Cancer staging: The Goldilocks principle Lydiatt, William M.
Cancer,
1 February 2024, 2024-02-01, 2024-02-00, 20240201, Letnik:
130, Številka:
3
Journal Article
Recenzirano
Modifications are critical to cancer staging evolution. This piece seeks to contextualize key examples of the necessity for balance when considering and adopting these modifications.
Ho et al suggest modifications to the pathological staging of oropharyngeal carcinoma. Their recommendations are placed into a broader context of some of the competing principles of cancer staging.
Abstract The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing despite a decrease in tobacco use. Almost 20–30% of patients with OPSCC do not have the traditional risk factors ...of smoking and alcohol use and in a vast majority of these patients, the human papilloma virus (HPV) appears to drive the malignant transformation. HPV induced malignant transformation is attributed to two viral oncogenes and their non-structural protein products (E6 and E7). These two proteins appear to affect carcinogenesis by their inhibitory effects on p53 and retinoblastoma proteins (Rb). Patients with HPV mediated OPSCC seem to have a better prognosis compared to their non-HPV counterparts. However, in the absence of strong evidence, standard of care at this time for OPSCC does not differ based on HPV status. Current research is focused on the role of de-escalation of treatment and elucidation of prognostic markers in this unique population. This review focuses on the pathogenesis of HPV mediated OPSCC and details the current evidence in the management of these patients.
Background
The present study aims to quantify the opportunity cost of training residents and fellows for head and neck surgery.
Methods
A 2005–2015 review of ablative head and neck surgical ...procedures was performed using the National Surgical Quality Improvement Program (NSQIP). Work relative value units (wRVU) generated per hour were compared among procedures performed by attendings alone, attendings with residents, and attendings with fellows.
Results
Among 34,078 ablative procedures, the rate of wRVU generation per hour was greatest for attendings alone (10.3), followed by attendings with residents (8.9) and attendings with fellows (7.0, p < 0.001). Resident and fellow involvement was associated with opportunity costs of $60.44 per hour (95% CI: $50.21–$70.66/h) and $78.98 per hour ($63.10–$94.87/h, 95% CI), respectively.
Conclusion
wRVU‐based physician reimbursement does not consider or adjust for the extra effort involved in training future head and neck surgeons.
Level of Evidence
NA Laryngoscope, 134:113–119, 2024
We investigated the relative value unit opportunity cost of including residents and fellow trainees in common head and neck surgical procedures sing the National Surgical Quality Improvement Program (NSQIP). Inclusion of residents and fellows in head and neck surgical procedures was associated with opportunity costs of $60.44 per hour (95% CI: $50.21–$70.66/h) and $78.98 per hour ($63.10–$94.87/h, 95% CI), respectively.
Background
Few studies have investigated the needs of head and neck surgery trainees and areas for improvement of fellowship programs.
Methods
We conducted a qualitative study by interviewing a ...nationally representative sample of program directors and national leaders in head and neck surgery. We asked about the current state and strengths of training; and areas for further improvement. All interviews were independently coded and analyzed by two reviewers.
Results
All experts (100%) believed that the current training provides a strong foundation and furthermore, a standardized curriculum is beneficial. Multidisciplinary training (80%), participation in tumor boards (75%), and a syllabus (60%) were the most frequently mentioned components. Most believed that a formal certification process would be beneficial (73%), though there was no consensus on the format.
Conclusion
Experts in head and neck surgery are generally in favor of a standardized curriculum. Further discussions of a formal certification process might be warranted.
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancers provide treatment recommendations for cancers of the lip, oral cavity, pharynx, larynx, ethmoid and ...maxillary sinuses, and salivary glands. Recommendations are also provided for occult primary of the head and neck (H&N), and separate algorithms have been developed by the panel for very advanced H&N cancers. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding the increase in human papillomavirus-associated oropharyngeal cancer and the availability of immunotherapy agents for treatment of patients with recurrent or metastatic H&N cancer.
The staging of oropharyngeal squamous cell carcinoma has undergone key changes in the eighth edition of the American Joint Committee on Cancer Staging Manual, set to take effect January 1, 2018. The ...most significant change relates to the development of a novel staging system for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinomas, distinct from that for non-HPV-associated squamous cell carcinomas of the oropharynx. We describe the revised staging parameters and the rationale in support of the changes.
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