Objectives/Hypothesis:
We systematically reviewed the published experience on the treatment outcomes of patients with head and neck cancer of unknown primary (CUP) to determine if treatment modality ...affects survival outcomes.
Study Design:
Meta‐analysis.
Methods:
A comprehensive literature search was performed for articles reporting survival outcomes for CUP in the head and neck published within the last 12 years.
Results:
Eighteen studies with 1,726 patients met the inclusion criteria. All studies reported at least 5‐year survival outcomes. Thirteen of the 18 studies also reported 5‐year survival based on N stage, and six reported 5‐year survival based on presence of extracapsular extension (EC). Overall 5‐year survival in the entire group was 48.6%. Five‐year survival based on N stage was as follows: N1 = 60.8%, all N2 = 51.1%, N2a = 63.6%, N2b = 42.5%, N2c = 37.5%, and N3 = 26.3%, with P < .001 on multivariate analysis. Patients who underwent surgical treatment with either postoperative radiation or chemoradiation had a 5‐year survival of 52.4% compared to 46.6% for those treated with chemoradiation alone; however, this difference was not statistically significant. Patients with EC had a 5‐year disease‐specific survival of 56.9% compared to 81.5% for those without EC (P = .01).
Conclusions:
In patients with CUP, survival outcomes are most significantly influenced by clinical stage at time of diagnosis. No significant 5‐year survival difference was seen between patients treated with radiation or chemoradiation alone when compared to patients who also received surgical treatment.
Objectives/Hypothesis
To describe rates of complications and mortality within 30 days of open anterior skull base surgery using a large, multi‐institutional outcomes database.
Study Design
...Retrospective cohort study.
Methods
The study included patients who underwent open anterior skull base surgery as listed in the American College of Surgeons National Surgical Quality Improvement Project database from 2007 through 2014.
Results
A total of 336 open anterior skull base surgeries were identified. One hundred nine (32.4%) patients experienced a complication, reoperation, or mortality. The most common events were postoperative transfusion (15.8%), reoperation (10.1%), and readmission (8.0%). Significant independent predictors of any adverse event included higher American Society of Anesthesiologists (ASA) score and increased total operative time (both P < .05). The only predictor of mortality was higher ASA score (P = .02). Predictors of increased hospital stay included impaired sensorium (P = .04), coma >24 hours (P < .001), lower preoperative hematocrit (P = .02), higher ASA score (P = .04), and increased total operative time (P < .001).
Conclusions
Open anterior skull base surgery is understandably complex, and is thus associated with a relatively high adverse event rate. Knowledge of factors associated with adverse events has the potential to improve preoperative optimization of controllable variables and translate into improved surgical outcomes for patients.
Level of Evidence
NA
Laryngoscope, 129:1407–1412, 2019
To determine the current epidemiology and management trends for patients with vestibular schwannomas (VS).
Retrospective cohort study.
The Surveillance, Epidemiology, and End Results (SEER) tumor ...registry.
The SEER database was queried to identify patients diagnosed with VS from 1973 to 2015. Demographics, patient and tumor characteristics, and treatment methods were analyzed.
A total of 14,507 patients with VS were identified. The mean age at diagnosis was 55 ± 14.9 years. Age-adjusted incidence from 2006 to 2015 was 1.4 per 100,000 per year and remained relatively stable. Incidence across age varied with sex, as younger women and older men had increased incidences comparatively. A higher percentage of patients underwent surgery alone (43%), followed by observation (32%), radiation alone (23%), and combined radiation and surgery (2%). Age 65 and older was associated with observation (odds ratio OR 1.417; p = 0.029) whereas age 20 to 39 and 40 to 49 were associated with surgery (OR 2.013 and 1.935; p < 0.001). Older age was associated with radiation. Larger tumor size was associated with surgery and combined treatment. African American patients and American Indian or Alaskan Native patients were more likely to undergo observation than surgery.
The overall incidence of VS is 1.4 per 100,000 per year and has remained relatively stable. There is a trend toward more conservative management with observation, which may be secondary to earlier diagnosis given widespread use of magnetic resonance imaging. Further studies are necessary to investigate differences in disease patterns and disparities in management.
Recently, induction chemotherapy has gained favor for managing locally advanced sinonasal malignancies. In this Trio Best Practices paper, we review the evidence surrounding the application of ...induction chemotherapy for definitive management of locally advanced sinonasal squamous cell carcinoma.
Objective/Hypothesis
Utilization of flaps for reconstruction of large head and neck cancer (HNCA) defects has become more prevalent. The present study aimed to assess the impact of center experience ...as measured by annual hospital caseload on mortality, major complications, resource utilization, and 90‐day readmissions following HNCA resection with flap reconstruction.
Study Design
Non‐Randomized Controlled Cohort Study.
Methods
All adult patients undergoing elective HNCA resection with flap reconstruction were identified utilizing the 2010 to 2018 Nationwide Readmissions Database. Hospitals were subsequently classified as low‐, medium‐, or high‐volume based on annual institutional surgical caseload tertiles. Multivariable regression models were implemented to assess the independent association of hospital volume with the outcomes of interest.
Results
Over the nine‐year study period, the proportion of HNCA resection with flap reconstruction gradually increased (12.8% in 2010 vs. 17.3% in 2018, P < .001). Although increasing hospital volume did not alter the odds of mortality, patients treated at high‐volume centers were less likely to experience both surgical (adjusted odds ratio AOR 0.81, 95% confidence interval CI 0.67–0.97, P = .025) and medical complications (AOR 0.70, 95% CI 0.57–0.85, P < .001). Furthermore, these patients had shorter hospitalizations (−2.1 days, 95% CI −2.7 to −1.4 days, P < .001) and decreased costs (−$8,100, 95% CI −11,400 to −4,700, P < .001) compared to counterparts at low‐volume centers. However, hospital volume did not impact 90‐day readmissions.
Conclusion
Patients undergoing HNCA resection with flap reconstruction at high‐volume centers were less likely to experience surgical and medical complications while incurring shorter hospitalizations and lower costs. Implementation of volume standards may be appropriate to improve outcomes in this surgical population.
Level of Evidence
3 Laryngoscope, 132:1381–1387, 2022
Oral fluid (saliva) meets the demand for noninvasive, accessible, and highly efficient diagnostic medium. Recent discovery that a large panel of human RNA can be reliably detected in saliva gives ...rise to a novel clinical approach, salivary transcriptome diagnostics. The purpose of this study is to evaluate the diagnostic value of this new approach by using oral squamous cell carcinoma (OSCC) as the proof-of-principle disease.
Unstimulated saliva was collected from patients (n = 32) with primary T1/T2 OSCC and normal subjects (n = 32) with matched age, gender, and smoking history. RNA isolation was done from the saliva supernatant, followed by two-round linear amplification with T7 RNA polymerase. Human Genome U133A microarrays were applied for profiling human salivary transcriptome. The different gene expression patterns were analyzed by combining a t test comparison and a fold-change analysis on 10 matched cancer patients and controls. Quantitative polymerase chain reaction (qPCR) was used to validate the selected genes that showed significant difference (P < 0.01) by microarray. The predictive power of these salivary mRNA biomarkers was analyzed by receiver operating characteristic curve and classification models.
Microarray analysis showed there are 1,679 genes exhibited significantly different expression level in saliva between cancer patients and controls (P < 0.05). Seven cancer-related mRNA biomarkers that exhibited at least a 3.5-fold elevation in OSCC saliva (P < 0.01) were consistently validated by qPCR on saliva samples from OSCC patients (n = 32) and controls (n = 32). These potential salivary RNA biomarkers are transcripts of IL8, IL1B, DUSP1, HA3, OAZ1, S100P, and SAT. The combinations of these biomarkers yielded sensitivity (91%) and specificity (91%) in distinguishing OSCC from the controls.
The utility of salivary transcriptome diagnostics is successfully demonstrated in this study for oral cancer detection. This novel clinical approach could be exploited to a robust, high-throughput, and reproducible tool for early cancer detection. Salivary transcriptome profiling can be applied to evaluate its usefulness for other major disease applications as well as for normal health surveillance.
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