Perinatal management for fetal oral epignathus with duplication of the pituitary gland (DPG)-plus syndrome: A case report and literature review.

The prenatal diagnosis of epignathus presents a unique challenge for physicians. Differential diagnosis is usually based on the anatomic location of the tumor. Typical prenatal ultrasound characteristics of epignathus include a mixed solid and cystic lesion with vascularity in the solid component, originating from the hard or soft palate, and it is often associated with other anomalies such as craniofacial clefts or trans-sphenoidal intracranial extension. Herein, we present a case of prenatal diagnosis of epignathus with rare ultrasonographic findings, prenatal management requiring collaborative efforts of a multidisciplinary team, and a well-planned innovative ex utero intrapartum treatment procedure. In addition, this report highlights the evolving postnatal diagnosis of the rare developmental anomaly, duplication of the pituitary gland-plus syndrome, which includes various midline craniofacial, central nervous system, spinal, and endocrine abnormalities.

Impact of human papillomavirus status on survival in patients with oral cancer.

Objectives: To examine the association between the human papillomavirus (HPV) infection and overall survival rate in patients with oral cancer. Methods: This retrospective cohort study examined HPV status in 454 patients who were diagnosed with oral squamous cell carcinoma (OSCC) using the records of patients who underwent an initial treatment for OSCC between 2012 and 2021 at our institution as retrieved from the Cancer Registry database. The survival rates of the HPV-positive and HPV-negative groups were assessed and compared, and independent factors associated with survival were analyzed using multivariate Cox regression models. Results: Of the 454 patients with OSCC included in this study, 73 were excluded for invalid HPV tests. Of the remaining patients, 39 and 342 patients were categorized into HPV-positive and HPV-negative groups, respectively. The prevalence of HPV-positive in the patients with OSCC was 10.2% (95% confidence interval 7.2%-13.2%). The 3-year overall survival rates were 56.2% and 53.9% in the HPV-positive and HPV-negative groups, respectively. The 3-year disease-specific survival rates in the HPV-positive and HPV-negative groups were 60.2% and 56.9%, respectively. The survival differences were not statistically significant. HPV-positive status was not a significant predictor of overall survival in the multivariable Cox regression analyses (p = 0.728). Conclusion: The prevalence of HPV-positivity among patients with OSCC in the study was 10.2%. No association was found between HPV-positive status and 3-year overall survival in patients with oral cancer. Level of evidence: Level 3.

Prognostic value of pretreatment lymphocyte-to-monocyte ratio in patients with advanced oral cavity cancer.

Introduction: Lymphocyte-to-monocyte ratio (LMR) has been reported as a prognostic factor in many cancers but the data are to date limited for its use in oral cavity cancer. The purpose of this study was to evaluate the prognostic value of LMR in advanced-stage oral cavity cancer. Methods: Data from 211 advanced-stage oral cancer patients treated with curative intent between January 2009 and December 2015 were obtained from the hospital information system. Pretreatment LMR and other hematologic parameters were recorded and an LMR cutoff value was calculated. Overall survival between the groups above (high LMR) and below (low LMR) the cutoff was compared and hazard ratios from univariate and multivariate analyses using a Cox proportional hazards model calculated. Results: Overall survival and disease-specific survival were better in the high LMR group. The 5-year overall survival rates were 31.6% and 15% in the high LMR and low LMR groups, respectively. Multivariate analysis using a Cox proportional hazards model showed that treatment modality and LMR were the only factors associated with overall survival. Conclusion: Low LMR was associated with poor survival outcome in patients with advanced-stage oral cavity cancer. Level of Evidence: 2b.

Long-term monitoring and predictive factors of critical weight loss among patients with nasopharyngeal carcinoma in a curative treatment setting.

PURPOSE: We aimed to determine weight change over time and identify risk factors of critical weight loss among patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: In this retrospective study, we investigated weight change over time in 445 patients with NPC who underwent curative treatment. Logistic regression analysis was used to identify possible predictors of critical weight loss. RESULTS: The incidence of critical weight loss was 67.87%. The long-term monitoring demonstrated a rapid weight loss, especially in the first 2 months of treatment, which continued up to 5 months. Patients with critical weight loss did not regain weight until 3 years. Univariate analysis showed that the following factors were significantly associated with critical weight loss: lower pretreatment body mass index (BMI), tumor stage, subjective global assessment score, Eastern Cooperative Oncology Group (ECOG) score, and enteral tube feeding. Multivariate analysis showed four factors that were associated with a lower critical weight loss: pretreatment BMI < 18.5 kg/m2 (p < 0.001, 95% confidence interval [CI] = 0.25 [0.12-0.52]), early tumor stage (p = 0.004, 95% CI = 0.46 [0.27-0.79]), ECOG grade II (p = 0.006, 95% CI = 0.15 [0.04-0.51]), and early prophylactic percutaneous gastrostomy (PEG) tube feeding (p = 0.001, 95% CI = 0.26 [0.12-0.59]). CONCLUSION: Patients having NPC with critical weight loss showed a significantly rapid decline in their weight in the first 2 months; the weight was persistently less than the baseline value during a 36-month follow-up period. Patients with lower BMI, early-stage cancer, and early prophylactic PEG tube feeding had a significantly lower critical weight loss than those without the abovementioned characteristics.

Transaxillary endoscopic thyroid lobectomy: gas insufflation versus gasless technique.

PURPOSE: The objective of this study is to compare the clinical outcomes between gas insufflation and gasless techniques used in transaxillary endoscopic thyroid lobectomy. METHODS: Data of patients who underwent transaxillary endoscopic thyroid lobectomy from June 2011 to August 2019 were reviewed. All surgeries were performed by one experienced surgeon. The patients were divided into two groups according to surgical technique as gas insufflation or gasless technique. The clinical outcomes such as complications, postoperative pain score assessed using VAS, length of hospital stay, and presence of iatrogenic ectopic thyroid tissue were compared between the two groups. RESULTS: During the study period, a total of 60 patients underwent transaxillary endoscopic thyroid lobectomy: 38 patients via gas insufflation and 22 using the gasless technique. The basic characteristic features of the patients and their diseases were not significantly different between the two groups. Gas insufflation yielded significantly better surgical outcomes than the gasless technique: shorter operative time (209.3 ± 63.1 min. vs. 267.6 ± 66.0 min.; P = 0.001), less estimated blood loss [10.0 (5.0, 20.0) mL vs. 30.0 (16.2, 50.0) mL; P < 0.001], less drainage content [10.0 (0.0, 70.0) mL vs. 81.5 (74.2, 104.5) mL; P < 0.001], and shorter hospital stay [1.5 (1.1, 2.0) days vs. 1.8 (1.5, 2.5) days; P = 0.032]. Regarding postoperative pain, there was no statistically significant difference in visual analog scales (VAS) at 24 and 48 h. Finally, no evidence of iatrogenic ectopic thyroid tissue was found in both groups. CONCLUSION: Compared to the gasless technique, the gas insufflation technique provided shorter operative time, less estimated blood loss, less drainage content, and shorter hospital stay. Moreover, there were comparable outcomes regarding postoperative pain, complications and iatrogenic ectopic thyroid tissue.

Treatment outcome of advance staged oral cavity cancer: concurrent chemoradiotherapy compared with primary surgery.

Concurrent chemoradiotherapy (CCRT) has been reported as effective and has become an acceptable treatment in advanced oral cancer. However, to date there is insufficient data to conclude that CCRT provides a good survival outcome. The purpose of this study was to compare survival rates and complications in patients with resectable advanced oral cavity squamous cell carcinoma treated with either CCRT or surgery with adjuvant radiotherapy (RT)/chemoradiotherapy (CRT). Stage III or IVa oral cavity carcinoma patients treated with curative intent by either CCRT or surgery with adjuvant RT were identified over a 7-year period (2009-2015). Survival rates and treatment complications were analyzed and compared between the two groups. 61 patients underwent CCRT and 128 patients underwent surgical excision and received postoperative RT. There was no statistically significant difference in survival outcome between the two treatment groups. 5-year overall survival rates (OS) were 33 versus 24% (P = 0.191) and the disease-specific survival rates (DSS) were 27 versus 25% (P = 0.857) when comparing the CCRT group and surgery with adjuvant RT/CRT group, respectively. Long-term complications were comparable between the two groups. CCRT has comparable survival outcome and complications for the treatment of advanced oral cavity squamous cell carcinoma, compared to surgery with adjuvant RT/CRT.