The increase in incidence of cancer of the tongue in the Nordic countries continues into the twenty-first century

Conclusions This study shows that heavy drinking is a risk factor for prolonged delay in presenting with head and neck cancer and for presenting with a large tumour in the head and neck region. Excessive smoking is only a risk factor for being diagnosed with a large tumour, although there is a weak association between smoking and prolonged diagnostic delay.

Objective It is reasonable to assume that prolonged delay in presenting with head and neck cancer is associated with an advanced stage of cancer at diagnosis. In this study we analysed the effects of drinking and smoking habits on diagnostic delay and the T stage of the tumour at diagnosis.

Material and methods A total of 427 patients with newly diagnosed head and neck carcinomas were eligible for this study. Of these, 306 (72%) actually participated: 134 (77%) with an oral tumour; 117 (69%) with a larynx tumour; and 55 (65%) with a pharynx tumour. Diagnostic delay was defined as a period of >30 days between the appearance of the first tumour-related symptoms and the first visit to a physician. T3–4 tumours were defined as advanced tumours. Drinking behaviour was classified into three types: light (0–2 drinks/day); moderate (3–4 drinks/day); and heavy (>4 drinks/day). Smoking habits were classified into 4 types: never; stopped; light (0–20 cigarettes/day); and heavy (>20 cigarettes/day).

Results Logistic regression showed that there were significantly more heavy than light drinkers [p=0.04; odds ratio (OR) 1.8; 95% CI 1.0–3.1] in the delay group than in the non-delay group. Light smokers showed a tendency towards prolonged delay (p=0.06; OR 2.2; 95% CI 1.0–5.0). Both heavy drinking (p=0.01; OR 2.0; 95% CI 1.2–3.6) and heavy smoking (p=0.03; OR 3.1; 95% CI 1.1–8.4) were risk factors for a patient to be diagnosed with a large tumour.     

Smoking cessation in patients diagnosed with head and neck cancer

OBJECTIVE: To determine patients' smoking status after the diagnosis and treatment of squamous cell carcinoma of the head and neck (SCCHN) and to identify factors associated with smoking cessation. DESIGN: Cross-sectional survey study conducted over a 2-year period. SETTING: Head and neck surgery clinic of an academic tertiary care hospital. METHODS: Two hundred thirteen consecutive patients diagnosed with SCCHN were interviewed to ascertain patients' smoking status and the incidence of smoking cessation. Information on demographics, tobacco and alcohol history, disease characteristics, and treatment modality was also collected. MAIN OUTCOME MEASURES: The rate of smoking cessation was evaluated, in which smoking cessation is defined as the use of no cigarettes at least 1 month prior to the interview. Possible predictors of smoking cessation were evaluated. RESULTS: One hundred twenty-five patients were found to be smoking at the time of diagnosis. Among these patients, 53.6% stopped smoking after diagnosis or during treatment. In the univariate analyses, tumour site (p = .01), concurrent alcohol use (p = .03), and number of attempts to quit pre- (p = .03) and postdiagnosis (p = .001) were found to be highly predictive of patient smoking cessation. Multivariable modelling showed that gender, tumour site, and number of attempts to quit smoking were significantly and independently related to smoking cessation. CONCLUSIONS: Although smoking cessation would be presumed to be high after cancer diagnosis, this study has identified patient subgroups in which postdiagnosis smoking cessation intervention programs need to be made more effective.     

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

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

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

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

Chemoprevention of head and neck cancer with aspirin: a case-control study

OBJECTIVE: To evaluate the chemopreventive potential of aspirin against head and neck cancer. DESIGN: Hospital-based case-control study. SETTING: National Cancer Institute-designated comprehensive cancer center. Patients Individuals who received medical services at the Roswell Park Cancer Institute, Buffalo, NY, between 1982 and 1998 and who completed a comprehensive epidemiologic questionnaire. MAIN OUTCOME MEASURE: Aspirin use among 529 patients with head and neck cancer and 529 hospital-based control subjects matched by age, sex, and smoking status. RESULTS: Aspirin use was associated with a 25% reduction in the risk of head and neck cancer (adjusted odds ratio, 0.75; 95% confidence interval, 0.58-0.96). Consistent risk reductions were also noted in association with frequent and prolonged aspirin use. Further, a consistently decreasing trend in risk was noted with increasing duration of aspirin use (P(trend) = .005). Risk reduction was observed across all 5 primary tumor sites, with cancers of the oral cavity and oropharynx exhibiting greater risk reduction. When analyzed by smoking and alcohol exposure levels, participants moderately exposed to either showed a statistically significant 33% risk reduction (adjusted odds ratio, 0.67; 95% confidence interval, 0.50-0.91), whereas participants exposed to both heavy smoking and alcohol use did not benefit from the protective effect of aspirin. The reduction in risk was relatively more significant in women. CONCLUSIONS: Aspirin use is associated with reduced risk of head and neck cancer. This effect is more pronounced in individuals with low to moderate exposure to cigarette smoke or alcohol consumption.     

Risk factors for sudden deafness: a case-control study

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

Incidence and significance of myocardial injury after surgical treatment of head and neck cancer

OBJECTIVE/HYPOTHESIS: To review the incidence of, and risk factors for myocardial injury after head and neck surgery to help optimize patient care and develop perioperative cardioprotective strategies. STUDY DESIGN: Observational cohort study. METHODS: Records of 65 patients surgically treated for upper aerodigestive tract squamous cell carcinoma between 2005 and 2006 were reviewed. Information about cardiovascular history, tumor characteristics, details of surgery, and postoperative complications were recorded. Patients had troponin assays on the third postoperative day. Logistic regression was used to identify risk factors for postoperative myocardial injury. RESULTS: The average age at presentation was 62+/-12 years. There were 46 (71%) males and 19 (29%) females. Troponin-positive and -negative groups were matched for age, sex, cardiovascular risks, comorbidity, site, tumor-node-metastasis status, and duration of the operations. Sixteen (25%) patients had postoperative myocardial injury including five clinical myocardial infarctions. Factors identified as independent predictors of postoperative myocardial injury were blood pressure level (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.04-1.31; P<.02), intraoperative heart rate variability (OR 1.33; 95% CI 1.04-1.71; P<.02), and the degree of postoperative inflammatory response (OR 1.07; 95% CI 1.02-1.13; P<.001). CONCLUSIONS: Postoperative myocardial injury is a known independent predictor of cardiovascular prognosis. Its incidence in head and neck patients could potentially be reduced through stringent blood pressure management, tight intraoperative heart rate control, and dampening of the postoperative inflammatory response. Troponin testing is a valuable screening tool, and patients who have elevated levels postoperatively should be closely monitored and referred to a cardiologist for optimization of cardiovascular care.     

XRCC3遗传变异与喉癌和下咽癌发病风险相关研究

目的研究DNA修复基因XRCC3 Thr 241 Met遗传变异与喉癌和下咽癌风险的关系。方法采用聚合酶链反应-限制性片段长度多态分析方法对175例喉癌及下咽癌患者和525名无肿瘤对照进行基因分型，采用多因素Logistic回归模型计算各基因型携带者喉癌和下咽癌的发病风险，以及与吸烟交互对喉癌下咽癌发病风险的影响。结果XRCC3 241 Met等位基因增加了喉癌、下咽癌发病风险，与XRCC3 241 Thr／Thr基因型携带者相比，至少携带一个241 Met等位基因的个体罹患喉癌、下咽癌的比值比（odds ratio，OR）为2．26，95％可信区间（confidence interval，CI）为1．33～3．82。分别分析XRCC3多态与喉癌及下咽癌发病风险关系发现，XRCC3 241 Met等位基因均增加喉癌与下咽癌的发生风险，与XRCC3 241 Thr／Thr基因型携带者相比，至少携带一个XRCC3 241 Met等位基因的个体发生喉癌和下咽癌风险的OR值（95％CI）分别为2．27（1．26～4．09）和2．99（1．27～7．04）。基因吸烟交互作用分析结果显示，重度吸烟和XRCC3 Thr 241 Met多态存在相乘交互作用，显著增加喉癌、下咽癌发病风险。至少携带一个XRCC3 241 Met等位基因的重度吸烟个体发生喉癌、下咽癌的OR值（95％CI）为19．09（7．38～49．40），大于至少携带一个XRCC3 241 Met等位基因的不吸烟个体（OR，0．91；95％CI，0．20～4．21）及重度吸烟但携带XRCC3 241 Thr／Thr基因型个体（OR，4．13；95％CI，2．38～7．17）的OR乘积。结论XRCC3 Thr 241 Met单核苷酸多态是喉癌、下咽癌的遗传易感因素。     

Human papillomavirus and head and neck cancer: a systematic review and meta‐analysis

?It has been suggested that the link between human papillomavirus (HPV) and head and neck squamous cell carcinoma (HNSCC) is specific to carcinoma of the tonsil. ? We systematically reviewed studies that tested for HPV16 exposure in anatomically defined sites in the head and neck and a control group. ? The association between HPV16 and cancer was strongest for tonsil (OR: 15.1, 95% CI: 6.8–33.7), intermediate for oropharynx (OR: 4.3, 95% CI: 2.1–8.9) and weakest for oral (OR: 2.0, 95% CI: 1.2–3.4) and larynx (OR: 2.0, 95% CI: 1.0–4.2). ? To investigate heterogeneity, further stratification by method of HPV16 detection, suggested that variation in the magnitude of the HPV‐cancer association with cancer site was restricted to studies using ELISA: among studies using PCR, the magnitude of the summary odds ratios was similar across the four sites. ? The association between HPV16 infection and HNSCC in specific sites suggests the strongest and most consistent association is with tonsil cancer, and the magnitude of this association is consistent with an infectious aetiology. ? However, the method of viral detection may be an important source of heterogeneity. Resolution of this issue will require further studies using both methods, examining associations separately in different sites.     

Pediatric head and neck malignancies: US incidence and trends over 2 decades

BACKGROUND: Recent reports have noted an increase in the overall incidence of pediatric cancer. OBJECTIVE: To determine whether this trend is applicable to malignancies of the head and neck in children. DESIGN: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results tumor database, we determined the incidence of all cancers diagnosed from 1973 through 1996 in children younger than 19 years. This was compared with the incidence of head and neck malignancies within the same population. Rates were then determined for eight 3-year periods from 1973-1975 to 1994-1996 and adjusted by use of three 5-year age groups weighted by the 1970 US standard population. RESULTS: A total of 24,960 malignancies diagnosed in children younger than 19 years were identified for the study period. From this group, 3050 tumors (12%) were located in the head and neck. The average annual rate of all cancer (number of malignancies per 100,000 person-years) in children younger than 15 years rose 25% from 11.22 (95% confidence interval [CI], 10.70-11.74) for 1973-1975 to 14.03 (95% CI, 13.46-14.60) for 1994-1996. Among malignancies of the head and neck, the incidence rate increased 35% from 1.10 (95% CI, 0.94-1.26) to 1.49 (95% CI, 1.30-1.68) during the same period. CONCLUSION: The incidence of head and neck malignancies among children younger than 15 years in the United States from 1973 through 1996 increased at a greater rate than childhood cancer in general.     

MicroRNA-146a前体区基因多态性与江苏地区汉族人群喉癌遗传易感性的关联性分析

目的 探讨microRNA-146a(miR-146a)前体区基因多态性位点rs2910164 G>C与喉癌的关联性。方法 建立病例-对照研究,选取204例喉癌患者和440例健康对照者,收集一般人口学资料和临床病理学特征,采用TaqMan探针对miR-146a rs2910164位点进行基因分型,logistic回归模型用于评价rs2910164位点与喉癌发病风险的关联性强度。结果 rs2910164多态性位点与增加罹患喉癌风险显著相关(GC/CC vs. CC：OR调整=2.49,95% CI=1.57-3.94)。分层分析显示,与携带GG基因型个体相比,携带C等位基因的吸烟、饮酒以及无肿瘤家族史个体罹患喉癌风险显著增加(P均< 0.05),吸烟、饮酒与miR-146a rs2910164位点的共同作用效应更加显著(吸烟与rs2910164 GC/CC：OR=6.39,95% CI=2.72-15.0;饮酒与rs2910164 GC/CC：OR=4.19,95% CI=2.24-7.83)。结论 miR-146a rs2910164 C等位基因与增加罹患喉癌风险有关,可以作为预测喉癌发病风险的潜在生物标志物。     

Non-squamous malignancy in lymph nodes: the occult primary

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

Deterioration in quality‐of‐life of late (10‐year) survivors of head and neck cancer

Objectives: To determine 10-year quality-of-life (QOL) in head and neck cancer patients and to examine the potential predictors of late QOL. Design: Prospective 10-year (QOL) assessment in a cohort of head and neck cancer patients. Setting: Tertiary referral head and neck cancer centre in Auckland, New Zealand. Participants: Two hundred patients diagnosed and were treated for head and neck cancer. Exclusion criteria were blindness, learning difficulties or inability to understand or read English. Main outcome measures: Quality-of-life at 10 years measured by Auckland QOL questionnaire, and analysed for associations with the following co-variates: age, gender; co-morbidities (alcohol intake and smoking), type and stage of disease; treatment modality; and QOL measures. Results: At 10 years following diagnosis, overall QOL (life satisfaction), decreased significantly by an average of 11% (95% CI: −5, −17) compared with before treatment, and by 15% when compared with years 1 and 2. Pre-treatment QOL significantly predicted late QOL, whilst QOL 1 year after treatment did not. None of the socio-demographic, disease- or treatment-related factors predicted long-term QOL on univariate analysis, but this may be due to the small sample size. Conclusions: This observed, late drop in the QOL of head and neck cancer patients requires further corroboration and investigation. Due to small sample sizes associated with long-term studies in head and neck cancer cohorts, studies of predictors of long-term QOL will only be likely to succeed if done as multi-centre studies. As there is some evidence to suggest that psychosocial interventions improve the QOL of head and neck cancer patients, it may be appropriate to consider screening for risk of a late deterioration in QOL in order to plan appropriate psycho-social intervention.     

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

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

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

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

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

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

细胞色素P4501A1基因多态性与喉癌遗传易感性的研究

OBJECTIVE: To assess the possible relation between the MspI polymorphism of Cytochrome P4501A1(CYP1A1) gene and the susceptibility to laryngeal cancer. METHODS: The genotypes of CYP1A1 MspI site were detected using the methods of polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) in 62 cases of laryngeal squamous carcinoma and 56 healthy controls. Genetic risk of CYP1A1 genotypes was analyzed by smoking index (SI, cigarettes smoked per day x years of smoking). RESULTS: Three genotypes of CYP1A1 MspI were classified into the predominant homozygotes (A), heterozygotes (B) and the rare homozygotes (C). The frequency of heterozygote B (58.1%) and genotype C (14.5%) in the patients with laryngeal cancer were higher than that of the controls (39.3%, 7.1%, P < 0.05), while their odds ratios were 2.89 (95% confidence interval, CI: 1.31-6.37) and 3.97 (95% CI: 1.10-14.28), respectively. The odds ratios of genotype C was 9 (95% CI: 1.60-50.74) in the high dose cigarette smoking group, but was 4.5 (95% CI: 0.64-31.61) in the low dose cigarette smoking group. CONCLUSIONS: With the carcinogenesis and development of laryngeal cancer, the polymorphism of CYP1A1 gene and smoking exposure together may play an important role. The individuals with genotype C are at especially high risk of laryngeal cancer, which grows with increasing cigarette consumption.     

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.     

Health insurance and stage at diagnosis of laryngeal cancer: does insurance type predict stage at diagnosis?

OBJECTIVE: To examine whether patients with no insurance or Medicaid are more likely to present with advanced-stage laryngeal cancer. DESIGN: Retrospective cohort study from the National Cancer Database, 1996-2003. SETTING: Hospital-based practice. PARTICIPANTS: Patients with known insurance status diagnosed as having invasive laryngeal cancer at Commission on Cancer facilities (N = 61 131) were included. Adjusted and unadjusted logistic regression models analyzed the likelihood of presenting at a more advanced stage. MAIN OUTCOME MEASURES: Overall stage of laryngeal cancer (early vs advanced) and tumor size (T stage) at diagnosis. RESULTS: Patients with advanced-stage laryngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.79-2.15) or covered by Medicaid (OR, 2.40; 95% CI, 2.21-2.61) compared with those with private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.92; 95% CI, 2.60-3.28) or covered by Medicaid (OR, 3.97; 95% CI, 3.56-4.34). Patients who were black, between ages 18 and 56 years, and who resided in zip codes with low proportions of high school graduates or low median household incomes were also more likely to be diagnosed as having advanced disease and/or larger tumors. CONCLUSIONS: Individuals lacking insurance or having Medicaid are at greatest risk for presenting with advanced laryngeal cancer. Results for the Medicaid group may be influenced by the postdiagnosis enrollment of uninsured patients. It is important to consider the impact of insurance coverage on stage at diagnosis and associated morbidity, mortality, quality of life, and costs.     

Sonografic evaluation of oxygenation in head and neck cancer

BACKGROUND: Tumor oxygenation is an important aspect of radiosensitivity. The authors describe a new method for a non-invasive assessment of tumor oxygenation in head and neck cancer. PATIENTS AND METHODS: A group of 20 patients with neck metastases of squamous cell cancer of the head and neck region was surveyed. At first a pO (2)-polarography was performed in the metastatic cervical nodes to investigate the tissue oxygenation. In a second step, the vascularisation of these nodes was visualised by color duplex sonography. In order to evaluate the extent of vascularisation in these nodes, the density of color pixels was quantified by a custom-made software program. The color pixel density and the pO (2) values were correlated and the statistic significance was calculated by Pearson's test. RESULTS: The mean vascularisation as evaluated by the means of color duplex sonography was 7.78 % [95 % CI 6.04 - 9.51]. The interindividual pO (2) values in the stroma of metastatic lymph nodes ranged between 9.0 and 27.4 mmHg (16.6 [95 % CI 14.06 - 19.13]). The mean values of pO (2)-fractions < 2.5/< 5.0/10 mm Hg were 32.25 %, 44.25 % and 53.29 % respectively. The median value of the pO (2)-fraction was 10.49 % [95 % CI 7.13 - 13.85]. The vascularisation as evaluated by color pixel density showed a statistically significant correlation with the pO (2)-fractions < 5.0 and < 10 mmHg (p < 0.045 and < 0.0001) and with the mean (p < 0.002) and median values of tissue pO (2) values (p < 0.0001) in polarography. CONCLUSION: The results in a limited number of patients suggest, that the proposed sonographic method allows a reliable non-invasive evaluation of tissue oxygenation in cervical metastases of squamous cell head and neck cancers.