Oral oncology最新文献

Background: Immune-related adverse events (irAEs) have been associated with better therapeutic outcomes in patients receiving immune checkpoint inhibitors (ICIs) across various cancers. This study investigates the association between irAEs and ICI outcomes in patients with recurrent or metastatic nasopharyngeal carcinoma (R/M NPC).

Methods: A post hoc analysis was performed on 153 patients with R/M NPC who received anti-PD-L1 inhibitors between February 26, 2019, and January 13, 2021. These patients were enrolled in a multicenter, single-arm, phase 2 clinical trial, which represents the largest study to date evaluating anti-PD-L1 therapy in previously treated R/M NPC.

Results: Patients who experienced irAEs had significantly higher overall response rates (ORR) and diseade control rates (DCR) compared to those without irAEs (31.2 % vs. 17.1 %, p = 0.039; 66.7 % vs. 44.8 %, p = 0.017). Additionally, the median progression-free survival (PFS) was longer in patients with irAEs (129 days vs. 56 days, p = 0.007). Patients with endocrine-related irAEs exhibited higher DCR (71.8 % vs. 46.2 %, p = 0.012), and longer PFS (144 days vs. 69 days, p = 0.02) and overall survival (OS: 746 days vs. 438 days, p = 0.02). In contrast, patients with grade ≥ 3 irAEs or thoserequiring systemic steroid therapy had shorter median OS (179 days vs. 466 days, p = 0.03; 166 days vs. 462 days, p = 0.02).

Conclusions: The occurrence of irAEs, particularly those involving the endocrine system, is associated with enhanced efficacy of anti-PD-L1 therapy and extended survival in patients with R/M NPC, highlighting their potential as prognostic biomarkers.

Background: The question as to whether prolonged diagnosis-to-surgery intervals (DSIs) may compromise survival outcomes in patients with oral cavity squamous cell carcinoma (OCSCC) remains unanswered. This nationwide study was designed to address this issue.

Methods: We analyzed data from 26,214 patients with first primary OCSCC identified in the Taiwanese Cancer Registry Database between 2011 and 2021. The optimal DSI cutoff was determined based on 5-year disease-specific survival (DSS) and overall survival (OS) rates using Cox regression analysis. Patients were categorized into three distinct DSI groups: ≤20 days (47 %), 21-31 days (31 %), and > 31 days (22 %).

Results: The 5-year DSS and OS rates for the ≤20/21-31/>31 days groups were 81 %/78 %/77 % and 73 %/70 %/68 %, respectively (both p < 0.0001). Patients in the ≤20 days group had a higher prevalence of pathological stages I-II. After adjustment for potential confounders in multivariable analysis, a DSI > 31 days (versus ≤ 20 days) retained independent associations with adverse outcomes at 5 years, with hazard ratios of 1.07 for both DSS and OS. Propensity score matching and multivariable analysis comparing DSI ≤ 20 days to DSI > 31 days stratified by pathological stage III-IV showed that higher DSS and OS rates were observed in patients with DSI ≤ 20 days than DSI > 31 days (68 %/66 %, p = 0.0586; 60 %/57 %, p = 0.0228, respectively), with hazard ratios of 1.09 for both DSS and OS.

Conclusions: Our findings indicate that DSI is an independent predictor of 5-year DSS and OS in patients with OCSCC. A DSI exceeding 31 days, or even 21 days, may potentially decrease survival outcomes.

Background: In the context of transoral robotic surgery (TORS) for oropharyngeal squamous carcinoma (OPSCC), preoperative imaging and intraoperative visualization plays a pivotal role in optimizing resection margins. Prior work has demonstrated the ability of transoral ultrasound (US) in identifying OPSCC margins and vascular structures. This study evaluates the effectiveness of transcervical ultrasound (TUS), as well as other preoperative imaging modalities, in evaluating OPSCC volumes and compares this to post TORS pathological OPSCC volumes.

Methods: Forty-one patients undergoing TORS between 2021 and 2023 were included. TUS was performed in all 41 patients, of which 37 had preoperative CT, 16 had PET-CT and 15 had MRI. Tumor dimensions on TUS, CT, and MRI were measured in craniocaudal, anteroposterior, and mediolateral planes to compute tumor volumes. Preoperative PET-CTs were analyzed to compute the metabolic tumour volume (MTV). Pathological tumor volumes served as the gold standard for comparison.

Results: No statistically significant differences were found between pathological tumor volumes and those measured by TUS, CT, PET-CT, or MRI (p = 0.57, 0.47, 0.28, 0.29). Both TUS and PET-CT showed strong correlation with pathology (R = 0.92, p < 0.0001), followed by CT (R = 0.83, p < 0.0001) and MRI (R = 0.55, p = 0.031). The percent difference of radiologic volumes from pathology volumes was lowest for MRI (19.37 % ± 28.28), followed by TUS (26.12 % ± 20.97), PET-CT (32.59 % ± 21.95), and CT (39.94 % ± 62.94).

Conclusions: TUS demonstrates comparable accuracy to CT, PET-CT, and MRI in assessing primary tumor volumes in patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing TORS. The strong correlation of TUS with final pathology, combined with its relatively non-invasive transcervical (versus transoral) approach and real-time acquisition, suggests that TUS has the potential to supplement TORS with image guidance.

Background: The histone gene H2AX and its phosphorylated protein γ-H2AX play a crucial role in the DNA damage response. This study investigates the expression of H2AX mRNA and its phosphorylated γ-H2AX protein in oropharyngeal squamous cell carcinoma (OPSCC), its association with distinct biological pathway alterations and its potential as a biomarker.

Materials and methods: Expression of H2AX mRNA in 76 OPSCC from The Cancer Genome Atlas (TCGA) cohort was analyzed. Patients were stratified into H2AX^high- and H2AX^low OPSCC based on a survival-associated cutoff. Differentially expressed genes were identified using DESeq2, followed by pathway enrichment analyses. Immunohistochemical staining of γ-H2AX protein expression was performed on an independent cohort of 209 OPSCC, followed by survival and Cox regression analyses.

Results: High H2AX mRNA expression was a significant prognostic factor associated with shorter OS in the TCGA OPSCC cohort (HR 4.77, p = 0.04). In H2AX^high tumors, differential gene expression analysis revealed upregulation of genes regulating DNA repair and cell cycle (CDK1, CCNB1, ZWINT). High γ-H2AX protein expression was significantly associated with HPV-negative OPSCC (p = 0.005), and remained an independent predictor of poor survival in the total OPSCC cohort (HR 2.24, p = 0.03) and particularly in HPV-negative patients (HR 3.67, p = 0.007).

Conclusion: H2AX/γ-H2AX expression is a potential prognostic biomarker in OPSCC, with elevated levels indicating poor survival, especially in HPV-negative cases. These findings suggest distinct molecular behaviors in OPSCC based on H2AX expression and highlight the need for further investigation into its therapeutic implications.

Background: Postradiotherapy nasopharyngeal necrosis with granulation mass (PRNN-GM) is a rare subtype of postradiotherapy nasopharyngeal necrosis (PRNN). It is characterized by the formation of isolated granulomatous tissue masses or masses combined with PRNN. However, the relationship between clinical features and survival outcomes in PRNN-GM remains unclear.

Methods: This retrospective study systematically evaluated 33 pathologically diagnosed PRNN-GM patients treated at three medical centres from January 2010 to May 2024. The clinical features, endoscopic and imaging characteristics, treatment methods, and survival outcomes of the patients were analysed.

Results: Among the 33 patients, 27 were male and 6 were female, with a mean age of 52 years (±10.9 years). Internal carotid artery exposure was observed in 5 patients. Nineteen patients underwent surgical treatment, whereas 14 received conservative management. Internal carotid artery exposure (OR = 6.863, 95 % CI: 1.196-39.385) and surgical treatment (OR = 0.130, 95 % CI: 0.026-0.659) were identified as independent prognostic factors influencing survival outcomes (P < 0.05).

Conclusions: Patients with PRNN-GM who have internal carotid artery exposure and do not undergo surgical treatment tend to have a poorer prognosis.

Objective: To analyze the role of lymph node level ratio (LNLR) in predicting prognosis and the benefits of postoperative radiotherapy (PORT) in patients with pathological N1 (pN1) head and neck squamous cell carcinoma (HNSCC).

Methods: Patients with pN1 HNSCC from January 2011 to February 2021 were included. Patients were grouped by the LNLR, lymph node yield (LNY), and lymph node ratio (LNR) and were analyzed with the Kaplan-Meier method and multivariate Cox model.

Results: This study identified 310 patients. Time-dependent receiver operating characteristic analyses showed superior prognostic ability for LNLR in comparison with LNY and LNR. Patients with an LNLR ≤ 5.25 had the worst survival. Multivariate regressions demonstrated larger hazard ratios (HRs) and a higher concordance index for the LNLR model versus the LNY and LNR models. The HRs (95 % confidence interval) for a LNLR ≤ 5.25 were 2.46 (1.71-3.54, p < 0.001) for DFS, 1.95 (1.38-2.75, p < 0.001) for OS, 2.25 (1.53-3.29, p < 0.001) for DSS. Furthermore, postoperative radiotherapy-related significant improvement in survival was observed exclusively in the LNLR ≤ 5.25 subgroup.

Conclusion: The LNLR is a more robust quality indicator for neck dissection. An LNLR of ≤ 5.25 significantly compromises survival and indicates the need for PORT in patients with pN1 HNSCC.