Oral oncology最新文献_第5页

Salvage surgery in nasopharyngeal Cancer: Unraveling the efficacy of transnasal endoscopic nasopharyngectomy for advanced stage recurrent tumors 鼻咽癌的挽救手术：揭示经鼻内窥镜鼻咽切除术对晚期复发肿瘤的疗效。

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

Oral oncology

Pub Date : 2024-10-02 DOI: 10.1016/j.oraloncology.2024.107048

Gulpembe Bozkurt , Mario Turri Zanoni , Marco Ferrari , Alessandro Ioppi , Sinem Kara Peker , Hasan Elhassan , Melis Ece Arkan Anarat , Yetkin Zeki Yilmaz , Stefano Taboni , Alessandra Ruaro , Vittorio Rampinelli , Davide Mattavelli , Alberto Schreiber , Alessandro Vinciguerra , Benjamin Verillaud , Paolo Battaglia , Cesare Piazza , Philippe Herman , Paolo Castelnuovo , Piero Nicolai , Alperen Vural

Objective

This systematic review evaluates the efficacy and morbidity of transnasal endoscopic nasopharyngectomy as a salvage treatment for advanced-stage recurrent nasopharyngeal carcinoma (rNPC).

Methods

Following PRISMA guidelines, we conducted a systematic search in Medline, Scopus, and PubMed, identifying studies on transnasal endoscopic nasopharyngectomy for rNPC. Inclusion criteria encompassed histologically confirmed rT3 and rT4 NPC patients previously treated with radiotherapy or chemoradiotherapy. Data on overall survival (OS), disease-free survival (DFS), and complications were extracted and analyzed.

Results

Nine studies, including a total of 429 patients, met the inclusion criteria. Five studies reported 2-year overall survival (OS) rates ranging from 34.6 % to 88.7 %. Three studies reported 3-year OS rates between 50 % and 63.5 %. Long-term 5-year survival varied widely from 0 % to 100 % across three studies. One study detailed 1-year disease-free survival (DFS) and OS at 93 % and 98 %, respectively. The pooled analysis included 429 patients with a median follow-up of 26.1 months. Complications were predominantly minor and transient. Major complications included necrosis, hemorrhage, cranial nerve palsy, and death. Advanced surgical techniques and pre-treatment measures, such as internal carotid artery embolization, improved resection outcomes and reduced complication rates.

Conclusion

Transnasal endoscopic nasopharyngectomy emerges as a viable salvage option for advanced rNPC, offering favorable survival outcomes and manageable complication profiles. Future research should focus on refining surgical techniques and improving patient selection criteria to further enhance treatment efficacy.

目的：本系统性综述评估了经鼻内窥镜鼻咽切除术作为晚期复发性鼻咽癌（rNPC）挽救治疗方法的疗效和发病率：按照 PRISMA 指南，我们在 Medline、Scopus 和 PubMed 上进行了系统检索，确定了经鼻内窥镜鼻咽切除术治疗复发性鼻咽癌的相关研究。纳入标准包括既往接受过放疗或化疗的组织学确诊的 rT3 和 rT4 鼻咽癌患者。对总生存期（OS）、无病生存期（DFS）和并发症的数据进行了提取和分析：结果：9项研究符合纳入标准，共纳入429名患者。5项研究报告了2年总生存率（OS），从34.6%到88.7%不等。三项研究报告的 3 年 OS 率介于 50% 到 63.5% 之间。三项研究的 5 年长期生存率差别很大，从 0% 到 100%。一项研究详细列出的 1 年无病生存率（DFS）和 OS 分别为 93% 和 98%。汇总分析包括429名患者，中位随访时间为26.1个月。并发症主要是轻微的一过性并发症。主要并发症包括坏死、出血、颅神经麻痹和死亡。先进的手术技术和颈内动脉栓塞等治疗前措施改善了切除效果，降低了并发症发生率：结论：经鼻内窥镜鼻咽切除术是治疗晚期鼻咽癌的可行挽救方案，可提供良好的生存效果和可控的并发症情况。未来的研究应侧重于完善手术技术和改进患者选择标准，以进一步提高治疗效果。

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引用次数: 0

Oral health-related quality of life among oropharyngeal cancer survivors 口咽癌幸存者与口腔健康相关的生活质量。

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

Oral oncology

Pub Date : 2024-10-02 DOI: 10.1016/j.oraloncology.2024.107062

Alzina Koric , Chun-Pin Chang , Siqi Hu , John Snyder , Vikrant G. Deshmukh , Michael G. Newman , Ankita P. Date , Marcus M. Monroe , Mia Hashibe

Objectives

The incidence of oropharyngeal cancer continues to rise in the United States, yet studies on the quality of life (QoL) of oropharyngeal cancer patients are limited. The objective of this pilot study was to assess the impact of oral health on the QoL in oropharyngeal cancer survivors.

Materials and Methods

Oropharyngeal cancer survivors with a confirmed cancer diagnosis from 1996 to 2016 were sampled from the Utah Cancer Registry. The Oral Health Impact Profile-14 (OHIP-14) questionnaire was administrated between January and May of 2019. The impact of oral health on QoL was evaluated using simple linear regression (β-coefficient).

Results

Among the 260 oropharyngeal cancer survivors, the majority were male (84.6 %) and ≥ 60 years of age at the time of cancer diagnosis (74.0 %). The most frequently reported symptoms of OHIP-14 were discomfort while eating any foods (19.2 %) and worsening sense of taste (16.0 %). The overall OHIP-14 mean score was 13.3. Significantly worse OHIP-14 scores were observed for females (β = 12.85, p = 0.01), chemotherapy recipients (β = 6.60, p = 0.02), and past smokers (β = 5.25, p = 0.04). Better OHIP-14 scores (better oral QoL) were observed in patients with distant cancer stage (β = −7.66, p = 0.01), higher income (β = −2.50, p = 0.05), and older age at cancer diagnosis (β = −0.35, p = 0.03).

Conclusion

The oral health-related quality of life scores observed in this pilot study suggest a need for improvement in patient symptom management over time.

研究目的在美国，口咽癌的发病率持续上升，但有关口咽癌患者生活质量（QoL）的研究却十分有限。本试验性研究的目的是评估口咽癌幸存者口腔健康对生活质量的影响：从犹他州癌症登记处抽取了 1996 年至 2016 年确诊癌症的口咽癌幸存者。在 2019 年 1 月至 5 月期间进行了口腔健康影响档案-14（OHIP-14）问卷调查。采用简单线性回归（β系数）评估了口腔健康对QoL的影响：在260名口咽癌幸存者中，大多数为男性（84.6%），癌症确诊时年龄≥60岁（74.0%）。最常报告的 OHIP-14 症状是进食任何食物时感到不适（19.2%）和味觉恶化（16.0%）。OHIP-14 的总平均分为 13.3 分。女性（β = 12.85，p = 0.01）、化疗接受者（β = 6.60，p = 0.02）和既往吸烟者（β = 5.25，p = 0.04）的 OHIP-14 评分明显较低。在癌症分期较远（β = -7.66，p = 0.01）、收入较高（β = -2.50，p = 0.05）和癌症诊断年龄较大（β = -0.35，p = 0.03）的患者中观察到较好的 OHIP-14 评分（较好的口腔生活质量）：本试验研究中观察到的口腔健康相关生活质量评分表明，随着时间的推移，患者症状管理需要改进。

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引用次数: 0

Loss of MACROD2 drives radioresistance but not cisplatin resistance in HPV-positive head and neck cancer MACROD2的缺失会导致HPV阳性头颈癌产生放射抗药性，但不会导致顺铂抗药性。

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

Oral oncology

Pub Date : 2024-10-01 DOI: 10.1016/j.oraloncology.2024.107061

Alice Dawson , Amir Hossein Karimi , Mushfiq H. Shaikh , Walid Gazala , Peter Y.F. Zeng , Sarah E.B. Ryan , Harrison Pan , Halema Khan , Matthew Cecchini , Adrian Mendez , David A. Palma , Joe S. Mymryk , John W. Barrett , Anthony C. Nichols

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer type worldwide. In recent years, there has been an increase in the rate of HNSCC cases attributed to the infection of the oropharynx by the human papillomavirus (HPV). Given the significant treatment-related toxicities of the current standard of care for HPV-positive HNSCC, there is an urgent need for the development of precision patient stratification and treatment strategies to improve patients’ quality of life while maintaining excellent survival rates. We have previously carried out whole genome sequencing of HPV+ HNSCC tumors that failed concurrent cisplatin and radiation treatment and discovered that MACROD2 deletion is enriched among these tumors. In the current study, we sought to investigate the mechanistic role of MACROD2 in HPV+ HNSCC treatment resistance. Our results indicate that MACROD2 depletion in HNSCC cell lines leads to increased cell viability and colony formation capacity. Interestingly, MACROD2 depletion did not alter cisplatin sensitivity but led to an increase in radiation resistance of HPV+ HNSCC cell lines. RNA sequencing and immunofluorescence microscopy demonstrated that MACROD2-depleted HPV+ HNSCC cells displayed elevated levels of hypoxia and an altered DNA damage response. Taken together, this study establishes and characterizes the role of MACROD2 in HPV+ HNSCC radioresistance. Further work is needed to validate MACROD2 as a biomarker of treatment failure and to understand how to overcome the identified molecular mechanisms of resistance.

头颈部鳞状细胞癌（HNSCC）是全球第六大常见癌症类型。近年来，由于人乳头瘤病毒（HPV）感染口咽部，导致 HNSCC 病例增加。鉴于目前治疗人乳头瘤病毒阳性 HNSCC 的标准疗法存在严重的治疗相关毒性，因此迫切需要开发精准的患者分层和治疗策略，以改善患者的生活质量，同时保持良好的生存率。我们曾对顺铂和放射治疗失败的HPV+ HNSCC肿瘤进行了全基因组测序，发现这些肿瘤中富含MACROD2缺失。在本研究中，我们试图探究MACROD2在HPV+ HNSCC耐药中的机制作用。我们的研究结果表明，在 HNSCC 细胞系中缺失 MACROD2 会导致细胞活力和集落形成能力增强。有趣的是，MACROD2 的缺失不会改变顺铂的敏感性，但会导致 HPV+ HNSCC 细胞系的耐辐射性增加。RNA 测序和免疫荧光显微镜检查表明，去除了 MACROD2 的 HPV+ HNSCC 细胞缺氧水平升高，DNA 损伤反应也发生了改变。综上所述，本研究确定并描述了MACROD2在HPV+ HNSCC放射抗性中的作用。要验证 MACROD2 作为治疗失败的生物标志物，并了解如何克服已确定的耐药性分子机制，还需要进一步的工作。

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引用次数: 0

Burden of oral cancer and associated risk factors at national and state levels: A systematic analysis from the global burden of disease in India, 1990–2021 国家和邦一级的口腔癌负担及相关风险因素：1990-2021 年印度全球疾病负担系统分析

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

Oral oncology

Pub Date : 2024-10-01 DOI: 10.1016/j.oraloncology.2024.107063

Akashanand , Quazi Syed Zahiruddin , Diptismita Jena , Suhas Ballal , Sanjay Kumar , Mahakshit Bhat , Shilpa Sharma , M. Ravi Kumar , Sarvesh Rustagi , Abhay M. Gaidhane , Lara Jain , Sanjit Sah , Muhammed Shabil

Background

Oral cancer is the sixth most prevalent cancer globally, posing a significant health concern, especially in India, where it accounts for one-third of the global cases. Despite high incidence and mortality rates, comprehensive national and regional data on risk factors and trends are scarce.

Methods

This study analyzed data from the Global Burden of Disease (GBD) 2021 report, focusing on the age-standardized incidence rate (ASIR), mortality rate (ASMR), disability-adjusted life years (ASDR), and prevalence rate (ASPR) of oral cancer in India from 1990 to 2021. Joinpoint regression analysis was used to assess trends, and ARIMA models were applied to forecast future trends from 2022 to 2031.

Results

From 1990 to 2021, India experienced a moderate increase in oral cancer mortality, with ASMR rising from 5.32 to 5.92, reflecting an annual percentage change (APC) of 11.18 %. ASDR increased from 152.94 to 163.61 (APC of 6.98 %), and ASPR showed a marked rise from 15.71 to 25.46 (APC of 62.06 %). The burden varied significantly across states. Gender disparities were observed, with males consistently exhibiting higher incidence and mortality rates. ARIMA forecasts projected an upward trend in oral cancer metrics from 2022 to 2031, with ASIR expected to reach 10.15 per 100,000 and ASPR 29.38 per 100,000 by 2031.

Conclusions

The study reveals a persistent and growing burden of oral cancer in India, highlighting the influence of lifestyle and socioeconomic factors. Targeted strategies to mitigate risk behaviors, improve early detection, and address disparities are urgently needed to reduce the disease’s impact.

背景口腔癌是全球发病率第六高的癌症，是一个重大的健康问题，尤其是在印度，占全球病例的三分之一。本研究分析了《2021 年全球疾病负担报告》（GBD）中的数据，重点关注 1990 年至 2021 年印度口腔癌的年龄标准化发病率（ASIR）、死亡率（ASMR）、残疾调整生命年（ASDR）和患病率（ASPR）。结果从 1990 年到 2021 年，印度的口腔癌死亡率适度上升，ASMR 从 5.32 上升到 5.92，反映了 11.18 % 的年百分比变化 (APC)。ASDR从152.94上升到163.61（年百分比变化率为6.98%），ASPR从15.71显著上升到25.46（年百分比变化率为62.06%）。各州的负担差异很大。性别差异明显，男性的发病率和死亡率一直较高。根据 ARIMA 预测，2022 年至 2031 年期间，口腔癌指标呈上升趋势，预计到 2031 年，ASIR 将达到每 10 万人 10.15 例，ASPR 将达到每 10 万人 29.38 例。为减少该疾病的影响，亟需采取有针对性的策略来减轻风险行为、提高早期检测率并解决差异问题。

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引用次数: 0

Risk of cardiovascular disease among head and neck cancer survivors: A population-based matched cohort study 头颈癌幸存者罹患心血管疾病的风险：基于人群的匹配队列研究

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

Oral oncology

Pub Date : 2024-09-29 DOI: 10.1016/j.oraloncology.2024.107041

Katherine Keefe , Hilary C. McCrary , Mei Wei , Bayarmaa Mark , Sarah Drejet , Richard B. Cannon , Luke O. Buchmann , Jason P. Hunt , Mark Dodson , Vikrant Deshmukh , Michael Newman , Marcus M. Monroe , Mia Hashibe

Background

In the United States, approximately 63,000 Americans develop head and neck cancer (HNC) annually. Our study aims were to investigate cardiovascular complications and risk factors for development of CVD among HNC survivors.

Methods

Utilizing the Utah Populations Database, a total of 1,901 HNC patients diagnosed and 7,796 birth year, sex, and birth state matched individuals from the general population were identified. Multivariate Cox proportional hazard models were used.

Results

Within the first two years after cancer diagnosis, HNC survivors had a higher likelihood of developing cardiovascular disease (CVD). High Charleston Comorbidity Index (CCI) score at baseline (Hazard Ratio (HR) 1.67, 95 % 1.28–2.17), stage II and IV disease (HR 1.80, 95 % 1.29–2.51), age >=65 years old (HR 2.31, 95 % 1.85–2.88), chemotherapy (HR 1.47, 95 % 1.15–1.88) were associated with increased CVD risk.

Conclusions

Compared to the general population, HNC survivors were more likely to develop cardiovascular diseases, particularly if they had the following risk factors: older age, stage II or IV cancer, high baseline CCI score, and chemotherapy were risk factors for development of CVD.

背景：在美国，每年约有 63,000 名美国人罹患头颈癌 (HNC)。我们的研究目的是调查 HNC 幸存者的心血管并发症和心血管疾病的风险因素：利用犹他州人口数据库，共确定了 1,901 名确诊的 HNC 患者和 7,796 名与出生年份、性别和出生州相匹配的普通人群。研究采用了多变量考克斯比例危险模型：结果：在癌症确诊后的头两年内，HNC 幸存者患心血管疾病（CVD）的可能性较高。基线查尔斯顿合并症指数（CCI）得分高（危险比（HR）1.67，95 % 1.28-2.17）、疾病处于II期和IV期（HR 1.80，95 % 1.29-2.51）、年龄>=65岁（HR 2.31，95 % 1.85-2.88）、化疗（HR 1.47，95 % 1.15-1.88）与心血管疾病风险增加有关：结论：与普通人群相比，HNC幸存者更容易罹患心血管疾病，尤其是当他们具有以下风险因素时：高龄、II期或IV期癌症、高基线CCI评分和化疗是罹患心血管疾病的风险因素。

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引用次数: 0

Surgical, Functional, and oncological outcomes of transoral robotic surgery for cT1-T3 supraglottic laryngeal Cancers: A systematic review 经口机器人手术治疗 cT1-T3 声门上型喉癌的手术、功能和肿瘤效果：系统性综述

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

Oral oncology

Pub Date : 2024-09-29 DOI: 10.1016/j.oraloncology.2024.107047

Jérôme R. Lechien

Background

This systematic review investigated the surgical, functional, and oncological outcomes of transoral robotic supraglottic laryngectomy (TORS-SGL) for cT1-T3 laryngeal squamous cell carcinoma (LSCC).

Methods

Two investigators conducted an updated PubMed, Scopus, and Cochrane Library systematic review for studies investigating the surgical, functional, and oncological outcomes of TORS-SGL using the PRISMA statements. The bias analysis was conducted with the MINORS.

Results

Twenty-one studies were included, accounting for 896 patients. TORS-SGL was primarily performed for cT1 (39.1 %), cT2 (46.9 %), and some selected cT3 (7.7 %) LSCCs. Surgical margins were positive in 10.8 % of cases. The mean hospital stay was 8.6 days. Hemorrhage (6.3 %), pneumonia (5.5 %), and aspiration (1.7 %) are the primary complications. The surgical margins were positive in 10.6 % of cases. Feeding tubes, temporary tracheotomy, and definitive percutaneous gastrostomy are found in 65.6 %, 19.7 %, and 5.2 % of patients, respectively. The oral diet is restarted after a mean of 7.2 days. The 5-year OS and DFS of TORS-SGL were estimated to be 78.3 %, and 91.7 %, with 5-year local-relapse-free survival and nodal-relapse-free survival of 90.8 %, and 86.6 %, respectively.

Conclusion

The TORS-SGL is a safe, and effective surgical approach for cT1-T3 SGL. The functional and surgical outcomes appear comparable with TOLM-SGL. The oncological outcomes of TORS-SGL could be better than TOLM and open SGLs, but further large cohort-controlled studies are needed to draw reliable conclusions.

背景：本系统综述调查了经口机器人声门上喉切除术（TORS-SGL）治疗 cT1-T3 喉鳞状细胞癌（LSCC）的手术、功能和肿瘤学结果：两名研究人员采用 PRISMA 声明对 PubMed、Scopus 和 Cochrane 图书馆中有关 TORS-SGL 手术、功能和肿瘤效果的研究进行了更新的系统综述。结果：结果：共纳入 21 项研究，涉及 896 名患者。TORS-SGL主要针对cT1（39.1%）、cT2（46.9%）和部分cT3（7.7%）LSCC。10.8%的病例手术边缘呈阳性。平均住院时间为 8.6 天。出血（6.3%）、肺炎（5.5%）和吸入（1.7%）是主要并发症。10.6%的病例手术边缘呈阳性。分别有 65.6%、19.7% 和 5.2% 的患者使用了喂食管、临时气管切开术和最终经皮胃造瘘术。平均 7.2 天后重新开始口服饮食。TORS-SGL的5年OS和DFS估计分别为78.3%和91.7%，5年无局部复发生存率和无结节复发生存率分别为90.8%和86.6%：结论：TORS-SGL 是治疗 cT1-T3 SGL 的一种安全有效的手术方法。其功能和手术效果与 TOLM-SGL 相当。TORS-SGL 的肿瘤治疗效果可能优于 TOLM 和开放式 SGL，但要得出可靠的结论，还需要进一步的大型队列对照研究。

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引用次数: 0

Reconstruction of extensive lower lip defects using vascularized mucosal flap with external skin complex tissue 利用血管化黏膜瓣和外部皮肤复合组织重建广泛的下唇缺损。

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

Oral oncology

Pub Date : 2024-09-28 DOI: 10.1016/j.oraloncology.2024.107056

Haosen Lian , Yufei Hua , Grace Paka Lubamba , Gaowei Zhang , Mingzhe Bao , Guanru Wang , Guile Zhao , Ning Gao , Bing Yan , Chunjie Li

Background

The complexity of lip anatomy and the roles played by the lip make the reconstruction of lip defects more challenging. Adequate reconstruction of lip defects requires adaptation of mucosa, vermilion, and skin features in lip as well as its specific function.

Methods

A 59-year-old male with left lower lip cancer underwent en-bloc resection and left selective neck dissection (SND), followed by immediate reconstruction using Facial Artery Myomucosal Island Flap (FAMMIF) with external Skin Complex Tissue.

Results

The use of chimeric flap based on FAMMIF and its external skin tissue allowed minimizing the postoperative problem of combination of both aesthetic and functional impairments. The FAMMIF is suitable for the reconstruction of lip mucosa and lip vermilion, while the external skin tissue can be use to replace the external lip skin defect. The patient was satisfied with the treatment outcomes. He is undergoing follow-up without any evidence of recurrence.

Conclusion

FAMMIF with external skin complex tissue, as a reconstructive approach selected in our case of lip defect secondary to lip cancer resection, combined the reconstruction of both aesthetics and functions of the lower lip. The technique was found feasible and provided satisfactory postoperative outcomes.

背景：唇部解剖的复杂性和唇部所扮演的角色使唇部缺损的重建更具挑战性。唇缺损的适当重建需要适应唇部粘膜、朱砂和皮肤的特征及其特定功能：方法：一名 59 岁男性左下唇癌患者接受了全层切除术和左侧选择性颈部切除术（SND），随后使用面部动脉粘膜岛状皮瓣（FAMMIF）和外部复合皮肤组织立即进行了重建：结果：使用基于 FAMMIF 及其外部皮肤组织的嵌合皮瓣，最大程度地减少了术后美学和功能障碍并存的问题。FAMMIF 适用于唇粘膜和唇朱砂的重建，而外部皮肤组织可用于替代唇外部皮肤缺损。患者对治疗效果感到满意。结论：结论：在本例唇癌切除术后继发唇部缺损的病例中，我们选择了外用皮肤复合组织 FAMMIF 作为重建方法，该方法结合了下唇美学和功能的重建。该技术可行，术后效果令人满意。

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引用次数: 0

Commentary on “Salivary DNA methylation derived estimates of biological aging, cellular frequency and protein expression as predictors of oral mucositis severity and survival in head and neck cancer patients” 关于 "唾液 DNA 甲基化衍生的生物老化估计值、细胞频率和蛋白质表达可预测头颈部癌症患者口腔黏膜炎的严重程度和生存期 "的评论

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

Oral oncology

Pub Date : 2024-09-27 DOI: 10.1016/j.oraloncology.2024.107053

Siva Dharshini Rajathirajan

引用次数: 0

Initial negative resection margin versus revised negative resection margin in patients who underwent surgery without adjuvant therapy for early-stage oral tongue squamous cell carcinoma 接受手术但未接受辅助治疗的早期口腔舌鳞状细胞癌患者初始阴性切除边缘与修正阴性切除边缘的比较

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

Oral oncology

Pub Date : 2024-09-27 DOI: 10.1016/j.oraloncology.2024.107046

Jun Young Kim , Younghac Kim , Eun Hye Kim , Man Ki Chung , Han-Sin Jeong , Chung-Hwan Baek , Young-Ik Son , Nayeon Choi

Background

In cases of positive resection margin (RM), re-resection is generally recommended. There has been controversy about the oncologic impact of revised negative RMs after re-resection. The aim of this study was to investigate the oncologic impact of revised negative RM in patients who underwent surgery without adjuvant therapy for early-stage (pT1-2/N0) oral tongue squamous cell carcinoma (OSCC).

Methods

We retrospectively analyzed patients with pT1-2 N0 OSCC who did not receive adjuvant therapy (N=441). These patients were classified into an initial negative RM (R0, n = 380) group and a revised negative RM (R1-R0, n = 61) group. Demographic and clinical data (T stage, tumor length, depth of invasion [DOI], lymphovascular invasion [LVI], perineural invasion [PNI], and recurrence) were compared between the R0 and R1-R0 groups.

Results

Age, sex, T stage, DOI, LVI, PNI, and SUVmax were not significantly different between the two groups. Local recurrence was more frequent (P=0.045) in the R1-R0 group (13.1 %) than in the R0 group (5.5 %). Local recurrence-free survival was better in the R0 group than in the R1-R0 group (P=0.046). There was no significant difference in overall recurrence or overall survival. On multivariate analysis, initial positive RM was the independent significant risk factor (hazard ratio, 2.249; 95 % confidence interval, 1.025–4.935; P=0.043) for local recurrence.

Conclusion

A revised clear RM after initial cut-through margin is a risk factor for local recurrence in early-stage OSCC. Cautious should be considered in early-stage OSCC patients with revised clear RM.

背景在切除边缘（RM）阳性的病例中，一般建议再次切除。关于再次切除后阴性RM的肿瘤学影响一直存在争议。本研究的目的是调查早期（pT1-2/N0）口腔舌鳞状细胞癌（OSCC）患者在未接受辅助治疗的情况下接受手术治疗后，修订后的阴性 RM 对肿瘤的影响。这些患者被分为初始阴性RM（R0，380人）组和修正阴性RM（R1-R0，61人）组。比较了R0组和R1-R0组的人口统计学和临床数据（T分期、肿瘤长度、浸润深度[DOI]、淋巴管浸润[LVI]、神经周围浸润[PNI]和复发）。结果两组患者的年龄、性别、T分期、DOI、LVI、PNI和SUVmax无显著差异。R1-R0组（13.1%）的局部复发率（P=0.045）高于R0组（5.5%）。R0组的无局部复发生存率高于R1-R0组（P=0.046）。总复发率和总生存率没有明显差异。多变量分析显示，初始阳性RM是局部复发的独立显著风险因素（危险比，2.249；95%置信区间，1.025-4.935；P=0.043）。早期OSCC患者在初始切缘清晰后出现修正切缘，是局部复发的危险因素，应慎重考虑。

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引用次数: 0

MR radiomics unveils neoadjuvant chemo-responsiveness with insights into selective treatment de-intensification in HPV-positive oropharyngeal carcinoma 磁共振放射组学揭示了新辅助化疗的反应性，并揭示了人类乳头瘤病毒阳性口咽癌选择性去强化治疗的原理

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

Oral oncology

Pub Date : 2024-09-27 DOI: 10.1016/j.oraloncology.2024.107049

Wenjiao Lyu , Jing Gong , Lin Zhu , Tingting Xu , Shenglin Huang , Chunying Shen , Cuihong Wang , Xiayun He , Hongmei Ying , Chaosu Hu , Yu Wang , Qinghai Ji , Yajia Gu , Xin Zhou , Xueguan Lu

Background

Accurate prediction of neoadjuvant chemotherapy (NAC) response allows for NAC-guided personalized treatment de-intensification in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). In this study, we aimed to apply baseline MR radiomic features to predict NAC response to help select NAC-guided de-intensification candidates, and to explore biological underpinnings of response-oriented radiomics.

Methods

Pre-treatment MR images and clinical data of 131 patients with HPV-positive OPSCC were retrieved from Fudan University Shanghai Cancer Center. Patients were divided into training cohort (n = 47), validation cohort 1 (n = 49) from NAC response-adapted de-intensification trial (IChoice-01, NCT04012502) and real-world validation cohort 2 (n = 35). NAC prediction model using linear support vector machine (SVM) was built and validated. Subsequent nomograms combined radiomics and clinical characteristics were established to predict survival outcomes. RNA-seq and proteomic data were compared to interpret the molecular features underlying radiomic signatures with differential NAC response.

Findings

For NAC response prediction, the fusion model with both oropharyngeal and nodal signatures achieved encouraging performance to predict good responders in the training cohort (AUC 0·89, 95% CI, 0·79-0·95) and validation cohort 1 (AUC 0·71, 95% CI, 0·59-0·83). For prognosis prediction, radiomics-based nomograms exhibited satisfactory discriminative ability between low-risk and high-risk patients (PFS, C-index 0·85, 0·76 and 0·83; OS, C-index 0·79, 0·76 and 0·87, respectively) in three cohorts. Expression analysis unveiled NAC poor responders had predominantly enhanced keratinization while good responders were featured by upregulated immune response and oxidative stress.

Interpretation

The MR-based radiomic models and prognostic models efficiently discriminate among patients with different NAC response and survival risk, which help candidate selection in HPV-positive OPSCC with regard to personalized treatment de-intensification.

背景准确预测新辅助化疗（NAC）反应有助于在NAC指导下对HPV阳性口咽鳞癌（OPSCC）进行个性化的去强化治疗。本研究旨在应用基线磁共振放射组学特征预测NAC反应，以帮助选择NAC指导下的去强化治疗候选者，并探索反应导向放射组学的生物学基础。方法从复旦大学上海肿瘤防治中心获取131例HPV阳性口咽鳞癌患者的治疗前磁共振图像和临床数据。患者被分为训练队列（n = 47）、NAC反应适应性去强化试验（IChoice-01，NCT04012502）验证队列1（n = 49）和真实世界验证队列2（n = 35）。利用线性支持向量机（SVM）建立并验证了 NAC 预测模型。随后建立了结合放射组学和临床特征的提名图来预测生存结果。研究结果对于NAC反应预测，口咽和结节特征的融合模型在预测训练队列（AUC 0-89，95% CI，0-79-0-95）和验证队列1（AUC 0-71，95% CI，0-59-0-83）中的良好反应者方面取得了令人鼓舞的成绩。在预后预测方面，三个队列中基于放射组学的提名图在低风险和高风险患者之间表现出令人满意的鉴别能力（PFS，C-指数分别为0-85、0-76和0-83；OS，C-指数分别为0-79、0-76和0-87）。基于磁共振成像的放射组学模型和预后模型能有效区分不同NAC反应和生存风险的患者，有助于HPV阳性OPSCC患者的候选者选择，从而减轻个性化治疗的强度。

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