•Compared to lower gum SCC, upper gum SCC had less favorable 5-year DSS and OS rates.•Upper gum SCC had higher frequencies of aged ≥ 65 years and margin status ≤ 4 mm.•Wide resection margins are ...recommended to improve outcomes of upper gum SCC.
This large-scale cohort study was designed to compare the clinical outcomes of Taiwanese patients with squamous cell carcinoma (SCC) of the upper versus lower gum.
Between 2004 and 2017, we identified 4244 patients with first primary SCC of the gum (694 upper gum; 3550 lower gum) who were treated with surgery either with or without adjuvant therapy. Of them, 1990 patients (329 upper gum; 1661 lower gum) enrolled from 2011 to 2017 had a higher number of histopathological variables and entered subgroup analyses. Five-year disease-specific survival (DSS) and overall survival (OS) rates served as outcome measures.
The 5-year DSS and OS rates of patients with upper gum SCC were lower than those of cases with lower gum SCC (65%/74%, p < 0.0001; and 55%/65%, respectively, p < 0.0001). Compared with lower gum SCC, upper gum SCC had a higher prevalence of the following variables: female sex, age ≥ 65 years, pNx (without neck dissection), no-betel chewing (2011–2017), no-smoking (2011–2017), and margin status ≤ 4 mm (positive and close margins, 2011–2017). On multivariable analysis, gum subsite (upper versus lower), age (≥65 versus < 65 years), pT (T3 − 4 versus T1 − 2), pN (N1 − 3 versus N0/Nx), depth (≥10 mm versus < 10 mm, 2011–2017), ENE (present versus absent, 2011–2017), and margins (≤4 mm versus > 4 mm 2011–2017, only DSS) were identified as independent adverse prognostic factors for 5-year DSS and OS.
Compared to lower gum SCC, upper gum SCC had less favorable 5-year outcomes. Wide resection margins are recommended to improve prognosis of upper gum SCC.
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.
Background
The current NCCN guidelines recommend considering elective neck dissection (END) for early‐stage oral cavity squamous cell carcinoma (OCSCC) with a depth of invasion (DOI) exceeding 3 mm. ...However, this DOI threshold, determined by evaluating the occult lymph node metastatic rate, lacks robust supporting evidence regarding its impact on patient outcomes. In this nationwide study, we sought to explore the specific indications for END in patients diagnosed with OCSCC at stage cT2N0M0, as defined by the AJCC Eighth Edition staging criteria.
Methods
We examined 4723 patients with cT2N0M0 OCSCC, of which 3744 underwent END and 979 were monitored through neck observation (NO).
Results
Patients who underwent END had better 5‐year outcomes compared to those in the NO group. The END group had higher rates of neck control (95% vs. 84%, p < 0.0001), disease‐specific survival (DSS; 87% vs. 84%, p = 0.0259), and overall survival (OS; 79% vs. 73%, p = 0.0002). Multivariable analysis identified NO, DOI ≥5.0 mm, and moderate‐to‐poor tumor differentiation as independent risk factors for 5‐year neck control, DSS, and OS. Based on these prognostic variables, three distinct outcome subgroups were identified within the NO group. These included a low‐risk subgroup (DOI <5 mm plus well‐differentiated tumor), an intermediate‐risk subgroup (DOI ≥5.0 mm or moderately differentiated tumor), and a high‐risk subgroup (poorly differentiated tumor or DOI ≥5.0 mm plus moderately differentiated tumor). Notably, the 5‐year survival outcomes (neck control/DSS/OS) for the low‐risk subgroup within the NO group (97%/95%/85%, n = 251) were not inferior to those of the END group (95%/87%/79%).
Conclusions
By implementing risk stratification within the NO group, we found that 26% (251/979) of low‐risk patients achieved outcomes similar to those in the END group. Therefore, when making decisions regarding the implementation of END in patients with cT2N0M0 OCSCC, factors such as DOI and tumor differentiation should be taken into account.
Purpose We submit an alternative treatment for unreleasable trismus to increase the interincisal distance and allow adequate oral nutrition and masticatory function. Patient and Methods The patient ...presented with severe trismus after receiving postoperation radiotherapy for oral carcinoma. We undertook radical release of the left-sided trismus, and covered the resultant soft tissue defect with an anterolateral thigh free flap, but the patient was only able to open his mouth an interincisal distance of 8 mm. The right mandible was accessed and the functionless residual teeth were extracted. Marginal mandibulectomy of the native mandible was performed. Results Dental implants (POI, Kyocera, Japan) were inserted into the leveled right mandible. A bridge dental prosthesis was inserted and resulted in a final functional interincisal distance of 19 mm. Conclusion We offer that leveling the native mandible to match the reconstructed side is a simple procedure that can be reasonably used as an alternative measure in a selected group of patients.
Summary Objectives The aim of this cohort study was to examine the role of chemokine (C-X-C motif) ligand 9 (CXCL9) on oral cavity squamous cell carcinoma (OSCC). Methods Sera from 181 OSCC patients, ...231 healthy individuals, and 50 OSCC tumor samples were enrolled. CXCL9 expression in tissue samples was analyzed by quantitative real-time PCR and immunohistochemistry. CXCL9 serum concentrations were measured by enzyme-linked immunosorbent assay. Effects of CXCL9 on OSCC cell function were investigated by cell proliferation assays, trans-well migration/invasion assays, and RNA interference. Results CXCL9 expression was significantly higher than for normal epithelium in the tissue samples. CXCL9 serum concentrations were also significantly higher in OSCC patients compared to those in healthy individuals. Serum CXCL9 levels were significantly higher in OSCC patients with higher pT status, pathological overall stages, tumor depths, and positive bone invasion ( P = 0.033, 0.004, 0.041, and 0.002, respectively). Moreover, OSCC patients with higher CXCL9 levels (>209 pg/mL, median level) before treatment had worse prognoses for overall survival and disease-specific survival ( P = 0.0006 and 0.0009, respectively). Multivariate logistic regression analyses also indicated that higher CXCL9 serum levels were an independent prognostic factor for overall survival and disease-free survival ( P = 0.003 and 0.004, respectively). The in vitro suppression of CXCL9 expression in SCC25 cells using specific interfering RNAs attenuated cell proliferation, migration and invasiveness. Conclusions Our study demonstrated that CXCL9 is associated with tumor burden and aggressiveness of OSCC tumors and serum level of this ligand may be useful as a prognostic indicator.
Head and neck cancer (HNC) is a prevalent cancer worldwide; however, clinically useful tumor markers for HNC have not been identified. Here, we aimed to identify secretory proteins from the tumor ...microenvironment as candidate circulating tumor markers.
Samples derived from seven pairs of tumor interstitial fluid (TIF) and normal interstitial fluid (NIF) samples from patients with HNC were analyzed. The proteomes were determined by gel-based-mass-spectrometry proteomic methods. The most up-regulated protein, fascin was confirmed in the cancer tissues and cell culture supernatant by immunoblotting and immunohistochemistry assays. Serum fascin was determined in 40 HNC and 40 normal individuals by ELISA.
After proteomics analysis, 189 peptides were identified, corresponding to 75 proteins. Of the 21 proteins which were identified more than twice, five up-regulated proteins identified most frequently including fascin. The most elevated fascin was over-expressed in cancer tissues and cell culture supernatant. Serum fascin was significantly up-regulated in the cancer patients (p<0.001) and correlated with pathological lymph node metastasis (p=0.022). To assess the diagnostic efficacy, serum levels of fascin and another potential biomarker SCCA were determined. Fascin showed a high predictable value with an area under the curve (AUC) of 0.808 (95% CI 0.723-0.901) in the receiver operator curve (ROC), compared to 0.501 (95% CI 0.378-0.634) for SCCA.
We have identified 75 potential circulating tumor markers associated with HNC, including fascin. Serum fascin could discriminate cancer patients from healthy individuals; thus, it may serve as a circulating biomarker for HNC.
This study investigated the effect of second-phase particles on the galvanic corrosion of anodized 6061 aluminum alloys coupled with C1100 copper alloys. The AA6061 alloys were solution treated at ...530– 570 °C for 1 h, followed by water quenching or furnace cooling. Anodic coatings of thicknesses 1, 5, and 12 μm were formed on AA6061-T6 after anodizing. The galvanic corrosion current of AA6061 coupled with C1100 copper was measured using a zero-resistance ammeter for 8 h in two solutions, namely 3.5 wt.% NaCl and 1.0 wt.% NaClO, at 25, 40, and 60 °C. Black Mg2Si particles measuring 3−5 μm and white Al-Fe-Si-Cu particles measuring 3–8 μm were observed in the furnace-cooled AA6061 specimens. The highest galvanic corrosion current density (1312 μA/cm2) in a flowing NaClO electrolyte was observed at 60 °C for the free-anodized AA6061-T6 alloy coupled with C1100 copper. The lowest galvanic corrosion current density (15 μA/cm2) was observed in a 12-μm-thick anodic coating on AA6061-T6 alloy coupled with C1100 copper in a static 3.5 wt.% NaCl electrolyte at 25 °C. A severe corrosion attack was observed for a thin and nonuniform anodic coating on AA6061 alloy coupled with C1100 copper after the galvanic corrosion test because the coarse second-phase particles in the thin anodic coating on AA6061 caused perforations in the anodic coating. However, the thick anodic coating on AA6061 can effectively reduce the galvanic corrosion of AA6061-T6 coupled with C1100 copper in static or flowing electrolyte solutions.
The hydraulic performance of fluid in a cross-corrugated channel has been investigated, numerically and experimentally, by a three-dimensional model with an exact geometry of the heat exchanger. The ...distributions of the fluid and local flow characteristics have been discussed, especially for the flow around the contact points in the developing and periodic fully developed sections. The velocity and pressure variations in different cross sections have also been presented. Experiments have been carried out to validate the numerical predictions. The friction factors between the numerical computation and the experimental data are in a reasonable agreement in the range of Reynolds number being equal to 660–2,000.
Background
We compared the clinical outcomes of patients with oral cavity squamous cell carcinoma (OCSCC) with cN+pN0 versus cN0pN0 disease.
Methods
A total of 1309 OCSCC patients with pN0 disease ...were included. Of them, 1019 and 290 cases had cN0pN0 and cN+pN0 disease, respectively. For comparison purposes, we also examined 799 patients with pN+disease (cN0pN+/cN+pN+, n = 239/560). Subgroup analysis was performed in a propensity score‐matched cohort with cN0pN0 and cN+pN0 disease (n = 284 each).
Results
Compared with cN0pN0, patients with cN+pN0 had a higher prevalence of the following variables: betel chewing, pT3−4, depth ≥10 mm, perineural invasion, and treatment with surgery and adjuvant therapy. The prognosis of patients with cN+pN0 (mean: 52 nodes) and cN0pN0 (mean: 39 nodes) disease was similar both in the original cohort and after propensity score matching. However, the 5‐year outcomes were more favorable for cN+pN0/cN0pN0 compared with cN0pN+/cN+pN+ (local control, 88%/88%/83%/81%; neck control, 94%/93%/82%/76%; distant metastases, 4%/3%/13%/31%; disease‐free survival, 84%/83%/68%/52%; disease‐specific survival, 92%/92%/77%/57%; overall survival, 81%/82%/59%/42%; all p values <0.001; cN+pN0 versus cN0pN0, all p values >0.05). cN+pN0 disease (vs. cN0pN0) was not significantly associated with local control, neck control, distant metastases, and survivals either in univariable or multivariable analyses.
Conclusions
Despite a higher risk factor burden, the prognosis of patients with cN+pN0 disease did not differ from that of cases with cN0pN0. The higher nodal yield and the more frequent use of adjuvant therapy in cN+pN0 disease may explain the lack of significant differences in terms of neck control compared with cN0pN0 disease.
Patients with oral cavity squamous cell carcinoma and cN+pN0 disease are characterized by a higher prevalence of adverse risk factors. However, this was not found to translate into a less favorable prognosis; therefore, the presence of cN+pN0 disease should not be considered as an adverse prognostic factor
Summary Objectives We have previously shown that the resection outcomes of cT4a and cT4b oral cavity squamous cell carcinoma (OSCC) are comparable, but whether similar conclusions can be applied for ...the pathological stage of this disease needs investigation. In this study, we sought to compare the outcomes and to identify the risk factors for both pT4a and pT4b tumors. Methods We retrospectively examined 181 pT4 OSCC patients who had radical resections between 2003 and 2010. The 5-year control and survival rates were the main outcome measures. Results Of the 181 resected pT4 OSCC patients, 133 (73%) had pT4a disease, and 48 (27%) had pT4b disease. All of the resected T4b tumors were below the mandibular notch (infra-notch pT4b). The 5-year outcomes of the patients with infra-notch pT4b and pT4a were comparable: local control, 80% vs. 78%, p = 0.7275; neck control, 87% vs. 82%, p = 0.4798; distant metastases, 22% vs. 23%, p = 0.8871; disease-free survival, 63% vs. 55%, p = 0.2813; disease-specific survival, 68% vs. 60%, p = 0.3526; and overall survival, 62% vs. 44%, p = 0.2643, respectively. Extracapsular spread was the only independent prognostic factor for 5-year survival rates in pT4a patients. Poor tumor differentiation and pN2 status were the independent 5-year survival prognostic factors for the infra-notch pT4b tumor patients. Conclusions Infra-notch pT4b had outcomes comparable with those of pT4a tumors, although they displayed different risk factors. We therefore recommend that resectable infra-notch pT4b tumors should be classified as pT4a disease in the AJCC tumor staging.
PDF