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

Background: This study elucidated sex disparities in head and neck squamous cell carcinoma (HNSCC) outcomes and investigated their interaction with race.

Methods: A total of 452 patients diagnosed with HNSCC were grouped by sex and race. Survival was analyzed using Kaplan-Meier curves with log rank tests and multivariable Cox models to assess sex/race associations while adjusting for confounders.

Results: Males were more likely to have advanced-stage cancer (79.6%, n = 257 vs. 70.5%, n = 91; p = 0.040). African American females had the best 5-year overall survival, followed by White females and Hispanic males. African American males had the worst survival (p = 0.0334). This sex disparity within the African American population persisted when controlling for confounding variables (HR = 0.343; 95% CI: 0.154-0.766; p = 0.0090) and was more pronounced in HPV-negative cases (HR = 0.184, 95% CI = 0.043-0.786).

Conclusions: Race-stratified analysis revealed a survival advantage for African American females over males. Further analysis shows that HPV status, alongside race, moderates the effect of sex on HNSCC outcomes.

Level of evidence: 3:

Background: Nodal metastases significantly affect prognosis in oral cavity squamous cell carcinoma (OCSCC). In early-stage OCSCC (cT1-T2 cN0), management of the clinically negative neck (cN0) remains controversial. Depth of invasion (DOI) is a key determinant for END, but other histopathological parameters, such as grading, perineural invasion (PNI), lymphovascular invasion (LVI), and worst pattern of invasion (WPOI), are emerging prognostic factors.

Methods: This multicenter retrospective study analyzed 1109 patients with cT1-T2 cN0 OCSCC treated at 30 Italian hospitals since 2017. Data on histopathological parameters, tumor characteristics, and patient outcomes were collected via the REDCap platform. Simple and multivariable logistic regression models were developed to assess predictors of occult nodal metastases.

Results: A total of 585 patients were clinically classified as cT1 tumors (53%), 503 as cT2 (45%), and cTis (1.9%). Of the 1109 patients, 193 (28%) had occult nodal metastases, with DOI, LVI, PNI, WPOI, and grading emerging as significant predictors. A predictive model integrating these variables demonstrated superior accuracy compared to a DOI-only model (AUROC comparison, p < 0.01).

Conclusion: This study highlights the importance of incorporating multiple histopathological parameters into risk models for occult nodal metastases, overcoming the fixed DOI as a cutoff. The proposed predictive model offers a more precise method for guiding END in early-stage OCSCC, allowing individualized risk estimation.

Background: Dysphagia is common in patients with oral cancer undergoing flap reconstruction surgery. Surgical resection and reconstruction can affect the sensory and motor functions associated with swallowing. Studies on dysphagia have not investigated patients with oral cancer undergoing flap reconstruction surgery. In this hospital-based retrospective study, we examined the occurrence rates, risk factors, and clinical outcomes of dysphagia in patients with oral cancer undergoing flap reconstruction surgery.

Methods: Data were collected from the Chang Gung Research Database, which includes structured and unstructured electronic medical records. These data covered the period from January 1 to November 30, 2022. A total of 892 patients were included in the study. Dysphagia was identified on the basis of NANDA International Nursing Diagnoses criteria. Univariate and multivariable logistic regression models were used for data analysis.

Results: Of a total of 892 patients, 679 (76.1%) experienced dysphagia. Body mass index, smoking status, alcohol consumption, betel nut chewing, pain score, neck lymph node dissection, radiotherapy, and chemotherapy were identified as significant risk factors for dysphagia. Compared with those without dysphagia, patients with dysphagia had significantly higher rates of nasogastric tube placement and tracheostomy at discharge, longer hospital stays, and higher readmission rates.

Conclusions: Dysphagia is common in patients with oral cancer undergoing flap reconstruction surgery and is associated with certain risk factors and clinical outcomes. Enhancing postoperative care and implementing targeted interventions can facilitate the development of precise treatment plans aimed at reducing the incidence of dysphagia and improving the overall quality of care for patients undergoing flap reconstruction surgery.

Background: Persistent opioid use after head and neck cancer surgery is a growing concern, but data regarding incidence and risk factors remain limited.

Methods: This retrospective cohort study included patients who underwent primary resection of oral cavity squamous cell carcinoma between 2016 and 2022. Preoperative opioid use was classified as naïve, intermittent, or chronic using prescription drug monitoring data. Persistent use was defined as filling an opioid prescription attributed to surgery and two consecutive prescriptions between 120 and 365 days postoperatively. Regression analysis identified independent predictors.

Results: Among 430 subjects, 18.8% met criteria for persistent opioid use. Chronic preoperative use (p = 0.008), G-tube persistence at 12 months (p = 0.041), chronic pain diagnosis (p = 0.036), and cancer recurrence (p = 0.021) were independent predictors. Persistent use peaked between 120 and 180 days postoperatively.

Conclusion: Persistent opioid use is common after oral cancer resection and is strongly associated with preoperative opioid use. Early risk stratification may improve outcomes.

Background: Recurrence of head and neck squamous cell carcinoma (HNSCC) affects nearly half of patients and greatly reduces survival. There are currently no well-established mechanisms to predict which HNSCC patients will experience disease recurrence. We have previously shown that an elevated proportion of highly differentiated, CD57+ effector memory T (HD TEMRA) cells in circulation is associated with early recurrence and poor locoregional disease control in HNSCC patients.

Methods: Here, we present refined flow cytometry panels utilizing fewer fluorescent antibodies that retain the prognostic value of HD TEMRA cells in predicting HNSCC recurrence.

Results: In our cohort of surgically treated HNSCC patients, identifying HD TEMRA cells via flow cytometry as live CD8+ CD28- CD57+ cells effectively predicted disease recurrence. When assessing this cohort by disease subsite, we found that for patients with oral squamous cell carcinoma, identifying HD TEMRA cells by CD8+ CD57+ alone was sufficient for predicting locoregional disease recurrence.

Conclusions: These refined panels enhance the clinical utility of HD TEMRA proportion as a biomarker due to their technical and analytic ease. Implementation of HD TEMRA cell proportion as a clinical biomarker could aid in personalized HNSCC treatment planning.

Background: The current study presents the efforts of a global collaborative group to review the management and outcomes of malignant tumors of the skull base in the pediatric population worldwide.

Patients and methods: A total of 28 institutions contributed data on 3061 patients. From this, there were 64 pediatric patients (2.1%). Clinical variables, overall and disease-free survival (OS and DFS) outcomes, and multivariable factors associated with outcome were evaluated.

Results: The male-to-female ratio was 37:27 and the median [IQR] age at diagnosis was 14.0 [9.6-16.0] years. The most common malignancy was sarcoma (57.8%), followed by esthesioneuroblastoma (25.0%) and carcinoma (17.2%). Negative margins were achieved in 53.1% children. Dural invasion was associated with reduced OS and DFS. Adjuvant radiotherapy was associated with improved survival outcomes.

Conclusions: Open approaches were widely used for pediatric skull base tumor resection in the period between 1995 and 2015 but we saw a rise in the use of endoscopic and combined techniques by the end of the period covered by this study. Our results may represent a transitional era in which alternative endoscopic techniques continue to expand.

Background: Bony nonunion is an important complication in head and neck reconstruction, but its definition, incidence, and treatment are not well-reported.

Methods: MEDLINE, Embase, CENTRAL, and Web of Science were searched from October 1st, 1990 to January 6th, 2025 for studies reporting bony union for maxilla or mandible reconstruction with vascularized free flap.

Results: The search strategy yielded 5985 abstracts and 52 were included in the review. Definitions of bony nonunion varied and were reported in 20 studies. Higher pooled rates of complete union were observed in reconstructions of the maxilla, reconstructions using the radius, and surgeries aided by virtual surgical planning. Treatment for nonunion was reported in 11 studies.

Conclusions: Virtual surgical planning has the potential to improve union outcomes and reduce the need for revision surgeries in nonunion cases. The heterogeneity of the studies necessitates randomized controlled trials for further analysis of the nonunion risk factors and consequences.

Background: Fibrous dysplasia (FD) is a rare osseous disorder with limited understanding. This study aimed to evaluate the clinical characteristics of craniofacial FD (CFD) and orbital FD (OFD), explore vision impairment mechanisms, and identify recurrence risk factors.

Methods: A retrospective analysis was conducted on 54 CFD patients across three centers, including 30 patients with orbit involved.

Results: OFD patients exhibited higher prevalences of polyostotic FD and McCune-Albright syndrome, and more often underwent debulking rather than radical surgery. Vision impairment was primarily attributed to compressive and stretched optic neuropathy. Polyostotic involvement (p = 0.034) was a risk factor of subjective recurrence. Surgery age < 16 years (p = 0.046) and abnormal body mass index (p = 0.002) were associated with greater postoperative lesion regrowth volume.

Conclusions: OFD patients exhibit distinct clinical features. Optic canal decompression is not required for all OFD-related vision loss patients. Recurrence risk should be thoroughly assessed before surgery.

Background: Nutrition and socioeconomic status are well-established risk factors for oropharyngeal squamous cell carcinoma (OPSCC) progression and mortality, but the impact of the food environment remains largely understudied.

Methods: In this retrospective study, race/ethnicity-stratified inferential and mediation analyses assessed selected clinical outcomes for 70 581 OPSCC patients from the Surveillance, Epidemiology, and End Results. We examined the effects of Food Environment Atlas scores composited from 282-county-level variables, adjusted for the effects of traditional social determinants of health.

Results: Worse food environments were modestly associated with increased risk of overall mortality (aHR-1.03, 95% CI, 1.02-1.04), 3-year overall mortality (aOR-1.04, 95% CI, 1.03-1.05), and advanced stage at diagnosis (aOR-1.02, 95% CI, 1.01-1.03) in the whole sample, with exacerbated associations across all outcomes among non-White patients. The food environment was not significantly associated with having more than one primary tumor at diagnosis. Traditional social determinants of health partially mediated mortality, but not staging effects.

Conclusions: Poor food environments were modestly associated with increased OPSCC mortality and advanced staging, with exacerbated effects in non-White patients. These retrospective findings support investigations into specific mechanisms of food environment inequity on OPSCC outcomes to guide targeted public health interventions such as subsidized transportation.

Background: The global incidence of thyroid cancer has risen over recent decades, largely attributed to increased detection of thyroid nodules. This trend has raised concerns regarding overdiagnosis and overtreatment. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) plays a pivotal role in preoperative risk stratification, yet clinical decision-making remains challenging in indeterminate categories (Bethesda III-V), particularly in resource-limited settings where molecular testing is unavailable.

Objective: To determine the risk of malignancy (ROM) for each TBSRTC category among patients who underwent thyroid surgery over a 10-year period at a tertiary care center in India, and to compare these rates with the 2023 TBSRTC risk estimates.

Methods: This retrospective study analyzed fine-needle aspiration cytology and histopathology data for all patients who underwent thyroid surgeries conducted between 2014 and 2024. ROM across TBSRTC categories was calculated and compared with established TBSRTC risk estimates.

Results: A 100% malignancy rate was observed in TBSRTC VI category, supporting the reliability of surgical decisions in this group. However, significantly higher malignancy rates were found in TBSRTC categories III (58.7%), IV (82.7%), and V (100%) compared to TBSRTC estimates (22%, 30%, and 74%, respectively). TBSRTC III nuclear had a significantly higher malignancy rate (70.0%) than TBSRTC III other (40.57%).

Conclusion: Institution specific malignancy data enhances the clinical utility of TBSRTC and improves patient counseling, particularly in settings where molecular diagnostics are not feasible.