Management Strategies for Skull Base Inverted Papilloma.

OBJECTIVE: Inverted papilloma attached to the ventral skull base presents a surgical dilemma because surgical removal of the bony pedicle is critical to decrease risk of recurrence. The objective of this study is to evaluate the effectiveness of endoscopic management of skull base inverted papilloma. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary medical center. SUBJECTS: Patients with skull base inverted papilloma. METHODS: Over 7 years, 49 patients with skull base inverted papilloma were referred for surgical resection. Demographics, operative technique, pathology, complications, recurrence, and postoperative follow-up were evaluated. RESULTS: Average age at presentation was 57 years. Twenty-six patients (53%) had prior attempts at resection elsewhere, and 5 had squamous cell carcinoma (SCCA) arising in an inverted papilloma. Six patients (12%) suffered major complications, including skull base osteomyelitis in 2 previously irradiated patients, cerebrospinal fluid leak with pneumocephalus (n = 1), meningitis (n = 1), invasive fungal sinusitis (n = 1), and cerebrovascular accident (n = 1). The mean disease-free interval was 29 months (range, 10-78 months). One patient with SCCA recurred in the nasopharynx (overall 2% recurrence rate). He is disease-free 3 years following endoscopic nasopharyngectomy. Three patients with SCCA had endoscopic resection of the skull base, while 1 subject with inverted papilloma pedicled on the superior orbital roof had an osteoplastic flap in conjunction with a Draf III procedure. All others received endoscopic resection. CONCLUSIONS: Removal of the bony pedicle resulted in excellent local control of skull base inverted papillomas. Our experience demonstrates that disease eradication with limited morbidity is attainable with this approach.

Human papillomavirus-active head and neck cancer and ethnic health disparities.

OBJECTIVES/HYPOTHESIS: Mortality for black males with head and neck squamous cell carcinoma (HNSCC) is twice that of white males or females. Human papillomavirus (HPV)-active HNSCC, defined by the concurrent presence of high-risk type HPV DNA and host cell p16(INK4a) expression, is associated with decreased mortality. We hypothesized that prevalence of this HPV-active disease class would be lower in black HNSCC patients compared to white patients. STUDY DESIGN: Multi-institutional retrospective cohort analysis. METHODS: Real-time polymerase chain reaction was used to evaluate for high-risk HPV DNA presence. Immunohistochemistry for p16(INK4a) protein was used as a surrogate marker for HPV oncoprotein activity. Patients were classified as HPV-negative (HPV DNA-negative, p16(INK4a) low), HPV-inactive (HPV DNA-positive, p16(INK4a) low), and HPV-active (HPV DNA-positive, p16(INK4a) high). Overall survival and recurrence rates were compared by Fisher exact test and Kaplan-Meier analysis. RESULTS: There were 140 patients with HNSCC who met inclusion criteria. Self-reported ethnicity was white (115), black (25), and other (0). Amplifiable DNA was recovered from 102/140 patients. The presence of HPV DNA and the level of p16(INK4a) expression were determined, and the results were used to classify these patients as HPV-negative (44), HPV-inactive (33), and HPV-active (25). Patients with HPV-active HNSCC had improved overall 5-year survival (59.7%) compared to HPV-negative and HPV-inactive patients (16.9%) (P = .003). Black patients were less likely to have HPV-active disease (0%) compared to white patients (21%) (P = .017). CONCLUSIONS: The favorable HPV-active disease class is less common in black than in white patients with HNSCC, which appears to partially explain observed ethnic health disparities.

Multi-spectral imaging analysis of HSPB1 expression in head and neck squamous cell carcinoma.

The objective of this study was to obtain more accurate quantitation of HSPB1 expression in HNSCC using a novel quantitative protein expression analysis system based on multispectral imaging. The study was a retrospective laboratory study of HNSCC patients treated at tertiary care academic medical center. Archival tissue samples from forty seven patients with HNSCC were subjected to immunohistochemistry using primary antibody to HSPB1. Seven of the patients had early stage cancers (TNM stage I/II) and forty patients had advanced stage cancers (TNM stage III/IV). HSPB1 expression was increased in advanced stage versus early stage cancers. Further investigation of HSPB1 as a potential biomarker for HNSCC is warranted.

Effects of smoking on quality of life following sinus surgery: 4-year follow-up.

OBJECTIVES/HYPOTHESIS: The purpose of this study is to report on long-term outcomes in a prospective study comparing the quality-of-life outcomes in smokers and nonsmokers undergoing functional endoscopic sinus surgery. STUDY DESIGN: : Prospective clinical trial. METHODS: A total of 235 patients were prospectively enrolled at a single tertiary academic center. Preoperative Sino-Nasal Outcomes Test (SNOT)-20 scores and comprehensive demographic and smoking data were obtained. Preoperative SNOT-20 scores were compared to postoperative SNOT-20 scores. RESULTS: Long-term follow-up results were available in 111/185 nonsmokers (60%) and 26/50 smokers (52%). Nonsmokers had a mean preoperative SNOT-20 score of 26.2, a short-term follow-up score of 10.1 (mean, 3.1 months) and a long-term follow-up score of 11.4 (mean, 44.2 months). Smokers had a mean preoperative SNOT-20 score of 27.8, a short-term follow-up score of 5.7 (mean, 3.1 months) and a long-term follow-up score of 8.3 (mean, 40.3 months). The mean improvement in SNOT-20 scores for smokers was significantly greater than nonsmokers in short-term follow-up (P = .044), however, no significant difference in improvement was seen between smokers and nonsmokers at long-term follow-up. CONCLUSIONS: Both smokers and nonsmokers continue to maintain a highly significant improvement in SNOT-20 scores following endoscopic sinus surgery at long-term follow-up. Although smoking remains a well-documented cause of medical morbidity, smokers maintained an improvement in quality of life after long-term follow-up from endoscopic sinus surgery in this prospective study.