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1.
Head Face Med ; 17(1): 34, 2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34399796

RESUMO

OBJECTIVE: To investigate the predictability of ophthalmic artery involvement in maxillary sinus cancer using preprocedural contrast enhanced CT and MRI. METHODS: We analyzed advanced (T3, T4a, and T4b) primary maxillary sinus squamous cell carcinoma treated with super-selective intra-arterial cisplatin infusion and concomitant radiotherapy (RADPLAT) from Oct 2016 to Mar 2020. Two diagnostic radiologists evaluated the tumor invasion site around the maxillary sinus using preprocedural imaging. These results were compared with the angiographic involvement of the ophthalmic artery using statistical analyses. We also evaluated our RADPLAT quality using complication rate, response to treatment, local progressive free survival (LPFS), and overall survival (OS). RESULTS: Twenty patients were included in this study. There were ten cases of ophthalmic artery tumor stain and there was a correlation between ophthalmic artery involvement and invasion for ethmoid sinus with statistically significant differences. Other imaging findings were not associated with ophthalmic artery involvement. CONCLUSIONS: Ethmoid sinus invasion on preprocedural imaging could suggest ophthalmic artery involvement in maxillary sinus cancer. It may be useful in predicting prognosis and treatment selection.


Assuntos
Antineoplásicos , Carcinoma de Células Escamosas , Neoplasias do Seio Maxilar , Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia , Cisplatino/uso terapêutico , Humanos , Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/terapia
3.
J Med Case Rep ; 15(1): 438, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34452644

RESUMO

BACKGROUND: Spindle cell squamous cell carcinoma is an uncommon variant of squamous cell carcinoma; its diagnosis is sometimes challenging because it histopathologically resembles neoplastic or reactive spindle cell lesions of mesenchymal origins. Here, we report a rare case of spindle cell squamous cell carcinoma exhibiting prominent neutrophil phagocytosis. CASE PRESENTATION: A 69-year-old Japanese man presented with pain and a polypoid mass on the lower left gingiva. He had received chemoradiotherapy for squamous cell carcinoma of the buccal mucosa 15 years prior to this consultation. In addition, he was treated for mandibular osteonecrosis 6 years after chemoradiotherapy without evidence of cancer recurrence. A biopsy revealed atypical spindle or pleomorphic cells scattered in the edematous and fibrin-rich stroma; however, no malignant squamous components were apparent. These atypical cells frequently contained neutrophils within their cytoplasm that formed cell-in-cell figures. Immunohistochemically, the atypical cells were negative for cytokeratins, epithelial membrane antigen, and E-cadherin, but positive for p63, vimentin, and p53. Although these findings suggested spindle cell squamous cell carcinoma, it was difficult to reach a definitive diagnosis. Based on a clinical diagnosis of a malignant tumor, the patient underwent a hemimandibulectomy. The surgically resected specimen had a typical spindle cell squamous cell carcinoma histology consisting of biphasic spindle cells and conventional squamous cell carcinoma components. Moreover, the surgical specimen also exhibited spindle tumor cells that frequently included neutrophils, around which intense staining for lysosomal-associated membrane protein 1 and cathepsin B was observed. This suggested that the cell-in-cell figures represent active neutrophil phagocytosis by tumor cells, and not emperipolesis. CONCLUSION: The presence of neutrophil phagocytosis may be a potent indicator of malignancy.


Assuntos
Carcinoma de Células Escamosas , Neutrófilos , Idoso , Carcinoma de Células Escamosas/terapia , Humanos , Masculino , Recidiva Local de Neoplasia , Fagocitose , Vimentina
4.
Oncology ; 99(9): 547-554, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34237725

RESUMO

PURPOSE: Esophageal cancer patients may simultaneously have resectable esophageal cancer and undiagnosable incidental minute solid pulmonary nodules. While the latter is rarely metastatic, only a few studies have reported on the outcomes of such nodules after surgery. In this retrospective study, we assessed the incidence of such nodules, the probability that they are ultimately metastatic nodules, and the prognosis of patients after esophagectomy according to the metastatic status of the nodules. METHODS: Data of 398 patients who underwent esophagectomy for resectable esophageal cancer between January 2012 and December 2016 were collected. We reviewed computed tomography (CT) images from the first visit and searched for incidental minute pulmonary nodules <10 mm in size. We followed the outcomes of these nodules and compared the characteristics of metastatic and nonmetastatic nodules. We also assessed the prognosis of patients whose minute pulmonary nodules were metastatic. RESULTS: Among the patients who underwent esophagectomy, 149 (37.4%) had one or more minute pulmonary nodules, with a total of 285 nodules. Thirteen (4.6%) of these nodules in 12 (8.1%) patients were ultimately diagnosed as being metastatic. Thirteen (8.7%) patients experienced recurrence at a different location from where the nodules were originally identified. Characteristics of the metastatic nodules were not unique in terms of size, SUVmax, or location in the lungs. Two-year and 5-year overall survival rates of patients whose nodules were metastatic were 64.2 and 32.1%, respectively. CONCLUSION: The rate of minute pulmonary nodules which were ultimately metastatic was 4.6%. Our findings suggest that esophagectomy followed by the identification of minute pulmonary nodules is an acceptable strategy even if the nodules cannot be diagnosed as being metastatic on the first visit CT due to their small size.


Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/patologia , Achados Incidentais , Neoplasias Pulmonares/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/terapia , Esofagectomia/métodos , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Tomografia Computadorizada por Raios X
5.
Acta Otorhinolaryngol Ital ; 41(3): 221-229, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34264915

RESUMO

Objective: To report outcome and predictive factors in patients with N3 (> 6 cm) non-metastatic locally advanced head and neck squamous cell carcinoma (LAHNSCC) treated with a conservative approach or with initial surgery. Methods: 104 patients were included: 69 treated with radiotherapy (RT) ± chemotherapy (CT) and 35 with nodal surgery with or without primary tumour resection, which was completed in 30 patients by adjuvant RT ± CT. Positron-emission tomography-computed tomography (PET-CT) guided surveillance after RT ± CT was standard. Results: Two-year overall survival (OS) and locoregional control (LRC) were 39.4% and 37.5%, respectively. In univariate analysis, body mass index (BMI), performance status (PS), p16 status and haemoglobin value influenced OS and disease-free survival (DFS). In multivariate analysis, p16 positive status and BMI ≥ 25 remained independent prognostic factors for better OS (p = 0.023) and DFS (p = 0.002). Only under/normal weight remained an independent and adverse significant prognostic factor in multivariate analysis for regional control (RC). Patients treated with primary RT ± CT had slightly better 2-year OS (43.5% versus 33.3%, p = 0.31). Conclusions: Patients with N3 LAHNSCC have poor prognosis, but long term LRC is achievable, especially in overweight patients and those with a good PS.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia
6.
Int J Mol Sci ; 22(13)2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34203211

RESUMO

Sinonasal squamous cell carcinoma (SNSCC) is an aggressive tumor predominantly arising in the maxillary sinus and nasal cavities. Advances in imaging, surgical and radiotherapeutic techniques have reduced complications and morbidity; however, the prognosis generally remains poor, with an overall 5-year survival rate of 30-50%. As immunotherapy may be a new therapeutic option, we analyzed CD8+ tumor-infiltrating lymphocytes (TILs) and the tumor microenvironment immune type (TMIT, combining CD8+ TILs and PD-L1) in a series of 57 SNSCCs. Using immunohistochemistry, tissue samples of 57 SNSCCs were analyzed for expression of CD8 on TILs and of PD-L1 on tumor cells. The results were correlated to the clinical and survival data. In total, 88% (50/57) of the tumors had intratumoral CD8+ TILs; 19% (11/57)-CD8high (>10%); and 39/57 (68%)-CD8low (1-10%). PD-L1 positivity (>5%) was observed in 46% (26/57) of the SNSCCs and significantly co-occurred with CD8+ TILs (p = 0.000). Using univariate analysis, high intratumoral CD8+ TILs and TMIT I (CD8high/PD-L1pos) correlated with a worse survival rate. These results indicate that SNSCCs are immunogenic tumors, similar to head and neck squamous cell carcinomas. Nineteen percent of the cases were both CD8high and PD-L1pos and this subgroup may benefit from therapy with immune checkpoint inhibitors.


Assuntos
Antígeno B7-H1/metabolismo , Linfócitos T CD8-Positivos/metabolismo , Carcinoma de Células Escamosas/imunologia , Carcinoma de Células Escamosas/metabolismo , Linfócitos do Interstício Tumoral/metabolismo , Antígeno B7-H1/genética , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Imunoterapia , Estimativa de Kaplan-Meier , Masculino , Prognóstico
7.
BMJ Case Rep ; 14(7)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253530

RESUMO

Corneal ocular surface squamous neoplasia usually begins at the limbus and presents as an avascular translucent sheet over the corneal surface. This case report describes a 67-year-old man with an unusual isolated, keratinous nodular corneal lesion. Slit-lamp examination showed an elevated, avascular, whitish plaque-like lesion at the central cornea surrounded by a normal corneal epithelium, with reduced visual acuity of 20/200 in the right eye. Anterior segment optical coherence tomography displayed a hyper-reflective, thickened epithelium with back shadowing. Histopathology showed keratinising hyperplastic stratified squamous epithelium with parakeratosis and moderate nuclear pleomorphism in lower second/third of epithelium suggestive of moderate dysplasia. His visual acuity returned to 20/20 after surgical excision but he developed multifocal corneal recurrences 6 weeks later, which were successfully managed with seven cycles of topical interferon immunotherapy. There are no recurrences observed at 6 months of follow-up.


Assuntos
Carcinoma de Células Escamosas , Doenças da Córnea , Neoplasias Oculares , Idoso , Carcinoma de Células Escamosas/terapia , Córnea , Doenças da Córnea/terapia , Neoplasias Oculares/terapia , Humanos , Masculino , Recidiva Local de Neoplasia , Tomografia de Coerência Óptica
8.
Acta Derm Venereol ; 101(8): adv00523, 2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34230977

RESUMO

Epidermolysis bullosa (EB), notably severe recessive dystrophic EB (RDEB-S), is associated with increased risk of aggressive mucocutaneous squamous cell carcinomas, the major cause of mortality in early adulthood. This observational, retrospective case review describes a series of EB patients with cutaneous squamous cell carcinomas over a 28-year period. Forty-four EB patients with squamous cell carcinomas were identified with a total of 221 primary tumours. They comprised: 31 (70%) with RDEB-S, 4 (9%) with other RDEB subtypes, 5 (11.4%) with dominant dystrophic EB, 3 (6.8%) with intermediate junctional EB and 1 (2.3%) with Kindler EB. Squamous cell carcinomas occurred earlier in RDEB-S (median age 29.5 years; age range 13-52 years) than other groups collectively (median age 47.1 years; age range 30-89 years) and most had multiple tumours (mean 5.8; range 1-44). Squamous cell carcinoma-associated mortality was high in RDEB-S (64.5%), with median survival after first squamous cell carcinoma of 2.4 years (range 0.5-12.6 years), significantly lower than previous reports, highlighting the need for early surveillance and better treatments.


Assuntos
Carcinoma de Células Escamosas , Epidermólise Bolhosa Distrófica , Epidermólise Bolhosa , Neoplasias Cutâneas , Adolescente , Adulto , Carcinoma de Células Escamosas/terapia , Epidermólise Bolhosa Distrófica/complicações , Epidermólise Bolhosa Distrófica/diagnóstico , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
9.
Head Neck ; 43(9): 2822-2843, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34096664

RESUMO

Standard of care for high-risk cutaneous squamous cell carcinoma (cSCC) is surgical excision of the primary lesion with clear margins when possible, and additional resection of positive margins when feasible. Even with negative margins, certain high-risk factors warrant consideration of adjuvant therapy. However, which patients might benefit from adjuvant therapy is unclear, and supporting evidence is conflicting and limited to mostly small retrospective cohorts. Here, we review literature from the last decade regarding adjuvant radiation therapy and systemic therapy in high-risk cSCC, including recent and current trials and the role of immune checkpoint inhibitors. We demonstrate evidence gaps in adjuvant therapy for high-risk cSCC and the need for prognostic tools, such as gene expression profiling, to guide patient selection. More large-cohort clinical studies are needed for collecting high-quality, evidence-based data for determining which patients with high-risk cSCC may benefit from adjuvant therapy and which therapy is most appropriate for patient management.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Cutâneas , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Humanos , Margens de Excisão , Estudos Retrospectivos , Neoplasias Cutâneas/terapia
10.
Head Neck ; 43(9): 2844-2858, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34117666

RESUMO

Hemorrhage in recurrent and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) may be attributed to chemotherapy and local tumor irradiation. Evidence of the relationship between hemorrhage in R/M HNSCC and targeted therapies, including epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) inhibitors, or immune checkpoint inhibitors, is limited. We aimed to identify epidemiological and clinical data related to the occurrence of hemorrhage in R/M HNSCC and to explore its relationship with various therapies. We describe information obtained from literature searches as well as data extracted from a commercial database and a database from the author's institution (Istituto Nazionale dei Tumori of Milan). Evidence suggests that most bleeding events in R/M HNSCC are minor. Clinical trial safety data do not identify a causal association between hemorrhage and anti-EGFR agents or immune checkpoint inhibitors. In contrast, anti-VEGF agents are associated with increased, and often severe/fatal, hemorrhagic complications.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Recidiva Local de Neoplasia , Carcinoma de Células Escamosas de Cabeça e Pescoço , Fator A de Crescimento do Endotélio Vascular
11.
Br J Dermatol ; 184(6): e196-e223, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34091895

RESUMO

Linked Article: Reynolds et al. Br J Dermatol 2021; 184:1113-1122. Squamous cell carcinoma (SCC) of the skin is the second most common skin cancer. Over half a million cases are diagnosed in the USA and UK each year. There are several ways to treat SCC of the skin, including different types of medications and surgery. To better understand the best methods for treating SCC of the skin, researchers can conduct clinical trials, which are experiments that compare the success of different treatments in humans. In clinical trials, treatment success is measured by looking at 'outcomes', or seeing how patients did in different ways. Our purpose was to find out which outcomes are most important to measure in all clinical trials of SCC and therefore should be part of a 'core outcome set' used by all researchers who study SCC of the skin. We worked with an international group of 44 experts and patients, and found seven important core outcomes. Some of these outcomes were patient quality of life, the side-effects of treatment and if the cancer is completely or partially gone after treatment. As researchers start using this core outcome set for skin SCC, it will be easier to compare the results of clinical trials of SCC treatment because they will all be measuring at least these same seven outcomes. By comparing the results of these outcomes, we will better understand which treatments are most successful for SCC.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Cutâneas , Carcinoma de Células Escamosas/terapia , Humanos , Qualidade de Vida , Pele , Neoplasias Cutâneas/terapia , Resultado do Tratamento
12.
Medicina (Kaunas) ; 57(5)2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34062896

RESUMO

Background and Objectives: Oral cancer is the 6th most common cancer in the world and oral leukoplakia is an oral potentially malignant disorder that could develop into oral cancer. This systematic review focusses on randomized clinical trials for recombinant adenovirus p-53 (rAD-p53) therapy for the treatment of oral leukoplakia and cancer. Materials and Methods: We searched for research articles on various databases such as Pubmed/Medline, Embase, CNKI (China National Knowledge Infra-structure), Springerlink, cochrane and Web of sciences from 2003 to 2020. MeSH (Medical Subject Headings) terms were used for the search. Inclusion criteria included original research, randomized clinical trials and articles only in English language. Exclusion criteria were any articles that were not research articles, not randomized trials, non-human studies, etc. The articles were further graded on the Jadad scale. Results: 578 articles were assessed from various databases; only 3 articles were found to be appropriate for this review. Thus, meta-analysis was not performed because of heterogeneity and lack of data. In the three studies, whether rAD-p53 was used as a standalone therapy or with other therapies, there was a beneficial effect of the therapy. Furthermore, there were no serious adverse events and the only adverse events reported were fever, pain at the local injection site, flu-like symptoms and lowered WBC count. Conclusions: Thus, we can conclude that this therapy has a potential for beneficial therapeutic effects and further clinical trials with more patients need to be performed to get better understanding of the effect of rAD-p53 therapy, which probably will pave the way to its approval in other parts of the world.


Assuntos
Adenovírus Humanos , Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Carcinoma de Células Escamosas/terapia , China , Humanos , Leucoplasia Oral/terapia , Neoplasias Bucais/terapia , Carcinoma de Células Escamosas de Cabeça e Pescoço , Proteína Supressora de Tumor p53
13.
Viruses ; 13(5)2021 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-34069114

RESUMO

The incidence of Human-papillomavirus-positive (HPV+) tonsillar and base-of-tongue squamous cell carcinoma (TSCC and BOTSCC, respectively) is increasing epidemically, but they have better prognosis than equivalent HPV-negative (HPV-) cancers, with roughly 80% vs. 50% 3-year disease-free survival, respectively. The majority of HPV+ TSCC and BOTSCC patients therefore most likely do not require the intensified chemoradiotherapy given today to head and neck cancer patients and would with de-escalated therapy avoid several severe side effects. Moreover, for those with poor prognosis, survival has not improved, so better-tailored alternatives are urgently needed. In line with refined personalized medicine, recent studies have focused on identifying predictive markers and driver cancer genes useful for better stratifying patient treatment as well as for targeted therapy. This review presents some of these endeavors and briefly describes some recent experimental progress and some clinical trials with targeted therapy.


Assuntos
Biomarcadores Tumorais , Carcinoma de Células Escamosas/etiologia , Oncogenes , Infecções por Papillomavirus/complicações , Neoplasias da Língua/etiologia , Neoplasias Tonsilares/etiologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/metabolismo , Carcinoma de Células Escamosas/terapia , Transformação Celular Neoplásica/genética , Transformação Celular Viral , Expressão Gênica , Humanos , Imuno-Histoquímica , Terapia de Alvo Molecular , Mutação , Infecções por Papillomavirus/virologia , Prognóstico , Inibidores de Proteínas Quinases/farmacologia , Inibidores de Proteínas Quinases/uso terapêutico , Neoplasias da Língua/diagnóstico , Neoplasias da Língua/metabolismo , Neoplasias da Língua/terapia , Neoplasias Tonsilares/diagnóstico , Neoplasias Tonsilares/metabolismo , Neoplasias Tonsilares/terapia , Resultado do Tratamento
14.
Artif Intell Med ; 115: 102060, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34001326

RESUMO

BACKGROUND: Oral cancer can show heterogenous patterns of behavior. For proper and effective management of oral cancer, early diagnosis and accurate prediction of prognosis are important. To achieve this, artificial intelligence (AI) or its subfield, machine learning, has been touted for its potential to revolutionize cancer management through improved diagnostic precision and prediction of outcomes. Yet, to date, it has made only few contributions to actual medical practice or patient care. OBJECTIVES: This study provides a systematic review of diagnostic and prognostic application of machine learning in oral squamous cell carcinoma (OSCC) and also highlights some of the limitations and concerns of clinicians towards the implementation of machine learning-based models for daily clinical practice. DATA SOURCES: We searched OvidMedline, PubMed, Scopus, Web of Science, and Institute of Electrical and Electronics Engineers (IEEE) databases from inception until February 2020 for articles that used machine learning for diagnostic or prognostic purposes of OSCC. ELIGIBILITY CRITERIA: Only original studies that examined the application of machine learning models for prognostic and/or diagnostic purposes were considered. DATA EXTRACTION: Independent extraction of articles was done by two researchers (A.R. & O.Y) using predefine study selection criteria. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) in the searching and screening processes. We also used Prediction model Risk of Bias Assessment Tool (PROBAST) for assessing the risk of bias (ROB) and quality of included studies. RESULTS: A total of 41 studies were published to have used machine learning to aid in the diagnosis/or prognosis of OSCC. The majority of these studies used the support vector machine (SVM) and artificial neural network (ANN) algorithms as machine learning techniques. Their specificity ranged from 0.57 to 1.00, sensitivity from 0.70 to 1.00, and accuracy from 63.4 % to 100.0 % in these studies. The main limitations and concerns can be grouped as either the challenges inherent to the science of machine learning or relating to the clinical implementations. CONCLUSION: Machine learning models have been reported to show promising performances for diagnostic and prognostic analyses in studies of oral cancer. These models should be developed to further enhance explainability, interpretability, and externally validated for generalizability in order to be safely integrated into daily clinical practices. Also, regulatory frameworks for the adoption of these models in clinical practices are necessary.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Inteligência Artificial , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Humanos , Aprendizado de Máquina , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/terapia , Carcinoma de Células Escamosas de Cabeça e Pescoço
15.
Head Neck ; 43(9): 2705-2711, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34019319

RESUMO

BACKGROUND: Regional metastasis of head and neck cutaneous squamous cell carcinoma (HNcSCC) can be seen in either parotid and/or cervical lymph nodes. The aim of this study was to assess whether there was a difference in prognosis between parotid and cervical nodal metastases. METHODS: Patients with regional metastasis from HNcSCC were identified from an institutional database. Disease-specific (DSS) and overall survival (OS) were calculated using the Kaplan-Meier method and Cox proportional hazards models. RESULTS: Five hundred and thirty-five patients were identified with median follow-up of 26.4 months (3-255 months). Two hundred and thirty-five patients had parotid metastasis, 96 patients had neck metastasis, and 204 patients had both. On multivariable analysis, any regional metastasis to the neck when compared to parotid alone conferred worse DSS (HR 1.8, p = 0.007) and OS (HR 1.3, p = 0.024). CONCLUSION: Regional metastasis of HNcSCC to the neck confers worse outcomes compared to metastasis to the parotid alone.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Cutâneas , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Linfonodos/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço
18.
BMC Cancer ; 21(1): 484, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933005

RESUMO

BACKGROUND: The assessment of retroperitoneal lymph node status in patients with locally advanced cervical cancer is still a problem. This study aimed to explore the choice of these assessment methods. METHODS: Laparoscopic retroperitoneal lymphadenectomy was performed in 96 patients with advanced cervical cancer. The positive rates of lymph node metastasis were analyzed. The values of computed tomography lymph node minimum axial diameter (MAD) and squamous cell carcinoma antigen (SCC-Ag), and their combination in predicting retroperitoneal lymph node metastasis were compared. High-risk factors for common iliac lymph node (CILN) and/or para-aortic lymph node (PALN) metastasis were analyzed. RESULTS: The lymph node metastasis rate was 62.50% and the CILN and/or PALN metastasis rate was 31.25%. Overall, 96 patients had 172 visible lymph nodes. The positive rate of lymph node metastasis was significantly higher in the MAD ≥1.0 cm group (83.33%) than in the 0.5 cm ≤ MAD < 1.0 cm group (26.82%). The critical values of MAD and SCC-Ag in determining lymph node metastasis were 1.0 cm and 5.2 ng/mL, respectively. The accuracy, specificity, and Youden index of MAD ≥1.0 cm combined with SCC-Ag ≥ 5.2 ng/mL for evaluating lymph node metastasis were 75.71%, 100%, and 0.59, respectively, and were significantly different from the values for the MAD ≥1.0 cm (72.09%, 80.56%, and 0.47, respectively) and SCC-Ag ≥ 5.2 ng/mL (71.43%, 68.97%, and 0.42, respectively) groups. Correlation analysis showed that non-squamous cell carcinoma, pelvic lymph node (PLN) MAD ≥1.0 cm plus number ≥ 2, and 1 PLN MAD ≥1.0 cm with CILN and/or PALN MAD 0.5-1.0 cm were risk factors for CILN and/or PALN metastasis. CONCLUSION: Patients with MAD ≥1.0 cm and SCC-Ag ≥ 5.2 ng/mL, as well as high risk factors for CILN and/or PALN metastasis, should undergo resection of enlarged lymph nodes below the common iliac gland and lymphadenectomy of CILN/PALN to reduce tumor burden and to clarify lymph node metastasis status for accurate guidance in follow-up treatment. Patients with MAD < 1.0 cm and SCC-Ag < 5.2 ng/mL may be treated with chemoradiotherapy directly based on imaging, given the low lymph node metastasis rate.


Assuntos
Linfonodos/patologia , Metástase Linfática/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Antígenos de Neoplasias/sangue , Área Sob a Curva , Carcinoma/sangue , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Carcinoma/terapia , Carcinoma de Células Escamosas/sangue , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Laparoscopia , Excisão de Linfonodo/métodos , Linfonodos/diagnóstico por imagem , Linfonodos/imunologia , Pessoa de Meia-Idade , Radioterapia de Intensidade Modulada , Espaço Retroperitoneal , Fatores de Risco , Sensibilidade e Especificidade , Serpinas/sangue , Tomografia Computadorizada Espiral , Neoplasias do Colo do Útero/sangue , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/terapia , Adulto Jovem
19.
JCO Oncol Pract ; 17(5): e695-e702, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33974822

RESUMO

PURPOSE: Human papilloma virus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC), diagnosed with p16 immunohistochemistry, is associated with favorable prognosis; however, this connection was established using European American (EA)-skewed populations. The impact of p16/human papillomavirus status on outcomes in African American (AA) OPSCC patients remains to be settled. In this study, we determine the association between cancer disparity and p16 status in an OPSCC cohort controlling for time to treatment initiation (TTI), a surrogate for medical care access. MATERIALS AND METHODS: We analyzed data from all patients diagnosed with OPSCC (N = 440) between 2010 and 2017, who received treatment at our academic medical center. Associations between age, disease stage, sex, p16 status, race, TTI, and overall survival (OS) were investigated. RESULTS: TTI was similar between AA and EA OPSCC patients in our p16+ (P = .291) or p16- (P = .715) cohorts. Among p16+ OPSCC patients, the median OS was > 8.65 years for EA patients compared with 5.038 years (95% CI, 2.019 to 5.30; P = .003, log-rank) for AA patients. For p16- patients, the median OS was 5.74 years (95% CI, 3.32 to 6.99) for EA patients and 1.85 years (95% CI, 0.978 to 4.50; P = .03, log-rank) for AA patients. Multivariate Cox regression analysis showed that race was an independent prognostic biomarker and the most impactful co-variate for OS (hazard ratio, 0.40; 95% CI, 0.00 to 0.69; P = .001). CONCLUSION: Our work showed that AAs with p16+ OPSCC have surprisingly poor clinical outcomes and are thus poor candidates for treatment de-escalation regimens. Caution should be exercised when extending clinical guidelines based on EA-majority studies to non-EA populations.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Orofaríngeas , Infecções por Papillomavirus , Afro-Americanos , Carcinoma de Células Escamosas/terapia , Humanos , Neoplasias Orofaríngeas/terapia , Carcinoma de Células Escamosas de Cabeça e Pescoço , Resultado do Tratamento
20.
J Transl Med ; 19(1): 222, 2021 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-34030694

RESUMO

BACKGROUND: The main limitation of current immune checkpoint inhibitors (ICIs) in the treatment of cervical cancer comes from the fact that it benefits only a minority of patients. The study aims to develop a classification system to identify immune subtypes of cervical squamous cell carcinoma (SCC), thereby helping to screen candidates who may respond to ICIs. METHODS: A real-world cervical SCC cohort of 36 samples were analyzed. We used a nonnegative matrix factorization (NMF) algorithm to separate different expression patterns of immune-related genes (IRGs). The immune characteristics, potential immune biomarkers, and somatic mutations were compared. Two independent data sets containing 555 samples were used for validation. RESULTS: Two subtypes with different immunophenotypes were identified. Patients in sub1 showed favorable progression-free survival (PFS) and overall survival (OS) in the training and validation cohorts. The sub1 was remarkably related to increased immune cell abundance, more enriched immune activation pathways, and higher somatic mutation burden. Also, the sub1 group was more sensitive to ICIs, while patients in the sub2 group were more likely to fail to respond to ICIs but exhibited GPCR pathway activity. Finally, an 83-gene classifier was constructed for cervical SCC classification. CONCLUSION: This study establishes a new classification to further understand the immunological diversity of cervical SCC, to assist in the selection of candidates for immunotherapy.


Assuntos
Carcinoma de Células Escamosas , Neoplasias do Colo do Útero , Biomarcadores Tumorais , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Fatores Imunológicos , Imunoterapia , Prognóstico , Neoplasias do Colo do Útero/terapia
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