Indoleamine 2,3-dioxygenase expression is associated with chronic rhinosinusitis with nasal polyps and antrochoanal polyps

Chronic rhinosinusitis without and with nasal polyps (CRSwNP and CRSsNP), and antrochoanal polyps are different phenotypes with different pathomechanisms. Indoleamine 2,3-dioxygenase (IDO) is an enzyme expressed in many cells involved in the catabolism of the essential amino acid tryptophan to kynurenine. IDO might have a role in allergic airway inflammation. The aim was to evaluate if IDO expression is associated with CRSsNP, CRSwNP, or ACP. One hundred fifty specimens from the nasal cavity and sinus mucosa were immunohistochemically stained with mAb anti-IDO. The expression of epithelial and leukocyte IDO was associated with CRSwNP and ACP. The presence of ASA intolerance, asthma, atopy, smoking and use of medication did not significantly change the results. The different expression of IDO could putatively indicate the differences in the pathomechanisms of CRSsNP, CRSwNP and ACP. Further studies on the role of IDO in upper airways pathologies are required.     

Hypermethylation of DcR1, DcR2, DR4, DR5 gene promoters and clinical significance in tongue carcinoma

ObjectiveTongue squamous cell carcinoma (TSCC) is one of the most common malignancies in the oral cavity, and its incidence and mortality have been constantly increasing these years. A large number of tumor suppressor genes are involved in the development of the TSCC and it has been reported that the aberrant hypermethylation of tumor suppressor genes may play a key role in the process of the TSCC. In this study, we sought to analyze the association of methylation of DcR1, DcR2, DR4 and DR5 gene promoters and clinical significance in the TSCC to evaluate association between methylation of DcR1, DcR2, DR4 and DR5 gene and Clinical Significance in tongue squamous cell carcinoma.MethodsMethylation-specific PCR(MSP) was used to analyze the methylation of the promoters of TRAIL (tumor necrosis factor-related apoptosis-inducing ligand) receptors in 45 TSCC cases. Real-Time PCR was used to detect the expression of the DcR1, DcR2, DR4 and DR5 gene.ResultsAll the four genes (DcR1, DcR2, DR4 and DR5) showed different methylation of promoters in TSCC, while methylation of these promoters in paired adjacent normal tissues were almost undetectable. Patients with high methylation index were diagnosed at younger age when compared with the ones with low methylation index. DcR1 and DR4 hypermethylation was correlated significantly with patients' TNM stage.ConclusionsMethylation of DcR1, DcR2,DR4 and DR5 promoters are found in TSCC and may associate with its occurrence and development. Taking the reversibility of methylation into account,methylation is a potential targeted therapy of TSCC.     

FoxP3 and indoleamine 2,3-dioxygenase immunoreactivity in sentinel nodes from melanoma patients

Objective1) Assess FoxP3/indoleamine 2,3-dioxygenase immunoreactivity in head and neck melanoma sentinel lymph nodes and 2) correlate FoxP3/indoleamine 2,3-dioxygenase with sentinel lymph node metastasis and clinical recurrence.Study DesignRetrospective cohort study.MethodsPatients with sentinel lymph node biopsy for head and neck melanoma between 2004 and 2011 were identified. FoxP3/indoleamine 2,3-dioxygenase prevalence and intensity were determined from the nodes. Poor outcome was defined as local, regional or distant recurrence. The overall immunoreactivity score was correlated with clinical recurrence and sentinel lymph node metastasis using the chi-square test for trend.ResultsFifty-six sentinel lymph nodes were reviewed, with 47 negative and 9 positive for melanoma. Patients with poor outcomes had a statistically significant trend for higher immunoreactivity scores (p = 0.03). Positive nodes compared to negative nodes also had a statistically significant trend for higher immunoreactivity scores (p = 0.03). Among the negative nodes, there was a statistically significant trend for a poor outcome with higher immunoreactivity scores (p = 0.02).ConclusionFoxP3/indoleamine 2,3-dioxygenase immunoreactivity correlates with sentinel lymph node positivity and poor outcome. Even in negative nodes, higher immunoreactivity correlated with poor outcome. Therefore higher immunoreactivity may portend a worse prognosis even without metastasis in the sentinel lymph node. This could identify a subset of patients that may benefit from future trials and treatment for melanoma through Treg and IDO suppression.     

Retrospective analysis of 659 laryngeal squamous cell carcinoma patients treated with open laryngeal function-preserving operations

Abstract

Background: Open laryngeal function-preserving surgery is a common therapeutic strategy for Chinese laryngeal squamous cell carcinoma (LSCC) patients.

Objectives: To explore the fundamental clinical characteristics and survival prognostic factors of LSCC patients treated with open laryngeal function-preserving operations.

Material and methods: about a total of 659 LSCC patients undergoing open laryngeal function-preserving operations were retrospectively reviewed. Kaplan–Meier method, Log-rank test and Cox regression model were performed in survival analyses.

Results: About 612 patients were glottic cancer, followed by 44 cases in supraglottis and 3 cases in subglottis. The number of patients in stage T1, T2, T3 and T4 was 190, 365, 100 and 4, respectively. Nineteen patients had positive cervical lymph nodes. The 5-year overall survival, disease-free survival and disease-specific survival rates were 90.1, 84.9 and 90.7%, respectively. T stage and second primary tumour were independent factors predicting overall survival, while T stage and pathological differentiation were independent risk factors for tumour recurrence and progression.

Conclusions and significance: Open laryngeal function-preserving surgery is a crucial therapeutic strategy for Chinese patients with early and, in some cases, advanced-stage LSCC. Early diagnosis and therapy and sufficient and safe surgical margins are key to improving the survival rate and reducing the risk of relapse in LSCC patients.     

Free flap reconstruction for early stage tongue squamous cell carcinoma: surgical margin and recurrence

Abstract

Background: To identify the difference of surgical margin and recurrence status of early stage tongue carcinoma via wide excision in a single institution with and without free flap reconstruction.

Objective: Survey whether the reconstruction methods for early tongue cancer affects disease control, survival outcomes.

Methods: This was a retrospective study and patients with early tongue cancer underwent surgery via tumor ablation with (group 1?=?56) or without free flap reconstruction (group 2?=?291).

Results: The percentage of patients with free margin less than 5?mm was higher in the group 2 than in group 1 (49.48% vs. 19.64%, p?<?.001), as the mean free margin was significantly larger in group 1 than in group 2 (7.88?mm vs. 5.68?mm; p?<?.001). Despite higher number of T2 stage patients in group 1 (89.29%), the group 1 resulted in a significant lower recurrence rate (p?=?.024).

Conclusions: The utilization of free flap reconstruction for early stage tongue cancer achieved a large pathologic free margin and had relative lower recurrence and good survival rates.     

Relationships between Tumor Volume and Lymphatic Metastasis and Prognosis in Early Oral Tongue Cancer

Objectives

Although T stage is an important prognostic tool for oral tongue cancer, it fails to define the depth of invasion and true three-dimensional volume of primary tumors. The purpose of this paper is to determine the relations between tumor volume and lymph node metastasis and survival in early oral tongue cancer.

Methods

Forty-seven patients with T1-2 tongue cancer were included. Tumor volumes were measured by the computerized segmentation of T2-weighted magnetic resonance imaging.

Results

The overall average tumor volume was 27.7 cm³ (range, 1.4 to 60.1 cm³). A significant positive correlation was found between tumor volume and pathological T stage, depth of invasion, and cervical lymph node metastasis (P<0.001, P<0.001, and P=0.002, respectively). When the tumor volume exceeded 20 cm³, the cervical metastasis rate increased to 69.2%. The overall 5-year disease specific survival rate was 80%. There was a statistically significant association between large tumor volume (≥20 cm³) and the 5-year disease-specific survival (P=0.046).

Conclusion

Tumor volume larger than 20 cm³ was associated with greater risk cervical lymph node metastasis and poor 5-year disease-specific survival rate in early oral tongue cancer patients.     

A descriptive study highlighting the differences in the treatment protocol for oral tongue cancer in Sweden and Finland

Abstract

Background and aims: Stage II cancer of the tongue is mostly managed surgically both locally and regionally. However, indications for postoperative radiotherapy and reconstructive options vary between centers. This paper aims to describe differences in treatment in a geographically homogenous cohort.

Methods: A retrospective comparison was made between two cohorts of clinical T2N0 tongue cancer from Finland and Sweden. The Finnish cohort included 75 patients and the Swedish 54. All patients had curative intent of treatment and no previous head and neck cancer. Data analyzed consisted of pathological stage, size and thickness of tumor, frequency of reconstruction, radiotherapy delivered, and survival.

Results: The Finnish cohort included a higher proportion of patients managed with reconstructive surgery (67%) than the Swedish cohort (0%), p?<?.00001. More patients were treated with postoperative radiotherapy (84%) in the Swedish cohort than in the Finnish (54%), p?<?.0002. The Finnish cohort had a higher level of survival and included more frequent downstaging (cTNM to pTNM).

Conclusions and significance: Our data indicate a major difference in the management of T2N0 oral tongue cancer. The optimal cut-off size and growth pattern of the tumor warranting reconstruction should be further evaluated in a prospective manner considering both survival and quality of life.     

Prognostic significance of the number of lymph nodes in elective neck dissection for tongue and mouth floor cancers

The presence of metastatic lymph nodes is a relevant aspect in the treatment of head and neck cancer, bringing about a 50% reduction in survival.ObjectiveTo assess the number of lymph nodes removed in the neck dissection and their relationship with the prognosis.MethodsA retrospective study involving 143 patients with tongue and mouth floor epidermoid carcinoma, which histological exam showed no lymph node metastases. Among those, 119 were males and 24 females, with mean age of 54 years. As to the primary tumor site, 65 were in the tongue and 78 in the mouth floor. T stage distribution was of four T1, 84 T2, 36 T3 and 19 T4. We carried out 176 neck dissections, unilateral in 110 cases and bilateral in 33. Of these, 78 were radical and 98 selective. The patients were broken down into three groups, according to the 33 and 66 percentiles of the number of lymph nodes resected.ResultsThe mean number of resected lymph nodes was 27; 24 in selective dissections and 31 in the complete ones. We did not have statistically significant differences when associated to the T and N stages.ConclusionsThe larger number of lymph nodes dissected in the neck dissection identifies the group of better prognoses among pN0 cases.     

The Expression of Defensin-Associated Genes May Be Correlated With Lymph Node Metastasis of Early-Stage Tongue Cancer

Objectives. We aimed to assess the genetic differences between cases of early-stage tongue cancer that were positive or negative for lymph node metastasis.Methods. In total, 35 cases of tongue cancer with RNA sequencing data were enrolled in this study. The gene expression profile of the following two groups was compared: N0 group (T stage 1 or 2 with N0 stage) and N+ group (T stage 1 or 2 with N+ stage). Using the R and limma packages in the Bioconductor program, we extracted the differentially expressed genes (DEGs). Gene ontology and pathway enrichment analysis were performed using the Database for Annotation, Visualization and Integration Discovery (DAVID) online tool. Immune cell infiltration was analyzed using the CIBERSORT online program. Immunochemical staining of the cancer tissue was evaluated and The Cancer Genome Atlas (TCGA) data were analyzed to validate the identified DEGs.Results. No significant differences were found in the infiltration of 22 types of immune cells. Among a total of 51 identified DEGs, 14 genes were significantly upregulated, while 37 genes were significantly downregulated (P<0.01; fold change >2). Pathway analysis revealed significant associations with the arachidonic acid metabolism-related pathway, calcium signaling, and the muscle contraction pathway. The following DEGs were the most significantly different between the two groups: DEFB4A, SPRR2B, DEFB103B, SPRR2G, DEFB4B, and FAM25A. TCGA data showed that DEFB4A and DEFB103B were more highly expressed in the N0 group than in the N+ group, although the difference did not achieve statistical significance. Immunochemical staining of cancer tissue revealed significantly higher expression of defensin in the N0 group.Conclusions.Defensin (DEFB4A, DEFB103B, DEFB4B) may be a novel biomarker for early regional metastasis in T1/2 tongue cancer.     

Factors Related to Regional Recurrence in Early Stage Squamous Cell Carcinoma of the Oral Tongue

Objectives

This study analyzed various clinical and histopathologic factors for patients with early stage squamous cell carcinoma (SCC) of the oral tongue to define a high risk group for regional recurrence and finally to find out the indication of elective neck dissection (END).

Methods

Retrospective chart review was performed for 63 patients with T1-T2N0 SCC of the oral tongue who underwent partial glossectomy with/without END. Clinical and histopathologic factors assessed were age, gender, clinical T stage, tumor cell differentiation, depth of invasion, pathologic nodal status, and intrinsic muscle involvement, perineural invasion, lymphovascular emboli and resection margin involvement.

Results

Five year overall survival rate was 97.1% in stage I and 76.2% in stage II, and 5-yr disease free survival rate was 76.7% in stage I and 43.5% in stage II. Rates of occult nodal metastasis in stage I and II were 15.4% and 42.9%, respectively. Overall regional recurrence rate was 15.9%, which consisted of 10.2% in stage I and 35.7% in stage II. The success rate of salvage treatment was 100% in stage I and 40% in stage II. Higher T stage, higher histologic grade, depth of invasion ≥3 mm, presence of intrinsic muscle involvement were significantly related to regional recurrence (P=0.035, P=0.011, P=0.016, P=0.009, respectively). In stage I, the non-END group (n=36) showed 13.9% of regional recurrence rate, while END group (n=13) did not have any regional recurrence (P=0.198). Five year disease free survival rate of END group was significantly higher than non-END group (100% and 68.7%, respectively, P=0.045).

Conclusion

We recommend to perform END in early stage SCC of the oral tongue if the primary tumor has T2 stage, and T1 stage with higher histologic grade, depth of invasion more than 3 mm, or presence of intrinsic muscle involvement.     

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.     

Tumor volume as a prognostic factor in oropharyngeal squamous cell carcinoma treated with primary radiotherapy

Objectives/Hypothesis: Tumor volume has been demonstrated to play a prognostic role in many head and neck cancers. The purpose of this study was to conduct an institutional review analyzing the correlation between tumor volume and locoregional control of oropharyngeal squamous cell cancer treated with primary radiotherapy. Study Design: Retrospective institutional chart analysis. Methods: Seventy‐nine patients from 1991 to 2005 with primary T1 to T4 oropharyngeal squamous cell carcinoma (base of tongue, n = 31; soft palate, n = 1; tonsils, n = 47) were treated with primary radiotherapy. Tumor volumes were measured from pretreatment computerized tomography scans by two observers. Three‐dimensional tumor volumes were calculated using a computer digitizer for each computed tomography slice showing the primary lesion. Survival analysis, using the methods of Kaplan and Meier, was performed to assess whether tumor volume, Tumor, Node, Metastasis classification, tumor stage, or location were associated with locoregional failure. Results: Tumor volume did not significantly correlate with locoregional failure (observer 1, P = .6244; observer 2, P = .5612). There was a high interobserver correlation (r = 0.98970). Univariate analysis did, however, demonstrate a significant difference in locoregional failure between T4 tumors and all other T stages (T1 vs. T4, P = .0107; T2 vs. T4, P = .0004; T3 vs. T4, P = .0155). Nodal status, tumor stage, and location did not significantly correlate with locoregional failure rate. Conclusions: Tumor volume does not appear to play a significant role in predicting locoregional recurrence for patients with primary squamous cell cancer of the oropharynx treated with primary radiotherapy. However, T4 status was predictive of poor locoregional control.     

Foxp3 expression in lymph node metastases in patients with head and neck cancer

Introduction: The prevalence and activity of regulatory T cells in patients with cancer correlates with poor prognosis. These cells are characterized by their expression of Forkhead box protein-3 (Foxp3). Squamous cell carcinoma is the most prevalent type of cancer in the head and neck region with overall poor survival rates, also due to early spread of metastatic cells.

Material and methods: Primary tumor specimens as well as lymph node specimens harvested during neck dissection of 65 patients with a diagnosis of HNSCC were subjected to immunohistochemical and H-score analysis of Foxp3 expression. Demographics, diagnoses, histopathology and subsequent outcome were analyzed.

Results: The primary cancer was squamous cell carcinoma in all patients (male/female 55:10) with the following tumor locations: oral cavity n?=?16, oropharynx n?=?28, hypopharynx n?=?11 and larynx n?=?10 (Stage III n?=?18; Stage IVA n?=?45; Stage IVB n?=?2). The H-score for Foxp3 expression in the primary lesion as well as metastatic lymph nodes was significantly higher in advanced stages compared to early stages with differences among tumor locations, which were not significant. High Foxp3 expression was associated with inferior overall survival rates at a mean follow-up of 83.4 months (6–204 months)

Conclusions: Foxp3 expression in HNSCC varied from the anatomical site and correlated positively with tumor stage and was associated with poor prognosis. Therefore, Foxp3 expressions in primary lesions as well as lymphogenic metastases appear to predict high-risk HSNCC patients. Novel therapeutic approaches targeting Foxp3⁺ cells might seem promising for this patient population.     

肿瘤转移抑制蛋白在舌鳞状细胞癌中的表达与临床意义

目的 研究肿瘤转移抑制蛋白1(MTSS1)在舌鳞状细胞癌、癌旁正常组织中的表达及其意义。 方法 应用免疫组织化学方法检测舌鳞状细胞癌、癌旁正常组织中MTSS1蛋白的表达,并用单因素分析法研究其与临床病理因素的关系。 结果 20例舌鳞状细胞癌组织中MTSS1的蛋白表达水平与20例配对癌旁正常组织相比,差异有统计学意义(P=0.005);34例转移组中MTSS1的蛋白表达水平与46例非转移组相比,差异有统计学意义(P =0.033);37例临床Ⅲ~Ⅳ期组中MTSS1的蛋白表达水平与43例临床Ⅰ~Ⅱ期组相比,差异有统计学意义(P<0.001)。 结论 MTSS1蛋白在舌鳞状细胞癌的早期进展中发挥了重要作用,MTSS1蛋白表达水平的降低可能与舌鳞状细胞癌的浸润转移有关,可能抑制了TSCC的发生和发展。     

鼻咽癌放疗后第二原发舌癌的临床分析

目的探讨鼻咽癌放疗后第二原发舌癌的临床特点及治疗效果，探索影响其预后的因素。方法1975年1月1日-2000年12月31日在中山大学肿瘤防治中心头颈科接受首治的舌癌患者共1263例，从中筛选此前有鼻咽癌放疗史者共53例，采用Kaplan—Meier法计算累积生存率，Cox回归方法进行多因素分析。结果53例中40例患者死亡，接受治疗的51例患者总的5年和10年生存率分别为41．64％、35．69％；舌癌发生在舌尖、侧缘、舌腹和舌背分别为0例、26例（49．06％）、8例（15．09％）和19例（35．85％）；舌癌临床检查颈淋巴转移6例（11．32％）后经病理证实为3例（5．66％）；第二原发舌癌治疗后18例复发（33．96％）。单因素分析提示原发灶大小（P=0．0005）、临床TNM分期（P=0．0017）影响预后；多因素分析显示临床与病理综合分期（P=0．000）、两癌发生的时间间隔（P=0．003）是影响预后的独立因素。结论鼻咽癌放疗后第二原发舌癌发生在舌背的比例较高，其淋巴转移率较低；临床和病理综合分期以及两癌发生的时间间隔是影响预后的独立因素；对鼻咽癌放疗后第二原发舌癌进行早期诊断，行手术或包含手术的综合治疗，可能会获得更好的疗效。     

The impact of surgical margin status on the outcomes of locally advanced hypopharyngeal squamous cell carcinoma treated by primary surgery

Abstract

Background: The extent of surgical safety margin remained unclear in hypopharyngeal carcinoma surgery.

Aim: The purpose of this study was to evaluate the influence of surgical margin status on the outcomes of patients with advanced hypopharyngeal carcinoma.

Material and methods: A retrospective analysis of clinical data was performed in 205 patients with stage III/IV hypopharyngeal carcinoma treated by primary surgery between January 2005 and December 2014. There were 129 patients with clear surgical margins (≥5?mm) and 76 with close surgical margins (<5?mm). The clinical characteristics and treatment outcomes were compared between the two groups.

Results: Close surgical margin (cSM) was found to be a significant risk factor for local recurrence, overall survival (OS) and disease-specific survival (DSS). Analysis by stratification according to pT classification showed that the OS and DSS rates of T1/T2 tumors with clear surgical margins (nSM) were significantly higher than those with cSM (p?<?.05), while there was no significant difference in the OS and DSS rates between T3/T4 tumors with cSM and nSM (p?>?.05).

Conclusions and significance: The tailored extent of surgical resection margin was recommended for locally advanced hypopharyngeal carcinomas according to primary tumor stage.     

Is there a role for neck dissection in T1 oral tongue squamous cell carcinoma? The UCLA experience

PurposeWe sought to examine prognostic and therapeutic implications, including cost-effectiveness, of elective neck dissection in the management of patients with clinically-determined T1N0 oral tongue carcinoma.Materials and methodsA retrospective review of patients with cT1N0 oral tongue squamous cell carcinoma who underwent surgical extirpation of primary tumor, with or without elective neck dissection, at UCLA Medical Center from 1990 to 2009 was performed. Cox proportional hazards regression was used to assess effects of variables on time to first loco-regional recurrence. A healthcare costs analysis of elective neck dissection was performed by querying the SEER-Medicare linked database.ResultsOf the 123 patients identified with cT1N0 squamous cell carcinoma of the oral tongue, 88 underwent elective neck dissection at the time of tumor resection while 35 did not. For all patients, disease-free survival at 3, 5, and 10 years was 93%, 82%, and 79%. Of the 88 patients undergoing elective neck dissection, 20 (23%) demonstrated occult metastatic disease. Male gender, tumor size, perineural invasion, and occult metastatic disease were individually associated with higher rates of loco-regional recurrence. There was no significant difference in loco-regional recurrence between those who underwent elective neck dissection and those who did not (HR = 0.76, p = 0.52). On cost analysis, neck dissection was not associated with any significant difference in Medicare payments.ConclusionsThe high rate of occult metastasis (23%) following elective neck dissection, which did not confer additional healthcare costs, leads to the recommendation of elective neck dissection in patients with cT1N0 oral tongue squamous cell carcinoma.     

Preoperative tracheotomy in the treatment of upper airway obstruction of patients with advanced stage supraglottic carcinoma

BackgroundPreoperative tracheotomy is an effective option that secures upper airway patency in laryngeal carcinoma patients suffering from upper airway obstruction, but the influence of this treatment on oncologic outcomes of laryngeal carcinoma remains controversial. The purpose of this study was to determine the impact of preoperative tracheotomy on overall survival in supraglottic carcinoma patients with tumor obstruction of the upper airway, and explore the potential causes.Materials and methodsThis retrospective study collected 243 consecutive patients with advanced stage supraglottic carcinoma from 2005 to 2010. Preoperative tracheotomy in the management of upper airway obstruction in patients with supraglottic carcinoma was analyzed.ResultsThe mean age was 60.9 years at diagnosis, with men accounting for 98.4% of all patients. Thirty nine (16.0%) patients presenting with tumor obstruction of the upper airway required preoperative tracheotomy. T4 stage patients had higher rate of tracheotomy than those of patients with T3 stage (36.8% vs 12.2%). Patients with upper airway obstruction presented with greater tumor area compared with patients without (13.7 cm² vs 9.0 cm²). The optimal cutoff value of tumor area for tracheotomy and OS rate were both at 10 cm². Supraglottic patients with upper airway obstruction receiving preoperative tracheotomy had poorer OS rate compared with patients without. T stage and tumor area were correlated with upper airway obstruction, and these two variables were independent predictors of OS rate in supraglottic carcinoma patients.ConclusionsAdvanced stage supraglottic carcinoma patients with upper airway obstruction undergoing preoperative tracheotomy experienced worse overall survival. Advanced T stage and greater tumor size were associated with upper airway obstruction, indicating that the negative influence of tumor obstruction on survival may be cause by these two preoperative variables. Therefore, preoperative tracheotomy acts only as an alternative procedure, and is not a prognostic agent.     

Laminin gamma2 chain expression in squamous cell carcinomas of the tongue and its clinical relevance

Laminin gamma2 chain (LNgamma2) expression and its clinical relevance were examined in squamous cell carcinomas of the tongue. When tumor cells were attached to each other and showed expansive growth, LNgamma2 was expressed only in the peripheral cells of the tumor nests (peripheral expression). In contrast, when tumor cells showed infiltrative growth diminishing cell-cell adhesion, LNgamma2 expression was diffusely observed in almost all of the cells (diffuse expression). Patients with caricinoma cells of the primary lesions showing peripheral LNgamma2 expression were classified as the peripheral expression type, whereas patients with carcinoma cells showing diffuse LNgamma2 expression at least in part of the invasive fronts were classified as the diffuse expression type. Among 30 patients with tongue carcinomas of more than stage II, 19 patients were the peripheral expression type and 11 patients were the diffuse expression type. The 3-year disease-specific survival rates for the peripheral type and diffuse type were 64% and 34%, respectively. LNgamma2 may play an important role in growth and invasion of tongue carcinomas. In particular, it seems likely that the diffuse LNgamma2 expression in carcinoma cells has a significant relevance to the malignant characteristics of infiltrative carcinoma cells. In addition, LNgamma2 expression may be a useful prognostic factor for the patients with carcinomas of the tongue.