Association between ambient exposure to PM2.5 and upper aerodigestive tract cancer in Los Angeles.

Fine particulate matter (PM2.5 ) contains carcinogens similar to those generated by tobacco smoking, which may increase the risks of developing smoking-related cancers, such as upper aerodigestive track (UADT) cancers, for both smokers and never-smokers. Therefore, it is imperative to understand the relation between ambient PM2.5 exposure and risk of UADT cancers. A population-based case-control study involving 565 incident UADT cancer cases and 983 controls was conducted in Los Angeles County from 1999 to 2004. The average residential PM2.5 concentration 1 year before the diagnosis date for cases and the reference date for controls was assessed using a chemical transport model. The association between ambient PM2.5 and the UADT cancers was estimated by unconditional logistic regression, adjusting for confounders at the individual and block-group level. Stratified analyses were conducted by sex, tobacco smoking status and UADT subsites. We also assessed the interaction between PM2.5 and tobacco smoking on UADT cancers. PM2.5 concentrations were associated with an elevated odds of UADT cancers (adjusted odds ratio = 1.21 per interquartile range [4.5 µg/m3 ] increase; 95% confidence interval: 1.02, 1.44). The association between PM2.5 and UADT cancers was similar across UADT subsites, sex and tobacco smoking status. The interaction between PM2.5 and tobacco smoking on UADT cancers was approximately additive on the odds scale. The effect estimate for PM2.5 and UADT cancers was similar among never smokers. Our findings support the hypothesis that exposure to PM2.5 increases the risk of UADT cancers. Improvements in air quality may reduce the risk of UADT cancers.

Sociodemographic reporting in videomics research: a review of practices in otolaryngology - head and neck surgery.

OBJECTIVE: To assess reporting practices of sociodemographic data in Upper Aerodigestive Tract (UAT) videomics research in Otolaryngology-Head and Neck Surgery (OHNS). STUDY DESIGN: Narrative review. METHODS: Four online research databases were searched for peer-reviewed articles on videomics and UAT endoscopy in OHNS, published since January 1, 2017. Title and abstract search, followed by a full-text screening was performed. Dataset audit criteria were determined by the MINIMAR reporting standards for patient demographic characteristics, in addition to gender and author affiliations. RESULTS: Of the 57 studies that were included, 37% reported any sociodemographic information on their dataset. Among these studies, all reported age, most reported sex (86%), two (10%) reported race, and one (5%) reported ethnicity and socioeconomic status. No studies reported gender. Most studies (84%) included at least one female author, and more than half of the studies (53%) had female first/senior authors, with no significant differences in the rate of sociodemographic reporting in studies with and without female authors (any female author: p = 0.2664; first/senior female author: p > 0.9999). Most studies based in the US reported at least one sociodemographic variable (79%), compared to those in Europe (24%) and in Asia (20%) (p = 0.0012). The rates of sociodemographic reporting in journals of different categories were as follows: clinical OHNS: 44%, clinical non-OHNS: 40%, technical: 42%, interdisciplinary: 10%. CONCLUSIONS: There is prevalent underreporting of sociodemographic information in OHNS videomics research utilizing UAT endoscopy. Routine reporting of sociodemographic information should be implemented for AI-based research to help minimize algorithmic biases that have been previously demonstrated.

Upper Aerodigestive Tract Endoscopy Combining Rigid Laryngoscopy and Flexible Endoscopy.

Upper Aerodigestive Tract Endoscopy (UATE) is recommended for initial examination of head and neck squamous cell carcinomas. Reducing delay of initial examination must be a challenge to manage head and neck cancers. We hereby describe the technic combining UATE and flexible endoscopy in a unique general anesthesia with overview of hypopharyngeal, larygeal, tracheal, esophageal, nasopharyngeal sub sites in a unique procedure with system of magnificense and to perform percutaneous gastrostomy during the same time before initiation of therapy.

Impact of surgical site infection on unplanned hospital readmissions, initiation of adjuvant treatment following surgery, and disease-free survival on patients with upper aerodigestive tract squamous cell carcinoma.

INTRODUCTION: Unplanned hospital readmission (UHR) is an important indicator of the quality of the healthcare system in place. It has various implications for the patients and the healthcare system at large. In this article, we have attempted to understand the various factors influencing UHR and the start of adjuvant treatment following cancer surgery. PATIENTS & METHODS: In this study adult patients above 18 years of age with upper aerodigestive tract squamous cell carcinoma who underwent surgery at our center between July 2019 to December 2019 were included in the study. Various factors influencing UHR and delay in receiving adjuvant treatment were analyzed. RESULTS: A total of 245 patients satisfied the inclusion criteria. Surgical site infection (SSI) was the factor that had the maximum influence on the UHR (p < 0.002, OR: 5.6, 95% CI: [1.911-16.4]) and delaying the start of adjuvant treatment (p = 0.008, OR: 3.786, 95% CI: [1.421-10.086]) on multivariate analysis. Surgery lasting for >4 h and patients who had received prior treatment tended to develop SSI postoperatively. The presence of SSI also seemed to have had a negative influence on disease-free survival (DFS) as well. CONCLUSIONS: SSI is an important postoperative complication having major implications in terms of increased UHR and delays in starting adjuvant treatment which in turn is reflected as a poorer DFS among patients who develop SSI postoperatively.

Opium, phencyclidine, and crack cocaine smoking associations with lung and upper aerodigestive tract cancers: exploratory findings from a case-control study in Los Angeles County.

Background: Illicit drug use has become a global epidemic, yet it is unclear if drug smoking increases the risk of tobacco-related cancers.Objectives: We aimed to evaluate hypothesized associations between smoking three drugs - opium, phencyclidine (PCP) and crack cocaine and lung and upper aerodigestive tract (UADT) cancers.Methods: A population-based case-control study with 611 lung cancer cases (50% male), 601 UADT cancers cases (76% male), and 1,040 controls (60% male) was conducted in Los Angeles County (1999-2004). Epidemiologic data including drug smoking histories were collected in face-to-face interviews. Associations were estimated with logistic regressions.Results: Adjusting for potential confounders, ever vs. never crack smoking was positively associated with UADT cancers (aOR = 1.56, 95% CI: 1.05, 2.33), and a dose-response relationship was observed for lifetime smoking frequency (p for trend = .024). Heavy (> median) vs. never crack smoking was associated with UADT cancers (aOR = 1.81, 95% CI: 1.07, 3.08) and lung cancer (aOR = 1.58, 95% CI: 0.88, 2.83). A positive association was also observed between heavy PCP smoking and UADT cancers (aOR = 2.29, 95% CI: 0.91, 5.79). Little or no associations were found between opium smoking and lung cancer or UADT cancers.Conclusion: The positive associations between illicit drug use and lung and/or UADT cancers suggest that smoking these drugs may increase the risk of tobacco-related cancers. Despite the low frequency of drug smoking and possible residual confounding, our findings may provide additional insights on the development of lung and UADT cancers.

Outcomes of comprehensive geriatric assessment and surgical management in head and neck cancers of the elderly: an observational study.

AIM: The aims of this study were to assess the survival benefit of optimal vs suboptimal management in elderly patients presenting with upper aerodigestive tract (UADT) cancer for which surgery was the standard of care, and determine if comprehensive geriatric assessment (CGA) was a prognostic factor for survival. MATERIALS AND METHODS: This single-center retrospective cohort study was conducted from January 2014 to December 2018. Included patients were aged 70 or older at the time of diagnosis, and presented with UADT cancer with a theoretical indication for curative-intent surgery according to international guidelines. RESULTS: A total of 188 patients were included, with a median age of 78 years. Treatment included surgery in 67.6% of cases and was considered optimal in 60.6% of patients. The overall 3-year survival was 55.2%, and was significantly better in case of optimal vs suboptimal treatment (74.5% vs 25.8%, p < 0.001). In univariate analysis, factors associated with a significantly improved 3-year survival included surgery (p < 0.001), age < 80 years, performance status < 2 and G8 score > 14. In multivariate analysis, CGA was associated with a better survival. CONCLUSIONS: In patients aged over 70 presenting with UADT cancer for which the standard of care is surgery, an optimal management is associated with better overall survival. Receiving a CGA seems to provide a survival benefit in patients with a G8 score ≤ 14, through an optimization of the care pathway before and after the cancer treatment.

Active upper aerodigestive tract hemorrhage in patients with head and neck cancers: the "dot-in-sludge" sign.

Active extravasation into the upper aerodigestive tract is a dramatic and potentially life-threatening complication in patients with head and neck cancers. It prompts presentation to the emergency room and subsequent urgent imaging to identify the source of hemorrhage. Imaging of these patients may be complicated by treatment-altered anatomy, posing a challenge to the emergency radiologist who needs to rapidly identify the presence of active hemorrhage and the potential source vessel. This retrospective review summarizes the clinical and imaging findings of 6 oropharyngeal and oral cavity squamous cell cancer (SCC) patients with active upper aerodigestive tract hemorrhage. Most patients had advanced stage disease and prior radiation therapy. All CECT or CTA exams on presentation demonstrated the "dot-in-sludge" sign of active extravasation, as demonstrated by a "dot" of avidly enhancing extravasated contrast material layered against a background "sludge" of non-enhancing debris in the lumen of the upper aerodigestive tract. Common sources of hemorrhage included the lingual, facial, and superior thyroidal arteries. Familiarity with these findings will help radiologists increase their accuracy and confidence in interpreting these urgent, complex examinations.

Fatal upper aerodigestive tract obstruction in an East Asian finless porpoise (Neophocaena asiaeorientalis sunameri): findings in post-mortem computed tomography.

The present case report aims to outline the post-mortem findings of an East Asian finless porpoise with upper aerodigestive tract obstruction using different post-mortem computed tomography (PMCT) visualization techniques and discusses the potential cause of death of this individual. A dead-stranded adult male East Asian finless porpoise was recovered from the Northern coast of Jeju Island, Republic of Korea. The carcass was frozen in Jeju National University within 2 h upon first reported. The PMCT examinations were performed at 120 kVp, 200 mAs with a section thickness of 1 mm. The scan field of view (sFOV) was set to 400 mm. Four image rendering techniques, including multi-planar reconstruction, three-dimensional volume rendering, perspective volume rendering, and minimum intensity projection technique, were used to aid the diagnosis of upper aerodigestive tract obstruction in the stranded finless porpoise. Conventional necropsy was performed to provide a complete necropsy report. Using PMCT, a Sebastidae of 24 cm measured length was found to be lodged in the left pharyngeal food channel and esophagus of the finless porpoise. Hard rays of the pectoral fin of the lodged fish have impaled the esophageal mucosa. Fishing gear was found to embed at the dorsal side of the lodged fish. The trachea was compressed ventrally and the arytenoepiglottic tube opening has been narrowed, which may precipitate to the finless porpoise difficult breathing. Pulmonary hyperinflation, pulmonary edema, pneumothorax, pneumopericardium, and pneumorrhachis were observed. This case report represents the first documentation of potential radiological indicators of upper aerodigestive tract obstruction in the East Asian finless porpoise using PMCT. Spatial location of the lodged item could be rendered in situ as the time of death. It has demonstrated that PMCT could provide objective measurements to adjunct the necropsy findings in diagnosis of fatal aerodigestive tract obstruction in stranded cetaceans.

A comparison of the efficacy of narrow band imaging and contact endoscopy in an early diagnosis of squamous malignancies of the upper aerodigestive tract.

Background: This study aims to compare the efficacy of narrow band imaging (NBI) endoscopy and contact endoscopy in early diagnosis of squamous malignancies of upper aerodigestive tract. Methods: This study was of 18 months duration, sample size 50, and carried out at tertiary care hospital. The patients were subjected initially to NBI endoscopy followed by contact endoscopy. Thereafter, the lesion was biopsied and subjected to histopathological examination as is done routinely. The images obtained were analyzed based on criteria proposed by earlier studies and compared with histopathological examination as gold standard. Results: The sensitivity, specificity, and negative predictive values of NBI in early diagnosis of squamous malignancies of upper aerodigestive tract were high and better than contact endoscopy. Conclusion: Endoscopic NBI is a noninvasive and promising tool used for in vivo differentiation between malignant and nonmalignant lesions of upper aerodigestive tract by using morphology of mucosal capillaries and is more efficacious than contact endoscopy. It can be employed as part of routine ENT examination in outpatient departments; however, it has got a learning curve associated with it.

COVID-VU - ENT-UK national survey of flexible nasendoscopy in the upper aerodigestive tract amidst the COVID-19 pandemic.

BACKGROUND: Flexible nasendoscopy (FNE) is an invaluable multi-disciplinary tool for upper aerodigestive tract (UADT) examination. During the COVID-19 pandemic concerns were raised that FNE had the potential of generating aerosols resulting in human cross-contamination when performed on SARS-COV2 carriers. In the UK, and other European countries, national guidelines were issued restricting FNE to essential cases. We surveyed ENT-UK members and Royal College of Speech and Language Therapists (RCSLT) members to determine the impact of the COVID-19 pandemic (first peak) on FNE practice in the UK. METHODS: An observational internet-based survey constructed in accordance to the CHERRIES checklist and setup in SurveyMonkey of FNE practice amongst UK-based ENT surgeons and speech and language therapists in community clinics, the outpatient department, inpatient wards, ICU, emergency department and operating theatres (through the NHS and private sector) prior to, during and following the first COVID-19 wave in the UK. RESULTS: 314 responses collected (24% response rate), 82% from ENT clinicians, 17% from SLTs and 1% from other allied healthcare professionals. Overall, there has been a large reduction in the volume and indications for FNE during the first peak of the COVID-19 pandemic with limited recovery by mid-August 2020. Cancer and airway assessments were impacted less. A wide range of FNE protocols influenced by local factors are reported, varying in endoscope preference, Personal Protective Equipment (PPE) and sterilization methods. Where dedicated Aerosol Generating Procedure (AGP) rooms were unavailable, clinicians resorted to window opening and variable room "down-time" between patients. Endoscope preference reflected availability and user familiarity, ENT trainees favoring the use of single-use video endoscopes. CONCLUSION: Despite national guidance, local practice of FNE remains interrupted and highly variable in the UK. A collaborative inter-disciplinary approach is required to re-introduce FNE safely in volume across healthcare settings, re-establishing timely endoscopic diagnosis and pre-pandemic levels of patient care.

Delayed Upper Aerodigestive Tract Perforation from Anterior Cervical Spine Hardware: Treatment and Swallowing Outcomes.

Delayed upper aerodigestive tract (UADT) perforation is a rare complication of anterior cervical spinal hardware. The purpose of this study was to investigate swallowing outcomes between treatment approaches for delayed UADT perforation. A retrospective chart review was performed on patients with anterior cervical hardware and delayed UADT perforation who were treated at a single tertiary care center between 2000 and 2020. Of the twelve patients identified, most patients presented with dysphagia (n = 9, 75%) and/or neck pain (n = 7, 58%). Perforations generally occurred at the level of C6 (n = 6, 50%) and C7 (n = 4, 33%) and spanned only one spinal level (n = 8, 67%). The majority (n = 8, 67%) of patients were past or current cigarette users. Operative approaches included primary repair (n = 5, 42%) and rotational flap (n = 4, 33%); the rotational flap harvest sites included supraclavicular fasciocutaneous (n = 2), infrahyoid muscle (n = 1), and sternocleidomastoid muscle (n = 1). While most patients demonstrated penetration and/or aspiration on first post-operative swallow study (n = 6), this resolved completely within a median time of 31 days. There were no differences in swallowing outcomes between repair approaches. Patient smoking history appears to be a clear risk factor for the development of delayed UADT perforation from anterior cervical spine hardware. A variety of techniques can be used to repair these perforations, and there were no differences in swallowing outcomes between repair approaches.

Learning Curve of Upper Aerodigestive Tract Foreign Body Management for Otorhinolaryngology Residents.

INTRODUCTION: Foreign body ingestion is the most common reason for otolaryngology specialist consultations in emergency departments. Among the different types of foreign bodies, fish bones are the most common, particularly in Asian populations. In Taiwan, upper aerodigestive tract foreign bodies (UADT-FBs) are mostly managed by residents in the otorhinolaryngology (ORL) department. Considering the learning curve required for all procedures, different management types between residents, and possible resulting safety issues, this study explored the outcomes of UADT-FB management by residents in different years of ORL training. MATERIALS AND METHODS: The medical records of 2,283 patients who visited Kaohsiung Veterans General Hospital's Emergency Department for UADT-FB during June 2013-August 2019 were retrospectively reviewed. The reviewed data included the demographic data of enrolled patients, outcomes of foreign body management, and follow-up chart records of the patients. RESULTS: Among the 2,283 patients, 1,324 (58%) were found to be negative for foreign bodies, and foreign bodies in 951 (41.7%) were removed immediately. In the negative finding (NF) group, 2 (4.9%) patients were later found to be positive for foreign bodies during follow-up in the outpatient department. One (2.4%) patient developed a deep neck infection and esophageal perforation. The percentage of NFs decreased from 62.58% in residents in the first half of their first year (R1a) to 54% for third-year residents (R3). Comparing R1a with R3, the number needed to harm for retained UADT-FBs after patients visited the emergency department was 12.2. DISCUSSION/CONCLUSION: This study provides data from 1 referral center regarding the management of UADT-FBs. With increasing resident training, the percentage of NFs declined from 62.58 to 54%. Young residents, especially those in the first 6 months of their training, should have senior residents perform a second examination if UADT-FBs are not found in suspected cases.

Aldehyde Accumulation in Aged Alcoholic Beer: Addressing Acetaldehyde Impacts on Upper Aerodigestive Tract Cancer Risks.

Aldehydes, particularly acetaldehyde, are carcinogenic molecules and their concentrations in foodstuffs should be controlled to avoid upper aerodigestive tract (UADT) and liver cancers. Highly reactive, acetaldehyde forms DNA and protein adducts, impairing physiological functions and leading to the development of pathological conditions. The consumption of aged beer, outside of the ethanol metabolism, exposes habitual drinkers to this carcinogen, whose concentrations can be over-increased due to post-brewing chemical and biochemical reactions. Storage-related changes are a challenge faced by the brewing industry, impacting volatile compound formation and triggering flavor instability. Aldehydes are among the volatile compounds formed during beer aging, recognized as off-flavor compounds. To track and understand aldehyde formation through multiple pathways during beer storage, consequent changes in flavor but particularly quality losses and harmful compound formation, this systematic review reunited data on volatile compound profiles through gas chromatography analyses from 2011 to 2021. Conditions to avoid flavor instability and successful methods for reducing beer staling, and consequent acetaldehyde accumulation, were raised by exploring the dynamic conversion between free and bound-state aldehydes. Future research should focus on implementing sensory analyses to investigate whether adding aldehyde-binding agents, e.g., cysteine and bisulfite, would contribute to consumer acceptance, restore beer flavor, and minimize acetaldehyde-related health damage.

Cancers of the Oral Cavity and Pharynx: 20-Year Comparative Survival and Mortality Analysis by Age, Sex, Race, Stage, Grade, Cohort Entry Time-Period and Disease Duration: A Systematic Review of 218,066 Cases for Diagnosis Years 1973-2014: (SEER*Stat 8.3.5).

This article summarizes the results of a retrospective population-based cohort study using the statistical database of SEER*Stat 8.3.54 (produced 3/5/2018 for diagnosis years 1973-2014) to assess, determine, compare, and summarize the occurrence, long-term survival, and mortality indices of 218,066 patients with oral cavity and pharynx cancers by age, sex, race, stage, grade, and disease duration.

Comparative study of true and virtual non-contrast imaging generated from dual-layer spectral CT in patients with upper aerodigestive tract cancer.

Purpose: Dual-layer spectral computed tomography (DLSCT) is a novel CT platform of dual-energy CT. Virtual non-contrast (VNC) imaging theoretically resembles true non-contrast (TNC) imaging by subtracting iodine attenuation from post-contrast data. We aimed to compare qualitative and quantitative datasets between TNC and VNC in patients with upper aerodigestive tract cancer (UATC) and to evaluate the potential radiation dose reduction obtained by omitting the TNC phase. Material and methods: The study included 61 patients with UATC who underwent DLSCT. The CT protocol included TNC and post-contrast phases. The VNC images were reconstructed from the post-contrast phase. The differences of mean CT attenuation values, imaging noise, and image quality for TNC and VNC images were compared. The effective radiation doses of a biphasic TNC and post-contrast CT protocol were compared with a single-phase protocol (post-contrast CT with VNC reconstruction). Results: There were a total of 732 ROIs from TNC and VNC. There was no statistical difference in the mean CT attenuation values between TNC and VNC images for all tissue types (p = 0.09-0.44), except for the buccal fat pad. Overall, 85.3% of cases revealed a difference of less than 10 HU. There was no significant difference in mean imaging noise (p = 0.5455) and image quality (p = 0.3214) between 2 acquisitions. All VNC images had acceptable quality for diagnostic purposes. The potential dose reduction by omitting the TNC was 49.5 ± 3.5%. Conclusion: VNC could replace TNC images in patients with UATC, with good image quality and the advantage of radiation dose reduction.

Early Upper Aerodigestive Tract Cancer Detection Using Electron Microscopy to Reveal Chromatin Packing Alterations in Buccal Mucosa Cells.

A profound characteristic of field cancerization is alterations in chromatin packing. This study aimed to quantify these alterations using electron microscopy image analysis of buccal mucosa cells of laryngeal, esophageal, and lung cancer patients. Analysis was done on normal-appearing mucosa, believed to be within the cancerization field, and not tumor itself. Large-scale electron microscopy (nanotomy) images were acquired of cancer patients and controls. Within the nuclei, the chromatin packing of euchromatin and heterochromatin was characterized. Furthermore, the chromatin organization was quantified through chromatin packing density scaling. A significant difference was found between the cancer and control groups in the chromatin packing density scaling parameter for length scales below the optical diffraction limit (200 nm) in both the euchromatin (p = 0.002) and the heterochromatin (p = 0.006). The chromatin packing scaling analysis also indicated that the chromatin organization of cancer patients deviated significantly from the control group. They might allow for novel strategies for cancer risk stratification and diagnosis with high sensitivity. This could aid clinicians in personalizing screening strategies for high-risk patients and follow-up strategies for treated cancer patients.

The (head and neck) carcinologic handicap index: validation of a modular type questionnaire and its ability to prioritise patients' needs.

PURPOSE: To validate the upgraded version of the CHI with two new dimensions ("limitation of neck and/or shoulder movements", "changes in physical appearance"). To assess the relationship between CHI scores and patient self-reported management needs. METHODS: 71 patients treated for cancer with ENT complaints and 36 controls were included. Construct validity, internal consistency, criterion validity (using visual analogue scales by dimension), clinical validity (comparison of patient and control scores) and temporal reliability (scores of a second CHI completed after a few days) were studied. A hierarchical ranking of the dimensions according to perceived difficulties was compared to the CHI scores. RESULTS: Correlations were moderate to high between items of the same dimension (0.38 < r<0.73), between scores on the two new dimensions and on the VAS (r > 0.68), and between scores on the two CHI completions (r > 0.67). Cronbach's alphas are greater than 0.72. Patients and controls had significantly different scores in the two new dimensions (Mann-Whitney: p < 0.001). Sensitivity, specificity and AUC calculated between CHI scores and hierarchy ranking determined patient priority cut-off scores for eight of the eleven dimensions. CONCLUSION: The new CHI dimensions have good psychometric qualities. Threshold scores by dimension allow the perceived management needs to be determined.

Trends and age-period-cohort analysis of upper aerodigestive tract and stomach cancer mortality in Lithuania, 1987-2016.

OBJECTIVES: Lithuania has among the highest mortality rates for upper aerodigestive tract (UADT) and stomach cancer in Europe. The aim of this study was to analyze trends during the period 1987-2016 in Lithuania, evaluating the effect of birth-cohort, period, and age. STUDY DESIGN: Observational time trends study. METHODS: Data on numbers of deaths and population size by each calendar year in 5-year age groups in 1987-2016 were obtained from the WHO mortality database. Joinpoint regression analysis was used to evaluate changes in time trends. Age-period-cohort analysis was performed to assess age, calendar period of death, and birth-cohort effects. RESULTS: UADT cancer mortality in men increased between 1987 and 1993, annual percentage change (APC) = 6.6% (95% confidence interval [CI]: 3.8, 9.4), and was stable thereafter, APC = 0.3% (95% CI: 0.0, 0.6). The age-standardized mortality rate (ASMR) was 23.6/100,000 in 2016. In women, rates increased steadily by 1.6% (95% CI: 0.9%, 2.3%) per year from 1987 to 2016, ASMR = 2.3/100,000 in 2016. Age-period-cohort analysis showed statistically significant cohort effects in both sexes. In men, rates peaked in birth-cohorts born around 1952, declined in 1957-1962 birth-cohorts, and fluctuated in later birth-cohorts. In women, rates started rising in 1947 birth cohort and peaked in the 1967 birth cohort. Stomach cancer mortality declined throughout the study period in men by -2.4%, (95% CI: -2.6%, -2.1%) annually, and women by -2.8% (95% CI: -3.1%, -2.4%), ASMR = 16.1/100,000 and 6.0/100,000 in 2016, respectively. Birth-cohort effects were significant in both sexes. Rates decreased in cohorts born around 1920 onwards, but declines in the youngest generations have slowed in men and reversed in women. CONCLUSIONS: The birth-cohort effects in UADT and stomach cancer mortality trends imply that the elevated burden in Lithuania could be reduced by effective strategies targeting known risk factors. Further research in causes of unfavorable trends in younger cohorts is warranted.

Inclusion of a gene-environment interaction between alcohol consumption and the aldehyde dehydrogenase 2 genotype in a risk prediction model for upper aerodigestive tract cancer in Japanese men.

The well-known gene-environment interaction between alcohol consumption and aldehyde dehydrogenase 2 (ALDH2) genotype in upper aerodigestive tract cancer risk may improve our ability to identify high-risk subjects. Here, we developed and validated risk prediction models for this cancer in Japanese men and evaluated whether adding the gene-environment interaction to the model improved the predictive performance. We developed two case-cohort datasets in the Japan Public Health Center-based Prospective Study: one from subjects in the baseline survey for model development (108 cases and 4049 subcohort subjects) and the second from subjects in the 5-year follow-up survey for model validation (31 cases and 1527 subcohort subjects). We developed an environmental model including age, smoking status, and alcohol consumption, and a gene-environment interaction model including age, smoking status, and the combination of alcohol consumption and the ALDH2 genotype. We found a statistically significant gene-environment interaction for alcohol consumption and the ALDH2 genotype. The c-index for the gene-environment interaction model (0.71) was slightly higher than that for the environmental model (0.67). The values of integrated discrimination improvement and net reclassification improvement for the gene-environment interaction model were also slightly higher than those for the environmental model. Goodness-of-fit tests suggested that the models were well calibrated. Results from external model validation by the 5-year follow-up survey were consistent with those from the model development by the baseline survey. The addition of a gene-environment interaction to a lifestyle-based model might improve the performance to estimate the probability of developing upper aerodigestive tract cancer for Japanese men.

Extranodal NK/T-cell lymphoma, nasal type, with extranasal presentation - a case report and a review of the literature.

BACKGROUND: Extranodal NK/T-cell lymphoma (ENKTCL), nasal type is a very rare and aggressive non-Hodgkin lymphoma. Most commonly it occurs in the upper aerodigestive tract. But, it can also manifest at locations such as the skin, soft tissue, gastrointestinal tract (GI), lungs, testis, etc. These locations are designated as extranasal ENKTCL. The patients with the latter have often more adverse clinical features and poorer survival rate compared with nasal sites. We present a case of an 83-year-old patient with a primary ENKTCL, nasal type, with extranasal presentation in the right upper eyelid. MATERIAL AND METHODS: Materials for the literature review was obtained by a comprehensive search on PubMed, which yielded 82 eligible cases with extranasal ENKTCL. RESULTS: Sixty-eight cases (83 %) were localized as primary ENKTCL in the lungs (17), central nervous system (CNS) (14), testis (11), GI-tract (7), skin (6), orbit and intraocular tissue (4), pancreas (2), adrenal gland (2), breast (1), etc. 14 cases (17 %) presented as extended or disseminated diseases involving exclusively organs outside the upper aerodigestive tract. There was no systematic pattern of organ involvement in the extended/disseminated ENKTCL. 63 % of the patient with localized extranasal ENKTCL and about 50% of patients with extended/disseminated disease were reported to have died of the disease. Treatment strategies varied with no preferred option. Among the used treatment options were chemotherapy, radiotherapy, surgery, stem cell transplantation alone or in different combinations. CONCLUSION: ENKTCL is a highly aggressive disease which may present in extranasal areas. Although the tumors respond to both chemotherapy and radiotherapy, durable complete remissions are very rare.