•Several studies indicated that margins < 1 mm should be classified as positive margins in OCSCC.•Margin < 1 mm exhibited distinct clinicopathological characteristics and a more favorable ...prognosis.•Positive margins should remain a high risk factor, whereas margins < 1 mm could be considered an intermediate risk factor.
While several studies have indicated that a margin status of < 1 mm should be classified as a positive margin in oral cavity squamous cell carcinoma (OCSCC), there is a lack of extensive cohort studies comparing the clinical outcomes between patients with positive margins and margins < 1 mm.
Between 2011 and 2020, we identified 18,416 Taiwanese OCSCC patients who underwent tumor resection and neck dissection. Of these, 311 had margins < 1 mm and 1013 had positive margins. To compare patients with margins < 1 mm and those with positive margins, a propensity score (PS)-matched analysis (n = 253 in each group) was conducted.
The group with margins < 1 mm displayed a notably higher prevalence of several variables: 1) tongue subsite, 2) younger age, 3) smaller depth of invasion), 4) early tumor stage, and 5) treatment with surgery alone. Patients with margins < 1 mm demonstrated significantly better disease-specific survival (DSS) and overall survival (OS) rates compared to those with positive margins (74 % versus 53 %, 65 % versus 43 %, both p < 0.0001). Multivariable analysis further confirmed that positive margins were an independent predictor of worse 5-year DSS (hazard ratio HR = 1.38, p = 0.0103) and OS (HR = 1.28, p = 0.0222). In the PS-matched cohort, the 5-year outcomes for patients with margins < 1 mm compared to positive margins were as follows: DSS, 71 % versus 59 %, respectively (p = 0.0127) and OS, 60 % versus 48 %, respectively (p = 0.0398).
OCSCC patients with a margin status < 1 mm exhibited distinct clinicopathological characteristics and a more favorable prognosis compared to those with positive resection margins.
Background
According to the AJCC third to seventh edition staging manuals (1988–2010), the presence of through cortex and/or skin invasion in oral cavity squamous cell carcinoma (OCSCC) identifies ...T4a tumors. The AJCC eighth edition (2018) introduced a depth of invasion (DOI) > 20 mm as a criterion for pT4a. Subsequently, a revision maintained that tumors > 4 cm with a DOI > 10 mm should be classified as pT4a. We sought to analyze the prognostic impact of the three distinct criteria identifying pT4a disease.
Methods
We examined 667 consecutive patients with pT3-4 buccal/gum/hard palate/retromolar SCC who underwent surgery between 1996 and 2016. pT1/pT2 (
n
= 108/359) disease were included for comparison purposes.
Results
The 5-year outcomes of patients with pT1/pT2/without (
n
= 406)/with tumor > 4 cm/DOI > 10 mm (
n
= 261), pT1/pT2/DOI ≤ 20 mm (
n
= 510)
/
> 20 mm (
n
= 157), and pT1/pT2/without (
n
= 305)
/
with through cortex/skin invasion (
n
= 362) were as follows: disease-specific survival (DSS), 98%/89%/79%/65%,
p
< 0.001, 98%/89%/78%/59%,
p
< 0.001, and 98%/89%79%/69%,
p
< 0.001; overall survival (OS), 90%/79%/63%/51%,
p
< 0.001, 90%/79%/63%/42%,
p
< 0.001, and 90%/79%/65%/52%,
p
< 0.001. In pT3-4 disease, a tumor > 4 cm/DOI > 10 mm was an independent adverse prognosticator for 5-year DSS rate, DOI > 20 mm was an independent adverse prognosticator for 5-year DSS and OS rates, whereas through cortex/skin invasion independently predicted 5-year OS rates.
Conclusions
All of the three criteria (tumor > 4 cm/DOI > 10 mm, DOI > 20 mm, and through cortex/skin invasion) identify high-risk patients, which should be reflected in further revisions of pT4a classification in OCSCC.
Background
To compare the clinical outcomes of two treatment modalities, initial surgery and primary definitive radiotherapy (RT), in Taiwanese patients diagnosed with cT1−2N0M0 oral cavity squamous ...cell carcinoma (OCSCC).
Methods
Between 2011 and 2019, we analyzed data for 13,542 cT1−2N0M0 patients who underwent initial surgery (n = 13,542) or definitive RT with a dosage of at least 6600 cGy (n = 145) for the treatment of OCSCC. To account for baseline differences, we employed propensity score (PS) matching, resulting in two well‐balanced study groups (initial surgery, n = 580; definitive RT, n = 145).
Results
Before PS matching, the 5‐year disease‐specific survival (DSS) rates were 88% for the surgery group and 58% for the RT group. After PS matching, the 5‐year DSS rates of the two groups were 86% and 58%, respectively. Similarly, the 5‐year overall survival (OS) rates before PS matching were 80% for the surgery group and 36% for the RT group, whereas after PS matching, they were 73% and 36%, respectively. All these differences were statistically significant (p < 0.0001). A multivariable analysis identified treatment with RT, older age, stage II tumors, and a higher burden of comorbidities as independent risk factors for both DSS and OS. We also examined the 5‐year outcomes for various subgroups (margin ≥5 mm, margin <5 mm, positive margins, RT combined with chemotherapy, and RT alone) as follows: DSS, 89%/88%/79%/63%/51%, respectively, p < 0.0001; OS, 82%/79%/68%/39%/32%, respectively, p < 0.0001.
Conclusions
In Taiwanese patients with cT1−2N0M0 OCSCC, a remarkably low proportion (1.1%) completed definitive RT. A significant survival disparity of 30% was observed between patients who underwent initial surgery and those who received definitive RT. Interestingly, even patients from the surgical group with positive surgical margins exhibited a significantly superior survival compared to those in the definitive RT group.
Patients with cT1−2N0M0 oral cavity cancer who underwent initial surgery demonstrated significantly improved disease‐specific and overall survival rates compared to those who received primary definitive radiotherapy (≥6600 cGy), even after propensity score matching. Subgroup analyses further revealed that survival outcomes remained significantly better for the positive margin subgroup compared to the radiotherapy group, irrespective of whether they received concurrent chemotherapy.
Methods
We sought to compare the prognostic impact of tumor differentiation with respect to adverse risk factors (RFs) identified by the National Comprehensive Cancer Network (NCCN) ...guidelines––including extranodal extension (ENE), positive/close margins, perineural invasion, lymphatic invasion, and vascular invasion––in patients with locally advanced oral cavity squamous cell carcinoma (OCSCC).
Results
Between 1996 and 2018, 1179 consecutive patients with first primary pT3–4 OCSCC were included. A three‐level grading system was adopted––in which the final classification was assigned according to the most prevalent tumor grade. We identified 382/669/128 patients with well/moderately/poorly differentiated tumors, respectively. Compared with well/moderately differentiated tumors, poorly differentiated OCSCC had a higher prevalence of the following variables: female sex (4%/6%/11%), ENE, (14%/36%/61%), positive margins (0.5%/2%/4%), close margins (10%/14%/22%), perineural invasion (22%/50%/63%), lymphatic invasion (2%/9%/17%), vascular invasion (1%/4%/10%), and adjuvant therapy (64%/80%/87%). The 5‐year rates of patients with well/moderately/poorly differentiated OCSCC were as follows: local control (LC, 85%/82%/84%, p = 0.439), neck control (NC, 91%/83%/70%, p < 0.001), distant metastases (DM, 6%/18%/40%, p < 0.001), disease‐free survival (DFS, 78%/63%/46%, p < 0.001), disease‐specific survival (DSS, 85%/71%/49%, p < 0.001), and overall survival (OS, 68%/55%/39%, p < 0.001). Multivariable analysis identified the following variables as independent prognosticators for 5‐year outcomes: ENE (LC/NC/DM/DFS/DSS/OS), poorly differentiated tumors (NC/DM/DFS/DSS/OS), positive margins (LC/DFS), lymphatic invasion (DFS/DSS/OS), perineural invasion (DM), and age ≥65 years (OS).
Conclusions
In addition to ENE, poor tumor differentiation was identified as the second most relevant adverse RF for patients with pT3–4 OCSCC. We suggest that the NCCN guidelines should include poor tumor differentiation as an adverse RF to refine and tailor clinical management.
Final tumor grading of oral cavity squamous cell carcinoma (OCSCC) is assigned according to the most prevalent grade. Relapses of poorly differentiated OCSCC tended to occur regionally and distantly. Poor tumor differentiation was the second most relevant adverse risk factor after extranodal extension. The NCCN guidelines should include poor differentiation as an adverse risk factor.
Purpose
The basic assumption is that there is a symmetric relationship between review valence and rating, but what if review valence and rating were linked asymmetrically? There are few studies which ...have investigated the situations in which positive and negative online reviews exert different influences on ratings. This study considers brand strength as having an important moderating role because the average rating of existing reviews for a particular product is a heuristic cue for decision makers. Thus, the purpose of this paper is to argue that an asymmetric relationship between review content valence and numerical rating will depend on brand strength.
Design/methodology/approach
The authors have conducted a sentiment analysis via text mining, using self-developed computer programs to retrieve a data set from the TripAdvisor website.
Findings
This study finds there is an asymmetric relationship between review valence (verbal) and numerical rating. The authors further find brand strength to have an important moderating role. For a stronger brand, negative review content will have a greater impact on numerical ratings than positive review content, while for a weaker brand, positive review content will have a greater impact on numerical ratings than negative review content.
Practical implications
Marketers could adopt sentiment analysis via text mining of online reviews as a valid measure or predictor of consumer satisfaction or numerical ratings. Strong brands should direct more attention to negative reviews, because in such reviews the negative impact transcends the positive. In contrast, weak brands should aim to exploit as many positive reviews as possible to minimize the impact of any negative reviews.
Originality/value
This study finds there is an asymmetric relationship between review valence (verbal) and numerical rating and considers brand strength to play an important moderating role. The authors have used real data from the TripAdvisor website, which allow people to express themselves in an unsolicited manner, and linked these with the results from the sentiment analysis.
Background
Elective tracheotomy is commonly performed in resected oral squamous cell carcinoma (OCSCC) to maintain airway patency. However, the indications for this procedure vary among surgeons. ...This nationwide study evaluated the impact of tracheotomy on both the duration of in‐hospital stay and long‐term survival outcomes in patients with OCSCC.
Methods
A total of 18,416 patients with OCSCC were included in the analysis, comprising 7981 patients who underwent elective tracheotomy and 10,435 who did not. The primary outcomes assessed were 5‐year disease‐specific survival (DSS) and overall survival (OS). To minimize potential confounding factors, a propensity score (PS)‐matched analysis was performed on 4301 patients from each group. The duration of hospital stay was not included as a variable in the PS‐matched analysis.
Results
Prior to PS matching, patients with tracheotomy had significantly lower 5‐year DSS and OS rates compared to those without (71% vs. 82%, p < 0.0001; 62% vs. 75%, p < 0.0001, respectively). Multivariable analysis identified tracheotomy as an independent adverse prognostic factor for 5‐year DSS (hazard ratio = 1.10 1.03–1.18, p = 0.0063) and OS (hazard ratio = 1.10 1.04–1.17, p = 0.0015). In the PS‐matched cohort, the 5‐year DSS was 75% for patients with tracheotomy and 76% for those without (p = 0.1488). Five‐year OS rates were 66% and 67%, respectively (p = 0.0808). Prior to PS matching, patients with tracheotomy had a significantly longer mean hospital stay compared to those without (23.37 ± 10.56 days vs. 14.19 ± 8.34 days; p < 0.0001). Following PS matching, the difference in hospital stay duration between the two groups remained significant (22.34 ± 10.25 days vs. 17.59 ± 9.54 days; p < 0.0001).
Conclusions
While elective tracheotomy in resected OCSCC patients may not significantly affect survival, it could be associated with prolonged hospital stays.
Our study indicates that, following propensity score matching, patients with oral cavity squamous cell carcinoma (OCSCC) who underwent tracheotomy exhibit similar 5‐year disease‐specific and overall survival rates compared to those who did not. While elective tracheotomy in resected OCSCC patients may not significantly affect survival, it could be associated with prolonged hospital stays.
An outbreak of respiratory syncytial virus (RSV) has been observed in Taiwan since August 2020. We reviewed a central laboratory-based surveillance network established over 20 years by Taiwan Centres ...for Disease Control for respiratory viral pathogens between 2010 and 2020.
A retrospective study of children <5 years old hospitalized with RSV infection at Chang Gung Memorial Hospital between 2018 and 2020 was conducted, and samples positive for RSV-A were sequenced. Clinical data were obtained and stratified by genotype and year.
Data from 2020 showed an approximately 4-fold surge in RSV cases compared to 2010 in Taiwan, surpassing previous years during which ON1 was prevalent. Phylogenetic analysis of G protein showed that novel ON1 variants were clustered separately from those of 2018 and 2019 seasons and ON1 reference strains. The variant G protein carried six amino acid changes that emerged gradually in 2019; high consistency was observed in 2020. A unique substitution, E257K, was observed in 2020 exclusively. The F protein of the variant carried T12I and H514N substitutions, which weren't at antigenic sites. In terms of multivariate analysis, age (OR: 0.97; 95% CI: 0.94-0.99; p = 0.02) and 2020 ON1 variant (OR:2.52; 95% CI:1.13-5.63; p = 0.025) were independently associated with oxygen saturation <94% during hospitalization.
The 2020 ON1 variant didn't show higher replication or virulence compared with those in 2018 in our study. The unprecedented 2020 RSV epidemic may attribute to antigenic changes and lack of interferon-stimulated immunity induced by seasonal circulating virus under non-pharmaceutical intervention.
This study investigated the reliability of top-gate p-type organic thin-film transistors in vacuum under positive bias stress-induced and positive bias illumination stress-induced instability ...degradation. The manufacturing process suggested that sidewall dielectric insulating layers are thin. In addition, a shorter organic gate dielectric sidewall causes a larger electric field. Therefore, sidewall electron traps exhibit parasitic transistor characteristics, and the parasitic channel experiences premature conduction, triggering an abnormal hump phenomenon. The mechanism of degradation is verified through electric field simulation; this mechanism is generated owing to the bias stress of the gate. These observations indicate that organic thin-film transistors should be designed with a suitable sidewall insulation thickness to reduce the influence of the sidewall electric field.
The Fenton reaction is a commonly used technique for the remediation of industrial pollution, but hydrogen peroxide required in this reaction is highly hazardous and the enormous volume of iron ...sludge byproducts increases significantly the cost of pollution remediation. To address this issue, this study examined the efficacy of the electro-Fenton reaction in degrading pollutants utilizing a complex of graphene and a high-entropy ceramic catalyst, and evaluated the potential of functionalized high-entropy materials for the decomposition of pollutants. The degradation of organic water contaminants was investigated utilizing a novel composite of graphene and (AlCrCuFeNi)O high-entropy ceramics, to increase the generation of H2O2 in the electro-Fenton process. Rapid calcination produced five-element (AlCrCuFeNi)O high-entropy ceramics to enhance both the electrocatalytic activity and the stability. Because of the high electro-Fenton efficiency of the high-entropy ceramics, the graphene/(AlCrCuFeNi)O HEC cathode effectively removed 99% methyl orange within 90 min of operation.
•Development of graphene combined with HEC, a new promising G@HEC is demonstrated in the field of environmental catalysts.•The G@HEC were analyzed and studied, interestingly, some HECs were reduced to form a high-entropy alloy phase.•The G@HEC cathode possessed a significant degradation effect, which can decompose 99% of pollutants within 90 min.
Objective
Clinical outcomes of patients with resected oral cavity squamous cell carcinoma (OCSCC) chiefly depend on the presence of specific clinicopathological risk factors (RFs). Here, we performed ...a combined analysis of FDG-PET, genetic markers, and clinicopathological RFs in an effort to improve prognostic stratification.
Methods
We retrospectively reviewed the clinical records of 2036 consecutive patients with first primary OCSCC who underwent surgery between 1996 and 2016. Of them, 345 underwent ultra-deep targeted sequencing (UDTS, between 1996 and 2011) and 168 whole exome sequencing (WES, between 2007 and 2016). Preoperative FDG-PET imaging was performed in 1135 patients from 2001 to 2016. Complete data on FDG-PET, genetic markers, and clinicopathological RFs were available for 327 patients.
Results
Using log-ranked tests based on 5-year disease-free survival (DFS), the optimal cutoff points for maximum standardized uptake values (SUV-max) of the primary tumor and neck metastatic nodes were 22.8 and 9.7, respectively. The 5-year DFS rates were as follows: SUVtumor-max ≥ 22.8 or SUVnodal-max ≥ 9.7 (
n
= 77) versus SUVtumor-max < 22.8 and SUVnodal-max < 9.7 (
n
= 250), 32%/62%,
P
< 0.001; positive UDTS or WES gene panel (
n
= 64) versus negative (
n
= 263), 25%/62%,
P
< 0.001; pN3b (
n
= 165) versus pN1-2 (
n
= 162), 42%/68%,
P
< 0.001. On multivariate analyses, SUVtumor-max ≥ 22.8 or SUVnodal-max ≥ 9.7, a positive UDTS/WES gene panel, and pN3b disease were identified as independent prognosticators for 5-year outcomes. Based on these variables, we devised a scoring system that identified four distinct prognostic groups. The 5-year rates for patients with a score from 0 to 3 were as follows: loco-regional control, 80%/67%/47%/24% (
P
< 0.001); distant metastases, 13%/23%/55%/92% (
P
< 0.001); DFS, 74%/58%/28%/7% (
P
< 0.001); and disease-specific survival, 80%/64%/35%/7% (
P
< 0.001) respectively.
Conclusions
The combined assessment of tumor and nodal SUV-max, genetic markers, and pathological node status may refine the prognostic stratification of OCSCC patients.
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