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

Background: To explore the relationship between anti-thyroglobulin antibody (TgAb) trajectories and recurrence risk in papillary thyroid cancer (PTC) patients.

Methods: This multiple-center, retrospective cohort included 4161 patients who had no evidence of structural disease and a stimulated thyroglobulin (s-Tg) of ≤ 10 ng/mL at the initial radioiodine (RAI) treatment. Among 3660 patients who had repeated TgAb measurements (before RAI treatment, 1, 6, or 12 months after treatment) and available response assessments, latent class models were used to identify TgAb trajectories. Associations of trajectories with the risk of recurrence were estimated.

Results: Four distinct TgAb trajectories were identified. Compared with patients belonging to the consistently negative trajectory, patients with the other three trajectories had higher risks of recurrence (medium-level descent: odds ratio = 3.46 [95% CI = 1.56-6.90], high-level descent: 8.04 [1.26-28.78], persistently increasing: 12.11 [5.73-23.75]).

Conclusions: TgAb trajectories within 1 year after RAI treatment are associated with the risk of recurrence in PTC patients with a s-Tg ≤ 10 ng/mL.

Trial registration: Registered at www.chictr.org.cn (identifier: ChiCTR2300075574).

Background: The objective of this study is to investigate the impact of preoperative anxiety symptoms (AS) and depression symptoms (DS) on clinical outcomes and time to treatment initiation (TTI) of oral squamous cell carcinoma (OSCC).

Methods: Seven hundred and twenty-five OSCC patients were included. Kaplan-Meier and Cox models analyzed hazard ratio (HR) for survival, while accelerated failure time models estimated time ratio (TR) for TTI.

Results: Females showed higher prevalence and severity of AS (p = 0.014) and DS (p = 0.002). Mild AS (HR: 2.132, 95% CI: 1.091-4.165; p = 0.027) and DS (HR: 2.061, 95% CI: 1.052-4.038; p = 0.035) increased mortality risk in females. Mild DS prolonged TTI in females (TR: 1.450, 95% CI: 1.001-2.099; p = 0.049). Males with mild DS (TR: 0.718, 95% CI: 0.549-0.940; p = 0.016) or moderate-severe AS (TR: 0.562, 95% CI: 0.382-0.826; p = 0.003) had reduced TTI.

Conclusions: Psychological distress impacts survival and TTI differently by gender.

Objective: Endoscopic endonasal approach to the petrous apex is feasible but presents challenges due to the obstruction posed by the internal carotid artery (ICA). Medial or inferomedial approaches, which involve ICA transposition or contralateral transmaxillary visualization, provide only limited lateral exposure of the apex. This study introduces a novel endoscopic endonasal "lateral" transpetrosal approach (EELPA) to the petrous apex.

Methods: Endoscopic endonasal transpterygoid anatomical dissections were performed bilaterally on nine formalin-fixed cadaveric heads. The study focused on the endosurgical identification of the dural layers and ligaments of the middle fossa. The extradural lateral petrosectomy through these dural layers and ligaments was assessed. A representative clinical case illustrates the findings.

Results: A newly identified anatomical structure, termed the "inferior" petrolingual ligament (IPLL), was described. This ligament spans from the ventral middle cranial fossa to the ventrolateral aspect of the foramen lacerum, surrounding the inferior part of the lingula. It is located above the junction of the greater superficial petrosal nerve into the Vidian nerve. Transection and detachment of the IPLL provide access to the lateral extradural space of the petrous apex. Following superior and lateral petrosectomy, critical structures such as the tentorium, trigeminal nerve, superior petrosal vein, facial and vestibulocochlear nerves, and abducens nerve can be exposed.

Conclusions: This study introduces the IPLL as a consistent and reliable anatomical landmark for EELPA. Identifying the IPLL facilitates extradural exposure and resection of the lateral petrous apex while minimizing disruption to the ICA and cranial nerves.

Background: Malnutrition is associated with worse outcomes in head and neck cancer (HNC). The geriatric nutritional risk index (GNRI) may predict postoperative morbidity and survival, but its role remains underexplored.

Methods: An ambispective study of patients undergoing HNC surgery at two academic centers (2015-2024) was performed. Preoperative GNRI was categorized into moderate-to-high risk (< 92), low risk (92-98), and no risk (> 98). Outcomes included 90-day mortality, treatment intolerance, overall survival, and disease-free survival. Analyses were performed using multivariable logistic and Cox regression adjusted for age, Charlson Comorbidity Index (CCI), tumor stage, primary tumor site, and percutaneous endoscopic gastrostomy (PEG) status. Patients with prior head and neck cancer or prior radiation were excluded.

Results: Among 312 treatment-naïve surgical patients, 13% were moderate-to-high GNRI risk and 8% low risk. Moderate-to-high GNRI risk had higher major adverse events (57% vs. 36% in no-risk), greater treatment intolerance (61% vs. 41%), and a trend toward higher 90-day mortality (11% vs. 4%). On multivariable models adjusted for tumor site and pathologic stage, moderate-to-high GNRI risk was associated with higher odds of 90-day mortality (OR 2.99, 95% CI 1.01-9.31; p = 0.048) and treatment intolerance (OR 2.35, 95% CI 1.21-4.56; p = 0.012). Cox regression showed shorter overall (HR 2.28, 95% CI 1.44-3.62; p < 0.001) and disease-free survival (HR 1.87, 95% CI 1.20-2.91; p = 0.005).

Conclusions: The GNRI predicted treatment intolerance and poorer survival in patients with operable HNC.

Background: This retrospective case-control study investigated surgical outcomes of head and neck paragangliomas (HNPGLs) with varying degrees of sclerosis.

Methods: Data from 95 patients who underwent HNPGL surgery over 20 years were analyzed. Based on histology, tumors were classified as having non-significant (< 30%) or significant (≥ 30%) sclerosis.

Results: Seventy patients had non-significant sclerosis and 25 had significant sclerosis. The significant sclerosis group was younger (39 vs. 44 years, p = 0.026), had more multiple tumors (48% vs. 12.9%, p = 0.001), higher nerve injury rates (p = 0.021), and more vascular injuries (20.8% vs. 4.17%, p = 0.022). Multivariate analysis identified tumor volume (OR = 1.014, p = 0.005) and sclerosis degree (OR = 0.276, p = 0.013) as independent risk factors for severe complications involving both nerve and vascular injury.

Conclusion: Sclerotic HNPGLs are associated with earlier onset, multiple tumors, and increased risk of intraoperative complications, suggesting unfavorable surgical outcomes.

Objective: To compare functional and oncologic outcomes in elderly (≥ 70 years) and nonelderly (< 70 years) patients after transoral robotic surgery (TORS).

Methods: A retrospective chart review was conducted on 114 patients who underwent TORS for head and neck squamous cell carcinoma between 2012 and 2022. Patient and tumor characteristics, perioperative details, complications, and survival parameters were analyzed. Swallowing function was assessed using the Functional Outcome Swallowing Scale (FOSS).

Results: Of the 114 patients, 37 (32.5%) were elderly, and 77 (67.5%) were nonelderly. Elderly patients had higher comorbidity scores (p < 0.001). Oropharyngeal and oral cavity primaries were more common in the nonelderly group, whereas laryngeal primaries predominated in elderly patients (p < 0.01). Complication rates were higher in nonelderly (37.6%) than in elderly (18.9%) patients, though not statistically significant (p = 0.07). In elderly patients, FOSS scores showed no significant change preoperatively, postoperatively (< 3 months), or at the last follow-up (median 36 months). The nonelderly group experienced worse early postoperative FOSS scores compared to baseline but showed significant improvement, returning to preoperative levels by the last follow-up. Nonelderly patients had better FOSS scores at last follow-up compared to elderly patients (p = 0.014). Overall and recurrence-free survival outcomes were better in the nonelderly group, but disease-specific survival rates were comparable.

Conclusion: Despite higher comorbidity rates in the elderly, TORS demonstrated favorable complication rates in the elderly population. Swallowing function returned to baseline after 3 months in both groups. TORS appears safe for elderly patients with comparable oncologic outcomes.

Background: The microvascular bone free flap (MBFF) is the preferred reconstruction after mandibular resection as it facilitates secondary dental rehabilitation.

Methods: In this multicenter study, patients were included if treated between January 2017 and January 2022 for head and neck cancer with MBFF reconstruction.

Results: Of the 487 identified patients, 104 patients were included. Median follow-up was 49 months. 61 patients (59%) had no dental rehabilitation. Of the 43 rehabilitated patients, 81% had a conventional prosthesis and 19% an implant-supported prosthesis. Neither the number of osteotomies, nor the complexity of the reconstruction, nor the radiotherapy, were statistically associated with dental rehabilitation. Only the absence of a dental specialist in the center (p = 0.04) and a number of one or fewer native mandibular teeth (p = 0.05) were significantly associated with no dental rehabilitation in multivariate analysis.

Conclusion: The rate of dental rehabilitation is still insufficient. The presence of a dental specialist is essential.

Background: Little is known regarding the interaction between vaccination and immunotherapy in cancer patients. Herein, we conducted a retrospective study to evaluate the impact of coronavirus disease 2019 (COVID-19) vaccinated status on survival in patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) treated with immune checkpoint inhibitors (ICI).

Methods: Patients who were treated with ICI for their R/M HNSCC were reviewed retrospectively. Patients who received at least one shot of the vaccine against COVID-19 were recruited into our study. Patients were stratified into fully vaccinated (FV) and partially vaccinated (PV) according to their vaccination status. Kaplan-Meier curves were estimated for progression-free survival (PFS) and overall survival (OS).

Results: A total of 127 patients were enrolled in our study for oncologic outcomes evaluation, including 70 FV and 57 PV. For the total population, the median PFS was 4.6 months and OS was 23.7 months. After stratifying according to COVID-19 vaccination status, the median PFS was 6.2 months in FV and 3.1 months in PV (p = 0.010). The median OS was 32.5 months in FV and 10.3 months in PV (p < 0.001). After the last dose of vaccination, the median neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were significantly lower in FV than in PV (p < 0.001). No new safety issues were found in our patient cohort and were insignificant between the FV and PV groups.

Conclusions: R/M HNSCC patients with FV had significantly lower NLR and PLR, and had better survival when treated with ICI without increasing treatment toxicity.