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

Importance: Sinonasal carcinomas are rare but aggressive malignancies. A subset is associated with high-risk HPV, but risk factors for HPV-associated sinonasal carcinoma (HPV-SNC) and HPV-independent disease remain poorly understood.

Objective: To evaluate behavioral and clinical risk factors, including sexual history and substance use, and HPV antibody seropositivity in patients with HPV-SNC and HPV-independent SNC.

Design, setting, and participants: This multi-institutional case-case-control study was conducted from 2021 to 2024 at two NCI-designated cancer centers. Fifty-two patients with sinonasal carcinoma were enrolled; 37 completed a survey of demographic, clinical, and behavioral factors (24 HPV-SNC, 13 HPV-independent SNC) and serology was obtained for 36 (24 HPV-SNC, 12 HPV-independent SNC). Control noncancer otolaryngology patients (n = 148) from a recent prior study were matched 4:1.

Exposure: Self-reported history of sexual behaviors, substance use, and medical history via electronic survey; serum testing for antibodies to low- and high-risk HPV E6, E7, E1, E2, and L1 oncoproteins using a multiplex bead-based assay.

Main outcome and measure: Odds of HPV-SNC or HPV-independent SNC diagnosis in relation to risk factors; differences in HPV seropositivity between groups.

Results: Among the 37 cancer patients who completed the survey, a history of tonsillectomy was significantly associated with reduced odds of HPV-SNC (OR 0.28, CI 0.09-0.86). No other factors explored (sexual behavior, substance use, or other clinical factors) were associated with HPV-associated SNC and HPV-independent SNC. Seroprevalence of anti-HPV16 E6 was significantly higher among HPV-associated SNC cases than either controls or HPV-independent SNC (45.8% vs. 0% and 13.1%), HPV-16 E6 (18.2% vs. 0% and 4.0%), and HPV-16 early proteins (16.7% vs. 0% and 0%) than HPV-independent SNC patients or controls, respectively.

Conclusions and relevance: HPV-SNC exhibits distinct serologic features without clear behavioral risk factors. The protective association of tonsillectomy suggests lymphoid tissue may play a role in HPV-associated sinonasal oncogenesis. In contrast, the absence of identifiable risk factors for HPV-independent SNC highlights the need for further etiologic studies.

Background: Ultrasound-guided fine-needle aspiration cytology (US-FNAC) is commonly used in the diagnostic work-up of head and neck cancer, but its ability to detect occult lymph node metastases in early-stage oral squamous cell carcinoma (OSCC) with a clinically negative neck remains unclear.

Methods: A retrospective analysis was performed in 578 patients with early-stage OSCC (cT1-3N0) who underwent US-FNAC prior to surgery. Histopathology, sentinel lymph node biopsy, and follow-up were used as reference standards.

Results: Occult nodal metastases were found in 179 patients (31.0%). US-FNAC showed low sensitivity (15.9%) and a negative predictive value of 72.9%, resulting in 149 false-negative cases (25.8%). Specificity (99.5%) and positive predictive value (90.3%) were high, with only 2 false-positive results.

Conclusions: In patients with early-stage oral cavity squamous cell carcinoma and a clinically negative neck, US-FNAC demonstrates high specificity but limited sensitivity and negative predictive value. These findings indicate that US-FNAC alone is insufficient to exclude occult nodal metastases and should be regarded as an adjunctive diagnostic tool rather than a stand-alone nodal staging strategy.

Background: Cutaneous adnexal carcinomas are a very rare group of cancers arising from appendageal structures of the skin. More than half occur in the head and neck region. No standard treatments exist for metastatic disease.

Methods: A 48-year-old postmenopausal female presented with an enlarging scalp lesion. Biopsy showed adenocarcinoma that was positive for estrogen and progesterone receptors. She underwent wide local excision with adjuvant radiation. Unfortunately, she presented with metastatic disease 1.5 years later.

Results: Given the tumor's hormone receptor profile, she was started on an aromatase inhibitor (AI) and a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor with a durable partial response for 2.5 years at the time of this report. She continues to work full-time.

Conclusions: This is the first case study describing the success of hormonal therapy combined with a CDK4/6 inhibitor for a rare head and neck cancer. Cutaneous adenocarcinomas in the head and neck region should have routine immunohistochemical assessment of hormone receptors.

Background: There is much controversy on the extent of lymph node dissection (LND) for papillary thyroid carcinoma (PTC) patients with lymph node metastasis (LNM) according to major guidelines. This study aims to explore the optimal extent of LND and discover a personalized and accurate surgical plan for pN1 PTC patients.

Methods: This prospective study included 550 patients with PTC who underwent initial surgery. For patients who were considered pN1a, LND of levels III and IV was completed. For patients who were considered LNM in levels III or IV, after taking 3-6 lymph nodes of level III for frozen pathological examination, if LNM was found, LND of levels II-IV was performed; otherwise, only levels III and IV were dissected, For patients who were considered to have LNM in level II, LND of levels II-V was performed. Statistical analysis was performed using SPSS software.

Results: 51.4% of patients with pN1a had postoperative pathologically confirmed occult LNM in levels III and IV. Among patients who underwent LND of levels II-IV due to positive lymph nodes in level III, 46.1% had occult LNM in level II. For patients with LNM in level II, the incidence of occult metastasis in level V was 20%. Only one patient presented with lymph node recurrence outside of the operative field. The proportion of patients with postoperative complications increased as the scope of dissection enlarged.

Conclusion: Combined with the distribution of LNM and the number of subregions of LNM(n) in preoperative ultrasonography, it is suggested that the range of LND in the lateral neck of pN1 PTC should be n + 1/2 anatomical subregions.

Background: Advanced head and neck and thyroid cancers often involve cervical lymph nodes and require neck dissection, causing pain and reduced neck/shoulder mobility. We developed a video-guided neck exercise to maintain mobility and improve quality of life (QOL).

Methods: Patients who underwent neck dissection (August 1, 2022-November 1, 2023) were randomized into groups using video-guided exercise (n = 21) or printed leaflets (n = 19). Cervical range of motion (CROM) and QOL were measured before surgery. Exercise started on postoperative day 7, and follow-up was conducted at weeks 2 and 12.

Results: Of the 40 participants, 36 completed the study (18/group). At week 2, both groups showed reduced CROM without between-group differences. By week 12, the video group improved in flexion and extension, whereas the leaflet group decreased (p = 0.01 and p = 0.04, respectively). Other motions and QOL were unchanged.

Conclusions: We recommend video-guided neck exercise for patients undergoing neck dissection, with specialist-supervised training to ensure proper technique and improve clinical outcomes.

Background: Two-month outcomes of advanced pneumatic compression device (APCD) and usual care (UC) in Head and Neck Cancer survivors with previously untreated lymphedema were compared.

Methods: Participants in this multisite, randomized clinical trial were randomized to APCD or UC. The primary endpoint was severity of lymphedema symptoms. Secondary endpoints were anatomical lymphedema changes, biopsychosocial outcomes, and barriers to care.

Results: Two hundred thirty-six participants were enrolled (119 APCD, 117 UC). Analysis was intention-to-treat. Lymphedema-associated symptom burden measured using the VHNSS and LSIDS was improved to a similar degree in both groups. APCD demonstrated a statistically significant improvement in external soft tissue swelling assessed by digital photography. No difference in CT imaging measures of lymphedema was noted. UC participants experienced barriers to care.

Conclusions: APCD is an effective treatment for lymphedema in HNCS. The APCD addresses clinically significant barriers to therapist guided treatment. A hybrid approach may be complementary and optimize patient outcomes.

Trial registration: NCT04797390.

Objective: The aim of this study is to evaluate the impact of extrathyroidal extension (ETE), multifocality, and lateral neck lymph node metastasis on survival outcomes for pediatric patients with differentiated papillary thyroid carcinoma (PTC).

Methods: This study was conducted in conformity with the PRISMA statement. The pooled hazard ratios (HRs) and the 95% confidence interval (CI) were calculated to define the impact of different pathological factors on disease-free survival (DFS).

Results: A total of 13 studies, enrolling 2641 patients (males: 29.5%, n = 780) with a median age of 16 years (95% CI: 15.4-19.0) years (n = 1370/2641), were included. The incidence of multifocality and ETE was 30.7% (n = 806/2625), and 45.4% (n = 1148/2528), respectively. The incidence of lateral neck lymph node metastasis (LNM) was 51.6% (n = 1224/2372). Overall, 61.5% of patients underwent postoperative radioactive iodine therapy (RAI) (n = 1381/2247). The median follow-up time was 85 months (95% CI: 57.0-176.4) (n = 2534/2641). The estimated pooled HRs for DFS were 1.86 (95% CI: 1.33-2.59; p = 0.002) for multifocality, 1.78 (95% CI: 1.20-2.63; p = 0.010) for ETE and 1.77 (95% CI: 0.76-4.11; p = 0.161) for lateral neck LNM.

Conclusions: Multifocality and ETE are significant predictors of recurrence in pediatric PTC, while lateral neck LNM does not seem to be a reliable prognostic factor. These results may warrant consideration in pediatric-specific risk stratification and help guide treatment and follow-up.

Background: Long-segment tracheal defects present complex reconstructive challenges due to the risk of airway collapse and disrupted mucociliary clearance. Osteocutaneous radial forearm free flaps (RFFFs) offer a promising alternative to traditional reconstructive methods, though long-term outcome data remain limited.

Methods: A previously-healthy 21-year-old male developed severe tracheal stenosis following prolonged intubation, tracheostomy, and multiple failed reconstructions. He underwent partial-circumference tracheal resection extending 41 mm from the larynx. Reconstruction was accomplished with a de-epithelialized osteocutaneous RFFF.

Results: The patient was decannulated within 6 months and experienced no breakdown of the bony reconstruction over 12.5 years of follow-up. He maintained stable respiratory function, diet tolerance, and speech, with no major complications or donor-site morbidity. Intermittent, elective endoscopic procedures addressed mild-to-moderate granulation and recurrent fibrosis.

Conclusions: This case demonstrates successful use of a de-epithelialized osteocutaneous RFFF for tracheal reconstruction with over a decade of follow-up. It supports this technique as an effective, durable option in appropriately selected patients.

Introduction: Transoral robotic surgery (TORS) is increasingly used for oropharyngeal squamous cell carcinoma (OPSCC), yet national patterns of TORS availability for Medicare beneficiaries are not well defined. We characterized hospital type, geographic distribution, and market concentration of TORS.

Methods: We conducted a retrospective cross-sectional study of inpatient Medicare claims from 2017 to 2023, identifying OPSCC with ICD-10-CM codes and TORS with ICD-10-PCS codes including a robotic-assistance qualifier. Claims were linked to inpatient prospective payment system files for hospital teaching status, disproportionate share hospital (DSH) percentage, urbanicity, and geographic labor market area (GLMA). We mapped county-level procedure counts, calculated GLMA-level Herfindahl-Hirschman Index (HHI), and used negative binomial regression to evaluate associations of hospital factors with TORS volume and inpatient length of stay (LOS).

Results: We identified 2499 unique TORS procedures at 161 hospitals; 86.2% occurred at teaching hospitals, and annual volume rose 31% from 2017 to 2023. TORS use was geographically diffuse but locally concentrated: among 102 GLMAs with any TORS, 64.7% had HHI = 10 000 and 28.4% had HHI 5000-9999. Six GLMAs with > 100 procedures accounted for 33.6% of all cases and were predominantly teaching centers. Higher teaching intensity was associated with greater TORS use (incidence rate ratio [IRR]: 1.99, 95% CI: 1.63-2.45). LOS was longer in urban and rural hospitals versus metropolitan centers and shorter in high-volume GLMAs (IRR: 0.82, 95% CI: 0.76-0.87).

Conclusion: Among Medicare beneficiaries with OPSCC, TORS is concentrated in teaching hospitals and a few high-volume markets, with shorter LOS in high-volume regions, highlighting trade-offs between centralization and access.

Objective: Aggressive care at the end of life (EoL) is a marker of poor-quality care for patients with advanced head and neck cancer (HNC). We aimed to investigate aggressive inpatient care and palliative care (PC) at the EoL for hospitalized patients with distant metastases.

Study design: Retrospective cohort study.

Setting: Patients with metastatic head and neck cancer and terminal hospitalization were identified in the National Inpatient Sample database between 2016 and 2020.

Methods: We examined the level of aggressive inpatient care (intensive care unit (ICU) level of care, chemotherapy, radiotherapy, and surgery) and PC at the EOL. Multivariate logistic regression was performed to determine their associations with selected patient and hospital characteristics.

Results: A total of 43 310 patients met the inclusion criteria. Thirty-five percent of patients received one or more forms of aggressive EOL interventions, and 61.76% received PC. Among the 15 095 receiving aggressive intervention, 76.9% received ICU level of care, 12.18% received chemotherapy, 19.2% surgery, and 8.04% radiotherapy during their terminal hospitalization. In multivariable analyses, younger age, lower PC use, larger hospitals, urban teaching hospitals, and higher risk of mortality were associated with a greater likelihood of aggressive care. PC was associated with lower hospital costs (-$20,115; [-$28,284, -$11,946]) and aggressive care was associated with higher terminal hospitalization costs ($100,309; [$91,373, $109,245]).

Conclusion: Receiving PC at the EoL was associated with less aggressive interventions and costly hospitalization. Further research should examine these associations using prospective designs and evaluate whether increased PC referral and early uptake might help diminish poor quality of care and costly hospitalizations.