopy exploration and (2) in the first control endoscopy after treatment for squamous cell carcinoma. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy diagnosis as well as for HPV-DNA detection on brush cytologies were assessed.
RESULTS
Before treatment, the brush cytology showed a sensitivity of 88%, specificity of 100%, and accuracy of 88%. After treatment, it showed a sensitivity of 71%, specificity of 77%, and accuracy of 75%. HPV-DNA detection in cytology samples showed a sensitivity of 85%, specificity of 100%, and accuracy of 91% before treatment and an accuracy of 100% after treatment.
CONCLUSIONS
Liquid-based brush cytology showed good accuracy for diagnosis of oropharyngeal and oral squamous cell carcinoma before treatment, but its value decreases after treatment. Nevertheless, it is useful for HPV-DNA detection, as well as to monitor the patients after treatment.
CLINICAL RELEVANCE
Brush cytology samples are reliable for the detection of HPV-DNA before and after treatment and may be a useful method to incorporate in the HPV testing guidelines.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Mouth Neoplasms; Oropharyngeal Neoplasms; Oropharynx; Papillomavirus Infections; Sensitivity and Specificity
PubMed: 34839418
DOI: 10.1007/s00784-021-04228-5 -
Asian Journal of Surgery Jun 2023This study assessed positive lymph node ratio (LNR) as a prognostic marker for patients with pyriform sinus cancer.
OBJECTIVE
This study assessed positive lymph node ratio (LNR) as a prognostic marker for patients with pyriform sinus cancer.
METHODS
The present study retrospectively analyzed 101 patients with pyriform sinus cancer to determine the association of LNR with recurrence-free survival (RFS) and disease-specific survival (DSS).
RESULTS
The patients were followed up for a median duration of 28 months (range: 6-196 months). The number of median dissected lymph nodes (LNs) was 41, and the number of median positive LNs was three. The receiver operating characteristic curve revealed an LNR cut-off value of 8.6%. Lymphovascular invasion (LVI) or perineural invasion (PNI) (P = 0.001), thyroid gland invasion (TGI, P = 0.000), positive LNs >4 (P = 0.036), and LNR >8.6% (P = 0.008) were significantly associated with poor RFS, and LVI or PNI (P = 0.005), tumor pT3/T4 stage (P = 0.028), positive LNs >4 (P = 0.033), TGI (P = 0.001), and LNR >8.6% (P = 0.003) were significantly associated with poor DSS. The multivariate analysis revealed that LVI or PNI (P = 0.010), TGI (P = 0.000), and LNR >8.6% (P = 0.022) were independent predictors for poor RFS, while tumor pT3/T4 stage (P = 0.049), TGI (P = 0.015), and LNR >8.6% (P = 0.001) were independent predictors for poor DDS.
CONCLUSION
LNR and other clinicopathological data can be used to predict the RFS and DSS of pyriform sinus cancer patients.
Topics: Humans; Retrospective Studies; Lymph Node Ratio; Pyriform Sinus; Neoplasm Staging; Lymph Nodes; Carcinoma, Squamous Cell; Prognosis; Lymph Node Excision
PubMed: 36184282
DOI: 10.1016/j.asjsur.2022.09.048 -
Journal of Translational Medicine Sep 2021The purpose of this study was to evaluate if HPV status serves as an independent predictor of early and late dysphagia outcomes when considered alongside standard...
PURPOSE
The purpose of this study was to evaluate if HPV status serves as an independent predictor of early and late dysphagia outcomes when considered alongside standard patient characteristics and dose metrics for head and neck cancer patients treated with radiotherapy.
METHODS AND MATERIALS
The age, sex, smoking history, cancer type (oropharyngeal vs non-oropharyngeal), HPV status, and early and late dysphagia outcomes were obtained for 99 retrospective head and neck cancer patients treated at our clinic with radiotherapy. Additionally for each patient, the mean radiation dose to the pharynx, superior/middle/inferior pharyngeal constrictor muscles, and cricopharyngeus was calculated. The predictive power of these clinical characteristics and radiation metrics was evaluated using chi-square tests for categorical variables and t-tests for continuous variables. Then multi-variate logistic models were built for each outcome using a single dose metric at a time, and either HPV status, cancer type, or both. Multi-variate models were built using both top-down and bottom-up technique to establish the most predictive independent covariates.
RESULTS
In the univariate analysis for early dysphagia, cancer type (p = 0.04) and four dose metrics (p ≤ 0.02) were significantly associated with outcome, while for late dysphagia, only cancer type (p = 0.04) was associated with outcome. In the multivariate analysis for early dysphagia, cancer type, smoking history, and mean dose to the five structures were consistently selected as covariates. For late dysphagia, either HPV status or cancer type was selected in each model and the mean dose to the cricopharyngeus was selected in one model.
CONCLUSION
While HPV is a known contributing factor for tumor prognosis in oropharyngeal cancers, its role in normal tissue toxicities for head and neck cancers has not previously been evaluated. Our results indicate having an oropharyngeal cancer may increase a patient's risk of high-grade early and late dysphagia while HPV status was seldom selected.
Topics: Deglutition Disorders; Head and Neck Neoplasms; Humans; Oropharyngeal Neoplasms; Pharyngeal Muscles; Retrospective Studies
PubMed: 34493300
DOI: 10.1186/s12967-021-03047-2 -
CA: a Cancer Journal For Clinicians 19891. Drinkers and cigarette smokers are at very high risk for the development of upper aerodigestive tract and lung squamous carcinomas. 2. The floor of the mouth, the... (Review)
Review
1. Drinkers and cigarette smokers are at very high risk for the development of upper aerodigestive tract and lung squamous carcinomas. 2. The floor of the mouth, the ventrolateral tongue, and the soft palate are high-risk sites within the oral cavity and oropharynx. 3. Mucosal erythroplasia rather than leukoplakia is the earliest visual sign of oral and pharyngeal carcinomas. 4. Areas of mucosal abnormality, especially redness or inflammation in high-risk sites, that persist for more than 14 days without obvious etiology or resolution should be biopsied. 5. Asymptomatic, erythroplastic lesions should not be regarded merely as precancerous changes. The evidence indicates that these lesions in high-risk sites should be considered to be invasive carcinoma or at the very least carcinoma in situ, unless proven otherwise by biopsy. 6. Toluidine blue staining is a useful diagnostic adjunct, particularly as a method of ruling out false-negative clinical impressions. It may also be used as a screening rinse in high-risk patients to encompass the entire oral mucosa after a negative clinical examination and as a guide to improve biopsy yields. 7. If oral or pharyngeal cancer is identified, evaluations of the larynx, hypopharynx, esophagus, and lungs should be performed to rule out second primary cancers. Yearly aerodigestive surveillance should be continued after satisfactory treatment of the index cancer.
Topics: Aged; Carcinoma, Squamous Cell; Humans; Male; Middle Aged; Mouth Neoplasms; Oropharyngeal Neoplasms; Pharyngeal Neoplasms; Risk Factors; Time Factors
PubMed: 2495159
DOI: 10.3322/canjclin.39.2.67 -
BMJ Case Reports Nov 2021
Topics: Carcinoma; Humans; Neck; Nose; Otolaryngology; Pharynx; Tongue
PubMed: 34848427
DOI: 10.1136/bcr-2021-246740 -
BMJ Case Reports May 2021
Topics: Adenocarcinoma; Humans; Neck; Nose; Pharynx
PubMed: 33958359
DOI: 10.1136/bcr-2020-241069 -
World Journal of Surgical Oncology May 2020This study evaluated the treatment outcomes of the primary surgery (PS) or concurrent chemoradiotherapy (CCRT) as the initial treatment for hypopharyngeal squamous cell... (Comparative Study)
Comparative Study
BACKGROUND
This study evaluated the treatment outcomes of the primary surgery (PS) or concurrent chemoradiotherapy (CCRT) as the initial treatment for hypopharyngeal squamous cell carcinoma (HPSCC).
METHODS
This retrospective cohort study included patients with stages III-IV HPSCC from four tertiary referral centers consecutively enrolled from 2003 to 2012; of them, 213 (32.6%) and 439 (67.4%) had received PS and CCRT as their primary treatments, respectively. The 5-year overall survival (OS) and disease-free survival (DFS) rates were analyzed using the Kaplan-Meier method and Cox regression models.
RESULTS
In patients undergoing PS and CCRT, OS rates were 45.0% and 33.1% (p < 0.001), respectively, and DFS rates were 36.2% and 28.9% (p = 0.003), respectively. In subgroup analysis, in patients with stage IVA HPSCC, PS was associated with higher OS rate (p = 0.002), particularly in those with T4 or N2 classification (p = 0.021 and 0.002, respectively). Multivariate analysis indicated that stage IVA HPSCC, stage IVB HPSCC, and CCRT were independent adverse prognostic factors for OS rate (p = 0.004, < 0.001, and 0.014, respectively). Furthermore, in patients with stage IVA HPSCC aged ≥ 65 years and with N2 classification, CCRT was significantly associated with lower OS rates than was PS (p = 0.027 and 0.010, respectively).
CONCLUSIONS
In patients with advanced HPSCC, PS was significantly associated with better prognosis than CCRT. PS could be a favorable primary treatment modality for the management of patients with stage IVA HPSCC, particularly those aged ≥ 65 years and with T4 and N2 classification.
Topics: Age Factors; Aged; Chemoradiotherapy; Clinical Decision-Making; Disease-Free Survival; Female; Humans; Hypopharyngeal Neoplasms; Hypopharynx; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Staging; Patient Selection; Pharyngectomy; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck
PubMed: 32357934
DOI: 10.1186/s12957-020-01866-z