Pub Date : 2026-02-01Epub Date: 2025-12-26DOI: 10.1016/j.oraloncology.2025.107841
Meng Zhang , Jian Song , Yiming Yuan , Xiujuan Cao
Purpose
To develop and validate a multimodal ensemble machine learning model integrating multi-sequence magnetic resonance imaging (MRI) radiomics, clinical characteristics, and hematological biomarkers for early prediction of Radiation-induced temporal lobe injury (RTLI) in Nasopharyngeal carcinoma (NPC) patients before radiotherapy.
Methods
A total of 161 NPC patients treated with intensity-modulated radiation therapy (IMRT) were retrospectively analyzed and randomly assigned to training (n = 113) and validation (n = 48) sets in a 7:3 ratio. Radiomic features were extracted from pretreatment T1WI, CE-T1WI, T2WI, and DWI, with features showing ICC > 0.75 retained. After SMOTE balancing, Elastic Net (EN) was used for feature selection to generate EN-scores, and Random Forest (RF) produced RF-scores. These, together with two SVM-based scores obtained from demographic and hematological biomarkers, were combined into an ensemble ERSS (EN–RF–SVM–SVM) model. Model performance was evaluated using ROC analysis, calibration, and decision curve analysis.
Results
The ERSS model demonstrated superior predictive performance compared with single-sequence, multi-sequence MRI integration models and LR model. The AUCs of the ERSS model were 0.957 in the training set and 0.968 in the validation set. Calibration curves showed excellent agreement between predicted and observed outcomes. DCA indicated that the ERSS model provided the highest net clinical benefit across a wide range of threshold probabilities compared with other models.
Conclusion
The ERSS multimodal ensemble learning model provides a highly accurate and clinically meaningful tool for early prediction of RTLI in NPC patients. By integrating multi-sequence MRI radiomics, hematological biomarkers, and clinical factors, the ERSS model enables individualized risk assessment and may assist in optimizing radiotherapy planning and follow-up strategies.
{"title":"Ensemble learning-based radiomics model for predicting radiation-induced temporal lobe injury in nasopharyngeal carcinoma","authors":"Meng Zhang , Jian Song , Yiming Yuan , Xiujuan Cao","doi":"10.1016/j.oraloncology.2025.107841","DOIUrl":"10.1016/j.oraloncology.2025.107841","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop and validate a multimodal ensemble machine learning model integrating multi-sequence magnetic resonance imaging (MRI) radiomics, clinical characteristics, and hematological biomarkers for early prediction of Radiation-induced temporal lobe injury (RTLI) in Nasopharyngeal carcinoma (NPC) patients before radiotherapy.</div></div><div><h3>Methods</h3><div>A total of 161 NPC patients treated with intensity-modulated radiation therapy (IMRT) were retrospectively analyzed and randomly assigned to training (n = 113) and validation (n = 48) sets in a 7:3 ratio. Radiomic features were extracted from pretreatment T1WI, CE-T1WI, T2WI, and DWI, with features showing ICC > 0.75 retained. After SMOTE balancing, Elastic Net (EN) was used for feature selection to generate EN-scores, and Random Forest (RF) produced RF-scores. These, together with two SVM-based scores obtained from demographic and hematological biomarkers, were combined into an ensemble ERSS (EN–RF–SVM–SVM) model. Model performance was evaluated using ROC analysis, calibration, and decision curve analysis.</div></div><div><h3>Results</h3><div>The ERSS model demonstrated superior predictive performance compared with single-sequence, multi-sequence MRI integration models and LR model. The AUCs of the ERSS model were 0.957 in the training set and 0.968 in the validation set. Calibration curves showed excellent agreement between predicted and observed outcomes. DCA indicated that the ERSS model provided the highest net clinical benefit across a wide range of threshold probabilities compared with other models.</div></div><div><h3>Conclusion</h3><div>The ERSS multimodal ensemble learning model provides a highly accurate and clinically meaningful tool for early prediction of RTLI in NPC patients. By integrating multi-sequence MRI radiomics, hematological biomarkers, and clinical factors, the ERSS model enables individualized risk assessment and may assist in optimizing radiotherapy planning and follow-up strategies.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"173 ","pages":"Article 107841"},"PeriodicalIF":3.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-31DOI: 10.1016/j.oraloncology.2025.107844
Guoming Xiao , Li Ning , Lihui Chen , Shu Zhang , Yingle Chen , Yanfeng Chen
Background
Head and neck squamous cell carcinoma (HNSCC) significantly impairs patients’ quality of life (QoL). While neoadjuvant immuno-chemotherapy offers potential survival benefits, it is associated with substantial treatment-related toxicities, including fatigue, sleep disturbances, and functional decline. Exercise therapy has shown promise in improving QoL in other cancers, but its role in HNSCC patients receiving neoadjuvant therapy remains underexplored.
Methods
This single-center, open-label, randomized phase II trial enrolled 114 HNSCC patients undergoing neoadjuvant immuno-chemotherapy. Participants were randomized 1:1 to an exercise group (personalized breathing and aerobic exercise program) or a control group (routine care). Outcomes were assessed using the BFI-C, EORTC QLQ-C30, QLQ-H&N35, and PSQI at baseline, after 2 cycles, and after 3 cycles of therapy.
Results
The exercise group demonstrated significantly lower fatigue scores (BFI) after 2 and 3 cycles compared to controls (P < 0.05). Sleep quality (PSQI) improved significantly in the exercise group and worsened in the control group. The exercise group also showed better outcomes in physical functioning, fatigue and insomnia.
Conclusion
Exercise therapy is feasible and effective in reducing fatigue and improving sleep quality in HNSCC patients receiving neoadjuvant immuno-chemotherapy. Early integration of exercise may mitigate treatment-related symptoms and improve tolerance and overall QoL.
{"title":"Exercise and quality of life in head and neck squamous cell carcinoma patients receiving neoadjuvant immuno-chemotherapy: A randomized, open-labeled phase II trial","authors":"Guoming Xiao , Li Ning , Lihui Chen , Shu Zhang , Yingle Chen , Yanfeng Chen","doi":"10.1016/j.oraloncology.2025.107844","DOIUrl":"10.1016/j.oraloncology.2025.107844","url":null,"abstract":"<div><h3>Background</h3><div>Head and neck squamous cell carcinoma (HNSCC) significantly impairs patients’ quality of life (QoL). While neoadjuvant immuno-chemotherapy offers potential survival benefits, it is associated with substantial treatment-related toxicities, including fatigue, sleep disturbances, and functional decline. Exercise therapy has shown promise in improving QoL in other cancers, but its role in HNSCC patients receiving neoadjuvant therapy remains underexplored.</div></div><div><h3>Methods</h3><div>This single-center, open-label, randomized phase II trial enrolled 114 HNSCC patients undergoing neoadjuvant immuno-chemotherapy. Participants were randomized 1:1 to an exercise group (personalized breathing and aerobic exercise program) or a control group (routine care). Outcomes were assessed using the BFI-C, EORTC QLQ-C30, QLQ-H&N35, and PSQI at baseline, after 2 cycles, and after 3 cycles of therapy.</div></div><div><h3>Results</h3><div>The exercise group demonstrated significantly lower fatigue scores (BFI) after 2 and 3 cycles compared to controls (P < 0.05). Sleep quality (PSQI) improved significantly in the exercise group and worsened in the control group. The exercise group also showed better outcomes in physical functioning, fatigue and insomnia.</div></div><div><h3>Conclusion</h3><div>Exercise therapy is feasible and effective in reducing fatigue and improving sleep quality in HNSCC patients receiving neoadjuvant immuno-chemotherapy. Early integration of exercise may mitigate treatment-related symptoms and improve tolerance and overall QoL.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"173 ","pages":"Article 107844"},"PeriodicalIF":3.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-15DOI: 10.1016/j.oraloncology.2026.107853
Francesca Carosi , Sara Demurtas , Antonio Ciarfella , Ester Orlandi , Laura D. Locati
{"title":"Perioperative immunotherapy for head and neck cancer: from early successes to clinical challenges in relapsed and/or metastatic disease","authors":"Francesca Carosi , Sara Demurtas , Antonio Ciarfella , Ester Orlandi , Laura D. Locati","doi":"10.1016/j.oraloncology.2026.107853","DOIUrl":"10.1016/j.oraloncology.2026.107853","url":null,"abstract":"","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"173 ","pages":"Article 107853"},"PeriodicalIF":3.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-07DOI: 10.1016/j.oraloncology.2026.107850
Chengwei Xing , Siyuan Xu , Ruiying Liu , Qiuju Wang , Jie Liu
Background
Super-selective neck dissection which declining level II and V for better neck function preservation remains controversial in the treatment of papillary thyroid carcinoma (PTC). This study aims to explore association between occult lymph node metastasis (OLNM) in level II and preoperative clinical characteristics.
Methods
This retrospective study reviewed unilateral cN1b PTC patients who underwent surgery (2000–2017), with clinical lateral neck metastasis limiting in level III and IV. The OLNM in level II was assessed with preoperative clinical characteristics using logistic regression model; its association with pathological nodes distribution was examined with restricted cubic spline; the prognosis value of level II OLNM was evaluated using Kaplan–Meier method and Cox regression model.
Results
A total of 640 patients (mean [SD] age, 41[11.3] years; 440[68.8 %] female individuals; 307[48.0 %] with OLNM in level II) were analyzed. Primary tumor size (>1.5 cm, OR, 1.625[1.174–2.252]; P = 0.003) and clinical positive lymph nodes (multiple, OR, 4.241 [2.283–8.506]; P < 0.001) are associated with elevated risk of level II OLNM. A non-linear relationship was found between level II OLNM and metastatic lymph nodes number in levels III and IV. No significant difference in all-site recurrence-free survival (RFS) or regional RFS was found between patients with or without level II OLNM, even after adjusting other potential risk factors.
Conclusion
The primary tumor size and metastatic burden in adjacent cervical compartments are associated with risk of level II OLNM, super-selective neck dissection could be considered in patients with small primary tumor cancer and low metastatic burden.
{"title":"Predicting occult lymph node metastasis in level II using preoperative factors","authors":"Chengwei Xing , Siyuan Xu , Ruiying Liu , Qiuju Wang , Jie Liu","doi":"10.1016/j.oraloncology.2026.107850","DOIUrl":"10.1016/j.oraloncology.2026.107850","url":null,"abstract":"<div><h3>Background</h3><div>Super-selective neck dissection which declining level II and V for better neck function preservation remains controversial in the treatment of papillary thyroid carcinoma (PTC). This study aims to explore association between occult lymph node metastasis (OLNM) in level II and preoperative clinical characteristics.</div></div><div><h3>Methods</h3><div>This retrospective study reviewed unilateral cN1b PTC patients who underwent surgery (2000–2017), with clinical lateral neck metastasis limiting in level III and IV. The OLNM in level II was assessed with preoperative clinical characteristics using logistic regression model; its association with pathological nodes distribution was examined with restricted cubic spline; the prognosis value of level II OLNM was evaluated using Kaplan–Meier method and Cox regression model.</div></div><div><h3>Results</h3><div>A total of 640 patients (mean [SD] age, 41[11.3] years; 440[68.8 %] female individuals; 307[48.0 %] with OLNM in level II) were analyzed. Primary tumor size (>1.5 cm, OR, 1.625[1.174–2.252]; P = 0.003) and clinical positive lymph nodes (multiple, OR, 4.241 [2.283–8.506]; P < 0.001) are associated with elevated risk of level II OLNM. A non-linear relationship was found between level II OLNM and metastatic lymph nodes number in levels III and IV. No significant difference in all-site recurrence-free survival (RFS) or regional RFS was found between patients with or without level II OLNM, even after adjusting other potential risk factors.</div></div><div><h3>Conclusion</h3><div>The primary tumor size and metastatic burden in adjacent cervical compartments are associated with risk of level II OLNM, super-selective neck dissection could be considered in patients with small primary tumor cancer and low metastatic burden.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"173 ","pages":"Article 107850"},"PeriodicalIF":3.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-12DOI: 10.1016/j.oraloncology.2026.107849
Sebastian Søby , Danny Mortensen , Anita Gothelf , Niels Gyldenkerne , Christian Maare , Camilla K Lonkvist , Maria Andersen , Rasmus Kjeldsen , Kasper Toustrup , Trine Tramm , Jesper Grau Eriksen
PD-1 inhibition has become an established treatment option for recurrent/metastatic head and neck squamous cell carcinoma (rmHNSCC). However, there is a clear need for improved prognostic tools.
This study aimed to identify immune-related tissue biomarkers associated with overall survival (OS) or progression-free survival (PFS) in patients treated with PD-1 inhibition.
This national real-world phase IV multicenter retrospective cohort study included Danish patients treated between 2017 and 2023. Pre-treatment biopsies were collected for immunohistochemical analyses. All patients were PD-L1 positive with histologically confirmed rmHNSCC treated with pembrolizumab or nivolumab monotherapy.
Biomarker expression was assessed for CD4, CD8, FOXP3, CD20, CD66b, CD68, STING, cGAS, and tumor-infiltrating lymphocytes (TILs), using the median expression as the cut-off value.
Formalin-fixed, paraffin-embedded tumor tissue was obtained from 263 eligible patients. Concurrent above median levels of FOXP3 and CD68 were associated with a lower risk of progression (HRPFS: 0.47 [95 % CI: 0.33–0.67]). This interaction appeared to be driven by p16+ oropharyngeal cancers (OPC), where patients with concurrent above median levels of FOXP3 and CD68 showed a median 2-year PFS of 68 % [95 % CI: 42–86] in contrast to those with one or none of the two markers above the median level with a 2-year PFS of 3 % [95 % CI: 0–12] (p < 0.001).
In this real-world cohort, a subgroup with a promising prognosis was identified. This subgroup was characterized by p16+ OPC along with concurrent above median levels of FOXP3 and CD68. PD-L1 alone showed no significant association with outcomes.
{"title":"Prognostic significance of p16 and immune cell infiltration in recurrent/metastatic head and neck squamous cell carcinoma treated with PD-1 inhibition: a national DAHANCA cohort study","authors":"Sebastian Søby , Danny Mortensen , Anita Gothelf , Niels Gyldenkerne , Christian Maare , Camilla K Lonkvist , Maria Andersen , Rasmus Kjeldsen , Kasper Toustrup , Trine Tramm , Jesper Grau Eriksen","doi":"10.1016/j.oraloncology.2026.107849","DOIUrl":"10.1016/j.oraloncology.2026.107849","url":null,"abstract":"<div><div>PD-1 inhibition has become an established treatment option for recurrent/metastatic head and neck squamous cell carcinoma (rmHNSCC). However, there is a clear need for improved prognostic tools.</div><div>This study aimed to identify immune-related tissue biomarkers associated with overall survival (OS) or progression-free survival (PFS) in patients treated with PD-1 inhibition.</div><div>This national real-world phase IV multicenter retrospective cohort study included Danish patients treated between 2017 and 2023. Pre-treatment biopsies were collected for immunohistochemical analyses. All patients were PD-L1 positive with histologically confirmed rmHNSCC treated with pembrolizumab or nivolumab monotherapy.</div><div>Biomarker expression was assessed for CD4, CD8, FOXP3, CD20, CD66b, CD68, STING, cGAS, and tumor-infiltrating lymphocytes (TILs), using the median expression as the cut-off value.</div><div>Formalin-fixed, paraffin-embedded tumor tissue was obtained from 263 eligible patients. Concurrent above median levels of FOXP3 and CD68 were associated with a lower risk of progression (HR<sub>PFS</sub>: 0.47 [95 % CI: 0.33–0.67]). This interaction appeared to be driven by p16+ oropharyngeal cancers (OPC), where patients with concurrent above median levels of FOXP3 and CD68 showed a median 2-year PFS of 68 % [95 % CI: 42–86] in contrast to those with one or none of the two markers above the median level with a 2-year PFS of 3 % [95 % CI: 0–12] (p < 0.001).</div><div>In this real-world cohort, a subgroup with a promising prognosis was identified. This subgroup was characterized by p16+ OPC along with concurrent above median levels of FOXP3 and CD68. PD-L1 alone showed no significant association with outcomes.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"173 ","pages":"Article 107849"},"PeriodicalIF":3.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-08DOI: 10.1016/j.oraloncology.2026.107851
Wei Fang Dai , Lena Nguyen , Ning Liu , Kelvin KW Chan
Introduction
Nivolumab was the first immunotherapy to have shown efficacy in platinum-resistant recurrent and/or metastatic squamous cell carcinoma of head and neck (R/M SCCHNC) in the CheckMate-141 trial. We conducted a population-based retrospective study to examine the survival outcomes and resource utilization of patients with R/M SCCHNC who were treated with nivolumab.
Method
Patients with R/M SCCHNC were included in the study if they received nivolumab between January 17th 2018 to August 31st 2022 in Ontario, Canada. The primary outcomes, including overall survival (OS) and time-to-treatment discontinuation (TTD), were assessed using Kaplan-Meier. Cox proportional hazard model was used to explore the association between baseline patient characteristics and all-cause death. The incidence of healthcare utilization was estimated using the cumulative incidence function, taking death as a competing event.
Results
A total of 498 R/M SCCHNC patients received nivolumab (Mean age 62.9, 78.7 % male). The median OS was 6.0 months (95 % CI: 5.0–7.3) and median time-to-treatment discontinuation was 2.6 months (95 % CI: 2.3–3.0). There is no significant OS difference between older patients (age > 75 years old) and younger patients (p-value 0.73). At 1-year post-nivolumab initiation, the cumulative incidence of emergency department visits is 50.6 % (95 % CI: 46.1–55.0 %) and direct hospitalization is 22.7 % (19.0–26.6 %).
Conclusion
In this real-world study, the survival outcomes of nivolumab were similar to those observed in CheckMate-141 trial. We demonstrated that there is no survival difference between older and younger patients. Furthermore, more than half of patients exaperienced an hospital encounter with the healthcare system, suggesting significant healthcare resource utilization.
{"title":"Real-world effectiveness and healthcare utilization of nivolumab for advanced head and neck cancer: A real-world population-based descriptive study","authors":"Wei Fang Dai , Lena Nguyen , Ning Liu , Kelvin KW Chan","doi":"10.1016/j.oraloncology.2026.107851","DOIUrl":"10.1016/j.oraloncology.2026.107851","url":null,"abstract":"<div><h3>Introduction</h3><div>Nivolumab was the first immunotherapy to have shown efficacy in platinum-resistant recurrent and/or metastatic squamous cell carcinoma of head and neck (R/M SCCHNC) in the CheckMate-141 trial. We conducted a population-based retrospective study to examine the survival outcomes and resource utilization of patients with R/M SCCHNC who were treated with nivolumab.</div></div><div><h3>Method</h3><div>Patients with R/M SCCHNC were included in the study if they received nivolumab between January 17th 2018 to August 31st 2022 in Ontario, Canada. The primary outcomes, including overall survival (OS) and time-to-treatment discontinuation (TTD), were assessed using Kaplan-Meier. Cox proportional hazard model was used to explore the association between baseline patient characteristics and all-cause death. The incidence of healthcare utilization was estimated using the cumulative incidence function, taking death as a competing event.</div></div><div><h3>Results</h3><div>A total of 498 R/M SCCHNC patients received nivolumab (Mean age 62.9, 78.7 % male). The median OS was 6.0 months (95 % CI: 5.0–7.3) and median time-to-treatment discontinuation was 2.6 months (95 % CI: 2.3–3.0). There is no significant OS difference between older patients (age > 75 years old) and younger patients (p-value 0.73). At 1-year post-nivolumab initiation, the cumulative incidence of emergency department visits is 50.6 % (95 % CI: 46.1–55.0 %) and direct hospitalization is 22.7 % (19.0–26.6 %).</div></div><div><h3>Conclusion</h3><div>In this real-world study, the survival outcomes of nivolumab were similar to those observed in CheckMate-141 trial. We demonstrated that there is no survival difference between older and younger patients. Furthermore, more than half of patients exaperienced an hospital encounter with the healthcare system, suggesting significant healthcare resource utilization.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"173 ","pages":"Article 107851"},"PeriodicalIF":3.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-19DOI: 10.1016/j.oraloncology.2025.107825
Qin Liu , Jing-Ni Wei , Jia-Yu Zhou , Chuan-Run Zhang , Liang-Ru Ke , Nian Lu , Ying Deng , Yu-Wen Kuang , Yu-Chen Hua , Meng-Wen Wang , Jie Gong , Shu-Hui Dong , Longjunyu Wu , Xing Lv , Yan-Qun Xiang , Xiang Guo , Wei-Xiong Xia
Purpose
To develop a retropharyngeal lymph node (RLN)-based scoring system using anatomical features and to evaluate its utility in optimizing N classification in patients with nasopharyngeal carcinoma (NPC).
Materials and methods
This retrospective cohort study included patients with nonmetastatic NPC treated at two tertiary referral cancer centers in China between January 2012 and December 2018. Univariate and multivariate analyses were used to evaluate the association between MRI-based RLN features and multiple survival endpoints. A simplified RLN risk scoring (RRS) system (incorporating RLN multiplicity, MID, adENE and CNN) was developed in SYSUCC cohort and validated in the GMUCH cohort. A new N classification system was proposed and compared with the 9th edition of AJCC N staging system using C-index.
Results
Positive RLNs were observed in 68.3 % of all patients, including 66.7 % (690/1035) in the SYSUCC cohort and 72.0 % (340/472) in the GMUCH cohort. High RRS (defined as RRS > 2) was independently associated with worse OS (hazard ratio [HR], 2.22; 95 % CI, 1.56–3.15, P < 0.001), PFS (HR, 2.45; 95 % CI, 1.87–3.20, P < 0.001), DMFS (HR, 2.71; 95 % CI, 1.88–3.91, P < 0.001), and RFS (HR, 2.20; 95 % CI, 1.51–3.20, P < 0.001). The proposed N classification system incorporated high RRS as a criterion for N3 disease, demonstrated higher C-index values compared with the 9th edition AJCC staging system for OS (0.666 vs 0.659), PFS (0.659 vs 0.639), DMFS (0.682 vs 0.663), and RFS (0.644 vs 0.629).
Conclusions
High RRS was strongly correlated with inferior survival outcomes in NPC patients. Integrating high RRS into the current staging system by reclassifying these patients as N3 might improve prognostic stratification and offer more precise treatment guidance.
目的建立基于咽后淋巴结（RLN）解剖特征的评分系统，并评价其在鼻咽癌（NPC）患者N分型优化中的应用价值。材料和方法本回顾性队列研究纳入了2012年1月至2018年12月在中国两家三级转诊癌症中心接受治疗的非转移性鼻咽癌患者。采用单因素和多因素分析来评估基于mri的RLN特征与多个生存终点之间的关系。在SYSUCC队列中开发了简化的RLN风险评分（RRS）系统（包括RLN多样性、MID、adENE和CNN），并在GMUCH队列中进行了验证。提出了一种新的氮素分级体系，并与第9版AJCC氮素分级体系进行了比较。结果68.3%的患者RLNs呈阳性，其中SYSUCC组66.7% (690/1035)，GMUCH组72.0%（340/472）。高RRS（定义为RRS >； 2）与较差的OS（风险比[HR]， 2.22; 95% CI, 1.56-3.15, P < 0.001）、PFS （HR, 2.45; 95% CI, 1.87-3.20, P < 0.001）、DMFS （HR, 2.71; 95% CI, 1.88-3.91, P < 0.001）和RFS （HR, 2.20; 95% CI, 1.51-3.20, P < 0.001）独立相关。提出的N分级系统将高RRS作为N3疾病的标准，与第9版AJCC分级系统相比，OS （0.666 vs 0.659）、PFS （0.659 vs 0.639）、DMFS （0.682 vs 0.663）和RFS （0.644 vs 0.629）的c指数值更高。结论高RRS与鼻咽癌患者较差的生存预后密切相关。通过将这些患者重新分类为N3，将高RRS纳入当前的分期系统可能会改善预后分层，并提供更精确的治疗指导。
{"title":"Development of a simplified scoring system for MRI-detected retropharyngeal lymph node features to optimize AJCC 9th edition N classification in nasopharyngeal carcinoma","authors":"Qin Liu , Jing-Ni Wei , Jia-Yu Zhou , Chuan-Run Zhang , Liang-Ru Ke , Nian Lu , Ying Deng , Yu-Wen Kuang , Yu-Chen Hua , Meng-Wen Wang , Jie Gong , Shu-Hui Dong , Longjunyu Wu , Xing Lv , Yan-Qun Xiang , Xiang Guo , Wei-Xiong Xia","doi":"10.1016/j.oraloncology.2025.107825","DOIUrl":"10.1016/j.oraloncology.2025.107825","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop a retropharyngeal lymph node (RLN)-based scoring system using anatomical features and to evaluate its utility in optimizing N classification in patients with nasopharyngeal carcinoma (NPC).</div></div><div><h3>Materials and methods</h3><div>This retrospective cohort study included patients with nonmetastatic NPC treated at two tertiary referral cancer centers in China between January 2012 and December 2018. Univariate and multivariate analyses were used to evaluate the association between MRI-based RLN features and multiple survival endpoints. A simplified RLN risk scoring (RRS) system (incorporating RLN multiplicity, MID, adENE and CNN) was developed in SYSUCC cohort and validated in the GMUCH cohort. A new N classification system was proposed and compared with the 9th edition of AJCC N staging system using C-index.</div></div><div><h3>Results</h3><div>Positive RLNs were observed in 68.3 % of all patients, including 66.7 % (690/1035) in the SYSUCC cohort and 72.0 % (340/472) in the GMUCH cohort. High RRS (defined as RRS > 2) was independently associated with worse OS (hazard ratio [HR], 2.22; 95 % CI, 1.56–3.15, <em>P</em> < 0.001), PFS (HR, 2.45; 95 % CI, 1.87–3.20, <em>P</em> < 0.001), DMFS (HR, 2.71; 95 % CI, 1.88–3.91, <em>P</em> < 0.001), and RFS (HR, 2.20; 95 % CI, 1.51–3.20, <em>P</em> < 0.001). The proposed N classification system incorporated high RRS as a criterion for N3 disease, demonstrated higher C-index values compared with the 9th edition AJCC staging system for OS (0.666 vs 0.659), PFS (0.659 vs 0.639), DMFS (0.682 vs 0.663), and RFS (0.644 vs 0.629).</div></div><div><h3>Conclusions</h3><div>High RRS was strongly correlated with inferior survival outcomes in NPC patients. Integrating high RRS into the current staging system by reclassifying these patients as N3 might improve prognostic stratification and offer more precise treatment guidance.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"173 ","pages":"Article 107825"},"PeriodicalIF":3.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-16DOI: 10.1016/j.oraloncology.2026.107857
Congcong Cheng, Juanjuan Zhang
{"title":"Advancing methodological rigor in exercise oncology trials for head and neck cancer","authors":"Congcong Cheng, Juanjuan Zhang","doi":"10.1016/j.oraloncology.2026.107857","DOIUrl":"10.1016/j.oraloncology.2026.107857","url":null,"abstract":"","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"173 ","pages":"Article 107857"},"PeriodicalIF":3.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-16DOI: 10.1016/j.oraloncology.2026.107855
Weiqun Wang, Yaling Lou
{"title":"Methodological and clinical considerations for a novel nomogram predicting central lymph node metastasis in papillary thyroid microcarcinoma","authors":"Weiqun Wang, Yaling Lou","doi":"10.1016/j.oraloncology.2026.107855","DOIUrl":"10.1016/j.oraloncology.2026.107855","url":null,"abstract":"","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"173 ","pages":"Article 107855"},"PeriodicalIF":3.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients treated for head & neck cancer (HNC) are at risk of developing head and neck lymphedema (HNL) that may impact their functions and quality of life (QoL). This study aimed to assess the prevalence of HNL, its risk factors, and evaluate its impact on QoL.
Methods
In this observational (cross-sectional) study, we included adult HNC patients who had completed definitive treatment at least 6 months prior and who had received some part of their treatment at our institute. The external lymphedema was rated using the MD Anderson Cancer Centre (MDACC) HNL rating system, and internal lymphedema using Patterson’s scale. Health-related QoL was assessed using the University of Washington quality of life questionnaire.
Results
A total of 421 were enrolled, with a median duration post-treatment of 19 months. HNL was present in 190 patients (45.1 %), either internal or external lymphedema or both. Most of them had stage 1a HNL. Factors that predisposed to the development of HNL were age (>47 years) [p = 0.002, 1.993(1.279–2.935)], tobacco use [p = 0.025, 1.864(1.081–3.214)], and the type of treatment received, especially those who received definitive chemoradiotherapy [p < 0.001,9.750(4.063–23.395)]. Patients with HNL, especially internal lymphedema, reported significantly more QoL impairments, particularly related to swallowing, chewing, xerostomia, taste and mood.
Conclusion
HNL was present in 45.1% of the patients in our cohort, predominantly stage 1a. Age, tobacco use, and treatment received predisposed the patient to develop HNL. Patients with internal lymphedema particularly had swallowing-related QoL issues.
{"title":"Prevalence, risk Factors, and quality of life in patients with head and neck lymphedema following treatment for head and neck Cancer: The HeNLy-1 study","authors":"Shivakumar Thiagarajan , T Rukmangathan , Drub Sharma , Aniket Kakade , Arun Balaji , Marri Rebeka , Vanita Noronha , Kumar Prabhash , Sarbani Ghosh-Laskar , Gouri Pantvaidya","doi":"10.1016/j.oraloncology.2025.107838","DOIUrl":"10.1016/j.oraloncology.2025.107838","url":null,"abstract":"<div><h3>Background</h3><div>Patients treated for head & neck cancer (HNC) are at risk of developing head and neck lymphedema (HNL) that may impact their functions and quality of life (QoL). This study aimed to assess the prevalence of HNL, its risk factors, and evaluate its impact on QoL.</div></div><div><h3>Methods</h3><div>In this observational (cross-sectional) study, we included adult HNC patients who had completed definitive treatment at least 6 months prior and who had received some part of their treatment at our institute. The external lymphedema was rated using the MD Anderson Cancer Centre (MDACC) HNL rating system, and internal lymphedema using Patterson’s scale. Health-related QoL was assessed using the University of Washington quality of life questionnaire.</div></div><div><h3>Results</h3><div>A total of 421 were enrolled, with a median duration post-treatment of 19 months. HNL was present in 190 patients (45.1 %), either internal or external lymphedema or both. Most of them had stage 1a HNL. Factors that predisposed to the development of HNL were age (>47 years) [p = 0.002, 1.993(1.279–2.935)], tobacco use [p = 0.025, 1.864(1.081–3.214)], and the type of treatment received, especially those who received definitive chemoradiotherapy [p < 0.001,9.750(4.063–23.395)]. Patients with HNL, especially internal lymphedema, reported significantly more QoL impairments, particularly related to swallowing, chewing, xerostomia, taste and mood.</div></div><div><h3>Conclusion</h3><div>HNL was present in 45.1% of the patients in our cohort, predominantly stage 1a. Age, tobacco use, and treatment received predisposed the patient to develop HNL. Patients with internal lymphedema particularly had swallowing-related QoL issues.</div></div>","PeriodicalId":19716,"journal":{"name":"Oral oncology","volume":"173 ","pages":"Article 107838"},"PeriodicalIF":3.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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