Stephanie Johnson-Obaseki

Head and neck cancer in Canada: trends 1992 to 2007.

Objectives The objective of this study was to investigate the changes in the epidemiology (incidence, age at diagnosis, and survival) of head and neck cancers (HNCs) in Canada in the past decade. Study Design Analysis of a national cancer data registry. Setting All Canadian hospital institutions treating head and neck cancer. Subjects and Methods Using Canadian Cancer Registry data (1992-2007), the authors categorized HNCs into 3 groups according to their possible association with human papillomavirus (HPV): oropharynx (highly associated), oral cavity (moderate association), and “other” (hypopharynx, larynx, and nasopharynx), which are not HPV related. They calculated age-adjusted incidence, median age at diagnosis, and survival for each category. Results Oropharynx tumors increased in incidence over the study time period (annual percent change: 1.50% men, 0.8% women), whereas oral cavity tumors decreased (2.10% men, 0.4% women), as did other HNCs (decreased by 3.0% for men and 1.9% for women). The median age at diagnosis for oropharynx cancer decreased by an average of 0.23 years/y. There was no change for oral cavity tumors but an increase for other HNCs of 0.12 years/y. Survival for patients with oropharynx cancer increased by 1.5%/y but was significant for men only. Survival for patients with oral cavity and other HNCs also increased in men only by 0.9%/y and 0.25%/y, respectively. Conclusion Oropharynx cancer, which is highly correlated with HPV infection, is increasing in incidence in Canada, with a decreasing age at diagnosis and an improvement in survival. This could have implications for screening strategies and treatment for oropharyngeal cancers in Canada.

Oncologic, functional and surgical outcomes of primary Transoral Robotic Surgery for early squamous cell cancer of the oropharynx: a systematic review

OBJECTIVES Transoral Robotic Surgery (TORS) has emerged as an alternative to radiotherapy or chemoradiotherapy for the treatment of oropharyngeal squamous cell carcinoma (OPSCC). Many centers restrict the use of TORS to early (T1-2) OPSCC. The purpose of this article was to assess oncologic and functional outcomes of TORS for primary treatment of early OPSCC. STUDY DESIGN Systematic review. METHODS A systematic literature search was performed for all relevant English language studies using Embase, Medline, and Pubmed. Our primary outcome measure was local control; secondary outcomes included overall survival (OS) and tracheostomy tube (TT) and gastrostomy tube (GT) dependence rates. Three authors independently extracted study information and analyzed all included articles for quality and bias using the Newcastle-Ottawa Quality Assessment Scale. RESULTS A total of 206 papers were identified, with 11 meeting the inclusion criteria (190 patients). For T1-2 OPSCC, the aggregate local control rate was 96.3% with an OS rate of 95.0%. Rates of prolonged (>12 month) TT and GT dependence were 0.0% and 5.0% respectively. CONCLUSIONS This systematic review suggests that TORS offers high rates of disease control with low rates of long-term TT or GT dependence in T1-2 OPSCC. However, further study is needed to compare TORS outcomes to those of traditional therapies.

The relationship between survival and socio-economic status for head and neck cancer in Canada

BackgroundHuman papilloma virus (HPV) is emerging as the primary cause for some head and neck cancers. The objective of this study was to investigate the association between head and neck cancer (HNC) survival and socioeconomic status (SES) in Canada, and to investigate changes in the relationship between HNC survival and SES from 1992 to 2005.MethodsCases were drawn from the Canadian Cancer Registry (1992–2005), and were categorized into three subsites: oropharynx, oral cavity, and “other” (hypopharynx, larynx, and nasopharynx). Demographic and socioeconomic information were extracted from the Canadian Census of Population data for the study period, which included three census years: 1991, 1996 and 2001. We linked cases to income quintiles (InQs) according to patients’ postal codes.ResultsOverall survival, without controlling for smoking, for oropharyngeal cancer increased dramatically from 1992–2005 in Canada. This increase in survival for oropharynx cancer was eliminated by the introduction of controls for smoking. Survival for all head and neck cancer subsites was strongly correlated with SES, as measured by income quintile, with lower InQ’s having lower survival than higher. Lastly, the magnitude of the difference in survival between the highest and lowest income quintiles increased significantly over the time period studied for oropharynx cancer, but did not statistically significantly change for oral cavity cancer or other head and neck cancers.ConclusionsThese data confirm a significant impact of socioeconomic deprivation on overall survival for head and neck cancers in Canada, and may provide indirect evidence that HPV-positive head and neck cancers are more common in higher socioeconomic groups.

Complication rates of open surgical versus percutaneous tracheostomy in critically ill patients.

In the setting of critical care, the most common indications for tracheostomy include: prolonged intubation, to facilitate weaning from mechanical ventilation, and for pulmonary toileting. In this setting, tracheostomy can be performed either via open surgical or percutaneous technique. Advantages for percutaneous dilatational tracheostomy (PDT) include: simplicity, smaller incision, less tissue trauma, lower incidence of wound infection, lower incidence of peristomal bleeding, decreased morbidity from patient transfer, and cost‐effectiveness. Despite many studies comparing surgical tracheostomy (ST) versus PDT, there remains no consensus on which of these techniques minimizes complications in critically ill patients.

HPV DNA in saliva from patients with SCC of the head and neck is specific for p16-positive oropharyngeal tumours

BackgroundHuman papillomavirus (HPV) is an important cause of head and neck squamous cell carcinoma (HNSCC), especially in young people. These tumours overexpress p16 and respond well to treatment. The rapid detection of HPV in patients with HNSCC may expedite treatment when p16 status is not immediately available.MethodsSaliva-based DNA collection kits and nested polymerase chain reaction (PCR) were used to determine the HPV status of 62 individuals with biopsy-proven HNSCC. Immunohistochemistry was used to determine tumour p16 status.ResultsA total of 62 patients were included in the study. Twenty-nine samples (47%) were positive for HPV DNA, the majority of which were high risk (HR) subtypes (79%). Patients who tested positive for HR HPV were more likely to have a tumour arising in the oropharynx compared to a non-oropharyngeal site (74 vs 26%; p = 0.003). A positive HR HPV saliva assay was 100% specific (95% CI 59–100%) and had a 100% positive predictive value (95% CI 75–100%) for a p16 positive tumour arising in the oropharynx. In contrast, a negative HR HPV assay had a 96% negative predictive value (95% CI 80–100%) for tumours arising in a non-oropharyngeal site. Independent of site, the saliva assay had a sensitivity of 77% (95% CI 54–91%) and a specificity of 94% (95% CI 77–99%), respectively, for a p16 positive tumour.ConclusionWe show that a saliva based assay is an effective method for detecting HPV in patients with HNSCC and that a positive HR HPV test is highly specific for p16 positive tumours arising in the oropharynx. This simple and rapid test could be used in cases where a biopsy of the primary tumour is not readily available.

Primary Burkitt lymphoma of the supraglottic larynx: a case report and review of the literature

BackgroundBurkitt lymphoma is a high-grade B cell lymphoma which accounts for less than 1% of all adult cases of non-Hodgkin lymphoma. Rare instances of Burkitt lymphoma developing secondary to prior irradiation have been described in the literature.Case presentationWe report a case of a 90-year-old white woman with a recent history of irradiation for Hodgkin lymphoma, who presented with primary Burkitt lymphoma of the supraglottic larynx. She underwent emergency awake tracheostomy with biopsy. A histopathological examination confirmed non-Hodgkin, B cell lymphoma of Burkitt type. Given her age and poor functional status, she underwent treatment with palliative radiotherapy.ConclusionsA literature review was performed to clarify the clinical characteristics of radiation-induced Burkitt lymphoma in the head and neck, as well as its diagnosis and management. The present case represents the second case of radiation-induced Burkitt lymphoma in the head and neck in the reported literature, and the first in the supraglottic larynx. It highlights the need to maintain a broad differential in the assessment of malignancies of the larynx, particularly in patients with a prior history of radiation treatment.

Sentinel Lymph Node Biopsy in Head and Neck Melanoma: A Review

The incidence of melanoma in the United States continues to rise. Head and neck melanomas comprise approximately 20% of all primary cutaneous melanomas. Sentinel lymph node (SLN) biopsy (SLNB) has become the standard of care for staging in melanoma. It has a number of advantages, including the addition of prognostic information, accurate staging, and the potential to add completion lymph node dissection (CLND) or adjuvant therapy when indicated. Furthermore, it may allow for the identification of patients who would benefit from inclusion in clinical trials; this advantage may be amplified based on the introduction of novel targeted therapies. SLNB does have some disadvantages in head and neck melanomas. The complex lymphatic drainage and anatomy of the head and neck can result in some technical challenges. SLN positivity rates in head and neck melanoma are lower than for trunk or extremity melanoma; despite this, overall and disease free survival rates are lower in head and neck melanoma. This review examines the literature evidence for the efficacy of SLNB in head and neck melanoma, and in particular attempts to estimate five variables: the likelihood of finding a SLN, the number of SLNs found, the likelihood of a positive SLN, the likelihood of identifying positive non-sentinel lymph nodes on CLND, and the likelihood of recurrence in the neck despite a negative SLNB. Overall, despite the technical challenges inherent in SLNB when applied to head and neck melanoma, it remains a technically feasible and effective procedure in this anatomic site. (J Patient-Centered Res Rev. 2014;1(1):27-32.)

Risk factors for postoperative complications in total thyroidectomy: A retrospective, risk-adjusted analysis from the National Surgical Quality Improvement Program

Abstract Thyroid cancer incidence is increasing, and with it, an increase in total thyroidectomy. There are limited studies comparing outcomes in total thyroidectomy performed in the inpatient versus outpatient setting. The objective of this study was to perform a comparative analysis of risk factors and outcomes of postoperative morbidity and mortality in total thyroidectomy performed as an inpatient versus outpatient surgery. Retrospective cohort study of data from the 2005 to 2014 multi-institutional, risk-adjusted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. A multivariate regression model with corresponding odds ratios and 95% confidence intervals was used to determine 30-day morbidity and mortality after total thyroidectomies, and also risk factors of postoperative outcomes. From 2005 to 2014, 40,025 total thyroidectomies were performed (48.5% inpatient, 51.5% outpatient). The 30-day complication rate for all total thyroidectomies was 7.74%. Multivariate logistic regression analysis was performed to control for potential confounding variables. Preoperative factors that affected complications rates for inpatient thyroidectomies included: age ≥70, non-Caucasian race, dependent functional status, history of congestive heart failure, smoking history, bleeding disorder, wound infection, and preoperative sepsis (P < 0.05). In addition, preoperative factors affecting complications in thyroidectomy performed as an outpatient surgery included malignant thyroid pathology (P  0.05). We identified a subset of preoperative conditions that affect risk of complications after total thyroidectomy. Recommendations for patient selection for outpatient total thyroidectomies should be modified to account for pre-existing conditions that increase the risk of postoperative morbidity.

C-reactive Protein in HPV-Positive and HPV-Negative Oropharyngeal Cancer

Objective Evaluate serum C-reactive protein (CRP) in human papillomavirus (HPV)–positive oropharynx cancer as compared with HPV-negative oropharynx cancer and determine if CRP levels were associated with overall survival and/or recurrence-free survival. Study Design Prospective cohort study. Setting Tertiary care academic cancer center between 2007 and 2010. Subjects and Methods Among patients with oropharynx cancer and confirmed HPV status, plasma CRP levels were measured with a high-sensitivity ELISA kit. Multivariable logistic regression analysis compared 4 categories of CRP (low, moderate, high, very high) between the HPV-positive and HPV-negative groups. Kaplan-Meier methods and Cox regression models were used to determine overall survival and recurrence-free survival by CRP level in both populations. Results Between 113 HPV-positive and 110 HPV-negative patients, CRP levels were significantly higher in the HPV-positive group, but these levels did not demonstrate a statistically significant dose-response trend. Higher CRP levels were also associated with reduced overall survival (P = .016) and recurrence-free survival (P < .001) within the HPV-negative group in univariable analysis; in multivariate analysis, the comparisons were not significantly different. Within HPV-positive oropharynx cancer, CRP levels were not significantly associated with overall survival or recurrence-free survival in univariable or multivariable analyses. Conclusion Circulating CRP was higher in HPV-positive versus HPV-negative oropharynx cancer. Among HPV-negative patients, higher CRP levels were associated with reduced survival.

Does Socioeconomic Status Affect Stage at Presentation for Larynx Cancer in Canada’s Universal Health Care System?

Objective Diagnosis of laryngeal cancer is dependent on awareness that persistent hoarseness needs to be investigated as well as access to an otolaryngologist. This study aimed to better classify and understand 3 factors that may lead to variability in stage at presentation of laryngeal cancer: (1) socioeconomic status (SES), (2) differences in access to health care by location of residence (rural vs urban or by province), and (3) access to an otolaryngologist (by otolaryngologists per capita). Study Design Registry-based multicenter cohort analysis. Setting This was a national study across Canada, a country with a single-payer, universal health care system. Subjects All persons 18 years or older who were diagnosed with laryngeal cancer from 2005 to 2013 inclusive were extracted from the Canadian Cancer Registry (CCR). Methods Ordered logistic regression was used to determine the effect of income, age, sex, province of residence, and rural vs urban residence on stage at presentation. Results A total of 1550 cases were included (1280 males and 265 females). The stage at presentation was earlier in the highest income quintile (quintile 5) compared to the lower income quintiles (quintiles 1-4) (odds ratio [OR], 0.68; P < .05). There was a statistically significant difference in stage at presentation based on rural or urban residence within the highest income quintile (OR, 1.73; P < .005). Conclusion There is a relationship between SES and stage at presentation for laryngeal cancer even in the Canadian universal health care system.