[A Study on the Significance of NST Early Intervention for Cancer Patients].

BACKGROUND: Cancer patients are often complicated by weight loss and malnutrition, thus it is important to provide nutritional therapy in parallel with disease treatment. This study examined the significance of early intervention by NST for cancer patients. METHODS: Seventy-five cancer patients out of 281 patients who underwent NST intervention between July 2021 and June 2022 were included. Intervention outcomes, such as energy and protein sufficiency(=intake/target), and final evaluation by a NST nutritionist at the end of the intervention("improvement"/"unchanged"/"disease progression"/ "death"), were compared between patients who received NST intervention within 7 days from admission(Group A)and after 7 days from admission(Group B). RESULTS: Nutritional sufficiency at the end of NST intervention was higher in Group A for both energy and protein, and the proportion of"improvement"was higher in Group A for the final evaluation by a NST nutritionist. Patients' situation(pre-initial treatment/post-chemotherapy/post-surgery/worsening nutritional status during follow-up)was biased between 2 groups, however Group A showed better results for nutritional sufficiency rate and final evaluation in each subgroup of patients' situation. CONCLUSION: Early intervention may improve the effectiveness of NST for cancer patients. It is important to extract subjects and start NST intervention at early timing.

Tertiary lymphoid structures in tongue cancer: Association with clinicopathological parameters, preoperative S-1 chemotherapy response, and prognosis.

BACKGROUND: Tertiary lymphoid structures (TLSs) are observed in cancer-invasive sites of various organs, and show evidence of tumor-specific B and/or T cells, suggesting an active humoral antitumor response. The aim of this study was to evaluate the relationship between TLSs and prognosis in patients with tongue squamous cell carcinoma (TSCC) after preoperative S-1 chemotherapy. METHODS: Among 196 TSCC cases, 111 patients who received preoperative S-1 chemotherapy were compared to 85 patients who did not receive chemotherapy. We investigated the incidence of TLSs in both preoperative biopsy and resected specimens. RESULTS: TLSs were present in 24 (12%) biopsy specimens and 31 (16%) resected specimens. TLSs were associated with clinicopathologically advanced cases and positivity for lymphatic invasion. None of the cases with pStage 0 (i.e., noninvasive cancer) showed TLSs. In preoperative S-1 chemotherapy cases, TLSs were significantly more common in those treated with S-1 for more than 21 days and in those with treatment effects 0, Ia, and Ib. TLSs may not be a favorable prognostic factor by themselves but maybe a prognostic factor when combined with preoperative S-1 treatment. CONCLUSION: The presence of TLSs was suggested to be a factor indicating a favorable prognosis when considering the indication for preoperative S-1 chemotherapy. The synergistic effect of S-1 by activating antitumor immunity may be associated with a better prognosis in TSCC patients with TLSs.

Relationship between histopathological therapeutic effect and prognosis in oral cancer patients after preoperative S-1 chemotherapy followed by surgery.

OBJECTIVES: Preoperative S-1 chemotherapy is administered to prevent tumor proliferation before surgery in oral squamous cell carcinoma (OSCC). The aim of this study was to investigate the relationship between the histological therapeutic effect and prognosis in patients with OSCC after pre-operative S-1 chemotherapy. MATERIALS AND METHODS: Among 461 OSCC cases, 281 patients who received preoperative S-1 chemotherapy were compared with 180 patients that did not receive chemotherapy to determine the histological therapeutic effect in the resected specimens and the differences in relapse-free survival. RESULTS: The histological chemotherapeutic effect was well correlated with the subsequent prognosis. In an examination of the combined effect of treatment and ypStage, the groups with good S-1 treatment effects had extremely good prognoses, even if the postoperative resection specimens were within the same ypStage. In a stratified search of patients who received S-1 for more than 7 days and who had a significantly better prognosis than those who did not receive S-1, it was found that the prognosis was significantly better for patients with tongue cancer according to site; furthermore, tongue cancer, age under 70 years of age, male sex, and clinical stage I were factors associated with a significantly better prognosis. CONCLUSIONS: Even if the postoperative resection specimens were within the same ypStage, the groups that responded to S-1 treatment were considered to have extremely good prognoses. CLINICAL RELEVANCE: A good adaptation for S-1 was tongue cancer, and especially tongue cancer with cStage I, male sex, and age less than 70 years old.

Intraosseous intraneural perineurioma derived from the inferior alveolar nerve with an abnormality of chromosome 22 and expression of the BCR-ABL fusion gene: report of a case and review of recent literature.

BACKGROUND: Perineurioma (PN) is a peripheral nerve disease that primarily develops in the limbs and trunk and very rarely occurs in the oral cavity. PN is classified into two types: intraneural perineurioma (INPN) and soft tissue perineurioma (extraneural perineurioma, ENPN). In this article, we report a patient with mandibular body INPN derived from the perineurium of the inferior alveolar nerve. CASE PRESENTATION: The patient was a 43-year-old male. He consulted our department for a detailed examination of the right mandibular body. A biopsy was performed at another hospital and he was diagnosed with a schwannoma. At his first visit, hypesthesia extending from the right lower lip to the mental region was recognized and enlargement of the right mandibular canal was confirmed with X-ray CT and MRI. Considering the possibility of future tumor growth, we extirpated the tumor under general anesthesia. Cystic tumor was seen continuously in the inferior alveolar nerve. Immunohistologically, the tumor cells were positive for Glut-1, weakly positive for EMA, and weakly positive for Claudin-1, and the histopathological diagnosis was INPN. In addition, absence of the BCR region of chromosome 22 and expression of the BCR-ABL fusion gene were observed by fluorescent in situ hybridization (FISH), and a chromosome 22 abnormality was confirmed. These findings indicated that the disease was a neoplastic lesion. CONCLUSION: Expression of the BCR-ABL fusion gene in INPN that develops in the oral cavity is thought to be very rare, and to the best of our knowledge, ours is the first case to be reported in the literature. About three postoperative years have passed, but findings suggestive of recurrence have not been observed.

Tumour budding evaluated in biopsy specimens is a useful predictor of prognosis in patients with cN0 early stage oral squamous cell carcinoma.

AIMS: Oral squamous cell carcinoma (OSCC) prognosis depends upon lymph node metastasis (LNM). We have reported recently that tumour budding is a good predictive factor for LNM in squamous cell carcinoma (SCC) of the tongue and floor of the mouth (FOM). Our aim was to evaluate whether tumour budding is a good prognostic factor in OSCC. METHODS AND RESULTS: We examined conventional histopathological assessment and a new factor, tumour budding, in 209 cases of OSCC in incisional biopsy specimens. The relationship of tumour budding with LNM and prognosis was studied. The budding score was evaluated using immunostaining for pan-cytokeratin in all biopsies specimens; the number of budding foci was counted using a ×20 objective lens. Significant factors using univariate analysis (P < 0.05) in association with LNM were the budding score (intermediate or high score ≥3; high score ≥5), tumour grade (2 and 3), tumour depth (≥5 mm), infiltrative pattern (INF), lymphatic invasion and vessel invasion. In multivariate analysis, the budding score, INF and lymphatic invasion were found to be independent risk factors for LNM; in particular, budding score concerning relapse-free survival was statistically significant among patients with T1/2 stage and cN0 cancer using the Kaplan-Meier method and the log-rank test. CONCLUSIONS: The assessment of tumour budding is effective in predicting prognosis in cN0 early stage OSCC. In T1/2 stage and cN0 cancer, prophylactic neck dissection to prevent LNM should be considered when the tumour budding score regarding pre-operative biopsy specimens is intermediate or high.

Histologic assessment of tumor budding in preoperative biopsies to predict nodal metastasis in squamous cell carcinoma of the tongue and floor of the mouth.

BACKGROUND: In squamous cell carcinoma (SCC) of the tongue and the floor of the mouth (FOM), it is important to predict lymph node metastasis, including occult metastasis, before operating. The purpose of this study was for us to determine practical histopathologic parameters as predictive factors for lymph node metastasis in preoperative SCC biopsy specimens. METHODS: We examined 91 cases of SCC for conventional histopathologic assessment and a new factor, tumor budding, and their relationship with lymph node metastasis. RESULTS: Significant factors via univariate analysis (p < .01) were budding (score ≥3) and tumor depth (≥3 mm) and these were associated with lymph node metastasis. Moreover, both budding and tumor depth significantly correlated with relapse-free survival; however, evaluating biopsy specimens often proved inaccurate for predicting true tumor depth of cancer invasion. CONCLUSION: Tumor budding using immunohistochemistry for cytokeratin should be added to routine histologic assessments as a new criterion factoring into the decision as to whether neck dissection is indicated. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1582-E1590, 2016.