Changes in Body Mass Index Are Associated with Squamous Cell Carcinomas of Oral Cavity, Oropharynx and Larynx: A Case-Control Study in Brazil.

Head and neck cancer (HNC) significantly impacts nutritional status because the tumor limits swallowing function. In this sense, it is important to monitor the nutritional status throughout the life of any individual. A multicenter case-control study was carried out to analyze the BMI at 30 years of age, two years before diagnosis and at the time of diagnosis of individuals with oral cavity, oropharynx, and larynx cancers. It was observed that a 5% reduction in BMI during the two years before enrollment was associated with an increased risk of the oral cavity (OR = 3.73), oropharyngeal OR = 5.25), and laryngeal (OR = 5.22). Reduced BMI of more than 5% over two years before diagnosis was associated with HNC. Weight loss remained significant at diagnosis, but it is not possible to exclude reverse causality since most cases are at an advanced stage. BMI monitoring of individuals at potential risk for HNC can promote early diagnosis and nutritional interventions for HNC.

Consumption of minimally processed foods as protective factors in the genesis of squamous cell carcinoma of the head and neck in Brazil.

BACKGROUND: Head and neck cancer (HNC) is the sixth most common cancer, and two-fifths of cases could be avoided by changing lifestyle and eating habits. METHODS: This multicenter case-control study was conducted under the International Consortium on Head and Neck Cancer and Genetic Epidemiology, coordinated by the International Agency for Research on Cancer. This consortium evaluated associations between minimally processed food consumption and the risk of HNC in three Brazilian states. RESULTS: We evaluated 1740 subjects (847 cases and 893 controls). In multiple analyses including recognized risk factors for HNC, the consumption of apples and pears was associated with reduced risks of oral cavity and laryngeal cancers; the consumption of citrus fruits and fresh tomatoes was associated with a reduced risk of oral cavity cancer; the consumption of bananas was associated with a reduced risk of oropharynx cancer; the consumption of broccoli, cabbage, and collard greens was associated with reduced risks of laryngeal and hypopharyngeal cancers; and the consumption of carrots and fresh fruits was associated with a reduced risk of hypopharyngeal cancer. CONCLUSIONS: The consumption of a heathy diet rich in fruits and vegetables was associated with a reduced risk of HNC. Public policies, including government subsidies, are essential to facilitate logistical and financial access to minimally processed foods, thereby strengthening environments that promote healthy behavior.

Factors that influence treatment decision in older patients with resectable head and neck cancer.

OBJECTIVES: To find clinical factors related to administration of substandard treatment in older patients with head and neck cancer. STUDY DESIGN: Historic cohort. METHODS: Patients of 70 years of age of older with diagnosis of resectable head and neck cancer were included. Treatment offered to patients was classified as standard or substandard by experienced surgeons. Relation of age, clinical stage, comorbidities, performance status, and treatment with substandard treatment was explored. The effect of substandard treatment on survival was assessed. RESULTS: Three hundred twelve patients were included. Substandard treatment was offered to 19.9% of patients. Associated factors related to selection of substandard treatment were higher age, oro/hypopharynx tumor site, severe comorbidity, advanced clinical stage, and low Karnofsky Index. Patients submitted to substandard treatment had lower overall and cancer-specific survival (45.9% vs. 19.9% and 63.0% vs. 33.1%, respectively). CONCLUSION: Selection of substandard treatment decreases overall and cancer-specific survival. Selecting substandard treatment for reasons such as chronologic age, tumor site, or moderate or mild comorbidities worsen patient prognosis.

Validation of the Washington University Head and Neck Comorbidity Index in a cohort of older patients.

OBJECTIVES: To validate the prognostic ability of the Washington University Head and Neck Comorbidity Index (WUHNCI) relative to 5-year survival in a cohort of older patients with head and neck cancer and to compare it with that of the Adult Comorbidity Evaluation 27 (ACE-27). DESIGN: Validation study. SETTING: Academic research. PATIENTS: Three hundred twenty-one patients older than 70 years with head and neck cancer in a tertiary cancer center. Comorbidity was measured using the ACE-27, WUHNCI, and National Cancer Institute (NCI) comorbidity index. MAIN OUTCOME MEASURE: Five-year overall survival. RESULTS: Five-year overall and cancer-specific survival, respectively, were as follows: Using the WUHNCI, 52.2% and 62.9% for a score of 0; 25.1% and 41.7% for a score of 1; 39.3% and 64.9% for a score of 2; and 19.5% and 45.0% for a score of 3 or higher. Using the ACE-27, 54.4% and 61.7% for a score of 0 (no comorbidity); 46.8% and 61.7% for a score of 1 (mild comorbidity); 31.7% and 51.6% for a score of 2 (moderate comorbidity); and 13.8% and 43.7% for a score of 3 (severe comorbidity). The C statistics were 0.641 for the NCI comorbidity index, 0.656 for the ACE-27, and 0.686 for the WUHNCI. CONCLUSIONS: The WUHNCI did not demonstrate good discriminative power compared with the ACE-27 in a cohort of older patients. To be widely used, instruments developed to measure comorbidities must be reliable in any population. We believe that the ACE-27 is still the best index to assess comorbidities and that it should be used in studies evaluating the prognostic effect of comorbidities.

Comorbidity is a prognostic factor in elderly patients with head and neck cancer.

BACKGROUND: The number of aged patients with head and neck cancer is increasing. Comorbidities are common in this population. It is necessary to evaluate the effect of comorbidities as measured with the ACE-27 index on recurrence and survival of elderly patients with head and neck cancer, adjusting by other prognostic factors as age, clinical stage and functional status index. PATIENTS: Three hundred and ten patients greater than 70 years of age with head and neck cancer in a referral cancer center were studied. Comorbidity measured with the ACE-27 index was the main independent variable. The outcomes were recurrence and survival. RESULTS: Comorbidities were present in 75% of patients. Five-year disease-free survival, overall survival and cancer-specific survival were 63.1, 42.8 and 55.8%, respectively. Advanced clinical stage and Karnofsky index < or =70 were associated with recurrence. Age >80 years, male gender, Karnofsky index < or =80, advanced clinical stage, and ACE value > or =2 were independently associated with overall survival. The ACE-27 value was not associated with cancer-specific survival. The Karnofsky performance index was associated with overall survival and mortality and acted as a confounding factor on multivariable analysis on overall and cancer-specific survival. CONCLUSIONS: Comorbidity measured with ACE-27 was a prognostic factor for overall survival in patients older than 70 years with head and neck cancer. The Karnofsky performance index could be included in multivariable analysis of survival for older patients with head and neck cancer.

Paraganglioma extra-adrenal / Extra-adrenal paraganglioma

Os paragangliomas extra-adrenais constituem um grupo raro de doenças, porém assumem dimensäo maior quando analisados em suas múltiplas facetas de apresentaçäo clínica. A trajetória histórica destes tumores, revela num passado näo täo longínquo, as dificuldades para o reconhecimento e correto diagnóstico dos mesmos. E, principalmente, o temor da abordagem cirúrgica, decorrente do alto grau de complicaçöes operatórias imediatas e tardias. A experiência na conduta e terapêutica de vinte casos destes tumores em um periodo de 35 anos é revista e analisada, objetivando comparar os dados do Departamento de Cirurgia de Cabeça e Pesco13o do Hospital A. C. Camargo da Fundaçäo Antonio Prudente com os obtidos e relatados pela literatura mundial.

Sensitivity and specificity of fine-needle aspiration of salivary glands

Foram estudados 101 casos de punçäo aspirativa de glândulas salivares efetuadas no hospital A. C. Camargo, de 1983 a 1989, em pacientes: 52 mulheres e 47 homens. A idade variou de dois a 86 anos. Foi obtida correlaçäo cito-histológica em 85 casos. O diagnóstico citológico revelou nove (9,1//) casos inconcludentes, 41 (41,4//) negativos para malignidade, 25 (25,3//) adenomas, um (1//) suspeito e 23 (23,2//) positivos. Três dos 41 casos diagnosticados citologicamente como negativos mostraram malignidades em cortes histológicos. Nenhum caso falso-positivo foi relatado. A sensibilidade da citologia foi 88//, a especificidade 100//, a eficiência 96//e os valores preditivos negativos foram 94 e 100//, respectivamente

Citologia de punçäo aspirativa por agulha fina no diagnóstico de tumores de cabeça e pescoço / Fine needle aspiration cytology in the diagnosis of head and neck tumors

Cento e sessenta e seis punçöes aspirativas de cabeça e pescoço foram realizadas em 1988, no Hospital A.C. Camargo. A correlaçäo com a histologia foi possível em 81 casos. Apenas três casos foram considerados falsos negativos e um falso positivo. A sensibilidade do método foi de 90,6%, a especificidade de 97,9% e a eficiência de 95,0%

Interferência de fatores anátomo-patológicos na definição do prognóstico de pacientes portadores de rabdomiossarcoma de cabeça e pescoço / Influence of histologic factors on survival of rhabdomyosarcoma of the head and neck

Rhabdomyosarcomas are rare in the head and neck, but it is the most common soft tissue sarcoma in children. The authors analysed 74 patients of all ages attended at A. C. Camargo Hospital from 1976 to 1996. They were submitted to many combinations of treatment including surgery, radiotherapy and chemotherapy. After univariated analysis, patient's age and size of tumor were identifíed as prognostic fators to disease-free survival (DFS); age, size of tumor and histologic type were identified as prognostic factors to the global survival (GS). After multiv@ated analysis, patients age, site of origin and size of tumor were identified as important to establish the DFS and the GS. The DFS was 43,2 por cento for 3 years, 40,4 por cento for 5 years and 40 por cento for l O years; the overall survival was 52,7 por cento for 3 years, 42,7 por cento for S years and 40 por cento for 10 years