Oral oncology最新文献

The accurate identification of the Clinical Target Volume (CTV) remains a challenge in providing postoperative adjuvant radiation therapy for patients with OSCC, due to postoperative changes in anatomy, along with the inability to define the exact location of the CTV during surgery. Holdorf et al. report on a pilot study assessing the utility of a digital navigation intraoperatively to identify and outline the tumor bed to improve planning of postoperative radiation therapy. Using navigated margins traced on imaging postoperatively, the authors demonstrate a reduction in CTV volume compared with traditional planning. They noted a mean reduction in CTV of 25.71%. Most importantly, the navigated method preserved the anatomic integrity of the CTV. This commentary discusses defining the CTV, including reducing the risk of irradiating healthy tissue while maintaining oncologic safety. This study supports integrating surgical navigation into approach for cancer care and provides evidence for further studies evaluating the long-term oncologic and radiation-related side effects. These data mark progress toward providing individualized adjuvant radiation therapy for patients with head and neck cancer.

Purpose: Efficient resource allocation in surgery requires thorough economic evaluation that reflects the true costs of a procedure, with micro-costing being a primary method. Existing economic studies on microvascular jaw reconstruction of the jaw often exclude or estimate key cost-drivers. The aim of this study was to estimate the direct financial costs and cost-drivers associated with surgical reconstruction of the jaw from the perspective of the healthcare provider.

Methods: A retrospective micro-costing study from the perspective of the healthcare provider was performed on 100 patients who underwent mandibular or maxillary free flap reconstruction. Direct financial costs of activities (in USD) from admission to discharge were examined, and classified into operative and perioperative admission periods.

Results: The mean cost for the entire admission was $36,415.95 ± 14,246.56 comprising 57.7% from the operative period and 42.3% from the perioperative admission period. Ward staffing and consumables (35.7%), prostheses (25.0%), and operating room staffing (21.0%) were the largest cost contributors. In adjusted analyses, higher costs were associated with vasculopathy (+$9142.02, p = 0.044), ASA IV ($19,495.93, p = 0.023), tracheostomy (+$10,445.81, p = 0.012), return to the operating room (+$19,920.22, p = 0.005), and return to the intensive care unit (+$25,316.26, p = 0.014).

Conclusion: Jaw reconstruction is associated with considerable direct financial costs to the healthcare provider with complications requiring return to the operating room and/or return to the intensive care unit the critical key cost-drivers. These insights will support future health technology assessments focused on jaw reconstruction to assist decision-makers in implementing or reimbursing these procedures.

Objective: Extranodal extension (ENE) of cervical lymph node metastases is a key prognostic factor in head and neck squamous cell carcinoma (HNSCC). This systematic review and meta-analysis evaluated the survival impact of ENE in HNSCC and identified global research trends relevant to this research field through a complementary bibliometric analysis.

Materials and methods: ScienceDirect, PubMed, and Scopus were systematically searched during 2000-2025. A systematic review and a meta-analysis were conducted in accordance with the PRISMA 2020 guidelines. A Scopus-based bibliometric analysis was conducted using the Biblioshiny package of R to identify and map the publication trends, influential authors, and major institutional contributions between 2010 and 2025.

Results: Of the 839 retrieved records, 711 studies were screened, and 16 studies comprising approximately 3900 patients met all inclusion criteria. The bibliometric analysis of 120 Scopus-indexed publications demonstrated a marked increase in ENE-related research from 2015 onward, driven primarily by institutions in Australia, Taiwan, and South Korea. Keyword mapping indicated expanding intersections of ENE research with radiomics, prognostic modelling, and refinement of staging systems. Meta-analysis confirmed a significant association between ENE and adverse survival outcomes. Subgroup analyses showed consistently poor prognostic implications across both pathologic and radiologic ENE assessments.

Conclusion: ENE in cervical lymph node metastases is an independent and strong predictor of adverse survival in HNSCC. The increasing global attention to ENE highlights its crucial role in multidisciplinary oncologic management. Therefore, standardized pathological and imaging-based assessment of ENE is essential for developing superior prognostic models and optimizing future treatment planning strategies.

Objectives: Optimal contouring of fibula free flaps (FFF) for mandibulectomy often requires osteotomies. This study aimed to define criteria for initial gap width by evaluating whether postoperative gap size and other factors influence long-term osseous union on CBCT, and to identify key determinants of bone healing.

Methods: This retrospective study included 75 patients who underwent segmental mandibulectomy with FFF reconstruction from 2017 to 2024. Initial osteotomy gaps were measured at four points on postoperative CBCT scans. Osseous union was assessed using a callus scale. Demographic, anatomical, and surgical variables-including 3D-assisted planning, fibula morphology, osteotomy location, systemic comorbidities, and segment number -were analyzed using uni- and multivariate regression models.

Results: A total of 202 osteotomy sites were evaluated. The mean initial gap was 1.68 ± 0.97 mm, and gap size did not significantly predict long-term union. Complete union occurred in 50.0% of sites, partial union in 36.6%, and nonunion in 13.4%. Fibula-fibula interfaces showed significantly better healing than fibula-mandible interfaces (p < 0.001). Symphyseal osteotomies demonstrated superior union compared with body and angle regions. Systemic vascular comorbidities were strong negative predictors of union, whereas reconstructions using more than two segments showed improved outcomes (p < 0.001). Alcohol consumption negatively affected both initial gap formation and union.

Conclusions: Long-term osseous union after FFF reconstruction is influenced mainly by systemic vascular health, osteotomy location, interface type, and fibula morphology rather than initial gap width.

Introduction: Head and neck cancers are the seventh most common malignancy worldwide, with laryngeal cancer (LC) the most prevalent subtype. Although squamous cell carcinoma (SCC) represents 85-90% of LC, rare non-SCC tumors-including laryngeal sarcomas (LS), neuroendocrine carcinomas (LNC), malignant salivary gland tumors (LMSGT), and mucosal melanomas (LMM)-are uncommon but clinically challenging. We combined a bicentric retrospective cohort with a systematic literature review to provide an integrated assessment of these entities.

Methods: Patients with non-SCC malignant laryngeal tumors treated with curative intent at two Italian tertiary centers were retrospectively analyzed. Tumors were classified as LS, LNC, LMSGT, or LMM. Primary endpoints were overall survival (OS), disease specific survival (DSS) and recurrence-free survival (RFS). A systematic review contextualized institutional outcomes.

Results: 74 patients were included: 34 LS, 25 LNC, 13 LMSGT, and 2 LMM. Surgery was the primary treatment in 98.6 % of cases. LS and LMSGT demonstrated favorable survival, whereas LNC showed poor outcomes (median OS, 2.89 years) and the highest recurrence rate (72 %). Radical tumor excision achieved effective loco-regional control across histologies. LMM prognosis was dismal, with recurrence in both cases. The literature review revealed marked heterogeneity and wide survival ranges, reflecting rarity and biological diversity.

Conclusion: Rare non-SCC laryngeal tumors comprise heterogeneous and often aggressive diseases with variable prognoses. Despite the absence of standardized management, radical surgery provides effective loco-regional control. Integrating bicentric clinical experience with published evidence highlights the need for multicenter collaboration to optimize treatment strategies and improve outcomes in this rare oncologic setting worldwide today.

Worst pattern of invasion (WPOI) has been evaluated in many single-institute cohorts. Our goal was to perform a large multicentre evaluation of WPOI as a prognostic marker in oral squamous cell carcinoma (OSCC). Retrospective pathology data was collated from 14 institutions and compared with clinical outcome in 1374 OSCC patients with upfront curative resection. Most cases were of oral tongue (n = 645, 47%); T2 (33%) and N0 (59%). WPOI 1-3 frequency was 29.4%, WPOI 4 47% and WPOI 5 22%. On univariable analysis, the 3-year disease free survival (DFS) was 54.2% for WPOI 5 vs. 69.7% for WPOI 1-4 (p < 0.001). The locoregional control (LRC) was 68.9% vs 79.2% (p = 0.001), and overall survival (OS) 68.4% vs 83.8% (p < 0.001). On multivariable Cox-regression in the entire cohort, WPOI 4 or 5 was strongly correlated with other known poor prognostic factors and not an independent predictor of OS (HR 1.10, 95% CI 0.92-1.52), LRC or DFS. However, in early-stage (pT1-2 N0) patients treated with surgery alone without adjuvant radiotherapy, WPOI 5 was a robust independent predictor of DFS (HR 4.36, 95% CI 1.54-12.32, p = 0.006), OS (HR 3.69, 95% CI 1.23-11.1, p = 0.020) and LRC (HR 3.52, 95% CI 2.13-5.82, p <0.001) after applying inverse probability weighting to correct for selection bias. Furthermore, in the entire cohort of early-stage patients, interaction modeling showed that adjuvant radiotherapy significantly reduces the risk for both DFS and LRC for those with WPOI-5 (Interaction p = 0.002). Therefore, it may act as a predictive biomarker for the benefit of adjuvant radiotherapy. The prognostic and predictive role of WPOI-5 should be validated in prospective trials.