Predicting Radiotherapy Necessity in Tongue Cancer Using Lymph Node Yield.

PURPOSE: In patients with head and neck cancer and a single metastatic lymph node (pN1), the value of lymph node yield (LNY) remains controversial in determining the prognosis and identifying patients who require radiotherapy. This study evaluated the role of LNY in predicting the adequacy of neck dissection, need for adjuvant radiotherapy, and survival in patients with pN1 oral tongue squamous cell carcinoma. MATERIALS AND METHODS: The authors implemented a retrospective cohort study. The predictor variable was LNY. The outcome variables were 5-year disease-specific survival and the need for adjuvant radiotherapy. Other study variables were age, gender, tumor stage, pathologic grade, growth pattern, tobacco and alcohol habits, and time frame. Descriptive and bivariate statistics were computed, and a P value less than .05 was considered statistically significant. RESULTS: The sample was chosen from among 2,792 patients who were histopathologically diagnosed as having oral squamous cell carcinoma and underwent surgical treatment from June 1996 through December 2012. One hundred forty-one patients treated at the Department of Oral and Maxillofacial-Head and Neck Oncology of the Beijing Stomatological Hospital (Beijing, China) were screened for the study. Receiver operating characteristics curve analysis identified that a cutoff (LNY, 20; area under the curve, 0.708; 95% confidence interval, 0.625-0.781; sensitivity and specificity, 64.94 and 70.31%, respectively; P = .0001) could best discriminate patients into 2 groups according to need for adjuvant radiotherapy. Interestingly, subgroup analyses showed that patients who underwent adjuvant radiotherapy had notably better 5-year disease-specific survival than those who did not undergo radiotherapy if the LNY was smaller than 20 (58.0 vs 21.0%; P = .021). However, there was no significant association for 5-year disease-specific survival between the low and high LNY groups (49.2 vs 58.7%; P = .363). CONCLUSIONS: An LNY smaller than 20 at levels I to III predicted a benefit from adjuvant radiotherapy in patients with tongue cancer who had pN1 neck status without other adverse histopathologic features.

[Primary acinic cell carcinoma in mandible: a case report].

Acinic cell carcinoma is a relatively rare salivary gland tumor predominantly occurring in the major glands. Therefore, acinic cell carcinoma rarely occurs in the mandible. In this study, a case of primary acinic cell carcinoma of the mandible was reported, and relevant literature was reviewed. The etiology, clinical symptom, image and histological features, diagnosis, treatment, and prognosis of acinic cell carcinoma in the mandible were discussed.

Second primary cancer after index head and neck squamous cell carcinoma in Northern China.

OBJECTIVE: To evaluate the clinicopathologic features, prognostic factors, and management of patients in the North Chinese population with head and neck squamous cell carcinoma (HNSCC) who developed a second primary malignancy (SPM). METHODS: This was a retrospective study including 1818 eligible patients between June 1999 and April 2011. RESULTS: A total of 188 HNSCC patients developed SPM. Multiple oral dysplastic lesions (MODLs) (P < .001) were among the risk factors for occurrence of SPM. However, MODLs were closely associated with many mild pathologic features, such as early T stage (P < .001), early N stage (P = .036), good pathologic differentiation (P < .001), and mild growth pattern (P < .001). Interestingly, multivariate survival analysis showed that SPM patients had a better prognosis if they had the characteristics of MODLs (P = .020). CONCLUSIONS: MODLs were a crucial risk factor leading to the occurrence of oral SPM after an index HNSCC in patients in Northern China. However, SPM patients with the characteristics of MODLs had a better prognosis.

Clinicopathological features, management and outcome of patients with poorly-differentiated oral and oropharyngeal squamous cell carcinoma.

BACKGROUND: The purpose of this study was to explore the clinicopathological features, risk factors, and management of poorly differentiated oral and oropharyngeal squamous cell carcinoma (OOSCC) patients in the northern Chinese population. METHOD: A total of 118 poorly differentiated OOSCC patients from 2236 consecutive cases were retrospectively enrolled in this study. RESULTS: Cox regression analysis showed that site (hazard ratio (HR): 2.561, 95% confidence interval (CI): 1.064-6.164, p = 0.036) and lymph node ratio (LNR) (HR: 3.915, 95% CI: 1.797-8.530, p = 0.001) were independent predictive factors for 5-year disease-specific survival (DSS). LNR >0.036, oropharynx site, and advanced clinical stage formulate a model of risk stratification. The patients with a risk score of ≥2 were identified as the high-risk population, and patients with a risk score of 0 or 1 were identified as the low-risk population. Patients in the high-risk population who underwent surgery plus concurrent chemoradiotherapy (CCRT) had markedly better 5-year DSS than those who only underwent surgery (60.0% vs. 20.0%, p = 0.016). However, patients in the low-risk population who underwent surgery alone exhibited a similar 5-year DSS (68.2%) compared with those who received surgery plus radiotherapy (RT) (68.2%) or surgery plus CCRT (50.0%) (p = 0.907). CONCLUSIONS: High LNR, oropharynx site and advanced clinical stage constitute a model of risk stratification for patients with poorly differentiated OOSCC. If two or more risk factors are present, surgery and adjuvant chemoradiotherapy can give the best prognosis.

Lymph node ratio is associated with adverse clinicopathological features and is a crucial nodal parameter for oral and oropharyngeal cancer.

The lymph node ratio(LNR) has been described as a novel predictor of the survival of patients with oral and oropharyngeal squamous cell carcinoma(O/OPSCC). The purpose of this study was to evaluate whether LNR is better at predicting survival and the need for adjuvant treatment than traditional tumour-nodal-metastasis(TNM) staging. Eight hundred nine patients with O/OPSCC and positive lymph node disease were retrospectively enrolled in this study. LNR equal to 0.075 is the best cut-off value for stratifying 5-year disease-free survival(DFS). High LNR is closely associated with more advanced T stage, higher N stage, more severe pathological grade, the presence of diffuse infiltration and extracapsular spread(ECS). LNR is better for evaluating prognosis than the pathological N stage. Patients with high LNR coupled with high number of positive lymph nodes who received adjuvant concurrent chemo-radiotherapy(CCRT) had a better 5-year DFS than patients who received surgery alone. Multivariate analyses revealed that T stage, ECS and LNR are independent prognostic factors of 5-year DFS and disease-specific survival(DSS). Therefore, high LNR is closely correlated with adverse parameters that markedly hinder prognosis. LNR is superior to traditional TNM staging for the evaluation of prognosis,and the combination of the LNR with the number of positive lymph nodes can predict the benefits of adjuvant CCRT.

Risk factors for relapse of middle-stage squamous cell carcinoma of the submandibular region and floor of mouth: the importance of en bloc resection.

Our aim was to investigate retrospectively the rate of recurrence in the intervening region for middle-stage squamous cell carcinoma (SCC) of the tongue and identify the factors that predict relapse and prognosis. A total of 204 patients were included, 96 in the en bloc group and 108 in the control group. The groups were comparable. Two patients in the en bloc group (2%) and 12 in the control group (11%) developed recurrences in the intervening region. Kaplan-Meier analysis showed a reduction in the 5-year disease-specific survival once a recurrence had developed after the primary operation (77% compared with 14%, p<0.001). The en bloc group developed significantly fewer recurrences (2%) than the control group (11%) during the five years; p=0.037), and also had better 5-year disease-specific survival (80% compared with 66%, p=0.04). Cox's multivariate regression indicated that the pathological nodal status (p=0.016) and surgical technique (p=0.037) were independent predictive factors for the 5-year recurrence rate, as well as of 5-year disease-specific survival (p=0.001 and p=0.050, respectively). Recurrence in the intervening region is a negative prognostic factor for these patients, and we recommend en bloc resection as the management of choice for middle-stage SCC of the tongue.

Risk factors for patients with multiple synchronous primary cancers involving oral and oropharyngeal subsites.

OBJECTIVE: To evaluate risk factors and prognosis for multiple synchronous primary cancers (MSPCs) associated with head and neck squamous cell carcinoma. STUDY DESIGN: The retrospective study included 1623 patients. RESULTS: The most common MSPC site involved was the head and neck region. The presence of multiple oral dysplastic lesions (P < .001) was the sole risk factor for the occurrence of MSPCs. A multivariate survival analysis showed that the pathologic grade (P = .003) was an independent predictive factor for the 5-year disease-specific survival of patients with MSPCs. A Kaplan-Meier analysis showed that the 5-year disease-specific survival of patients who developed MSPCs was worse than that of patients who did not develop MSPCs (P = .020). CONCLUSIONS: MSPCs are a significant negative prognostic factor for patients with head and neck squamous cell carcinoma. However, a worse prognosis is predicted for patients with MSPCs with several features: a higher pathologic grade, a more aggressive growth pattern, male gender plus a tobacco or alcohol habit, and no multiple oral dysplastic lesions.