Epidemiological and treatment-related factors contribute to improved outcome of oropharyngeal squamous cell carcinoma in Finland.

BACKGROUND: Treatment for oropharyngeal squamous cell carcinoma (OPSCC) has changed, as the proportion of human papilloma virus (HPV)-related disease has increased. We evaluated nationwide information on its management and outcome during the treatment paradigm change period. METHODS: We included all patients diagnosed and treated for OPSCC at the five Finnish university hospitals from 2000 to 2009. Patient records and pathology registries provided the clinicopathological data. p16 staining was performed on primary tumor samples of patients who had received treatment with curative intent. RESULTS: A total of 674 patients were diagnosed and treated for OPSCC and the incidence increased along the study period. Of the evaluable tumors 58.5% were p16-positive and the number of p16-positive tumors increased along the years. The treatment was given with curative intent for 600 patients and it was completed in 564. Of them, 47.9% underwent primary surgery and 52.1% received definitive oncological treatment. Also, the treatment protocol changed towards a more oncological approach. Among patients treated with curative intent the five-year overall, disease-specific and disease-free survival rates were 60.1, 71.5 and 57.0%. In multivariate analysis, p16-positivity seemed to relate to reduced disease mortality in lateral and anterior-wall disease. Depending on primary tumor localization, also sex, classes T3-4, presence of regional metastasis and radiotherapy modality had an association with disease mortality. CONCLUSION: The incidence of p16-positive OPSCC and delivery of definitive oncological treatment increased in Finland during the study period. An improved survival outcome compared with the previous nationwide investigation was observed in this subset of patients.

Total or subtotal glossectomy with laryngeal preservation: a national study of 29 patients.

Total glossectomy remains a controversial procedure as it often leads to notorious sequalae in swallowing and speaking functions. Disease entities indicating total glossectomy tend to have poor prognosis. We evaluated whether this type of surgery can be concidered justified based on our national series. We reviewed all total and subtotal glossectomies with laryngeal preservation performed in Finland between 2005 and 2014 in terms of overall survival (OS), disease-specific survival (DSS), locoregional control (LRC), and functional outcome as assessed by gastric tube or tracheostomy dependence and ability to produce intelligible speech. Of the 29 eligible patients, 15 had undergone total and 14 subtotal glossectomy with curative intent. In eight patients, total/subtotal glossectomy was performed as salvage procedure after the previous treatment. One-year estimates for OS, DSS, and LRC were 48, 59, and 66%, and corresponding 3-year estimates were 31, 46, and 46%, respectively. The gastrostomy and tracheostomy dependence rates at 1 year after operation were 77 and 15%, respectively. Fifty-nine percent of the patients were assessed to be able to communicate verbally. As in most other published studies, we found unsatisfactory survival figures after subtotal or total glossectomy and most patients remained dependent on gastrostomy tube. This surgery is, however, presumably the best and often only chance for cure in a selective patient population, and according to our opinion, it is indicated as a primary or salvage treatment provided that the reconstruction is planned optimally to guarantee a reasonable quality of life after surgery.

Endothelial function is well preserved in obese patients with mild obstructive sleep apnea.

PURPOSE: Endothelial dysfunction is one of the early markers of cardiovascular complications in obstructive sleep apnea (OSA). The aim of our study was to evaluate whether overweight patients with mild OSA displayed endothelial dysfunction, and to assess the effect of 1-year lifestyle intervention with an early very low calorie diet in endothelial function. METHODS: At baseline, the study population consisted of 83 overweight patients with mild OSA and 46 weight-matched non-OSA subjects. OSA patients were further randomized into a 1-year supervised lifestyle intervention group or control group which received routine lifestyle counselling. Endothelial function measured by brachial artery flow-mediated dilatation (FMD), apnea-hypopnea index (AHI), body mass index (BMI), and metabolic parameters were assessed at baseline and 12 months. RESULTS: No correlations between endothelial function and mild OSA were detected. However, patients with impaired endothelial function had lower mean saturation and impaired endothelial function correlated significantly with glucose intolerance and dyslipidemia. After the lifestyle intervention and successful weight reduction, AHI, BMI, serum triglycerides and insulin improved significantly; however, no improvement in FMD was detected. CONCLUSIONS: Mild OSA was not observed to be associated with endothelial dysfunction. Although in mild OSA endothelial function is still preserved, lifestyle intervention with weight reduction did achieve an improvement in other obesity-related risk factors for cardiovascular diseases, thus highlighting the importance of early intervention.

Patient and health care delays in large (class T3-T4) oral, oropharyngeal, and laryngeal carcinomas.

BACKGROUND: Head and neck cancers (HNCs) are often diagnosed at an advanced stage. We investigated the lengths and factors associated with patient, primary health care (PHC), and specialist care (SC) delays in T3-T4 oral, oropharyngeal, and laryngeal cancer. METHODS: A nationwide prospective questionnaire-based study (n = 203) with the 3-year long data collection period. RESULTS: The median patient, PHC and SC delays were 58, 13, and 43 days, respectively. Lower level of education, heavy alcohol use, hoarseness, difficulties breathing, and eventual palliative treatment associated with a longer patient delay. A lump on the neck or facial swelling associated with a shorter PHC delay. Conversely, if symptoms were treated as an infection, PHC delay was longer. The treatment modality and tumor site affected SC delay. CONCLUSIONS: Patient delay stands as the most notable factor contributing to delays before treatment. HNC symptom awareness thus remains especially important among HNC risk groups.

Impaired nasal breathing may prevent the beneficial effect of weight loss in the treatment of OSA.

BACKGROUND: Weight loss is considered an effective treatment for obstructive sleep apnoea (OSA) in overweight patients. Some patients, however, do not benefit from weight loss. It has been postulated that nasal obstruction may act as an independent risk factor for OSA. OBJECTIVE: The aim of our study was to evaluate whether impaired nasal airflow might explain the missing effect of weight reduction on OSA. METHODOLOGY: Fifty-two overweight adult patients with mild OSA were recruited. After the 12-month lifestyle intervention, all patients who achieved more than 5% weight loss were divided into two groups based on whether they still had OSA or not. Change in nasal resistance measured by rhinomanometer and AHI were the main outcome variables. RESULTS: A total of 26/52 patients achieved 5% weight reduction. Of those 26 patients, 16 were objectively cured from OSA and 10 patients did not benefit from weight loss. Nasal resistance reduced significantly more in patients who had been cured from OSA. Smoking had a negative impact on both nasal resistance and improvement of AHI. CONCLUSIONS: Impaired nasal breathing and smoking may prevent the beneficial effects of weight reduction in the treatment of OSA.

Mild obstructive sleep apnea does not modulate baroreflex sensitivity in adult patients.

BACKGROUND: Obstructive sleep apnea (OSA) is a chronic and progressive disease. OSA is associated with increased cardiovascular morbidity and mortality, the risk being more frequently encountered with severe degrees of OSA. Increased sympathetic activation and impaired cardiac autonomic control as reflected by depressed baroreceptor reflex sensitivity (BRS) are possible mechanisms involved in the cardiovascular complications of OSA. However, it is not known at what stage of OSA that changes in BRS appear. The aim of this study was to evaluate BRS in patients with mild OSA. METHODS: The study population consisted of 81 overweight patients with mild OSA and 46 body weight-matched non-OSA subjects. BRS, apnea-hypopnea index, body mass index, and metabolic parameters were assessed. The phenylephrine test was used to measure BRS. RESULTS: Patients in the OSA group were slightly but significantly older than the non-OSA population (50.3±9.3 years vs 45.7±11.1 years, P=0.02). Body mass index, percentage body fat, blood pressure, fasting glucose, insulin, and lipid levels did not differ between the OSA patients and non-OSA subjects. Absolute BRS values in patients with mild OSA and non-OSA subjects (9.97±6.70 ms/mmHg vs 10.51±7.16 ms/mmHg, P=0.67) and BRS values proportional to age-related and sex-related reference values (91.4%±22.7% vs 92.2%±21.8%, P=0.84) did not differ from each other. BRS <50% of the sex-specific reference value was found in 6% of patients with mild OSA and in 2% of non-OSA subjects (P=0.29). CONCLUSION: Patients with mild OSA did not show evidence of disturbed BRS in comparison with weight-matched non-OSA controls.