外周血中性粒细胞与淋巴细胞比值以及血小板与淋巴细胞比值评估声门型喉癌患者预后的价值

目的 探讨外周血中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）与声门型喉鳞状细胞癌患者预后的关系。方法 收集115例有明确病理诊断的声门型喉鳞状细胞癌患者的临床病理及随访资料,通过建立受试者工作特征曲线（ROC曲线）,确定术前外周血NLR及PLR预测术后生存的最佳截点,以此将患者分为低NLR和高NLR组以及低PLR和高PLR组,分析NLR及PLR与患者的临床病理特征之间的关系,并通过单因素及多因素分析评估术前外周血NLR及PLR对患者术后生存的影响。结果 115例患者中获得随访107例,失访8例,随访率为93.0%。随访患者中27例死于喉鳞状细胞癌,80例生存。根据ROC曲线计算出PLR、NLR的临界值分别为139.79和2.83。107例声门型喉鳞状细胞癌患者的5年生存率为74.8%,其中低PLR组患者的5年生存率为82.7%;高PLR组患者的5年生存率为56.3%,差异具有统计学意义（P=0.004）。低NLR组患者的5年生存率为81.8%;高NLR组患者的5年生存率为56.7%,差异具有统计学意义（P=0.003）。单因素分析显示,声门型喉鳞状细胞癌患者的预后与患者的T分期、有无淋巴结转移、NLR水平和PLR水平有关（P均<0.05）。多因素分析显示,PLR水平以及NLR水平为影响声门型喉鳞状细胞癌患者预后的独立因素（P均<0.05）。结论 PLR和NLR可能是影响声门型喉鳞状细胞癌患者预后的独立因素。     

耳部恶性肿瘤12例临床分析

目的 探讨耳部恶性肿瘤的治疗策略。方法 回顾性分析2014年3月—2020年12月收治的12例耳部恶性肿瘤患者的临床资料,其中鳞状细胞癌6例,腺样囊性癌6例;10例为初诊患者,根据改良匹兹堡分期标准,10例初诊患者中T1者1例,T3者3例,T4者6例,2例复发患者无法分期;4例手术切除,8例综合治疗(手术+放/化疗)。手术方式包括颞骨外侧切除术1例,颞骨次全切除术10例,颞下窝B型入路1例。利用生命表法计算生存率和Log-rank检验比较患者的生存差异。结果 随访8~53个月,3年生存率73%;单因素分析提示切缘阳性(P=0.033)与不良预后相关。结论 耳部恶性肿瘤发病率低且病程隐匿,手术切除结合术后放疗是有效的治疗方法。     

29例外伤性大脑半球间硬膜下血肿的临床分析

目的 探讨外伤性大脑半球间硬膜下血肿(TISH)的治疗方法和预后。方法 回顾性分析华中科技大学同济医学院附属同济医院2014年8月—2019年5月收治的29例TISH患者的临床资料。患者治疗后2周由Glasgow预后量表(GOS)评估短期疗效。GOS 1~3分为疗效差,GOS 4~5分为疗效好。结果 疗效良好者20例,占69.0%,疗效差者9例,占31.0%。疗效好组治疗后2周Glasgow昏迷评分(GCS)平均为(14.6±0.7)分,疗效差组为(9.4±2.2)分,两组间比较差异具有统计学意义(P＜0.001)。单因素分析显示影响TISH疗效的因素包括合并合并脑挫裂伤(P=0.032),入院时GCS评分(P＜0.001),住院期间病变变化(P=0.049),住院期间GCS极低值(P＜0.001),治疗方式(P=0.016)和手术方式(P＜0.05)。重症TISH患者(GCS≤8分)中7例行手术治疗,3例非手术治疗。手术组预后良好者4例,预后差者3例;而非手术组3例患者短期预后均较差。结论 TISH临床少见,多数患者病情较轻经保守治疗效果较好。部分患者出现迟发性出血,颅内压增高,神经功能障碍等,需严密监护。重症TISH患者手术治疗能够改善预后。     

男性阻塞性睡眠呼吸暂停低通气综合征患者血液学指标与睡眠呼吸暂停低通气指数的关系

目的 了解男性阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的血液常规及生化指标和睡眠呼吸暂停低通气指数（AHI）的关系。方法 对2011年1月—2019年12月住院手术治疗且入院前整夜睡眠监测数据完整的474例成年男性患者进行回顾性研究。根据AHI将患者分为4组：A组（AHI<30次/h，56例）、B组（30次/h≤AHI<60次/h，162例）、C组（60次/h≤AHI<90次/h，217例）和D组（AHI≥90次/h，39例）。收集的数据包括睡眠参数、Epworth嗜睡量表评分（ESS）、血液常规及生化指标和人口统计学特征。结果 4组患者的红细胞计数、血小板计数、白细胞计数、中性粒细胞、谷丙转氨酶（ALT）、谷草转氨酶（AST）、AST/ALT、葡萄糖、尿酸、甘油三酯、高密度脂蛋白差异均具有统计学意义（P<0.05）；高密度脂蛋白和甘油三酯与AHI的线性相关性较好，且前者呈负相关，后者呈正相关（r=-0.252，r=0.192）；多元线性回归分析表明红细胞计数（β=0.140，P=0.004）和甘油三酯（β=0.122，P=0.017）与AHI独立相关，多个相关系数R²=0.332。结论 高密度脂蛋白、甘油三酯与AHI的线性相关性较好，且前者呈负相关（r=-0.252），后者呈正相关（r=0.192），红细胞计数、甘油三酯与AHI独立相关，有潜力成为判断经多导睡眠监测（PSG）检查后诊断为OSAHS患者综合严重程度的辅助指标。     

耳内镜下鼓室成形术治疗慢性化脓性中耳炎术后听力恢复不良的相关因素分析

目的 分析耳内镜下鼓室成形术对静止期慢性化脓性中耳炎患者听力恢复不良的相关因素。方法 选择2017年2月-2019年11月在四川省八一康复中心治疗的静止期慢性化脓性中耳炎患者131例，所有患者均在全身麻醉下行耳内镜鼓室成形术。根据手术后6个月行纯音测听检测结果，骨气导间距（ABG）的不同将患者分为两组，ABG ≤ 20 dB为听力良好组，ABG>20 dB为听力不良组。采用单因素分析术后听力改善不良的原因及多因素Logistic回归法分析各因素对患者听力的综合作用。结果 术后ABG ≤ 20 dB患者81例，ABG>20 dB患者50例。两组患者因镫骨、鼓膜张肌腱、鼓室黏膜、咽鼓管、人工听骨类型及人工听骨材料的不同，导致术后听力差异具有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，镫骨完整并活动（OR=0.606，95%CI=0.393~0.919）、镫骨完整活动不佳（OR=0.563，95%CI=0.329~0.844）、存在鼓膜张肌腱（OR=1.913，95%CI=1.508~2.449）、咽鼓管通畅（OR=1.818，95%CI=1.417~2.328）及人工听骨材料为钛合金（OR=2.250，95%CI=1.816~2.755）为慢性化脓性中耳炎患者行耳内镜下鼓室成形术后影响听力恢复的独立危险因素。结论 耳内镜下鼓室成形术可一定程度改善静止期慢性化脓性中耳炎患者听力，其听力恢复效果受镫骨状况、鼓膜张肌腱、咽鼓管功能及人工听骨材料的影响。     

甲状腺乳头状癌患者甲状腺肿瘤特征对颈侧区淋巴结转移的影响

目的 研究甲状腺乳头状癌患者甲状腺肿瘤特征对颈侧区淋巴结转移的预测作用。方法 回顾性分析2017年1月—2020年12月手术治疗的甲状腺乳头状癌患者的临床资料509例,男105例,女404例;年龄18~85岁,平均(45.38±14.85)岁。其中临床分期Ⅰ期382例,Ⅱ期127例。采用多因素二元Logistic回归分析甲状腺乳头状癌患者颈侧区淋巴结转移的影响因素。结果 根据病理诊断结果是否存在颈侧区淋巴结转移,其中178例患者存在颈侧区淋巴结转移,331例患者不存在颈侧区淋巴结转移。存在颈侧区转移和不存在颈侧区转移的患者临床资料比较发现,存在颈侧区转移的患者中年龄<40岁、肿瘤最大直径>2 cm、转移中央区淋巴数量>5个、多灶性以及鼠类肉瘤滤过性毒菌致癌基因同源体B1(v-raf murine sarcoma viral oncogene homolog B1,BRAF)不存在突变的患者比例显著高于存在颈侧区转移的患者(P<0.05)。采用多因素二元Logistic回顾分析结果发现肿瘤最大直径>2 cm (OR=3.482,95%CI:1.482~5.642,P=0.000)、转移中央区淋巴结数量>5个(OR=6.583,95%CI:2.384~12.373,P=0.000)、多灶性(OR=3.473,95%CI:1.387~8.684,P=0.032)以及BRAF不存在突变(OR=3.952,95%CI:1.489~9.572,P=0.000)是甲状腺乳头状癌发生颈侧区淋巴结转移的独立危险因素。结论 肿瘤最大直径>2 cm、转移中央区淋巴数量>5个、多灶性以及BRAF不存在突变是甲状腺乳头状癌患者出现颈侧区淋巴结转移的独立危险因素。     

组织蛋白酶B在鼻咽癌患者组织和血清中的表达及临床意义

目的 通过测定组织蛋白酶B （Capthesin B）在鼻咽癌组织和血清标本中的表达量,探讨Capthesin B作为评估鼻咽癌患者治疗预后的可行性。方法 收集长沙金域医学检验中心2019年8月—2020年2月50例鼻咽癌组织和癌旁正常组织标本,免疫组织化学（IHC）检测组织标本Capthesin B表达,比较分析蛋白表达差异。收集湖南省肿瘤医院2019年7月—2020年3月106例鼻咽癌患者治疗前、治疗后及40例健康体检者的血清标本,ELISA试验检测血清Capthesin B浓度,并比较分析3组间的血清Capthesin B浓度。结果 IHC结果显示,鼻咽癌组织Capthesin B阳性率显著高于癌旁正常组织（P< 0.001）。ELISA结果表明,鼻咽癌患者血清Capthesin B 1.23（0.64,2.27） ng/mL显著高于健康体检组的（0.98 ±0.49） ng/mL （P< 0.05）,鼻咽癌患者治疗后血清Capthesin B 0.69（0.39,1.42） ng/mL显著低于治疗前的1.23（0.64,2.27） ng/mL （P<0.001）。TNM分期III、IV患者血清Capthesin B （2.09 ±1.50） ng/mL显著高于I、II期患者的1.14（0.60,2.12） ng/mL,提示Capthesin B水平与TNM分期显著相关（P<0.05）。鼻咽癌颈淋巴结转移组血清Capthesin B （2.63±1.67） ng/mL显著高于未转移组的1.10（0.59,2.14） ng/mL （P<0.01）,提示Capthesin B与转移相关。工作特征（ROC）曲线下面积（AUC）为0.670（P<0.001）,提示血清Capthesin B可作为鼻咽癌疗效预测的参考指标。结论 鼻咽癌组织Capthesin B高表达和患者血清Capthesin B浓度明显升高,治疗后其浓度降低,提示Capthesin B与鼻咽癌发生发展密切相关。Capthesin B与肿瘤淋巴结转移及TNM分期呈正相关,提示Capthesin B可作为鼻咽癌治疗预后的参考指标。     

不同时机鼓室内注射糖皮质激素治疗重度以上突发性聋的疗效分析

目的 观察全身联合不同时机鼓室内注射糖皮质激素治疗重度以上突发性聋的疗效,探讨鼓室内注射时机,分析影响重度以上突发性聋预后的因素。方法 回顾性分析108例重度以上突发性聋患者的临床资料及治疗效果,其中全身联合初始鼓室组64例,全身联合延后鼓室组44例;对两组患者出院时与随访时疗效分别进行比较,并分析治疗有效组和无效组临床特征。结果 出院时和随访时两种治疗方案平均听阈、平均听阈改善值、总有效率比较差异均无统计学意义（P均>0.05）,两种治疗方案痊愈率比较差异具有统计学意义（P<0.05）。两种治疗方案治疗前与出院时、治疗前与随访时分别比较差异均具有统计学意义（P均<0.001）。108例患者中,有效83例（76.9%）,伴眩晕者治疗有效率低（P<0.05）,治疗有效率与患者初始听阈损失程度（P<0.05）及听力曲线类型（P<0.05）相关,与年龄、性别、侧别、是否伴发耳鸣均无明显相关性（P均>0.05）。结论 对于重度以上突发性聋,听力损失程度、曲线类型、是否伴发眩晕与预后相关,治疗上建议尽早全身联合局部应用糖皮质激素。     

扩散加权成像和临床分期在鼻咽癌预后评估中的价值

目的探讨扩散加权成像(DWI)测量的表观扩散系数值(ADC)和鼻咽癌2017分期在预后评估中的价值。方法回顾性分析90例鼻咽癌患者的临床和影像资料,评估原发肿瘤ADC值与鼻咽癌分期的相关性。治疗后进行随访,患者的中位随访时间为54个月(5~90个月),根据疾病进展情况分为疾病进展组(29例)和非进展组(61例),探讨影响鼻咽癌预后的因素。结果Ⅰ、Ⅱ期患者原发肿瘤ADC值显著高于Ⅲ期和Ⅳa期患者(P＜0.05)。T1、T2期患者原发肿瘤ADC值显著高于T4期患者(P＜0.05)。多因素分析显示,Ⅳa期较Ⅰ~Ⅲ期发生疾病进展的风险更大(OR=3.497,P=0.001)。结论鼻咽癌原发肿瘤ADC值与我国鼻咽癌2017分期相关。临床分期是鼻咽癌预后的预测因子。     

先天性耳廓畸形耳模矫正的疗效分析

目的 分析先天性耳廓畸形耳模矫正治疗的临床疗效。方法 回顾2019年1月—2021年12月在湖南省妇幼保健院耳鼻咽喉科门诊进行耳模矫正的201例（318耳）先天性耳廓畸形患儿，按患儿开始治疗的日龄将其分为3组：109例（181耳）<14 d的患儿为1组，75例（117耳）14～42 d的患儿为2组，17例（20耳）43～89 d的患儿为3组；分析3组患儿的治疗效果、治疗时长、并发症发生率等。结果 201例（318耳）先天性耳廓畸形患儿治疗的显效及治愈率为93.4%，佩戴时长平均（32.4±10.8） d，并发症发生率45.9%。3组的治疗显效及治愈率分别为96.7％、90.6％、80.0％，组间差异具有统计学意义（χ²=10.479，P=0.005）；3组的矫正时长分别为（30.2±10.4）、（35.2±10.8）、（35.5±9.7） d，组间差异具有统计学意义（F=8.940，P=0.000）；3组的并发症发生率分别为37.0％、59.8％和45.0％，差异具有统计学意义（χ²=14.900，P=0.001）。结论 先天性耳廓畸形患儿通过耳模矫正可获得良好的治疗效果，14 d内开始治疗有助于提高治疗效率，缩短治疗时长，降低并发症发生率。     

Human papillomavirus co-infection and survival in oral and oropharyngeal squamous cell carcinoma: A study in 235 Brazilian patients

ObjectivesWhile unknown for oropharyngeal squamous cell carcinoma (OPSCC) and oral squamous cell carcinoma (OSCC), some studies assessing cervical carcinoma have shown that human papillomavirus (HPV) co-infection can be associated with its prognosis.MethodsThrough in situ hybridization (HPV and Epstein-Barr virus [EBV] probes) and immunohistochemistry (p16^INK4a, cyclin D1, p53, and Ki-67 antibodies), 126 OPSCC and 109 OSCC samples were assessed.ResultsAll patients were EBV-negative. OPSCC (25%) showed a significant association with HPV compared to OSCC (11%). Almost all HPV-associated cases were p16^INK4a-positive. Regarding OPSCC and OSCC, 23 and 7 cases were positive for high-risk HPV (HRHPV) only, 6 and 3 cases for low-risk HPV (LRHPV) only, and 3 and 2 cases for HRHPV/LRHPV, respectively. HPV-associated carcinomas showed a significantly higher proliferative index than HPV-unassociated carcinomas. Both carcinomas showed a similar overall survival rate, which was not affected by the HPV status. However, when comparing HPV-associated subgroups, patients with HRHPV/LRHPV-associated carcinomas showed worse survival.ConclusionLRHPV-associated and HRHPV/LRHPV-associated cases can also be detected when assessing OSCC and OPSCC. Further studies, especially in populations with a high prevalence of HPV-associated OPSCC, are necessary to understand the clinicopathological behavior of these neoplasm subgroups.     

Facility volume and survival: Human papilloma virus positive oropharyngeal squamous cell carcinoma

BackgroundTo analyze the impact of facility volume on survival for human papilloma virus positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC) patients.MethodsPatients treated for HPV+ OPSCC from 2010 to 2017 were queried from the National Cancer Database. Facilities of average annual case volume <50th percentile were categorized as low-volume (LV) and >95th percentile as high-volume (HV).Results11,546 were included, with 10,305 patients (89.3 %) treated at LV and 1241 (10.7 %) at HV facilities. A greater proportion of cases involving resection of base of tongue and lingual tonsil were treated at HV (30.3 %) compared to LV (22.3 %) facilities (p < 0.001). Patients treated at a HV facility had greater percentage of clinical T4 (11.2 % vs. 8.6 %, p = 0.001) and N+ disease (90.5 % vs. 85.7 %, p < 0.001) patients. Survival analysis showed no statistically significant difference between five-year overall survival rates by facility volume (p = 0.388) for all patients. On multivariable analysis, facility volume was not associated with survival (HR: 0.968 [0.758–1.235], p = 0.791). These trends were found for both patients undergoing primary surgery or chemoradiotherapy.ConclusionOur data indicates that patients with HPV+ OPSCC do not experience a survival benefit with treatment at HV facility, suggesting these patients may be adequately treated at LV centers.     

Treatment outcomes of transoral robotic and non-robotic surgeries to treat oropharyngeal,hypopharyngeal, and supraglottic squamous cell carcinoma: A multi-center retrospective observational study in Japan

ObjectivesThe aim of this multicenter retrospective cohort study was to compare efficacy and subsequent postoperative treatment between transoral robotic surgery (TORS) and any non-robotic transoral surgery in Japanese patients with early oropharyngeal squamous cell carcinoma (OPSCC), hypopharyngeal SCC (HPSCC), or supraglottic SCC (SGSCC).Materials and methodsClinical information and surgical outcomes were compared between patients with early-stage OPSCC, HPSCC, and SGSCC who underwent TORS (TORS cohort) and those who underwent non-robotic transoral surgery, including transoral videolaryngoscopic surgery (TOVS), endoscopic laryngopharyngeal surgery (ELPS), and transoral laser microsurgery (TLM) (non-robotic cohort). The data of the Head and Neck Cancer Registry of Japan (registry cohort) were used to validate the comparison. The main outcomes were the presence of positive margins under pathology and the requirement for postoperative therapy, including radiotherapy or chemoradiotherapy.ResultsSixty-eight patients in the TORS cohort, 236 patients in the non-robotic cohort, and 1,228 patients in the registry cohort were eligible for this study. Patients in the TORS cohort were more likely to have oropharyngeal tumor disease and T2/3 disease than those in the other cohorts (P<0.001 and P=0.052, respectively). The TORS cohort had significantly fewer patients with positive surgical margins than the non-robotic cohort (P=0.018), as well as fewer patients who underwent postoperative treatment, although the difference was not significant (P=0.069). In the subgroup analysis of patients with OPSCC, a total of 57 patients in the TORS cohort, 73 in the non-robotic cohort, and 171 in the registry cohort were eligible for the present study. Patients with OPSCC who underwent TORS were more likely to have lateral wall lesions than those in the other cohorts (P=0.003). The TORS cohort also had significantly fewer patients with positive surgical margins than the non-robotic cohort (P=0.026), and no patients in the TORS cohort underwent any postoperative treatment for OPSCC, although the difference was not significant (P=0.177).ConclusionsOur results suggest that TORS leads to fewer positive surgical margins than non-robotic transoral surgeries. The clinical significance of TORS may be further validated through the results of all-case surveillance for patients who underwent TORS running in Japan in the future.     

Tumor stromal desmoplasia and inflammatory response uniquely predict survival with and without stratification for HPV tumor infection in OPSCC patients

Abstract

Background: Oropharyngeal squamous cell carcinoma (OPSCC) positive for human papillomavirus (HPV) increases wolrd wide.

Aims/objectives: The objective for this study has been to evaluate tumor phenotypes and tumor host responses with respect to five-year disease-specific survival (DSS) in HPV(+) and HPV(?) patients.

Material and methods: Two hundred patients with OPSCC have been treated between 1992 and 2010. Histopathology slides from these patients have been morphologically evaluated in formalin-fixed, paraffin-embedded (FFPE) stained with hematoxylin–eosin (HE). From HE-stained sections tumor phenotype (keratinization, fraction of mature cancer cells and pattern of invasion) and tumor host responses (inflammation and stromal desmoplasia) were evaluated with respect to five years DSS.

Results: High tumor inflammatory response and low stromal desmoplasia had an independent effect predicting better five-year DSS among all patients and when analyzed separately in the HPV(?) and HPV(+) cohort of patients using a Cox regression survival analysis that also included standard clinical prognostic variables among OPSCC patients.

Conclusion: Tumor host responses, inflammation and stromal desmoplasia may become part of routine work-up in OPSCC patients due to prognostic value.

Significance: We present a method, accessible in most clinical locations and would give important additional information about prognosis in OPSCC patients.     

Peri-tumoral infiltrate associates with postoperative prognosis of patients with OSCC: Stronger association in HPV negative patients

PurposeThe current data on the relationship between local inflammatory infiltration and prognosis in oral squamous cell carcinoma (OSCC) are limited and controversial, especially in different HPV status. In this study, we analyzed the relationship between peri-tumoral inflammatory infiltrate (PTI) and HPV status and prognosis of patients with OSCC after surgery.MethodsA retrospective cohort of 99 primary OSCC patients who underwent surgery was constructed. P16 immunohistochemistry was used to determine HPV status. PTI was determined by hematoxylin-eosin staining and quantified into four levels: none (Score 0), weak (Score 1), moderate (Score 2) and strong (Score 3). The associations of PTI with clinico-pathological characteristics, HPV status and survival were examined.ResultsMost OSCC patients had weak to moderate PTI. PTI was significantly associated with lymph node metastasis (P = 0.041), and patients with moderate PTI had significantly better OS (P = 0.009) than those with no PTI. In HPV negative OSCC, patients with moderate PTI also had significantly better OS (P = 0.019) than those with no PTI. However, PTI was not significantly associated with survival in HPV positive OSCC.ConclusionsIn HPV negative OSCC, moderate PTI may suggest a better postoperative prognosis than no PTI.     

Clinical and molecular characteristics of HNSCC patients with brain metastases: a retrospective study

Among the metastasis patterns of head and neck squamous cell carcinoma (HNSCC), intracranial spread is a rare but dreaded event. To date only very few cases have been reported and clinical and molecular data are sparse. We screened our archives for HNSCC patients from 1992 to 2005 who were diagnosed with brain metastases (BM). For retrospective analysis, all clinico-pathological data including disease-free survival (DFS), local progression-free survival (LPFS), and overall survival (OS) were compiled. Additionally, we assessed the mutational status of the TP53 gene and the prevalence of HPV serotypes by PCR and Sanger sequencing. Immunohistochemistry was applied to detect p16INK4A expression levels as surrogate marker for HPV infection. The prevalence rate of BM in our cohort comprising 193 patients with advanced HNSCC was 5.7 %. Of 11 patients with BM, 3 were female and 9 were male. Seven of the primary tumors were of oropharyngeal origin (OPSCC). LPFS of the cohort was 11.8 months, DFS was 12.1 months and OS was 36.0 months. After the diagnosis of BM, survival was 10.5 months. Five tumors showed a mutation in the TP53 gene, while five of the seven OPSCC tumors had a positive HPV status displaying infection with serotype 16 in all cases. Compared with patients who harbored TP53wt/HPV-positive tumors, patients with TP53 mutations showed a poor prognosis. Compared with the whole cohort, the interval between diagnosis of the primary and the detection of BM was prolonged in the HPV-infected OPSCC subgroup (26.4 vs. 45.6 months). The prognosis of HNSCC patients with BM is poor. In our cohort, most tumors were OPSCC with the majority being HPV positive. Our study points toward a putatively unusual metastatic behavior of HPV-positive OPSCC.     

Carcinoma of the pyriform sinus: a retrospective analysis of treatment results over a 20-year period

One hundred and one patients with pyriform sinus carcinoma treated at the Netherlands Cancer Institute were studied retrospectively. The patients were staged according to the UICC criteria of 1987: there were no stage I, 23 stage II, 30 stage III, and 48 stage IV patients. The treatment consisted of radiotherapy (n= 45), a planned combination of surgery and post-operative radiotherapy (n= 47) or surgery alone (< = 9). The crude 5-year survival was 27%, whereas the 5-year disease-free survival was 37%. The locoregional disease-free survival was 52%. Stage according to the UICC 1987 criteria is an important prognostic variable (P= 0.0026). Furthermore, significantly less locoregional recurrences and a better disease-free survival were seen in the combined surgery and radiotherapy group than in the exclusively irradiated group (P < 0.0001).     

Presenting symptoms and clinical findings in HPV-positive and HPV-negative oropharyngeal cancer patients

Objectives: Oropharyngeal squamous cell carcinoma (OPSCC) is divided in two different disease entities depending on HPV involvement. We investigated differences in presenting symptoms and clinical findings in patients with HPV-positive and -negative OPSCC tumors.

Methods: Altogether 118 consecutive patients diagnosed with primary OPSCC between 2012 and 2014 at the Helsinki University Hospital were included. HPV-status of the tumors was assessed by PCR detection of HPV DNA and immunostaining with p16-INK4a antibody.

Results: Fifty-one (47.7%) of the patients had HPV-positive and 56 (52.3%) HPV-negative tumors. Forty-nine (49/51, 96.1%) of the HPV+ tumors were also p16+ showing high concordance. The most common presenting symptom among HPV+/p16+ patients was a neck mass (53.1%), whereas any sort of pain in the head and neck area was more frequently related to the HPV?/p16? (60.0%) group. HPV+/p16+ tumors had a tendency to locate in the tonsillar complex and more likely had already spread into regional lymph nodes compared with HPV?/p16? tumors. Smoking and heavy alcohol consumption were significantly more common among HPV?/p16? patients but also rather common among HPV+/p16+ patients.

Conclusions: This analysis of symptoms and signs confirm that OPSCC can be dichotomized in two distinct disease entities as defined by HPV status.     

鼻咽癌放疗中肿瘤退缩变化对大体肿瘤靶区的影响

目的 探讨鼻咽癌放疗中肿瘤退缩变化对大体肿瘤靶区的影响及调整放疗计划的必要性。方法 收集确诊的鼻咽癌患者52例,其中T1期5例、T2期17例、T3期19例和T4期11例。所有患者均接受放/化疗综合治疗。患者在放疗前及放疗疗程中的第20、22次分别进行1次放疗定位CT扫描。分别在2次定位CT扫描的图像上勾画GTV靶区,在Pinnacle计划系统内将前后2次CT扫描的图像及勾画的靶区进行匹配、融合,然后逐层比较前后2次勾画的GTV靶区的重合度,分别找出GTV靶区在前界、后界、左侧界及右侧界偏差最大的层面,测量并记录最大位移距离。按照肿瘤T分期将患者分为T1、T2、T3及T4共4组进行统计学分析。结果 放疗后GTV靶区在前、后及两侧界等4个边界上的退缩程度不同,在肿瘤前界上产生的最大位移距离最大,其中以T4期最大,为（4.7±1.2） mm,其后依次为后界、左右侧界。将所测量到的各个边界在不同T分期肿瘤中的最大位移距离分别进行方差分析,结果显示,后界、左右侧界的最大位移距离在不同T分期肿瘤中的差别具有统计学意义（F值分别为：17.26、19.35、3.51;P值分别为：0.001、0.001、0.03）,但前界的最大位移距离在不同T分期肿瘤中的差别无统计学意义（F=0.73,P=1.05）。结论 不同T分期肿瘤在4个边界上的退缩程度不同;当治疗前影像提示咽旁隙仅肿瘤压迫而非侵犯时及T4期肿瘤侵犯颅内时,放疗期间由于肿瘤的退缩,及时修改治疗计划非常必要,这样对于更好地保护正常组织器官功能有重要意义。