Treatment outcome of oropharyngeal squamous cell carcinoma through propensity score analysis.

According to an extensive database, the Objective is to compare surgical versus non-surgical treatment through Propensity Score (PS) for patients with Oropharyngeal Squamous Cell Carcinoma (OPSCC). METHODS: We retrospectively evaluated epidemiological data from 8075 patients with OPSCC diagnosed between 2004 and 2014 and used PS matching to analyze possible prognostic factors for its outcomes with regression analyses. RESULTS: Cox multiple regression analysis to study survival after PS matching shows that type of treatment was associated with death with a hazard ratio of 1.753 (p<0.05) of non-surgical treatment. However, it was not associated with recurrence (p>0.05). In the surgical treatment group, overall survival was 79.9% at one year, 36.4% at five years, and 20.5% at ten years. Disease-free survival was 90.1%, 64.8%, and 56.0% at 1, 5, and 10-years, respectively. In the non-surgical treatment group, overall survival was 60.6% at one year, 21.8% at five years, and 12.7% at ten years. Disease-free survival was 90.8%, 67.2%, and 57.8% at 1, 5, and 10-years, respectively. CONCLUSION: Patients in the surgical treatment group had better outcomes related to survival. Recurrence is associated with the survival of OPSCC cancer. Recurrence-free survival is similar to both treatments. LEVEL OF EVIDENCE: 2C.

Treatment outcome of oropharyngeal squamous cell carcinoma through propensity score analysis

Abstract According to an extensive database, the Objective is to compare surgical versus nonsurgical treatment through Propensity Score (PS) for patients with Oropharyngeal Squamous Cell Carcinoma (OPSCC). Methods: We retrospectively evaluated epidemiological data from 8075 patients with OPSCC diagnosed between 2004 and 2014 and used PS matching to analyze possible prognostic factors for its outcomes with regression analyses. Results: Cox multiple regression analysis to study survival after PS matching shows that type of treatment was associated with death with a hazard ratio of 1.753 (p < 0.05) of non-surgical treatment. However, it was not associated with recurrence (p> 0.05). In the surgical treatment group, overall survival was 79.9% at one year, 36.4% at five years, and 20.5% at ten years. Disease-free survival was 90.1%, 64.8%, and 56.0% at 1, 5, and 10-years, respectively. In the non-surgical treatment group, overall survival was 60.6% at one year, 21.8% at five years, and 12.7% at ten years. Disease-free survival was 90.8%, 67.2%, and 57.8% at 1, 5, and 10-years, respectively. Conclusion: Patients in the surgical treatment group had better outcomes related to survival. Recurrence is associated with the survival of OPSCC cancer. Recurrence-free survival is similar to both treatments. Level of evidence: 2C.

Prognostic factors in oropharyngeal squamous cell carcinoma in the state of São Paulo, Brazil: 10-year follow-up

Abstract Objective: To descriptively analyze the epidemiological data, clinical stage, and outcomes of oropharyngeal squamous cell carcinoma in the state of São Paulo, Brazil, and to estimate the influence of clinical stage and treatment type on overall and disease-free survival. Methods: We retrospectively analyzed epidemiological data from the São Paulo Cancer Center Foundation database relative to patients with oropharyngeal squamous cell carcinoma diagnosed between 2004 and 2014 in the state of São Paulo. Univariate and multivariate Cox regression analyses were performed to assess factors associated with the outcomes. A forward stepwise selection procedure was used. Survival curves were estimated by the Kaplan-Meier method and compared by the Gehan-Breslow-Wilcoxon test. Results: A total of 8075 individuals with oropharyngeal squamous cell carcinoma were identified. Of these, 86.3% were diagnosed at an advanced stage and 13.7% at an early stage. Only 27.2% of patients were treated surgically, whereas 57.5% were treated medically. Patients undergoing surgery had longer overall survival than those receiving medical treatment in both early- and advanced-stage oropharyngeal squamous cell carcinoma. However, there was no significant difference in disease-free survival between surgical and medical treatment. Conclusion: No significant difference in disease-free survival between medical and surgical treatment suggests similar complete remission rates with both approaches. Patients receiving medical treatment had shorter overall survival, which may be due to complications from chemotherapy and radiotherapy. However, we cannot confirm this relationship based on the data provided by the São Paulo Cancer Center Foundation. Prospective studies are warranted to assess whether the lower overall survival rate in patients receiving medical treatment is secondary to complications from chemotherapy and radiotherapy. Level of evidence: 2C.

Secondary tracheoesophageal puncture with a flexible transillumination device: a new technique and its outcomes

Abstract Objectives: This study aims to describe a new secondary tracheoesophageal puncture technique with voice prosthesis insertion under local anesthesia with a low-cost device and evaluate its outcome. Methods: With a transoral flexible transillumination device of aluminum of 2.3 mm with fiberoptic light, the esophagus's anterior wall is visualized through the tracheostomy. A tracheoesophageal fistula is made with a blade and passed through the fistula. Then a bent trocar is introduced into the lumen using the device as a guidewire. Once in the lumen, a thin guide wire is passed through up to the mouth. The voice prosthesis is positioned with retrograde insertion. Then, the patient is discharged without hospitalization. Results: 15 patients submitted to this technique had a successful surgical outcome. There were no complications as pneumothorax, esophageal perforation, bleeding, or hospitalization. Conclusion: The new device is feasible under local anesthesia.

Prognostic factors in oropharyngeal squamous cell carcinoma in the state of São Paulo, Brazil: 10-year follow-up.

OBJECTIVE: To descriptively analyze the epidemiological data, clinical stage, and outcomes of oropharyngeal squamous cell carcinoma in the state of São Paulo, Brazil, and to estimate the influence of clinical stage and treatment type on overall and disease-free survival. METHODS: We retrospectively analyzed epidemiological data from the São Paulo Cancer Center Foundation database relative to patients with oropharyngeal squamous cell carcinoma diagnosed between 2004 and 2014 in the state of São Paulo. Univariate and multivariate Cox regression analyses were performed to assess factors associated with the outcomes. A forward stepwise selection procedure was used. Survival curves were estimated by the Kaplan-Meier method and compared by the Gehan-Breslow-Wilcoxon test. RESULTS: A total of 8075 individuals with oropharyngeal squamous cell carcinoma were identified. Of these, 86.3% were diagnosed at an advanced stage and 13.7% at an early stage. Only 27.2% of patients were treated surgically, whereas 57.5% were treated medically. Patients undergoing surgery had longer overall survival than those receiving medical treatment in both early- and advanced-stage oropharyngeal squamous cell carcinoma. However, there was no significant difference in disease-free survival between surgical and medical treatment. CONCLUSION: No significant difference in disease-free survival between medical and surgical treatment suggests similar complete remission rates with both approaches. Patients receiving medical treatment had shorter overall survival, which may be due to complications from chemotherapy and radiotherapy. However, we cannot confirm this relationship based on the data provided by the São Paulo Cancer Center Foundation. Prospective studies are warranted to assess whether the lower overall survival rate in patients receiving medical treatment is secondary to complications from chemotherapy and radiotherapy. LEVEL OF EVIDENCE: 2C.

Secondary tracheoesophageal puncture with a flexible transillumination device: a new technique and its outcomes.

OBJECTIVES: This study aims to describe a new secondary tracheoesophageal puncture technique with voice prosthesis insertion under local anesthesia with a low-cost device and evaluate its outcome. METHODS: With a transoral flexible transillumination device of aluminum of 2.3 mm with fiberoptic light, the esophagus's anterior wall is visualized through the tracheostomy. A tracheoesophageal fistula is made with a blade and passed through the fistula. Then a bent trocar is introduced into the lumen using the device as a guidewire. Once in the lumen, a thin guide wire is passed through up to the mouth. The voice prosthesis is positioned with retrograde insertion. Then, the patient is discharged without hospitalization. RESULTS: 15 patients submitted to this technique had a successful surgical outcome. There were no complications as pneumothorax, esophageal perforation, bleeding, or hospitalization. CONCLUSION: The new device is feasible under local anesthesia.

Influence of bladder fullness on the detection of urinary tract obstruction by dynamic renal scintigraphy.

OBJECTIVE: To investigate the influence of bladder fullness on the diagnosis of urinary tract obstruction during dynamic renal scintigraphy with a diuretic stimulator. MATERIALS AND METHODS: We studied 82 kidneys in 82 patients submitted to dynamic renal scintigraphy with a diuretic stimulator. We compared the proportional elimination of the radiopharmaceutical 99mTc-DTPA from the kidneys before and after bladder emptying in post-diuretic images, classifying each image as representing an obstructed, indeterminate, or unobstructed kidney. RESULTS: The overall elimination of 99mTc-DTPA from the kidneys was 10.4% greater after bladder emptying than before. When the analysis was performed with a full bladder, we classified 40 kidneys as obstructed, 16 as indeterminate, and 26 as unobstructed. When the 40 kidneys classified as obstructed were analyzed after voiding, 11 were reclassified as indeterminate and 3 were reclassified as unobstructed. Of the 16 kidneys classified as indeterminate on the full-bladder images, 13 were reclassified as unobstructed after voiding. CONCLUSION: In dynamic renal scintigraphy with a diuretic stimulator, it is important to obtain images after voiding, in order to perform a reliable analysis of the proportional excretion of 99mTc-DTPA from the kidneys, avoiding possible false-positive results for urinary tract obstruction.

OBJETIVO: Verificar a influência da repleção vesical no diagnóstico da obstrução do trato urinário durante a cintilografia renal dinâmica com estímulo de diurético. MATERIAIS E MÉTODOS: Foram estudados, retrospectivamente, 82 rins de 82 pacientes submetidos a cintilografia renal dinâmica. Compararam-se as porcentagens de excreção do radiofármaco DTPA-99mTc pelos rins antes e após o esvaziamento vesical nas imagens pós-diurético, classificando-os como obstruídos, indeterminados ou não obstruídos. RESULTADOS: A avaliação da excreção do radiofármaco pelos rins mostrou que houve aumento de 10,4% na taxa de excreção global quando a bexiga foi esvaziada. Dos 82 rins estudados, 40 foram considerados obstruídos, 16 indeterminados e 26 como não obstruídos, na análise com a bexiga repleta. Na análise das imagens após micção, dos 40 classificados como obstruídos, 11 passaram a ser classificados como indeterminados e 3 como não obstruídos. Além disso, dos 16 rins apontados como indeterminados nas imagens com a bexiga repleta, 13 passaram a ser considerados não obstruídos com a bexiga vazia. CONCLUSÃO: É fundamental uma imagem após a micção na cintilografia renal dinâmica para uma análise fidedigna da porcentagem de excreção do radiofármaco pelo rim, evitando-se possíveis falso-positivos para obstrução do trato urinário.

Influence of bladder fullness on the detection of urinary tract obstruction by dynamic renal scintigraphy / Influência da repleção vesical na pesquisa de obstrução do trato urinário utilizando cintilografia renal dinâmica

Abstract Objective: To investigate the influence of bladder fullness on the diagnosis of urinary tract obstruction during dynamic renal scintigraphy with a diuretic stimulator. Materials and methods: We studied 82 kidneys in 82 patients submitted to dynamic renal scintigraphy with a diuretic stimulator. We compared the proportional elimination of the radiopharmaceutical 99mTc-DTPA from the kidneys before and after bladder emptying in post-diuretic images, classifying each image as representing an obstructed, indeterminate, or unobstructed kidney. Results: The overall elimination of 99mTc-DTPA from the kidneys was 10.4% greater after bladder emptying than before. When the analysis was performed with a full bladder, we classified 40 kidneys as obstructed, 16 as indeterminate, and 26 as unobstructed. When the 40 kidneys classified as obstructed were analyzed after voiding, 11 were reclassified as indeterminate and 3 were reclassified as unobstructed. Of the 16 kidneys classified as indeterminate on the full-bladder images, 13 were reclassified as unobstructed after voiding. Conclusion: In dynamic renal scintigraphy with a diuretic stimulator, it is important to obtain images after voiding, in order to perform a reliable analysis of the proportional excretion of 99mTc-DTPA from the kidneys, avoiding possible false-positive results for urinary tract obstruction.

Resumo Objetivo: Verificar a influência da repleção vesical no diagnóstico da obstrução do trato urinário durante a cintilografia renal dinâmica com estímulo de diurético. Materiais e métodos: Foram estudados, retrospectivamente, 82 rins de 82 pacientes submetidos a cintilografia renal dinâmica. Compararam-se as porcentagens de excreção do radiofármaco DTPA-99mTc pelos rins antes e após o esvaziamento vesical nas imagens pós-diurético, classificando-os como obstruídos, indeterminados ou não obstruídos. Resultados: A avaliação da excreção do radiofármaco pelos rins mostrou que houve aumento de 10,4% na taxa de excreção global quando a bexiga foi esvaziada. Dos 82 rins estudados, 40 foram considerados obstruídos, 16 indeterminados e 26 como não obstruídos, na análise com a bexiga repleta. Na análise das imagens após micção, dos 40 classificados como obstruídos, 11 passaram a ser classificados como indeterminados e 3 como não obstruídos. Além disso, dos 16 rins apontados como indeterminados nas imagens com a bexiga repleta, 13 passaram a ser considerados não obstruídos com a bexiga vazia. Conclusão: É fundamental uma imagem após a micção na cintilografia renal dinâmica para uma análise fidedigna da porcentagem de excreção do radiofármaco pelo rim, evitando-se possíveis falso-positivos para obstrução do trato urinário.