Oral oncology最新文献

Background: Data addressing health-related quality of life (HRQOL) following maxillary reconstruction with free flaps remain scarce. Insight into these outcomes is essential for clinical decision-making.

Methods: A systematic review of Medline, Embase, Web of Science, Cochrane, and Google Scholar was performed for publications on HRQOL after free flap reconstruction of maxillary defects following tumor resection or osteoradionecrosis. A meta-analysis was conducted using pooled estimates and random-effect models.

Results: In total, 5,818 unique articles were screened, 123 underwent full-text review, and 7 studies comprising 196 patients were included. Most studies used the UW-QoL (42.9%) or EORTC QLQ-H&N35 (42.9%); one used the FACE-Q Head and Neck Cancer Module. Meta-analyses revealed consistent pronounced impairments in functional domains. In the EORTC QLQ-H&N35, highest symptom burdens were observed for dry mouth, mouth opening, speech, and social eating, while pain and social contact were less affected. Lowest domain scores in UW-QoL were seen for chewing, appearance, and activity. FACE-Q results corroborated these findings, with lowest scores for eating, drinking, oral competence, and salivation. Psychosocial domains such as pain, social contact, and cancer worry were less affected. One study reported significantly better HRQOL outcomes with virtual surgical planning assisted reconstruction compared to conventional planning.

Conclusions: Functional impairments were the most consistently patient-reported symptoms following maxillary free flap reconstruction. There is a need for well-designed, adequately powered studies that identify patient- and treatment-related predictors of HRQOL and compare different treatment options. Such insights could improve preoperative counseling and support shared decision-making, ultimately enabling more personalized, effective care.

Objective: To define oncologic outcomes in Veterans in the modern era using a multi-institutional cohort designed to support development and validation of prognostic and predictive biomarkers for oropharyngeal squamous cell carcinoma (OPSCC).

Methods: A retrospective analysis was conducted including adult OPSCC patients treated at one of nine Veterans Affairs Medical Centers between 2000 and 2024; inclusive of 597 HPV-associated and 197 HPV-independent tumors. All patients were treated with curative intent external beam radiotherapy (100%) with (90%) or without concurrent chemotherapy.

Results: A total of 894 adult patients (mean age, 64 years; 881 (99.5%) male) were included in the study; 22% of patients self-identified as Black. The estimated 2- and 5-year OS rates for the entire cohort were 71% and 54%, respectively and lagged substantially behind locoregional control (LRC) and distant metastatic control (DMC). For Veterans with HPV-associated OPSCC, LRC and DMC at 5 years were 87% and 87% respectively. The strongest drivers of OS and LRC were T-classification and chemotherapy choice on univariate and multivariate analysis.

Conclusions: Although LRC and DMC rates among Veterans track well with recently completed clinical trial outcomes, OS rates lag substantially suggestive of higher rates of non-cancer-specific mortality. Together, these data suggest that predictive biomarker strategies focused on treatment effectiveness should be predicated on LRC and DMC rather than OS. This multicenter study is the first step in providing a robust dataset capable of developing and optimizing artificial intelligence (AI)-informed prognostic and predictive strategies essential to a precision oncology approach to OPSCC.

Objectives: In pT3-T4 oral cavity squamous cell carcinoma (OCSCC), standard management includes surgical resection with elective neck dissection (END), frequently followed by postoperative radiotherapy (PORT). While PORT is commonly administered for advanced primary tumors, the benefit of elective neck irradiation (ENI) in patients with a pathologically node-negative (pN0) neck after adequate high-yield END remains uncertain. This study evaluated whether ENI improves regional control or overall survival (OS) in this setting.

Methods: We conducted a retrospective multicenter cohort study of adults with pT3-T4N0 OCSCC treated between 2004 and 2024 at two tertiary referral centers. All patients underwent high-yield END (≥ 18 lymph nodes). Patients were stratified by PORT field: no PORT, PORT to the primary site only, or PORT to the primary site plus ENI. The primary outcome was regional recurrence-free survival (RFS); secondary outcomes included OS. Survival was analyzed using Kaplan-Meier methods and Cox proportional hazards modeling.

Results: A total of 156 patients were included. Over a median follow-up of 91 months, regional recurrence occurred in 6.4% of patients. There was no significant difference in RFS between patients who received ENI and those who did not (log-rank p = 0.16), nor in OS (log-rank p = 0.30). Stratification by radiotherapy field revealed no differences in RFS (log-rank p = 0.33) or OS (log-rank p = 0.51). In multivariable analysis, ENI was not independently associated with regional recurrence. Tumor stage (pT3 vs pT4a) did not influence regional control or survival.

Conclusions: In patients with pT3-T4N0 OCSCC who undergo high-yield END, ENI is not associated with improved regional control or OS. These findings support a selective, risk-adapted PORT strategy that omits routine neck irradiation in appropriately staged patients, potentially reducing treatment-related morbidity without compromising oncologic outcomes. Prospective multicenter studies are warranted to confirm these results.

Background: Smoking and alcohol consumption are major risk factors for oral and pharyngeal cancer (OPC) mortality. However, the interaction between these risks and tooth loss, as an indicator of cumulative consequences of oral health disadvantages, has not been investigated.

Methods: We used data from the Japan Gerontological Evaluation Study, which included functionally independent Japanese adults aged ≥ 65 years. The baseline survey was conducted in 2010 and followed up until 2022. The outcome was OPC mortality. The exposures were smoking, drinking, and the number of teeth. To estimate the hazard ratio (HR) and 95% confidence interval (CI) of OPC mortality, the Cox proportional hazards model was applied. We also assessed multiplicative and additive interactions by calculating the relative excess risk due to interaction (RERI).

Results: A total of 39,882 participants were included (men: 46.8%). The mean age at baseline was 73.7 years (SD = 6.0). The mean follow-up was 3,689 days. Among them, 0.2% had OPC mortality. Both smoking and drinking were associated with a higher risk of OPC mortality compared with none (HR, 2.87; 95%CI, 1.26-6.55). Those with 0-19 teeth were associated with a higher risk of OPC mortality than those with ≥ 20 teeth (HR, 1.96; 95%CI, 1.11-3.46). Interaction analysis showed higher OPC mortality risk among those with both smoking and drinking and 0-19 teeth (multiplicative interaction; HR, 5.02; 95%CI, 1.09-23.21, additive interaction; RERI, 2.97; 95%CI, 0.06-5.88).

Conclusions: Both smoking and drinking were associated with a higher risk of OPC mortality, particularly among those with fewer teeth.