Infection of human papillomavirus and head and neck cancer / 中华肿瘤杂志

High-risk human papillomavirus (HPV)-related cancers consist of cervical cancer, anal cancer, penile cancer, vulvar cancer, vaginal cancer, and head and neck cancer (HNC). Of these, the disease burden of HNC is second only to cervical cancer. HNC mostly originates from malignant lesions of squamous epithelial cells and mainly includes oral cavity cancer, pharyngeal cancer (including nasopharyngeal cancer, oropharyngeal cancer, and hypopharyngeal cancer), and laryngeal cancer. Tobacco use, alcohol abuse, and HPV infection are three primary risk factors. Recently, there is an upward trend of HNC incidence globally, especially in high-income countries. In China, the disease burden and trends of HPV-related HNC are still not clear. A few small sample size and single-center studies suggest a high HPV prevalence and increasing trend in HNC. Methodological differences in HPV testing and regional variabilities still exist among these studies. Among the anatomic sites, oropharyngeal cancer has been shown to be caused by HPV infection, but the association of HPV with other sites is still under debate. In addition, there is a paucity of relevant studies. Here, this review narrates the association between HPV infection and HNC, compares the differences between global and Chinese studies, and then explores the importance of HPV infection in various anatomical sites. The main objective is to highlight the research on HPV-related HNC and promote relevant prevention and treatment programs.

High risk human papilloma virus (HPV) oropharyngeal squamous cell carcinoma in a private tertiary care setting in the Philippines: Prevalence, clinical characteristics and testing

Objective@#To determine the prevalence and describe the clinical characteristics of high risk HPV mong patients with oropharyngeal squamous cell carcinomas in our institution utilizing p16 and HPV DNA in-situ hybridization testing and to determine the factors associated with high risk HPV positivity.@*Methods@# Design: Retrospective Cohort Review Setting: Tertiary Private Training Hospital Participants: 29 @*Results@#A total of 29 primary oropharyngeal squamous cell carcinomas were diagnosed during the 11-year study period (January 2010 to December 2021). Based on the HPV in-situ hybridization status, the prevalence of high risk HPV oropharyngeal squamous cell carcinoma in our institution was 52%. Majority of these cases were males (87.5%) with a median age of ≤55 years old (60%) who are non-smokers (88.2%) and non-drinkers of alcoholic beverages (80%). There was no statistically significant association between age group, sex, smoking status, alcohol intake, lymph node status and high risk HPV infection. The most common tumor site involved in HPV-positive oropharyngeal squamous cell carcinoma was the tonsil (87%). Majority demonstrated a nonkeratinizing histology (73%) with positive lymph node status (67%) upon clinical presentation. Fifteen (83%) of the 18 p16 positive squamous cell carcinomas were positive for high risk HPVDNA. Of note, 3 (17%) out of the 18 p16 positive squamous cell carcinomas turned out to have negative HPV DNA-ISH status.@*Conclusion@#Although no statistically significant correlation between any clinical characteristic with viral status was established, HPV-mediated oropharyngeal squamous cell carcinoma in this institution was commonly seen among males aged 54 years old and below who are nonsmokers and non-drinkers of alcoholic beverages with the palatine tonsil as the most common site presenting with a non-keratinizing histology. In terms of testing, p16 staining correlates well with high risk HPV status. Future studies utilizing a larger patient population may aid in elucidating statistically significant clinical associations in our local population

Fotobiomodulação no tratamento do trismo em pacientes tratados por câncer de boca ou orofaringe: um ensaio clínico controlado randomizado / Photobiomodulation in the treatment of trismus in patients treated for oral or oropharyngeal cancer: a randomized controlled clinical trial

RESUMO Objetivo investigar a eficácia da associação entre a fotobiomodulação de baixa frequência e a terapia fonoaudiológica tradicional no tratamento do trismo, em pacientes tratados por câncer de boca ou orofaringe. Métodos ensaio clínico controlado, randomizado, longitudinal e prospectivo, realizado de acordo as normas da declaração CONSORT 2010. Para a coleta de dados, foi utilizado o questionário sociodemográfico, a avaliação clínica, a mensuração da abertura de boca por paquímetro, o protocolo de dor McGuill e o protocolo de qualidade de vida WHOQOL-Bref. A amostra foi composta por 30 participantes, de ambos os gêneros na faixa etária de 35-75 anos, divididos em dois grupos, controle e experimental, de forma controlada, mediante sorteio igualitário no que tange aos critérios de inclusão e exclusão. Resultados por meio dos dados analisados, observou-se que houve aumento da amplitude vertical de mandíbula em ambos os grupos, GC: p<0,005 e GE: p<0,001. Não houve correlação estatística entre os grupos na comparação da abertura de boca, p>0,19, assim como em relação à dor orofacial e à qualidade de vida, p= 0,72, ambas as avaliações após a intervenção fonoaudiológica, porém, com melhores resultados para o GE, p<0,001. Conclusão Conclui-se pela eficácia da intervenção fonoaudiológica tradicional e a associação com a fotobiomodulação de baixa frequência no tratamento do trismo. Para a dor orofacial e qualidade de vida, o tratamento associado é mais benéfico.

ABSTRACT Purpose to investigate the effectiveness of the association between low-frequency photobiomodulation and traditional speech therapy in the treatment of trismus in patients treated for oral or oropharyngeal cancer. Methods controlled, randomized, longitudinal and prospective clinical trial, carried out in accordance with the norms of the CONSORT 2010 declaration. For data collection, a sociodemographic questionnaire, clinical evaluation, measurement of mouth opening by caliper, the protocol of McGuill pain and the WHOQOL-Bref quality of life protocol. The sample consisted of 30 participants, of both genders, aged between 35-75 years, divided into two groups, control and experimental, in a controlled manner, through an equal draw with regard to the inclusion and exclusion criteria. Results through the analyzed data, it was observed that there was an increase in the vertical amplitude of the mandible in both groups, CG: p0.19, as well as in relation to orofacial pain and quality of life, p= 0.72, both assessments after the speech therapy intervention, however, with better results for the EG, p<0.001. Conclusion It is concluded that the traditional speech therapy intervention and its association with low-frequency photobiomodulation are effective in the treatment of trismus. For orofacial pain and quality of life, associated treatment is more beneficial.

Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: impacts of the covid-19 pandemic / Hospitalizações por câncer bucal e orofaríngeo no Brasil pelo SUS: impactos da pandemia de covid-19

ABSTRACT OBJECTIVE To analyze the impact of the different phases of the covid-19 pandemic on hospitalizations for oral (CaB) and oropharyngeal (CaOR) cancer in Brazil, carried out within the scope of the Brazilian Unified Health System (SUS). METHODS We obtained data regarding hospital admissions due to CaB and CaOR between January 2018 and August 2021 from the SUS Hospital Information System, analyzing hospital admissions as rates per 100,000 inhabitants. We divided the pandemic (January 2020 to August 2021) and pre-pandemic (January 2018 to December 2019) periods into four-month periods, comparing the pandemic period rates with analogous rates for the pre-pandemic period - for Brazil, by macro-region and by a group of procedures performed during hospitalization. We also analyzed the impact of the pandemic on the average cost of hospitalizations, expressing the results in percentage change. RESULTS Rates of hospitalization in the SUS due to CaB and CaOR decreased during the pandemic in Brazil. The most significant reduction occurred in the second four-month period of 2020 (18.42%), followed by decreases in the third four-month period of 2020 (17.76%) and the first and second four-month periods of 2021 (respectively, 14.64% and 17.07%), compared with 2019. The South and Southeast showed the most expressive and constant reductions between the different phases of the pandemic. Hospitalizations for clinical procedures suffered a more significant decrease than for surgical procedures. In Brazil, the average expenditure per hospitalization in the four-month pandemic periods was higher than in the reference periods. CONCLUSION After more than a year of the pandemic's beginning in Brazil, the SUS hospital care network for CaB and CaOR had yet to be re-established. The repressed demand for hospitalizations for these diseases, which have fast evolution, will possibly result in delays in treatment, negatively impacting the survival of these patients. Future studies are needed to monitor this situation.

RESUMO OBJETIVO Analisar o impacto das diferentes fases da pandemia de covid-19 sobre as hospitalizações por câncer bucal (CaB) e de orofaringe (CaOR) no Brasil, realizadas no âmbito do Sistema Único de Saúde (SUS). MÉTODOS Os dados quanto às internações hospitalares por CaB e CaOR, entre janeiro de 2018 e agosto de 2021, foram obtidos no Sistema de Informações Hospitalares do SUS. As internações foram analisadas sob a forma de taxas por 100 mil habitantes. Os períodos de pandemia (janeiro de 2020 a agosto de 2021) e pré-pandemia (janeiro de 2018 a dezembro de 2019) foram divididos em quadrimestres; as taxas quadrimestrais do período pandêmico foram comparadas às taxas análogas do período pré-pandemia - para o Brasil, por macrorregião e por grupo de procedimentos realizados na internação. O impacto da pandemia sobre o valor médio das internações também foi analisado. Os resultados foram expressos em variação percentual. RESULTADOS As taxas de internação hospitalar no SUS por CaB e CaOR reduziram durante a pandemia no Brasil. Em comparação com os quadrimestres de 2019, a maior redução foi identificada no segundo quadrimestre de 2020 (18,42%), seguida das reduções do terceiro quadrimestre de 2020 (17,76%) e do primeiro e segundo quadrimestres de 2021 (respectivamente, 14,64% e 17,07%). Sul e Sudeste apresentaram as reduções mais expressivas e constantes entre as diferentes fases da pandemia. As internações para procedimentos clínicos sofreram maior redução do que para procedimentos cirúrgicos. No Brasil, o gasto médio por internação nos quadrimestres da pandemia foi maior do que nos quadrimestres de referência. CONCLUSÃO Após mais de um ano do início da pandemia no Brasil, a rede hospitalar de cuidado ao CaB e CaOR do SUS ainda não tinha se restabelecido. A demanda reprimida de hospitalizações por essas doenças, que são de rápida evolução, possivelmente resultará em atrasos para tratamento, com impacto negativo para a sobrevida desses pacientes; futuros estudos são necessários para monitorar essa situação.

Epidemiología y frecuencia de enfermedades de transmisión sexual y su repercusión en la mucosa bucal: una revisión narrativa / Epidemiology and frequency of sexually transmitted diseases and their impact on oral mucosa: a narrative review

El objetivo de la presente revisión fue analizar y compa- rar las publicaciones sobre la prevalencia de manifestaciones bucales de pacientes infectados por el Virus de la Inmuno- deficiencia Humana, Virus del Papiloma Humano y sífilis. Se seleccionaron los artículos más relevantes y se abordó la incidencia según sexo, edad, distribución geográfica y locali- zaciones anatómicas frecuentes. Se encontró que las lesiones orales más prevalentes producidas por el Virus de la Inmu- nodeficiencia Humana son la candidiasis oral, la leucoplasia vellosa y enfermedades periodontales, entre otras. La sífilis presentó una frecuencia de 7,5% de manifestaciones orales en la etapa primaria, 92,5% en la secundaria y rara vez lesio- nes en la terciaria. Las formas más prevalentes fueron parches mucosos, pápulas y úlceras. Las lesiones orales benignas rela- cionadas con el Virus del Papiloma Humano halladas fueron la verruga vulgar, el papiloma plano, el condiloma acuminado y la hiperplasia epitelial focal. La prevalencia de carcinomas orofaríngeos y orales fue del 33,6% y del 22,2% respectiva- mente. Se encontraron similitudes en el comportamiento se- xual y las vías de transmisión de las enfermedades analizadas, y se observó que son más prevalentes en adultos jóvenes de sexo masculino y en países en vías de desarrollo (AU)

The aim of this review was to analyze and compare pub- lications on the prevalence of oral manifestations in patients infected with Human Immunodeficiency Virus, Human Pap- illoma Virus and syphilis. The most reliable studies were se- lected, and incidence was evaluated according to gender, age, geographic location and frequent anatomic sites. It was found that the most prevalent Human Immunodeficiency Virus oral lesions were oral candidiasis, hairy leukoplakia and perio- dontal diseases, among others. Syphilis had a 7.5% preva- lence of oral manifestations in the primary stage, 92.5% in the secondary, and rarely lesions in the tertiary. The most prevalent forms were mucous patches, papules and ulcers. The benign oral lesions related to the Human Papilloma Vi- rus were verruca vulgaris, squamous papilloma, condyloma acuminatum and multifocal epithelial hyperplasia. The preva- lence of oropharyngeal and oral carcinomas were 33.6% and 22.2%, respectively. Similarities were found in sexual behavior and transmis- sion routes of the diseases analyzed, which were more preva- lent among young adult males, and in developing countries (AU)

Malignant neoplasms of the oral cavity and oropharynx treated in Brazil: what do hospital cancer records reveal? / Neoplasias malignas da cavidade oral e orofaringe tratadas no Brasil: o que revelam os registros hospitalares de câncer?

Abstract Introduction: Head and neck cancer has an impact on the global burden of diseases, representing an important cause of morbidity and mortality in Brazil, as well as worldwide. Objective: To learn and describe the clinical, epidemiological and care configuration provided to patients with cancer of the oral cavity and oropharynx recorded in Brazil, diagnosed from 2007 to 2016. Methods: This is a cross-sectional study, carried out using secondary hospital-based data, using the indirect documentation technique. Results: There were 52,799 hospital records of oral cavity cancer and 34,516 cases of oropharyngeal cancer in the assessed period. There was a predominance of male patients, aged 50-59 years, mostly Caucasians, and with a low level of schooling. Throughout the period there was a significant reduction in the positive history of alcohol and tobacco consumption, except for alcoholic beverages in oral cavity cancer. Most patients were diagnosed at an advanced stage of the disease (III or IV). Most patients with oral cavity cancer had no evidence of the disease on follow-up, while most patients with oropharyngeal cancer died. The first most frequent treatment offered to patients with oral cavity cancer was surgery, while for patients with oropharyngeal cancer it chemoradiotherapy predominated. Conclusion: Despite the fact that, in general, there was a reduction in the records of patient alcohol and tobacco consumption, the increase in the number of medical consultations, the predominantly late diagnosis and the patients' low level of schooling indicate the need for health education, primary prevention and early diagnosis of cancer of the oral cavity and oropharynx.

Resumo Introdução: O câncer de cabeça e pescoço impacta a carga global de doenças, representa importante causa de morbimortalidade no Brasil e no mundo. Objetivo: Conhecer e descrever a compleição clínica, epidemiológica e assistencial dos atendimentos a pacientes com câncer de cavidade oral e orofaringe registrados no Brasil, diagnosticados de 2007 a 2016. Método: Estudo transversal, feito a partir de dados secundários de base hospitalar, por meio de técnica de documentação indireta. Resultados: Houve 52.799 registros hospitalares de câncer de cavidade oral e 34.516 casos de câncer de orofaringe no período considerado. Predominaram pacientes do sexo masculino, da faixa etária de 50-59 anos, predominantemente branca, e de baixo nível de escolaridade. Ao longo do período houve redução expressiva do histórico positivo de consumo de bebida alcoólica e tabaco, exceto para bebida alcoólica no câncer de cavidade oral. A maioria dos pacientes foi diagnosticada em estágio avançado da doença (III ou IV). A maior parte dos pacientes de câncer de cavidade oral apresentava-se sem evidência da doença, enquanto que grande parte dos pacientes com câncer de orofaringe evoluiu a óbito. O primeiro tratamento mais frequente oferecido aos pacientes com câncer de cavidade oral foi cirurgia, enquanto para os pacientes com câncer de orofaringe foi a quimioradioterapia. Conclusão: Apesar de se observar, de maneira geral, redução dos registros do consumo de bebida e tabaco, o aumento do número de atendimentos, o diagnóstico tardio predominante e o baixo nível de escolaridade dos pacientes apontam para a necessidade da educação em saúde, de prevenção primária e do diagnóstico precoce do câncer de cavidade oral e orofaringe.

Application value of indocyanine green fluorescence in sentinel lymph node biopsy for early-stage tongue cancer and oropharyngeal cancer / 中南大学学报(医学版)

OBJECTIVES@#Occult cervical lymph node metastasis is the most important reason for recurrence of early-stage tongue cancer and oropharyngeal cancer. Cervical sentinel lymph node (SLN) biopsy may help to identify them. Pigment dyes and radionuclide were used to label SLN. Both of them had shortage. This study aims to investigate the application and clinical value of indocyanine green fluorescence imaging in cervical SLN biopsy for patients with early-stage tongue cancer and oropharyngeal cancer.@*METHODS@#Retrospective analysis was conducted on 23 patients with early tongue cancer and oropharyngeal cancer, who received surgical treatment and used indocyanine green as a tracer to find SLN in Hunan Cancer Hospital from April to October 2021. The detection rate of SLN was calculated and the distribution of SLN in different regions of the neck was analyzed.@*RESULTS@#SLN was successfully identified in 22 of 23 patients, with a detection rate of 95.65%. Among these 22 patients, 3 patients were found to have cancer metastasis, and the rate of occult lymph node metastasis was 13.63%. No pathologically positive lymph nodes were detected in SLN-negative patients, and thus the positive predictive rate was 100%. For patients with primary lesions located in the anterior 2/3 of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 15.15%, 71.72%, 13.13%, and 0, respectively. For patients with primary lesions located in base of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 0, 44.44%, 44.44%, and 11.12%, respectively.@*CONCLUSIONS@#Indocyanine green fluorescence imaging has a high detection rate with accurate positive prediction in the anterior cervical SLN biopsy in patients with early-stage tongue cancer and oropharyngeal cancer. Meanwhile, it can also reflect the lymphatic drainage of tumors located at different primary sites, which has high clinical value.

Caracterização dos Casos de Câncer de Cavidade Oral e Faringe da Região Norte do Brasil, 2012-2015 / Characterization of Oral Cavity and Pharyngeal Cancer Cases in Northern Brazil, 2012-2015 / Caracterización de Casos de Cáncer de Cavidad Oral y Faringe en el Norte de Brasil, 2012-2015

Introdução: O câncer de cavidade oral e faringe é um problema de saúde pública, apresentando elevadas taxas de incidência e mortalidade. Objetivo: Caracterizar o perfil clínico-epidemiológico e os atrasos no diagnóstico e tratamento de casos atendidos nas unidades de referência da Região Norte do Brasil. Método: Estudo descritivo dos casos de câncer de cavidade oral e faringe registrados nas bases de dados dos Registros Hospitalares de Câncer (RHC) de 2012 a 2015. Foram analisados os intervalos entre a primeira consulta e o diagnóstico, e o diagnóstico e o tratamento. As variáveis contínuas foram avaliadas por meio de medidas de tendência central e de dispersão. As diferenças entre proporções nas variáveis categóricas foram avaliadas pelo teste qui-quadrado, considerando-se o nível de significância de 5%. Resultados: Entre os homens, os casos de orofaringe foram mais incidentes (19,2%) e nas mulheres os mais incidentes (16,3%) de outras partes e partes não especificadas da língua. A maior parte dos casos era de homens, cor parda, >60 anos, sem cônjuge, com escolaridade até o nível fundamental. O carcinoma de células escamosas foi o mais comum. Com relação ao tempo, 69,6% dos casos que chegaram ao hospital sem diagnóstico e sem tratamento foram diagnosticados até 30 dias após a primeira consulta, e 67,8% dos casos receberam o primeiro tratamento em até 60 dias. Conclusão: A maioria dos casos analisados apresentou tempo de diagnóstico dentro do prazo recomendado, porém foi observado que os casos com diagnóstico e sem tratamento demoraram mais de 60 dias

Introduction: Oral cavity and pharyngeal cancer is a public health problem with high incidence and mortality rates. Objective: To characterize the clinical-epidemiological profile and delays in diagnosis and treatment of cases of oral cavity and pharyngeal cancer treated in reference units in Brazil's North Region. Method: Descriptive study of oral cavity and pharyngeal cancer registered in the Hospital-based Cancer Registry (HBCR) in the North Region from 2012 to 2015. The intervals between the 1st consultation and diagnosis and diagnosis and treatment were analyzed. Continuous variables were evaluated using measures of central tendency and dispersion. Differences between proportions in categorical variables were assessed using the chi square test, considering a significance level of 5%. Results: Among men, cases of oropharynx were more incidents (19.2%) and in women, the most incidents (16.3%) were from other parts and unspecified parts of the tongue. Most of the cases were males, brown, >60 years old, without spouse and elementary education. Squamous cell carcinoma was the most common. 69.6% of cases that arrived at the hospital without diagnosis and without treatment were diagnosed within 30 days after the 1st consultation and 67.8% of cases received the 1st treatment within 60 days. Conclusion: Most of the cases analyzed were diagnosed within the recommended timeframe. However, cases with diagnosis and without treatment took more than 60 days

Introducción: El cáncer de cavidad oral y faringe es un problema de salud pública, con altas tasas de incidencia y mortalidad. Objetivo: Caracterizar el perfil clínico-epidemiológico y las demoras en el diagnóstico y tratamiento de los casos de cáncer de cavidad oral y faringe atendidos en unidades de referencia del Norte de Brasil. Método: Se realizó un estudio descriptivo de los casos analíticos de cáncer de cavidad oral y faringe registrados en las bases de datos del Registros Hospitalarios de Cáncer (RHC) en la Región Norte de 2012 a 2015. Se analizaron los intervalos entre la primera consulta y el diagnóstico y diagnóstico y tratamiento. Las variables continuas se evaluaron mediante medidas de tendencia central y dispersión. Las diferencias entre proporciones en variables categóricas se evaluaron mediante la prueba chi cuadrado, considerando un nivel de significancia del 5%. Resultados: Entre los hombres, los casos de orofaringe fueron más incidentes (19,2%) y entre las mujeres los de otras partes y partes no especificadas del idioma fueron los más incidentes (16,3%). La mayoría de los casos fueron del sexo masculino, moreno, >60 años, sin pareja, con educación hasta el nivel elemental. El carcinoma de células escamosas fue el más común. En cuanto al tiempo, el 69,6% de los casos que llegaron al hospital sin diagnóstico y sin tratamiento fueron dentro de los 30 días posteriores a la primera consulta y el 67,8% de los casos recibieron el 1er tratamiento dentro de los 60 días. Conclusión: La mayoría de los casos analizados presentaron tiempo de diagnóstico dentro del período recomendado. Sin embargo, se observó que los casos con diagnóstico y sin tratamiento demoran más de 60 días

Impacto da dor orofacial na qualidade de vida de portadores de câncer de boca e orofaringe / Impact of orofacial pain on the quality of life of mouth and oropharynge cancer patients

RESUMO Objetivo investigar o impacto da dor orofacial na qualidade de vida de portadores de câncer de boca e orofaringe. Métodos trata-se de um estudo de corte transversal, observacional, descritivo, com amostra de conveniência. Participaram da pesquisa 30 pacientes de ambos os sexos, na faixa etária de 35 a 75 anos. Para a coleta de dados, foi utilizado questionário sociodemográfico elaborado pelos pesquisadores e o Questionário de Dor McGill. Resultados Os achados experimentais apresentaram resultados relevantes em diversos níveis classificatórios para dor orofacial. As maiores repercussões foram encontradas nos aspectos sociais, como em relação ao sono (40%), apetite/alimentação (78%), higiene pessoal (55%) e lazer (40%), que foram os subitens que tiveram maior impacto da dor na qualidade de vida dos portadores de câncer de boca e orofaringe. Conclusão Portadores de câncer de boca e orofaringe apresentam variados níveis de dor orofacial e sofrem impactos em suas vidas, principalmente nos quesitos relacionados a atividades simples do cotidiano.

ABSTRACT Purpose To investigate the impact of orofacial pain on the quality of life of patients with oral and oropharyngeal cancer. Methods This is a cross-sectional, observational, descriptive study with a convenience sample. Thirty patients of both sexes participated in the research, aged between 35 and 75 years. For data collection, a sociodemographic questionnaire prepared by the researchers, the McGuill pain protocol, was used. Results The experimental findings show us relevant results at different classification levels for orofacial pain. The greatest repercussions were found in social aspects, such as sleep (40%), appetite/food (78%), personal hygiene (55%) and leisure (40%), which were the sub-items that had the greatest impact on pain (or which were the sub-items mostly affected by pain), affecting the the quality of life of patients with oral and oropharyngeal cancer. Conclusion Under these experimental conditions, it is concluded that patients with oral and oropharyngeal cancer present different levels of orofacial pain, and suffer impacts on their lives, especially in matters related to simple daily activities.

Perfil epidemiológico do carcinoma de células escamosas de cavidade oral e orofaringe diagnosticados na liga mossoroense de estudos e combate ao câncer / Epidemiologic Profile of squamous cell carcinoma of the oral cavity and oropharynx in the MossoróLeague for Studying and Combating Cancer / Perfil epidemiológico del carcinoma epidermoide de cavidad oral y orofaringe diagnosticado en la Liga Mossoroense de Estudios y Combate al Cáncer

Introdução:O carcinoma de células escamosas de cavidade oral e orofaringe é uma neoplasia epitelial maligna comum, respondendo pela maioria dos casos de tumores de cabeça e pescoço. Ele está relacionado a hábitos comportamentais, como tabagismo e etilismo de longa duração, e à infecção pelo Papilomavírus humano. Objetivos:Esse estudo objetivou descrever o perfil epidemiológico dos pacientes diagnosticados com essa neoplasia na Liga Mossoroense de Estudos e Combate ao Câncer. Metodologia: Foi realizado um estudo observacional com delineamento transversal a partir de dados presentes nos prontuários clínicos e laudos anatomopatológicos e no Sistema de Informações sobre Mortalidade no período entre 2006 a 2018. Os dados foram analisados a partir do Software R, utilizandoo teste de Wilcoxon-Mann-Whitney para as análises inferenciais e o método de Kaplan-Meier para análise da sobrevida. Resultados:225 prontuários foram analisados, sendo 70,22% de homens, 65,33% na faixa etária entre 46-70 anos e cor branca (51,57%). Destes, 25,78% eram tabagistas e 39,11% tabagistas e etilistas. O principal tratamento identificado foi a associação de cirurgia, quimioterapia e radioterapia. Observou-se que 49,10% dos óbitos foram em decorrência dessa neoplasia. O principal estádio patológico encontrado foi o quatro A (34,22%). Foi identificada maior sobrevida nos pacientes acima de 70 anos, cujo tratamento foi exclusivamente cirúrgico. Menor sobrevida foi identificada em indivíduos que tinham associação de hábitos (etilismo e tabagismo). Conclusões:Nossos resultados sugerem que a evolução à óbito foi o principal desfecho clínico e, isso pode estar relacionado aos hábitos comportamentais que influenciam diretamente o curso e prognóstico da doença. Ademais, destaca-se a importância do diagnóstico precoce a fim de reduzir óbitos e melhorar a qualidade de vida dos indivíduos, assim como a necessidade de implementar políticas educativas sobre os principais fatores de risco associados ao desenvolvimento dessa neoplasia (AU).

Introduction: Squamous cell carcinoma of the oral cavity and oropharynx is a common malignant epithelial neoplasm, accounting for most cases of head and neck tumors. It is related to behavioral habits, such as long-standing smoking and alcoholism, as well as to the human Papillomavirus infection. Objectives: This study aimed at describing the epidemiological profile of the patients diagnosed with this neoplasm in the Mossoró League for Studying and Combating Cancer. Methodology:An observational study with a cross-sectional design was carried out based on data present in the medical records and anatomopathological reports and in the Mortality Information System during the 2006-2018 period. The data were analyzed using the R Software, resorting to the Wilcoxon-Mann-Whitneytest for the inferential analyses and to the Kaplan-Meier method for survival analysis. Results: 225 medical records were analyzed: 70.22% belonging to men, 65.33% aged between 46 and 70 years old and white-skinned (51.57%). Of these, 25.78% were smokers and 39.11% were smokers and alcoholics. The main treatment identified was the association of surgery, chemotherapy and radiotherapy. It was observed that 49.10% of the deaths were due to this neoplasm. The main pathological stage found wasfour A(34.22%).Longer survival was identified in patients over 70 years of age, whose treatment was exclusively surgical. Shorter survival was identified in individuals who had associated habits (alcoholism and smoking). Conclusions:Our results suggest that evolution to death was the main clinical outcome; this can be related to the behavioral habits that exert a direct influence on the course and prognosis of the disease. Furthermore, the importance of early diagnosis is highlighted in order to reduce the number of deaths and improve the individuals' quality of life, as well as the need to implement educational policies on the main risk factors associated with the development of this neoplasm (AU).

Introducción: El carcinoma de células escamosas de la cavidad oral y la orofaringe es una neoplasia epitelial maligna común, que representa la mayoría de los casos de tumores de cabeza y cuello. Se relaciona con hábitos de comportamiento, como el tabaquismo y el alcoholismo, y la infección por el virus papiloma humano. Objetivos:Este estudio tuvo como objetivo describir el perfil epidemiológico de los pacientes diagnosticados con esta neoplasiaen la Liga Mossoroense de Estudios y Combate al Cáncer. Metodología: Se realizó un estudio observacional, transversal a partir de los datos presentes en las historias clínicas e informes patológicos y en el Sistema de Información de Mortalidad en el período 2006-2018. Los datos se analizaron mediante el Software R, con utilización de la Prueba de Wilcoxon-Mann-Whitney para análisis inferencial y el método de Kaplan-Meier para análisis de supervivencia. Resultados:Se analizaron 225 historias clínicas, 70,22% en hombres, 65,33% con edades entre 46-70 años y blancos (51,57%). De estos, 25,78% eran fumadores y 39,11% eran fumadores y alcohólicos. El principal tratamiento identificado fue la asociación de cirugía, quimioterapia y radioterapia. 49,10% de las muertes se debieron a esta neoplasia. El principal estadio patológico encontrado fue cuatro A (34,22%). Se identificó mayor sobrevida en pacientes mayores de 70 años, cuyo tratamiento fue exclusivamente quirúrgico. Se identificó una menor sobrevida en personas que tenían hábitos asociados. Conclusiones:Nuestros resultados sugieren que la evolución hacia la muerte fue el principal resultado clínico y esto puede estar relacionado con hábitos de comportamiento que influyen directamente en el curso y pronóstico de la enfermedad. Además, se destaca la importancia del diagnóstico precoz para reducir las muertes y mejorar la calidad de vida, así como la necesidad de implementar políticas educativas sobre los principales factores de riesgo asociados al desarrollo de esta neoplasia (AU).

Avaliação do nível de conhecimento dos pacientes atendidos na atenção básica sobre a prevenção dos cânceres de cabeça e pescoço / Assessment of the level of knowledge of patients treated in primary care on the prevention of head and neck cancers / Evaluación del nivel de conocimiento de los pacientes atendidos en cuidados básicos sobre la prevención del cáncer de cabeza y cuello

Introdução:O câncer de cabeça e pescoço é um conjunto de neoplasias que atingem o trato aero digestivo superior. Essas neoplasias apresentam sintomatologia variada, que depende da localização do tumor, gravidade e tempo de ocorrência. Objetivo:Avaliar o nível de conhecimento da população, usuária da atenção básica, acerca da prevenção e tratamento dos Cânceres de Cabeça e Pescoço.Metodologia:Trata-se de um estudo de campo transversal descritivo, em que se coletou informações acerca do conhecimento sobre cânceres de cabeça e pescoço, informações sociodemográficas, histórico familiar, características clínicas e de tratamentos. A coleta foi realizada em julho de 2019, em três Estratégias de Saúde da Família da cidade de Piripiri,Piauí. A pesquisa foi submetida e aprovadapelo Comitê de Ética em Pesquisa com o Parecer nº 3.221.522.Resultadose discussão:A maioria dos entrevistados foram mulheres solteiras com idade média de 44,4 anos e de baixa renda. Dentre os questionamentos realizados, grande parte não soube responderquestões sobre conhecimentos gerais a respeito dessas enfermidades. Outro fator importante é a baixa procura por serviços de saúde. Conclusões:Observou-se que os entrevistados apresentam desinformação a respeito da prevenção e tratamento desse grupo de cânceres, sendo necessário o fortalecimento de ações de educação popular em saúde (AU).

Introduction:Head and neck cancer is a group of neoplasms that affect the upper aerodigestive tract. These neoplasms have varied symptoms, depending on the location of the tumor, severity and time of occurrence.Objective:To assess the level of knowledge of the population, users of primary care, about the prevention and treatment of Head and Neck Cancer. Methodology:This is a descriptive cross-sectional study, in which information about knowledge about head and neck cancers, sociodemographic information, family history, clinical and treatment characteristics was collected. The collection was carried out in July 2019, in three Family Health Strategies in the city of Piripiri, Piauí. The research was submitted and approved by theResearch Ethics Committee with Opinion No. 3,221,522. Resultsand discussion:Most of the interviewees were single women with an average age of 44.4 years and low income. Among the questions asked, most of them did not know how to answer questions about general knowledge about these diseases. Another important factor is the low demand for health services. Conclusions:It was observed that the interviewees have misinformation regarding the prevention and treatment of this group of cancers, and it is necessary to strengthen popular health education actions (AU).

Introducción:El cáncer de cabeza y cuello es un grupo de neoplasias que afectan el tracto aerodigestivo superior. Estas neoplasias tienen síntomas variados, que dependen de la ubicación del tumor, la gravedad y el momento de aparición. Objetivo:Evaluar el nivel de conocimiento de la población, usuarios de la atención primaria de salud, sobre la prevención y el tratamiento del Cáncer de Cabeza y Cuello. Metodología:Se trata de un estudio descriptivo transversal, en el que se recopiló información sobre conocimientos sobre cánceres de cabeza y cuello, información sociodemográfica, antecedentes familiares, características clínicas y de tratamiento. La recolección se realizó en julio de 2019, en tres Estrategias de Salud de la Familia en la ciudad de Piripiri, Piauí. La investigación fue sometida y aprobada por el Comité de Ética en Investigación con Opinión No. 3.221.522. Resultados y discusión:La mayoría de los encuestados eran mujeres solteras con una edad promedio de 44,4 años y bajos ingresos. Entre las preguntas formuladas, la mayoría de ellos no sabía cómo responder preguntas sobre conocimientos generales sobre estas enfermedades. Otro factor importante es la baja demanda de servicios de salud. Conclusiones:Se observó que los entrevistados tienen desinformación sobre la prevención y tratamiento de este grupo de cánceres, y es necesario fortalecer las acciones de educación popular en salud (AU).

Analysis on cancer incidence and mortality attributed to human papillomavirus infection in China, 2016 / 中华流行病学杂志

Objective: We aim to evaluate the morbidity and mortality of cancer attributable to human papillomavirus (HPV) infection in China in 2016. Methods: Based on the cancer incidence and mortality rates, national population data, and population attributable fraction (PAF) in China, we calculated the number of incidence and death cases attributed to HPV infection in different areas, age groups, and gender in China in 2016. The standardized incidence and mortality rates for cancer attributed to HPV infection were calculated by using Segi's population. Results: In 2016, a total of 124 772 new cancer cases (6.32 per 100 000) were attributed to HPV infection in China, including 117 118 cases in women and 7 654 cases in men. Of these cancers, cervical cancer was the most common one, followed by anal cancer, oropharyngeal cancer, penile cancer, vaginal cancer, laryngeal cancer, oral cancer, and vulvar cancer. A total of 41 282 (2.03 per 100 000) deaths were attributed to HPV infection, of which 37 417 occurred in women and 3 865 in men. Most deaths were caused by cervical cancer, followed by anal cancer, oropharyngeal cancer, penile cancer, laryngeal cancer, vaginal cancer, oral cancer, and vulvar cancer. The incidence and mortality rates of cervical cancer increased rapidly with age, peaked in age group 50-54 years, then decreased obviously. The morbidity and mortality rates of non-cervical cancer increased with age. The cancer case and death numbers in rural areas (57 089 cases and 19 485 deaths) were lower than those in urban areas (67 683 cases and 21 797 deaths). However, the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of cervical cancer were higher in rural areas than in urban areas. There were no significant differences in ASIR and ASMR of non-cervical cancers between urban areas and rural areas. Conclusions: The incidence of cancers attributed to HPV infection in China was lower than the global average, but the number of incidences accounted largely, furthermore there is an increasing trend of morbidity and mortality. The preventions and controls of cervical cancer and male anal cancer are essential to contain the increases in cancer cases and deaths attributed to HPV infection.

The clinical value of oral robotic surgery in the treatment of oropharyngeal squamous cell carcinoma / 中华肿瘤杂志

Objective: To explore the therapeutic effects of transoral robotic surgery (TORS) and traditional surgical modes in oropharyngeal squamous cell carcinoma (OPSCC). Methods: The clinicopathological data of patients with oropharyngeal squamous cell carcinoma treated at Sun Yat-sen University Cancer Center from 2010 to 2018 were retrospectively analyzed. 135 cases were treated with traditional surgery (non-TORS group), while 52 cases were treated with TORS (TORS group). The prognosis of the two groups of patients were analyzed by Kaplan-Meier method and Log rank test, the influencing factors were analyzed by Cox regression model. Results: The 2-year overall survival (OS, 94.2%) and 2-year progression-free survival (PFS, 93.8%) of patients in the TORS group were better than those in the non-TORS group (71.4% and 71.4%, respectively, P<0.05). The 2-year OS (93.3%) and 2-year PFS (92.8%) of TORS group patients in T1-2 stage were better than those of non-TORS group (73.1% and 72.8%, respectively, P<0.05). The 2-year OS (95.8%) and 2-year PFS (95.2%) of patients with stage Ⅰ to Ⅱ in the TORS group were not significantly different from those in the non-TORS group (84.1% and 83.9%, respectively, P>0.05). The 2-year OS (92.9%) and 2-year PFS rate (92.7%) of patients with stage Ⅲ to Ⅳ in the TORS group were better than those in the non-TORS group (64.7% and 63.9%, respectively, P<0.05). The 2-year OS (94.4%) of HPV-positive patients in the TORS group was not significantly different from that in the non-TORS group (83.3%, P=0.222). The 2-year OS of HPV-negative patients in the TORS group (94.1%) was significantly different from that in the non-TORS group (43.7%, P<0.001). HPV status was an independent prognostic factor (P=0.008). Conclusions: TORS has a better prognosis in the treatment of oropharyngeal squamous cell carcinoma compared with the traditional treatment methods. The patients with T1-T2 can achieve better survival benefits after TORS treatment. The HPV-positive OPSCC patients has a better prognosis than that of HPV-negative OPSCC patients, and regardless of HPV status, OPSCC patients in the TORS group could obtain a better survival prognosis.

Preliminary experience of transoral robotic surgery for oropharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the oncological and functional efficacy and safety of transoral robotic surgery (TORS) in the treatment of oropharyngeal carcinoma. Methods: Twenty-six patients with oropharyngeal cancer were enrolled who underwent TORS at Beijing United Hospital from June 1, 2017 to December 31, 2020. Among them, 22 patients were males and 4 were females, aged 39 to 76 years old. T1-2 patients accounted for 88.5% (23/26). Clinicopathological data including the time of removal of gastric and endotracheal tube were collected. The SPSS software package was used for survival analysis, and the overall survival rate and disease-free survival rate were calculated. Results: All the 26 patients with oropharyngeal cancer received TORS without conversion to open surgery, and 20 of them underwent simultaneous cervical lymph node dissection. TORS operation time ranged from 65 to 360 minutes with an average of 215 minutes. Intraoperative blood loss ranged from 5 to 600 ml with an average of 70 ml. Four patients (15.4%) underwent tracheotomy, of whom 3 patients had the removals of tracheal tubes within 1 month after surgery and 1 case remained to wear a tube by the end of follow-up. Twelve patients (46.2%) underwent gastric tube implantation, among them, 11 patients had removals of gastric tubes within 1 month after surgery and 1 patient died of oropharyngeal hemorrhage 13 days after operation. One patient (3.8%) had a positive surgical margin and others had pathologically negative surgical margins. Sixteen patients (61.5%) received postoperative radiotherapy, of whom 11 patients (42.3%) received platinum-based concurrent chemotherapy. The median follow-up time was 21.5 months (0.4 to 45 months). The overall survival and the disease-free survival rates were 83.0% and 75.8%, respectively. Conclusion: The application of TORS in treatment of oropharyngeal cancer can achieve good oncological and functional outcomes in selected patients.

Application of transoral robotic surgery in treatment of oropharyngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the therapeutic and prognostic outcomes of transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OSCC). Methods: A retrospective study of 99 OSCC patients treated with TORS in Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center between April 2017 and May 2021 was conducted. There were 84 males and 15 females, with an age range of 35-85 years. Patients' clinical characteristics, including clinical staging, HPV infection status, perioperative management and postoperative adjuvant treatment, were recorded. The overall survival (OS) and progression-free survival (PFS) were analyzed. The survival outcomes were analyzed with Kaplan-Meier method and Log-rank test. Results: The hospital stay of OSCC patients with TORS was (5.3±2.9) days and the average time of postoperative nasal feeding tube indwelling was (15.2±10.8) days. Among the 99 patients, 21 (21.2%) received tracheotomy and the average time of tracheotomy tube indwelling was (11.9±11.4) days. The two-year OS and PFS in patients with follow-up over two years were 94.0% and 87.7%, respectively and the three-year OS and PFS of patients with follow-up over three years were 94.0% and 78.9%, respectively. The two-year OS and PFS were respectively 97.4% and 88.9%, for patients with stages I-II and 86.8% and 88.9% for patients with stages III-IV. HPV-negative and HPV-positive patients had respectively two-year OS (100.0% vs. 91.5%) and PFS (88.9% vs. 87.2%). There was no significantly statistical difference in survival between patients with and without adjuvant radiotherapy after TORS (82.6% vs. 90.5%, HR=0.52, 95%CI: 0.12-2.23, P=0.400). Conclusions: TORS is more suitable for the treatment of patients with early (Ⅰ-Ⅱ) or HPV-positive oropharyngeal squamous cell carcinoma, and the recovery after TORS treatment is good.

Factors associated with advanced-stage oral and oropharyngeal squamous cell carcinoma in a Brazilian population

Diagnosis of oral and oropharyngeal cancer in advanced stages may be associated with social nature factors, access to health care, education, occupation, and behavioral/ cultural factors. Aim: To determine the factors related to high clinical-staging in patients diagnosed with squamous cell carcinoma in the oral and oropharyngeal region in a Cancer Center in Brazil between 2009 and 2015. Methods: It is an epidemiological, retrospective, and exploratory study. Patients diagnosed with squamous cell carcinoma had their medical records analyzed. The variables considered were sociodemographic, lifestyle, and disease characteristics. Descriptive and exploratory tests (Pearson's, chi-square test and, Student's t-test) were realized. Results: We analyzed 365 patient records, among which 289 (79.17%) were male, and 73 (20.0%) were female. Age ranged from 16 to 101 years, with a mean of 61.13. Regarding education, 157 (43.01%) studied < 8 years, 103 (28.21%) were illiterate and 102 (27.94%) studied > 8 years. 305 (83.56%) patients live in urban areas. There was an association between high clinical-staging and low educational level. For high clinical-staging, symptomatology, tobacco, and alcohol intake as well. Conclusion: Patients with low educational levels tend to report the disease later, and their diagnostics occurred in advanced stages. Thus, specific public health policies for this population, including access to dental care to recognize the clinical signs and early diagnosis, are necessary

Avaliação epidemiológica de pacientes com câncer de boca e orofaringe da liga mossoroense de estudos e combate ao câncer / Epidemiological evaluation of patients with oral and oropharyngeal cancer from the Mossoroense League of Studies and Combating Cancer / Evaluación epidemiológica de pacientes con cáncer de boca y orofaringe de la Liga Mossoroense de Estudos e Combate ao Câncer

Introdução:Os tumores de cabeça e pescoço têm expressiva incidência e mortalidade, assim comoalta letalidade, e constituem um relevante problema de saúde pública, particularmente nos países em desenvolvimento. Dentre as neoplasias malignas diagnosticadas no mundo, aproximadamente 10% estão localizadas na boca, sendo esse o sexto tipo de câncer mais incidente. Objetivo:Avaliar o perfil epidemiológico de pacientes diagnosticados com câncer de boca e faringe da Liga Mossoroense de Estudos e Combate ao Câncer do município de Mossoró, Rio Grande do Norte,Brasil,entre janeiro 2013 e junho de 2018.Metodologia:Estudo transversal, fundamentado na análise retrospectiva e descritiva de prontuários médicos.Resultados:Dos221 prontuáriosanalisados, a cor branca (56,6%) e o gênero masculino (70,6%) foram os mais prevalentes, com média de idade entre 55 e65 anos. A maioria (61,9%) apresentava ensino fundamental incompleto, sendo residentes de área urbana (59,6%) com histórico de uso de tabaco (64,6%) e/ou bebidas alcoólicas (53,9%). Osítio mais prevalente de câncer em boca foi a base da língua (12,7%).Conclusões:Conhecer o perfil dos pacientes com câncer de boca e orofaringe é um importante passo para melhor traçar e direcionar ações de saúde pública visando tanto àprevenção quanto o diagnóstico precoce (AU).

Introduction:Head and neck tumors have a significant incidence and mortality, as well as high lethality, and are a relevant public health problem, particularly in developing countries. Among the malignant neoplasms diagnosed in the world, approximately 10% are located in the mouth, this being the sixth most frequent type of cancer. Objective:To evaluate the epidemiological profile of patients diagnosed with oral and pharyngeal cancer of the Mossoroense League of Studies and Cancer Fighting in the municipality of Mossoró, Rio Grande do Norte, Brazil,between January 2013 and June 2018.Methodology:Cross-sectional study, based on retrospective and descriptive analysis of medical records.Results:Of the 221 records analyzed, white (56.6%) and male (70.6%) were the most prevalent, with a mean age between 55 and 65 years. Most (61.9%) had incomplete primary education, being residents of an urban area (59.6%) with a history of tobacco use (64.6%) and / or alcoholic beverages (53.9%).The most prevalent site of cancer in the mouth was the base of the tongue (12.7%). Conclusions:Knowing the profile of patients with oral and oropharyngeal cancer is an important step to better outline and direct public health actions aimed at both prevention and early diagnosis (AU).

Introducción: Los tumores de cabeza y cuello tienen una expresiva incidencia y mortalidad, así como alta letalidad, y constituyen un relevante problema de salud pública, especialmente en los países en desarrollo. Entre las neoplasias malignas diagnosticadas en el mundo,aproximadamente el 10% están localizadas en la boca, siendo este el sexto tipo de cáncer más común.Objetivo: Evaluar el perfil epidemiológico de pacientes diagnosticados con cáncer de boca y faringe de la Liga Mossoroense de Estudos e Combate ao Câncer del municipio de Mossoró, Rio Grande do Norte, Brasil,entre enero de 2013 y junio de 2018.Metodologia: Estudio transversal, basado en el análisis retrospectivo y descriptivo de los registros médicos.Resultados: De los 221 registros analizados, blancos (56,6%) y varones (70,6%) han sido los más prevalentes, con una media de edad entre 55 y 65 años. La mayoría (61,9%) presentaba educación primaria incompleta, siendo residentes de área urbana (59,6%) con antecedentes de uso de tabaco (64,6%) y/o bebidas alcohólicas (53,9%). El sitio más prevalente de cáncer en boca fuelabase de la lengua (12,7%). Conclusiones: Conocer el perfil de los pacientes con cáncer de boca y orofaringe es un importante paso para mejor delinear y dirigir acciones de salud pública objetivando tanto la prevención como el diagnóstico precoz (AU).

Comparison of three kinds of free flaps used in patients with oral and oropharyngeal tumors / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the recovery and quality of life of patients with oral and oropharyngeal tumors treated with three kinds of free soft tissue flaps. Methods: The clinical data of 103 patients, including 66 males and 37 females, aged 26-74 years, who underwent primary repair of defects after resection of oral and oropharyngeal tumors in Sichuan Tumor Hospital from July 2014 to August 2020 were analyzed. Anterolateral thigh flap (ALTF) was used in 43 patients, radial forearm free flap (RFFF) in 45 patients, and lateral arm free flap (LAFF) in 15 patients. Postoperative qualities of life of patients were evaluated by the university of Washington quality of life questionnaire and oral health impact scale (HIP-14 Chinese edition). SPSS 23.0 software was used for statistical analysis. Results: The T staging of RFFF or LAFF group was significantly lower than that of ALTF group (P<0.05). There was no significant difference in mean flap areas between ALTF group ((55.87±27.38) cm2) and LAFF group ((49.93±19.44) cm2), while RFFF group had smaller mean flap area ((33.18±6.05) cm2) than ALTF group (t=5.311, P<0.001) and LAFF group (t=3.284, P=0.005). In terms of oral functions including swallowing, mastication, taste and spitmouth, there were no significant differences between LAFF group and RFFF group (P>0.05), but both groups had better oral functions than ALTF group (P<0.05). There was no significant difference in appearance scores between LAFF group (75(75, 75)) and ALTF group (75(75,75) vs.75(75,75),Z=-1.532, P=0.126), and both groups had higher scores than RFFF group (50(50, 75),Z values were -3.447 and -3.005 respectively, P<0.05). RFFF group had higher speech score (100(67, 100)) than LAFF group (67(50, 76),Z=-2.480, P<0.05) and ALTF group (67(33, 67),Z=-5.414, P<0.05). ALTF group had lower mean score of quality of life than RFFF group [72(56,77) vs.79(69, 89),Z=-3.070, P<0.05), but there was no statistical difference in the mean scores of qualities of life between ALTF group and LAFF group (Z=1.754, P=0.079). According to the evaluation of oral health impact scale (HIP-14 Chinese version) 1 year after surgery, individual item scores and the average score of all items in ALTF group were lower than those in RFFF and LAFF groups (P<0.05), with no significant difference between RFFF group and LAFF group (P>0.05). Conclusions: RFFF has unique advantages for small tissue defects, while ALTF is suitable for large tissue defects, such as buccal penetrating defect, whole tongue and near whole tongue defect, and LAFF is a compromise choice between ALTF and RFFF. ALTF is inferior to RFFF and LAFF in oral functional reconstruction, including swallowing, chewing, taste and spittle. ALTF and LAFF are superior to RFFF in postoperative appearance.

Mortalidade por câncer de cavidade bucal e orofaringe nos estados brasileiros: uma análise de tendência / Mortality from oral cavity and oropharyngeal cancer in Brazilian states: a trend analysis

Introdução - Os cânceres orais são componentes do grupo de câncer de cabeça e pescoço que representa o sexto tipo de neoplasia maligna de maior incidência no mundo e com tendência de incremento das taxas de mortalidade para os próximos anos. Sua incidência está relacionada a fatores socioeconômicos e sua evolução está associada com a provisão de serviços de saúde. Apesar do esforço dispensado pelos sistemas de saúde, o câncer de cavidade bucal e de orofaringe ainda exerce grande impacto na morbimortalidade, sendo necessário manter a vigilância e prevenção constante. Objetivos - 1) Descrever a magnitude e a tendência das taxas de mortalidade por câncer de cavidade bucal e de orofaringe nos Estados do Brasil e Distrito Federal, entre os anos de 1996 e 2016. 2) Analisar a associação destas taxas com o desenvolvimento humano nos Estados do Brasil e Distrito Federal, 3) Comparar a tendência da mortalidade por câncer de orofaringe, que a literatura indica como sendo relacionada ao HPV, com a tendência da mortalidade por câncer de cavidade bucal, que a literatura indica como não sendo relacionada ao HPV, nos Estados do Brasil e Distrito Federal, entre os anos de 1996 e 2016. Métodos - Este é um estudo ecológico que avaliou dados oficiais georreferenciados sobre população, mortalidade e desenvolvimento humano. O Índice de Desenvolvimento Humano foi obtido através do Programa das Nações Unidas no Brasil. As taxas de mortalidade foram padronizadas por sexo e faixa etária utilizando como padrão a população mundial. Foi utilizada a regressão linear generalizada pelo método de Prais-Winsten. A classificação das taxas de mortalidade foi ascendente (p<0,05 e coeficiente de regressão positivo), declinante (p<0,05 e coeficiente de regressão negativo) ou estacionária (p>0,05). Resultados - A magnitude e as taxas de mortalidade do câncer de cavidade bucal e de orofaringe foram mais elevadas nos estados das regiões sul e sudeste. A tendência para ambos os tipos de câncer teve crescimento mais elevado da mortalidade nos estados das regiões norte e nordeste. A correlação entre os dois tipos de câncer foi positiva. Conclusão - As taxas de variação anual da mortalidade para os dois tipos de cânceres se mostraram análogas. No período inicial e final da série histórica a magnitude das taxas de mortalidade foi mais elevada nos estados das regiões Sul e Sudeste tanto para o câncer de cavidade bucal quanto para o câncer de orofaringe. Porém quando observada a tendência, aos estados das regiões Norte e Nordeste mostraram valores mais elevados.

Introduction - Oral cancers are components of the group of head and neck cancer that represent the sixth type of malignant neoplasia with the highest incidence in the world and with an increase on the trend of mortality rates for the next years. Its incidence is related to socioeconomic factors and its evolution is associated with the provision of health services. Despite the efforts made by health systems, cancer of the oral cavity and oropharynx still has a great impact on morbidity and mortality, and it is necessary to maintain constant surveillance and prevention. Objectives - 1) To describe the trend of mortality rates due to oral cavity and oropharyngeal cancer in the States of Brazil and the Federal District, between the years 1996 and 2016. 2) To analyze the association of these rates with human development in the States of Brazil and the Federal District. 3) Compare the trend of mortality from oropharyngeal cancer, which the literature indicates as being related to HPV, with the trend of mortality from oral cavity cancer, which the literature indicates as not being related to HPV, in the States of Brazil and the Federal District, between 1996 and 2016. Methods - This is an ecological study that evaluated official georeferenced data on population, mortality and human development. The Human Development Index was obtained through the United Nations Program in Brazil. Mortality rates were standardized by sex and age group using the world population as standard. Generalized linear regression by the Prais- Winsten method was used. The classification of mortality rates was ascending (p <0.05 and positive regression coefficient), declining (p <0.05 and negative regression coefficient) or stationary (p> 0.05). Results - The magnitude and mortality rates of cancer of the oral cavity and oropharynx were higher in the states of the South and Southeast regions. The trend for both types of cancer had a higher increase in mortality in the states of the North and Northeast regions. The correlation between the two types of cancer was positive. Conclusion - The annual percent rates in mortality for both types of cancers were analogous. In the initial and final period of the historical series, the magnitude of mortality rates was higher in the states of the South and Southeast regions for both oral cavity and oropharyngeal cancer. However, when the trend was observed, the states of the North and Northeast regions showed higher values.

Symptoms and factors associated with symptom clusters among older adults with oral and oropharyngeal cancers at diagnosis / Sintomas e fatores associados a clusters de sintomas entre idosos com câncer de cavidade oral e orofaringe no momento do diagnóstico

OBJECTIVE: Describe differences in pretreatment symptoms and the composition of symptom clusters in older patients with oral and oropharyngeal cancer. METHODS: In this cross-sectional study, quality of life (QoL) assessments for cancer patients (EORCT QLQ-C30 and QLQ-H & N35) were applied to 161 cases of oral and oropharyngeal cancer at the time of enrollment in an outpatient clinic. They were used to evaluate QoL-related symptoms reported by patients, according to their occurrence. To identify symptom clusters, an exploratory factor analysis (EFA) was performed, and the relationships between these clusters and independent variables were assessed with linear regression models. RESULTS: The most prevalent symptoms were pain (52%), worry (48%), and weight loss (44%). Five factors were extracted from the EFA, of which 3 were noteworthy. The dysphagia cluster was common to both cancer sites, although more frequent in oropharyngeal cancer patients, and included symptoms such as difficulty swallowing, pain, and weight loss. The psychological cluster included symptoms related to feeling worried, nervous, and depressed. The asthenia cluster, in addition to being age-related, may represent the advanced stage or progression of the disease. CONCLUSION: The dysphagia cluster loaded the most symptoms and was common to both cancers. In addition to pain (one of the main symptoms of the dysphagia cluster), psychological symptoms were also important in both groups of patients. Adequate and early control of these symptom clusters at diagnosis could favor better management of symptoms during treatment.

OBJETIVO: Descrever diferenças nos sintomas pré-tratamento e na composição de clusters de sintomas em pacientes idosos com câncer oral e orofaríngeo. METODOLOGIA: Neste estudo seccional, avaliações de qualidade de vida (QV) para pacientes com câncer (EORCT QLQ-C30 e QLQ-H & N35) foram aplicadas a 161 casos incidentes de câncer oral e orofaríngeo no momento da inscrição no ambulatório. Essas avaliações foram utilizadas para analisar os sintomas relatados pelos pacientes quanto à QV, de acordo com a ocorrência. Para identificar agrupamentos de sintomas, uma análise fatorial exploratória (AFE) foi realizada, e a relação entre esses agrupamentos de sintomas e variáveis independentes foi avaliada com modelos de regressão linear. RESULTADOS: Os sintomas mais prevalentes foram dor (52%), preocupação (48%) e perda de peso (44%). Cinco fatores foram extraídos do AFE, três dignos de nota. Embora mais relatado por pacientes orofaríngeos, o agrupamento de disfagia foi comum a ambos os locais de câncer e incluiu sintomas como dificuldade para engolir, dor e perda de peso. O agrupamento psicológico incluiu sintomas relacionados a sentir-se preocupado, nervoso e deprimido. O agrupamento da astenia, além de relacionado à idade, pode representar o estágio avançado ou progressão da doença. CONCLUSÕES: O cluster de disfagia carregou a maioria dos sintomas e foi comum a ambos os tipos de câncer. Além da dor, que era um dos principais sintomas desse cluster, os sintomas psicológicos também foram importantes em ambos os grupos de pacientes. O controle adequado e precoce desses grupos de sintomas no diagnóstico pode favorecer o melhor manejo dos sintomas durante o tratamento.