Oral and oropharyngeal cancer in the West of Scotland—long-term outcome data of a prospective audit 1999-2001

We prospectively studied patients from the west of Scotland who presented with a primary cancer of the oral cavity or oropharynx over a period of 24 months from November 1999, and report long-term outcomes and prognostic factors. A total of 481 patients had squamous cell carcinoma (SCC), 5-year disease-specific survival (DSS) was 50%, and overall survival (OS) was 35%. One hundred were not suitable for treatment with curative intent, and factors other than stage were important in this decision. Of those treated with curative intent, 249 had SCC of the oral cavity (5-year DSS 67%; OS 42%), and 132 had SCC of the oropharynx (5-year DSS 62%; OS 42%). Multivariate analysis showed that pathological nodal stage (p = 0.051, 95% CI 0.998-1.955), and perineural invasion (p = 0.001, 95% CI 0.186-0.666) were prognostic indicators. Improved results using intensive treatment protocols that have been seen in trials are not likely to translate directly into a general population of patients with head and neck cancer. Algorithms that allow several pathological prognostic indicators to be incorporated into decisions about adjuvant treatment should be used.     

Primary head and neck mucosal melanoma: Predictors of survival and a case series on sentinel node biopsy

IntroductionHead and neck mucosal melanoma (HNMM) is a rare tumor with a poor outcome. The objective of this study was to assess outcome and prognostic factors for a cohort of patients treated in a head and neck cancer center. In addition, a case series on sentinel lymph node biopsy (SLNB) was included to evaluate it as a method for staging the node-negative neck.MethodsA retrospective study design was chosen, and 50 patients who were treated from 1973 to 2015 in our institution for primary HNMM were included. The Kaplan–Meier method was used to estimate survival rates. Uni- and multivariate analyses were used to study the influence of possible risk factors on the patients' outcome. These risk factors included patient demographics, tumor characteristics, and treatment modalities.ResultsAll patients were treated surgically and 50% received adjuvant treatment. The median disease specific survival (DSS) was 38 months, with a 5-year survival rate of 44%. Positive surgical margin (p = 0.004) and distant failure (p = 0.005) were associated with a worse DSS. The median disease-free survival (DFS) was 27 months, with a 5-year disease-free rate of 12%. Only tumor depth >5 mm (p = 0.002) was associated with a worse DFS. Five clinically node-negative patients received SLNB and only the two SLN-positive individuals suffered from distant failure. Radiotherapy, chemotherapy, and AJCC/UICC stage had no influence on any outcome measure.ConclusionsPositive surgical margin and distant failure are the only independent prognostic factors for DSS. Tumor depth can predict distant failure. SLNB may be a valuable staging tool for the node-negative neck.     

Prognostic factors and survival rates for parotid duct carcinoma patients

ObjectiveTo investigate the survival rates of patients diagnosed with parotid duct carcinoma (PDC) and analyze the associated risk factors.MethodsThis study included 38 patients with PDC and the following information was collected for each patient: gender, age, tumor size, TNM classification, neck node metastasis, House–Brackmann grade, neural invasion, use of postoperative radiation therapy and survival data. The Kaplan–Meier method and the Cox model were used to determine prognostic factors for disease-specific survival (DSS) and recurrence-free survival (RFS) rates.ResultsOf the 38 patients, 36 (94.7%) were male. Mean age at initial diagnosis was 59.9 years (range: 43–79). A total of 32 (84.2%) patients had T3/T4 tumors, and 29 (76.3%) patients had a preoperative House–Brackmann grade of Ⅰ/Ⅱ. A correlation analysis showed that tumor stage was significantly associated with House–Brackmann grade (Spearman r = 0.521, p = 0.001). The 5-year DSS and RFS rates were 45% and 30%, respectively. Using Cox-regression analysis, node metastasis and the preoperative House–Brackmann grade were the independent predictors of both RFS and DSS. Postoperative radiation could decrease disease recurrence, but did not improve disease-specific survival.ConclusionParotid duct carcinoma is an aggressive tumor. Node status and preoperative House–Brackmann grade are key prognostic factors.     

Determining the epidemiologic,outcome, and prognostic factors of oral malignant melanoma by using the Surveillance,Epidemiology, and End Results database

Background

The authors conducted a retrospective analysis to determine the epidemiologic, outcome, and prognostic factors in patients with oral malignant melanoma (OMM).

101例头颈部横纹肌肉瘤临床、病理及预后分析

目的:总结头颈部横纹肌肉瘤的临床病理特点及影响预后的因素.方法:对上海交通大学医学院附属第九人民医院2006—2013年收治的头颈部横纹肌肉瘤患者进行回顾性研究.收集患者的临床、影像、病理、治疗资料及随访记录,采用SPSS 22.0软件包对数据进行统计分析.结果:给定时间段内共纳入101例患者,75例获得随访.其中,男...     

口腔颌面-头颈部黏膜相关淋巴组织边缘区淋巴瘤临床及预后分析

目的：探讨口腔颌面-头颈部黏膜相关淋巴组织边缘区淋巴瘤（MALT淋巴瘤）的临床特征、分期、治疗方法及预后,为临床治疗提供更强的循证医学证据。方法：回顾分析上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科收治的105例原发于口腔颌面-头颈部的MALT淋巴瘤患者的临床资料,采用SPSS 22.0软件包对其预后进行分析。结果：105例MALT淋巴瘤患者中,男女比例为1∶2.5,中位年龄56岁（18~86岁）。主要临床表现为单纯渐增性肿块,52%的患者有长期口干症状或曾被诊断为自身免疫性疾病或慢性腮腺炎。根据Ann Arbor分期,Ⅰ期48例,Ⅱ期25例,Ⅲ期7例,Ⅳ期25例;有B症状者仅1例,无骨髓受侵的患者。最常见的部位为腮腺、腭、下颌下腺。50例接受单一治疗,49例接受联合治疗。中位随访时间60个月,8例失访,初治后完全缓解率为80%;疾病进展12例,死亡14例。5年总生存期和无进展生存期分别为89%、88%;全身治疗（化疗或利妥昔单抗）可显著提高晚期患者的无进展生存期（P<0.05）,MALT淋巴瘤的国际预后指数（MALT-IPI）是影响总生存期的独立预后因素,Ann Arbor分期是影响无进展生存期的独立预后因素。结论：口腔颌面-头颈部MALT淋巴瘤初治疗效良好,进展缓慢;晚期患者应辅助全身治疗。MALT-IPI和Ann Arbor分期是影响预后的独立因素。     

头颈部肿瘤调强放疗联合手术和化疗的回顾性分析

目的:回顾性分析头颈部肿瘤调强放疗(IMRT)的长期随访结果和影响预后的因素。方法:136例初治头颈部肿瘤接受全程IMRT,48例(35.3%)联合化疗。手术联合放疗平均剂量62.14 Gy(50～73 Gy),根治性放疗平均剂量68.99 Gy(56.4～77 Gy)。结果:中位随访时间19个月,3年局控率、区域控制率、无远处转移生存率、无瘤生存率和总生存率分别为83.2%、93.2%、75.8%、66.4%、67.6%。多因素分析显示临床分期、治疗模式、放疗前有无贫血是影响患者生存率的独立预后因素。急性0、1、2、3级皮肤反应发生率分别为3.7%,71.3%,24.3%,0.7%;0、1、2、3、4级黏膜反应发生率分别为4.4%,22.8%,57.4%,14.7%,0.7%。治疗结束1年后1、2、3度口干发生率分别为21.3%、16.2%、0.7%。结论:IMRT联合手术和化疗治疗头颈部肿瘤可取得较好疗效,不良反应可以耐受。临床分期、治疗模式、放疗前有无贫血是影响生存的主要因素。     

Malignant peripheral nerve sheath tumours in the head and neck region: retrospective analysis of clinicopathological features and treatment outcomes

Malignant peripheral nerve sheath tumours (MPNST) are rare soft tissue sarcomas. The aim of this study was to assess clinicopathological characteristics and prognostic factors in order to improve the treatment of such tumours in the head and neck region. We performed a retrospective analysis of head and neck MPNST patients in our hospital between 1996 and 2012. Clinical features and pathological findings of these cases (n = 43) were summarized. In addition, prognostic variables were evaluated by univariate and multivariate analyses. The median age of the patients at presentation was 41 years. Surgery was the main treatment approach. Pertinent information regarding the presence of neurofibromatosis type 1 was found in 13 patients (30.2%). Two-thirds of these patients were admitted for a primary tumour (n = 27, 62.8%), while one-third (n = 16, 37.2%) were treated for recurrent neoplasms. The overall survival rate was 46.5%. Multivariable analysis identified tumour size, surgical margins, and postoperative radiotherapy to be independent prognostic factors. MPNST of the head and neck is extremely difficult to manage. Surgery with postoperative radiation may be the optimum choice of treatment for primary head and neck MPNST.     

Merkel cell carcinoma of the tongue and head and neck oral mucosal sites

Merkel cell carcinoma (MCC) is an uncommon primarily dermal malignancy of relatively aggressive biologic course. Several presentations in the mucosa of the head and neck region have been reported in the literature, and 3 such patients have recently been seen at our institution. We review this recent experience and present the first reported primary lingual MCC in a 57-year-old caucasian man. We provide a review of oral mucosal MCC and guidelines for histopathologic and immunohistochemical diagnosis. Merkel cell carcinoma should be included in the differential diagnosis of head and neck mucosal lesions, especially if the tumor is submucosal, and MCC may involve the tongue. Mucosal MCC is aggressive, and there is a high risk for local recurrence and regional and distant metastasis. Fulminating courses are often seen. We discuss our treatment policies based on the current literature.     

Prognostic features in angiosarcoma of the head and neck: A retrospective monocenter study

BackgroundCutaneous angiosarcoma of the head and neck (cAS-HN) is a rare malignancy with poor survival. Most of the histological markers and grading were not proven to be significant for prediction of outcomes in cAS-HN. This study aimed to find prognostic clinical features and histologic markers for cAS-HN.Material and methodsWe retrospectively analysed primary cAS-HN's seen in a single institution between 1980 and 2009. Clinical data and specific histologic characteristics were assessed. Outcome parameters were analysed using uni- and multivariate statistics.Results80 patients (mean age 71.4 (SD 14.4) years, average follow-up time 55.3 (SD 74.4) months) were included. 5-year DSS rate was 62%. Univariate analysis revealed the extent of primary tumour (affecting more than one anatomical region), incomplete resection and initial metastatic disease as significant (p < 0.05) predictors for unfavourable disease specific survival (DSS) rates and time. Multivariate analysis confirmed age over 70 years, incomplete resection and initially distant metastasis influencing outcome adversely. Analysis of specific histological markers in 37 cases found patterns of growth (solid areas greater than 80%) associated with better survival (p = 0.011).ConclusionIn conclusion age, number of affected regions, initial metastasis, complete initial resection and pattern of growth significantly affected mortality rates.     

Extranodal extension in head and neck squamous cell cancer: is there a role for further stratification?

To investigate the prognostic significance of the stratification of extranodal extension (ENE) into ENE minor (ENEmi, up to 2 mm) and ENE major (ENEma, over 2 mm) in non-HPV-related squamous cell cancers of the head and neck, we retrospectively reviewed microscopic slides from neck dissection specimens of ENE-positive patients and subcategorised them into ENEmi and ENEma. We then compared the two groups in terms of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Forty-four patients with pathologically positive necks had ENE in the histological report. Twenty-six had ENEmi and 18 ENEma. The three-year OS was 46% in the ENEmi group and 38.9% in the ENEma group. DSS and DFS were 80.8% and 80.8%, respectively, in the ENEmi group and 61.1% and 77.8%, respectively, in the ENEma group. None of the comparisons revealed any statistically significant difference. The results of our survival analysis seem to show a trend towards better survival rates in the ENEmi group, particularly regarding OS. Nonetheless, extension of the tumour outside the lymph node capsule by more than 2 mm was not found to be significantly associated with any of the explored survival outcomes.     

Oncological outcome and prognostic factors in malignant parotid tumours

ObjectiveTo evaluate the oncological outcome of malignant parotid tumours and identify the prognostic factors for survival.Study designRetrospective study.MethodsOne hundred and forty-one patients with primary epithelial carcinoma of the parotid gland were examined. The overall survival (OS) and disease specific survival (DSS) rates were calculated. The DSS was evaluated according to different parameters.ResultsThe 5- and 10-year OS rates were 72.3% and 58.4%. The 5- and 10-year DSS rate was 75% and 71%, respectively. The univariate analysis showed that the pathological staging, clinical and pathological tumour and nodal status, surgical procedure and histological subtype significantly influenced the DSS (P ≤ 0.05). The 5- and 10-year loco-regional control rates were 82.1% and 78%. The multivariate analysis showed that the pathological nodal status and the pathological staging influenced the DSS. It further demonstrated that the clinical tumour status and the histological subtype were the most important preoperative prognostic factors.ConclusionThe pathological nodal status, the pathological staging, the clinical tumour status and the histological subtype are the most important factors influencing survival in malignant parotid tumours.     

Tumor–stroma ratio is a crucial histological predictor of occult cervical lymph node metastasis and survival in early-stage (cT1/2N0) oral squamous cell carcinoma

Occult cervical lymph node metastasis is a significant prognostic factor in patients with early-stage (cT1/2N0) oral squamous cell carcinoma (OSCC). The aim of this study was to investigate the potential value of the tumor–stroma ratio (TSR) as a histological predictor of occult cervical metastasis and survival in early-stage OSCC. This retrospective study included 151 patients who underwent excision of the primary lesion and elective neck dissection from 2013 to 2017. The clinicopathological features of the tumor, risk factors associated with occult neck metastasis, and prognostic factors for overall survival (OS) and disease-free survival (DFS) were studied. A significant correlation of TSR (P = 0.009) was found with occult neck metastasis in the multivariate logistic regression model. Multivariate Cox proportional hazards regression analysis showed that the TSR (P = 0.002) and perineural invasion (P = 0.011) were associated with OS. Occult neck metastasis (P = 0.032) was associated with DFS. These findings indicate that assessment of the TSR might be useful in prognostication for early-stage OSCC patients. Moreover, the TSR is effective in allowing an accurate evaluation of the risk of occult neck metastasis, and this may be easily applicable in the routine pathological diagnosis and clinical decision-making for elective neck dissection.     

Comparison Among Clark's, Breslow's, and TNM classifications for cutaneous head and neck malignant melanoma

This retrospective study was carried out to assess the prognostic value of three classification systems used for staging cutaneous head and neck malignant melanoma (CHNME). Fifty-three patients with histologically proven CHNME were analyzed. Thirty patients were never treated before admission, whereas 23 (43.4%) had a second radical resection of the primary tumor location, 9 (17%) had neck nodes, none had distant metastasis, and all had a minimum of 5 years of follow-up. Results show that T-stage is the most important clinical prognostic parameter, whereas Clark's and Breslow's classifications have lower impact in defining prognosis. Sites of primary tumor determines different clinical outcomes, but this does not reach statistically significant values. A second surgery on the primary tumor location is possible and is effective toward survival. No statistical differences were noted between the previously untreated and treated groups. Neck nodes have to be removed with neck dissection, and this regimen can improve the clinical outcome; however, only 40% of neck positive patients survive more than 5 years.     

Prognostic significance of dysplasia associated with oral squamous cell carcinoma in patients undergoing surgery with curative intent

The aim of this study was to evaluate the prognostic significance of dysplasia in patients undergoing primary surgery with curative intent in the treatment of oral squamous cell carcinoma (OSCC). This study specifically aimed to demonstrate the effect of dysplasia on local recurrence, disease specific survival (DSS) and overall survival (OS). Data collection for 833 patients with OSCC undergoing treatment for curative intent was undertaken retrospectively for the period of February 2006 to May 2020. Analysis of any association between known clinicopathological prognostic categorical variables with respect to dysplasia was undertaken using the chi squared test. A Kaplan-Meier analysis was performed to demonstrate the impact of dysplasia on DSS and OS, and Cox’s proportional-hazards model deployed to obtain hazard ratios associated with dysplasia and the outcomes of interest. Dysplasia was statistically significant in predicting disease specific and overall survival in patients undergoing primary surgery for OSCC (DSS p<0.001, HR 0.577; 95%CI 0.428 to 0.777), OS p<0.001 HR 0.691; 95%CI 0.562 to 0.850) with the absence of dysplasia predicting poorer outcomes. The absence of dysplasia correlated with pathological higher T and N stage, increased categorised depth of tumour invasion, non-cohesive invasive front, lymphovascular invasion, perineural invasion, extranodal extension and increased modified Glasgow Prognostic Score. No significant prognostic relationship was attributable to the presence of dysplasia at a surgical margin. The absence of dysplasia appeared to be a significant independent prognostic indicator for patients with OSCC. The presence or absence of dysplasia may provide a heuristic means of stratifying OSCC primary lesions in terms of disease hostility.     

Prognostic indicators and outcomes following surgical management of metastatic cutaneous squamous cell carcinoma of the head and neck

Metastatic cutaneous SCC carries a poor prognosis with five-year survival of 25%–57%. The aim of this study is to examine the outcomes following surgery with adjuvant therapy for management of metastatic cSCC in a UK-based population. This is a retrospective review of patients with metastatic cSCC of the head and neck who underwent primary surgery at a regional center during a six-year period. Overall and disease specific survival were calculated using Kaplan–Meier and log-rank tests. Results were reported as hazard ratios (HR) with 95% confidence intervals. Forty-five patients met the inclusion criteria. The mean time to discovery of metastases was 9.3 months (range, 0–40 months). Only two patients (4%) had discovery of metastases after two years, with none after 3.3 years. The overall five5-year survival was 31% (95% CI 15%to 48%) with two-year survival at 48% (95% CI 31%to 63%). The median OS survival was 722 days (95% CI 607to 1359). Patients aged >80 years had a decreased OS. This is the largest UK based study documenting the overall and disease specific survival associated with metastatic cutaneous SCC of the head and neck. Our overall survival is comparable to similar studies, but remains poor. Total number of involved nodes, and lymph node ratio were not statistically significant.     

Correlation of immune makers with HPV 16 infections and the prognosis in oropharyngeal squamous cell carcinoma

Objectives

This study aims to investigate the association of immune markers with high risk human papillomavirus 16 (HPV 16) infection status and to evaluate the prognostic value of programmed death ligand-1 (PD-L1) in patients with oropharyngeal squamous cell carcinoma (OPSCC).

Materials and methods

This retrospective study collected 50 cases of HPV positive and HPV negative OPSCC from January 2011 to December 2015. The correlation of CD8 + tumor infiltrating lymphocytes (TILs), programmed death-1 (PD-1), and PD-L1 expression with HPV 16 infection status was analyzed via immunofluorescent staining and quantitative real-time PCR.

Results

There was no significant difference in the baseline data between the two groups. Patients with HPV + OPSCC had better prognosis compared to HPV − patients (5-year overall survival [OS], 66% vs. 40%, P = 0.003; 5-year disease specific survival [DSS], 73% vs. 44%, P = 0.001). The expressions of immunity related makers were significantly higher in the HPV + group than the HPV − group (CD8 + TIL: P = 0.039; PD-L1: P = 0.005; PD-1: P = 0.044). Positive CD8 + TIL and PD-L1 were independent factors for better prognosis of OPSCC (DSS, P < 0.001; OS, P < 0.001, respectively). Kaplan–Meier survival analysis indicated that patients with TILs of high HPV + /CD8 + expression were more likely to have better prognosis than those with TILs of low HPV + /CD8 + expression (DSS, P < 0.001; OS, P < 0.001), TILs of high expression of HPV − /CD8 + (DSS, P = 0.010; OS, P = 0.032), and TILs of low expression of HPV − /CD8 + (DSS, P < 0.001; OS, P < 0.001). Furthermore, HPV + /PD-L1 + OPSCC patients had significant better prognosis compared to patients with HPV + /PD-L1 − (DSS, P < 0.001; OS, P = 0.004), HPV − /PD-L1 + (DSS, P = 0.010; OS, P = 0.048) and HPV − /PD-L1 − (DSS, P < 0.001; OS, P < 0.001).

Conclusions

HPV + OPSCC had a significantly better prognosis, and PD-L1 expression was elevated in HPV + OPSCC. PD-L1 positivity might be related to the better prognosis of HPV + OPSCC.

Clinical relevance

This study provides a theoretical basis and baseline data for the application of immune checkpoint inhibitors in head and neck tumors.

     

Postoperative adjuvant therapy for patients with loco-regionally advanced oral squamous cell carcinoma who are at high risk of recurrence

Extranodal extension (ENE) of lymph node metastasis and the presence of a positive or close margin (PCM) are major risk factors for head and neck squamous cell carcinoma recurrence. This retrospective multicentre cohort study compared the prognostic impact of postoperative radiotherapy (RT) and concurrent chemoradiotherapy (CCRT) in oral squamous cell carcinoma (OSCC) patients at high risk of recurrence. One hundred and eighteen patients with PCM and/or ENE who underwent definitive surgery plus either adjuvant RT or CCRT using cisplatin for OSCC were investigated. The cohort-wide 5-year loco-regional control (LRC), disease-free survival (DFS), and overall survival (OS) rates (the main outcome measures) were 54.3%, 35.8%, and 43.2%, respectively. Multivariate analysis showed that age ≥64 years (hazard ratio (HR) 0.584), cT3–4 stage (HR 1.927), ≥4 metastatic lymph nodes (HR 1.912), and PCM (HR 2.014) were significant independent predictors of OS. Moreover, postoperative CCRT with cisplatin was associated with a significantly improved LRC rate, but not with improved DFS or OS rates, compared to postoperative RT (HR 0.360). Given that CCRT with cisplatin does not significantly improve survival, additional clinical trials will be required to validate new regimens that further improve the outcomes of patients with loco-regionally advanced OSCC going forward.     

Squamous cell carcinoma of the tongue and floor of the mouth: analysis of survival rate and independent prognostic factors in the Amazon region

Oral squamous cell carcinoma (OSCC) accounts for more than 95% of all malignant neoplasms in the oral cavity. Although several studies have shown the epidemiology of this cancer in Brazil, there do not seem to be any studies that describe the prognostic factors related to OSCC in the Amazon region. Therefore, the aim of this study was to determine the survival rate and prognostic significance of different factors in patients from this region affected by OSCC. Data from 85 patients with histologically confirmed squamous cell carcinoma of the tongue and floor of the mouth identified from the Ofir Loyola Hospital archives were collected and analyzed using univariate (log-rank test) and multivariate (Cox proportional hazard model) tests. The overall 5-year survival rate was found to be 27%. Univariate analysis showed that the 5-year survival rate was significantly higher for younger (≤ 45 y) female patients, patients with T1-2 tumors and clinically clear neck nodes (N0), patients with early stage cancers (AJCC stage I-II), and patients treated with surgical procedures. However, multivariate analysis showed that the 5-year survival rate was significantly higher only in the younger patients and those who underwent surgical treatment. The age of the patient at the moment of diagnosis and treatment with surgical procedures were the only independent prognostic factors that affected the 5-year survival rate of the patients in this region.