Research progress of pathomics in head and neck neoplasms / 国际肿瘤学杂志

Pathomics, the integration of digital pathology and artificial intelligence, is used to assess tumor diagnosis, treatment and prognosis by extracting, screening and analyzing the data features contained in pathological pictures. In recent years, more and more pathomics studies of head and neck neoplasms have shown great value in the areas of computer-assisted diagnosis, tumor microenvironment and biomarker identification as well as prognosis evaluation. It is expected to play an important role in clinical assistance and precise treatment of head and neck neoplasms in the future.

Advances of spatial omics in the individualized diagnosis and treatment of head and neck cancer / 临床耳鼻咽喉头颈外科杂志

Spatialomics is another research hotspot of biotechnology after single-cell sequencing technology, which can make up for the defect that single-cell sequencing technology can not obtain cell spatial distribution information. Spatialomics mainly studies the relative position of cells in tissue samples to reveal the effect of cell spatial distribution on diseases. In recent years, spatialomics has made new progress in the pathogenesis, target exploration, drug development and many other aspects of head and neck tumors. This paper summarizes the latest progress of spatialomics in the diagnosis and treatment of head and neck cancer.

Efficacy evaluation of transaxillary non-inflatable endoscopic surgery and open neck surgery in the treatment of PTC: a single center report of 342 cases / 临床耳鼻咽喉头颈外科杂志

Objective:To compare the clinical effect of transaxillary non-inflatable endoscopic surgery and traditional open thyroid surgery in the treatment of PTC. Methods:A retrospective analysis was performed on 342 patients with PTC treated in the Otorhinolaryngology Department of Qilu Hospital of Shandong University from December 2020 to December 2022. There were 73 males and 269 females, aged 16-72 years, who underwent unilateral non-inflatable transaxillary endoscopic thyroid surgery（endoscopic group） and unilateral traditional open thyroid surgery（open group）. There were 108 patients in the endoscopic group and 234 in the open group. Results:The endoscopic group was lower in age（37.1±9.4 vs 43.5±11.2） years and BMI（23.4±3.4 vs 25.7±3.8 ）kg/m² than that in the open group, and the difference was statistically significant（t was 5.53, 5.67 respectively, P<0.01）. There was no significant difference in hospitalization days between the two groups（P>0.05）. The logarithmic curve of the operation time showed a smooth downward trend, and the overall operation time of the endoscopic group was relatively consistent. There was no significant difference in intraoperative blood loss between the endoscopic group（13.3±3.2） mL and the open group（14.7±6.3） mL（P>0.05）, but the operation time（130.1±37.9） min was longer than that in the open group（57.4±13.7） min, and the difference was statistically significant（t=19.40, P<0.01）. There was no significant difference in complications such as temporary recurrent laryngeal nerve injury within 3 days after operation between the two groups（P>0.05）. The aesthetic satisfaction score of the surgical incision and the incision concealment effect score in the endoscopic group were higher than those in the open group, and the difference was statistically significant（P<0.05）. Conclusion:Compared with traditional open thyroidectomy, transaxillary non-inflatable endoscopic thyroidectomy has more advantages in the concealment and aesthetics of postoperative incision. Although the former has longer operation time and more drainage, it is still a safe and feasible surgical method with good postoperative clinical effect.

A case of pediatric tracheal inflammatory myofibroblastic tumor / 临床耳鼻咽喉头颈外科杂志

Inflammatory myofibroblastic tumor is a rare tumor of mesenchymal origin. A case of intratracheal inflammatory myofibroblastic tumor in a male child was reported. The clinical characteristics, diagnosis, treatment and prognosis of the disease were reviewed based on the literature, and a differential diagnosis between inflammatory myofibroblastic tumor and hamartoma was performed to ultimately confirm the nature of the tumor in the child.

Treatment options for advanced laryngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Laryngeal cancer is one of the most common malignancies in the head and neck. With the development in clinical research of multimodality therapy for recent years, the treatment strategies for laryngeal cancer, especially for advanced cases, have changed significantly. The management for laryngeal cancer needs the adequate assessments of the primary tumor and the general condition of patient, the comprehensive application of multiple treatment modalities including surgery, radiation, chemotherapy and biotherapy, and the design of individualized regimens. The goal is to eradicate the tumor completely with maximal reconstruction and preservation of laryngeal functions, and to improve patient′s quality of life without reduction in survival rate.

Surgical treatment in 184 patients with supraglottic carcinoma at a single institute / 中华耳鼻咽喉头颈外科杂志

Objective@#To summarize clinical experience in surgical treatment of supraglottic carcinoma and reconstructive techniques.@*Methods@#Medical files of 184 patients (173 men, 11 women) were collected and retrospectively analyzed, who underwent surgeries between January 2008 and December 2012 at Qilu Hospital of Shandong University. Among them, T1, T2, T3 and T4 staging tumors accounted respectively for 14.1% (26/184), 41.9%(77/184), 31.5%(58/184) and 12.5%(23/184). Cervical metastasis was histologically identified in 86 cases (98 for N0, 31 for N1 and 55 for N2). Advanced cases (56 cases at stage Ⅲ and 67 at stage Ⅳ), early cases (22 at stage Ⅰ and 39 at stage Ⅱ) accounted respectively for 66.8% and 33.2%. Supraglottic horizontal laryngectomy or total laryngectomy was performed to allow for tumor excision without compromising margins and the tongue flap or sternohyoidmyofascial flap was subsequently used for repairing the defect after removal of tumor. Survival rates were analyzed by the Kaplan-Meier method.@*Results@#Patients receiving conservation laryngeal surgery accounted for 75.5% (139/184). The 3-year and 5-year survival rates for all cases were 84.2% and 70.7%, respectively. Log-rank test demonstrated that cervical lymph node metastasis, primary tumor staging and clinical TNM staging were significantly associated with prognoses of patients (P=0.003, 0.010, 0.035). Dysphagia was not observed in any case and speech function was maintained in petients with partial laryngectomy.@*Conclusion@#Adequate pre-operative evaluation, individualized treatment, and comprehensive application of flaps for repair are critical to precise tumor excision and reconstruction of laryngeal functions.

Comprehensive treatment of 335 patients with pyriform sinus carcinoma by surgery via the paraglottic space approach / 中华耳鼻咽喉头颈外科杂志

Objective@#To report the experience in comprehensive surgical treatment of pyriform sinus carcinoma via the paraglottic space approach.@*Methods@#Three hundred and thirty-five cases with pyriform sinus carcinoma (according to UICC 2012 criteria, stage Ⅰ, 12 cases; Ⅱ, 36; Ⅲ, 79; Ⅳ, 208; T1, 26; T2, 139; T3, 121; T4, 49; cN0, 83; cN1, 61; cN2a-b, 118; cN2c, 71; cN3, 2) treated between 2006 and 2013 were retrospectively reviewed. There were 323 males and 12 females. Age aged from 36 to 80 years old with a median of 60 years old. There was no case with distant metastasis. All patients received modified neck dissection, including unilateral in 240 patients and bilateral in 95 patients. Pharyngoesophageal defects were reconstructed with directly suture in 246 cases, pectoralis major musculocutaneous flaps in 74 cases, and laryngotracheal flaps in 15 cases. Three hundred and nineteen patients received postoperative radiotherapy (55-65 Gy).@*Results@#The overall 3 and 5 year survival rates were 68.6% (230/335) and 52.1%(139/267), respectively. The cervical lymph node metastases were found in 265 (79.1%) patients. Pathologic findings showed that all patients had squamous cell carcinoma. Laryngeal functions (voice, respiration and deglutition) were completely restored in 277 (82.7%) patients.@*Conclusions@#The oncological efficacy of surgery via the paraglottic space approach is sure for pyriform sinus carcinoma, especially suitable for the early and medium-term lesions. The function of the larynx can retain after surgery, with the decreased incidences of cough and pharynx fistula.

Surgical treatment of differentiated thyroid carcinoma with laryngeal or tracheal invasion / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the clinical characters, surgical treatments and prognosis of differentiated thyroid carcinoma (DTC) with laryngeal or tracheal invasion.@*METHOD@#Forty-six cases including 33 papillary and 13 follicular were retrospectively reviewed. Thirty-four cases with tracheal invasion received conservative resection (17), window resection (11) and sleeve resection (6). One case with subglottic invasion was performed subglottic partial laryngectomy. Eleven cases with trachea-laryngeal invasion received total laryngectomy(4), 3 shave technique and 4 preservative laryngectomy.@*RESULT@#Complications included infections and hypocalcaemia, 15 patients got permanent fistula. 5-year survival rate in cases of tracheal shave resection was 88.2%, while 63.6% in those of window resection and 83.3% in those of sleeve resection. Survival rate within 5 years of patients received preservative laryngectomy was 62. 5%. Conclusion: With meticulous preoperative examination and positive surgical treatment, both survival rate and quality of life could be improved in patients of DTC with laryngeal or tracheal invasion.

Clinical analysis of 91 cases of primary parapharyngeal space tumors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To summarize and analyze the clinical features, diagnosis methods, surgical approaches and treatment outcomes of patients with primary parapharyngeal space tumors.</p><p><b>METHODS</b>A retrospective review of 91 cases with primary parapharyngeal space tumors treated from January 1999 to December 2011 was performed. All patients underwent preoperative enhanced CT scan and postoperative histopathologic examination. Intraoperative frozen section biopsies were performed in 36 of 91 cases. The surgical approaches included trans-cervical approach in 73 cases, trans-parotid approach in 5 cases, trans-oral approach in 5 cases, and mandibulotomy in 8 cases.</p><p><b>RESULTS</b>The postoperative pathological diagnoses consisted of 29 variants, including 20 for benign tumors and 9 for malignant tumors. Of the 80 cases with benign tumors, 6 cases were lost to follow-up and 74 cases were followed up for 31-84 months with no recurrence. Eleven cases with malignant tumor were followed up for 8-51 months (median 29 months), of them 7 cases died and 1 case was lost to follow-up. The post-operative complications included Horner syndrome in 3 cases, hoarseness in 2 cases, hypoglossal nerve palsy in 1 case, accessory nerve palsy in 1 case, upper airway obstruction in 1 case, and internal carotid artery cavernous sinus fistula in 1 case.</p><p><b>CONCLUSIONS</b>Parapharyngeal space tumors are rare, with atypical clinical manifestation, and have pathological types of diversification. CT or MRI is helpful to evaluate the tumor size, location and possible sources, and to make operation scheme. Surgery is the first choice for parapharyngeal space tumors. Trans-cervical approach can be applied to most tumors. Parapharyngeal benign tumors have good prognosis, but malignant tumors have poor prognosis.</p>

Mutation and abnormal expression of FHIT gene in hypopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the mutation and abnormal expression of the FHIT gene in human hypopharyngeal carcinoma.@*METHOD@#Matched normal and cancerous tissues from 24 patients with hypopharyngeal squamous cell carcinoma were obtained immediately after surgery. Total RNA was extracted, the FHIT gene was detected by nested RT-PCR and DNA sequencing technology.@*RESULT@#Normal sized FHIT transcript was detected in 23 of the 24 cases of normal matched tissues. Aberrant FHIT transcripts were found in 9/24 (37.5%) cases in hypopharyngeal carcinoma. Aberrant FHIT transcripts rate of well-differentiated, moderately differentiated and poorly differentiated squamous cell carcinoma, was 28.6% (2/7), 50.0% (4/8) and 33.3% (3/9), respectively. There the carcinoma with FHIT aberrant transcripts was neither corresponding to histological grade (P>0.05) nor to lymphatic metastasis. The sequence analyses of the two aberrant cDNAs revealed absence of exon 8 and exon 7-9. All initial deletion were in conjunction of exons.@*CONCLUSION@#High deletion rate of the FHIT gene in Chinese hypopharyngeal squamous cell carcinoma suggested the FHIT gene, a candidate tumor suppressor gene at 3p14.2, plays an important role in the tumor carcinogenesis, development and progression of the tumor, and thus may become a new prognostic marker in hypopharyngeal carcinoma.

Expressions of cyclin D1 and p16 in hypopharyngeal squamous cell carcinoma and their clinical significance / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the expressions of Cyclin D1 and p16 proteins in hypopharyngeal squamous cell carcinoma and their clinical significance.@*METHOD@#Immunohistochemical technology (P-V) was applied to detect the expression of Cyclin D1 and p16 in 36 cases of hypopharyngeal squamous cell carcinoma and 10 cases of normal epithelium.@*RESULT@#(1) The expression of cyclin D1 in the tumorous cell was significantly higher than that in normal epithelium (P 0.05); (3) There was correlation between the expression of Cyclin D1 and the expression of p16 (r(s) = -0.420, P < 0.05).@*CONCLUSION@#The over-expression of Cyclin D1 and the under-expression of p16 may play a significant role in the occurrence incidence and development of hypopharyngeal squamous cell carcinoma, and may be important indicators for cervical lymph node metastases.

Clinic effects of the compound danshen diwan in menopause women with ST changes and angina / 中国实用内科杂志

Objective To investigate the clilic effects of the compound danshen diwan in menopause women with ST changes and angina.Methods56 menopause women with ST changes and angina were randomly divided into two groups,a controlled group(n=28)with base medicine treatment and a observed group(n=28)with the compound danshen diwan.The change of vasodilation endothelium functon and symptom relief were oberved before and after treatment in all patients.ResultsVasodilation endothelium functon were improved markedly in the observed group while the controlled group had no significantly changes;Meanwhile,the clinic relief rates of the observed group was markedly superor to that of controlled group.ConclusionThe compound danshen diwan would have a positive effect in menopause women with ST changes and angina.

Surgical management of supraglottic laryngeal carcinoma in 182 patients with special emphasis on functional preservation / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the surgical methods and evaluate the long-term result of laryngectomy in patients with supraglottic laryngeal cancer.</p><p><b>METHODS</b>182 patients with supraglottic laryngeal carcinoma underwent operation from 1979 to 1999, with stage I 11, stage II 45, stage III 49 and stage IV 77 lesions. The choice of surgical procedure was decided with the disease condition of the larynx. The surgical procedures proposed by TD Wang were adhered to as: minor partial laryngectomy 36, major partial laryngectomy 85, subtotal partial laryngectomy with laryngoplasty 22 and total laryngectomy 39.</p><p><b>RESULTS</b>The ultimate rate of larynx preservation was 78.6% (143/182) with 69.8% (88/126) in stage III and IV diseases. The decannulation rate was 81.8% in cases with preservation of laryngeal function. The overall 3- and 5-year survival rates were 82.9% and 67.3%, with 76.88% and 57.4% in the advanced (stage III and IV) cases who survived with preserved laryngeal function. They were 82.5% and 67.0% in similar advanced cases who were treated by total laryngectomy. The difference in the survival rates between these two groups was not statistically significant.</p><p><b>CONCLUSION</b>It is suggested that preservation of the laryngeal function be possible for advanced supraglottic laryngeal carcinoma without compromising the remote survival rate. To improve the rate of larynx preservation, one should follow the surgical methods suggested.</p>

Relationship between polymorphism of N-acetyltransferase 2 and genetic susceptibility to laryngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the relationship between polymorphism of N-acetyltransferase (NAT2) gene and genetic susceptibility to laryngeal carcinoma.</p><p><b>METHODS</b>A case-control study on 62 laryngeal carcinoma patients and 56 controls was conducted. NAT2 alleles were differentiated by polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) methods using originally created PCR primers and genomic DNA extracted from peripheral white blood cells. Genetic risk for NAT2 genotype was analyzed by smoking index (SI, cigarettes smoked per day x years of smoking).</p><p><b>RESULTS</b>The frequency of NAT2 slow genotype was 80.6% in patients with laryngeal carcinoma and 60.7% in the controls, the difference of which was statistically significant (chi(2) = 5.70, P = 0.017). The odds ratios were 2.70 (95% CI 1.19 approximately 6.11). Among the individuals with NAT2 slow genotype at high level of cigarette smoking, there was a significantly higher risk of 5.64 (95% CI 1.77 approximately 17.92), while those at low level were considered the reference group (OR 1.38, 95% CI 0.42 approximately 4.52).</p><p><b>CONCLUSION</b>NAT2 slow genotype increases the risk of susceptibility to laryngeal carcinoma. The combined effect of NAT2 slow genotype and exposure to smoking is observed during the development of laryngeal cancer.</p>

Preservation of laryngeal function in surgery for medial wall pyriform sinus cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the feasibility, surgical technique and results of laryngeal function preservation in surgical treatment for medial wall pyriform sinus cancer.</p><p><b>METHODS</b>From 1992 to 1999, 31 patients with medial wall pyriform sinus cancer including stage I 1, II 4, III 14 and IV 12 lesions were treated. Partial resection of pyriform sinus and partial laryngectomy were performed, then, the remains of epiglottis and uni-pedicled sternohyoid myofascial flap were used to restore the defects of larynx. At last, the remaining hypopharyngeal mucosa was sutured to cover the wound of hypopharynx and for artificial rebuild-up. All patients received postoperative radiotherapy.</p><p><b>RESULTS</b>The 3- and 5-year survival rates were 62.1% and 43.6% respectively, with 77.4% patients having laryngeal functions (voice, respiration and deglutition) completely restored and 32.6% partially restored (voice and deglutition).</p><p><b>CONCLUSION</b>Conservative surgery so introduced is feasible for selected medial wall pyriform sinus cancer patients with the lesion completely resected.</p>

Clinical studies on sternocleidomastoid myoperiosteal flap for cervical tracheal reconstruction / 临床耳鼻咽喉头颈外科杂志

Objective:To introduce the experience of repairing the defect of cervical trachea wall by using the sternocleidomastoid myoperiosteal flap after the anterior or posterior wall of cervical trachea was invaded by cervical neoplasm. Method:Between 1989 to 1998 the sternocleidomastoid myoperiosteal flap was applied in 12 patients with different diseases, among which 3 cases were thyroid carcinoma, 5 cases were laryngeal carcinoma, 4 cases were cervical esophageal carcinoma. Result:The operation was successful. 12 patients were decannuated and had normal exercise tolerance. The time from reconstruction to decannulation was ranging from 20 days to 6 months. Conclusion: The sternocleidomastoid myoperiosteal flap is an ideal transplant for cervical tracheal reconstruction.

Measurement of microvessel density in laryngeal carcinoma and its clinical significance / 临床耳鼻咽喉头颈外科杂志

Objective:To determine the microvessel density (MVD) in laryngeal carcinoma and its clinical significance.Method:Thirty-eight tumor specimens were selected from laryngeal cancer patients from January,1994 to March,1996.Histological sections of the tumors were stained immunohistochemically for factor Ⅷ.Using light microscopy,we counted microvessels per 400×field in the most active areas of tumor angiogenesis.Result:①The tumor blood vessels,composed of only one layer of endothelium were mainly distrbuted heterogenously in the interstitial tissue of laryngeal carcinoma with irregular lumen,poorly developed structure.②The MVD in the cancer tissues were statistically higher than that in peritumoral tissues (P＜0.01).③The MVD in the cancer tissues in group of patients with metastasis to cervical lymphonodes were statistically higher than in group without metastasis (P＜0.01),the MVD in the cancer tissues in group of advanced cases (Ⅲ,Ⅳ stages) were statistically higher than that in group of early cases (Ⅰ,Ⅱ stages,P＜0.01).④There was no statistically difference in MVD in the cancer tissue between supraglottic and glottic laryngeal carcinoma patients (P＞0.05).⑤There was no statistically difference in MVD in the cancer tissue among the G1,G2 and G3 group (P＞0.05).Conclusion:The laryngeal cancer blood vessels have some characteristics that don′t appear in normal vessels.It is suggested that tumor angiogenesis can promote tumor growth and metastasis and MVD may be a new prognostic indicator of laryngeal carcinoma.