Ultrasound in patients with treated head and neck carcinomas: A retrospective analysis for effectiveness of follow-up care

Correct follow-up is necessary to avoid under- or overtreatment in the care of patients with treated carcinomas of head and neck. Ultrasound is a cost-effective, harmless, easy, and feasible method. It can be applied in the outpatient clinic in follow-up but the United Kingdom National Multidisciplinary guidelines are recommended computed tomography or magnetic resonance imaging for the detection of metastasis for head and neck carcinomas in the follow-up period. The purpose of the study was to state that neck ultrasound would be the method of choice on follow-up care of Chinese patients who received primary treatment for carcinoma of head and neck.Patients who received primary treatment for carcinoma of the head and neck were examined for 5-years in follow-up through physical, clinical, and neck ultrasound (n = 198). If patients had no evidence of disease after 60 months of definitive therapy considered as a cure. If patients had no evidence of disease after 36 months of salvage therapy considered as a cure of recurrence.Irrespective of definitive treatment used, the study was monitored through neck ultrasound during 5 years of a follow-up visit and was reported cure in 126 (64%) patients and recurrence in 72 (36%; distant metastasis: 33 [17%], local recurrence: 24 [12%], and regional recurrence: 15 [7%]) patients. Primary tumor stage IV, III, II, and I had 63% (15/24), 51% (21/41), 32% (18/56), and 23% (18/77) recurrence, respectively. The time to detect regional recurrence was shorter than that for local recurrence (P < .0001, q = 15.059) and distant recurrence (P < .0001, q = 7.958). Local recurrence and stage I primary tumor had the highest percentage cure for recurrence.Neck ultrasound in the follow-up period is reported to be effective for the detection of recurrence of patients who received primary treatment for carcinoma of head and neck especially regional recurrence and primary tumor stage I.Level of Evidence: III.     

Improving lung cancer screening rates among patients with head and neck cancer in a radiation oncology clinic

BackgroundThe United States Preventive Services Task Force (USPSTF) recommends lung cancer screening via annual low dose computed tomography (LDCT) for high risk patients. Despite the strong evidence of a mortality benefit from several randomized clinical trials, rates of lung cancer screening remain low. We plan to assess how screening guidelines are implemented in a radiation oncology clinic for patients with head and neck cancer.MethodsA single institution, retrospective chart review was used to identify patients with head and neck cancer seen in a radiation oncology clinic who were potentially eligible for lung cancer screening under the current USPSTF guidelines. Patients who were potentially screening-eligible were enrolled in a phone survey to assess their knowledge about lung cancer screening and willingness to be screened.ResultsOf the 184 patients with head and neck cancer seen in the clinic, 8 (4%) patients were eligible for lung cancer screening under the previous USPSTF recommendations, including 1 (0.5%) patient already being screened. One patient (0.5%) became eligible under the expanded guidelines. All 184 patients had smoking history documented. Of the 87 current or former smokers, there were 24 (28%) who did not have pack-years documented; of the 82 former smokers, there were 8 (10%) who did not have quit date documented. Among the 16 phone survey participants (response rate: 70%) only 6 (38%) were aware there is a way to screen for lung cancer and 12 (75%) patients would be interested in screening if they are found to be eligible.ConclusionsThese findings highlight a potential opportunity to increase rates of lung cancer screening among patients with head and neck cancer by both enhancing provider awareness as well as patient education at the community level.     

Evaluation of tissue and serum VEGF in patients with head and neck carcinoma

Serum vascular endothelial growth factor (VEGF) was measured in 54 cancer patients with head and neck carcinoma. In addition, tumor VEGF was examined by immunohistochemistry in sections of biopsies obtained within 4 weeks to serum sampling in 37 of these patients. Serum VEGF levels were higher in the sera of the tumor patients than in the sera of healthy control subjects (P < 0.005). Patients with stage II–IV tumors showed increased levels of serum VEGF, whereas patients with stage I tumors did not. The receiver operating characteristics (ROC) of serum VEGF were similar to those observed with TPS (tissue protein specific antigen). Immunohistochemistry of tissue sections showed that 24/37 tumors were VEGF positive. No connection was observed between strong VEGF staining of tumor tissue sections and high levels of serum VEGF. We conclude that serum VEGF could be a useful marker for monitoring head and neck carcinoma patients, but that serum and tissue VEGF levels do not appear to correlate with each other. This revised version was published online in June 2006 with corrections to the Cover Date.     

Nomograms for predicting overall survival and cancer-specific survival in patients with head and neck non-Hodgkin lymphoma: A population-based study

This study aimed to develop comprehensive nomograms for patients with head and neck non-Hodgkin lymphoma (H&NNHL) to determine their overall survival (OS) and cancer-specific survival (CSS). In this study, 602 H&NNHL patients were analyzed from the Surveillance, Epidemiology, and End Results database. The R software was used to randomly divide the patients into the training cohort (n = 421) and the validation cohort (n = 181) in a 7-to-3 ratio. To develop nomograms for projecting OS and CSS, multivariable Cox regression was used to acquire independent predictive factors. We have constructed nomograms to predict the 3-, 5-, and 8-year OS and CSS probabilities of H&NNHL patients. The consistency index of the nomograms for OS (CSS) was 0.74 (0.778) and 0.734 (0.775), in the training and validation cohort respectively, and was higher than that of the Ann Arbor staging system. Calibration plotting showed that our models have good calibration ability. Moreover, assessments of the area under the time-dependent receiver operating characteristics curve, net reclassification improvement, integrated discrimination improvement and decision curve analysis demonstrated that our nomograms performed better and were more clinically useful than the Ann Arbor staging system. This is the first research to establish comprehensive nomograms for predicting OS and CSS in patients with H&NNHL at 3-, 5-, and 8-year. The validation of the models demonstrated good performance. It can provide clinicians with reference information for determining customized clinical treatment options and providing personalized prognoses.Indexes such as the concordance index, the area under the time-dependent receiver operating characteristics curve, calibration curves, the net reclassification improvement, the integrated discrimination improvement, and decision-curve analysis were used to compare new survival models to the classical Ann Arbor staging system.     

Routine endoscopic screening for synchronous esophageal neoplasm in patients with head and neck squamous cell carcinoma: a prospective study

Early detection of synchronous esophageal squamous cell neoplasm (ESCN) in head and neck squamous cell carcinoma (HNSCC) patients can significantly affect their prognosis. We investigated the prevalence of synchronous ESCN and the risk factors for developing ESCN in patients with HNSCC, and evaluated the effect of routine endoscopic screening in these patients. Subjects who were diagnosed as HNSCC from May 2010 to January 2014 were eligible. All patients underwent conventional white light endoscopic examinations with narrow band imaging and Lugol chromoendoscopy. Among 458 subjects screened, 28 synchronous ESCN were detected in 24 patients (5.2%). The prevalence of ESCN was greatest in patients with hypopharyngeal cancer (20.9%). In multivariate analysis, pyriform sinus involvement was independent risk factor for developing synchronous ESCN (odds ratio 171.2, P < 0.001). During the follow‐up period (median, 24 months), the 3‐year overall survival rates was significantly lower in patients with ESCN than in patients without ESCN (54.2% vs. 78.3%, P = 0.0013). Routine endoscopic screening for detecting synchronous ESCN should be recommended for patients with HNSCC, especially those with pyriform sinus involvement.     

综合性康复治疗对老年头颈部肿瘤患者放疗后生活质量的影响

目的探讨综合性康复治疗对老年头颈部肿瘤患者放疗后情绪、营养状况和生活质量的影响。方法选取2015年6月至2017年6月在吉林大学中日联谊医院放疗科完成放疗的老年头颈部肿瘤患者62例,采用随机数字表法分为康复组(n=31)和对照组(n=31)。对照组接受常规健康咨询和随访;康复组在此基础上接受包括心理疏导、体力锻炼、吞咽训练和营养干预的综合性康复治疗。在放疗结束和放疗后6个月时,2组患者均接受老年抑郁量表(GDS)、微型营养评估简表(MNA-SF)和生活质量调查表(QLQ-C 30)评价。采用SPSS 19.0统计软件进行统计分析,计量资料以均数±标准差表示,组间比较采用t检验,计数资料以例数(百分率)表示,组间比较采用χ~2检验。结果放疗结束时,2组患者GDS、MNA-SF、QLQ-C 30评分差异均无统计学意义。放疗后6个月时,康复组的GDS评分[(7.35±1.75)vs(10.20±1.94)]、MNA-SF评分[(10.85±3.23)vs(9.56±4.21)]和QLQ-C 30评分[(57.84±9.57)vs(49.73±10.01)]均明显优于对照组(P0.05);而对照组MNA-SF评分较放疗结束时明显改善[(9.56±4.21)vs(8.24±4.05),P0.05]。结论综合性康复治疗可更有效改善老年头颈部患者放疗后的抑郁状态和营养状况,提高患者的生活质量。     

头颈部鳞状细胞癌中SP100蛋白的表达及其临床意义

目的探讨SP100蛋白在头颈部鳞状细胞癌（HNSCC）中的表达及临床意义。方法应用免疫组织化学法检测SP100蛋白在128例头颈部鳞状细胞癌及相应的癌旁黏膜组织中的表达情况,并分析其与HNSCC临床病理因素之间的关系。结果 SP100蛋白表达定位于细胞核和细胞质内,在正常黏膜上皮细胞和分化良好的癌细胞中,以细胞核内染色为主;在低分化癌细胞中,在细胞质内呈弥漫性分布。SP100蛋白在癌旁正常黏膜上皮组织中呈中度阳性和强阳性表达,阳性表达率89.1%（114/128）、阴性表达率10.1%（14/128）,在HNSCC原发灶中分别为37.5%（48/128）和62.5%（80/128）（P〈0.05）。SP100蛋白表达水平与癌细胞病理分化程度密切相关（P〈0.05）,与患者性别、年龄、P-TNM分期、淋巴结转移无相关性。结论 HNSCC不同分化程度细胞中存在SP100蛋白的差异化表达。     

Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study

BACKGROUNDHepatorenal syndrome (HRS) is a severe complication of cirrhosis with high mortality, which necessitates accurate clinical decision. However, studies on prognostic factors and scoring systems to predict overall survival of HRS are not enough. Meanwhile, a multicenter cohort study with a long span of time could be more convincing.AIMTo develop a novel and effective prognostic model for patients with HRS and clarify new prognostic factors. METHODSWe retrospectively enrolled 1667 patients from four hospitals, and 371 eligible patients were finally analyzed to develop and validate a novel prognostic model for patients with HRS. Characteristics were compared between survivors and non-survivors, and potential prognostic factors were selected according to the impact on 28-d mortality. Accuracy in predicting 28-d mortality was compared between the novel and other scoring systems, including Model for End-Stage Liver Disease (MELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Chinese Group on the Study of Severe Hepatitis B-Acute-on-Chronic Liver Failure (COSSH-ACLF). RESULTSFive prognostic factors, comprised of gender, international normalized ratio, mean corpuscular hemoglobin concentration, neutrophil percentage, and stage, were integrated into a new score, GIMNS; stage is a binary variable defined by the number of failed organs. GIMNS was positively correlated with MELD, CLIF-SOFA, and COSSH-ACLF. Additionally, it had better accuracy [area under the receiver operating characteristic curve (AUROC): 0.830] than MELD (AUROC: 0.759), CLIF-SOFA (AUROC: 0.767), and COSSH-ACLF (AUROC: 0.759) in the derivation cohort (P < 0.05). It performed better than MELD and CLIF-SOFA in the validation cohort (P < 0.050) and had a higher AUROC than COSSH-ACLF (P = 0.122).CONCLUSIONWe have developed a new scoring system, GIMNS, to predict 28-d mortality of HRS patients. Mean corpuscular hemoglobin concentration and stage were first proposed and found to be related to the mortality of HRS. Additionally, the GIMNS score showed better accuracy than MELD and CLIF-SOFA, and the AUROC was higher than that of COSSH-ACLF.     

Efficacy of GMI,a fungal immunomodulatory protein,for head and neck cancer patients with chemotherapy-related oral mucositis: An open-labeled prospective single-arm study

Background:Cancer patients usually suffer from intensive chemotherapy-related oral mucositis (OM), yet limited effective treatment can rapidly alleviate OM severity.Methods:This prospective study examined the efficacy of Reishimmune-S containing one fungal immunomodulatory protein, GMI on OM in patients with head and neck cancer. Patients with head and neck cancer and the diagnosis of chemotherapy-related OM were enrolled randomizedly to receive standard supportive care with/without Reishimmune-S 500 mg/day orally for consecutive 14 days. Due to intolerance to standard supportive care alone in the control arm, only the experimental arm with Reishimmune-S supplementation was analyzed in our trial. OM grading was evaluated as the primary outcome on day 1, 8, and 15. Secondary outcomes were absolute neutrophil counts and quality of life assessed by the EORTC-QLQ-H&N 35 questionnaire on day 1, 8, and 15.Results:Reishimmune-S supplement significantly reduced OM grading both at day 8 and 15. Trouble with social contact and weight loss conditions were also improved by Reishimmune-S. Reishimmune-S did not significantly affect absolute neutrophil counts during the 15-day follow-up.Conclusion:Reishimmune-S supplement potentially alleviates the severity of chemotherapy-mediated OM.     

The effect of comprehensive oral care program on oral health and quality of life in patients undergoing radiotherapy for head and neck cancer: A quasi-experimental case-control study

Objectives:The purpose of this study is to investigate the effect of the comprehensive oral care program on oral health status and symptoms in head and neck cancer (HNC) patients undergoing radiotherapy.Methods:This was a quasi-experimental study using a non-equivalent control group in non-synchronized design. All participants including control and experimental group were asked for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire H&N35 (EORTC QLQ-H&N35) and given an oral health education 4 times at baseline, immediate postradiotherapy, 3 months after radiotherapy, and 6 months after radiotherapy. In each visit except for final, the experimental group was given fluoride varnish application and fluoride mouth rinsing solution for daily use. Oral health examination for dental caries, plaque score (PS), bleeding on probing (BOP), and salivary flow rate was performed in baseline and 6 months after radiotherapy. Statistical analyses were done by paired t-tests and mixed ANCOVA repeated-measures analysis.Results:From November 1, 2013 to October 31, 2015, a total 61 patients undergoing radiotherapy for HNC cancer were enrolled (30 in control and 31 in experimental groups). Decrease in salivary flow rate was comparable between 2 groups. Dental caries increased in control group (P = .006); PS and BOP were decreased in experimental group (P < .001 and .004, respectively). Experimental group showed lower swallowing, speech problems, and less sexuality scores in EORTC QLQ-H&N35 than control group.Conclusion:We found improvement in oral health and the quality of life in HNC patients with comprehensive oral care intervention by dental professionals. Communicating and cooperating between the healthcare and dental professionals is needed to raise the quality of health care services for HNC patients receiving radiotherapy.     

Risk of second primary malignancy in patients with sinonasal tumors: a population‐based cohort study

Background

The 5‐year overall survival rate for patients with sinonasal cancers has remained around 50% for the last 3 decades. Prior studies on head and neck cancers have suggested that 1 reason for poor survival is the frequent development of second primary malignancies (SPMs). The purpose of this study is to assess overall and site‐specific risks of SPM following treatment of sinonasal malignancy.

Methods

A retrospective, population‐based cohort study was performed on 2614 patients in the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with primary sinonasal malignancy between 1973 and 2014. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) were calculated to assess risk of SPM relative to incidence in the general population.

Results

A total of 422 (16.1%) patients with primary sinonasal malignancies developed a total of 480 SPMs. This cohort had a significantly higher frequency of SPMs than expected in the general population (SIR 1.32; 95% confidence interval [CI], 1.20 to 1.44; AER 53.41). Site‐specific analyses of SIRs suggested highest risk of malignancy in the sinonasal tract (SIR 75.64; 95% CI, 53.53 to 103.83; AER 17.22), followed by bone, eye and orbit, oral cavity and pharynx, and lung and mediastinum.

Conclusion

Patients with history of sinonasal cancer are at significantly increased risk of developing an SPM. Careful monitoring for development of additional tumors may be warranted.

     

Physical activity is associated with decreased incidence of chronic kidney disease in type 2 diabetes patients: A retrospective cohort study in Taiwan

AimsTo assess the effect of physical activity in patients with type 2 diabetes mellitus on prevention of diabetes with chronic kidney disease.MethodsThis is a cohort study on stratified selected subjects in Taiwan from 2004/01/01 to 2005/12/31. Demographic data, lifestyle factors and clinical characteristics were analyzed for an association with the occurrence of chronic kidney disease. Applicable analysis weights, Stata 11.0, were applied to adjust the design variables for clustering and stratification.ResultsDuring the two year study period, the univariate Cox proportional hazards model showed significant associations of age, physical activity, and the Charlson comorbidity index (CCI) with chronic kidney disease. Physical activity had a beneficial effect in diabetic subjects with chronic kidney disease (HR: 0.31, p < 0.01). Older age and a CCI greater than 2 were both harmful in diabetic subjects with chronic kidney disease (1.06 and 3.44, respectively). The results of a multivariate Cox proportional hazards evaluation model were similar to those of a univariate evaluation model, except that CCI was not significantly different. Moreover, medications for hypertension of diabetic subjects created an increased risk of chronic kidney disease (HR: 5.85 and 3.74, respectively), indicating that the presence of hypertension is a strong risk factor for the progression of chronic kidney disease.ConclusionIn this study, physical activity was not only a healthful lifestyle factor but also a treatment to decrease incidence of chronic kidney disease in diabetic patients.     

Association of aldehyde dehydrogenase 2 gene polymorphism with multiple oesophageal dysplasia in head and neck cancer patients

BACKGROUND: Multiple occurrences of oesophageal dysplasia are frequently observed in head and neck cancer patients, and closely associated with alcohol consumption. Acetaldehyde, the first metabolite of ethanol, is thought to play an important role in the carcinogenesis of the upper aerodigestive tract. AIM: To investigate if genetic polymorphism in alcohol metabolising enzymes (ADH3, alcohol dehydrogenase 3; ALDH2, aldehyde dehydrogenase 2) is associated with oesophageal multiple dysplasia in head and neck cancer patients. METHODS: Thirty one consecutive patients with head and neck cancer were included in the study. Multiple oesophageal dysplasia was detected endoscopically as multiple Lugol voiding lesions (multiple LVL) using the Lugol dye staining method. The ADH3 and ALDH2 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: Among the 31 patients with head and neck cancer, 17 had multiple LVL. Multiple LVL were closely associated with a second primary oesophageal carcinoma in head and neck cancer patients (odds ratio 60.7, 95% CI 5.6-659). Furthermore, the mutant ALDH2 allele was significantly more prevalent in patients with multiple LVL (65% v 29%; p<0.05) whereas no difference was observed in ADH3 polymorphism. CONCLUSIONS: The mutant ALDH2 allele appears to be a risk indicator for multiple LVL in head and neck cancer patients. Accumulation of acetaldehyde due to low ALDH2 activity may play a critical role in cancerous changes throughout the mucosa in the upper aerodigestive tract.     

Preoperative biliary drainage in severely jaundiced patients with pancreatic head cancer: A retrospective cohort study

BackgroundGuidelines recommend against preoperative biliary drainage (PBD) in patients with pancreatic head cancer if bilirubin levels are <250 μmol/l. However, patients with higher bilirubin levels undergo PBD, despite the lack of supporting evidence. This study aims to evaluate outcomes in patients with a bilirubin level ≥250 and < 250.MethodsPatients were identified from databases of 3 centers. Outcomes were compared in patients with a bilirubin level ≥250 versus <250 both at the time of diagnosis and directly prior to surgery.Results244 patients were included. PBD was performed in 64% (123/191) with bilirubin <250 at diagnosis and 91% (48/53) with bilirubin ≥250. PBD technical success (83% vs. 81%, p = 0.80) and PBD related complications (33% vs. 29%, p = 0.60) did not differ between these groups.Analyzing bilirubin levels ≥250 versus <250 directly prior to surgery, no differences in severe postoperative complications and mortality were found.ConclusionsIn patients with a pancreatic head cancer, PBD technical success and complications, and severe postoperative complications did not differ between patients with a bilirubin level ≥250 and < 250. Our study does not support a different approach regarding PBD in patients with severe jaundice.     

Prognostic significance of plasma prostaglandin E concentration in patients with head and neck cancer

Summary Plasma prostaglandin E (PGE) levels were determined by radioimmunoassay in 53 patients with various stages (II, III, and IV) of hypoharyngeal and laryngeal sequamous cell carcinoma, in 12 non-cancer patients and in 10 healthy volunteers. The mean PGE concentration was somewhat higher in non-cancer patients (mean ± SD=34.6±5.37 pg/ml) than in healthy subjects (28.1±4.96 pg/ml). In spite of a high data variability, the mean preoperative PGE levels in cancer patients were proportional to the stage of the disease and higher than in non-cancer patients (41.2±19.7 pg/ml, 52.8±26.7 pg/ml and 82.0±34.9 pg/ml in stages II, III and IV respectively). The mean plasma PGE concentration significantly decreased for all tumour stages 15–30 days after surgical removal of the tumour, but rose again in some patients within 6–18 months after surgery. The incidence of tumour recurrences 6 and 18 months after surgery was significantly higher in patients with an increased preoperative PGE level (>43.3 pg/ml) than in those patients with a PGE level within the normal range (<43.3 pg/ml). The mortality was also higher in the former group, but the difference did not reach the level of significance. Similarly, the mean preoperative and most postoperative concentrations of PGE were significantly higher in patients in whom tumour recurred within 18 months than in tumour-free patients.