Jeng-Yuh Ko

Prognostic factors of unknown primary head and neck squamous cell carcinoma

OBJECTIVE: To evaluate the prognostic factors of unknown primary head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN: Retrospective study. SUBJECTS: Patients with unknown primary HNSCC from 1980 to 2000 were included. RESULTS: Forty-eight patients, predominantly male and with a mean age of 63.3 ± 11.6 years, were recruited. The median survival time (MST) was 44 months. The overall survival rate was 60.4 percent at three years and 39.6 percent at five years. Forty-two patients receiving intervention regimens had a MST of 45 months, while six patients receiving palliative therapy had a MST of 8.5 months (log rank test, P = 0.016). With multivariate Cox regression analysis, age (per year), higher nodal stage (N3 vs N1 or N2), and treatment (operation vs nonoperation) had a hazard ratio of 1.081 (P < 0.0001), 5.852 (P = 0.010), and 0.4 (P = 0.042), respectively. CONCLUSION: Older age, higher nodal stage, and palliative treatment indicated poor prognosis. Survival time might be prolonged if surgical treatment is tolerable.

Malignant parotid tumor and facial palsy

OBJECTIVE: To evaluate risk factors for postoperative facial palsy in patients with parotid carcinoma. STUDY DESIGN AND SETTING: We conducted a retrospective chart review of patients with parotid carcinoma who underwent parotidectomy at National Taiwan University Hospital from 1980 to 2000. RESULTS: Eighty-eight patients with a mean age of 53 ± 17 y were recruited. Sixty patients (68.2%) experienced postoperative facial palsy. Tumor size of larger than 4 cm was associated with an increased incidence of facial palsy (P = 0.0422). Facial palsy was noted in 95.5 percent of patients with facial nerve involvement and 51.3 percent of patients without facial nerve involvement (P = 0.0004). Of 42 patients with tumor over the deep lobe, 37 (88.1%) had facial palsy but only 50 percent (23 of 46) of those with tumor over the superficial lobe had facial palsy (P = 0.0001). CONCLUSION: There were no significant associations between histopathology and facial palsy. Increasing tumor size, deep lobe tumor location, and tumor invasion of facial nerve increased the incidence of postparotidectomy facial palsy. SIGNIFICANCE: By paying attention to these risk factors a reduction of postoperative facial nerve palsy my be achieved.

The clinical predictive factors for subsequent distant metastasis in patients with locoregionally advanced oral squamous cell carcinoma

OBJECTIVES Only a small portion of the patients with locoregionally advanced oral squamous cell carcinoma (OSCC) experience subsequent distant metastasis. This study is to evaluate the occurrence of distant metastasis after curative treatment and to explore the predictive factors for subsequent distant metastasis in patients with locoregionally advanced OSCC. MATERIALS AND METHODS The medical records of all patients with locoregionally advanced OSCC without distant metastasis at the time of diagnosis (AJCC stage III, IV but not IVC) who underwent curative surgery with or without adjuvant radiation between 2004 and 2009 were retrospectively reviewed. RESULTS A total of 628 patients were enrolled, including 562 male and 66 female patients. The 5-year distant metastasis rate was 13.2%. The 5-year disease-free and overall survival rates were 57.0% and 60.3%, respectively. Multivariate analyses revealed that poorly differentiated tumors (HR=2.3 (1.16-4.53), p=0.02) and contralateral neck metastasis (HR=7.55 (3.20-17.83), p<0.001) were independent adverse factors for distant metastasis-free survival. The 5-year distant metastasis rates of 447 patients with well-differentiated tumors, 140 patients with moderately differentiated tumors and 41 patients with poorly differentiated tumors were 12.1%, 18.2%, and 34.1%, respectively. The 5-year distant metastasis rates of 227 patients without neck metastasis, 350 patients with ipsilateral neck metastasis and 51 patients with contralateral neck metastasis were 6.7%, 15.1%, and 55.3%, respectively. CONCLUSIONS Poorly differentiated tumors and contralateral neck metastasis were independent factors for subsequent distant metastasis in patients with locoregionally advanced OSCC.

Evaluation of swallowing disorders by use of transnasal esophagoscopy in patients treated for head and neck cancer

The purposes of this study were to identify an index of symptoms and signs of swallowing disorders that indicate the occurrence of local recurrence or second primary malignancy and to evaluate the application of transnasal esophagoscopy in patients treated for head and neck squamous cell carcinoma (HNSCC).