Oral oncology最新文献_第4页

Therapeutic strategy for advanced stages salivary carcinomas of the tongue: A multicenter REFCOR study 舌涎癌晚期的治疗策略：一项多中心 REFCOR 研究。

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology

Pub Date : 2024-10-20 DOI: 10.1016/j.oraloncology.2024.107072

Valentine Poissonnet , Emilien Chabrillac , Emmanuelle Uro-Coste , Virginie Woisard , Antoine Moya-Plana , Florent Espitalier , Joel Castelli , Thibault Dedieu , Sébastien Salas , Renaud Garrel , Robin Baudouin , Gilles Poissonnet , Claire Castain , Jonathan Barbut , Haitham Mirghani , Diane Evrard , Olivier Bouchain , Jean Paul Marie , Hélène Orliac , Philippe Ceruse , Sébastien Vergez

Introduction

Salivary carcinomas of the tongue represent a therapeutic challenge as their radical excision is particularly mutilating. We aimed to study the oncologic and functional outcomes of advanced stages salivary carcinomas of the tongue.

Materials and methods

This retrospective multicentric study, based on the French national network on rare head and neck cancers (REFCOR), included all patients with a T3-T4 salivary carcinoma of the tongue, diagnosed between January 2009 and December 2018.

Results

In total, 47 patients were included, of which 44.7 % underwent surgery. Histologies were mostly adenoid cystic carcinomas (61.7 %), followed by other adenocarcinomas (27.7 %) and mucoepidermoid carcinomas (10.6 %). Median follow-up duration was 63.9 months. In multivariable analysis, surgery was significantly associated with better Recurrence-Free Survival (HR = 0.23, 95 %CI [0.09;0.55]) and Local/Regional Recurrence-Free Survival (HR = 0.31, 95 %CI [0.10;0.95]). The rate of distant metastasis at the end of follow-up was 61.9 % in the surgical group and 57.7 % in the non-surgical group. The Distant Metastasis Free Survival was 54.9 % [38.3;68.7], without statistical difference between both groups. There were similar rates of definitive gastrostomies but the rate of normal oral diet at the last follow-up seemed higher in the surgery group (38.1 % vs 15.4 %).

Conclusion

Radical surgery in that population mainly aims to improve local/regional control, which may result in better long-term swallowing functions. About half of these tumors may be associated with occult distant metastasis at initial presentation. More studies are warranted to establish the role of postoperative RT and non-surgical treatment with concurrent CRT.

简介舌涎腺癌是一种治疗难题，因为根治性切除特别伤身体。我们旨在研究晚期舌涎腺癌的肿瘤学和功能性结果：这项回顾性多中心研究以法国国家罕见头颈部癌症网络（REFCOR）为基础，纳入了2009年1月至2018年12月期间确诊的所有T3-T4舌涎腺癌患者：共纳入47名患者，其中44.7%接受了手术治疗。组织学类型主要为腺样囊性癌（61.7%），其次为其他腺癌（27.7%）和黏液表皮样癌（10.6%）。中位随访时间为 63.9 个月。在多变量分析中，手术与较好的无复发生存期（HR = 0.23，95 %CI [0.09;0.55]）和局部/区域无复发生存期（HR = 0.31，95 %CI [0.10;0.95]）显著相关。随访结束时，手术组的远处转移率为61.9%，非手术组为57.7%。无远处转移生存率为 54.9% [38.3;68.7]，两组间无统计学差异。最终胃造瘘的比例相似，但手术组在最后一次随访时正常口服饮食的比例似乎更高（38.1% vs 15.4%）：结论：该人群接受根治性手术的主要目的是改善局部/区域控制，从而改善长期吞咽功能。这些肿瘤中约有一半在初次发病时可能伴有隐匿性远处转移。有必要开展更多研究，以确定术后 RT 和同时进行 CRT 的非手术治疗的作用。

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引用次数: 0

Lymphatic mapping in second primary or recurrent oral cavity cancer with prior neck treatment: A case series and scoping review 曾接受过颈部治疗的二次原发性或复发性口腔癌的淋巴图谱：病例系列和范围综述。

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology

Pub Date : 2024-10-19 DOI: 10.1016/j.oraloncology.2024.107077

Michael J. De Biasio , Ravi Mohan , Aaron Hendler , C. Jillian Tsai , Andrew McPartlin , Ali Hosni , Mirko M. Kolarski , David P. Goldstein , John R. de Almeida , Christopher M.K.L. Yao

Objectives

Lymphatic mapping is an established technique to map drainage patterns in oral cancer. Its utility in patients who have undergone prior radiation or neck dissection is not well studied.

Methods

Patients presenting to a single tertiary cancer center between 2021–2023 for a recurrent/second oral cancer that underwent lymphatic mapping were considered. All patients had a history of a head and neck cancer treated with either radiation or neck dissection. We further conducted a scoping review in MEDLINE, Embase, and Web of Science of lymphatic mapping in oral cancer patients with previous neck treatment.

Results

In our single center review, a total of 11 patients were included. 73 % received prior radiotherapy and 55 % underwent prior neck dissections for a head and neck cancer. Lymphoscintigraphy-directed neck dissections identified sentinel nodes in 9/11 patients, with only one patient who had positive sentinel node disease. There were no reports of regional recurrence at a median of 10 months follow-up. Our scoping review of 980 studies identified 151 additional patients who underwent sentinel node biopsy for a second oral cancer after previous neck treatment. Overall, the negative predictive value of lymphatic mapping in all studies was 96.7 %.

Conclusion

Lymphatic mapping is feasible in secondary or recurrent oral cavity cancers even in patients with prior radiation or surgical management of the neck. The literature to date demonstrates a negative predictive value of ∼ 97 % for sentinel node mapping and warrants further consideration in the management of salvage oral cancer.

目的：淋巴管图是一种绘制口腔癌引流模式的成熟技术。该技术对曾接受过放射治疗或颈部切除术的患者的实用性研究尚不充分：方法：研究对象为 2021-2023 年间因复发/二次口腔癌到一家三级癌症中心就诊并接受淋巴管图绘制的患者。所有患者均有接受过放射治疗或颈部切除术的头颈部癌症病史。我们还进一步在 MEDLINE、Embase 和 Web of Science 上对曾接受过颈部治疗的口腔癌患者的淋巴管造影进行了范围性综述：在我们的单中心回顾中，共纳入了 11 名患者。73%的患者曾接受过放疗，55%的患者曾因头颈部癌症接受过颈部切除术。淋巴管造影引导的颈部切除术在9/11例患者中发现了前哨结节，只有1例患者的前哨结节病变呈阳性。在中位 10 个月的随访中，没有区域复发的报道。我们对 980 项研究进行了范围界定，发现还有 151 名患者在接受颈部治疗后因第二次口腔癌而接受了前哨节点活检。总体而言，所有研究中淋巴造影的阴性预测值为 96.7%：即使是颈部曾接受过放射治疗或手术治疗的患者，也可以对继发性或复发性口腔癌进行淋巴造影。迄今为止的文献显示，前哨淋巴结造影的阴性预测值为 97%，值得在口腔癌抢救治疗中进一步考虑。

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引用次数: 0

Commentary on “The association of frailty with morbidity and mortality following major mucosal head and neck surgery” 关于 "虚弱与头颈部粘膜大手术后发病率和死亡率的关系 "的评论。

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology

Pub Date : 2024-10-19 DOI: 10.1016/j.oraloncology.2024.107075

Dhivya Viswanathan, Rajakumar Govindasamy

引用次数: 0

Incidence and predictive factors for positive non-sentinel lymph nodes in completion neck dissection following a positive sentinel node biopsy in early oral cancer 早期口腔癌前哨淋巴结活检阳性后完成颈部清扫非前哨淋巴结阳性的发生率和预测因素。

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology

Pub Date : 2024-10-18 DOI: 10.1016/j.oraloncology.2024.107081

Searan Karamchandani , Axel Sahovaler , Elizabeth Crosbie-Jones , Mark McGurk , Selvam Thavaraj , Mustansir Alibhai , Simon Wan , Martin D Forster , Isabel Sassoon , Clare Schilling

引用次数: 0

Characteristics and treatment of epistaxis in nasopharyngeal carcinoma 鼻咽癌鼻衄的特点和治疗方法

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology

Pub Date : 2024-10-18 DOI: 10.1016/j.oraloncology.2024.107071

Wen-Bin Wu , Le Xia , Zheng-Kai Feng , Jiong-Lin Liang , Xi Ding , Si-Yuan Chen , Rui You , Ming-Yuan Chen , You-Ping Liu

Objectives

To analyze the risk factors and explore effective treatments for epistaxis in nasopharyngeal carcinoma (NPC) patients.

Methods

From March 2006 to February 2020, 351 epistaxis patients visited our center and 195 patients meeting the inclusion criteria were enrolled in the study. Characteristics and treatments, including step-up hemostatic treatment (including medication, anterior ± posterior nostril packing, or further surgical hemostasis) and the CTPI emergency hemostasis method (including common carotid artery compression, tracheotomy / intubation, packing of nasal and nasopharynx, and interventional treatment), were analyzed.

Results

The median total bleeding volume was 100.0 ml (range 20–4430 ml). 126 (64.6 %) and 69 (35.4 %) patients suffered from non-massive epistaxis and massive epistaxis. The 1-year overall survival (OS) rate was 60.1 % for patients with massive epistaxis and 97.3 % for those with non-massive epistaxis treated with step-up hemostatic treatment. Among patients with massive epistaxis, the 1-year OS rate was 80.0 % for those who received CTPI and 13.3 % for those who received step-up hemostatic treatment.

Conclusion

ICA exposure and hemostasis failure was adverse prognostic factors for OS in NPC patients with epistaxis. The step-up hemostatic treatment is effective for controlling non-massive epistaxis. The CTPI emergency method might be an effective hemostasis treatment for NPC patients with massive epistaxis, especially those with PRNN and ICA exposure.

摘要] 目的分析鼻咽癌（NPC）患者鼻衄的危险因素并探讨有效的治疗方法。方法 2006年3月至2020年2月，本中心共收治351例鼻衄患者，其中195例符合纳入标准。结果总出血量的中位数为 100.0 毫升（范围为 20-4430 毫升）。非大量鼻衄和大量鼻衄患者分别为 126 人（64.6%）和 69 人（35.4%）。大面积鼻衄患者的 1 年总生存率（OS）为 60.1%，而接受加强型止血治疗的非大面积鼻衄患者的 1 年总生存率（OS）为 97.3%。在大面积鼻衄患者中，接受CTPI治疗的患者的1年OS率为80.0%，接受阶梯止血治疗的患者的1年OS率为13.3%。阶梯止血治疗对控制非严重性鼻衄有效。CTPI急救法可能是鼻咽癌大面积鼻衄患者的有效止血疗法，尤其是那些有PRNN和ICA暴露的患者。

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引用次数: 0

Comprehensive functional evaluation of head and neck squamous cell carcinoma with BH3-profiling demonstrates apoptotic competency and therapeutic efficacy of BH3-mimetics 利用 BH3 图谱对头颈部鳞状细胞癌进行综合功能评估，证明了 BH3-模拟物的凋亡能力和疗效

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology

Pub Date : 2024-10-17 DOI: 10.1016/j.oraloncology.2024.107069

Daniel Li , Andrea Lopez , Nitisha Shrivastava , Wesley Chan , Carlos Thomas , Robert Burk , Jeff Segall , Stelby Augustine , Gregory Rosenblatt , Vikas Mehta , Bradley A. Schiff , Richard V. Smith , Michael B. Prystowsky , Nicolas F. Schlecht , Chandan Guha , Evripidis Gavathiotis , Thomas J. Ow

Evasion of apoptosis promotes tumor survival and contributes to resistance to cancer therapeutics in head and neck squamous cell carcinoma (HNSCC). Our recent work has demonstrated that HNSCC’s highly express pro-survival anti-apoptotic proteins Bcl-xL and Mcl-1. Nevertheless, the mechanism of HNSCC to evade apoptosis is still not well understood. We used BH3 profiling, a functional assay which measures mitochondrial depolarization in response to the introduction of BH3 peptides, to evaluate apoptosis competency and dependency upon BCL-2 family anti-apoptotic proteins in a panel of immortalized and patient-derived HNSCC lines. We assessed response to BH3 mimetics including ABT-263 (navitoclax), an inhibitor of Bcl-2/Bcl-xL/Bcl-w, and S63845, an inhibitor of Mcl-1, both as single agents and in combination. We demonstrate that apoptosis signaling appears to be intact in the majority of HNSCC cells, and they are co-dependent upon Bcl-xL and Mcl-1 for survival. We found the combination to be highly synergistic in 2D culture and in 3D organoid models of HHNSCC. Given our findings that co-dependency on Bcl-xL and Mcl-1 is common, and co-inhibition of these molecules is synergistic for growth suppression in HNSCC cells, these results elucidate the therapeutic potential of BCL-xL and MCL-1 inhibition in HNSCC.

在头颈部鳞状细胞癌（HNSCC）中，凋亡的逃避会促进肿瘤的存活并导致对癌症疗法的抗药性。我们最近的研究表明，HNSCC高表达促生存的抗凋亡蛋白Bcl-xL和Mcl-1。然而，HNSCC逃避凋亡的机制仍不甚明了。我们使用 BH3 分析（一种功能性检测方法，用于测量线粒体去极化对引入 BH3 肽的反应）来评估永生化和患者来源 HNSCC 株系的凋亡能力和对 BCL-2 家族抗凋亡蛋白的依赖性。我们评估了Bcl-2/Bcl-xL/Bcl-w抑制剂ABT-263（navitoclax）和Mcl-1抑制剂S63845等BH3模拟物对单药和联合用药的反应。我们发现，大多数 HNSCC 细胞的凋亡信号似乎是完整的，而且它们的存活共同依赖于 Bcl-xL 和 Mcl-1。我们发现，在 HHNSCC 的二维培养和三维类器官模型中，这两种药物的组合具有高度协同作用。鉴于我们的研究结果表明Bcl-xL和Mcl-1共同依赖HNSCC细胞，而共同抑制这些分子能协同抑制HNSCC细胞的生长，这些结果阐明了抑制BCL-xL和MCL-1对HNSCC的治疗潜力。

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引用次数: 0

FOXP3 inhibits proliferation and migration by competitively inhibiting YAP1 in nasopharyngeal carcinoma FOXP3 通过竞争性抑制 YAP1 来抑制鼻咽癌的增殖和迁移

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology

Pub Date : 2024-10-15 DOI: 10.1016/j.oraloncology.2024.107066

Yiqing Zang , Yi Lu , Jiaxi Yu , Qiuping Dong , Yue Shi , Guoguang Ying , Zheng Liang

Hippo signalling is involved in the coordination of extracellular signals that control tissue homeostasis and organ size. Yes-associated protein 1 (YAP1) is regulated primarily by Hippo signalling through coactivation of transcription factors with GATA domains called TEADs. However, small-molecule orthosteric inhibitors of YAP1 are difficult to develop due to its tight binding to TEAD4 via a flat interface. Previous studies have shown that chlorpromazine (CPZ) can inhibit YAP1 expression. MTT, colony formation, wound healing, Transwell migration and Western blot assays were performed to explore how CPZ affects nasopharyngeal carcinoma (NPC) cells through FOXP3. In addition, immunofluorescence and live-cell imaging were used to detect YAP1 intracellular localization after CPZ administration. Through the HDOCK website, we predicted protein binding regions between FOXP3 and TEAD4. Western blot and co-IP experiments were used to verify the relationship between FOXP3 and YAP1. The UCSC Xena database, LinkedOmics database and KM plotter website were used to assess the prognostic value of FOXP3 in head and neck squamous cell carcinoma (HNSCC). Age, sex, pathological tumour–node–metastasis (pTMN) stage, grade, smoking status and FOXP3 expression were included in an overall survival nomogram model. Our findings revealed that FOXP3 has the ability to competitively interacts competitively with TEAD4 to inhibit YAP1 expression. By increasing FOXP3 expression, CPZ induces YAP1 nuclear export and phosphorylation, consequently suppressing NPC cell proliferation and migration. Collectively, our findings indicate that FOXP3 competitively binds TEAD4 to regulate YAP1 localization in the nucleus and cytoplasm to suppress NPC progression. Consequently, FOXP3 may be a prognostic indicator for HNSCC.

Hippo 信号传递参与了细胞外信号的协调，这些信号控制着组织的稳态和器官的大小。是相关蛋白1（YAP1）主要通过与具有GATA结构域的转录因子（TEADs）共激活来调节Hippo信号。然而，由于YAP1通过扁平界面与TEAD4紧密结合，因此很难开发出小分子的正交抑制剂。先前的研究表明，氯丙嗪（CPZ）可以抑制 YAP1 的表达。为了探讨 CPZ 如何通过 FOXP3 影响鼻咽癌（NPC）细胞，我们进行了 MTT、菌落形成、伤口愈合、Transwell 迁移和 Western 印迹检测。此外，我们还使用免疫荧光和活细胞成像技术检测了服用 CPZ 后 YAP1 在细胞内的定位情况。通过 HDOCK 网站，我们预测了 FOXP3 和 TEAD4 之间的蛋白结合区域。我们利用 Western 印迹和 coIP 实验来验证 FOXP3 和 YAP1 之间的关系。我们利用 UCSC Xena 数据库、LinkedOmics 数据库和 KM plotter 网站来评估 FOXP3 在头颈部鳞状细胞癌（HNSCC）中的预后价值。年龄、性别、病理肿瘤-结节-转移（ppTMN）分期、分级、吸烟状况和 FOXP3 表达均被纳入总生存期提名图模型。我们的研究结果表明，FOXP3能与TEAD4竞争性相互作用，抑制YAP1的表达。通过增加 FOXP3 的表达，CPZ 可诱导 YAP1 核输出和磷酸化，从而抑制鼻咽癌细胞的增殖和迁移。总之，我们的研究结果表明，FOXP3与TEAD4竞争性结合，调节YAP1在细胞核和细胞质中的定位，从而抑制鼻咽癌的进展。因此，FOXP3可能是HNSCC的一个预后指标。

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引用次数: 0

Surgeon-performed intraoperative transoral ultrasound improves the detection of human papillomavirus-positive head and neck cancers of unknown primary 外科医生在术中进行经口超声检查可提高对人类乳头瘤病毒阳性的不明原发性头颈部癌症的检测率

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology

Pub Date : 2024-10-14 DOI: 10.1016/j.oraloncology.2024.107073

Martin Garset-Zamani , Anne Fog Lomholt , Birgitte Wittenborg Charabi , Rikke Norling , Danijela Dejanovic , Johanna Maria Hall , Fatemeh Makouei , Tina Klitmøller Agander , Annette Kjær Ersbøll , Christian von Buchwald , Tobias Todsen

Background

Squamous cell carcinomas of unknown primary (SCCUP) are often Human Papillomavirus (HPV)-positive. Due to their small size, extensive surgical workup is required to locate the primary tumors. High-frequency transoral ultrasound (US) may provide improved visualization of these small tumors. Our study aimed to explore whether surgeon-performed intraoperative transoral US for patients with HPV-positive SCCUP could improve primary tumor detection during panendoscopy.

Methods

This was a single-center, prospective diagnostic study including patients undergoing panendoscopy under general anesthesia with HPV-positive SCCUP. Preoperative MRIs, PET/CTs, and HPV DNA-testing of lymph node metastases were performed in all patients. Intraoperative transoral US was performed prior to panendoscopy. Frozen section biopsies were performed unblinded to US results, and transoral US-guided biopsies were attempted if initial biopsies were negative. Final histopathology was obtained with palatine- and/or lingual tonsillectomy if frozen section was negative. The main outcome was the primary tumor detection rate with intraoperative transoral US and panendoscopy.

Results

Thirty patients were included: 24 (80 %) were men, and the median age was 60 years [range 35–79 years]. Twenty-nine primary tumors (97 %) were confirmed; 18 (62 %) and 10 (34 %) in the lingual- and palatine tonsils, respectively, and one (3 %) in the posterior oropharynx. Transoral US had a significantly higher sensitivity than panendoscopy to locate the primary tumor (93 % vs 76 %, p = 0.02), and significantly higher than pre-operative PET/CT (62 %, p = 0.002), CT (45 %, p < 0.001), and MRI (28 %, p < 0.001).

Conclusions

Intraoperative transoral US during panendoscopy is a promising diagnostic tool that may improve the detection of HPV-positive SCCUP.

背景原发灶不明的鳞状细胞癌（SCCUP）通常是人乳头状瘤病毒（HPV）阳性。由于其体积较小，需要进行大量的手术检查才能确定原发肿瘤的位置。高频经口超声（US）可改善这些小肿瘤的可视化。我们的研究旨在探讨外科医生为HPV阳性SCCUP患者进行术中经口超声检查是否能提高全内镜检查时原发肿瘤的检测率。方法这是一项单中心、前瞻性诊断研究，包括在全身麻醉下接受全内镜检查的HPV阳性SCCUP患者。所有患者都进行了术前核磁共振成像、PET/CT 和淋巴结转移的 HPV DNA 检测。全腔镜检查前进行术中经口 US 检查。冷冻切片活检与 US 结果无关，如果最初的活检结果为阴性，则尝试在 US 引导下进行经口活检。如果冷冻切片呈阴性，则通过腭和/或舌扁桃体切除术获得最终组织病理学结果。主要结果是术中经口 US 和全内镜检查的原发肿瘤检出率：其中 24 例（80%）为男性，中位年龄为 60 岁[35-79 岁]。确诊原发性肿瘤 29 例（97%），其中 18 例（62%）和 10 例（34%）分别位于舌扁桃体和腭扁桃体，1 例（3%）位于口咽后部。经口 US 定位原发肿瘤的灵敏度明显高于全内镜检查（93 % vs 76 %，p = 0.02），明显高于术前 PET/CT（62 %，p = 0.002）、CT（45 %，p < 0.001）和 MRI（28 %，p < 0.001）。

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引用次数: 0

Nomograms to predict occult contralateral central lymph node metastases in unilateral papillary thyroid carcinoma with ipsilateral clinical lymph node metastasis 预测同侧临床淋巴结转移的单侧甲状腺乳头状癌隐匿性对侧中央淋巴结转移的提名图

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology

Pub Date : 2024-10-14 DOI: 10.1016/j.oraloncology.2024.107051

Chunhao Liu , Hao Zhao , Ying Lu , Yu Xia , Ziwen Liu , Ge Chen , Yuewu Liu , Shuzhou Liu , Luying Gao , Xiaoyi Li

Background

No significant difference in disease-specific survival and recurrence-free survival exists between papillary thyroid cancer (PTC) patients with high-risk features subjected to lobectomy and thyroidectomy. However, it is unclear which type of patients with unilateral PTC combined with ipsilateral clinical involved lymph nodes (cN1) can receive a less aggressive treatment.

Methods

We collected the medical records of 631 patients diagnosed with unilateral PTC and ipsilateral cN1. These patients initially underwent total thyroidectomy and bilateral central lymph node dissection (LND), with or without lateral LND. We conducted an analysis to investigate the associations between contralateral occult central lymph node metastasis (CLNM) and clinicopathologic factors.

Results

The proportion of contralateral occult CLNM was 38.9 %. Age ≤45 years, tumor diameter >1 cm, obesity, and involvement of lymph node regions ≥2 were independent risk factors for contralateral occult CLNM. Multifocality and ipsilateral neck high-volume lymph node metastases were independent risk factors among the postoperative pathological factors. A predicting model was developed to quantify the risk of each factor, which revealed that patients without any of the risk factors mentioned above had a 20–30 % probability of contralateral occult CLNM, whereas the probability was greater than 60 % when all factors were present.

Conclusion

Based on the predictive nomograms, we proposed a risk stratification scheme based on different nomogram scores. In the debate about prophylactic central LND among contralateral central lymph node in unilateral PTC with ipsilateral clinical LNM, our nomograms provide the balance to avoid overtreatment and undertreatment through personal risk assessment.

背景接受甲状腺叶切除术和甲状腺切除术的高危甲状腺乳头状癌（PTC）患者在疾病特异性生存率和无复发生存率方面没有明显差异。方法我们收集了 631 例单侧 PTC 合并同侧临床受累淋巴结（cN1）患者的病历资料。这些患者最初都接受了甲状腺全切除术和双侧中央淋巴结清扫术（LND），包括或不包括侧淋巴结清扫术。我们进行了一项分析，研究对侧隐匿性中央淋巴结转移（CLNM）与临床病理因素之间的关联。年龄≤45岁、肿瘤直径≥1厘米、肥胖、淋巴结受累区域≥2个是导致对侧隐匿性中央淋巴结转移的独立危险因素。多灶性和同侧颈部高体积淋巴结转移是术后病理因素中的独立危险因素。我们建立了一个预测模型来量化每个因素的风险，结果显示，没有上述任何风险因素的患者发生对侧隐匿性 CLNM 的概率为 20%-30%，而当所有因素都存在时，概率则大于 60%。在单侧 PTC 伴有同侧临床淋巴结肿大的对侧中央淋巴结预防性 LND 的争论中，我们的提名图提供了一种平衡，可通过个人风险评估避免过度治疗和治疗不足。

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引用次数: 0

Bivalirudin for unsalvageable venous congestion or obstruction in head and neck free flap reconstruction 比伐卢定治疗头颈部游离皮瓣重建中无法修复的静脉充血或阻塞

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology

Pub Date : 2024-10-14 DOI: 10.1016/j.oraloncology.2024.107076

Micah K. Harris , Sophia Dang , Joshua D. Smith , Steven Chinn , Shaum S. Sridharan , Kevin J. Contrera , Matthew E. Spector

Microvascular free flap surgery permits single-stage reconstruction of complex head and neck ablative defects. Venous congestion can occur in the early postoperative period, risking partial or total flap loss. While prompt surgical re-exploration is often required, a number of adjunct medical treatments have been explored. Recently, there has been an anecdotal rise in the use of the anticoagulant bivalirudin, a recombinant derivative of hirudin. However, there has only been one case series report on the use of bivalirudin in head and neck free flap venous congestion. Here, we describe our team’s experience with bivalirudin through a series of 7 patients.

微血管游离皮瓣手术可对复杂的头颈部消融缺损进行单阶段重建。术后早期可能会出现静脉充血，导致皮瓣部分或全部脱落。虽然通常需要及时进行手术再探查，但人们也探索了一些辅助医疗方法。最近，抗凝血剂比伐卢定（一种水蛭素的重组衍生物）的使用有所增加。然而，目前仅有一例系列报道称双醋芦定可用于头颈部游离皮瓣静脉充血。在此，我们介绍了我们团队在 7 例患者中使用比伐卢定的经验。

引用次数: 0