Cervicofacial and Pharyngolaryngeal Lymphedema and Deglutition After Head and Neck Cancer Treatment.

One of the sequelae of head and neck cancer treatment is secondary lymphedema, with important impact on breathing, swallowing and vocal functions. The aim of the study was to assess the presence, staging characteristics and relationship of external and internal lymphedema and dysphagia after head and neck cancer treatment. The MDACC Lymphedema Rating Scale in Head and Neck Cancer was employed for the assessment and staging of face and neck lymphedema; the Radiotherapy Edema Scale for internal lymphedema; and a fiberoptic endoscopic evaluation of swallowing (FEES) for swallowing. The sample consisted of 46 patients with a diagnosis of head and neck cancer. Lymphedema was detected in 97.8% (45) of the evaluations with predominance of the composite type (73.9%-34). A high percentage of external lymphedema of the neck (71.7%-33) and submandibular (63%-29) were detected, with predominance of the more advanced levels. Internal edema was found in almost all structures and spaces at moderate/severe level. At FEES, residue (higher percentage in valleculae and pyriform sinus), penetration and aspirations were observed. The residue was detected in higher occurrence in patients with composite lymphedema (p = 0.012). The combined treatment with radiotherapy was related to submandibular external lymphedema (p = 0.009), altered pharyngolaryngeal sensitivity (0.040), presence of residue (p = 0.001) and penetration to pasty (p = 0.007) and internal edema in almost all structures. There was also a higher percentage of residue in cases with internal altered pharyngolaryngeal sensitivity, residue, penetration and aspiration. Combined treatment with radiotherapy is an associated factor of edema. Cervicofacial and pharyngolaryngeal lymphedema is a frequent event after treatment for HNC, with important impact on swallowing performance characterised by altered pharyngolaryngeal sensitivity, residue, penetration and aspiration. Combined treatment with radiotherapy is an associated factor.

Correction to: Cervicofacial and Pharyngolaryngeal Lymphedema and Deglutition After Head and Neck Cancer Treatment.

The original version of this article unfortunately contained a mistake. Figure 2 was repeated in Figure 3.

Oral Cancer Treatment: Still an Indication for Elective Neck Dissection?

INTRODUCTION: Oral squamous cell carcinoma has a high incidence and, although elective neck dissection is recommended, the removed nodes frequently present without metastasis. This surgical approach causes disabilities and increases possible surgical complications. OBJECTIVE: To evaluate the possibility of a watchful waiting approach in oral cancer. METHODS: We compared 78 patients with clinical and pathological node metastases and their counterparts with pathological node metastases but without evident clinical neck disease. Therefore, we provided a theoretical comparison between the patients who had an elective neck dissection and those who waited until a clinically positive node was evident. RESULTS: The prognostic factor rates were similar between the groups. Their regional recurrence and mortality rates had no statistical differences. CONCLUSION: A watchful waiting policy could be applied to selected oral cancer patients who can undergo a very close follow-up. This option would be more cost-effective and less harmful than elective neck dissection.

DEATH RELATED TO PULMONARY METASTASIS IN PATIENTS WITH DIFFERENTIATED THYROID CANCER.

OBJECTIVE: The purpose of the present study was to investigate the predictive factors for shorter disease-specific survival in patients with pulmonary disease secondary to differentiated thyroid cancer (DTC). METHODS: This was a retrospective cohort study conducted over a 5-year period that included 54 patients with pulmonary disease secondary to DTC during the follow-up. Among these patients, 13 (24.1%) died from the disease. Dedifferentiation characteristics were identified at pathological examination of the metastatic disease (lymph node or distant metastases) and was defined as the abrupt transformation of a well-differentiated tumor into high-grade morphology lacking the original distinct histologic characteristics. RESULTS: Tumor dedifferentiation marked by cellular aberrations and radioiodine (RAI) therapy resistance occurred in 5 (9.3%) patients. Four of them died due to pulmonary progression (80.0%), and the median survival of this group was 30 months compared to 279 months in the patients without dedifferentiation. The cumulative disease-specific survival was 20.0% in the patients with dedifferentiation during the follow-up versus 46.1% among the cases without this condition (P = .003, log-rank test). Moreover, dedifferentiation was independently associated with shorter disease-specific survival (hazard ratio [HR] = 31.607; 95% confidence interval [CI]: 4.815-207.478; P<.0001, Cox regression model) as were age over 45 years (HR = 10.904; 95% CI: 1.145-103.853; P = .038) and male sex (HR = 4.210; 95% CI: 1.056-16.783; P = .042). CONCLUSION: DTC patients with pulmonary disease exhibited shorter disease-specific survival, particularly those who developed tumor dedifferentiation, and these patients require special attention during follow-up. ABBREVIATIONS: CI = confidence interval DTC = differentiated thyroid cancer FTC = follicular thyroid carcinoma HR = hazard ratio IQR = interquartile range LN = lymph node LR = likelihood ratio PTC = papillary thyroid carcinoma RAI = radioiodine pTNM = pathologic tumor-node-metastasis stage system.

Risk Factors for Distant Metastasis in Patients with Oral Cavity Squamous Cell Carcinoma Undergoing Surgical Treatment.

OBJECTIVE: The aim of this study is to investigate the clinical and pathological factors related to distant metastasis in patients with oral cavity squamous cell carcinoma (OCSCC) undergoing surgery. STUDY DESIGN: A retrospective data review was conducted on patients who underwent primary surgery for OCSCC at the Instituto do Cancer do Estado de São Paulo (ICESP) between 2009 and 2015. Distant metastasis rates were calculated and predictive factors were determined by the Cox proportional-hazards model. RESULTS: There was a total of 274 patients, including 210 (76.6%) men and 64 (23.4%) women, with a mean age of 59.9 ± 10.9 years. The incidence of distant metastasis was 9.6%, with the lung being the most common site. The mean time interval between surgical treatment and the diagnosis of distant metastasis was 12 months (range 2-40 months). In the multivariate analysis, angiolymphatic invasion (HR = 2,87; p = 0.023), contralateral cervical metastasis (HR = 3.3; p = 0,007), tumor thickness >25 mm (HR = 3.50; p = 0.009), and locoregional recurrence (HR = 6.59; p < 0.0001) were the only independent risk factors for distant metastasis. CONCLUSION: Patients with OCSCC who have contralateral lymph node metastasis, tumors with a thickness >25 mm, angiolymphatic invasion, or locoregional recurrence after surgical treatment have a greater risk of developing distant metastasis.

Videoendoscopic Evaluation of Swallowing After Thyroidectomy: 7 and 60 Days.

Deglutition complaints are frequent after thyroidectomy. The purpose of this study was to follow-up on patients with thyroidectomy indication to compare the videoendoscopic evaluation of swallowing on the seventh day (early postoperative, EPO) and on the 60th day after thyroidectomy, (late postoperative, LPO) and to compare patients that evolved with normal laryngeal mobility (NLM) and abnormal laryngeal mobility (ALM). Nasofibroscopic evaluation was performed preoperatively (PRE), on the EPO and LPO. Two groups were compared: ALM and NLM. The majority of people were women, age bracket 46-65, who underwent total thyroidectomy and with high frequency of carcinoma. 30 out of the 54 patients in the study had change in swallowing (55 %). Dysphagia occurred in 87 % (13/15) of patients with ALM in the EPO and remained in 67 % of them in the LPO. In the NLM group, dysphagia occurred in 44 % (17/39) in EPO and 25 % in LPO. There was a statistical difference between PRE and EPO, and PRE and LPO (P < 0,001). In the ALM group, liquid penetration and aspiration were identified in 33 % of the cases during EPO (P = 0,014); retention of food occurred in 87 % in EPO and in 60 % in LPO (P < 0,001). Dysphagia occurs in patients after thyroid surgery (regardless of larynx mobility alteration) and characterized by stasis of food in the oro and hypopharynx, which is also noticed in LPO, though more frequently in EPO.

Tumor thickness as an independent risk factor of early recurrence in oral cavity squamous cell carcinoma.

The aim is to determine if tumor thickness is a risk factor related to the development of early recurrences in surgically treated oral cavity squamous cell carcinoma (SCC). Retrospective cohort study conducted at Instituto do Câncer do Estado de São Paulo (ICESP). Fifty-seven patients with oral cavity SCC (excluding lip tumors and patients previously submitted to any treatment) were analyzed regarding the occurrence of an early disease progression (locoregional or distant metastasis) within the first 12 months after initial treatment. Tumor thickness and other histological characteristics related to the development of recurrence up to 1 year after treatment were tested. Results demonstrated that tumor thickness greater than 10 mm (P = 0.034), as well as angiolymphatic invasion (P = 0.001), perineural invasion (P = 0.041) and lymph-node metastasis (P = 0.021) was associated with a worse 12-month disease-free survival (Log-Rank test). In multivariate analysis, tumor thickness greater than 10 mm emerged as an independent risk factor for early recurrence in oral cavity tumors (HR = 3.4, 95% CI: 1.005-11.690; P = 0.049--Cox regression). Post-operative radiotherapy seems to be a protective factor for early recurrences in patients with tumor thickness greater than 10 mm (P = 0.017--Log-Rank test; HR = 0.32, 95% CI: 0.12-0.87, P = 0.026--Cox regression). The results of the present research suggest that tumor thickness greater than 10 mm may be an independent adverse factor for early progression of surgically treated oral cavity SCC. Adjuvant therapies, in particular post-operative radiotherapy, should be advocated in this group of patients, regardless of the co-existence of other well-described histological risk factors.

Functional outcomes and quality of life in patients who undergone conventional or endoscopic/robotic retroauricular neck dissection: a case-control study.

Background: Neck dissection performed via retroauricular approach emerged as an alternative to the conventional approach, aiming to maintain therapeutic efficacy with lower postoperative morbidity. Differences among these modalities in terms of functional aspects and quality of life (QOL) remains unclear. This study aims to evaluate the anatomical and functional aspects and the QOL in patients undergoing unilateral neck dissection via conventional or retroauricular (endoscopic or robotic) access. Methods: This study involved consecutively 35 patients who underwent unilateral neck dissection for head and neck cancer, 25 submitted to the conventional surgery [conventional group (CG)] and 10 to the retroauricular approach [retroauricular group (RG)]. Patients were evaluated preoperatively and on the 30th postoperative day (POD) regarding range of motion (ROM) of the cervical spine and shoulder, trapezius muscle strength and QOL. Results: The CG and RG were similar in terms of anthropometric, clinical and surgical variables. The mean age of both groups was between 52 and 55 years old. There was a predominance of females in the CG (52%) and males in the RG (70%); P=0.08. The most affected site was the oropharynx followed by the thyroid in the two groups and the most frequently dissected levels were I-III in both groups. There was a difference in the length of hospital stay {CG: 5 [1-22] days and RG: 2 [1-6] days; P=0.02} and pain scores at the 30th POD was higher in CG group (P=0.002). Regarding the cervical spine ROM, it was better in RG in the 30th POD for neck extension, ipsilateral lateroflexion, contralateral lateroflexion and contralateral rotation (P<0.05). No significant differences were found regarding shoulder ROM. Trapezius muscle strength, was also higher at the 30th POD in RG group (P<0.05). QOL was most impacted in the CG in the Chewing and Shoulder domains and Physical Function dimension at the 30th POD (P<0.05). Conclusions: Postoperative functional morbidity was lower in patients undergoing retroauricular neck dissection. The cervical spine ROM and trapezius muscle strength were better in patients undergoing retroauricular approach and postoperative QOL was worse in patients undergoing conventional neck dissection.

Detection of serum biomarkers of HPV-16 driven oropharynx and oral cavity cancer in Brazil.

BACKGROUND: HPV-16 driven oropharynx/oral cavity squamous cell carcinomas prevalence varies globally. We evaluated the presence of HPV-16 ctDNA and HPV-16 E6 antibodies in samples obtained from participants treated at the Instituto do Cancer do Estado de Sao Paulo, ICESP, and from whom tumoral HPV DNA, HPV-16 E6*I mRNA, and p16INK4a status was also accessed. METHODS: HPV was genotyped by PCR-hybridization. All HPV DNA positive and ∼10 % HPV DNA negative cases underwent p16INK4a immunohistochemistry and E6*I RNA testing using a multiplex bead based protocol. HPV-16 ctDNA and anti-E6 antibodies were assessed by ddPCR (digital droplet PCR) and multiplex serology, respectively. RESULTS: The prevalence of HPV-16 in oropharynx carcinoma (OPC) cases was low (8.7 %) when considering solely HPV-16 DNA detection, and even lower (5.2 %) when taken into consideration the concomitant detection of HPV-16 E6*I RNA and/or p16INK4 (HPV-16 attributable fraction - AF). None of the oral cavity cancer (OCC) cases were detected with HPV-16 DNA. HPV-16 ctDNA was more commonly detected than HPV-16 E6 antibodies (29.8 % versus 10.6 %). Both serum biomarkers attained 100 % sensitivity of detecting HPV-16 AF OPC, however the specificity of the HPV-16 anti-E6 biomarker was higher compared to ctDNA (93.2 % versus 75.0 %). Finally, when both HPV-16 ctDNA and anti-E6 biomarkers were considered together, the sensitivity and specificity for HPV-16 OPC detection was 100 % and about 70 %, respectively, independently of analyzing HPV-16 DNA positive or HPV-16 AF tumors. CONCLUSIONS: Our findings corroborate that serum biomarkers are highly sensitive and specific biomarkers for detection of HPV-associated OPC.

Latin American Consensus on the Treatment of Head and Neck Cancer.

Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.

Prognostic Value of Hematological Parameters in Oral Squamous Cell Carcinoma.

INTRODUCTION: Oral squamous cell carcinoma (OSCC) remains a significant public health concern. The variables utilized to determine appropriate treatment for this disease also represent its most unfavorable prognostic factors, with these parameters solely determined by the neoplasm and its behavior. However, a lack of well-established indices is evident in the literature that specifically relate to the patient and indicate a worse prognosis. OBJECTIVE: To assess the prognostic impact of hematological indices in patients with OSCC. METHODS: This retrospective cohort study included patients with oral squamous cell carcinoma (OSCC) who underwent curative-intent treatment. Treatment encompassed surgery, followed by adjuvant therapy, as necessary. Laboratory tests were conducted immediately prior to surgery, and demographic information was obtained from medical records. RESULTS: The cohort comprised 600 patients, with 73.5% being male subjects. Adjuvant treatment was recommended for 60.3% of patients. Throughout the follow-up period, 48.8% of participants died. Univariate analysis indicated that perineural invasion, angiolymphatic invasion, pT4 tumors, lymph node metastases, extranodal extravasation, RDW > 14.3%, NLR (neutrophil-lymphocyte ratio) > 3.38, PLR (platelet-lymphocyte ratio) > 167.3, and SII (systemic inflammatory/immune response index) > 416.1 were factors associated with increased mortality. These threshold values were established through ROC curve analysis. In the multivariate analysis, angiolymphatic invasion (HR = 1.43; 95% CI: 1.076-1.925; p = 0.014), pT4a/b tumors (HR = 1.761; 95% CI: 1.327-2.337; p < 0.001), extranodal extravasation (HR = 1.420; 95% CI: 1.047-1.926; p = 0.024), and RDW (HR = 1.541; 95% CI: 1.153-2.056; p = 0.003) were identified as independent risk factors for decreased overall survival. CONCLUSIONS: RDW > 14.3% was proven to be a reliable parameter for assessing overall survival in patients with OSCC. Further studies are required to evaluate the clinical applicability of other hematological indices.

Sialendoscopy for treatment of major salivary glands diseases: a comprehensive analysis of published systematic reviews and meta-analyses.

OBJECTIVES: Sialendoscopy is a minimally invasive procedure used to diagnose and treat obstructive salivary gland diseases. Previous studies in the topic have shown mixed results. The present study aimed to evaluate the efficacy and safety of sialendoscopy through previous systematic reviews for different outcomes of several diseases. We also aimed to assess studies' methodological quality and heterogeneity. METHODS: We conducted a comprehensive systematic literature search of Pubmed, Embase, Lilacs and Cochrane Library. We included systematic reviews and meta-analyses that used sialendoscopy to treat both lithiasic and alithiasic salivary glands diseases. Data extraction included studies' characteristics and results. We assessed studies' methodological quality using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews 2) tool. RESULTS: 13 studies were included in the review, being 9 in adult populations and 4 in pediatric populations. Sialendoscopy proved to be effective at the treatment of different lithiasic and other obstructive diseases, but with important heterogeneity. The technique was also considered highly safe in most studies. However, studies had a critically low quality of evidence. CONCLUSIONS: Most studies demonstrated high efficacy and safety of sialendoscopy, but with critically low quality of evidence. We still lack randomized studies in this field, and future systematic reviews on the topic should follow current guidelines to improve conduction and reporting.

Ultrasound in cervical traumatic neuromas after neck dissection in thyroid carcinoma patients: descriptive analysis and diagnostic accuracy.

Objective: Cervical traumatic neuromas (CTNs) may appear after lateral neck dissection for metastatic thyroid carcinoma. If they are misdiagnosed as metastatic lymph nodes (LNs) in follow-up neck ultrasound (US), unnecessary and uncomfortable fine-needle aspiration biopsy are indicated. The present study aimed to describe US features of CTNs and to assess the US performance in distinguishing CTNs from abnormal LNs. Subjects and methods: Retrospective evaluation of neck US images of 206 consecutive patients who had lateral neck dissection as a part of thyroid cancer treatment to assess CTN´s US features. Diagnostic accuracy study to evaluate US performance in distinguishing CTNs from abnormal LNs was performed. Results: Eight-six lateral neck nodules were selected for analysis: 38 CTNs and 48 abnormal LNs. CTNs with diagnostic cytology were predominantly hypoechogenic (100% vs. 45%; P = 0.008) and had shorter diameters than inconclusive cytology CTNs: short axis (0.39 cm vs. 0.50 cm; P = 0.03) and long axis (1.64 cm vs. 2.35 cm; P = 0.021). The US features with the best accuracy to distinguish CTNs from abnormal LNs were continuity with a nervous structure, hypoechogenic internal lines, short/long axis ratio ≤ 0.42, absent Doppler vascularization, fusiform morphology, and short axis ≤ 0.48 cm. Conclusion: US is a very useful method for assessing CTNs, with good performance in distinguishing CTNs from abnormal LNs.

Exploring the use of the GLIM criteria to diagnose malnutrition in cancer inpatients.

OBJECTIVES: The Global Leadership Initiative on Malnutrition (GLIM) criteria establish a diagnosis of malnutrition based on the presence of at least one phenotypic and one etiologic criterion. This study aimed to assess the concurrent and predictive validity of the GLIM criteria in hospitalized cancer patients. METHODS: This is an observational retrospective study, including 885 cancer patients, ages >18 y, admitted to a medical oncology inpatient unit between 2019 and 2020. All patients at risk for malnutrition according to the Nutritional Risk Screening 2002 score were assessed by the subjective global assessment (SGA) and 14 different combinations of the GLIM criteria. The SGA was considered the gold standard for assessing the concurrent validity of the GLIM combinations. For a subsample of patients with data available on inflammatory markers (n = 198), the serum albumin and C-reactive protein were included in the combinations as etiologic criteria. The predictive validity of the different combinations was tested using the occurrence of surgical complications as the clinical outcome. The sensitivity and specificity values were calculated to assess the concurrent validity, univariate and multivariate logistic regression models were used to test predictive validity. Adequate concurrent and predictive validity were determined as sensitivity and specificity values >80% and odds ratio values ≥2.0, respectively. RESULTS: The median age of the patients was 61.0 y (interquartile range = 51.0-70.0). Head and neck cancer was the prevailing diagnosis and 375 patients were at nutritional risk. According to the SGA, 173 (26.1%) patients were malnourished (SGA categories B or C) and the prevalence of malnutrition ranged from 3.9% to 30.0%, according to the GLIM combinations. None of the tested combinations reached adequate concurrent validity; however, the presence of malnutrition according to four combinations independently predicted surgical complications. CONCLUSIONS: The predictive validity of the GLIM was satisfactory in surgical cancer patients.

Malignant neoplasms of the oral cavity and oropharynx treated in Brazil: what do hospital cancer records reveal?

INTRODUCTION: Head and neck cancer has an impact on the global burden of diseases, representing an important cause of morbidity and mortality in Brazil, as well as worldwide. OBJECTIVE: To learn and describe the clinical, epidemiological and care configuration provided to patients with cancer of the oral cavity and oropharynx recorded in Brazil, diagnosed from 2007 to 2016. METHODS: This is a cross-sectional study, carried out using secondary hospital-based data, using the indirect documentation technique. RESULTS: There were 52,799 hospital records of oral cavity cancer and 34,516 cases of oropharyngeal cancer in the assessed period. There was a predominance of male patients, aged 50-59 years, mostly Caucasians, and with a low level of schooling. Throughout the period there was a significant reduction in the positive history of alcohol and tobacco consumption, except for alcoholic beverages in oral cavity cancer. Most patients were diagnosed at an advanced stage of the disease (III or IV). Most patients with oral cavity cancer had no evidence of the disease on follow-up, while most patients with oropharyngeal cancer died. The first most frequent treatment offered to patients with oral cavity cancer was surgery, while for patients with oropharyngeal cancer it chemoradiotherapy predominated. CONCLUSION: Despite the fact that, in general, there was a reduction in the records of patient alcohol and tobacco consumption, the increase in the number of medical consultations, the predominantly late diagnosis and the patients' low level of schooling indicate the need for health education, primary prevention and early diagnosis of cancer of the oral cavity and oropharynx.

How to Identify Cervical Traumatic Neuromas in the Post-operative Neck Dissection: Brief Review of the Cervical Plexus Ultrasound.

Cervical traumatic neuromas (CTNs) are a non-neoplastic hyperplasia of damaged nerves and may be misinterpreted as metastatic lymph nodes during cervical ultrasound of patients with thyroid cancer after lateral neck dissection, resulting in unnecessary and painful fin-needle aspiration biopsy. The anatomy of the cervical plexus is challenging, and the correct identification and recognition of its neural roots and branches on ultrasound are key to the correct CTN diagnosis. This review outlines the US technique used to characterize CTNs in 10 standardized steps and describes the sonographic features of the cervical plexus, to assist the radiologist in the recognition of CTNs and their differentiation from lymph node metastases.

Nutritional and immunological parameters as prognostic factors in patients with advanced oral cancer.

OBJECTIVE: The aim of the present study was to analyze the prognostic relationship of weight loss and preoperative hematological indexes in patients surgically treated for pT4a squamous cell carcinoma of the oral cavity. METHODS: A retrospective cohort study. RESULTS: Percent weight loss greater than 10% was identified in 49 patients (28.2%), and any weight loss in relation to the usual weight occurred in 140 patients (78.7%). Percent weight loss greater than 10% (HR = 1.679), Red cell distribution width (RDW) values greater than 14.3% (HR = 2.210) and extracapsular spread (HR = 1.677) were independent variables associated with risk of death. CONCLUSION: Patients with advanced squamous cell carcinoma of the oral cavity present significant weight loss and as significantly immunocompromised. Increased values of RDW and higher percentages of weight loss in relation to the individual's usual weight, together with extracapsular spread of metastatic lymph nodes, were risk factors for lower survival, regardless of other clinical and anatomopathological characteristics.

The impact of sentinel lymph node biopsy on the quality of life in patients with oral cavity squamous cell carcinoma.

INTRODUCTION: Sentinel lymph node biopsy is a proven method for staging the neck in patients with early oral cavity squamous cell carcinoma because it results in less comorbidity than the traditional method of selective neck dissection, with the same oncological results. However, the real effect of that method on the quality of life of such patients remains unknown. OBJECTIVE: The present study aimed to evaluate the quality of life of patients with oral cavity squamous cell carcinoma T1/T2N0 submitted to sentinel lymph node biopsy compared to those that received selective neck dissection. METHODS: Cross-sectional study including 24 patients, after a 36 month follow-up, 15 of them submitted to the sentinel lymph node biopsy and 9 to selective neck dissection. All patients answered the University of Washington quality of life questionnaire. RESULTS: The evaluation of the questionnaires showed a late worsening of the domains appearance (p=0.035) and chewing (p=0.041), as well as a decrease of about 10% of general quality of life (p=0.025) in patients undergoing selective neck dissection ​​in comparison to those undergoing sentinel lymph node biopsy. CONCLUSION: Patients with early-stage oral cavity squamous cell carcinoma undergoing sentinel lymph node biopsy presented better late results of general quality of life, mainly regarding appearance and chewing, when compared to patients submitted to selective neck dissection.

Effect of age on resting energy expenditure in patients with cancer.

OBJECTIVE: Because older patients with cancer are at high risk for developing malnutrition, it is critical to understand their energy needs and to feed them appropriately. The aim of this study was to determine whether there are differences in resting energy expenditure between younger and older adults with cancer and in various age groups of older patients. METHODS: This retrospective, observational, and descriptive study from a single center included adult (≥18 to <60 y) and older (≥60 y) outpatients with gastrointestinal tract and head and neck cancers. According to the World Health Organization classification for adults and Pan American Health Organization for older individuals, nutritional status was estimated using body mass index. Nutritional risk screening was used to assess the nutritional risk and Patient-Generated Subjective Global Assessment for those at risk. Resting energy expenditure (REE) was measured by indirect calorimetry coupled to a gas exchange canopy. Bodystat and Quadscan 4000 multifrequency electrical bioimpedance devices were used to assess body composition at four frequencies (5, 50, 100, and 200 kHz). RESULTS: The study included 326 patients of whom 197 were older (60.4%), 244 were men (74.8%), 197 had gastric cancer (60.4%), and 129 had head and neck cancer (39.6%). Most patients had advanced cancer (stages III and IV) and had not undergone cancer treatment in the previous 3 mo. Compared with the younger adults, patients ≥60 y had a higher rate of malnutrition (88.4 versus 54.3%; P < 0.001), a higher percentage of fat-free mass deficit (88.3 versus 74.4%; P < 0.001), and higher percentage of fat mass (91.4 versus 58.9% adult; P < 0.001). The REE of older patients (1263.3 [234.1] kcal/d) was lower than that of patients ≥18 to <60 y (1382.5 [210.5] kcal/d; P < 0.001), for women (1055.2 kcal/d for the older adults versus 1214.3 kcal/d for younger adults), and men (1337.9 versus 1433 kcal/d; P = 0.001). The REE comparison categorized by decades has shown that for patients <60 y, an REE greater than those for individuals 60 to 69 y, 70 to 79 y, and ≥80 y (P < 0.001). REE in patients 60 to 69 y was greater than for those ≥80 y (P < 0.001). When compared with the Harris-Benedict formula, the REE intraclass correlation coefficient for all older patients was 0.514 (95% confidence interval [CI], 0.064-0.736); for ages 60 to 69 y it was 0.527 (95% CI, 0.126-0.733), and for ages >70 y, it was 0.466 (95% CI, -0.080 to -0.756). CONCLUSION: Measured REE in patients with cancer decreases with age. This finding is critical for appropriate caloric provision for older patients with cancer.

Survival in differentiated thyroid carcinoma: Comparison between the 7th and 8th editions of the AJCC/UICC TNM staging system and the ATA initial risk stratification system.

BACKGROUND: The AJCC/UICC TNM staging system evaluates the risk of death from cancer. Its 8th edition aimed to increase its accuracy. In turn, the American Thyroid Association proposed an initial risk stratification system (IRSS) focusing on the risk of recurrence in differentiated thyroid carcinoma. The present study intended to analyze their prediction abilities. METHODS: Six hundred and eighty-five consecutive surgical patients (mean follow-up 71.6 months) were staged. Correlations with disease-free survival (DFS) and overall survival (OS) were carried out. RESULTS: IRSS was discriminative for DFS but not for OS. Applying TNM 8th, 36.9% of the cohort was downstaged. Their DFS was shorter, compared with other patients in the same stage, but with no impact on OS. However, all those who died of the disease had been downstaged. CONCLUSIONS: IRSS was more effective to predict DFS, but not OS. TNM 8th was more appropriate for OS analysis than TNM 7th and IRSS.