Oral oncology最新文献_第7页

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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引用次数: 0

Predicting outcomes in head and neck surgery with modified frailty index and surgical apgar scores 用改良虚弱指数和手术 apgar 评分预测头颈部手术的结果

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

Oral oncology

Pub Date : 2024-09-26 DOI: 10.1016/j.oraloncology.2024.107045

Ayham Al Afif , Philip Rosen , Jae Gardella , Timothy G. Norwood , Adam Abbas , Lindsay S. Moore , Jessica W. Grayson , Kristine E. Day , Andrew C. Prince , Benjamin J. Greene , William R. Carroll , Sejong Bae

Objective

To compare the efficacy of the Modified Frailty Index and Modified Surgical Apgar scores in predicting postoperative outcomes in head and neck cancer patients.

Methods

We retrospectively reviewed patients who underwent major head and neck surgery between 2012 and 2015. Modified Surgical Apgar, and Frailty Index, scores were calculated on 723 patients. The primary outcome was 30-day complication and/or mortality.

Results

The mean Modified Frailty Index was 0.11 ± 0.12, and mean Modified Surgical Apgar score was 6.15 ± 1.67. Both scores were significantly associated with 30-day complication (P<0.05). The Modified Surgical Apgar score was superior to the Modified Frailty Index in predicting complications (Area Under the Curve (AUC) = 0.76; 95 % Confidence Interval (CI), 0.722–0.793; and AUC=0.59; 95 % CI, 0.548–0.633, respectively). Concurrent use of both scoring systems (AUC=0.77) was not superior to individual use. An increase in the mFI from 0.27 to 0.36 was associated with an increase in the risk of complication postoperatively (Odds Ratio (OR) = 3.67; 95 % CI, 1.30–10.34, P=.014). A reduction in the mSAS from 7 to 6 increased the risk of complication following surgery (OR=2.64; 95 % CI, 1.45–4.80; P=.002).

Conclusion

Both scores are useful in risk stratifying head and neck cancer patients. The Modified Surgical Apgar score was superior at predicting complications; concurrent use of both scores added minimal benefit.

目的比较改良虚弱指数和改良手术阿普加评分在预测头颈部癌症患者术后预后方面的效果。方法我们回顾性地分析了 2012 年至 2015 年间接受头颈部大手术的患者。计算了723名患者的改良手术阿普加评分和虚弱指数。结果改良虚弱指数的平均值为 0.11 ± 0.12，改良手术 Apgar 评分的平均值为 6.15 ± 1.67。两项评分均与 30 天并发症有明显相关性（P<0.05）。改良外科 Apgar 评分在预测并发症方面优于改良虚弱指数（曲线下面积 (AUC) = 0.76; 95 % 置信区间 (CI), 0.722-0.793; 和 AUC=0.59; 95 % CI, 0.548-0.633）。同时使用两种评分系统（AUC=0.77）并不优于单独使用。mFI 从 0.27 增加到 0.36 与术后并发症风险的增加有关（Odds Ratio (OR) = 3.67; 95 % CI, 1.30-10.34, P=0.014）。mSAS从7降至6会增加术后并发症的风险（OR=2.64；95 % CI，1.45-4.80；P=.002）。改良手术阿普加评分在预测并发症方面更胜一筹；同时使用两种评分的益处微乎其微。

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引用次数: 0

Disruption of oncogenic pathways in mucoepidermoid carcinoma: CREB inhibitor 666.15 as a potential therapeutic agent 粘液表皮样癌致癌途径的中断：CREB 抑制剂 666.15 作为一种潜在的治疗药物

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

Oral oncology

Pub Date : 2024-09-26 DOI: 10.1016/j.oraloncology.2024.107029

Maria Eduarda Pérez-de-Oliveira , Vivian Petersen Wagner , Colin D. Bingle , Pablo Agustin Vargas , Lynne Bingle

Objectives: Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumour with around 50 % of cases carrying the CRTC1-MAML2 translocation. The CREB pathway has been associated with the transforming activity of this translocation. The aim of this study was to determine the effects of CREB inhibition on MEC cell behaviour in vitro. Material and Methods: Two translocation-positive (UM-HMC-2 and H292) and one translocation-negative (H253) MEC cell lines were treated with 666.15, a CREB inhibitor. Drug IC50 doses were determined for each cell line. Clonogenic and spheroid assays were used to assess survival, including percentage of cancer stem cells, and transwell and scratch assays evaluated invasive and migratory capacities, respectively. Immunofluorescence staining was used to determine E-cadherin expression. Results: CREB inhibition significantly reduced the number of surviving colonies and spheroids and delayed cell invasion in all cell lines, but this was more significant in the fusion positive, UM-HMC-2 cells. The expression of E-cadherin was significantly higher in treated UM-HMC-2 and H292 cells. Conclusion: CREB inhibition with 666.15 impaired key MEC oncogenic behaviours associated with metastasis and drug resistance, including cell invasion and survival.

研究目的蕈样表皮样癌（MEC）是最常见的恶性唾液腺肿瘤，约 50% 的病例携带 CRTC1-MAML2 易位。CREB通路与这种易位的转化活性有关。本研究旨在确定 CREB 抑制对 MEC 细胞体外行为的影响。材料与方法：用 CREB 抑制剂 666.15 处理两种易位阳性（UM-HMC-2 和 H292）和一种易位阴性（H253）的 MEC 细胞系。确定了每种细胞系的药物 IC50 剂量。克隆形成试验和球形试验用于评估存活率，包括癌症干细胞的百分比，而透孔试验和划痕试验则分别评估侵袭能力和迁移能力。免疫荧光染色用于确定 E-cadherin的表达。结果在所有细胞系中，CREB抑制都能明显减少存活菌落和球形细胞的数量，延缓细胞侵袭，但这在融合阳性的UM-HMC-2细胞中更为明显。经处理的 UM-HMC-2 和 H292 细胞中 E-cadherin 的表达明显升高。结论用 666.15 抑制 CREB 会损害与转移和耐药性相关的 MEC 关键致癌行为，包括细胞侵袭和存活。

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引用次数: 0

Achieving negative superficial resection margins with NBI and white light in carcinoma oral cavity: Could it be a norm? 在口腔癌中使用 NBI 和白光可使浅表切除边缘呈阴性：这可能是一种常态吗？

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

Oral oncology

Pub Date : 2024-09-25 DOI: 10.1016/j.oraloncology.2024.107044

Kajal Mahto , Gaurav Kumar Goldar , Akash Varshney , Manu Malhotra , Madhu Priya , Amit Kumar , Bhinyaram , Ashok Singh , Abhishek Bhardwaj , G. Vetrivel , Subrata Nag , Amit Kumar Tyagi

Introduction

In India, oral cavity cancer rates are the highest, largely due to tobacco and areca nut use. The primary goal of oncologic surgery is complete tumor resection with adequate margins, yet no accepted guidelines exist margin identification. NBI enhances mucosal lesion detection and may improve margin assessment in OSCC.

Aims

This study aims to evaluate the proportion of negative superficial resection margins using NBI and to compare these results with margins assessed using white light (WL) examination.

Materials and Methods

The study at AIIMS, Rishikesh, included 38 patients with T1-T3 biopsy-proven OSCC. Surgical margins were marked using WL and NBI. Histopathology classified margins as clear (>5mm), close (1–5 mm), or involved. Sensitivity, specificity, and predictive values of NBI were calculated.

Results

The average NBI examination duration was 227 s. Negative margins were achieved in 68.42 % (>5mm) and 78.94 % (>3mm) of NBI cases, compared to 71.05 % and 84.21 % for WL. NBI had a sensitivity of 12.50 %, specificity of 96.67 %, and overall accuracy of 78.95 %.

Discussion

NBI showed high specificity but low sensitivity. This could be due to the smaller number of patients in NBI positive group. In the present study, the single positive margin identified with NBI could also have been detected with the combined approach of white light and palpation, ensuring that no positive margins were missed.

Conclusion

NBI can complement WL for margin assessment in oral SCC but requires a long learning curve and a dedicated team. Integrating NBI into standard protocols could improve surgical outcomes and reduce recurrence.

导言在印度，口腔癌的发病率是最高的，这主要是由于烟草和槟榔的使用。肿瘤手术的首要目标是完整切除肿瘤并保留足够的边缘，但目前尚无公认的边缘识别指南。本研究旨在评估使用 NBI 进行表层切除边缘阴性的比例，并将这些结果与使用白光 (WL) 检查评估的边缘进行比较。使用 WL 和 NBI 对手术边缘进行标记。组织病理学将边缘分为清晰（5 毫米）、接近（1-5 毫米）或受累。68.42%（5 毫米）和 78.94%（3 毫米）的 NBI 病例边缘为阴性，而 WL 病例边缘为阴性的比例分别为 71.05% 和 84.21%。NBI 的灵敏度为 12.50%，特异性为 96.67%，总体准确率为 78.95%。这可能是由于 NBI 阳性组的患者人数较少。在本研究中，通过 NBI 发现的单个阳性边缘也可以通过白光和触诊联合方法检测到，从而确保不会漏掉任何阳性边缘。结论 NBI 可以补充 WL 对口腔 SCC 边缘的评估，但需要较长的学习曲线和专门的团队。将 NBI 纳入标准方案可提高手术效果并减少复发。

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引用次数: 0

Comment on “Sexual Health, sexuality and sexual intimacy in patients with head and neck cancer” 关于 "头颈部癌症患者的性健康、性行为和性亲密关系 "的评论

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

Oral oncology

Pub Date : 2024-09-25 DOI: 10.1016/j.oraloncology.2024.107054

Prithviraj

引用次数: 0

Letter to the editor: Risk factors associated with ototoxicity in long-term survivors of nasopharyngeal carcinoma 致编辑的信与鼻咽癌长期存活者耳毒性相关的风险因素

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

Oral oncology

Pub Date : 2024-09-24 DOI: 10.1016/j.oraloncology.2024.107052

R. Dineshkumar

引用次数: 0

Da Vinci robot-assisted surgery for deep lobe of parotid benign tumor via retroauricular hairline approach: Exploration of a new surgical method for parotid tumors 达芬奇机器人辅助手术经耳后发际入路治疗腮腺深叶良性肿瘤：腮腺肿瘤新手术方法的探索

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

Oral oncology

Pub Date : 2024-09-24 DOI: 10.1016/j.oraloncology.2024.107043

Linjie Ma, Chao Li

Background

Resection of deep lobe benign tumors of parotid requires the preservation of facial nerve and other important structures, which is closely related to the refinement of surgical operations and the aesthetics of facial incisions. The Da Vinci robotic surgical operating system is more conducive to improving treatment effects. Combined with the hairline incision behind the ear, the surgical method can be explored for both aesthetic and curative effect.

Methods

A case of a child with deep lobe benign tumor of parotid, who undergo tumor resection via the retroauricular hairline approach with the assistance of Da Vinci robot.

Results

The child successfully completed the operation. During postoperative follow-up, the patient showed no facial palsy manifestations such as crooked mouth, the incision healed well.

Conclusions

It is feasible to remove the benign tumor of deep lobe of parotid with Da Vinci robot-assisted combined with via retroauricular hairline approach, which has clinical exploration value.

背景腮腺深叶良性肿瘤的切除需要保留面神经等重要结构，这与手术操作的精细化和面部切口的美观密切相关。达芬奇机器人手术操作系统更有利于提高治疗效果。方法一例腮腺深叶良性肿瘤患儿，在达芬奇机器人的辅助下，经耳后发际入路进行肿瘤切除术。结论采用达芬奇机器人辅助联合耳后发际入路切除腮腺深叶良性肿瘤是可行的，具有临床探索价值。

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引用次数: 0

Pralsetinib as neoadjuvant therapy for RET-Altered differentiated thyroid cancer: Two case reports 普拉塞替尼作为新辅助疗法治疗RET改变的分化型甲状腺癌：两例报告

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

Oral oncology

Pub Date : 2024-09-21 DOI: 10.1016/j.oraloncology.2024.107014

Nai-Si Huang , Jia-Ying Chen , Yan Meng , Qiu-Li Li , Qing-Hai Ji , Yu Wang

Background

5–10% of thyroid cancers are at locally advanced stage. Neoadjuvant targeted therapy will likely create surgical opportunities for these patients with unresectable or borderline resectable tumors. Pralsetinib, a RET inhibitor, has been approved for advanced or metastatic RET-altered thyroid cancer. However, there is no evidence on the efficacy of pralsetinib as neoadjuvant therapy in locally advanced RET-altered thyroid cancer.

Case report

Two patients with locally advanced pappilary thyroid carcinoma (PTC) were treated with pralsetinib (400 mg daily) to reduce tumor size and increase the chance of R0 resection. Both PTCs, characterized by RET-fusion, underwent successful R0 resection without major surgical complications after 4-months neoadjuvant pralsetinib.

Conclusion

There is a potential for pralsetinib as a neoadjuvant treatment in PTC with RET-fusion.

背景5%-10%的甲状腺癌处于局部晚期。新辅助靶向治疗将为这些无法切除或边缘可切除肿瘤的患者创造手术机会。普拉塞替尼是一种RET抑制剂，已被批准用于治疗晚期或转移性RET改变的甲状腺癌。病例报告两名局部晚期帕皮拉氏甲状腺癌（PTC）患者接受了普拉塞替尼治疗（每天400毫克），以缩小肿瘤大小，增加R0切除的机会。结论普拉塞替尼作为新辅助治疗RET融合型PTC的药物具有潜力。

引用次数: 0

The tumor cell killing capacity of head and neck cancer patient-derived neutrophils depends on tumor stage, gender and the antibody isotype 头颈癌患者来源的中性粒细胞对肿瘤细胞的杀伤能力取决于肿瘤分期、性别和抗体异构型

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

Oral oncology

Pub Date : 2024-09-21 DOI: 10.1016/j.oraloncology.2024.107042

Alexander Valcenko , Anabel Zwick , Lissy Schneider , Maximilian Linxweiler , Stefan Lohse

Neutrophils play a crucial role in the tumor microenvironment (TME) of head and neck squamous cell carcinomas (HNSCC) and significantly influence treatment outcomes. Phenotypic and functional properties of neutrophils adapt to the TME with distinct subsets modulating disease progression and therapeutic interventions. Here, we evaluated phenotypic and functional differences of neutrophils derived from HNSCC patients and healthy donors. We observed significant phenotypic differences between neutrophils from healthy donors and HNSCC patient-derived neutrophils. Gender and tumor stage influenced neutrophil phenotypes and their ability to lyse tumor cells through antibody-dependent cell-mediated cytotoxicity (ADCC). Patients with advanced HNSCC and males may benefit less from neutrophil-centered immunotherapy. An engineered IgA2 antibody specific for the epidermal growth factor receptor (EGFR) demonstrated superior efficacy in activating neutrophils for ADCC compared to Panitumumab using healthy and patient-derived neutrophils, underscoring the potential of the IgA isotype as a therapeutic alternative. The distinct behavior and antibody-isotype dependent ADCC competence of CD177+/- neutrophils of healthy but not HNSCC donors warrants further exploration. Our study emphasizes the importance of personalized immunotherapy treatments that consider the characteristics of neutrophils, patient demographics, and the type of antibody to improve ADCC and ultimately enhance treatment outcomes for HNSCC.

中性粒细胞在头颈部鳞状细胞癌（HNSCC）的肿瘤微环境（TME）中发挥着至关重要的作用，并对治疗效果产生重大影响。中性粒细胞的表型和功能特性与肿瘤微环境相适应，不同的亚群可调节疾病的进展和治疗干预。在这里，我们评估了来自 HNSCC 患者和健康供体的中性粒细胞的表型和功能差异。我们观察到健康供体的中性粒细胞与 HNSCC 患者来源的中性粒细胞之间存在明显的表型差异。性别和肿瘤分期影响了中性粒细胞的表型及其通过抗体依赖性细胞介导的细胞毒性（ADCC）裂解肿瘤细胞的能力。晚期HNSCC患者和男性可能从以中性粒细胞为中心的免疫疗法中获益较少。与帕尼单抗相比，一种针对表皮生长因子受体（EGFR）的特异性 IgA2 工程抗体利用健康和患者来源的中性粒细胞在激活中性粒细胞的 ADCC 方面表现出更高的疗效，这凸显了 IgA 同工型作为一种治疗选择的潜力。健康而非 HNSCC 供体的 CD177+/- 中性粒细胞的不同行为和依赖于抗体同种型的 ADCC 能力值得进一步探讨。我们的研究强调了个性化免疫疗法的重要性，这种疗法应考虑到中性粒细胞的特征、患者的人口统计学特征和抗体类型，以改善 ADCC 并最终提高 HNSCC 的治疗效果。

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引用次数: 0

Impact of post-operative transoral robotic surgery hemorrhage on adjuvant treatment delays in patients with oropharyngeal squamous cell carcinoma 经口机器人手术后出血对口咽鳞状细胞癌患者辅助治疗延迟的影响

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

Oral oncology

Pub Date : 2024-09-20 DOI: 10.1016/j.oraloncology.2024.107031

Kelly E. Daniels , Daniel R. Awad , Shirley X. Liu , Joseph Mocharnuk , Mark Kubik , Seungwon Kim , Robert L. Ferris , Umamaheswar Duvvuri , Shaum S. Sridharan

Objectives

Transoral robotic surgery (TORS) for the treatment for oropharyngeal squamous cell carcinoma (SCC) carries a risk of post-operative hemorrhage. Increased time from surgery to completion of adjuvant therapy has been associated with decreased survival. Our objective was to assess for adjuvant treatments delays in patients with post-operative bleeding. Secondarily, to assess post-operative swallowing outcomes.

Materials and Methods

Retrospective chart review of all patients who underwent TORS from 2014 to 2021 at a tertiary care center. Patient demographics, adjuvant therapy course, treatment-related dysphagia outcomes, incidence and severity of post-operative bleeding were reviewed.

Results

221 patients underwent TORS, 160 (72%) of which were recommended to undergo adjuvant treatment. 33 patients developed post-operative bleeding, of which 22 patients underwent at least partial radiation therapy (RT) where there was an average of 53.0 ± 12 days elapsed from surgery to the initiation of RT. In the control group, 124 completed at least partial adjuvant treatment and there was an average of 55.3 ± 23 days from surgery to start of adjuvant RT. Time to start of RT was not significantly different between the cohorts (p=0.47). 9.1% of patients with bleeding and 23.7% of those without bleeding started radiation therapy within 6 weeks. The odds ratio of requiring a feeding tube during treatment in patients with post-operative bleeding compared to those without was 1.3 (95% C.I. 0.54–3.13).

Conclusion

Patients with post-operative bleeding following TORS with TAL were not found to have a significantly higher risk of treatment delays or dysphagia burden, independent of hemorrhage severity.

目的经口机器人手术（TORS）治疗口咽鳞癌（SCC）有术后出血的风险。从手术到完成辅助治疗的时间延长与生存率下降有关。我们的目标是评估术后出血患者的辅助治疗延迟情况。材料与方法回顾性分析一家三级医疗中心从 2014 年到 2021 年接受 TORS 手术的所有患者的病历。结果 221 名患者接受了 TORS，其中 160 人（72%）被建议接受辅助治疗。33 名患者出现术后出血，其中 22 名患者至少接受了部分放疗（RT），从手术到开始放疗的平均时间为 53.0±12 天。在对照组中，有124名患者至少完成了部分辅助治疗，从手术到开始辅助RT的平均时间为（55.3±23）天。两组患者开始 RT 的时间无明显差异（P=0.47）。9.1%的出血患者和23.7%的未出血患者在6周内开始接受放疗。有术后出血的患者与无出血的患者相比，在治疗期间需要插管进食的几率比为1.3（95% C.I.0.54-3.13）。

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引用次数: 0