Austin Sim

Prognostic Significance of p16 and Its Relationship With Human Papillomavirus in Pharyngeal Squamous Cell Carcinomas

IMPORTANCE The prognostic significance of p16 in squamous cell carcinoma (SCC) of the hypopharynx (HP) and nasopharynx (NP) and relationship between human papillomavirus (HPV) and p16 is unclear. OBJECTIVES To evaluate the prognostic significance of p16 in pharyngeal subsites (oropharynx [OP], HP, and NP) and assess the relationship between HPV and p16 in the HP and NP. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review of 172 patients with SCC of the pharynx treated with definitive radiation therapy from 2002 to 2013 at a university tertiary referral center, with tissue available for immunohistochemical analysis. The median follow-up was 30.1 months. INTERVENTIONS A total of 118 patients were treated with chemoradiation, and 54 patients were treated with radiation alone. Immunohistochemical analysis for p16 was performed for all tumors. Hypopharynx and NP tumors were tested for HPV using in situ hybridization, and NP tumors were tested for Epstein-Barr virus. MAIN OUTCOMES AND MEASURES Overall survival, locoregional control, and disease-free survival were analyzed according to p16, HPV, and Epstein-Barr virus status. RESULTS Thirty-two patients had HP SCC, 127 had OP SCC, and 13 had NP SCC. p16 Was positive in the HP (34%), OP (66%), and NP (46%). Prevalence of HPV was 14% in the HP and 50% in the NP. As a test for HPV, p16 had a positive predictive value of 38% (HP) and 67% (NP) and a negative predictive value of 100% in HP and NP tumors. p16 Status was a significant predictor of all clinical outcomes for patients with OP SCC (P<.001), but not for patients with HP or NP SCC. Patients with Epstein-Barr virus- or HPV-associated NP SCC had improved clinical outcomes. CONCLUSIONS AND RELEVANCE p16 Was not associated with improved outcomes in patients with HP or NP SCC. The positive predictive value of p16 as a test for HPV is too low for p16 testing alone in the HP and NP. However, p16 negativity is sufficient to rule out HPV. As a research approach, we recommend p16 immunohistochemistry as a screening test for HPV in NP SCC and HP SCC followed by confirmatory HPV in situ hybridization when p16 positive.

Medical Malpractice in Uveitis: A Review of Clinical Entities and Outcomes.

ABSTRACT Purpose: To guide risk management in uveitis. Methods: Retrospective review of malpractice verdicts, rulings, and settlements. Results: The WestLaw® database was reviewed for lawsuits related to uveitis in the United States from 1930–2014. Twenty-five cases met inclusion criteria, and 48% of these were infectious. Overall, 64% of outcomes favored the defendant ophthalmologist. The most common diagnoses were viral retinitis (28%), iritis (12%), syphilis (8%), and toxoplasmosis (8%). Seven suits (28%) were resolved by settlement, with mean adjusted indemnities of

Malpractice Litigation in Pediatric Ophthalmology

724,302 (median,

Patterns of Distant Failure and Second Primary Cancers in Patients with Oropharyngeal Squamous Cell Carcinoma: Implications for Surveillance Methodology

409,390; range,

Malpractice Litigation in Ocular Oncology

127,837–2,021,887). Two cases (8%) resulted in plaintiff verdict, with adjusted awards of

Review of Postoperative and Elective Nodal Irradiation in Head and Neck Cancer

1,399,800 and

Analysis of Treatment Costs and Outcomes With the Addition of Induction Chemotherapy (IC) to Concurrent Chemoradiation (CRT) for Oropharyngeal Squamous Cell Carcinoma (OPSCC)

630,799. Conclusions: Despite being a rare diagnosis, viral retinitis (especially acute retinal necrosis) is the most common clinical entity associated with litigation in uveitis and should be considered early. Educating patients about potential adverse events, early testing for syphilis, and maintaining a positive relationship may also minimize risk.

A Phase 2 Pilot Single-Arm Prospective Clinical Trial of the STAT RAD Workflow for Osseous Metastases: Preliminary Results

Importance Understanding outcomes of pediatric malpractice litigation allows ophthalmologists to gain insight into how to best care for patients and prevent such litigation. Objectives To report and analyze the causes and outcomes of ophthalmology medical malpractice litigation involving patients younger than 18 years. Design, Setting, and Participants The WestLaw database was reviewed from April 1 to 30, 2015, for ophthalmology-related lawsuits, including settlements and trial verdicts, in the United States from January 1, 1930, to December 31, 2014. Search terms included ophthalmology or ophthalmologist and malpractice anywhere in the retrieved documents. Cases in which the plaintiffs were younger than 18 years at the time of the inciting event were included. Pediatric cases were compared with adult cases. Main Outcomes and Measures Pediatric malpractice case outcomes and settlement amounts. Results Sixty-eight ophthalmology malpractice cases involving plaintiffs younger than 18 years were included in the study. Thirty-five cases (51.5%) were resolved via jury trial. Of these 35 cases, verdicts in favor of the plaintiff were issued in 17 pediatric cases (48.6%), compared with 168 of 584 adult cases (28.8%) (difference, 33%; 95% CI, -24% to 64%; P = .01). The 17 cases that resulted in verdicts in favor of the pediatric plaintiff had a mean jury award of

Malpractice Litigation in Cornea and Refractive Surgery: A Review of the WestLaw Database

4 815 693 (median,

Malpractice litigation in ocular oncology

883 281; range,