Role of alcohol and smoking in diagnostic delay of head and neck cancer patients

CONCLUSIONS: This study shows that heavy drinking is a risk factor for prolonged delay in presenting with head and neck cancer and for presenting with a large tumour in the head and neck region. Excessive smoking is only a risk factor for being diagnosed with a large tumour, although there is a weak association between smoking and prolonged diagnostic delay. OBJECTIVE: It is reasonable to assume that prolonged delay in presenting with head and neck cancer is associated with an advanced stage of cancer at diagnosis. In this study we analysed the effects of drinking and smoking habits on diagnostic delay and the T stage of the tumour at diagnosis. MATERIAL AND METHODS: A total of 427 patients with newly diagnosed head and neck carcinomas were eligible for this study. Of these, 306 (72%) actually participated: 134 (77%) with an oral tumour; 117 (69%) with a larynx tumour; and 55 (65%) with a pharynx tumour. Diagnostic delay was defined as a period of >30 days between the appearance of the first tumour-related symptoms and the first visit to a physician. T3 4 tumours were defined as advanced tumours. Drinking behaviour was classified into three types: light (0 2 drinks/day); moderate (3 4 drinks/day); and heavy ( >4 drinks/day). Smoking habits were classified into 4 types: never; stopped; light (0 20 cigarettes/day); and heavy (>20 cigarettes/day). RESULTS: Logistic regression showed that there were significantly more heavy than light drinkers [p = 0.04; odds ratio (OR) 1.8; 95% CI 1.0-3.1] in the delay group than in the non-delay group. Light smokers showed a tendency towards prolonged delay (p = 0.06; OR 2.2; 95% CI 1.0-5.0). Both heavy drinking (p = 0.01; OR 2.0; 95% CI 1.2-3.6) and heavy smoking (p = 0.03; OR 3.1; 95% CI 1.1-8.4) were risk factors for a patient to be diagnosed with a large tumour.     

Metachronous second primary tumours in the aerodigestive tract in patients with early stage head and neck squamous cell carcinomas

Early-stage head and neck carcinomas can usually be controlled with the appropriate treatment. In these patients, the long-term prognosis mainly depends on second metachronous malignancies, frequently in the aerodigestive tract. Our study aims to identify risk factors for the appearance of second tumours in this group of patients with early head and neck cancer. Of 949 patients included in the study, 189 (20%) developed a metachronous second primary malignancy, most frequently in the aerodigestive tract. Independent risk factors associated with second tumours were heavy alcohol use and the location of the index tumour in the oropharynx. Compared to non-drinkers, heavy drinkers (>80 g/day) presented a 1.8-times higher risk of a second tumour (CI 95%: 1.01–3.50). Patients with oropharyngeal tumours had a 2.15-higher risk than patients with oral cavity tumours (CI 95%: 1.03–4.47). Recursive partitioning analysis was used to characterise two risk groups for second tumours. The low-risk group included patients over 75 years and patients with low levels of carcinogen use. It comprised 171 patients (18%) with a 5.3% frequency of second tumours. The high-risk group accounted for 80% of the patients ( n =778), and the rate of second neoplasms was 16.3%. Classification of the patients according to the mentioned variables allows us to focus follow-up and prevention efforts on high-risk patients.     

Pre‐treatment haemoglobin level predicts response and survival after TPF induction polychemotherapy in advanced head and neck cancer patients

Objective: To investigate the prognostic value of the pre‐treatment haemoglobin level in patients with advanced squamous cell head and neck cancer treated with induction polychemotherapy. Design: Seventy‐two patients with advanced squamous cell head and neck cancer received primary combination chemotherapy consisting of docetaxel 75 mg/m² on day 1, cisplatin 100 mg/m² on day 1, and 5‐fluorouracil (5‐FU) 1000 mg/m²/day on days 1–4 (total dose 4000 mg/m²), repeated on days 1, 22 and 43 followed by chemoradiation. The data collected included pre‐treatment haemoglobin, response to treatment, disease‐free and overall survival. Results: The pre‐treatment haemoglobin level was found to be a significant predictor of response to induction chemotherapy (P = 0.01) and an independent predictor of overall survival [hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.58–1.03, P = 0.0001] and disease free survival (HR 2.09, 95% CI 1.41–3.09, P = 0.0001). Furthermore N‐stage was found to be a significant prognostic factor of overall survival (HR 9.24, 95% CI 6.90–21.34, P = 0.005). The Eastern Cooperative Oncology Group performance status scale was also found to be significant for disease free survival (HR 7.66, 95% CI 2.61–22.46, P = 0.003). Conclusion: In patients with advanced squamous cell head and neck cancer, the haemoglobin level prior to induction chemotherapy is significantly related to outcome including response and survival.     

The prognostic value of cyclin D1 expression in head and neck squamous cell carcinoma

The correlation between cyclin D1 overexpression and the clinical outcome of head and neck cancer is not defined. The aim of this meta-analysis was to evaluate the prognostic value of cyclin D1 in patients with head and neck cancer. A search thorough Ovid MEDLINE was performed to enroll all eligible articles. Twenty-two studies comprising a total of 1,929 patients with different head and neck cancers were included. Cyclin D1 overexpression was significantly associated with lymph node metastasis [OR 2.25; 95 % confidence interval (CI) 1.76–2.87] and worse disease-free survival (OR 3.06; 95 % CI 2.42–3.87]. Subgroup analysis revealed that cyclin D1 overexpression correlated significantly with nodal metastasis for laryngeal cancer (OR 2.26; 95 % CI 1.61–3.16) and was a significant poor predictor for nasopharyngeal cancer (OR 4.44; 95 % CI 1.89–10.42). Our meta-analysis suggests that cyclin D1 overexpression could represent an important prognostic indicator for patients with head and neck cancer.     

Head and neck cancer in renal transplant patients in Finland

Conclusions. This study found a 0.8% incidence of non-cutaneous head and neck cancer during a mean follow-up of 10 years. The benefits of successful renal transplantation clearly outweigh the observed risk of malignancy. Objective. Increased cancer incidence after organ transplantation is well documented but few studies have reported on the rate of head and neck malignancies among these patients. This study aimed to determine the incidence and specific sites of head and neck cancer in a nationwide series of renal transplant patients in Finland. Patients and methods. Data from the National Kidney Transplant Registry and the Finnish Cancer Registry were used. A total of 2884 kidney transplant patients from the period 1964 to 1997 were followed for cancer incidence during the period from 1967 to 2003. Results. There were 113 non-lymphomatous head and neck malignancies. The standardized incidence ratio (SIR), as compared with the general population, was 13.6, with a 95% confidence interval (CI) of 11.2–16.2. The SIR was significantly elevated for cancers of the skin (47.3, 95% CI 36.3–60.7), lip (31.8, 95% CI 20.8–46.6), oral cavity (6.5, 95% CI 2.4–14.0) and thyroid (5.8, 95% CI 3.0–10.2).     

Non-squamous malignancy in lymph nodes: the occult primary

The present study presents 105 patients seen at a head and neck specialist clinic with a neck gland which subsequently proved to be a non-squamous malignancy. Of the 105 patients, 50 patients were eventually found to have a tumour in the head and neck region, 30 to have a distant primary and in 25 no primary site was ever found. The majority of patients were diagnosed in the clinic after careful examination and most of the remainder were diagnosed during endoscopy/biopsy. Chest radiography was the most useful investigation for diagnosing primary tumours of the lung. The 5-year-survival for the whole group of 105 patients was 28% (95% CI 17–39). The 5-year-survival for the head and neck primary tumour group was 44% (95% CI 25–60). The median survival of patients with a distant primary tumour was only a 6 months, there was one 5-year-survivor. The median survival for those in whom the primary was never discovered was 18 months. However, a reasonable proportion of these patients survived, five being alive at 5 years. The difference between survival for the three groups was statistically significant (P < 0.001). The most common histological type was undifferentiated/anaplastic tumours (37 out of 105) and this was followed by adenocarcinoma (33 out of 105). There was a significant difference in the survival between these two groups (χ²= 2.02, d.f. = 1, P= NS). Multi-variate analysis suggested that survival was better in the older age group and was affected by histology (P= 0.0093, P= 0.0332 respectively). The present study suggests that the treatment of patients in whom the primary site is eventually found to be in the head and neck region is rewarding with the same survival as a similar group of patients with squamous cell carcinoma. Sixty of the group of 105 patients had excision biopsies of the neck node and this did not affect survival.     

Use of Swedish moist snuff,smoking and alcohol consumption in the aetiology of oral and oropharyngeal squamous cell carcinoma. A population-based case-control study in southern Sweden

Conclusions. The results of this study confirm that both smoking of tobacco and alcohol consumption are risk factors for oral and oropharyngeal squamous cell carcinoma (OOSCC). The use of moist snuff had no effect on the risk of OOSCC, probably due to the low levels of tobacco-specific N-nitrosamines in Swedish moist snuff. Objective. The aims of this population-based case-control study in southern Sweden were to establish risk estimates for cigarette and alcohol consumption and to evaluate whether Swedish moist snuff is a risk factor for OOSCC. Material and methods. Between September 2000 and January 2004, 132/165 consecutive cases (80%) diagnosed with OOSCC and 320/396 matched controls (81%) were investigated. All subjects were interviewed and examined according to a standardized protocol. Results. Individuals who drank ≥350?g of alcohol/week showed an increased risk of OOSCC (OR 2.6; 95% CI 1.3–5.4). Total lifetime consumption of tobacco for smoking (>250?kg) had a dose–response effect on the risk of OOSCC (OR 4.7; 95% CI 2.4–9.1). We found no increased risk of OOSCC associated with the use of Swedish moist snuff (OR 1.1; 95% CI 0.5–2.5).     

Predictors of Olfactory Dysfunction in Patients With Chronic Rhinosinusitis

Objectives: To measure the prevalence of and identify clinical characteristics associated with poor olfactory function in a large cohort of patients with chronic rhinosinusitis (CRS). Study Design: Multi‐institutional, cross sectional analysis. Methods: An objective measure of olfactory dysfunction, the Smell Identification Test, demographic data, clinical factors, and comorbidity data were collected from a cohort of 367 patients who presented with CRS at three tertiary care centers. Data were analyzed using univariate and multivariate analyses. Results: Sixty‐four percent of men and women aged 18 to 64 had olfactory dysfunction whereas 95% of patients older than or equal to 65 years had olfactory dysfunction (P < .001); no significant difference was noted by gender. By multivariate logistic regression analysis, patients with nasal polyposis [Odds ratio (OR) 2.4, 95% confidence interval (CI) 1.3–4.2, P = .003] and patients older than or equal to 65 years (OR 10.0, 95% CI 2.3–43.7, P = .002) were at increased risk of hyposmia. Patients with nasal polyposis (OR 13.2, 95% CI 5.7–30.7, P < .001), asthma (OR 4.2, 95% CI 1.8–9.8, P = .001), older than or equal to 65 years (OR 15.6, 95% CI 2.3–104.9, P = .005), and smokers (OR 7.6, 95% CI 1.8–31.6, P = .005) were at increased risk of anosmia. Conclusions: Poor olfactory function is common in patients with CRS. Age, nasal polyposis, smoking, and asthma were significantly associated with olfactory dysfunction in patients with CRS. Neither prior endoscopic sinus surgery nor a history of allergic rhinitis was associated with olfactory dysfunction. Septal deviation and inferior turbinate hypertrophy were associated with normal olfactory function.     

The role of human papillomavirus in head and neck cancer and the impact on radiotherapy outcome

Conclusion: HPV?+?HNSCC patients have improved Overall Survival (OS), Disease Specific Survival (DSS), Disease Free Survival (DFS), and Progression Free Survival (PFS). The radiotherapy treatment can’t improve the Survival of the HPV-negative HNSCC patients.

Objective: To investigate the role of Human papillomavirus in head and neck cancer and the impact on radiotherapy outcome.

Methods: A search in PubMed and Chinese CNKI (2000–2015) was performed. This meta-analysis was done using RevMan 5.1 software. Outcomes included OS, DSS, DFS, PFS, and Treatment responses rates (RR).

Results: A total of 2620 patients in 10 studies were included. The Positive detective rates of HPV and P16 are 32.5% (425/1309) and 42.5% (526/1239). OS and PFS were improved in HPV?+?patients compared to HPV???patients (HR?=?0.48; 95% CI?=?0.37–0.62, p?p?p?p?p?= 0.05).     

Effect of body mass index on chemoradiation outcomes in head and neck cancer

Objective: To investigate the association between initial body mass index (BMI) and chemoradiation therapy (CRT) outcomes in head and neck cancer patients. Methods: Retrospective study of 72 patients with American Joint Committee on Cancer stage III or IV squamous cell carcinoma of the oropharynx, hypopharynx, or larynx treated with primary concurrent CRT with curative intent over a 5 year period. Logistic and Cox regression analyses were used to determine the association between initial BMI and percutaneous endoscopic gastrostomy tube dependence, tumor recurrence, disease‐free survival, and overall survival while controlling for the independent variables of age, sex, race, site, stage, and smoking and alcohol use. Results: Patients with normal or low BMI (BMI ≤25 kg/m²) were significantly more likely to be percutaneous endoscopic gastrostomy dependent at last follow‐up (odds ratio 4.13; 95% confidence interval [CI] 1.3–12.9; P = .014). This group also had significantly earlier recurrence (hazard ratio 4.4; 95% CI 1.2–15.9; P = .026) and shorter overall survival (hazard ratio 3.6; 95% CI 1.04–12.6, P = .043). Conclusions: The present study suggests that CRT patients with BMI greater than 25 have improved swallowing outcomes, longer time to disease recurrence, and improved survival when compared with similar patients with lower BMI. BMI at presentation may be an important clinical factor to consider when determining the optimal treatment modality for a head and neck cancer patient. Further investigation is required to determine whether primary surgery should be the preferred treatment in normal or low BMI patients.     

Observing stage‐shifts in head and neck squamous cell carcinoma from initial clinical outpatient staging to definite clinical tumour board staging using radiological and endoscopical investigations: will less do?

Clin. Otolaryngol. 2011, 36 , 352–360 Objectives: Staging head and neck squamous cell carcinoma usually is initiated in the outpatient department (OPD) using patient history and physical examination. To reach consensus on stage and therapy, imaging and panendoscopy are more or less routinely applied as additional staging tests. Staging results from the outpatient department were evaluated for tumour and neck stage. We investigated in which situations additional staging tests are needed. Design: Prospective cohort study. Setting: Head and Neck Oncology Group, University Medical Centre. Participants: Of 341 patients, initial staging results from the outpatient department were compared with the ultimate staging results from the tumour board review, which provides the basis for decisions on therapy. Main outcome measures: Tumour stage and neck stage migrations during this staging tract. Results: In staging head and neck tumours are squamous cell carcinomas, additional staging tests like imaging and/or panendoscopy remain necessary to evaluate the primary tumour stage. Average accuracies of T‐staging in oral cavity, pharynx and larynx only amount to 71%, 47% and 61%, respectively. For T1N0 and T2N0 oral cavity tumours, neck assessment in the outpatient department was accurate in 100% (95% CI: 91–100%) and 93% (95% CI: 80–98%), respectively. In the larynx group, this was 100% (95% CI: 91–100%) and 97% (95% CI: 86–100%), respectively. Conclusions: For oral cavity and laryngeal tumours staged as T1‐2N0 in the outpatient department, we concluded that the outpatient department staging is highly predictive of the final pre‐treatment staging. In these cases, computer tomography and/or MRI remain a necessity but additional ultrasound with or without fine needle aspiration cytology can be omitted. In our institution, this would have resulted in a 46% reduction in ultrasound procedures. If T‐stage is upgraded during imaging or panendoscopy, additional staging tests for N‐stage should still be considered.     

Risk factors for sudden deafness: a case-control study

In order to investigate risk factors for idiopathic sudden sensorineural hearing loss (sudden deafness), a case-control study was done in 109 patients with sudden deafness who visited our hospital between 1992 and 1994, with 109 controls matched to each patient by gender and age. Odds ratio (OR) and 95% confidence interval (CI) for smoking habits, drinking habits, dietary habits, environmental noise, past history of disease, sleeping hours, appetite, fatigue, incidence of common cold were obtained. Fatigue (OR: 3.28; 95% CI: 1.36–7.90) and loss of appetite (OR: 8.00; 95% CI: 1.00–64.0) elevated the risk for sudden deafness. Those who ate many fresh vegetables were at a decreased risk (OR: 0.48; 95% CI: 0.24–0.96 for light-colored vegetables, OR: 0.55; 95% CI: 0.30–1.02 for green-yellow vegetables). Personal histories of hypertension and thyroid disease, and susceptibility to colds appeared to be positively associated with the risk (0.05<P<0.10). Smoking habits, drinking habits and environmental noise had no significant association with sudden deafness. These results suggested that environmental factors, including diet, may be importantly involved in the genesis of sudden deafness.     

Hearing impairment among adults: The impact of cardiovascular diseases and cardiovascular risk factors

Objective: To investigate the influence of cardiovascular diseases on hearing impairment (HI) among adults. Furthermore, to seek other potential risk factors for HI, such as smoking, obesity, and socioeconomic class. Design: A cross-sectional, unscreened, population-based, epidemiological study among adults. Study sample: The subjects (n = 850), aged 54–66 years, were randomly sampled from the population register. A questionnaire survey, an otological examination, and pure-tone audiometry were performed. Results: Cardiovascular diseases did not increase the risk for HI in a propensity-score adjusted logistic regression model: OR 1.24, 95% CI 0.79 to 1.96 for HI defined by better ear hearing level (BEHL), and OR 1.48, 95% CI 0.96 to 2.28 for HI defined by worse ear hearing level (WEHL), in the 0.5–4 kHz frequency range. Heavy smoking is a risk factor for HI among men (BEHL: OR 1.96, WEHL: OR 1.88) and women (WEHL: OR 2.4). Among men, obesity (BEHL, OR 1.85) and lower socioeconomic class (BEHL: OR 2.79, WEHL: OR 2.28) are also risk factors for HI. Conclusion: No significant association between cardiovascular disease and HI was found.     

Analysis of patient factors associated with hospital visits for allergic rhinitis in Japanese adult patients: A cross-sectional study

ObjectiveAllergic rhinitis (AR) is one of the most common diseases in Japan. However, several AR patients do not seek optimal treatments at clinics/hospitals. This may affect the patient's quality of life and labor productivity. In this study, we assessed the characteristics of the outpatients’ AR and factors associated with their hospital visit, using the dataset obtained from a nation-wide survey in Japan.MethodsIn this cross-sectional study, we used data from the nation-wide 2013 and 2016 Comprehensive Survey of Living Conditions (CSLC) in Japan. We analyzed the data of AR outpatients through logistic regression, using the outcome as the dependent variable, and age groups, sex, household size, educational status, smoking history, alcohol use, household expenditure, psychological distress, quality of sleep, asthma and atopic dermatitis outpatients as explanatory variables.ResultsAmong the data of 317,984 outpatients aged between 20 and 79 years in 2016 CSLC survey, the proportion of AR outpatients was significantly less among current smokers (odds ratio (OR); 0.47, 95% confidence interval (CI); 0.43–0.51, P < 0.001) and those with large household sizes (OR; 0.80, 95% CI; 0.72–0.89, P < 0.001). Conversely, the proportion of AR outpatients was significantly more among subjects with a past smoking habit (OR; 1.19, 95% CI; 1.08–1.31, P < 0.001), insufficient sleep (OR; 2.93, 95% CI; 2.52–3.42, P < 0.001), psychological distress (OR; 1.71, 95% CI; 1.62–1.80, P < 0.001), high household expenditures (OR; 1.68, 95% CI; 1.56–1.80, P < 0.001), and asthma and atopic dermatitis outpatients (OR; 8.97, 95% CI; 8.13–9.89 P < 0.001 for asthma and OR; 7.61, 95% CI; 6.76–8.58 P < 0.001 for atopic dermatitis). We observed the same trend using the dataset of 2013 CLSC survey.ConclusionThis study revealed that smoking habit, psychological distress, insufficient sleep, high household expenditures and outpatients with other allergic diseases are the factors associated with AR outpatient visit.     

Oral status,oral infections and some lifestyle factors as risk factors for oral and oropharyngeal squamous cell carcinoma. A population-based case-control study in southern Sweden

Conclusion. Our results show that average and poor oral hygiene and inadequate dental status are independent risk factors for oral and oropharyngeal squamous cell carcinoma (OOSCC), irrespective of tobacco and alcohol consumption. Objective. To evaluate a possible relationship between oral cancer, oral hygiene, dental status, oral mucosal lesions and some lifestyle factors in a population-based case-control study. Material and methods. Between September 2000 and January 2004, 132/165 (80%) of all incident cases of OOSCC and 320/396 (81%) of the intended eligible matched controls participated in the study. Cases and controls were subjected to an identical oral examination. A standardized protocol specially designed for the study was used. Results. After adjusting for tobacco and alcohol consumption, average oral hygiene (OR 2.0; 95% CI 1.1–3.6) and poor oral hygiene (OR 5.3; 95% CI 2.5–11.3) emerged as significant risk factors for OOSCC. More than 20 lost teeth (OR 3.4; 95% CI 1.4–8.5), >5 defective teeth (OR 3.1; 95% CI 1.2–8.2) and poorly fitting or defective complete dentures (OR 3.8; 95% CI 1.3–11.4) were significant risk factors. Regular dental check-ups were associated with a decreased risk of OOSCC (OR 0.4; 95% CI 0.2–0.6).     

Presentation,course, and outcome of head and neck skin cancer in african americans: A case-control study

Background: Several reports have shown that the presentation, course, and outcome of skin cancer is altered in African Americans. Subset data from these studies suggest that the course of head and neck skin cancer may be different from that occurring in other sites. However, very few studies have specifically investigated skin cancer involving the head and neck region in African-American patients. Methods: Retrospective case-control study including 215 patients with skin cancer (squamous cell carcinoma [SCC], basal cell carcinoma [BCC], malignant melanoma, and adnexal tumors) presenting to a tertiary care institution over a 9.5-year period. Cases were defined as African Americans with skin cancer, and the control group included white and Latin-American patients with skin cancer. Results: Skin cancer occurred in the head and neck region in 135 cases (62%). However, head and neck involvement was less common in African-American patients (44%) than the control group (76%; P < .001). The anatomic distribution of head and neck skin lesions was similar between the groups, with nasal and scalp skin most often involved. In the head and neck region, the ratio of BCC to SCC (4:1) was similar among all groups. In contrast, in non–sun-exposed regions, the ratio was 1:8.5 for African-American patients compared with 1:1 for the control group (P < .001). The overall distribution of malignant melanoma was not influenced by sun exposure in either groups. The study groups were similar in gender distribution, primary treatment modality, rates of positive margins, and development of second skin cancers. Although African Americans presented with more advanced lesions (P < .001), their disease-free interval was similar to the control group. Only the margin status was a significant predictor of disease-free survival by multivariate analysis, with a relative risk of 1.68 (95% CI: 1.58–18.24) Conclusions: Head and neck skin cancer is similar with regard to presentation and distribution in patients of all skin types. Moreover, in contrast to previous reports, the course of head and neck skin cancer may be less aggressive in African Americans, if appropriate treatment is provided. This report suggests that differences in skin cancer in African Americans reported in the literature reflect cancer occurring in non–sun-exposed regions.     

Impact of delay in diagnosis on survival to head and neck carcinomas: a systematic review with meta-analysis

Clin. Otolaryngol. 2012, 37 , 99–106 Objective:  To address the contradictory information on the role of delay in diagnosis on head and neck cancer survival. Study design:  Systematic review and meta‐analysis. Search strategy:  Search on MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011) and ISI proceedings (from inception to March 2011). The terms used were (‘Head and neck cancers’) AND (‘delay’OR‘prognostic’OR‘survival’) both in MeSH terms and free‐text words. The reference lists of the retrieved articles were also revised manually to identify other potentially relevant papers. All searches were independently undertaken by two clinicians and one epidemiologist, and the results merged. Setting:  Primary and specialised care levels. Participants:  Meta‐analysis of data from papers on the subject published from 1966 to 2011. Main outcome measures:  Survival. Methods:  After search in Medline and other databases, we computed pooled relative risks (RR) and 95% confidence interval (95%CI) from the 10 studies retrieved. Results:  The estimate of the relative risk of mortality related to any diagnostic delay (either patient or professional delay) was 1.34 (95%CI 1.12–1.61). Referral delay was associated with a three‐fold increase in mortality. Total delay was marginally related to mortality (RR: 1.04, 95%CI: 1.01–1.07). By anatomic location, pharynx cancer shows the highest association (RR: 1.68, 95%CI: 1.22–2.31). Conclusions:  Diagnostic delay is a moderate risk factor of mortality from head and neck cancer. However, part of the effect observed may be due to residual confounding (confounding from unknown variables that are not eliminated by adjustment).     

Independent and joint exposure to passive smoking and cooking oil fumes on oral cancer in Chinese women: a hospital-based case-control study

Conclusions: Passive smoking and COF exposure are independent risk factors for oral cancer in Chinese women, with the multiplicative interactions from combined exposures. Avoiding exposure to environmental tobacco smoke and COF may contribute to the prevention of oral cancer in Chinese women.

Objective: To evaluate the independent and joint effects of passive smoking and cooking oil fumes (COF) on oral cancer in Chinese women.

Methods: A case-control study was performed including 238 female patients with pathologically confirmed oral cancer and 470 controls as age-matched controls. Face-to-face interviews were conducted based on a structured questionnaire. The effects of passive smoking and COF exposure were analyzed using non-conditional logistic regression models.

Results: Passive smoking significantly increased the risk of oral cancer in Chinese women: adjusted ORs were 2.12 (95% CI?=?1.11–4.07) for those only exposed before age 18, 1.52 (95% CI?=?1.01–2.31) for those only exposed after age 18, and 2.38 (95% CI?=?1.47–3.85) for those both exposed before and after age 18. In addition, COF exposure was significantly associated with a risk of oral cancer (adjusted ORs were 1.69 (95% CI?=?1.03–2.78) for light exposure and 2.06 (95% CI?=?1.21–3.50) for heavy exposure). Furthermore, there was a significantly multiplicative interaction between passive smoking and COF for oral cancer.     

Diagnostic value of sentinel lymph node biopsy in head and neck cancer: a meta-analysis

This study aimed to evaluate the diagnostic reliability of sentinel lymph node biopsy in patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx by reviewing the published literature. A systematic literature review was performed using MEDLINE from 1970 to 2011. With Boolean search strings, search terms included sentinel node, supraglottic, supraglottis, tongue, head and neck, oral, pharynx, laryngeal, and larynx. Additional studies were identified through article references. Duplicate data and articles were excluded based on treating institution and study inclusion time period. Additional studies were excluded if the head and neck subsite or tumor stage was not specifically identified or if the sentinel lymph node biopsy occurred in previously treated necks. All patients had sentinel lymph node biopsy performed followed by a concurrent neck dissection. Twenty-six studies met our inclusion criteria (n = 766 patients). The pooled sensitivity and negative predictive value of SLNB for all head and neck tumors was 95 % (95 % CI 91–99 %) and 96 % (95 %CI 94–99 %), respectively. The overall sensitivity and negative predictive value of SLNB in the subset of oral cavity tumors (n = 631) was 94 % (95 % CI 89–98 %) and 96 % (95 % CI 93–99 %), respectively. One-hundred percent of oropharyngeal (n = 72), hypopharyngeal (n = 5), and laryngeal (n = 58) tumor sentinel lymph biopsy results correlated with subsequent neck dissections giving a negative predictive value of 100 %, showing that, sentinel lymph node biopsy is a valid diagnostic technique to correctly stage regional metastases in patients with head and neck squamous cell carcinoma.     

Perineural invasion as a prognostic factor in head and neck squamous cell carcinoma: a systematic review and meta-analysis

Abstract

Background: Squamous cell carcinoma (SCC) is the most common type of head and neck cancer, and head and neck squamous cell carcinoma (HNSCC) was proved to having a high prevalence of perineural invasion (PNI). Although some reports have revealed a relationship between PNI and the prognosis in HNSCC patients, the contribution of PNI to the prognosis remains unclear.

Objectives: This study was aimed to comprehensively and quantitatively summarize the prognostic value of PNI for the survival of patients with HNSCC.

Material and methods: We conducted PubMed and EMBASE to identify all relevant studies. A meta-analysis and subgroup analysis were performed to clarify the prognostic role of PNI.

Results: A total of 18 studies (n?=?3894) were included. 989 (25.4%) of the 3894 patients exhibited positive PNI, PNI was shown to be significantly associated with overall survival (OS) [hazard ratio (HR): 2.8, 95% confidence interval (CI): 1.88–4.16], disease-free survival (DFS) (HR = 2.42, 95% CI: 1.92–3.05) and disease-specific survival (DSS) (HR = 2.60, 95% CI: 1.86–3.63).

Conclusions: The presence of PNI significantly affected OS, DFS and DSS in patients with HNSCC.