Head and Neck-Journal for the Sciences and Specialties of the Head and Neck最新文献

Background: Neutrophil-to-lymphocyte ratio (NLR) can be treated as a simple indicator of patients' immune status by representing the state of the systemic inflammatory response. Immunotherapy now is the accepted second-line treatment for recurrent or metastatic nasopharyngeal carcinoma (R/M NPC). However, the significance of NLR in patients with R/M NPC undergoing treatment with PD-L1 (programmed cell death-ligand 1) inhibitors is still uncertain.

Methods: We analyzed the relationship between baseline NLR with 153 patients' efficacy and survival from a multicenter, prospective, Phase 2 study. We employed restricted cubic spline plots to get the nonlinear relationship between NLR and progression-free survival (PFS) or overall survival (OS). We identified the ideal cut-off value through the analysis of the receiver operating characteristic curve (ROC curve). We used Logistic regression, Cox regression, Log-rank test, and Kaplan-Meier method to analyze the association between NLR and patients' disease control rate (DCR) and PFS or OS.

Results: The ideal threshold value for NLR was 2.826. NLR was identified as a significant independent predictor of DCR (OR = 0.17, 95% CI = 0.05-0.48, p = 0.001), indicating that a higher NLR is associated with worse DCR. NLR (AUC = 0.634) showed superior predictive capability for DCR in comparison to lymphocytes (AUC = 0.602) and neutrophils (AUC = 0.593). High NLR values were risk factors both for poor PFS (HR = 2.53, 95% CI = 1.58-4.06, p < 0.001) and OS (HR = 3.89, 95% CI = 2.09-7.24, p < 0.001).

Conclusion: Elevated NLR is strongly associated with lower response to treatment and reduced survival rates in patients with R/M NPC being treated with PD-L1 inhibitors. Patients with high NLR values have poor efficacy and survival.

Background: Neck hematoma following thyroid surgery is a potentially life-threatening complication.

Methods: This retrospective case-control study reviewed neck hematoma reoperations following thyroid surgery (2009-2024), using 3:1 matching. Univariable analysis identified hematoma and delayed onset (≥ 6 h) risk factors, with odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Among 5502 surgeries, the hematoma incidence was 0.55% (n = 30). The mean age was 54 and the female-to-male ratio was 7:3. Key risk factors included pre-induction blood pressure > 160 mmHg (OR = 3.04 [95% CI = 1.25-7.39], p = 0.014) and limited blood pressure change postmedication (OR = 6.25 [95% CI = 1.03-38.08], p = 0.047). The hematoma group had higher rates of smoking, hypertension, diabetes, Graves' disease, and prior thyroid surgery, and, in delayed hematoma cases, larger nodules, total thyroidectomy, and central neck dissection, though not statistically significant.

Conclusion: Patients with poorly controlled blood pressure may not be candidates for outpatient thyroidectomy.

Background: Distant metastasis is a leading cause of thyroid cancer (TC)-related deaths. Genetic profiling is typically limited to one sample per patient due to cost and sampling-risk concerns. Differences between samples from thyroid and distant metastasis within individual patients are unclear.

Methods: Patients with TC and distant metastasis were recruited for genetic analysis.

Results: Using a TC-specific NGS panel, 66 specimens from 29 patients were analyzed, identifying 16 mutations and 4 fusions, including two novel fusions (FGFR2-SHTN1 and RFTN1-BRAF). Genetic alterations differed between primary and metastatic sites in nine patients (31%), predominantly in additional oncogenic alterations (89%). More genetic alterations were found at the primary site in three patients and metastatic sites in four. Distinct mutations were found in two patients. A longer time interval between specimen acquisitions was significantly associated with genetic discrepancies (p = 0.032).

Conclusion: Patterns of genetic discrepancies between primary and metastatic TC vary, offering valuable insights for clinical practice.

Background: Head and neck cancer (HNC) due to its nature and proximity to essential vasculature, along with different treatments, can lead to stroke, significantly contributing to morbidity and mortality. Our aim is to systematically evaluate the association of stroke incidence, mortality, and predictors with HNC treatment.

Methods: Pubmed, Web of Science, Embase, and ScienceDirect were searched from inception to July 2024 for articles reporting stroke incidences, mortality, or associated risk factors following treatment in HNC patients. A random-effects meta-analysis assessed cumulative incidence and mortality rates with proportional analysis and risk factors using hazard ratios (HRs) associated with HNC treatment. Subgroup analyses of incidence and mortality were conducted for pre- and post-2010 periods, reflecting changes in stroke protocols.

Results: Out of 1561 studies, 69 studies with 258 850 HNC patients were included. The global cumulative incidence of stroke in HNC was 4.1% (95% CI: 3.3%-5.0%), with similar rates before and after 2010 (4.4% vs. 4.0%). In patients undergoing chemoradiotherapy (CRT), stroke incidence was 4.9% (95% CI: 3.5%-6.7%) with a median time to first stroke of 45 months (range: 14-51.7 months). Following radiation therapy (RT), stroke incidence was 3.8% (95% CI: 2.7%-5.3%) with a median time to stroke of 36 months (range: 6.8-130 months). The incidence rates of stroke in HNC patients were higher compared to the general population (HR: 1.69, 95% CI: 1.24-2.31, p = 0.001). Stroke mortality decreased from 28.5% (95% CI: 11.6%-54.9%) pre-2010 to 14.5% (95% CI: 11.6%-17.9%) 2010-2024. Stroke mortality was 39.3% (95% CI: 17.8%-66.0%) post-CRT and 21% (95% CI: 7.2%-47.7%) post-RT. Hypertension (HR = 1.75), diabetes (HR = 1.71), and age > 65 (HR = 2.17) increased stroke risk (p < 0.0001 for all). Geographically, South Korea (6.6%) had the highest incidence of stroke.

Conclusion: This is the first systematic review to analyze the association between stroke and HNC treatment. Stroke mortality decreased from 28.5% to 14.5% (pre-2010 vs. 2010-2024), with the highest mortality in the CRT group (39.3%). Given that stroke occurs 36-45 months after CRT, a screening protocol within 3-4 years is crucial.

Background: Perineural spread of cutaneous head and neck squamous cell carcinoma is most effectively managed by surgical resection with a clear central margin at the affected nerve. For ophthalmic nerve disease, there is no clear consensus regarding the extent of spread which is resectable via an orbit-preserving neurectomy, either in regard to oncological outcome or technical feasibility.

Methods: Cadaveric anatomical study of 10 human orbits, with endoscopic and exoscopic dissection of the frontal division of the ophthalmic nerve, to quantify the maximal extent of resection via orbit-preserving techniques and to discern the advantages and disadvantages of exoscopic versus endoscopic visualization aids.

Results: Mean achievable resection length measured from the supraorbital ridge was 40.9 mm (n = 10). No branching patterns were identified which would preclude neurectomy as an oncologically sound option.

Conclusions: Orbit-preserving resection of the ophthalmic nerve is technically feasible to a distance of approximately 4 cm, encompassing the majority of Williams Zone 1.

Background: The associations between head and neck cancer (HNC) and anxiety and depression are well-known, but knowledge regarding the association between demographic factors and rates of diagnosis and treatment for these disorders among HNC survivors is incomplete.

Methods: This retrospective study utilized propensity score matching to compare rates of selected new anxiety and/or depressive disorder diagnoses among HNC survivors and treatment of those disorders by sex, race, ethnicity, and language.

Results: Results suggested lower likelihood of anxiety and/or depressive disorder diagnosis among individuals of male sex, and any minority, African American, Asian, and Other race, while diagnosis rates were higher among native Hawaiian/Pacific Islanders. Treatment with pharmacotherapy was less likely among individuals of male sex, any minority and African American Asian race, Hispanic ethnicity, and Spanish language.

Conclusions: This study suggests that mental health diagnosis and treatment among HNC survivors may be inequitable, although further research is necessary to confirm these associations and understand underlying mechanisms.

Background: Lipoblastoma-like tumors (LLTs) are uncommon lipogenic neoplasms that predominantly occur in the vulva of female individuals. This study presents a novel case of LLT located on the tongue with an IDH1 mutation. Both the site of occurrence and molecular alterations are reported for the first time.

Case presentation: A 65-year-old female patient presented to the hospital 1 month ago with an incidental finding of a multinodular mass at the right lingual margin. We performed an incision along the outer edge of the mass and completely excised it 0.5 cm beyond its periphery. The final pathological diagnosis after routine examination confirmed a lipoblastoma-like tumor. Furthermore, Next-generation sequencing revealed the presence of mutations in IDH1.

Conclusions: This study presents the first documented case of LLT, thereby expanding its anatomical site of tongue and confirming the presence of a significant IDH1 mutation, thus enhancing our understanding of the molecular alterations in LLT.

This video introduces a medial-to-lateral neck dissection technique in the management of head and neck cancer, emphasizing the importance of the middle layer of the deep cervical fascia as a key surgical landmark. The technique involves systematic dissection from superficial lymphatic tissue (Paddle 1) to deeper structures (Paddles 2 and 3), offering better visualization and preservation of functionally important structures, such as the cervical nerves. This approach enhances surgical precision, minimizes nerve damage, and optimizes lymphatic tissue removal.

Background: This study compares the oncological outcomes of primary transoral surgery (TOS) and primary radiotherapy (RT) in elderly patients with HPV-related oropharyngeal squamous cell carcinoma (OPSCC).

Methods: This retrospective cohort study included patients with cT1-2 HPV-related OPSCC from the National Cancer Database (NCDB).

Results: A total of 2566 patients were included, with 73.9% receiving primary RT and 22.3% undergoing primary TOS. Subgroup analysis showed a higher 5-year overall survival (OS) rate for primary TOS (81.6%; 95% CI: 79.6%-83.6%) compared to primary RT (70.7%; 95% CI: 68.3%-73.1%), with an adjusted hazard ratio (HR) of 0.64 (95% CI: 0.50-0.81; p < 0.001) after propensity score matching. Notably, only (13.6%) of patients diagnosed in 2020 underwent primary TOS, with a significant decline over the study period.

Conclusions: This study suggests that primary TOS may offer better survival outcomes for elderly patients with HPV-related OPSCC compared to primary RT.

Background: The failure rate of free flaps varies from 0.8% to 10.6% in the literature in head and neck reconstruction. The primary objective was to identify prognostic factors for free flap failure.

Methods: We prospectively included all consecutive free flaps performed between August 2021 and January 2024, and used a multivariate Cox proportional hazard model.

Results: We included 307 free flaps, performed on 274 patients. Age, cardiovascular risk, radiotherapy history, type of flap, type of arterial anastomosis, and ischemia duration were not statistically linked to the risk of flap failure. In multivariate analysis, a venous anastomosis to the anterior jugular vein or to the superior thyroid vein were associated with an increased risk of flap failure, such as per- or postoperative revision of the anastomoses.

Conclusions: The choice of venous anastomosis, appear to have a greater influence on the success or failure of a microvascularized transfer than patient characteristics.