CCR7-CCL21 axis promotes the cervical lymph node metastasis of tongue squamous cell carcinoma by up-regulating MUC1

This study aims at investigating the potential role of MUC1 in CCR7-CCL21 axis-induced metastasis of tongue squamous cell carcinoma (TSCC).TSCC patients were selected for epidemiologic trends. The expression of CCR7 and MUC1 was detected via immunohistochemistry. SCC15 and CAL27 cells were induced by CCL21 and specific antibody to CCR7. Gene and protein expression was detected using qRT-PCR and western blotting. Migration and invasion capacities of TSCC cells were determined using wound healing and Transwell invasion assays.The male:female ratio of 78 patients was 1.6:1. Metastasis rate of cervical lymph nodes (CLNs) was 42.3%. CLN metastasis significantly correlated with T staging (P = 0.026), clinical staging (P = 0.024), and depth of invasion (DOI, P = 0.001). DOI significantly influenced CLN metastasis (P = 0.033, OR = 10.919) of TSCC, as did CCR7 (P = 0.041) and MUC1 (P = 0.026). The consistency of CCR7 and MUC1 expression was fairly good (Kappa = 0.683, P < 0.001). Reduced survival was significantly associated with higher expression of CCR7 (P = 0.039) and MUC1 (P = 0.030). CCL21 up-regulated MUC1 in SCC15 cells, which was inhibited when CCR7 was blocked. MUC1 positively correlated with TSCC cell migration and invasion.CCR7-CCL21 axis might promote CLN metastasis of TSCC by up-regulating MUC1. CCR7 and MUC1 show promise as potential biomarkers for TSCC treatment.     

Surgery for maxillary oral squamous cell carcinoma: the effect of surgical resection margins and elective neck dissection on oncological outcomes

Maxillary oral squamous cell carcinoma (OSCC) is uncommon. Surgical resection is challenging due to the anatomy, and the role of elective neck dissection (END) is not well-defined. A retrospective cohort study of patients with maxillary OSCC treated with primary surgery between 2007 and 2019 was conducted. Primary tumours of sinonasal origin with extension into the oral cavity were excluded. Survival analysis was performed using Kaplan–Meier and Cox proportional hazards models. Sixty-seven patients were included; mean follow-up was 55 months. On univariate analysis, clear (≥5 mm) margins were associated with higher disease-free (68% vs 36%, P = 0.019) and overall survival (75% vs 36%, P = 0.004) than close/involved (<5 mm) margins. In clinically node-negative patients, the risk of occult cervical metastasis in tumours with depth of invasion (DOI) ≥ 3 mm and T2–4 tumours was 22% and 25%, respectively. END in these groups was associated with a lower rate of loco-regional recurrence (DOI ≥3 mm subgroup: 5% vs 38%, P = 0.029; T2–4 subgroup: 6% vs 50%, P = 0.028) and longer time to recurrence (DOI ≥3 mm subgroup: 119 months vs 96 months, P = 0.042; T2–4 subgroup: 117 months vs 56 months, P = 0.031) than observation of the neck. On multivariate analysis, close/involved margins were associated with an increased risk of overall mortality (hazard ratio 3.4, 95% confidence interval 1.0–11.3, P = 0.043) and disease recurrence (hazard ratio 2.8, 95% confidence interval 1.1–7.1, P = 0.031). In maxillary OSCC, a ≥ 5 mm histological margin should remain the goal of ablative surgery. END should be considered in tumours with DOI ≥ 3 mm.     

Usefulness of contrast-enhanced CT in the evaluation of depth of invasion in oral tongue squamous cell carcinoma: comparison with MRI

Objectives

There is currently no standardized approach for assessing the depth of invasion (DOI) of oral tongue squamous cell carcinoma via diagnostic imaging. We investigated the usefulness of contrast-enhanced computed tomography (CECT) for estimating the pathological DOI of oral tongue squamous cell carcinoma by evaluating the correlation of pathological DOI with the DOIs on CECT and magnetic resonance imaging (MRI).

Methods

We retrospectively reviewed 21 of 139 patients who underwent radical surgery for primary oral tongue squamous cell carcinoma between 2009 and 2018. The 21 cases were evaluable, without dental artifacts on CECT. DOIs on CECT and MRI, and pathological DOI were measured.

Results

The median pathological DOI was 9 mm, that on CECT was 10.9 mm, that on T2-weighted MRI was 14.2 mm, and that on contrast-enhanced T1-weighted MRI was 13.1 mm. The DOIs on CECT and on MRI were larger than the pathological DOI (p?=?0.003 to <?0.001). The absolute value of the difference between pathological DOI and DOI on CECT was smaller than that between pathological DOI and DOI on MRI (p?=?0.01 and 0.003). DOIs on CECT and on MRI correlated with pathological DOI (r?=?0.74–0.66, all p?<?0.001). Spearman’s correlation coefficient between DOI on CECT and pathological DOI was greater than that between DOI on MRI and pathological DOI.

Conclusions

Compared to the DOI determined on an MRI scan, the DOI determined on a CECT scan correlated with and better approximated pathological DOI. Therefore, CECT can be useful for preoperative staging of patients with oral tongue squamous cell carcinoma.

     

The prognostic significance of the lymph node ratio in oral cancer differs for anatomical subsites

The aim of this study was to validate the prognostic significance of the lymph node ratio (LNR) in patients suffering from oral squamous cell carcinoma in regard to different anatomical subsites. A cohort of 430 patients was investigated to determine the rates of primary metastasis and local and regional disease recurrence. Correlation analysis of the LNR with relevant clinical and pathological parameters was performed. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the prognostic impact for different subsites. Significantly differing rates of primary metastasis and loco-regional disease recurrence were found for cancer of different anatomical subsites of the head and neck. Furthermore, ROC curve analysis suggested that LNR has prognostic relevance in subsets of cancer (tongue, P <  0.001; alveolar process, P =  0.04; maxilla, P =  0.03; buccal mucosa, P =  0.02). The LNR of cancer located in the soft palate (P =  0.6) and floor of the mouth (P =  0.11) showed little or no association with the clinical outcome. There is the need for a more sensitive consideration of the LNR as a factor in the assessment of risk and the treatment decision, as the anatomical subsite plays a crucial role in its impact on the clinical outcome.     

Preoperative plasma fibrinogen predicts cervical metastasis in patients with stage I/II carcinoma of the tongue

The aim of this study was to evaluate the association of preoperative plasma fibrinogen levels with clinico-pathological parameters and disease-free survival in patients with oral tongue squamous cell carcinoma (OTSCC). We retrospectively studied 76 patients with OTSCC who underwent a partial glossectomy only, at a single centre, between 1996 and 2007. Among the 76 patients, 30 eventually developed cervical metastasis. Preoperative plasma fibrinogen levels were determined and correlated with clinico-pathological findings by t-test or analysis of variance methods. Univariate and multivariate analyses were used to determine the association of preoperative plasma fibrinogen levels and disease-free survival. Elevated levels of plasma fibrinogen were positively related with growth type (P < 0.001), differentiation (P < 0.001), thickness (P < 0.001), and the infiltrative growth ratio (P = 0.032). Univariate analysis showed that growth type (P < 0.001), differentiation (P < 0.001), thickness (P < 0.001), and preoperative plasma fibrinogen levels (P < 0.001) were significantly correlated with disease-free survival. Multivariate analysis showed that the plasma fibrinogen level remained an independent factor for disease-free survival after partial glossectomy for OTSCC (P = 0.029). A high preoperative plasma fibrinogen level is an independent predictor of cervical metastasis after partial glossectomy for OTSCC. A conservative supraomohyoid neck dissection is appropriate in patients with stage I/II carcinoma of the tongue whose preoperative plasma fibrinogen is >300 mg/dl.     

Can MRI-derived depth of invasion predict nodal recurrence in oral tongue cancer?

Objectives

To evaluate the prognostic value of preoperative radiological findings for nodal recurrence in clinically node-negative (cN0) patients with oral tongue squamous cell carcinoma (SCC).

Methods

The study population consisted of 52 patients with cT1-2N0 oral tongue SCC classified according to the 7th edition of the Union for International Cancer Control (UICC) staging system. The subjects had undergone preoperative radiological examinations, including magnetic resonance imaging (MRI) and ¹⁸F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography. All patients were treated with local resection and watchful waiting for neck management. Using an unpaired t test, Pearson’s chi-squared test, and the Kaplan–Meier method, the MRI-derived depth of invasion (DOI), the standardized uptake value (SUV) on FDG-PET, and the T stage according to the 7th and 8th UICC were assessed as prognostic factors.

Results

The MRI-derived DOI was recorded as?≤?5 mm in 24 patients and?>?5 mm in 28 patients. During the follow-up period, nine patients exhibited nodal recurrence, with the MRI-derived DOI being significantly higher in patients with positive than in those with negative (p?=?0.011). The SUV was not significant. Five-year cumulative nodal recurrence probabilities were 4.5% for patients with an MRI-derived DOI?≤?5 mm, while it was 32.1% for?>?5 mm (p?=?0.013). Although the T classifications were not significant, none of our patients whose T stage according to the 8th UICC was T1 suffered nodal recurrence.

Conclusions

MRI-derived DOI can predict nodal recurrence, while preoperative information may assist in treatment planning for oral tongue SCC.

     

Elective neck dissection versus observation in the management of early tongue carcinoma with clinically node-negative neck: A retrospective study of 229 cases

BackgroundThe aim of the study is to evaluate the results of elective neck dissection (END) versus conservative management (observation) in the treatment of stages I and II squamous cell carcinoma of tongue.Patients and methodsThis is a retrospective study including 229 patients with surgical treatment between June 1993 and May 2010.ResultsThere were 15 (9.6%) patients in the END group and 14 (19.2%) patients in the observation group who developed nodal recurrence alone without associated local recurrence or distant metastasis. Node-related mortality rate was 5.1% (8/156) for END and 12.3% (9/73) for observation. Further analysis for subgroups of stage T1 showed that the patients from END group had a better 5-year disease-specific survival (DSS) than those from the observation group in spite of no statistical difference (87.2% vs. 76.0%, Log-rank p = 0.282). END compared with observation for patients with stage T2 had a better 5-year DSS (74.2% vs. 41.2%, Log-rank p = 0.008).ConclusionsElective neck dissection significantly reduces mortality due to lymph nodal metastasis and also increases the 5-year DSS, most marked in patients with stage T2 OSCC. This retrospective study suggests that END should be a preferred treatment strategy for tongue carcinoma in stage T2.     

Diagnostic accuracy of magnetic resonance imaging in detecting depth of invasion of tongue cancers

The recent eighth edition of the American Joint Committee on Cancer (AJCC) staging system has introduced depth of invasion (DOI) as one of its important components. DOI is also important for deciding neck management in superficial tongue cancers. Magnetic resonance imaging (MRI) is mainly used to assess DOI, and in this study we have evaluated the efficacy of MRI to detect it. This is a retrospective study consisting of 60 treatment-naïve tongue cancer patients operated on between July 2017 and June 2019. Patients underwent MR imaging on an Optima MR450W 1.5T unit, and MRI was reported by two experienced head and neck radiologists. Postoperative histological DOI was considered the gold standard. The correlation coefficient was derived for postoperative DOI and MRI-detected DOI. A subgroup analysis of superficial tongue cancer was also done. The mean MRI DOI was 13.7 mm and the mean histological DOI 12.45 mm. The shrinkage factor was 0.6 mm. Pearson’s correlation coefficient was 0.80 (p=<0.001) for Radiologist 1 and 0.85 (p=<0.001) for Radiologist 2. The interobserver variation was low, with a correlation coefficient between the two radiologists of 0.965 (p=<0.001). For superficial tongue cancers there was moderate correlation for MRI and histologically-detected DOI with a kappa value of 0.681 (p=0.03). As per the ROC curve, the cut-off value for MRI DOI to predict nodal metastasis was 4.6 mm. MRI has high reliability to predict the DOI of tongue cancers. The interobserver variation was low. The diagnostic accuracy in cases of superficial tongue cancer was moderate.     

The prognostic role of the pre-treatment neutrophil to lymphocyte ratio (NLR) and tumor depth of invasion (DOI) in early-stage squamous cell carcinomas of the oral tongue

The appropriate surgical management of early-stage oral tongue squamous cell carcinoma (OTSCC) remains a debated topic. The aim of this study is to investigate the role of the pre-treatment neutrophil to lymphocyte ratio (NLR) and tumor depth of invasion (DOI) in predicting the presence of occult neck metastases in early-stage OTSCC. A retrospective analysis of patients affected by early-stage (cT1-T2 cN0) OTSCC who were submitted to elective neck dissection (END) was performed. Tumors were classified retrospectively according to the 8th TNM classification, the DOI was assessed on the pre-operative magnetic resonance imaging, and the pre-treatment NLR was calculated for each patient. A logistic regression model to estimate the probability π (x) of cervical metastases by studying the NLR and DOI was carried out. Next, the correlation between the two variables, the NLR and DOI, was preliminarily studied. A cohort of 110 patients was analyzed (mean age, 62 years old; male to female ratio 1.2:1). The patients were staged as cT1 in 53 cases and cT2 in 57 cases. A DOI greater than 5.4 mm and a NLR greater than 2.93 are associated with an increased risk of presenting occult cervical metastases. Furthermore, the variables NLR and DOI are linearly associated with a positive correlation, proved by Spearman’s rank correlation coefficient rho of 0.64, with a unitary increase in the DOI of 1 mm directly associated with an increase of 0.47 in the NLR. The DOI and NLR can be effectively used to predict the occurrence of occult neck metastasis and therefore to plan an END in early-stage OTSCC.

     

The impact of lymph node density as a predictive factor for survival and recurrence of tongue squamous cell carcinoma

The oral tongue is considered the most frequently involved site in cases of oral squamous cell carcinoma (OSCC). Lymph node (LN) density, defined as the number of positive LNs divided by the total number of resected LNs, is considered an important prognostic factor in OSCC; however the cut-off point remains uncertain. A retrospective study was performed involving 104 patients who underwent a glossectomy procedure for oral tongue squamous cell carcinoma (OTSCC) between the years 2008 and 2018. LN density and other related prognostic factors, including pathological N-stage (pN), extranodal extension (ENE), perineural invasion (PNI), and depth of invasion (DOI), were investigated in relation to survival and recurrence rates. pN + stage, the presence of ENE, the presence of PNI, and increased DOI were found to be associated with increased LN density values, as well as lower patient survival and higher recurrence rates. The statistical analysis identified a cut-off point for LN density of 2.5%. In advanced stage disease, LN density values above 2.5% had a significant impact on the survival rate (P = 0.005), as well as the recurrence rate (P = 0.038). In conclusion, in addition to other previously known prognostic factors, LN density may serve as a strong prognostic factor for survival and recurrence in patients with advanced- and early-stage OTSCC.     

Combination of fluorescence visualization and iodine solution-guided surgery for local control of early tongue cancer

The control of enclosed oral epithelial dysplasia is important for the control of oral cancer. Fluorescence visualization and iodine solution are able to detect oral epithelial dysplasia and surrounding oral cancer. The purpose of this study was to clarify the effectiveness of combining fluorescence visualization and iodine solution-guided surgery for early tongue cancer. Participants comprised 264 patients with primary early tongue cancer who underwent surgery. The surgical margin was set at 10 mm outside the clinical tumour, and 5 mm outside the area of fluorescence visualization loss, and 5mm outside the iodine unstained area. The 5-year disease-free survival rate was 87.1% vs 76.1% (P = 0.016) and the 5-year local control rate was 98.6% vs 93.0% (P = 0.008) for combination-guided surgery when compared to conventional surgery. Positive margin rates were 0% for cancer, and 6.5% and 0% for low- and high-grade dysplasia, respectively, with combination-guided surgery (P = 0.257). Multivariate analysis revealed that combination-guided surgery (odds ratio 0.140, 95% confidence interval 0.045–0.437; P < 0.001) and intraoperative frozen section examination (odds ratio 0.302; 95% confidence interval 0.115–0.791; P = 0.015) were significantly associated with local control. The combination of fluorescence visualization and iodine solution are effective in selecting surgical margins for early tongue cancer.     

A precise glossectomy for tongue cancer adjacent to or crossing the midline: a novel anatomical unit resection surgery

Previous studies have lacked a clear anatomical and functional definition of glossectomy for tongue cancer adjacent to or crossing the midline (TCML). The aim of this study was to provide a novel surgical approach based on anatomical unit resection surgery to treat TCML. A total of 120 patients with TCML who had undergone radical surgery were recruited retrospectively into the study. The patients who were treated with compartment surgery formed the control group; those treated with anatomical unit resection surgery formed the experimental group. The TCML was classified into cancer adjacent to the midline, cancer invading but not breaching the contralateral musculus verticalis linguae–genioglossus complex (MGC), and cancer breaching the contralateral MGC. No significant difference in the overall survival rate was found between the experimental and control groups overall (P = 0.853) or by TCML classification. In patients with cancer adjacent to the midline, the swallowing score (P = 0.040) and cosmetic outcome (P = 0.015) were significantly better in the experimental group than in the control group. For patients with cancer invading but not breaching the contralateral MGC, the speech intelligibility score (P = 0.001), swallowing score (P = 0.002), and cosmetic outcome (P = 0.037) were significantly better in the experimental group than in the control group. Anatomical unit resection surgery was found to provide a precise surgical treatment to address tongue cancer adjacent to or crossing the midline and maximally maintain tongue tissue and function.     

Usefulness of intra‐oral ultrasonography to predict neck metastasis in patients with tongue carcinoma

Objective: To assess tissue characterization relating with neck metastasis of invasive tongue cancer, we investigate the usefulness of intra‐oral ultrasonography (US). Materials and methods: The patients with squamous cell carcinoma of the tongue (n = 110) were preoperatively evaluated with intra‐oral US. The US images were compared with histological sections. The histological and ultrasonographic parameters were evaluated for their correlation with neck metastasis. Results and conclusion: High‐quality ultrasonic images were obtained, and all lesions over 1 mm thickness by histology were detected. There was a significant correlation (P < 0.0001) between measurements of tumor thickness by US and histology. Univariate analysis showed that the histological parameters influencing neck metastasis were mode of invasion (P = 0.0006), muscular invasion (P < 0.0001), stromal reaction (P = 0.0002), and tumor thickness (P = 0.0004). Of the ultrasonographic parameters, shape of margin (P = 0.019), pattern of margin (P = 0.033), internal echo signal (P = 0.035), and tumor thickness (P < 0.0001) showed a significant correlation with neck metastasis. Ultrasound images of oral tongue cancer reflected the histological structures. Tumors with diffuse invasive mode shows an irregular and unclear tumor margins on US image. Thickness of 8 mm by ultrasound is useful as a cut‐off point of predicting risk of neck metastasis of tongue cancer. Intra‐oral US is a reliable tool in objectively predicting subclinical neck metastasis in tongue cancer.     

Clinical comparison of superior thyroid artery perforator flap and sternocleidomastoid myocutaneous flap for intraoral reconstruction

The aim was to evaluate the techniques and outcomes of superior thyroid artery perforator flaps (STAPF) for intraoral reconstruction and to compare them with those of the sternocleidomastoid myocutaneous flap (SCMMF). The cases of 43 patients who underwent reconstruction with either a SCMMF or STAPF for the repair of a medium-sized intraoral defect, between January 2013 and December 2020, were reviewed retrospectively. Although both flaps are based on the superior thyroid artery, their specific harvesting techniques largely differ. All SCMMF (n = 23) were superiorly-based rotational flaps with myocutaneous designs. The STAPF cases (n = 20) included 18 septocutaneous flaps and two chimeric flaps. The flap size was larger in the STAPF group (P = 0.008), while incomplete level IIB dissection (oncological safety) was more frequent in the SCMMF group (P = 0.002). The flap necrosis rate was lower in the STAPF group (STAPF 15% vs SCMMF 34.8%, though this was not statistically significant). Cox multivariate analysis showed that the postoperative flap outcome (total flap necrosis vs flap survival; hazard ratio 27, 95% confidence interval 2.149–336.05; P = 0.001) and complications (excluding fistula) (hazard ratio 14, 95% confidence interval 1.314–142.767; P = 0.029) were associated with overall patient survival. Both speech (P < 0.001) and neck mobility (P < 0.001) functions were superior with STAPF reconstruction. Compared with the traditional SCMMF, the STAPF was found to have a lower necrosis rate with uncompromised oncological safety during harvesting. The STAPF is a good alternative for the repair of medium-sized head and neck defects.     

Oral abnormalities in an Iranian newborn population

ObjectiveThe prevalence of oral findings in newborn infants in Iran is not known, as only isolated case reports have been published. We determined the prevalence of intraoral findings in a group of newborns and assessed the relationship between these findings and maternal systemic and gestational medical complications during pregnancy and parental consanguinity.Study designA total of 995 newborn children were examined in Hafiz Hospital, Shiraz, Iran. Oral cysts, ankyloglossia, an attached upper midline frenum, and other medical diagnoses at birth were investigated. Medical information for each child and parent was recorded via a standard questionnaire. The data were analyzed using the Pearson χ² test (P < 0.05).ResultsThe most common findings were oral cysts (15%). There were significant relationships between oral cyst prevalence and parental consanguinity (P = 0.009) and between the presence of at least one finding and medication consumption during pregnancy (P = 0.04).ConclusionsSome 32.3% of the neonates examined had at least one oral finding within 3 days of birth, of which the most common was oral cyst. Parental consanguinity and drug intake during pregnancy were correlated with the occurrence of oral findings.     

Tumor–stroma ratio is a crucial histological predictor of occult cervical lymph node metastasis and survival in early-stage (cT1/2N0) oral squamous cell carcinoma

Occult cervical lymph node metastasis is a significant prognostic factor in patients with early-stage (cT1/2N0) oral squamous cell carcinoma (OSCC). The aim of this study was to investigate the potential value of the tumor–stroma ratio (TSR) as a histological predictor of occult cervical metastasis and survival in early-stage OSCC. This retrospective study included 151 patients who underwent excision of the primary lesion and elective neck dissection from 2013 to 2017. The clinicopathological features of the tumor, risk factors associated with occult neck metastasis, and prognostic factors for overall survival (OS) and disease-free survival (DFS) were studied. A significant correlation of TSR (P = 0.009) was found with occult neck metastasis in the multivariate logistic regression model. Multivariate Cox proportional hazards regression analysis showed that the TSR (P = 0.002) and perineural invasion (P = 0.011) were associated with OS. Occult neck metastasis (P = 0.032) was associated with DFS. These findings indicate that assessment of the TSR might be useful in prognostication for early-stage OSCC patients. Moreover, the TSR is effective in allowing an accurate evaluation of the risk of occult neck metastasis, and this may be easily applicable in the routine pathological diagnosis and clinical decision-making for elective neck dissection.     

Supraomohyoid neck dissection and modified radical neck dissection for clinically node-negative oral squamous cell carcinoma: A prospective study of prognosis,complications and quality of life

BackgroundTo assess the prognosis and morbidity between supraomohyoid neck dissection (SOND) and modified radical neck dissection (MRND) for oral squamous cell carcinoma (OSCC) in patients with a clinically node-negative neck (cN0).Patients and methodsThis prospective randomized study began in June 1999, and patient accrual concluded in May 2010. The cN0 neck was confirmed on clinical palpation by senior doctors. Ultimately, there were 322 patients recruited into the study.ResultsPatient demographics were well balanced between the two groups. There were 10 patients in the SOND group and 21 patients in the MRND group who developed nodal recurrence without associated local recurrence or distant metastasis. The 3-year neck control rate (NCR) rate was 92.6% for the SOND group and 87.5% for the MRND group (in favor of SOND, P = 0.108). There was no significant difference between the SOND group and the MRND group in the 3-year disease-specific survival (DSS) rate (79.0% vs. 76.9%, P = 0.659). Importantly, there were significantly fewer complications in the SOND group compared with the MRND group (13.0% vs. 21.9%, P = 0.040). The disease-free survivors in the SOND group also reported better pain relief (P = 0.013) and shoulder function (P < 0.001) than those in the MRND group one year after treatment.ConclusionsWe recommend SOND as a priority treatment for cN0 OSCC patients.     

Increased expression of MUC1 predicts poor survival in salivary gland mucoepidermoid carcinoma

BackgroundMucoepidermoid carcinoma (MEC) is a malignant neoplasm that originates most commonly in the major and minor salivary glands. The aim of this study is to determine the relationship between mucin-1 (MUC1) expression and patient outcome based on a large number of cases.Patients and methodsSurgical specimens from 357 patients with primary salivary gland MEC and 10 patients with normal salivary gland tissue were examined by immunohistochemistry. The relationship between MUC1 expression and the clinicopathological data and patient survival was analyzed.ResultsResults showed that MUC1 expression level was higher in MEC tissues than in paired normal tissues (P = 0.001), and the expression level of MUC1 was significantly associated with gender (P = 0.02), location (P = 0.001), grade (P = 0.001), stage (P = 0.0018) and lymph node metastasis (P = 0.001). In addition, increased expression of MUC1 was confirmed as a strong predictor of poor survival in salivary gland MEC (HR 2.175 [95% CI 1.263, 3.745]; P = 0.0051).ConclusionThe findings indicate that an increased expression of MUC1 may be of great value in assessing the development and prognosis of salivary gland MEC, and could be used as a new molecule target to improve outcomes for these patients in the future.     

Sinonasal melanoma: a systematic review of the prognostic factors

The objective was to evaluate the available published data on sinonasal melanoma and analyse its clinical features, treatment modalities, and prognostic factors. An electronic search was undertaken in March 2018 in multiple databases. Eligibility criteria included publications with sufficient clinical, histological, and immunohistochemical information to confirm the diagnosis. Seventy-three publications (439 cases) were included. The lesion was more prevalent in females than in males. There was a higher prevalence in the seventh and eighth decades of life. The lesions mainly presented as epistaxis and commonly involved the nasal cavity. Age (>67.6 years; P = 0.0012), primary location (middle turbinate; P = 0.0112), disease stage (advanced disease stage; P = 0.0026), treatment (radiotherapy; P = 0.0111), recurrence (recurrence presented; P = 0.0137), and distant metastasis (distant metastasis presented; P = 0.0011) were independently associated with a lower survival rate. Recurrence was significantly correlated with age (>67.6 years; P = 0.0021), sex (males tended to present a higher recurrence rate than females; P = 0.0051), disease stage (stages III and IV presented a higher recurrence rate than stages I and II; P = 0.0331), and histological type (amelanotic lesions presented a higher index of recurrence than melanotic lesions; P = 0.0095). In conclusion, sinonasal melanoma is a neoplasm with a poor prognosis, presenting a 30.69% possibility of survival after 5 years.     

Optimization of total tongue functional reconstruction with the sushi roll technique and its application in pectoralis major myocutaneous flaps

A protuberant shape and sufficient volume are the most important parameters for total tongue reconstruction. The conventional pectoralis major myocutaneous (PMMC) flap undergoes collapse due to atrophy of the denervated muscle. In a new technique, this flap was rolled up like sushi to reshape the neotongue. This study explored the feasibility and effect of the ‘sushi roll’ technique for precise total functional reconstruction of the tongue using a PMMC flap. Thirty patients scheduled for total glossectomy and PMMC flap reconstruction were recruited. The sushi roll technique was performed in 15 patients and the conventional repair in 15 patients. Outcomes were compared between the two groups. The flap survived in all 30 patients. The sushi roll group showed superior results to the conventional group in terms of time to oral alimentation (P = 0.012) and decannulation (P = 0.041), as well as swallowing function (P = 0.032), speech intelligibility (P < 0.001), shape (P < 0.001), and quality of life score (P < 0.001) at 12 months. The innovative sushi roll technique uses a folding method that utilizes the length rather than the thickness and width of the flap to maintain the volume and protuberance of the neotongue, which results in acceptable function and improved quality of life.