A comparison of the prognostic significance of tumor diameter, length, width, thickness, area, volume, and clinicopathological features of oral tongue carcinoma

BACKGROUND: The present study aims at evaluation of the prognostic value of tumor size including diameter, length, thickness, width, area, and volume in the prediction of nodal metastasis, local recurrence, and survival of oral tongue carcinoma. The results will have important implications for the management of patients. METHODS: Eighty-five glossectomy specimens of oral tongue carcinoma were serially sectioned in 3 mm thickness for the tumor size evaluation with computer image analyzer. RESULTS: Among all the tumor size parameters being evaluated, tumor thickness was the only significant factor for the prediction of local recurrence, nodal metastasis, and survival. With the use of 3 mm and 9 mm division, tumor of up to 3 mm thickness has 10% nodal metastasis, 0% local recurrence, and 100% 5-year actuarial disease-free survival; tumor thickness of more than 3 mm and up to 9 mm has 50% nodal metastasis, 11% local recurrence, and 77% 5-year actuarial disease free survival; tumor of more than 9 mm has 65% nodal metastasis, 26% local recurrence, and 60% 5-year actuarial disease-free survival. CONCLUSIONS: Tumor thickness should be considered in the management of patients with oral tongue carcinoma.     

Preoperative measurement of tumor thickness of oral tongue carcinoma with intraoral ultrasonography

BACKGROUND: Tumor thickness of oral tongue carcinoma is an important independent prognostic factor for local recurrence, subclinical nodal metastasis, and survival. An accurate preoperative assessment of tumor thickness is therefore essential in optimizing treatment algorithm. The present study aims at evaluating the accuracy of intraoral ultrasonography in preoperative measurement of tumor thickness. METHODS: Forty-five patients with oral tongue carcinoma had intraoral ultrasonography to document tumor thickness using a 7.5 MHz right angle probe. The ultrasonic tumor thickness was correlated with the fresh unpreserved surgical specimen pathologic tumor thickness. RESULTS: Ultrasonic tumor thickness had significant correlation with pathologic tumor thickness. The accuracies of ultrasonic measurement of tumor thickness in staging of tumor thickness at cutoff values between 3 and 15 mm were above 91%. CONCLUSION: Intraoral ultrasonography had satisfactory accuracy in the measurement of tumor thickness and is a useful adjunct in assisting pretreatment staging and prognosis evaluation of oral tongue carcinoma.     

Treatment of stage I and II oral tongue cancer

We reviewed 156 previously untreated patients with squamous cell carcinoma of the oral tongue staged T1 and T2 to determine the incidence of nodal metastasis, and if elective neck dissection affected local/regional control or survival. Patients were divided into two nonrandomized groups: group 1, intraoral glossectomy only (102 patients); and group 2, intraoral glossectomy plus neck dissection (54 patients). Analysis revealed no significant differences for tumor location, histologic differentiation, status of margins, or clinical appearance; however, perineural invasion significantly adversely affected survival and local/regional control. In group 1 patients, 16.5% subsequently developed cervical metastasis, and 20.4% of patients in group 2 had occult nodal disease. The survival and local/regional control for group 1 patients subsequently developing nodes was 33% and 50%, respectively. The survival and local/regional control for group 2 patients with occult metastasis was 55% and 91%, respectively. We believe elective neck dissection is indicated for early staged oral tongue cancer.     

Clinicopathological analysis of elective neck dissection for N0 neck of early oral tongue carcinoma

BACKGROUND: The study aims at evaluation of the efficacy of elective neck dissection as a staging and therapeutic procedure for N0 neck of early carcinoma of the oral tongue by whole organ serial sectioning. METHODS: There were 50 stage I and II patients. The neck dissection specimens were whole organ sectioned in 3-mm intervals for the evaluation of nodal metastasis. RESULTS: There were 18 (36%) patients with subclinical nodal metastasis. The total number of metastatic nodes were 31 (1%) among all 2,826 nodes being examined. The metastatic foci had a median size of 3 mm and occupied a median of 6% of the cross sectional area of the involved nodes. The ipsilateral level II nodes were the commonest (26%) site of metastasis. Metastatic nodes were present in 34% patients who had negative preoperative radiological assessment and in 20% patients who had negative intraoperative frozen section sampling of neck nodes. Patients with subclinical nodal metastasis had a high incidence of regional recurrence (62%) and low survival (27%) when postoperative radiotherapy was not given after elective neck dissection. CONCLUSIONS: Ipsilateral level I,II,III neck dissection is an adequate diagnostic procedure for staging of the N0 neck of early oral tongue carcinoma. Its diagnostic role cannot be replaced by the available pre-operative radiological screening and intra-operative frozen section sampling. However, elective selective neck dissection is an effective but not adequate therapeutic procedure, and post-operative adjuvant radiotherapy and chemotherapy have to be considered for all pathologically positive necks.     

Horizontal supraglottic partial laryngectomy for selected squamous carcinoma of the vallecula

BACKGROUND: Our aim was to determine the incidence of local control in patients with selected squamous carcinoma of the vallecula treated with horizontal supraglottic laryngectomy; to analyze the consequences of local recurrence in terms of nodal recurrence, distant metastasis, survival, causes of death, overall local control, and laryngeal preservation; and to identify any clinical factors predictive of these outcomes. METHODS: This was a retrospective nonrandomized case series in a university teaching hospital. An inception cohort of 95 previously untreated patients were followed until death or for a minimum of 5 years. According to the 2002 Union Internationale Contre le Cancer (UICC) staging classification system, the tumor was classified as T1, T2, and T3 in 13, 60, and 22 patients, respectively, while disease in 67 patients was considered to be in stages III to IV. All patients underwent a horizontal partial supraglottic partial laryngectomy. Ninety-four patients had an associated neck dissection. An induction chemotherapy regimen was used in 91 patients; postoperative radiation therapy was given for 49 patients. The main outcome measures were local recurrence, nodal recurrence, distant metastasis, and survival. RESULTS: The 1-, 3-, and the 5-year actuarial survival estimates were 86.3%, 64.2%, and 47.4%, respectively. Overall, the main causes of death were as follows: metachronous second primary tumor (47.2% of patients), intercurrent disease (16.7%), distant metastasis (15.3%), local recurrence (6.3%), and nodal recurrence, (4.2%). The 1-, 3-, and 5-year actuarial local recurrence rates were 4.5%, 11%, and 11%, respectively. Nine patients developed a local recurrence; 3 were successfully salvaged. Using multivariate analysis, no single variable was found to increase the risk for local recurrence. The overall laryngeal preservation rate and local control rate were 89.5% (85/95) and 93.4% (89/95), respectively. Local recurrence was associated with a significant increase in nodal recurrence (p <.04) and distant metastasis (p = .03). CONCLUSIONS: Based on this experience, horizontal partial supraglottic laryngectomy appears to be a valid approach for functional organ-preservation in patients with selected T1-T3 SCC of the vallecula.     

Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgery

PURPOSE: The efficacy of salvage treatment of recurrent head and neck squamous cell carcinomas (HNSCC) after primary curative surgery was evaluated. METHODS: The management outcome of 377 patients who had recurrent squamous cell carcinoma of oral cavity, oropharynx, hypopharynx, and larynx after primary curative surgery was reviewed. RESULTS: The surgical salvage rates of recurrence were 29% local, 30% tracheostomal, 56% unilateral nodal recurrence of previously undissected neck, 32% of unilateral neck recurrence after prior neck dissection, and 11% lung metastasis. The 5-year tumor-free actuarial survival rates of those patients who received surgical salvage was 35% for local recurrence, 32% for unilateral nodal recurrence of the previously undissected neck, and 18% for nodal recurrence of the previously dissected neck. One patient of six with tracheostomal recurrence salvaged with surgery and one patient of six with lung metastasis salvaged with lobectomy survived without tumor at 5 years. There was no 5-year survivor of all patients salvaged with other nonsurgical methods. The mean survival of patients without surgical salvage was 6 months. CONCLUSIONS: There was a moderate chance of cure after surgical salvage of locoregional recurrent HNSCC. Surgical salvage was, however, only feasible for early recurrent tumor. Close follow-up surveillance of early recurrence is essential after primary treatment of patients.     

Tumor thickness influences prognosis of T1 and T2 oral cavity cancer—but what thickness?

BACKGROUND: Previous studies have demonstrated that tumor thickness might influence prognosis in oral cancer, but the significant point at which outcome changes has varied from 1.5 mm to 6 mm. The clinical relevance of thickness remains unclear, and a reproducible prognostic "breakpoint" needs to be defined. METHODS: Tumor thickness was measured in 145 oral cavity squamous cancers, clinically staged T1 (n = 62) or T2 (n = 83). Clinical and pathologic data were collected prospectively between 1988 and 2000, but thickness was measured on paraffin sections for this study. Minimum follow-up was 2 years, and thickness was correlated with local control, cervical node involvement, and survival. Patients with clinically positive nodes (n = 21) were not excluded. Overall, 55 patients had pathologic node involvement at some time in their disease. RESULTS: Median tumor thickness was 6.2 mm, and there was little variation between sites: tongue, 6.4 mm; floor of mouth, 6.6 mm; and other sites, 5.7 mm. Median thickness for T1 tumors was 4.3 mm, significantly less than the T2 group, 8 mm (p <.01). Median thickness also varied significantly for tumors with associated nodal disease (8.5 mm) and without nodal disease (5.8 mm) (p <.01). Prognosis changed significantly at a cutoff of 4 mm with local control, nodal disease, and survival rates of 91%, 8%, and 100%, respectively, for tumors <4 mm compared with 84%, 48%, and 74% for those 4 mm or more thick (p <.01). Subgrouping greater than and less than 3 mm and 5 mm also showed a difference but with poorer discrimination. Thickness and pathologic nodal involvement were highly significant independent prognostic factors. CONCLUSIONS: Tumor thickness is a highly significant, objectively measurable prognostic factor in early stage oral cancers. There is a need to standardize techniques of measurement to allow a multi-institutional study to be carried out. This will facilitate the development of strategies aimed at improving the outcome of higher risk patients.     

Perineural Invasion as a Major Determinant for the Aggressiveness Associated with Increased Tumor Thickness in T1–2 Oral Tongue and Buccal Squamous Cell Carcinoma

Background

Neck management for cN0 neck remains controversial for T1–2 oral tongue and buccal squamous cell carcinoma (SCC). Increased tumor thickness and perineural invasion (PNI) are two pathologic features that correlated with cervical lymph node (LN) metastasis and poor survival. However, the relationships between these two features remain unclear.

Methods

Detailed histologic reevaluation under hematoxylin and eosin staining was performed in tumors of 212 consecutive patients with T1–2, cN0 oral tongue and buccal SCC. The interrelationships between the impacts of tumor thickness and PNI on cervical LN metastasis and disease-specific survival (DSS) were analyzed.

Results

Increased tumor thickness (>6 mm) correlated with higher LN metastasis and poor 5-year DSS rates in univariate analysis. However, only PNI independently predicted both in multivariate analysis (P = 0.004 and P = 0.039, respectively). When stratified by PNI status, increased tumor thickness did not correlate with higher LN metastasis rate in either PNI-negative or PNI-positive groups (P = 0.337 and P = 0.730). Compared to patients with thin tumors (≤6 mm), patient with thick tumors revealed significantly higher LN metastasis rate (41.9 vs. 16.4 %, P = 0.001) and lower 5-year DSS rate (77.5 vs. 93.7 %, P = 0.006) only at the presence of PNI.

Conclusions

PNI can be a major determinant for higher LN metastasis and poor 5-year DSS rates associated with increased tumor thickness in T1–2 oral tongue and buccal SCC. Careful evaluation of PNI should be mandatory in routine pathologic examination, aside from the measurement of tumor thickness.     

中低位直肠癌系膜浸润程度的临床研究

目的探讨中低位直肠癌直肠系膜浸润程度与临床病理特征及预后的关系。方法采用大组织切片技术,测量行全直肠系膜切除术的49例中低位直肠癌标本的肿瘤浸润深度及直肠系膜厚度,计算直肠系膜浸润程度;并分析其临床病理特征和随访结果。结果本组中低位直肠癌术后局部复发率为12．2％（6／49）,远处转移率为26．5％（13／49）。直肠癌直肠系膜浸润程度Ⅰ度20例（40．8％）,Ⅱ度13例（26．5％）,Ⅲ度16例（32．7％）,Ⅰ、Ⅱ、Ⅲ度者术后局部复发率分别为0、7．7％和31．3％（X^2=7．357,P=0．015）;远处转移率分别为10％、23．1％和50％（X^2=7．405,P=0．025）;5年生存率则分别为90．9％、69．2％和28．6％（p=0．013）。直肠系膜浸润程度与肿瘤直径（X^2=6．849,P=0．033）、T分期（X^2=34．845,P=0．000）、N分期（X^2=17．266,P=0．002）有关。结论直肠系膜浸润程度是影响直肠癌预后的重要因素。     

血管内皮生长因子C与胰腺癌根治术后复发的相关性研究

目的 探讨血管内皮生长因子C(VEGF-C)表达及多种临床病理因素在预测胰腺癌根治术后复发的价值.方法 应用Envision免疫组化法测定47例胰腺癌根治性切除标本中胰腺癌组织和自身胰腺正常组织中VEGF-C的表达.通过Kaplan-Meier生存分析和Cox风险比例模型,评估VEGF-C和各临床病理因素对胰腺癌根治术后复发的影响.结果 VEGF-C在胰腺癌组织中的表达比例及其在自身正常胰腺组织中的表达比例分别为29例(61.7%)、7例(14.9%),VEGF-C在胰腺癌组织中的表达比例明显高于其在自身正常胰腺组织中的表达(P=0.018).胰腺癌根治术后患者无病中位生存期为11.9个月,平均为(18.4±2.4)个月.1年、2年、3年累计无病生存率分别为46.8%、23.4%和14.4%.VEGF-C的表达与淋巴结转移有显著的相关性(P=0.036).单因素生存分析显示VEGF-C(P=0.020)、肿瘤直径(P=0.013)、年龄(P=0.057)、术后辅助化疗(P=0.017)与无病生存期明显相关.Cox回归多因素分析显示,VEGF-C(P=0.009),肿瘤直径(P=0.010)、术后辅助化疗(P=0.017)是胰腺癌根治术后患者无病生存期独立的预后因素.结论 VEGF-C在胰腺癌组织中表达明显增高,VEGF-C的表达与淋巴结转移有显著的相关性,VEGF-C可作为判断胰腺癌根治术后患者无病生存期的独立指标.

Abstract：

Objective To investigate the prognostic value of vascular endothelial growth factor C (VEGF-C) and clinicopathologic indexes in predicting recurrence following curative resection of pancreatic cancer. Methods The expressions of VEGF-C of 47 patients who underwent curative resection for curative pancreatic cancer resection were detected by Envision immunohistochemical methods. The effects of VEGF-C and clinicopathologic indexes on recurrence were assessed by the Kaplan-Meier and Cox proportional hazards model. Results The positive rates of VEGF-C were 61. 7% in = 29) and 14. 9%(n = 7), respectively, in pancreatic cancer and normal pancreatic tissues. The positive expression of VEGF-C in pancreatic carcinoma was obviously higher than the normal pancreatic tissues (P = 0. 018). The median disease-free survival time was 11. 9 months, the average disease-free survival time was 18. 4 + 2. 4 months, and the cumulative 1-year, 2-year and 3-year actuarial recurrence free survival rates were 46. 8%, 23. 4%, 14. 4%, respectively. There was a significant correlation between the VEGF-C expression and lymph node metastasis in pancreatic cancer (P = 0. 036). On Kaplan-Meier analysis, VEGF-C (P = 0. 020), tumor diameter (P = 0. 013), age (P = 0. 057) and adjuvant chemotherapy (P=0. 017) were associated with disease-free survival time. Multivariate analysis showed VEGF-C (P = 0. 009), tumor diameter (P = 0. 010) and adjuvant chemotherapy (P = 0. 017)were independent prognostic factors of disease-free survival after surgery for pancreatic cancer.Conclusion The expression of VEGF-C was higher in pancreatic cancer, and VEGF-C was correlated with lymph node metastasis. VEGF-C was the biomarker that independently predicted disease-free survival after surgery for pancreatic cancer.     

Risk Stratification in Oral Cavity Squamous Cell Carcinoma by Preoperative CRP and SCC Antigen Levels

Background

Squamous cell carcinoma antigen (SCC-Ag) level and C-reactive protein (CRP) have been shown to be associated with tumor invasion, lymph node metastasis, staging and survival in patients with oral squamous cell carcinoma (OSCC). The purpose of the present study was to analyze the relationship between preoperative levels of both SCC-Ag and CRP, with clinicopathologic factors and prognosis in OSCC patients.

Methods

A retrospective study was performed on 142 OSCC patients between March 2008 and March 2011. Their serum SCC-Ag and CRP levels were measured preoperatively.

Results

SCC-Ag level of ??2.0?ng/ml and CRP level ??5.0?mg/L were significantly associated with pathologic tumor status (P?<?0.001), pathologic nodal metastasis (P?=?0.001), tumor depth (??10?mm vs. <10?mm, P?<?0.001), disease-free survival (P????0.001) and overall survival (P????0.001). The influence of SCC-Ag and CRP level on disease-free survival (hazard ratio 4.046, 95?% confidence interval 1.698?C9.692) and overall survival (hazard ratio 3.655, 95?% confidence interval 1.464?C9.130) still existed after adjusting for tumor status, lymph node metastasis and tumor cell differentiation.

Conclusions

Concurrent high levels of both preoperative SCC-Ag and CRP levels act as a predictor for lymph node metastasis, advanced tumor stage and tumor recurrence. It therefore has significant potential as a biomarker for risk stratification in OSCC.     

Strong Immunohistochemical Expression of Vascular Endothelial Growth Factor Predicts Overall Survival in Head and Neck Squamous Cell Carcinoma

Background Head and neck squamous cell carcinoma (HNSCC) has high morbidity and mortality, and its relationship with tumor angiogenesis as measured by mircovessel density (MVD) or vascular endothelial growth factor (VEGF) expression has shown mixed results, with some, but not others, reporting correlation with outcome. Methods A retrospective study of 186 patients with HNSCC was performed. Patients were evaluated for MVD and VEGF and to correlate the levels with clinical parameters, including age at diagnosis, sex, site of tumor, stage, survival (disease free and overall), pathological tumor grade, and the presence of lymph node metastases. Results The 186 cancers included the following sites: oral tongue (n = 69), palate (n = 9), maxillary sinus (n = 8), floor of mouth (n = 13), oropharynx (n = 27), hypopharynx (n = 26) and larynx (n = 34). Over three-quarters of patients had advanced tumor (stage III/IV) and 58.6% had lymph node metastases. MVD and VEGF were assessed in 166 and 164 cases, respectively, but these were not correlated with site and grade. The 3-year overall and disease-free survival rates were 55.4% and 53.2%, respectively. Both univariate and multivariate survival analysis showed that advanced T stage, nodal metastasis, and strong VEGF intensity were independent adverse predictors for overall and disease-free survival. In stage IV disease, strong VEGF immunoreactivity was found to be the single adverse factor affecting the overall survival and a contributory factor for disease-free survival. Conclusions VEGF immunoreactivity is a strong predictor of adverse outcome, particularly in locoregionally advanced disease.     

Prognosis of recurrent laryngeal carcinoma after laryngectomy

Background. Recurrence is common after total laryngectomy for advanced laryngeal carcinoma. The aim of the present study was to review the prognosis of recurrent laryngeal carcinoma after total laryngectomy. Methods. The records of 165 patients who developed recurrences after total laryngectomy for laryngeal squamous cell carcinoma between January 1971 and December 1990 were reviewed. Results. Of the 165 patients who developed recurrences, 34 (21%) patients had surgical salvage. The sites of recurrence of these 34 operable patients included 11 pharyngeal, 3 tracheostomal, 15 nodal, 2 pharyngeal with nodal, and 3 pulmonary metastasis. Pharyngeal recurrence had the highest salvage rate, followed by nodal and pulmonary recurrence. All patients with tracheostomal had recurrence after salvage surgery. After the surgical salvage, the tumor recurrence rate was 44% and the 5-year actuarial survival rate was 42%. Of the other 131 patients who had palliative treatment without surgical salvage, the 5-year actuarial survival rate was 2%. Conclusions. The present study showed that patients who had surgical salvage for recurrent tumor after total laryngectomy had satisfactory prognosis. Close follow-up of patients after initial operation is essential to detect recurrence early, while surgical salvage is still feasible.     

Association of tumor satellite distance with prognosis and contralateral neck recurrence of tongue squamous cell carcinoma

BACKGROUND: The margin status is an important prognosticator for the survival of patients with tongue cancer. Although a positive margin is associated with a poor prognosis, those with clear margins do not always have good clinical outcomes. METHODS: We investigated the margin status, pattern of tumor invasion (POI), and tumor satellite distance (TSD) in 119 freshly treated tongue cancers and assessed their association with the characteristics and clinical outcomes. RESULTS: A close or clear margin and POI were not associated with overall survival. Tumor satellites occurred in 92% of tumors and were significantly associated with betel nut exposure. Patients with TSD 0.5 mm had a higher incidence of local recurrence, shorter intervals to neck recurrence, and a higher propensity to contralateral or bilateral cervical nodal metastasis. CONCLUSION: TSD is associated with local recurrence, contralateral neck metastasis, and the overall survival of patients with tongue cancer.     

Adjuvant postoperative radiation therapy for colonic carcinoma.

One hundred thirty-three patients with Stage B2, B3, and C colonic carcinoma had resection for curative intent followed by adjuvant postoperative radiotherapy to the tumor bed. The 5-year actuarial local control and disease-free survival rates for these 133 patients were 82% and 61%, respectively. Stage for stage, the development of local regional failure was reduced for patients receiving postoperative radiotherapy compared with a historic control series. Local recurrence occurred in 8%, 21%, and 31% of patients with Stage B3, C2, and C3 tumors who had radiation therapy, respectively, whereas the local failure rates were 31%, 36%, and 53% in patients treated with surgery alone. There was a 13% and 12% improvement in the 5-year disease-free survival rate in the patients with Stage B3 and C3 lesions who had radiotherapy compared with the historic controls. For patients with Stage C disease, local control and disease-free survival rates decreased progressively with increasing nodal involvement; however, local control and disease-free survival rates were higher in the patients who had radiotherapy than in those who had surgery alone. Failure patterns in the patients who had radiotherapy did not show any notable changes compared with those for patients who had surgery alone. Postoperative radiation therapy for Stage B3, C2, and C3 colonic carcinoma is a promising treatment approach that deserves further investigation.     

Isolated local recurrence is rare after radical prostatectomy in men with Gleason 7 prostate cancer and positive surgical margins: therapeutic implications

PURPOSE: We determined whether the high biochemical failure rate in men with Gleason score 7 disease and positive surgical margins after radical retropubic prostatectomy is secondary to distant metastasis or to local tumor recurrence that could be eliminated by immediate adjuvant radiation therapy. MATERIALS AND METHODS: Between 1982 and 1997, 112 men with Gleason score 7 disease and positive surgical margins but no seminal vesicle or lymph node involvement underwent radical retropubic prostatectomy without immediate adjuvant radiation or hormonal therapy. Median followup was 8 years (range 1 to 16) and 45 men (40%) were followed 10 years or more. Kaplan-Meier actuarial survival estimates were used to determine the actuarial 5 and 10-year post-prostatectomy, and 5-year post-radiation recurrence rates. RESULTS: The actuarial 5 and 10-year post-prostatectomy biochemical, local and distant recurrence rates were 40% and 52%, 6% and 6%, and 7% and 16%, respectively. For 20 men who received radiation therapy for isolated prostate specific antigen elevation actuarial 5-year post-radiation biochemical recurrence-free rate was 34%. For 5 men who received radiation therapy for local recurrence actuarial 5-year post-radiation biochemical recurrence-free rate was 20%. CONCLUSIONS: Isolated clinical local recurrence is rare during long-term followup of men with Gleason score 7 disease and positive surgical margins at radical prostatectomy. Radiation therapy given at prostate specific antigen elevation poorly controlled the disease. Because patients with biochemical failure rarely had local recurrence at long-term followup, they most likely harbored subclinical distant metastasis. These data suggest that immediate adjuvant radiation therapy will not have a major impact on outcome because most men with Gleason score 7 disease and positive surgical margins in whom treatment fails most likely had distant metastasis at surgery. To improve the outcome in cases of Gleason score 7 disease and positive surgical margins a systemic approach to adjuvant therapy is necessary.     

Postoperative radiotherapy for oral cavity cancers: impact of anatomic subsite on treatment outcome

We have retrospectively reviewed the treatment results of postoperative radiotherapy (RT) for advanced oral cavity cancers. The purpose of this study was to determine the impact of anatomic subsite on the results of treatment. Between 1975 and 1985, 51 patients with squamous cell carcinoma of the oral tongue (OT = 29 patients) and floor of mouth (FOM = 22 patients) were treated with combined surgery plus RT. All had an indication(s) for RT including advanced primary disease (T3 or T4) (29 patients), close or positive margins (34 patients), and multiple positive neck nodes and/or extracapsular extension (41 patients). With a median follow-up of 6 years, the 5-year actuarial local control rate was 74% and the rate of distant metastasis (DM) was 34%. Despite the similar T stage, margin status and median RT dose, the 5-year actuarial local failure rate was 38% for OT vs. 11% for FOM (p = 0.03). Furthermore, the median survival after recurrence was 9 months for OT and 40 months for FOM (p = 0.02). At 5 years the determinate survival for both sites was (55%), and the likelihood of developing a second malignancy was 31%. The likelihood of developing DM was 50% for FOM (N0-N1 = 3 of 12, N2-N3 = 8 of 10) and 21% for OT (N0-N1 = 4 of 21, N2-N3 = 1 of 8). This study highlights significant differences between FOM and OT cancers in response to combined surgery and RT. Future strategies should be directed at the enhancement of local control for OT and better systemic therapy for those with advanced N-stage FOM.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of some prognostic factors in small squamous cell carcinoma of the mobile tongue: a multicenter study in Sweden

In a retrospective study of 58 patients from all over Sweden, treated for small squamous cell carcinoma of the mobile tongue (T1N0M0), different prognostic factors were evaluated. A partial glossectomy was performed as primary treatment in all patients. The cancer recurred in 28 (38%) of 58 patients. One of 7 patients with only local recurrence, and 9 of 14 with recurrence in the neck died of their disease. The relative survival rate was 77%. Of the prognostic factors tested, tumor thickness was found to be the most significant. In patients with tumor thickness was found to be the most significant. In patients with tumor thickness exceeding 10 mm, recurrences occurred in 58% (P less than 0.0048), and 87% (P less than 0.0164) died of their cancer. This represents a statistically significant higher degree when compared with tumor thickness of less than 10 mm. Elective treatment of the neck nodes is recommended in epidermoid cancer of the mobile tongue when tumor thickness exceeds 10 mm, even in stage I tumors (i.e., the surface extension diameter is smaller than 20 mm at most).     

Is Final TNM Staging A Predictor for Survival in Locally Advanced Rectal Cancer after Preoperative Chemoradiation Therapy?

Background Neoadjuvant chemoradiation therapy has improved the local control rate and overall survival in locally advanced rectal cancers. The purpose of this retrospective study is to evaluate the correlation between the final pathologic stage and survival in these patients. Methods Patients with biopsy-proven rectal carcinoma, pretreatment staging by magnetic resonance imaging such as T3 or T4 tumors, or node-positive disease were treated with preoperative concomitant 5-fluorouracil-based chemotherapy and radiation, followed by radical surgical resection. Clinical outcome with survival, disease-free survival, recurrence rate, and local recurrence rate were compared with each T and N findings using the American Joint Committee on Cancer Tumor-Node-Metastasis (TNM) staging system. Results A total of 248 patients were enrolled in this study. Overall survival and disease-free survival at 1, 3, and 5 years were 97.1, 92, and 89.9% and 87.5, 71.1, and 69.5%, respectively. Thirty-six patients (14.5%) had a pathologic complete response after neoadjuvant therapy. The recurrence rate was significantly different between the pathologic complete response group and residual group (5.6 vs 31.1%; P = .002). Five-year disease-free survival was significantly better in the complete response group than the residual tumor group (93 vs 66%; P = .0045). There was no statistical difference in survival or locoregional recurrence rate between these two groups. Conclusions Posttreatment pathologic TNM stage is correlated to disease-free survival and tumor recurrence rate in locally advanced rectal cancer after preoperative chemoradiation. Also, pathologic complete response to neoadjuvant treatment has its oncologic benefit in both overall recurrence and disease-free survival.     

Laparoscopic versus open partial nephrectomy for the treatment of pathological T1N0M0 renal cell carcinoma: a 5-year survival rate

PURPOSE: We retrospectively compared the oncological adequacy of laparoscopic partial nephrectomy to that of open partial nephrectomy in the treatment of patients with pathological stage T1N0M0 renal cell carcinoma. MATERIALS AND METHODS: A total of 143 patients with stage T1N0M0 renal tumors confirmed by pathological examination of the surgical specimen underwent partial nephrectomy between January 1996 and June 2004 with a followup of at least 1.5 years. Of these patients 85 were treated laparoscopically and the remaining 58 underwent open surgery. Medical and operative records were retrospectively reviewed with emphasis on tumor recurrence and survival. Statistical analysis was performed using Kaplan-Meier analysis. RESULTS: The mean followup for the laparoscopy group was 40.4 +/- 18.0 months. A total of 83 patients survived. Of these patients 2 patients experienced disease recurrence within 18 to 46.2 months, 1 patient died of cancer metastasis to brain within 29.7 months and 1 died of an unrelated cause. Seeding of the port sites did not develop in any of the patients. The 5-year disease-free and actuarial survival rates for this group were 91.4%, and 93.8%, respectively. The 58 patients who underwent open surgery had a mean followup of 49.68 +/- 28.84 months. A total of 53 patients survived without any disease recurrence, 1 survived with recurrence within 8 months, 1 survived with metastasis within 49 months and 3 died of unrelated causes. The 5-year disease-free and patient survival rates for this group were 97.6% and 95.8%, respectively. Kaplan-Meier disease-free survival and patient survival analysis revealed no significant differences between the laparoscopic and open partial nephrectomy groups. CONCLUSIONS: Laparoscopic partial nephrectomy is an alternative technique with mid-range oncological results comparable to open partial nephrectomy in patients with localized pathological stage T1N0M0 renal cell carcinoma.