The Prognostic Value of Preoperative Plasma Fibrinogen and Neutrophil-to-Lymphocyte Ratio in Patients With Laryngeal Squamous Cell Carcinoma.

OBJECTIVES: Treatment effects in patients with laryngeal squamous cell carcinoma may vary significantly even among those with the same TNM stage. Routine preoperative blood and coagulation tests are economical and easily available hematological indicators. This study aimed to investigate the clinical predictive significance of pretreatment evaluation of plasma fibrinogen (FIB) level, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in patients with laryngeal carcinoma. METHODS: Clinicopathological and demographic data from 203 patients who underwent surgery for laryngeal carcinoma were collected and analyzed. The optimal cutoff values for FIB, NLR, and PLR were determined using receiver operating characteristic curve analysis. Univariate and multivariate Cox regression analyses were used to study the relationship between blood markers and patient survival. RESULTS: The optimal cutoff values for FIB, NLR, and PLR were 3.05 g/L, 2.41, and 110.94, respectively. Preoperative hyperfibrinemia (FIB >3.05 g/L) was an independent prognostic factor for overall survival (OS) and disease-free survival in patients with laryngeal carcinoma. An NLR >2.41 was associated with reduced OS in patients with laryngeal carcinoma, while PLR >110.94 had no effect on prognosis in these patients. CONCLUSIONS: Fibrinogen and NLR were valuable markers in predicting survival in patients with laryngeal carcinoma and may be used to inform clinicians in designing individual treatment strategies.

[Longterm impact on swallowing quality-of-life after partial laryngectomy].

OBJECTIVE: To discuss the longterm quality-of-life related to swallowing function after different partial laryngectomy. METHODS: The worldwide known swallow quality-of-life questionnaire (SWAL-QOL, Hongkong, Chinese edition); was used in this research to evaluate the swallowing QOL on 96 postoperative patients who underwent different kinds of partial laryngectomy more than one year before. The patients were divided into 4 groups: supracricoid partial laryngectomy-cricohyoidopexy (SCPL-CHP), supracricoid partial laryngectomy-cricohyoidoepiglottopexy (SCPL-CHEP), horizontal supraglottic partial laryngectomy (horizontal PL), and vertical partial laryngectomy (vertical PL). RESULTS: A one-way MANOVA revealed a significant multivariate (the 11 scales of SWAL-QOL) main effect for groups (P < 0.01), and significant univariate main effects were obtained for groups in 9 scales out of 11 (P < 0.01). In all the 9 scales vertical PL group acquired near full scores except the communication scale, and was significantly higher than the other 3 groups in many scales (P < 0.05). CHP group acquired the worst scores of the 4 groups, showing significant differences in most of the 9 scales (P < 0.05). No significant difference was found between Horizontal PL and CHEP except in communication (P > 0.05). Patients with deglutition disorders (choke/cough) had a lower score in the social function scale. CONCLUSIONS: Swallowing quality-of-life of postoperative patients was deeply influenced even when more than one year had passed after surgery. Some of them felt deeply burdened by deglutition disorder. Patients after CHP proved to have a worst quality of life than the others, while vertical PL the best. The QOL between Horizontal PL and CHEP was shown to be almost the same. The influence over QOL from longterm dysphagia was multi-dimensional, containing the degeneration of social function.

[Comparison of postoperative deglutition disorder in patients with laryngeal carcinoma after different types of supracricoid partial laryngectomy].

OBJECTIVE: To Evaluate the incidence rates and extents of deglutition disorder in patients with laryngeal carcinoma after different types of supracricoid partial laryngectomy. METHODS: Retrospective analysis of postoperative deglutition disorder in patients with laryngeal carcinoma after different types of supracricoid partial laryngectomy treated in our department from 2005 to 2009. The extents of postoperative deglutition disorder were evaluated using a homemade quantitative score table at 5-20 days postoperation. RESULTS: The score of deglutition disorder was 2.71 ± 0.31 in the supracricoid partial laryngectomy-cricohyoidoepiglottopexy (SCPL-CHEP) operation group and 3.43 ± 0.64 in the supracricoid partial laryngectomy-cricohyoidopexy (SCPL-CHP) group, respectively. The deference was statistically significant between the two groups (P < 0.001). The coefficient between age and score of postoperative deglutition disorder was assessed by Pearson correlation analysis. The coefficient of correlation was 0.947 (P < 0.0001) in the SCPL-CHEP group and 0.907 (P < 0.0001) in the SCPL-CHP group. The incidence rate of deglutition disorder was 1/37 in the SCPL-CHEP group and 7/30 in the SCPL-CHP group, evaluated at 8 weeks postoperation (P = 0.012). The deference between the two groups was significant. CONCLUSIONS: The type of operation procedure is an important factor affecting the occurrence of postoperative deglutition disorder in the patients after supracricoid partial laryngectomy, more serious in the SCPL-CHP group. The severity of postoperative deglutition disorder is more serious along with the increase of patient's age. For the elderly (> 70 years of age) patients with laryngeal carcinoma, the choice of surgical procedure should be more cautious, especially with the SCPL-CHP operation.

[Comparing extended vertical partial laryngectomy and cricohyoidoepiglottopexy in the treatment of laryngeal carcinoma].

OBJECTIVE: To compare the results of extended vertical partial laryngectomy (similar to modified supracricoid partial laryngectomy with cricohyoidoepiglottopexy) and cricohyoidoepiglottopexy in the treatment of laryngeal carcinoma. METHODS: Retrospectively analyzed on the results and prognosis in patients underwent extended vertical partial laryngectomy and cricohyoidoepiglottopexy between 1998 and 2005. The operation was similar to extended vertical partial laryngectomy. The healthy vocal cord and ventricular band as well as about 1/3 to 2/3 laminas of thyroid cartilage were removed. The healthy cricoarytenoid joint was reserved. The vocal cord, ventricular band, fixed or limitation of motion arytenoid cartilage and 2/3 laminas of thyroid cartilage in ill side were removed. The posteroinferior border of laminas of thyroid cartilage in both sides were reserved. The cricoid was lifted and fixed with hyoid epiglottis directly. Extended vertical partial laryngectomy group consisted of 37 patients with glottic carcinoma (stage T2 16 cases, stage T3 21 cases) and cricohyoidoepiglottopexy group consisted of 34 patients with glottic carcinoma (stage T2 12 cases, stage T3 21 cases, stage T4 1 case). RESULTS: Kaplan-Meier analysis was performed to calculate the survival rates. The three-year cumulative survival rate was 91.7% in extended vertical partial laryngectomy group and 87.5% in cricohyoidoepiglottopexy group respectively. There was no significant difference between the two groups (P > 0.05). The five-year cumulative survival rate was 80.6% in extended vertical partial laryngectomy group and 81.3% in cricohyoidoepiglottopexy group respectively. There was also no significant difference between the two groups (P > 0.05). The decannulation rate was 100% (37/37) in extended vertical partial laryngectomy group and 94.1% (32/34) in cricohyoidoepiglottopexy group respectively. The decannulation time was (14.0 + or - 2.3) days in extended vertical partial laryngectomy group and (19.0 + or - 4.6) days in cricohyoidoepiglottopexy group respectively. The incidence of aspiration was 2.7% (1/37) in modified group and 23.5 (8/34) in cricohyoidoepiglottopexy group respectively evaluated at 8th weeks post-operatively. The evaluation of deglutition disorder was analyzed by Ridit analysis in both groups and the results showed that there was significant difference between the two groups (U = 7.341, P < 0.001). The symptom of aspiration in extended vertical partial laryngectomy group was significant less than in cricohyoidoepiglottopexy group. CONCLUSIONS: Although the survival rate was not different between the two groups. The preservation of laryngeal function in extended vertical partial laryngectomy group was significant better than in cricohyoidoepiglottopexy group and extended vertical partial laryngectomy.

[Establishment and preliminary application of polymerase chain reaction with confronting two-pair primers for the single nucleotide polymorphisms of metabolic enzymes].

OBJECTIVE: To develop a simple, accurate, rapid, economic, large-scale detection method for the detection of single nucleotide polymorphisms (SNPs) metabolic enzymes, using polymerase chain reaction with confronting two-pair primers (PCR-CTPP). METHODS: The primers of CYP1A1 (A4889G), EPHX1 (A416G) and NQO1 (C609T) were designed for PCR-CTPP, and the PCR conditions were optimized. The results of genotyping were verified by DNA sequencing. The above SNPs were detected by the PCR-CTPP detection method in a randomly selected 183 healthy individuals of Han ethnicity. The genotype frequencies were analyzed and compared with people from other ethnicities. RESULTS: The allele-specific bands of CYP1A1 (A4889G), EPHX1 (A416G) and NQO1 (C609T) were successfully amplified by PCR-CTPP under the optimal conditions and the results of genotyping were consistent with DNA sequencing. Among 183 healthy Han individuals, the genotypic distributions of CYP1A1 (A4889G) , EPHX1 (A416G) and NQO1 (C609T) showed that the wild-type, homozygous variants, and heterozygotes were 103 (56.3%), 8 (4.4%), 72 (39.3%) and 142 (77.6%), 4 (2.2%), 37(20.2%), 60(32.8%), 32 (17.5%), 91 (49.7%) respectively. The distributions of genotypes were all in accordance with the Hardy-Weinberg equilibrium (P > 0.05), with statistical differences and with other ethnic populations (P < 0.05). CONCLUSION: The SNPs of metabolic enzymes can be detected by PCR-CTPP method which is simple, accurate, rapid, economic and with large scale. PCR-CTPP can be used for large scale clinical and epidemiological screening.

[Role of microvessel density on human middle ear cholesteatoma].

OBJECTIVE: To explore the role of microvessel density in acquired middle ear cholesteatoma, to analyze it playing the possible role in proliferative ability of cholesteatoma epidermis. METHODS: The specimens from 15 cases acquired middle ear cholesteatoma patients having typical perforation in the posterior fold (the adjacent skin around perforation and the normal deep external ear skin) were examined by immunohistochemical ABC method. The microvessel density was analyzed by computer, and was compared with 20 cases non-cholesteatoma otitis media's the adjacent skin around perforation. RESULTS: Counts of microvessel and relative area of all microvessels per image in the adjacent skin around perforation were 14.395 +/- 2.000 and (9.927 +/- 2.600)%, respectively. These were significantly higher than the normal deep external ear skin's with the average of 6.218 +/- 0.949 and (5.076 +/- 0.807)% in 15 cases acquired middle ear cholesteatoma patients (P < 0.001). The adjacent skin around perforation of cholesteatoma was also significantly higher than non-cholesteatoma's with the average of 6.163 +/- 1.051 and (5.785 +/- 1.428)% (P < 0.001). CONCLUSIONS: The adjacent skin around perforation in human middle ear cholesteatoma had a relatively hyperproliferative ability.

[Roles of epidermal growth factor and its receptor on the chronic tympanic membrane perforations].

OBJECTIVE: To evaluate the possible roles of epidermal growth factor(EGF) and its receptor (EGFR) on the chronic tympanic membrane perforations. METHODS: A phosphate buffer saline of EGFR was administered to a Gelfoam pledget placed over chronic tympanic membrane perforations in guinea pigs. The EGFR of 10 specimens from the acquired middle ear cholesteatoma of the adjacent skin around perforation was examined by immunohistochemical SP method and computer image analysis. Results Complete closure of the tympanic membrane perforations was observed in 82.6% of EGF-treated ears, but only 33.3% in the controls(P < 0. 01). No case was led to middle ear cholesteatoma in the experiment group (0/23). The positive expression in the adjacent skin around perforation was (39.3 -/+ 7.4)%; and the normal external ear skin was (25.4 +/- 3.7)%; There were distinctly significant differences between the adjacent skin around perforation and the normal external ear skin (P < 0. 01). CONCLUSIONS: EGF is effective on closing chronic tympanic membrane perforations in the guinea pigs. Present data suggests that EGF-treated may induce the occurrence of middle ear cholesteatoma.