Oncological Outcomes after Pulmonary Metastasectomy for Head and Neck Squamous-Cell Carcinoma and Adenoid Cystic Carcinoma.

INTRODUCTION: Pulmonary metastatic head and neck cancer has a poor prognosis. Pulmonary metastasectomy has been performed but only in carefully selected patients. The aim of this study was to examine the clinical characteristics and oncological follow-up of patients who underwent pulmonary metastasectomy. METHODS: Data of 54 patients with squamous-cell carcinoma (SCC) or adenoid cystic carcinoma (ACC) who underwent metastasectomy between 2003 and 2019 at two tertiary referral centers were retrospectively reviewed. RESULTS: The 3-year and 5-year disease-free survival rates after metastasectomy were 49.9% and 39.9% for SCC and 38.9% and 32.4% for ACC, respectively. Univariate analysis revealed that a disease-free interval (DFI) less than 14 months and R1 resection (hazard ratio [HR] [95% confidence interval]: 2.95 [0.77-5.62], 4.64 [0.99-21.65], respectively) were risk factors for recurrence in SCC and that a high T stage (HR: 5.24 [1.22-22.58]) was a risk factor in ACC. In SCC, a DFI less than 14 months and R1 resection (hazard ratio: 6.35 [1.36-29.54], 12.79 [1.53-106.95], respectively) were risk factors in a multivariate analysis. CONCLUSION: Pulmonary metastasectomy had a fair effect on head and neck SCC and ACC, and the prognosis was better in SCC patients with a DFI greater than 14 months.

Primary versus modified secondary closure techniques for persistent tracheocutaneous fistula in pediatric patients.

PURPOSE: This study aimed at compating two closure techniques for tracheocutaneous fistulas (TCFs) in pediatric patients. METHODS: A total of 106 consecutive pediatric patients who underwent closure of a persistent TCF between April 2007 and February 2021 at a tertiary pediatric hospital were evaluated, and 103 pediatric patients aged between 12 months and 18 years were included. The clinical characteristics, perioperative outcomes, and postoperative outcomes were compared between TCF closure by primary closure (Group 1) and a modified secondary healing technique (Group 2). RESULTS: Of the 103 patients, 58 were classified into Group 1, and 45 into Group 2. The mean age at tracheostomy and TCF closure was significantly younger in Group 2, and the interval between decannulation to TCF closure was significantly shorter in Group 2. Procedural time and hospital stay were significantly shorter in Group 2 than Group 1. Group 2 had a significantly lower complication rate, need for revision surgery, and recannulation rate than Group 1. CONCLUSIONS: Modified secondary healing was more efficient in terms of procedural time and hospital stay, and safer (i.e., fewer complications). It is an effective surgical technique for closing a persistent TCF in younger patients more quickly after decannulation compared to primary closure.

Postoperative biochemical remission of serum calcitonin is the best predictive factor for recurrence-free survival of medullary thyroid cancer: a large-scale retrospective analysis over 30 years.

CONTEXT: The increase in thyroid screening in the general population may lead to earlier detection of medullary thyroid carcinoma (MTC). OBJECTIVE: We aimed to evaluate secular trends in clinicopathological characteristics and long-term prognosis of MTC and its prognostic factors. DESIGN: This was a retrospective analysis from 1982 to 2012. PATIENTS: Three hundred and thirty-one patients with MTC were included and grouped based on the year of diagnosis (1982-2000, 2001-2005, 2006-2010 and 2011-2012). MEASUREMENTS: These included recurrence and mortality as well as biochemical remission (BCR) of serum calcitonin. RESULTS: Mean tumour size (from 2·5 cm to 1·7 cm, P < 0·001) and percentage of extrathyroidal extension (from 52·0% to 26·0%, P = 0·026) decreased. The percentage of patients achieving BCR within six postoperative months (po-BCR) increased with time (from 39·6% to 76·1%, P < 0·001). The 5-year overall recurrence rate significantly decreased in 2006-2012 compared to 1982-2005 (10% vs 18%, respectively, P = 0·031), although the 5-year survival rate did not improve (92% vs 92%, P = 0·929). Failure to achieve po-BCR was the strongest predictive factor associated with recurrence (hazard ratio [HR] = 58·04, 95% CI 7·14-472·11; P < 0·001). Male gender (HR = 3·18, 95% CI 1·18-8·56; P = 0·022), tumour size >2 cm (HR = 18·33, 95% CI 2·35-143·06; P = 0·006) and distant metastasis (HR = 4·00, 95% CI 1·31-12·21; P = 0·015) were significant prognostic factors for mortality. CONCLUSIONS: Clinicopathological characteristics and recurrence of MTC improved with time. Po-BCR was the best predictive factor for recurrence-free survival.

5-lipoxygenase mediates docosahexaenoyl ethanolamide and N-arachidonoyl-L-alanine-induced reactive oxygen species production and inhibition of proliferation of head and neck squamous cell carcinoma cells.

BACKGROUND: Endocannabinoids have recently drawn attention as promising anti-cancer agents. We previously observed that anandamide (AEA), one of the representative endocannabinoids, effectively inhibited the proliferation of head and neck squamous cell carcinoma (HNSCC) cell lines in a receptor-independent manner. In this study, using HNSCC cell lines, we examined the anti-cancer effects and the mechanisms of action of docosahexaenoyl ethanolamide (DHEA) and N-arachidonoyl-L-alanine (NALA), which are polyunsaturated fatty acid (PUFA)-based ethanolamides like AEA. METHODS AND RESULTS: DHEA and NALA were found to effectively inhibit HNSCC cell proliferation. These anti-proliferative effects seemed to be mediated in a cannabinoid receptor-independent manner, since the antagonist of cannabinoid receptor-1 (CB1) and vanilloid receptor-1 (VR1), two endocannabinoid receptors, did not reverse the ability of DHEA and NALA to induce cell death. Instead, we observed an increase in reactive oxygen species (ROS) production and a decrease of phosphorylated Akt as a result of DHEA and NALA treatment. Antioxidants efficiently reversed the inhibition of cell proliferation and the decrease of phosphorylated Akt induced by DHEA and NALA; inhibition of 5-lipoxygenase (5-LO), which is expected to be involved in DHEA- and NALA-degradation pathway, also partially blocked the ability of DHEA and NALA to inhibit cell proliferation and phosphorylated Akt. Interestingly, ROS production as a result of DHEA and NALA treatment was decreased by inhibition of 5-LO. CONCLUSIONS: From these findings, we suggest that ROS production induced by the 5-LO pathway mediates the anti-cancer effects of DHEA and NALA on HNSCC cells. Finally, our findings suggest the possibility of a new cancer-specific therapeutic strategy, which utilizes 5-LO activity rather than inhibiting it.

Predictive and prognostic value of PET/CT imaging post-chemoradiotherapy and clinical decision-making consequences in locally advanced head & neck squamous cell carcinoma: a retrospective study.

BACKGROUND: The accuracy of (18)F-fluorodeoxygluocose positron emission tomography/computed tomography (PET/CT) in predicting immediate failure after radical chemoradiotherapy (CRT) for HNSCC is poorly characterized at present. The purpose of this study was to examine PET/CT as a predictive and prognostic gauge of immediate failure after CRT and determine the impact of these studies on clinical decision making in terms of salvage surgery. METHODS: Medical records of 78 consecutive patients receiving radical CRT for locally advanced HNSCC were reviewed, analyzing PET/CTs done before and 3 months after CRT. Immediate failure was defined as residual disease or locoregional and/or systemic relapse within 6 months after CRT. RESULTS: Maximum standard uptake value (SUV) of post CRT PET/CT (postSUVmax) was found optimal for predicting immediate failure at a cutpoint of 4.4. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 90.0%, 83.8%, 98.3%, and 45.0%, respectively. Of 78 patients studied, postSUVmax ≥ 4.4 prevailed in 20 (25.6%), with postSUVmax <4.4 in 58 (74.4%). At postSUVmax ≥ 4.4 (vs. postSUVmax <4.4) OS was poorer by comparison (3-year OS: 56.9 vs. 87.7%; P = 0.005), as was progression-free survival (3-year PFS: 42.9 vs. 81.1%; P < 0.001). At postSUVmax ≥ 4.4, OS with and without immediate salvage surgery did not differ significantly (3-year OS: 60.0 vs. 55.6%; Log-rank P = 0.913). CONCLUSION: Post CRT PET/CT imaging has prognostic value in terms of OS and PFS and is useful in predicting immediate therapeutic failure, given its high NPV. However, OS was not significantly altered by early salvage surgery done on the basis of post CRT PET/CT findings.

Is There Any Age Cutoff to Treat Elderly Patients with Head and Neck Cancer? Comparing with Septuagenarians and Octogenarians.

With the increase in life expectancy, age is no longer considered as a limitation for treatment. Nevertheless, the treatment of elderly patients with head and neck cancer (HNC) remains controversial. Here, we aimed to review our experience with the treatment for elderly patients, while particularly focusing on the differences among older old patients (septuagenarians vs. octogenarians). We retrospectively reviewed the records of 260 elderly patients who were assigned to 3 groups according to age: 70 years old ≤ group 1 < 75 years old, 75 years old ≤ group 2 < 80 years old, and group 3 ≥ 80 years old. The patients were assessed for comorbidities using the Adult Comorbidity Evaluation (ACE)-27, and the American Society of Anesthesia (ASA) physical status was also compared. Group 1, 2, and 3, consisted of 97, 102, and 61 patients, respectively. No significant difference in demographic data was noted among the groups. However, group 3 showed more comorbidities than groups 1 and 2. With regard to the initial treatment for HNC, radiation therapy (RT) was more frequently performed in group 3 than in groups 1 and 2. Among 7 patients of non-compliant to treatment in group 3, 6 patients had have performed RT. In group 3, a total of 18 patients underwent surgery, including microvascular free flap reconstruction and no significant difference in complications was observed postoperatively compared with group 1 and 2. Moreover, no significant difference was noted in overall survival between the groups, regardless of the treatment modality chosen. In conclusion, octogenarians with HNC should be more carefully managed than septuagenarians with HNC. Surgical treatment can be considered in octogenarians with HNC, if it can be tolerated.

Prognostic factors of locally invasive well-differentiated thyroid carcinoma involving the trachea.

To report our experience with tracheal invasive thyroid carcinoma with emphasis on clinical characteristics and treatment modalities, and to identify the prognostic factors for tracheal invasive thyroid carcinoma. Totally 1919 patients underwent surgical extirpation of thyroid cancer from 1990 to 2010. Among them, 65 patients had well-differentiated thyroid cancer with tracheal invasion. The incidence was higher in male and older patients. Patients were treated with tracheal shave excision (n = 18), tracheal resection (n = 37) and total laryngectomy (n = 10). Locoregional recurrence occurred in 39 patients, and metastasis occurred in 25 patients. Simultaneous involvement of the trachea and the esophagus was associated with locoregional recurrence (p = 0.039) in univariate analysis, but not confirmed by multivariate analysis. There was significant difference in the disease-specific survival (DSS) according to laryngeal involvement (p = 0.002). All the patient in the shave excision group survived until the end of the study period. Although it is categorized in same classification of T4a, simultaneous involvement of the trachea and the esophagus showed higher locoregional recurrence and laryngeal involvement showed lower DSS. Despite the invasion of thyroid cancer into the adjacent aerodigestive tract, many patients showed long survival when they underwent appropriate surgery.

Prevalence and prognostic value of human papillomavirus genotypes in tonsillar squamous cell carcinoma: a Korean multicenter study.

BACKGROUND: This study was aimed at investigating the change in the prevalence of human papillomavirus (HPV) genotypes in tonsillar squamous cell carcinoma (TSCC) and the association of the HPV genotype with the prognosis. METHODS: This multicenter study included 175 patients with TSCC from 3 general hospitals between 1991 and 2009. HPV DNA was detected in paraffin-embedded tissues with genotyping chips. A survival analysis that considered clinicopathological factors, the HPV genotype, and the expression of p53, retinoblastoma protein, p16, and epidermal growth factor receptor (assessed with immunohistochemistry) was performed with Cox regression analysis. RESULTS: High-risk HPV types were found in 23.4% of the cases. The prevalence of HPV-18 (10.3%) was as high as that of HPV-16 (10.3%). The proportion of high-risk HPV-positive tumors increased from 5.9% in 1991 to 31.6% in 2009. HPV-16 positivity was associated with an advanced stage and lymph node metastasis, whereas HPV-18 positivity was associated with old age and an advanced T stage. The survival analysis showed that old age and T classification were poor prognostic factors, whereas the expressions of various biomarkers were not associated with prognosis. HPV-18-positive cases had a poorer prognosis than HPV-16-positive cases and non-HPV-related TSCC cases. A multivariate analysis revealed that HPV-18 positivity, old age, and an advanced T stage were independent prognostic factors for predicting poor outcomes for patients with TSCC. CONCLUSIONS: The proportion of HPV-positive tonsillar cancer cases has increased during the last 20 years in the Republic of Korea. The presence of HPV-18 may serve as a biomarker for a poor prognosis.

A Randomized, Multicenter, Phase II Study of Cetuximab With Docetaxel and Cisplatin as Induction Chemotherapy in Unresectable, Locally Advanced Head and Neck Cancer.

BACKGROUND: We investigated the efficacy of cetuximab when added to induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) in patients with locally advanced head and neck squamous cell carcinoma. METHODS: Patients were randomized to receive three cycles of docetaxel and cisplatin (TP regimen) with or without cetuximab (TP plus cetuximab [CTP] vs. TP) as induction chemotherapy. Patients in the CTP arm received CCRT with cetuximab and cisplatin, whereas patients in the TP arm received cisplatin alone. The primary endpoint was the objective response rate (ORR) after induction chemotherapy. RESULTS: Overall, 92 patients were enrolled. The ORRs for induction chemotherapy in the CTP and TP arms were not different (81% vs. 82%). Adding cetuximab lowered the completion rate of induction chemotherapy and CCRT and resulted in more frequent dose reductions of the induction chemotherapy, although this did not reach statistical significance. In the CTP and TP arms, respectively, the 3-year progression-free survival (PFS) rates were 70% and 56% (p = .359), and the overall survival (OS) rates were 88% and 74% (p = .313). When limited to patients who completed induction chemotherapy, 3-year PFS rates of 78% and 59% (p = .085) and OS rates of 94% and 73% (p = .045) were observed in the CTP and TP arms, respectively. CONCLUSION: Adding cetuximab to sequential treatment did not increase the treatment efficacy and resulted in greater toxicity. In the intent-to-treat population, neither PFS nor OS was improved by the addition of cetuximab to sequential treatment; however, a suggestion of improved survival outcomes was observed in patients completing cetuximab-containing induction chemotherapy.

Efficacy and Safety of Radiofrequency Ablation for Treatment of Locally Recurrent Thyroid Cancers Smaller than 2 cm.

PURPOSE: To evaluate the efficacy and safety of radiofrequency ablation (RFA) for localized small recurrent thyroid cancers less than 2 cm by comparing them with those at repeat surgery. MATERIALS AND METHODS: This retrospective study was institutional review board-approved, and informed consent was waived. From December 2008 to December 2011, this study evaluated 73 patients (17 men and 56 women; age, 50.3 years ± 13.6) with recurrent thyroid cancer who had been treated with RFA (n = 27) or repeat surgery (n = 46) who met the following criteria: (a) three or fewer recurrences or lesions with high probability of recurrence at ultrasonography; (b) no tumor other than the target tumors; and (c) at least 1 year of follow-up. RFA was recommended and performed in cases of surgical ineligibility, such as patient refusal and poor medical condition. Recurrence-free survival rates and posttreatment complication rates (eg, hoarseness and hypocalcemia) were compared between RFA and reoperation groups after adjustment with weighted analysis by using inverse probability of treatment weights. RESULTS: After this adjustment, the 1- and 3-year recurrence-free survival rates were comparable (P = .681) for RFA (96.0% and 92.6%, respectively) and reoperation (92.2% and 92.2%, respectively) groups. The posttreatment hoarseness rate did not differ between the RFA (7.3% [1.8 of 24]) and reoperation (9.0% [3.6 of 39.5]) groups (P = .812), and posttreatment hypocalcemia occurred exclusively in the reoperation group (11.6% [4.6 of 39.5]) but not in the RFA group (0% [0 of 24]) (P = .083). CONCLUSION: RFA may be an effective and safe alternative to repeat surgery in patients with locally recurrent small thyroid cancers.

Expression of hypoxic signaling markers in head and neck squamous cell carcinoma and its clinical significance.

Hypoxia is a consistent finding in fast-growing tumors; it contributes to tumor progression and therapeutic responses. We explored the expression of hypoxia-associated biomarkers in head and neck squamous cell carcinoma (HNSCC) to assess their relationship with clinical factors in HNSCC. In total, 90 patients with HNSCC were enrolled. Expression of HIF-1α, HSP70, HSP90, VEGF, IGF-1R, and P16 was investigated by immunohistochemistry. Their correlations with clinical factors, including location of primary sites, T stage, N stage, M stage, HPV status, primary treatment success/failure, recurrences, disease-free survival (DFS), and overall survival, were analyzed. HIF-1α, HPS70, HPS90, VEGF, and IGF-1R were positive in 33 of 89 (37.1 %), 62 of 87 (71.3 %), 83 of 89 (93.3 %), 41 of 87 (47.1 %), and 50 of 56 (89.3 %) cases, respectively. Expression levels of some of these markers were correlated. High HIF-1α or HSP 70 correlated with poor DFS, and expression of HSP70 correlated with LN metastasis. HPV-related carcinomas showed high HSP 70 and IGF-1R expression. Hypoxia-associated proteins were highly expressed and associated with aggressive clinical features in HNSCC. Expression of HIF-1α or HSP70 can be considered poor prognostic indicator in HNSCC. Our results suggest that hypoxic signaling is activated in HNSCC, especially in HPV-related tumors.

Analysis of various risk factors predisposing subjects to allergic rhinitis.

BACKGROUND: In Korea, the prevalence of allergic rhinitis (AR) is increasing, as in other industrialized countries. However, no large population-based study defining risk factors for AR has yet been conducted. OBJECTIVE: The purpose of this study was to evaluate the prevalence and risk factors of AR in large population-based study. METHODS: A cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. We evaluated data from 31,217 subjects who were interviewed between 2008 and 2011. RESULTS: The prevalence of AR decreased with age (adjusted odds ratio [AOR] = 0.985; 95% CI = 0.984-0.987). Higher-level stress (AOR for severe stress = 1.470; 95% CI = 1.209-1.788); asthma (AOR = 1.868; 95% CI = 1.582-2.205); atopic dermatitis (AOR = 1.552; 95% CI = 1.309-1.841); pulmonary tuberculosis (AOR = 1.320; 95% CI = 1.119-1.555); depression (AOR = 1.250; 95% CI = 1.117-1.400); and thyroid disease (AOR = 1.328; 95% CI = 1.104-1.597) increased the risk of AR. Participants whose parents had a history of AR also had higher AORs (father, AOR = 1.566; 95% CI = 1.130-2.172; mother, AOR = 1.546; 95% CI = 1.190-2.008). Marriage (AOR = 0.846; 95% CI = 0.741-0.966) decreased the risk of AR. Farmers, fishers, laborers, and soldiers were at lower risk of AR. Although high BMI, a high educational level, living in a large household, specific types of daily living, and a history of diabetes mellitus have been reported as risk factors for AR; none of these factors attained statistical significance in the present study. CONCLUSION: Our study revealed that age, stress level, marriage, occupation, asthma, atopic dermatitis, pulmonary tuberculosis, depression, thyroid disease, and parental AR history, all affected the prevalence of AR. We believe that defining the influence of various factors on AR will help to prevent development of the condition in the future.

Neck computed tomography in pediatric neck mass as initial evaluation in ED: is it malpractice?

BACKGROUND: Although ultrasound is regarded as the first choice imaging modality for evaluating a pediatric neck mass, neck computed tomography (CT) is necessary for urgent surgical conditions such as deep neck infections. Our aim was to evaluate the diagnostic effectiveness of and proper patient selection for neck CT as a method for the initial evaluation of pediatric neck masses in the emergency department. METHODS: We analyzed the medical records of 105 pediatric patients who visited the emergency department with neck mass whose initial imaging work-up was a neck CT and who visited the emergency department with a neck mass. The parameters investigated included the patient's age, sex, symptom duration, clinical impression, CT interpretation, final diagnosis, and treatment. The positive predictive value (PPV) for CT was calculated, and the parameters that correlated with an urgent surgical condition post-CT were evaluated. RESULTS: The median age was 6.5 years (1 month to 12 years), and the male-to-female ratio was 2:1. The most common initial impression was acute cervical lymphadenopathy. A comparison of the final diagnosis and CT scan demonstrated that the overall PPV was 96.2%. If the initial impression was a deep neck infection, a salivary gland infection, or tonsillitis, the PPV for CT was 100%. Fever (>38.0°C) and severe tenderness were significant between patients with and without urgent surgical conditions on CT. CONCLUSIONS: Computed tomography could be considered as the first diagnostic modality when an urgent surgical condition such as a deep neck infection is highly suspected.

Influences of demographic changes and medical insurance status on tonsillectomy and adenoidectomy rates in Korea.

In Korea, the proportion of the pediatric population is decreasing due to low fertility rates and aging of the society. It is hypothesized that this change in population structure and medical insurance status may affect rates of elective surgeries more significantly than clinical factors. An observational study conducted using data from the Health Insurance Review and Assessment Service for tonsillectomy and adenoidectomy, with 403,924 registered patients from 2007 through 2011. We analyzed longitudinal changes in crude and age-adjusted surgery rates of three surgeries-tonsillectomy without adenoidectomy (T), adenoidectomy without tonsillectomy (A), and tonsillectomy with adenoidectomy (T&A)-according to medical insurance status: health insurance (HI) group (better economic status) versus health aid (HA) group (poorer economic status). Most of the surgeries (51.8 % of T, 93.7 % of A, and 95.1 % of T&A) were performed in patients younger than 15. Over 5 years, the proportion of the child population numbers decreased, from 17.43 to 15.41 % in the HI group and from 21.20 to 13.15 % in the HA group. Thus, crude surgery rates for T, A, and T&A decreased more rapidly in the HA group (7.50, 14.79, and 15.55 %) than the HI group (1.69, 1.49, and 0.90 %) each year. Adjusted surgery rates for T, A, and T&A increased in the HI group (1.01, 2.64, and 3.36 %) and decreased in the HA group (1.39, 2.86, and 2.76 %) each year. These adjusted surgery rates partially explains the sharper decrease in crude surgery rates in the HA group than the HI group. The crude and adjusted rates of surgeries were usually higher in lower economic status groups. In conclusion, surgery rates were affected by changes in the population structure, but by other factors as well. Predictable socioeconomic factors could be used to calculate and predict the rates for other well-established surgeries.

Fine needle aspiration of parotid tumors: diagnostic utility from a clinical perspective.

PURPOSE: The utility of fine needle aspiration (FNA) for parotid tumors is limited owing to its low diagnostic accuracy. In this study, the authors sought to analyze and interpret FNA results for parotid tumors from a clinical perspective. MATERIALS AND METHODS: Parotid tumors subjected to preoperative FNA and subsequent complete excision were the subject of this study. Patient demographics, medical records, FNA findings, and final pathology of 158 consecutive cases were analyzed. RESULTS: The accuracy of FNA was 77.8%. The positive predictive value and likelihood ratio for malignancy were 90.0% and 52.8% (95% confidence interval, 7.02-397), respectively. The positive predictive value and likelihood ratio for benign pathology of Warthin tumor plus pleomorphic adenoma were 97.8% and 7.67% (2.03-29.0), respectively. CONCLUSIONS: The FNA diagnosis of Warthin tumor or pleomorphic adenoma is reliable and can be safely regarded as a benign tumor. Based on the high positive predictive value and likelihood ratio, FNA of the parotid gland can offer valuable information in surgical planning and patient counseling in many centers.

Excisional biopsy for management of lateral tongue leukoplakia.

BACKGROUND: Leukoplakia of the lateral tongue is frequently associated with the risk of malignancy. Although incisional biopsy is accepted as a standard technique for evaluation, the possibility of underdiagnosis, and therefore missed diagnosis of malignancy, remains at all times. The aim of this study was to determine the rate of underdiagnosis by incisional biopsy for leukoplakia of the lateral tongue and to elucidate the underlying cause of for underdiagnosis. METHODS: Twenty-two patients with leukoplakia in the lateral tongue who had undergone excisional biopsy for suspicion of malignancy were included in the study. Pathology was reviewed and classified into 'no dysplasia,''dysplasia,' and 'carcinoma'. Underdiagnosis was defined as a change of diagnosis to a graver classification following excisional biopsy. To analyze the factors contributing to underdiagnosis, incisional and excisional biopsy specimens were re-evaluated. RESULTS: Of the 22 patients with leukoplakia of the lateral tongue, 59.1% had coexistent malignancy, including nine squamous cell carcinomas and four verrucous carcinomas. Incisional biopsy resulted in underdiagnosis in 73.3% of the cases. Underdiagnosis was attributable to three common errors, which were mis-selection of sampling site within a large area of leukoplakia, error in pathology specimen preparation owing to small specimen size, and superficial biopsy frequently associated with punch biopsy. CONCLUSION: Leukoplakia of the lateral tongue is highly coexistent with malignancy, and incisional biopsy frequently leads to underdiagnosis. Therefore, complete excision with adequate margin is warranted for leukoplakia of the lateral tongue, preferably under general anesthesia, which could be performed with minimal morbidity and function preservation.

Serial endoscopic analysis of the glottis following laser cordectomy: from an oncological perspective.

From the oncological point of view, discrimination between the normal healing process and a pathological condition following laser surgery of the larynx is important in the management of possible residual/recurrent disease. However, the wound-healing process following laser surgery of the larynx is not well understood, especially regarding the gross morphological changes over time. The aims of this study were to analyze the serial temporal changes in the laryngeal endoscopic findings following laser cordectomy and to define the process involved in stabilization of the laryngeal mucosa. The study group comprised 46 consecutive patients with early glottic cancer undergoing laser cordectomy using the CO(2) laser. All outpatient clinic endoscopic examinations were documented and archived, and were examined serially in a semiquantitative manner to assess the dynamic change and the process involved in stabilization of the laryngeal mucosa. Clinical parameters affecting the healing process were analyzed. Mucosal stabilization was achieved at a median of 57 days. The laryngeal mucosa was stabilized within 100 days following the surgery in 80.4% of the patients. Tumor base width was significantly correlated with healing time. Early healers (≤40 days) had smaller tumors and had undergone a less-extensive procedure. Recurrences were observed in 33% of the patients with delayed healing for over 100 days. Healing of the laryngeal mucosa took no more than 100 days following laser cordectomy in the majority of the patients. Therefore, cautious waiting for up to 3 months (100 days) may be warranted to discriminate between the normal healing process and a pathological condition in order to establish a proper management plan and avoid unnecessary biopsy.

Long-term impact of smoking cessation on new glottic cancer events in patients with early glottic cancer.

Objective: Patients with early glottic cancer sometimes exhibit new glottic cancer events after 5 years. This study aimed to analyse the patterns and risk factors of new glottic cancer events in patients with early glottic cancer 5 years after initial treatment. Methods: In total, 209 patients were included in this study. Age, sex, T stage, anterior commissure involvement, smoking pattern and treatment modality were retrospectively analysed. Results: The median follow-up was 91 (range, 60-266) months. The median time for the occurrence of new glottic cancer events was 97 (range, 61-199) months. New glottic cancer events occurred 5 years after initial treatment in 16 (7.6%) patients, among whom 12 (75.0%) had new glottic cancer event lesions overlapping with initial lesions. Smoking cessation after treatment was significantly correlated with fewer new glottic cancer events after 5 years. Conclusions: New glottic cancer events occurring 5 years after initial treatment in patients with early glottic cancer are not negligible. In particular, if smoking is continued after treatment, these patients can experience new glottic cancer events even after 5 years.

The Expression of Defensin-Associated Genes May Be Correlated With Lymph Node Metastasis of Early-Stage Tongue Cancer.

OBJECTIVES: We aimed to assess the genetic differences between cases of early-stage tongue cancer that were positive or negative for lymph node metastasis. METHODS: In total, 35 cases of tongue cancer with RNA sequencing data were enrolled in this study. The gene expression profile of the following two groups was compared: N0 group (T stage 1 or 2 with N0 stage) and N+ group (T stage 1 or 2 with N+ stage). Using the R and limma packages in the Bioconductor program, we extracted the differentially expressed genes (DEGs). Gene ontology and pathway enrichment analysis were performed using the Database for Annotation, Visualization and Integration Discovery (DAVID) online tool. Immune cell infiltration was analyzed using the CIBERSORT online program. Immunochemical staining of the cancer tissue was evaluated and The Cancer Genome Atlas (TCGA) data were analyzed to validate the identified DEGs. RESULTS: No significant differences were found in the infiltration of 22 types of immune cells. Among a total of 51 identified DEGs, 14 genes were significantly upregulated, while 37 genes were significantly downregulated (P<0.01; fold change >2). Pathway analysis revealed significant associations with the arachidonic acid metabolism-related pathway, calcium signaling, and the muscle contraction pathway. The following DEGs were the most significantly different between the two groups: DEFB4A, SPRR2B, DEFB103B, SPRR2G, DEFB4B, and FAM25A. TCGA data showed that DEFB4A and DEFB103B were more highly expressed in the N0 group than in the N+ group, although the difference did not achieve statistical significance. Immunochemical staining of cancer tissue revealed significantly higher expression of defensin in the N0 group. CONCLUSION: . Defensin (DEFB4A, DEFB103B, DEFB4B) may be a novel biomarker for early regional metastasis in T1/2 tongue cancer.