Circulating hybrid cells predict presence of occult nodal metastases in oral cavity carcinoma.

BACKGROUND: Levels of circulating hybrid cells (CHCs), a newly identified circulating tumor cell (CTC), correlate with disease stage and progression in cancer. We investigated their utility to risk-stratify patients with clinically N0 (cN0) oral cavity squamous cell carcinoma (OCSCC), and to identify patients with occult cervical lymph node metastases (pN+). METHODS: We analyzed peripheral blood samples for CHCs with co-expression of cytokeratin (tumor) and CD45 (leukocyte) from 22 patients with cN0 OCSCC using immunofluorescence microscopy, then correlated levels with pathologic lymph node status. RESULTS: CHC levels exceeded CTCs and correlated with the presence of both clinically overt (p = 0.002) and occult nodal metastases (p = 0.006). CONCLUSIONS: For evaluated cN0 OCSCC patients, those with cN0 → pN+ status harbored elevated CHC levels compared to patients without occult disease. Our findings highlight a promising blood-based biologic assay with potential utility to determine the necessity of surgical neck dissection for staging and treatment.

Cutaneous squamous cell carcinoma of the lip: A population-based analysis.

OBJECTIVES/HYPOTHESIS: The role of cumulative ultraviolet (UV) radiation in cutaneous squamous cell carcinoma of the lip (CSCCL) is well understood. This study seeks to evaluate overall survival as well as incidence and demographics across geographic regions, given differences in UV exposure across the United States. STUDY DESIGN: Retrospective population-based analysis. METHODS: A total of 14,901 CSCCL cases were identified as being from the West, Midwest, South, or Northeast, utilizing the Surveillance, Epidemiology, and End Results registry from 1973 to 2013. Demographics, stage of disease, and treatment modalities were compared among regions. RESULTS: Of the CSCCL cases reported, 58.3%, 24.5%, 10.8%, and 6.4% originated from the West, Midwest, South, and Northeast, respectively. Patients most commonly presented with T1 tumors (81.3%), and nodal and distant metastasis was rare for patients from all regions (3.1% and 0.3%, respectively). Patients with American Joint Committee on Cancer stage II and higher were most likely from the Northeast or South. Overall, most patients were treated with surgery monotherapy (89.5%); however, surgical monotherapy was least commonly utilized in patients in the Northeast and South. Overall 5-year disease specific survival was measured at 94.7%. CONCLUSION: Although areas of high UV index are implicated in increased morbidity and mortality due to CSCCL, this study indicates that a variety of factors play a role in CSCCL incidence and outcomes in the United States. The elderly and non-white populations were identified as poor prognostic demographic factors. Investigation detailing differences in CSCCL detection and treatment may aid in the identification of higher-risk populations. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:84-90, 2018.