Elective neck dissection improves the survival of patients with T2N0M0 oral squamous cell carcinoma: a study of the SEER database.

BACKGROUND: Treatment of clinical N0 neck tumours is controversial in early-stage oral squamous cell carcinoma (OSCC), possibly because T1N0M0 and T2N0M0 merge together at early stages. The purposes of this study were to compare survival outcomes only for T2N0M0 cases based upon treatment elective neck dissection versus neck observation. METHODS: T2N0M0 OSCC cases were identified in the Surveillance, Epidemiology, and End Results database of the United States National Cancer Institute between 2004 and 2015. Survival curves for different variable values were generated using Kaplan-Meier estimates and compared using the log-rank test. Variables that achieved significance at P < 0.05 were entered into multivariable analyses via the Cox proportional hazards multivariate regression. RESULTS: A total of 2857 patients were selected, and 2313 cases were available for disease specific survival (DSS). The 5-year and 10-year overall survival (OS) were 66.7 and 46% for patients receiving elective neck dissection (END), respectively, and 56.4 and 37.2% for patients with neck observation (P < 0.0001). The 5-year and 10-year DSS were 73.6 and 64% for the END group, respectively, versus 64.5 and 54.5% for the neck observation group (P < 0.0001). More importantly, performing END was independently associated with favourable DSS and OS for patients with T2N0M0 OSCC [hazard ratio (HR) = 0.769, P = 0.0069 for DSS; HR = 0.829, P = 0.0031 for OS, neck observation group as reference] according to multivariate survival analysis. CONCLUSION: END is recommended for T2N0M0 OSCC cases and it is associated with improved DSS and OS.

Patients With cT1N0M0 Oral Squamous Cell Carcinoma Benefit From Elective Neck Dissection: A SEER-Based Study.

BACKGROUND: The incidence of oral squamous cell carcinoma (OSCC) is increasing, with an estimated 369,000 new patients each year worldwide. Surgery is the primary treatment modality for early-stage OSCC, but there is scant evidence to prove the value of elective neck dissection (END) for relatively small early-stage OSCC. This study aimed to identify factors predicting survival for patients with clinical stage T1N0M0 (cT1N0M0) OSCC and whether up-front END improved survival. PATIENTS AND METHODS: Patients with cT1N0M0 OSCC who underwent tumor resection with or without END were identified and extracted from the SEER database. Kaplan-Meier survival analysis was used to assess overall survival and disease-specific survival. Prognostic factors were determined using Cox regression analysis. RESULTS: A total of 5,752 patients with cT1N0M0 OSCC were extracted, of whom 2,194 (38.1%) underwent tumor resection surgery with concurrent END and 3,558 (61.9%) underwent only tumor resection. In a multivariate Cox analysis, a relatively advanced age (>62 years) and relatively high pathologic grade were the significant negative predictors, but married status (hazard ratio, 0.709; P=.006) and undergoing END (hazard ratio, 0.708; P<.001) were identified as significant independent positive factors. CONCLUSIONS: Patients with cT1N0M0 OSCC gain significant overall and disease-specific survival benefit from END.

Clinicopathological characteristics, treatment and prognosis of head & neck small cell carcinoma: a SEER population-based study.

BACKGROUND: To investigate the clinicopathological characteristics of head and neck small cell carcinoma (H&NSmCC) and identify prognostic factors on the basis of the Surveillance, Epidemiology and End Results (SEER) database. METHODS: Total of 789 primary cases from 1973 to 2016 were included. Univariate and multivariate analyses were performed to identify independent prognostic indicators. An H&NSmCC-specific nomogram was constructed and compared with the AJCC staging system by calculating the time-dependent area under the curve (AUC) of the receiver operating characteristic (ROC) curves. RESULTS: The incidence of H&NSmCC peaked during the period of 50 to 70 years old, and the most frequent location was the salivary gland. The 5-year disease specific survival (DSS) was 27%. In the multivariate survival analysis, AJCC III + IV stage [HR = 2.5, P = 0.03, I + II stage as Ref], positive N stage [HR = 1.67, P = 0.05, negative N stage as Ref], positive M stage [HR = 4.12, P = 0.000, negative M stage as Ref] and without chemotherapy [HR = 0.56, P = 0.023, received chemotherapy as Ref] were independently associated with DSS. The H&NSmCC-specific nomogram was built based on the independent prognostic indicators. The nomogram demonstrated better predictive capacity than the AJCC staging system for 5-year DSS [(AUC: 0.75 vs 0.634; Harrell's C-index (95% CI): 0.7(0.66-0.74) vs 0.59(0.55-0.62), P < 0.05]. CONCLUSION: N stage, M stage, AJCC stage and chemotherapy were independent prognostic indicators included in the prognostic nomogram model, which can better predict the survival of H&NSmCC than the AJCC staging system.

Malignant tumours of temporomandibular joint.

BACKGROUND: Malignant tumours of the temporomandibular joint (MTTMJ) are extremely rare. Studies describing its unique epidemiology, clinicopathological features, treatment and prognosis comprehensively are limited. To address these issues, current investigation was performed. METHODS: A retrospective research was carried out by using population-based data from the Surveillance, Epidemiology, and End Results database (1973-2016). RESULTS: Data for a total of 734 patients, including 376 men and 358 women, was found. The median age was 47 years. The 5-year and 10-year disease specific survival (DSS) rates were 69.2 and 63.6%, respectively. Significant differences in DSS were found according to age, race, tumour type, AJCC/TNM stage, surgery, radiotherapy, chemotherapy and different treatment modalities (P < 0.05). In the multivariate survival analysis, age > 44 years and AJCC stage III and IV were associated with poor DSS. CONCLUSION: MTTMJ was mostly found in white people with a median age of 47 years without any sex predominance. Patient's age and AJCC stage was independent predictor of DSS.

Head & neck acinar cell carcinoma: a population-based study using the seer registry.

BACKGROUND: To explore the clinicopathologic characteristics, treatment and prognostic factors of head and neck acinar cell carcinoma (HNACC) comprehensively. METHODS: A population-based study was conducted using data from the Surveillance, Epidemiology, and End Results database (1975-2016). Overall survival (OS) and HNACC-specific survival of patients with different clinicopathologic variables were compared using the Kaplan-Meier method and Cox multivariate regression. RESULTS: A total of 2624 primary HNACC cases (1052 males, 1572 females) were identified. There was a significant difference in gender distribution. Among the total cohort, 2416 cases originated from salivary glands, including 2325 parotid gland ACC cases. Regardless of confounding factors, the 10-year and 20-year disease-specific survival (DSS) was 93.6 and 90%, respectively. Surgery was favourably associated with better DSS and OS [HR = 0.13, P = 0.0092 and HR = 0.23, P = 0.0203]. Gender was the only demographic independent prognostic factor for both DSS and OS [Male vs female, HR = 3.3, P = 0.0028 for DSS; HR = 2.44, P = 0.0376 for OS]. Higher pathological grade was adversely associated with DSS and OS [Grade II, HR = 4.03, P = 0.0444; Grade III + IV, HR = 35.64, P = 0.0000 for DSS; Grade III + IV, HR = 4.49, P = 0.0000 for OS, Grade I as reference]. In addition, TNM/AJCC stage was commonly associated with prognosis. CONCLUSION: Surgery was the only favourable prognostic indicator for both DSS and OS. Gender, age, pathological differentiation and TNM/AJCC stage were independent prognostic factors for survival.

Desmoplastic melanoma: Demographic and clinicopathological features and disease-specific prognostic factors.

Desmoplastic melanoma (DM) is a rare morphological subtype of melanoma that remains uncharacterized. The aim of the present study was to investigate the incidence of DM, its general demographics, clinicopathological features and disease-specific prognostic factors. DM cases were sampled from the Surveillance, Epidemiology and End Results (SEER) program from between 1973 and 2017. A total of 3,657 cases (median age, 68 years) were identified. The results indicated that DM primarily occurred in Caucasian subjects, with a male-to-female ratio of 2:1. Statistically significant overall survival (OS) and disease-specific survival (DSS) rate differences were identified according to sex, age, treatment, T stage, N stage and SEER historic tumor stage (P<0.05). In multivariate Cox regression analysis, age >68 years, male sex, American Joint Committee on Cancer (AJCC) stage II and III, and SEER historic tumor stage of the regional tumor were all factors associated with poorer OS and DSS rates. The findings also revealed that surgical treatment was associated with favorable DSS and OS rates. In conclusion, DM occurred primarily in Caucasian subjects of 60-80 years of age, with predominance in males. Furthermore, age, sex, AJCC stage, SEER historic tumor stage and surgical treatment were identified as independent prognostic factors of DM in terms of DSS and OS.

Spindle cell melanoma: Incidence and survival, 1973-2017.

Spindle cell melanoma (SCM) is a rare morphological subtype of melanoma, which is relatively uncharacterized. The aim of the present study was to investigate the incidence of SCM, its general demographics, basic clinico-pathologic features, treatment outcomes and disease-specific prognostic factors. SCM cases were sampled from the Surveillance, Epidemiology and End Results (SEER) Program (1973-2017). A total of 4761 SCM cases were identified, with a median age of 66 years. The female:male ratio was 0.62:1. Statistically significant overall survival (OS) and disease-specific survival (DSS) rate differences were identified depending on age, sex, ethnicity, tumor location, T stage, N stage, M stage, pathological grade, AJCC stage, SEER stages and surgical treatment (P<0.05). Multivariate Cox regression analysis revealed that age >66 years, T3+T4 stage disease, positive N stage and SEER historic stage of regional and distant metastasis tumor were associated with poor DSS and OS rates. In summary, SCM was most common in Caucasian people of 60~80 years of age with a predominance in males. Patient's age, ethnicity, T stage, N stage, and SEER historic stage were identified as independent prognostic factors of SCM in terms of DSS and OS.

Desmoplastic melanoma versus spindle cell melanoma: Incidence and survival, 1973 to 2017.

Desmoplastic melanoma (DM) and spindle cell melanoma (SCM) are 2 rare subtypes of melanoma. This study aims to investigate these 2 melanomas comprehensively by comparison.Cases were identified in the Surveillance, Epidemiology, and End Results (SEER) database (1973-2017).A total of 3657 DM and 4761 SCM cases were identified. DM's female-to-male ratio was 1:2 and SCM's was 0.62:1. The age distribution was similar. Both tumor mostly originated from skin and the eye and orbit was SCM-specific tumor site. Comparing both tumors with DM as reference, significant overall survival (OS) were found depending on sex (women, P < .001), age (age ≤65 years, P < .001), race (white, P = .01), tumor orientation (skin, P < .001), T stage (T3 + T4, P = .001), SEER historic stage (regional tumor, P = .04), and surgery (P = .01). Meanwhile, significant disease specific survival (DSS) differences were found depending on sex (men, P < .001), age (age ≤65 years, P < .001), race (white, P < .001), tumor orientation (skin, P < .001), T early stage (T1 + T2, P = .02), T advanced stage (T3 + T4 stage, P = .001), SEER historic stage (regional tumor, P < .001), and surgery (P < .001). The chance of DSS and OS of SCM were significantly higher comparing to DM for female patients (HR = 1.268, for OS; HR = 1.711, for DSS), patients age ≤65 years (HR = 1.290, for OS; HR = 1.638, for DSS), No-Spanish-Hispanic-Latino patients (HR = 1.098, for OS; HR = 1.426, for DSS), patients with skin tumor (HR = 1.174; for OS; HR = 1.444; for DSS) and patients who received surgery (HR = 1.091; for OS; HR = 1.398, for DSS).DM and SCM mostly occurred in white people' skin at 60 to 80 years old and eye and orbit was another most affected site for SCM. SCM had slightly higher occurrence in women and the risk of DSS and OS were significantly higher comparing to DM depending on the women, patients age ≤65 years, patients with skin tumor, No-Spanish-Hispanic-Latino patients and patients who received surgery.

Spindle cell sarcoma: a SEER population-based analysis.

Due to the substantial limitation of study population, Spindle cell sarcoma (SCS) was unexplored comprehensively. In this study, we investigated the clinical characteristics and disease specific prognostic factors of SCS. 3299 SCS cases were identified and extracted from Surveillance, Epidemiology, and End Results (SEER) database (1973-2017). White people account for 79.1% with median age of 57 years without predominance in any gender. Significant disease specific survival (DSS) and overall survival (OS) were found differentiated in age, T stage, N stage, M stage, AJCC stage, SEER historic stage, tumor locations, surgery, and pathologic grade. In the multivariate Cox analysis, the age >64 years (for DSS, P < 0.001 and for OS, P < 0.001; Reference age ≤64 years), AJCC stage III (for DSS, P = 0.006 and for OS, P = 0.04; Reference: AJCC stage I), and non-surgical treatment (for DSS, P < 0.001 and for OS, P < 0.001; Reference: surgery) were independently associated with worse DSS and OS. In brief, our study demonstrated that SCS mostly found in white people at fifth to seventh decades of life without gender predilection. The patient's age, AJCC stage, tumor location and surgery were independent prognostic indicators for both DSS and OS of SCS.