JAMA otolaryngology-- head & neck surgery最新文献

Importance: Patients with papillary thyroid carcinoma (PTC) with lateral neck metastases (N1b) are usually treated with total thyroidectomy (TT), neck dissection, and adjuvant radioactive iodine (RAI). This philosophy comes with higher risks of complications and sequela than thyroid lobectomy (TL) and neck dissection alone. There are no prior studies on patients from the Western hemisphere that compare survival and recurrence outcomes between these groups.

Objective: To compare recurrence and survival outcomes in propensity-matched TL vs TT + RAI patients who presented with ipsilateral N1b PTC at a tertiary cancer center in the US.

Design, setting, and participants: This cohort propensity-matched study was conducted at a single US tertiary cancer center included 37 TL patients and 37 of 561 TT + RAI patients (after excluding patients with M1 disease), with a median (IQR) follow-up of 113 (58-241) and 90 (48-185) months, respectively. Adult patients with PTC with lateral neck node metastases (N1b) were identified from a thyroid cancer database. The study included patients undergoing surgery at Memorial Sloan Kettering Cancer Center from 1986 to 2020, inclusive, and the study was conducted from 2024 to 2025.

Main outcomes and measures: Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS).

Results: Of 598 total individuals, the median (IQR) age was 41 (33-55) years, and 341 (57%) were female. The 5-year OS was 96.9% in the TL group and 96.8% in the TT + RAI group (hazard ratio [HR], 0.2; 95% CI, 0.03-1.58). The 5-year DSS was 96.7% in the TL group and 100% in the TT +RAI group. The 5-year RFS was 89.8% in the TL group and 88.9% in the TT + RAI group (HR, 1.48; 95% CI, 0.39-5.58). The survival rates did not change between 5 and 10 years.

Conclusions and relevance: This cohort study found that a select group of patients with N1b PTC treated with TL had no important difference in survival and recurrence outcomes compared with patients treated with TT + RAI. Therefore, TL is an effective and safe treatment option in carefully selected and appropriately counselled patients with N1b PTC with unilateral tumors and low-volume regional lymph node metastases without clinical extranodal extension.

Importance: Historical evidence demonstrated that delays or interruptions in radiotherapy (RT) are associated with poorer oncologic outcomes in head and neck squamous cell carcinoma (HNSCC). Substantial concerns arose during the COVID-19 pandemic, when treatment schedules were frequently disrupted.

Objective: To determine the association of RT interruptions with locoregional failure (LRF) and overall survival (OS).

Design, setting, and participants: This retrospective review and secondary analysis of 3 randomized clinical trials (NRG/RTOG 0129, 0522, and 1016) included patients enrolled in the trials who were treated with RT. Patients with HNSCC were grouped as (1) p16-positive oropharynx (p16+ OPSCC) and (2) p16-negative oropharynx and all other subsites regardless of p16 status (called locally advanced HNSCC [LAHNSCC])). Cox proportional hazards models were fit to assess the association of an RT interruption (binary model) and length of RT interruption (continuous model) with LRF and OS.

Exposures: Presence of RT interruption.

Main outcomes and measures: LRF and OS.

Results: There were 1549 patients (200 female patients [12.9%]; mean [SD] age, 57 [6] years; 1048 p16+ OPSCC [67.7%]; 501 LAHNSCC [32.3%]) who were included in the binary model; 439 (28.3%) had RT interruption. There were 1083 patients (69.9%) with available length of RT interruption (continuous model). A binary RT interruption was associated with hazard ratios (HRs) of 1.04 (95% CI, 0.90-1.36) for LRF and 1.22 (95% CI, 0.99-1.50) for OS. As a continuous predictor, each 7-day interruption corresponded to HRs of 1.45 (95% CI, 1.12-1.89) for LRF and 1.41 (95% CI, 1.07-1.86) for OS. Analyses did not indicate effect modification by p16 status, and results are presented from models that estimated the effect of RT interruption across both groups. Using covariate-adjusted predictions from models that included clinical and tumor characteristics, a mean 7-day interruption in RT was associated with a 3-year LRF decrement of 4.1% in p16+ OPSCC and 9.1% in LAHNSCC. Predicted 3-year LRF detriment due to RT interruption ranged from 2.0% for a patient with non-T4, non-N3, p16+ OPSCC to 11.2% for a patients with LAHNSCC with a T4N3 p16-negative cancer.

Conclusions and relevance: The secondary analysis suggests that RT treatment interruptions may be negatively associated with LRF and OS in HNSCC, but the magnitude of the association varies depending on p16 status and clinical characteristics. While treatment interruptions should globally be discouraged, patients with LAHNSCC or higher-stage disease may be most affected.

Trial registration: ClinicalTrials.gov Identifiers: NCT00047008; NCT00265941; NCT01302834.

Importance: Neural recordings from cochlear implant users provide a valuable, noninvasive measure of auditory nerve function. However, inconsistent methods for acquiring and analyzing these recordings limit their clinical application.

Objective: To develop and validate an automated method for standardizing the analysis of electrically evoked compound action potentials in cochlear implant users, and to characterize longitudinal changes in auditory nerve function across the largest cohort studied to date.

Design, settings, and participants: This multicenter cohort study used nonlinear curve-fitting models to analyze electrically evoked compound action potentials acquired during clinical programming and follow-up at multiple US centers from July 28, 2002, to August 13, 2017. Data were analyzed from October 8, 2024 to May 6, 2025.

Main outcomes and measures: Model fit success rates; variation in auditory nerve response parameters with age, sex, electrode location, and duration of implant use; and identification of age-related periods of peripheral neural plasticity.

Results: The analysis included 1 145 323 electrically evoked compound action potential recordings comprising 169 159 growth functions from 10 111 cochlear implants in 7416 patients (3560 [48%] female and 3856 [52%] male individuals). Both models successfully fit approximately 80% of auditory-nerve growth functions. Thresholds increased from apex to base along the cochlear array, paralleled by a decline in response slope and plateau. Latencies remained stable across electrode locations. Age at implantation significantly predicted nerve response slope, with younger recipients showing steeper slopes that declined with increasing age, particularly after adolescence. In infants and toddlers, slopes continued to increase over 5 years of implant use, suggesting peripheral neural plasticity early in life. Older recipients showed minimal slope change over time. Although thresholds rose modestly with prolonged device use, slope and plateau stabilized after age 30 years, indicating that age at implantation, rather than stimulation duration, was the primary determinant of auditory nerve responsiveness.

Conclusions and relevance: This cohort study introduces a robust and scalable framework for in vivo assessment of auditory nerve function and monitoring of peripheral plasticity across the lifespan. The findings highlight the critical importance of early cochlear implantation for preserving neural health and optimizing long-term outcomes.