Sang-Yeon Kim

Characteristics and Prognostic Implications of High-Risk HPV-Associated Hypopharyngeal Cancers

Background High-risk human papillomavirus (HPV) is an oncogenic virus that causes oropharyngeal cancers, and it has a favorable outcome after the treatment. Unlike in oropharyngeal cancer, the prevalence and role of high-risk HPV in the etiology of hypopharyngeal squamous cell carcinoma (HPSCC) is uncertain. Objective The aim of the present study was to evaluate the effect and prognostic significance of high-risk HPV in patients with HPSCC. Methods The study included 64 subjects with HPSCC who underwent radical surgery with or without radiation-based adjuvant therapy. Primary tumor sites were the pyriform sinus in 42 patients, posterior pharyngeal wall in 19 patients, and postcricoid area in 3 patients. High-risk HPV in situ hybridization was performed to detect HPV infection. Results The positive rate of high-risk HPV in situ hybridization was 10.9% (7/64). There was a significant difference in the fraction of positive high-risk HPV among pyriform sinus cancer (16.7%), posterior pharyngeal wall cancer (0%), and postcricoid area cancer (0%) (p = 0.042). The laryngoscopic examination revealed a granulomatous and exophytic appearance in 85.7% (6/7) of patients with high-risk HPV-positive pyriform sinus cancer, but in only 31.4% (11/35) of patients with high-risk HPV-negative pyriform sinus cancer (p = 0.012). Significant correlations were found between positive high-risk HPV and younger age (p = 0.050) and non-smoking status (p = 0.017). HPV-positive patients had a significantly better disease-free survival (p = 0.026) and disease-specific survival (p = 0.047) than HPV-negative patients. Conclusions High-risk HPV infection is significantly related to pyriform sinus cancer in patients with HPSCC.

Prognostic impact of lymph node micrometastasis in oral and oropharyngeal squamous cell carcinomas.

The purpose of this study was to determine the role of lymph node micrometastasis in oral and oropharyngeal cancers.

Prognostic impact of perineural invasion in hypopharyngeal squamous cell carcinoma

Abstract Objectives: The aim of this study was to evaluate the role of PNI in HPSCC. Methods: The medical records of 105 patients who underwent surgery-based treatment for HPSCC were reviewed. Clinicopathologic parameters including disease-specific survival were correlated with PNI. Results: PNI was identified in 27 of the 105 (25.7%) cases of HPSCC. Correlation analysis demonstrated that PNI in HPSCC was significantly correlated with pN classification (10.3% in N0/N1 vs 34.8% in N2/N3, p = 0.006). Patients with PNI had decreased 5-year disease-specific survival with borderline significance (p = 0.065). In a sub-set of 31 patients who did not receive post-operative radiotherapy, PNI was determined to be a significant prognostic predictor (p = 0.033). In multivariate analysis, extracapsular invasion was the only independent prognostic factor for disease-specific survival (p = 0.001). Conclusion: Perineural invasion (PNI) should be considered an independent predictor for cervical lymph node involvement. PNI status in primary hypopharyngeal squamous cell carcinoma (HPSCC) specimens should be considered in decisions concerning adjuvant radiotherapy.

Efficacy and Safety of Adjunctive Steroid Injection After Microsurgical Removal of Benign Vocal Fold Lesions

OBJECTIVE This study aims to investigate the clinical efficacy and safety of immediate intralesional steroid injection in patients undergoing laryngeal microsurgery (LMS) for benign vocal fold lesions (BVFLs). STUDY DESIGN This is a single-institution, retrospective cohort study. METHODS Patients were divided into two groups according to whether or not they received adjunctive steroid injection after LMS. We evaluated the outcomes using objective, perceptual voice analysis and videostroboscopy. We also analyzed clinical parameters and identified risk factors associated with persistent dysphonia after LMS. RESULTS The study included a total of 211 patients with BVFLs (82 men and 129 women), which comprised 136 vocal polyps (64.5%), 49 nodules (23.2%), and 30 cysts (14.2%); 84 patients (39.8 %) had intralesional steroid administration combined with LMS. The overall results for postoperative voice parameters in both groups were significantly improved. On videostroboscopic examination, the rate of recurrent lesions was lower in the group that received adjunctive steroid injection than in the group with only LMS (P = 0.014). In the multivariate analysis, older age (compared to <50 years of age; odds ratio [OR] = 2.697, 95% confidence interval [CI]: 1.300-5.595, P = 0.008) and duration of hoarseness longer than 6 months (compared to <3 months; OR = 2.729, 95% CI: 1.193-6.242, P = 0.017) were identified as independent risk factors associated with persistent dysphonia. Nevertheless, adjunctive steroid injection was associated with a 0.3-fold (OR = 0.345, 95% CI: 0.152-0.784, P = 0.011) lower risk of persistent dysphonia. CONCLUSION Steroid injection combined with LMS in the treatment of BVFLs was safe and associated with improved voice quality.

Association between the standardized uptake value and high-risk HPV in hypopharyngeal squamous cell carcinoma

Abstract Conclusion: Median 18F-FDG PET/CT maximum standardized uptake values (SUVmax) cut-off values of 7.9 or greater were associated with high-risk human papillomavirus (HPV) negativity in patients with hypopharyngeal squamous cell carcinoma (HPSCC). Furthermore, median 18F-FDG PET/CT SUVmax cut-off values of 7.9 or greater and high-risk HPV negativity were associated with adverse outcomes. Objectives: We studied the association and the potential prognostic significance of 18F-FDG PET/CT and high-risk HPV status in HPSCC. Methods: The medical records of 45 patients who underwent 18F-FDG PET/CT for HPSCC before surgery were reviewed. High-risk HPV in situ hybridization was performed to detect HPV infection. Results: The median SUVmax was 9.91 ± 4.91 (range 1.9–22.1) and the positive rate of high-risk HPV in situ hybridization was 11% (5 of 45). The SUVmax values of negativity for the high-risk HPV subtypes (10.47 ± 4.87) and positivity (5.48 ± 2.45) were found to be significantly different (p = 0.030). The SUVmax cut-off value for differentiating negativity for the high-risk HPV subtypes from positivity was 7.9, with a sensitivity of 65% and a specificity of 80%. The 5-year disease-specific survival rate (DSSR) in our cohort was 57%. Patients with an SUVmax value higher than 7.9 (p = 0.005) and high-risk HPV negativity (p = 0.047) had decreased 5-year DSSR.

Effects of Voice Therapy Using the Lip Trill Technique in Patients With Glottal Gap

OBJECTIVES Lip trills are widely used as a voice warm-up technique among singers. However, little is known about the effects of lip trills in cases of voice disorders. We examined the therapeutic effects of lip trills in patients with glottal gap. METHODS Patients with glottal gap were classified into three groups according to the type of gap: gap-only, gap with muscle tension dysphonia (MTD), and a sulcus vocalis group. Patients underwent perceptual, acoustic/aerodynamic analyses, stroboscopic evaluations, and subjective analyses using a questionnaire before and after lip trills. The results were analyzed before and after trills and according to and between the groups. RESULTS The results in 42 patients were analyzed. Most of the parameters were improved and glottal gap was significantly reduced after trills in all patients. In the gap-only group (n = 19), most of the parameters showed improvement and were within the respective normal ranges, and glottal gap was improved after trills. In the MTD group (n = 13), although many parameters were improved, the improvement was not as prominent as in the gap-only group. In the sulcus vocalis group (n = 10), only some of the parameters were improved and the improvement in glottal gap was limited. CONCLUSIONS Lip trills were an effective treatment for glottal gap. The therapeutic effect was prominent in the gap-only group, followed by the MTD and sulcus vocalis groups. Trills can be used as an adjuvant treatment option in voice therapy in cases of various voice disorders.

Clinicopathological factors influencing the outcomes of surgical treatment in patients with T4a hypopharyngeal cancer

BackgroundThe purpose of this study was to determine prognostic factors influencing outcomes of surgical treatment in patients with T4a hypopharyngeal cancer.MethodsThe present study enrolled 93 patients diagnosed with T4a hypopharyngeal cancer who underwent primary surgery between January 2005 and December 2015 at six medical centers in Korea. Primary tumor sites included pyriform sinus in 71 patients, posterior pharyngeal wall in 14 patients, and postcricoid region in 8 patients. Seventy-two patients received postoperative radio(chemo)therapy.ResultsFive-year disease-free survival (DFS) and disease-specific survival (DSS) rates were 38% and 45%, respectively. In univariate analysis, 5-year DFS was found to have significant and positive correlations with margin involvement (p < 0.001) and extracapsular spread (p = 0.025). Multivariate analysis confirmed that margin involvement (hazard ratio (HR): 2.81; 95% confidence interval (CI): 1.49-5.30; p = 0.001) and extracapsular spread (HR: 2.08; 95% CI: 1.08-3.99; p = 0.028) were significant factors associated with 5-year DFS. In univariate analysis, cervical lymph node metastasis (p = 0.048), lymphovascular invasion (p = 0.041), extracapsular spread (p = 0.015), and esophageal invasion (p = 0.033) were significant factors associated with 5-year DSS. In multivariate analysis, extracapsular spread (HR: 2.98; 95% CI: 1.39-6.42; p = 0.005) and esophageal invasion (HR: 2.87; 95% CI: 1.38-5.98; p = 0.005) remained significant factors associated with 5-year DSS.ConclusionMargin involvement and extracapsular spread are factors influencing recurrence while extracapsular spread and esophageal invasion are factors affecting survival in patients with T4a hypopharyngeal cancer treated by primary surgery.

Swallowing function in patients with vertical hemipharyngolaryngectomy for hypopharyngeal squamous cell carcinoma

The purpose of this study was to evaluate the long‐term swallowing function in patients with vertical hemipharyngolaryngectomy (VHPL) for hypopharyngeal cancer.

High Risk HPV and Lymph Node Size in Single Node Metastasis of Oral Oropharyngeal Cancer

Objectives: Examine the relationship between high risk human papillomavirus (HPV) infection and lymph node size in patients with single node metastasis of oral and oropharyngeal carcinoma. Methods: The study included 48 subjects with squamous cell carcinoma,21 in the oral cavity and 27 in the oropharynx. High risk HPV in situ hybridization was performed to detect HPV infection. The pathologic N stages were 36 N1and 12 N2a. Results: The positive rate of high risk HPV in situ hybridization was 29% (14/48). There was a significant difference in the fraction positive high risk HPV between oral (9.5%) and oropharyngeal (44.4%) cancer (P = 0.008). The average diameter of positive lymph node was 20.7 ± 12.6 mm (range, 5-54 mm). A significant positive correlation was found between high risk HPV status and lymph node size (P = 0.018). The mean lymph node diameter in cases with high risk HPV positive was 27.3 ± 13.1 mm, whereas in cases with high risk HPV negative was 18.0 ± 11.5 mm. Extracapsular spread was also significantly related to the lymph node size (P = 0.030). Patients with high risk HPV negativity (P = 0.043), advanced T stage (P = 0.009), or the presence of extracapsular spread (P = 0.038) had a significant adverse effect on 5-year disease specific survival according to the Kaplan-Meier survival curves. Conclusions: High risk HPV infection is significantly related to lymph node size in patients with single node metastasis of oral and oropharyngeal cancer.