Chinese journal of otorhinolaryngology head and neck surgery最新文献

Objective: To investigate the response to induction chemotherapy (IC) as prognostic indicators for radiotherapy response and survival outcomes in patients with loco-regionally advanced tonsil squamous cell carcinoma (LATSCC). Methods: A retrospective analysis was conducted on 84 LATSCC patients who were admitted to the Eye & ENT Hospital of Fudan University. There were 67 males and 17 females, aged from 42 to 76 years. Among them, 55 patients (65.5%) were p16 positive and 29 patients (34.5%) were p16 negative. All patients received initial IC with TPF chemotherapy regimen (docetaxel+cisplatin+capecitabine) followed by either radiotherapy alone or concurrent chemoradiotherapy. The differences in categorical variables were compared using Chi-square test and Fisher exact test. Logistic regression was employed to identify independent factors associated with radiotherapy sensitivity. Kaplan-Meier method was utilized to calculate cumulative survival, while Log-rank test and Cox risk model were performed for univariate and multivariate analyses of overall survival (OS), locoregional relapse-free survival (LRFS), and distant metastasis free survival (DMFS). Results: After IC, the objective response rates (ORR) in p16 positive group and p16 negative group were 87.3% and 89.7%, respectively (χ²=0.103, P=0.749). Following radiotherapy, the complete response rates in p16 positive group and p16 negative group were 87.3% and 72.4%, respectively (χ²=5.058, P=0.115). Sensitivity to IC (OR=10.883, 95%CI: 2.555-45.930, P=0.001) was independently associated with complete response to radiotherapy and in the p16 positive group, the 3-year OS, LRFS, and DMFS were 90.0%, 81.5%, and 96.4%, respectively. In the p16 negative group, they were 82.1%, 89.1%, and 92.0%, with no statistically significant difference in the rates between two groups(P>0.05). Compared to IC-resistant patients, IC-sensitive patients showed significant improvements in 3-year LRFS (90.2% vs. 40.0%, χ²=19.750, P<0.001). IC resistance was identified as an independent risk factor for LRFS (HR=2.180, 95%CI=1.235-3.849, P=0.007). Conclusions: The response to IC is a significant prognostic factor for tonsil squamous cell carcinoma treated with definitive radiotherapy. Poor response to IC is associated with unsatisfactory outcomes either in p16-positive or p16-negative cancer.

Objective: To analyze the current status of diagnosis, treatment and prognostic factors of poorly differentiated thyroid carcinoma (PDTC) and anaplastic thyroid carcinoma (ATC) using a multicenter cohort database. Methods: A retrospective analysis was performed on clinical data of 882 patients with PDTC/ATC who received treatment from 14 centers between January 2016 and June 2025. There were 346 cases of PDTC and 536 cases of ATC, including 424 cases of conventional ATC (con-ATC) and 112 cases of coexisting papillary and anaplastic thyroid carcinoma (co-PTC/ATC). Demographic, clinicopathologic, and treatment and follow-up data were collected. Kaplan-Meier method was used to plot survival curves, and Cox proportional hazards regression model was applied to evaluate the factors influencing overall survival (OS). Results: This cohort included 514 females and 368 males. 74.72%(659/882) of the patients were over 55 years. At the time of diagnosis, the tumors frequently invaded vital adjacent structures, with 58.28% (514/882) of patients presenting with stage T3b-T4b disease. Distant metastases were observed in 27.66% (244/882) of patients, most commonly involving the lungs (78.28%, 191/244). The median OS of con-ATC patients was 8.0 months (95%CI: 7.0-10.0). The median OS of co-PTC/ATC patients was 36.0 months (95%CI: 18.0-65.0), that of PDTC patients was 104.0 months (95%CI: 72.0-NA). Patients who underwent surgery as the initial treatment appeared to have prolonged survival compared with those receiving systemic therapy (surgery 36.0 months (95%CI: 28.0-57.0) vs systemic therapy 12.0 months (95%CI: 9.0-17.0): HR (95%CI)=1.342 (1.100-1.637), P=0.004). Among patients who underwent R2 resection followed by adjuvant radiotherapy, OS did not differ significantly from that of patients who achieved R0 or R1 resection (R0/R1 resection 44.0 months (95%CI: 32.0-65.0) vs R2 resection followed by adjuvant radiotherapy 25.0 months (95%CI: 18.0-46.0): HR (95%CI)=0.860 (0.654-1.131), P=0.279). For patients with unresectable PDTC/ATC, combined targeted therapy and immunotherapy were associated with superior overall survival compared with other systemic treatment regimens (combined targeted therapy and immunotherapy 13.0 months (95%CI: 9.0-27.0) vs other systemic treatment regimens 9.0 months (95%CI: 6.0-16.0): HR (95%CI)=0.681 (0.495-0.936), P=0.018). Conclusions: Long-term survival is achievable in selected patients with PDTC/ATC through active multimodal treatment. When formulating treatment strategies, radical surgery should be considered as the key to cure.

Objective: To establish a predictive system for aerosol drug deposition by integrating computational fluid dynamics (CFD) and artificial intelligence (AI) modeling, and to propose optimized strategies for intranasal drug delivery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) after various Draf procedures. Methods: Post-operative 3D nasal airway models of Draf Ⅱa, Ⅱb, and Ⅲ were reconstructed based on CT data from a CRSwNP patient treated at the Second Affiliated Hospital of Xi'an Jiaotong University. CFD simulations were employed to assess the impact of inspiratory flow rates (15, 30, and 45 L/min), nebulizer oxygen flow rates (6 and 8 L/min), and particle sizes (5-50 μm) on drug deposition efficiency (DE) across three target areas (TAs): the frontal sinus (TA1), the olfactory region and ethmoid sinus (TA2), and the respiratory zone (TA3). Based on 540 sets of CFD data, XGBoost machine learning models were developed to predict regional DE and to interpret variable importance. Statistical analysis was performed using SPSS 21.0. Results: Regarding particle size, optimal DE was observed with 25 μm drug particles for TA1 (DE_max=30.19%), 15-25 μm for TA2 (27.55%), and 20-35 μm for TA3 (25.77%). Nowadays, clinically available nebulizers producing small particles (1-5 μm) generated extremely low DE in TA1 (<1%) and TA2 (<2%). Among the surgical variants, Draf Ⅲ provided the largest frontal sinus ostium with the highest airflow velocity (1.53 m/s), resulting in the highest DE of TA1 (τ=0.75, P<0.001). However, Draf IIb achieved the highest cumulative DE across all three TAs (τ=0.40, P=0.001). The XGBoost models exhibited excellent predictive performance (R²: 0.81-0.98). Feature importance analysis and SHapley Additive exPlanations (SHAP) values revealed that drug particle size was the primary determinant of cumulative DE across all three TAs (accounting for >40% of importance), while surgical procedure had a dominant influence on the DE of TA1 (accounting for >40% of importance), with the Draf Ⅲ surgery significantly promoting frontal sinus drug deposition. Conclusion: By integrating CFD and AI techniques, this study demonstrates that the Draf III procedure significantly improves frontal sinus ventilation and inhances drug deposition. Medium-sized particles (25 μm) combined with low-to-moderate inspiratory flow rates (15-30 L/min) are optimal for nasal-targeted aerosol therapy.

Objective: To evaluate the safety of neoadjuvant therapy with pembrolizumab combined with 5-fluorouracil (5-FU) and cisplatin in patients with advanced temporal bone squamous cell carcinoma (TBSCC), and its impact on tumor response rate and disease-free survival (DFS). Methods: This prospective, single-arm, open-label clinical study enrolled patients with advanced (Stage Ⅲ/Ⅳ) TBSCC from Sun Yat-sen Memorial Hospital. Patients received 2-3 cycles of neoadjuvant therapy with pembrolizumab, 5-FU, and cisplatin, followed by definitive surgery. Postoperatively, patients received 6 cycles of pembrolizumab combined with radiotherapy. The primary endpoint was the 2-year disease-free survival (DFS) rate. Secondary endpoints included objective response rate (ORR) and safety indicators. Survival analysis was performed using the Kaplan-Meier method. Adverse events (AE) were assessed using the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Statistical analyses were conducted using SPSS software, version 22.0. Results: From August 2021 to April 2024, 16 patients with advanced TBSCC were enrolled (13 males and 3 females), with a median age of 54 years and a median follow-up time of 2.32 years. Following neoadjuvant therapy, the objective response rate (ORR) was 64.3% (9/14), and the disease control rate (DCR) was 92.9% (13/14). The 2-year DFS rate was 86.6%. Common treatment-related adverse events (TRAE) included leukopenia (56.3%, 9/16), nausea and vomiting (50.0%, 8/16), diarrhea, oral mucositis, and elevated liver function tests (25.0%, 4/16). One patient (6.25%) experienced a grade 3 adverse event. Conclusion: Neoadjuvant pembrolizumab-chemotherapy significantly enhances objective response rate and disease-free survival in advanced TBSCC.

Objective: To evaluate the therapeutic efficacy of combined therapy with a speaking valve and transcranial direct current stimulation (tDCS) for dysphagia in stroke patients post-tracheostomy. Methods: This retrospective case-control study enrolled 120 stroke patients with post-stroke tracheostomy-associated dysphagia, admitted to the Department of Rehabilitation Medicine at Huai'an Second People's Hospital. Participants were randomly allocated to either a control group [45 males and 15 females, aged from 46 to 78 (65.78±8.68) years]receiving tDCS and conventional rehabilitation or an intervention group [41 males and 19 females, aged from 46 to 79 (66.32±9.18) years]receiving tDCS plus speaking valve therapy, with 60 patients per group. Swallowing function was assessed before and after a 3-week intervention using the Standardized Swallowing Assessment (SSA), Water Swallowing Test (WST) grading, Functional Oral Intake Scale (FOIS), and Swallowing-quality of life score (SWAL-QOL).The SPSS 22.0 was used for statistical analysis. Results: The intervention group demonstrated a significantly higher overall treatment response rate than the control group [95.0%(57/60)vs 78.3%(44/56), χ²=-6.056,P<0.001]. Post-treatment, the intervention group showed significantly greater improvements, as evidenced by a lower SSA score (21.50±1.82 vs 24.92±1.42, t=-11.480,P<0.001) and superior WST grades (observation group: 45 cases at grade 1, 12 cases at grade 2, 5 cases at grade 3; control group: 33 cases at grade 1, 11 cases at grade 2, 16 cases at grade 3, Z=5.484, P<0.001). Furthermore, the intervention group achieved significantly higher FOIS scores (observation group: 1 case at grade 1, 1 case at grade 2, 1 case at grade 4, 8 cases at grade 5, 7 cases at grade 6, 45 cases at grade 7; control group: 2 cases at grade 1, 7 cases at grade 2, 3 cases at grade 3, 4 cases at grade 4, 5 cases at grade 5, 6 cases at grade 6, 33 cases at grade 7, Z=-3.559, P<0.001) and greater improvements in SWAL-QOL scores (P<0.001), indicating enhanced oral intake and quality of life. Conclusion: The combination of a speaking valve and tDCS effectively promotes the swallowing recovery and improves quality of life in stroke patients with post-tracheostomy dysphagia. This combined modality represents a promising and effective therapeutic strategy for this patient population.