Evaluation of the prognostic utility of the hemoglobin-to-red cell distribution width ratio in head and neck cancer.

PURPOSE: Hemoglobin is a known prognostic marker in many cancers, including head and neck cancer (HNC). There is some evidence that the red cell distribution width, which is an index of variation in size of red blood cells (RBCs), might be associated with prognosis as well. Recently, a novel prognostic biomarker has been reported-the ratio of the hemoglobin-to-red cell distribution width (Hb/RDW). Our objective was to evaluate the prognostic utility of the pretreatment Hb/RDW in HNC, controlled with known prognostic indices. METHODS: Retrospective cohort study in a tertiary academic hospital setting. Patients diagnosed with HNC treated with curative-intent surgery were eligible. Metastatic disease was excluded. The variables collected were age, sex, BMI, alcohol/tobacco exposure, performance scores, ACE-27, tumor characteristics, adjuvant treatment, and lab values. The primary endpoints were event-free survival (EFS) and overall survival (OS). OS was defined as time from start of treatment to death from any cause, and EFS was defined as time from start of treatment to any progression, recurrence, or death from any cause. Univariate and multivariate survival analysis was performed on the primary endpoints. RESULTS: A total of 205 patients were enrolled from 2010 to 2016. In multivariate analysis, the factors independently associated with EFS were BMI (p = 0.0364), advanced T stage (p = 0.001), and low Hb/RDW ratio (p = 0.017). The factors independently associated with OS were ECOG score (p = 0.042), advanced T stage (p < 0.0001), positive nodes (p = 0.0195), and Hemoglobin (0.0134). CONCLUSION: A low Hb/RDW ratio was associated with poorer EFS (HR = 2.02, 95% CI 1.13-3.61, p = 0.017), but was not associated with OS. This is the first study reporting the prognostic utility of Hb:RDW in head and neck cancer.

The lymphocyte-to-monocyte ratio as a prognostic indicator in head and neck cancer: a systematic review and meta-analysis.

PURPOSE: The aim of this systematic review and meta-analysis was to investigate the relationship between the pre-treatment lymphocyte-to-monocyte ratio (LMR) and prognosis in HNC. METHODS: PubMed (via the Web), Embase, Scopus, and the Cochrane Library were searched. A systematic review and meta-analysis was done to generate the pooled hazard ratios (HR) for overall survival (OS) and disease-free survival (DFS). RESULTS: Our analysis included the results of 4260 patients in seven cohorts. The pooled data demonstrated that an elevated LMR was associated with significantly improved OS (HR 0.5; 95% CI 0.44-0.57), and DFS (HR 0.70; 95% CI 0.62-0.80). Of note, there was no detectable heterogeneity in either OS (I2 = 0%) or DFS (I2 = 0%). CONCLUSIONS: An elevated LMR may be an indicator of favorable prognosis in HNC. However, our results should be interpreted with some degree of caution due to the retrospective nature of cohort studies. Further research with high-quality prospective studies is needed to confirm the effect of LMR in HNC prognosis.

Network Analysis of Women in Otolaryngology and Demographic Trends.

OBJECTIVE: This study analyzes gender disparities between men and women otolaryngology faculty in the top 20 otolaryngology departments ranked by research output and discusses the implications of these disparities. METHODS: This was a cross-sectional study of all articles published by faculty from January 2020 to December 2021 at the top 20 otolaryngology departments as ranked by Doximity's 2022 research output report. Integrated data from Web of Science, faculty directories, and NIH RePORT were used to collect data on faculty. Social network analysis was performed using ORA-LITE. Student's and Welch's t-tests and Pearson chi-squared tests were used to evaluate gender differences in academic metrics. RESULTS: The findings revealed significant gender disparities, with men holding higher academic positions (men = 3.16, women = 2.69, p < 0.0001), higher H-indices (22.4, 13.8, p < 0.0001), more NIH grants (0.15, 0.07, p = 0.0032), and greater total degree centrality (3.98E-4, 2.4E-4, p < 0.0001) and betweenness centrality (4.47E-3, 3.00E-3, p = 0.0021). Men also had more publications (9.8, 6.8, p < 0.0001) with more distinct co-authors, both within (4, 3.1, p = 0.0074) and across (38.1, 25.8, p < 0.0001) institutions. Disparities persisted after accounting for career length. Notably, total degree centrality differences between men and women were statistically significant from 1991 to 2017 (p < 0.0001), but not from 2018 to 2022 (p = 0.83). CONCLUSIONS: This study highlights gender inequities in otolaryngology, encouraging mentors to foster new collaborations with female peers. Importantly, it identifies a trend toward narrowing the gender gap within the specialty, particularly over the past 5 years, emphasizing the need to sustain these positive changes for enhanced gender equity. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Dysplastic Lesions of the Larynx.

There have been many advancements in the clinical and histologic diagnosis of laryngeal dysplasia (LD), but diagnosis still necessitates invasive histologic evaluation. Furthermore, despite improved histologic identification of dysplastic lesions, the exact details of pathophysiologic progression and the risk of malignant transformation is still uncertain. These unknowns create a barrier to establishing an ideal grading and classification system, which prevents the establishment of a precise and consistent treatment paradigm. Identifying these gaps in knowledge serves to highlight where further studies are warranted, ideally focusing on a better understanding of the biological behavior of LD. This would ultimately allow for the creation of a reliable grading and classification system and for the formalization of management and treatment guidelines for LD.

Anaphylactoid hypersensitivity reaction from intra-arterial cetuximab: Clinical considerations and management.

Intra-arterial infusion of drugs shows promising results in terms of safety and efficacy. Intra-arterial cetuximab, a monoclonal antibody treatment, is currently being tested for its use in head and neck cancers. We present the case of a 45-year-old Asian male who developed an anaphylactoid hypersensitivity reaction, manifesting itself in the form of bronchospasm, tachycardia, and hypotension, during intra-arterial infusion of cetuximab. The symptoms were quickly diagnosed, and the patient was treated accordingly. Despite the safety profile of cetuximab and the decreased risk of systemic effects with intra-arterial infusion versus intravenous infusion, severe hypersensitivity reactions are still a risk in intra-arterial cetuximab infusions. Consequently, proper planning and care must be taken to prophylactically prevent and in the case of a reaction, treat the reaction accordingly. The case presented herein is, to the best of our knowledge, the first recorded moderate-to-severe infusion reaction in a patient receiving intra-arterial cetuximab treatment for head and neck cancer.

Platelet-Lymphocyte Ratio as a Predictor of Prognosis in Head and Neck Cancer: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to investigate the prognostic utility of the platelet-to-lymphocyte ratio (PLR) in head and neck cancer. Medline (via PubMed), EMBASE, Scopus, and the Cochrane Library databases were searched from their inception to May 2017 for relevant literature. A systematic review and meta-analysis were performed to generate the pooled hazard ratios (HR) for overall survival (OS) and disease-specific survival (DSS). The study was conducted in accordance with the Cochrane Handbook and PRISMA guidelines. Risk of bias was assessed using the QUIPS tool. The logarithm of the HR with standard error was used as the primary summary statistic. Heterogeneity was assessed using Cochran's Q and Higgins' I2. A total of 13 studies were included in the final analysis, combining data from 4,541 patients. The results demonstrated that an elevated PLR was significantly associated with poorer OS [HR 1.85, 95% CI 1.35-2.52, p < 0.00001] and DSS [HR 1.57, 95% CI 1.25-1.97, p < 0.0001]. Significant heterogeneity was detected for the pooled end points. Subgroup analysis demonstrated reduction of heterogeneity by controlling for sample size and cutoff value. 95% prediction intervals showed wide ranges crossing the null threshold.

Evaluation of the prognostic utility of the combination of platelet count with mean platelet volume as a prognostic indicator in head and neck cancer.

The combination of platelet count to mean platelet volume (COP-MPV) has been recently reported as a prognostic indicator of oral cavity cancer and other cancer sites. The aim of the present study was to validate the utility of the COP-MPV as a prognostic indicator in all head and neck cancer (HNC) sites. The clinicopathological characteristics of the COP-MPV with HNC were also investigated. This is a retrospective cohort study that recruited consecutively treated patients at a tertiary level academic hospital. Clinicopathological characteristics were recorded, including the COP-MPV scores. Survival was analyzed using Kaplan-Meier analysis, as well as multivariate Cox Proportional Hazards regression. COP-MPV was not associated with the survival outcome in univariate or multivariate analysis. In the multivariate model, tumor differentiation, tumor stage, nodal stage, surgical margins and hemoglobin were revealed to be significantly associated with survival. The results demonstrated that the COP-MPV is not a suitable prognostic factor for HNC.

Evaluation of Time to Surgery and Its Effect on Prognosis in Head and Neck Cancer.

BACKGROUND: Recently, time to treatment initiation has been observed to be increasing specifically for head and neck cancer. It is acknowledged that the pattern of increase is reflective of the use of sophisticated diagnostic and therapeutic techniques but was also determined to affect survival. OBJECTIVES: Our study sought to further investigate time to surgery (TTS) for surgically treated patients to see whether TTS would influence patient survival. METHOD: TTS was defined as the time from the earliest pathological report or scan, whichever was earlier, to surgery. The endpoints were overall survival (OS) and event-free survival (EFS). RESULTS: A total of 294 patients with head and neck cancer were included. Patients were organized into TTS quartiles of 0-14 days (quartile 1), 15-29 days (quartile 2), 30-49 days (quartile 3), and ≥50 days (quartile 4). The median follow-up time was 651 days, and the median TTS was 32 days. Using a univariable analysis of Cox regression, TTS was not significantly associated with OS or EFS. Kaplan-Meier curves were not significant for OS (p = 0.8904) and EFS (p = 0.9556). CONCLUSION: In this cohort study, we could not conclude that TTS was associated with OS or EFS.

Venous Thromboembolism Risk in Head and Neck Cancer: Significance of the Preoperative Platelet-to-Lymphocyte Ratio.

Objective We aimed to investigate the association between the preoperative platelet-to-lymphocyte ratio (PLR) and venous thromboembolism (VTE) in patients with head and neck cancer (HNC) undergoing major surgery. Study Design Retrospective cohort study. Setting Academic tertiary hospital from 2011 to 2017. Subjects and Methods Patients with confirmed HNC undergoing major surgery were included in this study. The preoperative PLR was recorded for all patients. Known VTE risk factors, including Caprini score, age, sex, smoking, body mass index, prior VTE, and anticoagulation, were also recorded. Risk factors were screened in univariate analysis using Wilcoxon's rank sum test and χ2 test (Bonferroni corrected). Significant covariates were included in a multivariate regression model. Bootstrap techniques were used to obtain credible confidence intervals (CIs). Results There were 306 patients enrolled with 7 cases of VTE (6 deep vein thromboses and 1 pulmonary embolism. On univariate analysis, length of stay ( P = .0026), length of surgery ( P = .0029), and PLR ( P = .0002) were found to have significant associations with VTE. A receiver operator characteristic (ROC) curve was constructed that yielded an area under the ROC of 0.905 (95% CI, 0.82-0.98). Using an optimized cutoff, the multivariate model showed that length of surgery (ß 95% CI, 0.0001-0.0006; P = .0056) and PLR (ß 95% CI, 5.3256-5.3868; P < .0001) were significant independent predictors of VTE. Conclusion This exploratory pilot study has shown that PLR offers a potentially accurate risk stratification measure as an adjunct to current tools in VTE risk prediction, without additional cost to health systems.