Immunotherapy as a treatment modality for mucosal melanoma of the head and neck: A systematic review

Introduction:Mucosal melanoma (MM) is a rare disease, accounting for approximately 1.4% of all melanomas and only 0.03% of all new cancer diagnoses. Traditionally, it has been associated with a poor prognosis, with an overall 5-year survival rate of <25%. Progress in treatment has been hindered by its rarity and lack of evidence. However, studies on the treatment of subcutaneous melanoma with immunotherapy have demonstrated significant improvement in survival rates and have become a core part of oncological strategies. This paper discusses the revision of the evidence for the use of immunotherapy in the head and neck.Methods:This systematic review was conducted on January 19, 2019. The Medline and Embase databases were searched. In total, 509 articles were collated and screened. Inclusion criteria for the study included treatment-naive cohorts, cohorts with recurrent disease, primary outcomes with overall survival and disease-free survival at 5 years and at the longest follow-up, and studies of adults with MM in whom immunotherapy was reported as a treatment strategy. The exclusion criteria included duplicate papers, anatomical sites other than the head and neck, case reports, and those not published in English.Results:Fifty-two papers out of the 509 collated papers met the inclusion criteria. The results are shown as a comparison of yearly survival rates following different treatment modalities (immunotherapy vs nonimmunotherapy) at 2, 3, and 5 years. It was found that, with immunotherapy, survival rates at all intervals were higher than those without immunotherapy.Discussion:Immunotherapy outcomes in small studies have shown good data for increasing survival rates at yearly intervals in MM of the head and neck. Larger clinical trials are needed to accurately distinguish the efficacy and survival outcomes of immunotherapy when compared with treatment modalities, excluding immunotherapy. However, the ability to perform larger trials is limited by the rarity of MM of the head and neck.     

Analysis of postoperative radiotherapy for non-metastatic head and neck adenoid cystic carcinoma based on SEER data

ObjectiveThe postoperative role of adjuvant radiotherapy in non-metastatic head and neck adenoid cystic carcinoma (ACC) remains controversial. We analyzed adjuvant radiotherapy’s effect on surgical patient survival.MethodsPatients diagnosed with ACC from 2004 to 2015 in the Surveillance, Epidemiology, and End Results database were analyzed. The overall survival (OS) and disease-specific survival (DSS) of patients after adjuvant radiotherapy were assessed using the Kaplan–Meier and multivariate Cox methods. Propensity score matching (PSM) was performed to adjust confounders between patients with or without adjuvant radiotherapy; a forest plot was generated by subgroup analysis.ResultsThe study included 742 patients. In the PSM cohort, adjuvant radiotherapy did not improve OS or DSS. Radiotherapy was not a protective factor for OS or DSS in the univariate and multivariate Cox proportional hazard models. In the subgroup analysis, postoperative radiotherapy improved the OS of female and N1-stage patients and those with oropharyngeal tumors or over 79 years and the DSS of N1-stage patients.ConclusionsPostoperative radiotherapy showed different benefits in ACC patients, and postoperative radiotherapy recommendations should be individualized. Female and N1-stage ACC patients and those with oropharyngeal tumors or patients over 79 years without distant metastases postoperatively could benefit from adjuvant radiotherapy.     

青壮年股骨颈骨折患者行闭合复位内固定手术后发生股骨头无菌性缺血坏死影响因素分析

目的探讨青壮年股骨颈骨折患者经闭合复位内固定手术治疗后发生股骨头无菌性缺血坏死的影响因素。方法回顾性分析自2015年1月至2020年1月北部战区总医院骨科收治的经闭合复位内固定手术治疗的62例青壮年股骨颈骨折患者临床资料,包括年龄、性别、体质量指数、骨折侧、Garden分型、损伤至手术前时间、术前是否牵引、内固定是否取出、股骨头后倾角度、是否有股骨颈皮质粉碎、术后负重活动时间、复位质量等,并分析上述指标对术后发生股骨头无菌性缺血坏死的影响。结果青壮年患者发生术后股骨头无菌性缺血坏死与Garden分型、内固定是否取出、股骨头后倾角度、股骨颈皮质粉碎情况、复位质量相关(P<0.05)。多因素Logistic分析显示,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头无菌性缺血坏死关系密切(P<0.05)。结论青壮年股骨颈骨折闭合复位内固定术后发生股骨头坏死的影响因素较多,其中,内固定是否取出、复位质量、股骨头后倾角度与术后发生股骨头坏死密切关系。     

颈清患者保留及重建肩功能的研究进展

<正>1906年,Crile等人针对头颈部恶性肿瘤易发生颈淋巴结转移的情况提出了根治性颈淋巴清扫术(radical neck dissection,RND),这一术式在后来的很多年里,挽救了许多患者的生命。但RND损伤了副神经和颈部的一些重要的解剖结构,常导致患者斜方肌瘫痪萎缩,出现翼状肩胛、垂肩、肩周疼痛麻木、手臂活动受限、功能障碍等并发症,     

距骨颈骨折的手术治疗

目的探讨距骨颈骨折的手术治疗及并发症防治。方法回顾2000年至2004年手术治疗的距骨颈骨折12例,总结其手术入路、内固定方法及术后处理。结果所有患者均在术后12~14d伤口拆线出院,无伤口感染、不愈合或皮肤坏死发生。12例患者中有10例获得随访,随访7个月至5年,平均3年4个月。按Hawkins标准优2例、良7例、中1例,创伤性骨关节炎4例,距骨无菌性坏死2例。结论对于复位不理想的距骨颈骨折应积极行切开复位内固定,强调骨折的解剖复位,避免术后过早负重,降低术后并发症的发生几率。     

Framing Concerns about Body Image during Pre- and Post-Surgical Consultations for Head and Neck Cancer: A Qualitative Study of Patient–Physician Interactions

Patients with head and neck cancer report high unmet psychosocial needs as they undergo lifesaving treatments that can significantly alter their appearance and cause functional impairments. This qualitative analysis of recordings of 88 pre- and post-surgical consultations involving 20 patients respond to the need for empirical studies of patient–provider conversations about body image concerns. It indicates that the emphasis on concerns about survival, cure, and physical recovery during clinical consultations may leave concerns about the impacts of surgery on appearance and function unexplored and even silenced. The interviews with patients and medical team members that complement the analysis of the recordings suggest that an emphasis on survival, cure, and physical recovery can respond to the need for reassurance in the context of serious illness. However, it can also be problematic as it contributes to the silencing of patients’ concerns and to a potential lack of preparedness for the consequences of surgery. The results of this study can contribute to raising surgeons’ awareness of the interactional dynamics during clinical consultations. Moreover, the results highlight the unique role that surgeons can play in validating patients’ psychosocial concerns to support patients’ rehabilitation in both physical and psychosocial domains.     

Psychological Problems among Head and Neck Cancer Patients in Relation to Utilization of Healthcare and Informal Care and Costs in the First Two Years after Diagnosis

Background: To investigate associations between psychological problems and the use of healthcare and informal care and total costs among head and neck cancer (HNC) patients. Method: Data were used of the NETherlands QUality of Life and Biomedical Cohort study. Anxiety and depression disorder (diagnostic interview), distress, symptoms of anxiety and depression (HADS), and fear of cancer recurrence (FCR) and cancer worry scale (CWS) were measured at baseline and at 12-month follow-up. Care use and costs (questionnaire) were measured at baseline, 3-, 6-, 12-, and 24-month follow-up. Associations between psychological problems and care use/costs were investigated using logistic and multiple regression analyses. Results: Data of 558 patients were used. Distress, symptoms of anxiety or depression, FCR, and/or anxiety disorder at baseline were significantly associated with higher use of primary care, supportive care, and/or informal care (odds ratios (ORs) between 1.55 and 4.76). Symptoms of anxiety, FCR, and/or depression disorder at 12-month follow-up were significantly associated with use of primary care, supportive care, and/or informal care (ORs between 1.74 and 6.42). Distress, symptoms of anxiety, and FCR at baseline were associated with higher total costs. Discussion: HNC patients with psychological problems make more use of healthcare and informal care and have higher costs. This is not the result of worse clinical outcomes.     

122例非甲状腺来源的颈部囊性肿块临床分析

目的：探讨各种非甲状腺来源的颈部囊性肿块的特点,提高颈部肿块术前诊断的准确性,降低手术的盲目性和风险。方法：回顾性分析1999～2005年收治的非甲状腺来源的颈部囊性肿块122例。结果：资料表明,非甲状腺来源的颈部囊性肿块以先天性来源肿块最为多见,共84例,其中最常见的是甲状舌管囊肿;其次是感染性肿块30例,其中颌下腺囊肿25例;肿瘤来源最少见,共8例。主要根据肿块发生时间的长短,肿块的位置,颈部囊性肿块特异性表现和辅助检查来进行术前诊断。发现肿块的位置没有特殊性。根据某些肿块特征性的体征和穿刺检查,可明确诊断。结论：对非甲状腺来源的颈部囊性肿块,术前尽可能的明确诊断能有效地减少手术盲目性,降低手术并发症。     

舌癌的淋巴管生成与颈部淋巴结转移

目的：探讨人舌鳞癌淋巴管生成与颈淋巴结转移的关系。方法：采用淋巴管内皮透明质酸受体-1（lymphatic vessel endothelial HA receptor-1,LYVE-1）为淋巴内皮标记物,对照血管标记物CD34和CD105进行免疫组织化学染色,光镜下计数依次获得肿瘤间质淋巴管密度、肿瘤间质淋巴管开放面积、癌巢内淋巴管密度、肿瘤间质血管密度及癌巢内血管密度等指标。结果：舌鳞癌肿瘤间质淋巴管密度（5.66±2.34）与正常舌组织淋巴管密度（3.18±0.88）比较差别有统计学意义（P〈0.001）。肿瘤间质、癌巢内血管和淋巴管密度及肿瘤间质淋巴管开放面积在病理证实淋巴结转移组和淋巴结未转移组间有明显差异。结论：肿瘤间质、癌巢内淋巴管密度和血管密度,以及肿瘤间质淋巴管开放面积等指标各自与颈淋巴结转移有相关性;肿瘤间质淋巴管密度升高是颈淋巴结转移首位风险因素。     

髋关节置换治疗老年移位股骨颈骨折的术式选择

目的 探讨老年(＞65岁)移位股骨颈骨折人工关节置换术的适应症及术式选择.方法 2003年1月-2008年6月共收治108例移位股骨颈骨折患者,年龄65～90岁,平均76.8岁,全部骨折为Garden Ⅲ或Ⅳ型.全髋关节置换(THA组)62例,人工双极股骨头置换(BH组)46例,随访36～60个月,平均45.6个月.分...