The role of magnetic resonance imaging in assessing the extent of tongue squamous cell carcinoma: A prospective cohort study.

PURPOSE: To assess the false-positive and false-negative MRI results in evaluating the extent of tongue squamous cell carcinoma. METHODS: A prospective cohort series of 165 patients was enrolled to assess the false-positive and false-negative MRI results in evaluating the extent of tongue squamous cell carcinoma by comparing intraoperative tumor profile images and postoperative pathological sections. The differences between two-dimensional tumor margins were analyzed using Mimics 15.0 and Geomagic Control 16.0. A paired-samples t-test was used to analyze the agreement among MRI, intraoperative and pathological findings regarding the extent of tongue tumors. Multiple linear regression analysis was used to analyze associated factors. RESULTS: The mean and maximum false-positive values of pathological specimens was 1.95±1.39 mm (95% limit of agreement (LoA) 1.70-2.14) and 3.21 mm, respectively; the false-negative value was 0.44±0.49 mm. The false-positive value of intraoperative specimens was 1.52±0.87 mm (95% LoA 1.36-1.64); the false-negative value was 0.35±0.20 mm. Tumor morphology (ulcer type) (p<0.01) and depth of invasion (DOI) (≤5 mm) (p<0.01) were significantly correlated with the false-positive values of intraoperative and pathology specimens. CONCLUSION: The false-positive values are important when judging the invasion margin of tongue cancer and forming MRI-based operative plans; the false-negative value was almost negligible.

Prognosis of Pediatric Patients With Mucoepidermoid Carcinoma of the Parotid Gland.

OBJECTIVE: To summarize the prognosis of pediatric patients with mucoepidermoid carcinoma (MEC) of the parotid gland. METHODS: Pediatric patients with MEC of parotid gland who were surgically treated at the Capital Medical University School of Stomatology from 2000 to 2014 were retrospectively analyzed. Clinical characteristics, pathology reports, and operation records were reviewed and analyzed. RESULTS: In total, 33 patients with an average age of 13.2 years were enrolled. The 5-year overall survival and disease-free survival were 95.8% and 84.4%, respectively. The disease-free survival and overall survival rates were lower in the under-10 age group (75.0 versus 87.7% and 83.3% versus 100%), though no statistically significant difference was found (P = 0.279 and P = 0.075). The patients who underwent complete resection all had a good prognosis without any recurrence or death regardless of whether the cut margin was 1.0 cm, 0.5 cm, or only extracapsular. One patient experienced 3 recurrences within 18 months and eventually died of disease. CONCLUSION: Good outcomes were achieved in pediatric patients with MEC of the parotid gland. Radical resection ensured a good prognosis regardless of the extent of resection. Frequent recurrence in a short period was associated with a poor prognosis. TRIAL REGISTRATION: None.

Accuracy of magnetic resonance imaging in evaluating the depth of invasion of tongue cancer. A prospective cohort study.

OBJECTIVES: This study compared the consistency of depth of invasion (DOI) measurements by magnetic resonance imaging (MRI) and intraoperative and postoperative pathological sections due to a lack of large sample studies. MATERIALS AND METHODS: From April 2015 to December 2017, patients with squamous cell carcinoma of the tongue were included in the study. Different invasion depths were measured by MRI and on intraoperative and postoperative pathological sections. The differences between two-dimensional tumor margins were analyzed using Mimics 15.0 and Geomagic Control 16.0. Statistical analyses were performed using IBM SPSS software version 25.0 (IBM Corp., Armonk, NY). RESULTS: This study included 150 patients, the overall difference between MRI and postoperative pathological sections (DMP) and the overall difference between intraoperative and postoperative pathological sections (DIP) based on pathological specimens were 2.32 ±â€¯1.68 mm and 0.68 ±â€¯0.99 mm. The overall difference between MRI and intraoperative pathological sections (DMI) based on intraoperative specimens was 1.64 ±â€¯1.32 mm. The tumor growth pattern and T stage were significantly correlated with measurement differences. The cutoff value of MRI depth that could identify nodal metastasis was 8 mm, and were both 11 mm for OS and DSS. CONCLUSION: Clinicians performing T staging on patients with tongue cancer based on MRI measurements must consider the false-positive mean depth of 2.3 mm as well as the growth pattern and specific infiltration depth. The prognostic MRI depths that enabled the identification of nodal metastasis, OS and DSS were 8 mm, 11 mm and 11 mm, respectively. CLINICAL TRIAL REGISTRATION: Name: A Prospective, Observational, Real-world Study Based on the Register System of Oral and Maxillofacial Malignant Tumors. (ClinicalTrials.gov ID: NCT02395367).

Lymph node ratio is associated with adverse clinicopathological features and is a crucial nodal parameter for oral and oropharyngeal cancer.

The lymph node ratio(LNR) has been described as a novel predictor of the survival of patients with oral and oropharyngeal squamous cell carcinoma(O/OPSCC). The purpose of this study was to evaluate whether LNR is better at predicting survival and the need for adjuvant treatment than traditional tumour-nodal-metastasis(TNM) staging. Eight hundred nine patients with O/OPSCC and positive lymph node disease were retrospectively enrolled in this study. LNR equal to 0.075 is the best cut-off value for stratifying 5-year disease-free survival(DFS). High LNR is closely associated with more advanced T stage, higher N stage, more severe pathological grade, the presence of diffuse infiltration and extracapsular spread(ECS). LNR is better for evaluating prognosis than the pathological N stage. Patients with high LNR coupled with high number of positive lymph nodes who received adjuvant concurrent chemo-radiotherapy(CCRT) had a better 5-year DFS than patients who received surgery alone. Multivariate analyses revealed that T stage, ECS and LNR are independent prognostic factors of 5-year DFS and disease-specific survival(DSS). Therefore, high LNR is closely correlated with adverse parameters that markedly hinder prognosis. LNR is superior to traditional TNM staging for the evaluation of prognosis,and the combination of the LNR with the number of positive lymph nodes can predict the benefits of adjuvant CCRT.

Clinicopathological features, management and outcome of patients with poorly-differentiated oral and oropharyngeal squamous cell carcinoma.

BACKGROUND: The purpose of this study was to explore the clinicopathological features, risk factors, and management of poorly differentiated oral and oropharyngeal squamous cell carcinoma (OOSCC) patients in the northern Chinese population. METHOD: A total of 118 poorly differentiated OOSCC patients from 2236 consecutive cases were retrospectively enrolled in this study. RESULTS: Cox regression analysis showed that site (hazard ratio (HR): 2.561, 95% confidence interval (CI): 1.064-6.164, p = 0.036) and lymph node ratio (LNR) (HR: 3.915, 95% CI: 1.797-8.530, p = 0.001) were independent predictive factors for 5-year disease-specific survival (DSS). LNR >0.036, oropharynx site, and advanced clinical stage formulate a model of risk stratification. The patients with a risk score of ≥2 were identified as the high-risk population, and patients with a risk score of 0 or 1 were identified as the low-risk population. Patients in the high-risk population who underwent surgery plus concurrent chemoradiotherapy (CCRT) had markedly better 5-year DSS than those who only underwent surgery (60.0% vs. 20.0%, p = 0.016). However, patients in the low-risk population who underwent surgery alone exhibited a similar 5-year DSS (68.2%) compared with those who received surgery plus radiotherapy (RT) (68.2%) or surgery plus CCRT (50.0%) (p = 0.907). CONCLUSIONS: High LNR, oropharynx site and advanced clinical stage constitute a model of risk stratification for patients with poorly differentiated OOSCC. If two or more risk factors are present, surgery and adjuvant chemoradiotherapy can give the best prognosis.

Surgery combined with postoperative 125 I seed brachytherapy for the treatment of mucoepidermoid carcinoma of the parotid gland in pediatric patients.

BACKGROUND: This retrospective study was undertaken to analyze the effectiveness and safety of surgery combined with postoperative 125 I seed brachytherapy in the treatment of mucoepidermoid carcinoma (MEC) of the parotid gland with risk factors in pediatric patients. PROCEDURE: From September 2002 to January 2012, 24 patients, ages 5-16 years (mean, 13.2 years; median, 12.3 years), with MEC of the parotid gland were included. Patients with high risk factors received 125 I seed brachytherapy (median actuarial D90, 97 Gy) within 4 weeks following surgery. Radioactivity was 18.5-33.3 MBq per seed and the prescription dose was 60-120 Gy. Overall and disease-free survival rates, local control rate, and distant metastasis were recorded. Radiation-associated late side effects, including dermatitis, hearing loss, thyroid nodules, and secondary malignancy, were also evaluated. RESULTS: During the follow-up period of 5-13.4 years (median, 7.2 years), the overall and disease-free survival rates were all 100%. No patients developed local recurrence, regional/distant metastasis, and no severe radiation-associated complications including the second malignancy were noted. CONCLUSION: Surgery combined with postoperative 125 I seed brachytherapy is effective and safe in the treatment of MEC of the parotid gland in pediatric patients, with no evidence of severe late radiation-related complications. More patients and longer follow-up data are still needed to prove the efficacy of 125 I brachytherapy.

Second primary cancer after index head and neck squamous cell carcinoma in Northern China.

OBJECTIVE: To evaluate the clinicopathologic features, prognostic factors, and management of patients in the North Chinese population with head and neck squamous cell carcinoma (HNSCC) who developed a second primary malignancy (SPM). METHODS: This was a retrospective study including 1818 eligible patients between June 1999 and April 2011. RESULTS: A total of 188 HNSCC patients developed SPM. Multiple oral dysplastic lesions (MODLs) (P < .001) were among the risk factors for occurrence of SPM. However, MODLs were closely associated with many mild pathologic features, such as early T stage (P < .001), early N stage (P = .036), good pathologic differentiation (P < .001), and mild growth pattern (P < .001). Interestingly, multivariate survival analysis showed that SPM patients had a better prognosis if they had the characteristics of MODLs (P = .020). CONCLUSIONS: MODLs were a crucial risk factor leading to the occurrence of oral SPM after an index HNSCC in patients in Northern China. However, SPM patients with the characteristics of MODLs had a better prognosis.

Predicting Radiotherapy Necessity in Tongue Cancer Using Lymph Node Yield.

PURPOSE: In patients with head and neck cancer and a single metastatic lymph node (pN1), the value of lymph node yield (LNY) remains controversial in determining the prognosis and identifying patients who require radiotherapy. This study evaluated the role of LNY in predicting the adequacy of neck dissection, need for adjuvant radiotherapy, and survival in patients with pN1 oral tongue squamous cell carcinoma. MATERIALS AND METHODS: The authors implemented a retrospective cohort study. The predictor variable was LNY. The outcome variables were 5-year disease-specific survival and the need for adjuvant radiotherapy. Other study variables were age, gender, tumor stage, pathologic grade, growth pattern, tobacco and alcohol habits, and time frame. Descriptive and bivariate statistics were computed, and a P value less than .05 was considered statistically significant. RESULTS: The sample was chosen from among 2,792 patients who were histopathologically diagnosed as having oral squamous cell carcinoma and underwent surgical treatment from June 1996 through December 2012. One hundred forty-one patients treated at the Department of Oral and Maxillofacial-Head and Neck Oncology of the Beijing Stomatological Hospital (Beijing, China) were screened for the study. Receiver operating characteristics curve analysis identified that a cutoff (LNY, 20; area under the curve, 0.708; 95% confidence interval, 0.625-0.781; sensitivity and specificity, 64.94 and 70.31%, respectively; P = .0001) could best discriminate patients into 2 groups according to need for adjuvant radiotherapy. Interestingly, subgroup analyses showed that patients who underwent adjuvant radiotherapy had notably better 5-year disease-specific survival than those who did not undergo radiotherapy if the LNY was smaller than 20 (58.0 vs 21.0%; P = .021). However, there was no significant association for 5-year disease-specific survival between the low and high LNY groups (49.2 vs 58.7%; P = .363). CONCLUSIONS: An LNY smaller than 20 at levels I to III predicted a benefit from adjuvant radiotherapy in patients with tongue cancer who had pN1 neck status without other adverse histopathologic features.

Risk factors for patients with multiple synchronous primary cancers involving oral and oropharyngeal subsites.

OBJECTIVE: To evaluate risk factors and prognosis for multiple synchronous primary cancers (MSPCs) associated with head and neck squamous cell carcinoma. STUDY DESIGN: The retrospective study included 1623 patients. RESULTS: The most common MSPC site involved was the head and neck region. The presence of multiple oral dysplastic lesions (P < .001) was the sole risk factor for the occurrence of MSPCs. A multivariate survival analysis showed that the pathologic grade (P = .003) was an independent predictive factor for the 5-year disease-specific survival of patients with MSPCs. A Kaplan-Meier analysis showed that the 5-year disease-specific survival of patients who developed MSPCs was worse than that of patients who did not develop MSPCs (P = .020). CONCLUSIONS: MSPCs are a significant negative prognostic factor for patients with head and neck squamous cell carcinoma. However, a worse prognosis is predicted for patients with MSPCs with several features: a higher pathologic grade, a more aggressive growth pattern, male gender plus a tobacco or alcohol habit, and no multiple oral dysplastic lesions.

Risk factors for relapse of middle-stage squamous cell carcinoma of the submandibular region and floor of mouth: the importance of en bloc resection.

Our aim was to investigate retrospectively the rate of recurrence in the intervening region for middle-stage squamous cell carcinoma (SCC) of the tongue and identify the factors that predict relapse and prognosis. A total of 204 patients were included, 96 in the en bloc group and 108 in the control group. The groups were comparable. Two patients in the en bloc group (2%) and 12 in the control group (11%) developed recurrences in the intervening region. Kaplan-Meier analysis showed a reduction in the 5-year disease-specific survival once a recurrence had developed after the primary operation (77% compared with 14%, p<0.001). The en bloc group developed significantly fewer recurrences (2%) than the control group (11%) during the five years; p=0.037), and also had better 5-year disease-specific survival (80% compared with 66%, p=0.04). Cox's multivariate regression indicated that the pathological nodal status (p=0.016) and surgical technique (p=0.037) were independent predictive factors for the 5-year recurrence rate, as well as of 5-year disease-specific survival (p=0.001 and p=0.050, respectively). Recurrence in the intervening region is a negative prognostic factor for these patients, and we recommend en bloc resection as the management of choice for middle-stage SCC of the tongue.

Nodal Yield: Is it a Prognostic Factor for Head and Neck Squamous Cell Carcinoma?

PURPOSE: The prognostic value of lymph node yield (LNY) in head and neck squamous cell carcinoma (HNSCC) remains controversial. The aim of this study was to explore whether LNY influences locoregional recurrence risk and prognosis in patients with HNSCC. PATIENTS AND METHODS: This retrospective cohort study reviewed the records of 1,546 eligible patients with HNSCC who were treated at Beijing Stomatological Hospital, Capital Medical University, from July 1989 to October 2012. The predictor variable was LNY. The main outcome assessment parameters were 2-year neck recurrence rate (NRR) and 5-year disease-specific survival (DSS). All statistical analyses were performed using SPSS 19.0 for Windows. RESULTS: The mean and median LNY per neck dissection were 25.1 and 23.0, respectively. There was no significant association between LNY quartile and 2-year NRR in the pN0 (P = .397) or pN(+) (P = .335) group. Univariate analysis of the pN0 group showed no significant association between LNY and 5-year DSS (P = .676). The analysis of patients with pN(+) who underwent only selective neck dissection showed a significantly higher prognostic risk with an increased LNY (LNY <19 vs ≥34, 79.2% vs 59.4%; P = .014). Interestingly, in the comprehensive neck dissection subgroup, there was an obvious tendency for patients with a high LNY to have a better 5-year DSS than those with a low LNY (LNY <19 vs ≥34, 55.6% vs 76.4%; P = .021). Multivariate analysis showed that LNY was not an independent predictive factor for 2-year NRR or 5-year DSS. CONCLUSIONS: LNY is statistically associated with the risk of lymph node metastasis, but does not predict neck recurrence. The exact prognostic value of LNY for patients with pN(+) remains unknown, and further study is needed to validate the present findings.

[Increase of saliva nitrate and nitrite level in patients with oral candidiasis].

OBJECTIVE: To observe the alterations of saliva nitrate and nitrite level in patients with oral candidiasis. METHODS: Parotid saliva and whole saliva were collected from 33 patients and 34 healthy volunteers. Concentrations of nitrate and nitrite in saliva were determined by high-performance liquid chromatography. Follow-up observation was performed on 10 patients after treatment. The data were statistically analyzed with independent-samples t test or paired-samples t test at alpha = 0.05. RESULTS: There was significant increase of the concentrations and secretion rate of parotid saliva nitrate in patient group as compared with controls: (49.70 +/- 0.50) vs (21.51 +/- 0.60) mg/L (t = 2.692, P = 0.009) and (27.71 +/- 0.50) vs (12.55 +/- 0.60) microg/min (t = 2.554, P = 0.013), respectively. Significantly increased concentrations and secretion rate of nitrate and nitrite [nitrate: (6.46 +/- 0.94) vs (1.11 +/- 0.70) mg/L (t = 3.792, P = 0.000); nitrite: (8.48 +/- 0.58) vs (3.39 +/- 0.53) mg/L (t = 2.888, P = 0.005); nitrate secretion rate: (10.57 +/- 0.91) vs (2.10 +/- 0.74) microg/min (t = 3.464, P= 0.001); nitrite secretion rate: (13.91 +/- 0.55) vs (6.42 +/- 0.58) microg/min (t = 2.397, P = 0.020)] were revealed in whole saliva of patients group. Significantly decreased nitrate and nitrite levels were also observed in patients after treatment, especially the changes of parotid saliva nitrate secretion rate [(37.50 +/- 0.50) vs (14.34 +/- 0.64) microg/min (t = 3.142, P = 0.012)], whole saliva nitrate [(14.29 +/- 1.01) vs (2.59 +/- 1.03) mg/L (t = 3.475, P = 0.007)] and whole saliva nitrate secretion rate [(25.97 +/- 0.93) vs (4.12 +/- 1.00) microg/min (t = 3.922, P = 0.003)]. CONCLUSION: The present study revealed the significant increase of salivary nitrate and nitrite level in patients with oral candidiasis is considered to be associated with the host defense reaction.