Kan Gao

Implications for Clinical Staging of Metastatic Cutaneous Squamous Carcinoma of the Head and Neck Based on a Multicenter Study of Treatment Outcomes

Cutaneous squamous cell carcinoma (SCC) of the head and neck is a common cancer that has the potential to metastasize to lymph nodes in the parotid gland and neck. Previous studies have highlighted limitations with the current TNM staging system for metastatic skin carcinoma. The aim of this study was to test a new staging system that may provide better discrimination between patient groups.

Nodal yield and survival in oral squamous cancer: Defining the standard of care.

BACKGROUND: Elective neck dissection (END) is commonly used as a staging and therapeutic procedure for oral squamous cell carcinoma (SCC) at high risk of nodal metastases. The authors aimed to determine whether the extent of lymphadenectomy, as defined by nodal yield, is a prognostic factor in this setting. METHODS: A retrospective database review identified 225 patients undergoing END with curative intent for oral SCC between 1987 and 2009. Nodal yield was studied as a categorical variable for association with overall, disease-specific, and disease-free survival in univariate and multivariate analyses. RESULTS: Nodal yield <18 was associated with 5-year overall survival of 51% compared with 74% in those with nodal yield ≥18 (P = .009). Five-year disease-specific survival rates were 69% in those with <18 nodes and 87% in patients with ≥18 nodes (P = .022). Similar results were obtained for disease-free survival, with 5-year rates of 44% with <18 nodes versus 71% with ≥18 nodes (P = .043). After adjusting for the effect of age, nodal status, T stage, and adjuvant radiotherapy on multivariate analysis, nodal yield <18 was associated with reduced overall (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.1-3.6; P = .020), disease-specific (HR, 2.2; 95% CI, 1.1-4.5; P = .043), and disease-free survival (HR, 1.7; 95% CI, 1.1-2.8; P = .040). In the pathologically lymph node-negative subgroup (n = 148), similar results were obtained. CONCLUSIONS: Nodal yield is an independent prognostic factor in patients undergoing END for oral SCC. These results suggest that an adequate lymphadenectomy in this setting should include at least 18 nodes. Cancer 2011.

Lymph node ratio as an independent prognostic factor in oral squamous cell carcinoma

We aimed to validate the lymph node ratio (LNR) as an independent prognostic factor in oral squamous cell carcinoma (OSCC) and compare its utility with the current nodal staging system.

The assessment of pharyngocutaneous fistula rate in patients treated primarily with definitive radiotherapy followed by salvage surgery of the larynx and hypopharynx

To determine whether definitive radiotherapy prior to surgery increases the rate of pharyngocutaneous fistula (PCF) following laryngectomy or hypopharyngectomy and to determine if differences in duration of time between definitive radiotherapy and surgery alters PCF rate.

Outcomes of primary surgical treatment of T1 and T2 carcinomas of the oropharynx

Oropharyngeal cancers represent 10%–15% of all head and neck cancers. At presentation 60%–70% will have advanced‐stage disease with a high incidence of neck metastases. Primary treatment employing radiotherapy, with or without chemotherapy, is widely prescribed. The aim of this study is to analyze the outcome of definitive surgical management of T1–T2 cancers of the oropharynx.

The prognostic and staging implications of bone invasion in oral squamous cell carcinoma

A study was undertaken to determine whether bone invasion is an independent prognostic factor in oral squamous cell carcinoma (SCC) after taking into account the extent of bone invasion.

Prognostic Implications of Lymph Node Yield and Lymph Node Ratio in Papillary Thyroid Carcinoma

BACKGROUND The lymph node yield (LNY) and the lymph node ratio (LNR) have been shown to be important prognostic factors in oral, colon, and gastric cancers. The role of the LNY and LNR in papillary thyroid cancer (PTC) is unclear. The aims of this study were to determine if a high LNR and a low LNY decrease disease-free survival rates. This study further aimed to determine an optimum nodal yield. METHODS A retrospective analysis was conducted of 198 patients with PTC undergoing total thyroidectomy with neck dissection between 1987 and 2011. The LNY and LNR were adjusted by relevant covariates in a multivariate Cox regression analysis with Andersen-Gill extension. RESULTS The LNR was associated with a decrease in disease-free survival (hazard ratio 3.2 [95% confidence interval 1.4-7.3], p=0.005). Patients with an LNR of 0.30 or higher had a 3.4 times higher risk of persistent or recurrent disease compared with patients with an LNR of 0.00 ([95% confidence interval 1.1-10.5], p=0.031). Conversely, patients with an LNR of 0.11 or lower had an 80% chance of remaining disease free during 5 years of follow-up. The LNY showed no significant independent effect and an optimum nodal yield was not determined. CONCLUSIONS The LNR is an important independent prognostic factor in PTC and can be used in conjunction with existing staging systems. A clinical relevant cut-off point of 0.3 (one positive lymph node out of three total) is proposed. No prognostic implications for LNY were identified.

Outcome of treatment for advanced cervical metastatic squamous cell carcinoma

Patients with advanced cervical metastases from mucosal squamous cell carcinoma have a poor prognosis because of their high risk of regional and distal failure. This study aims to evaluate the outcomes of patients with clinical N2 or N3 disease managed with surgery and postoperative radiotherapy.

Prognostic factors in the surgical treatment of patients with oral carcinoma

The aim of the study was to analyse the clinical outcome of patients treated surgically for oral carcinoma. A retrospective cohort study was undertaken of 356 patients with oral cavity cancer whose clinicopathological information had been collected prospectively onto a dedicated head and neck database. Disease recurrence and survival were assessed. Neck metastases occurred in 42% of patients. Tumour thickness (both 2 and 5 mm) predicted the presence of nodal metastases. Both pathological T stage (P < 0.001) and tumour thickness cut‐off of 5 mm (P = 0.03) were independent predictors of disease‐specific survival. With a median follow up of 41 months, overall survival at 5 years was 59% and disease‐specific survival was 73%. Patients with thick tumours have a high risk of nodal metastases and this supports the liberal use of elective selective neck dissection in patients with clinically negative necks.

The Prognostic Impact of Extent of Bone Invasion and Extent of Bone Resection in Oral Carcinoma

Objective: The prognostic impact of mandibular invasion by oral squamous cell carcinoma (SCC) is controversial. The objective of this study was to assess the effect that extent of bone invasion has on recurrence and survival in patients treated with marginal and segmental mandible resection.