Zhengxue Han

Prognostic Value of Tumor-Infiltrating Lymphocytes for Patients With Head and Neck Squamous Cell Carcinoma

BACKGROUND: The prognostic value of tumor-infiltrating lymphocytes (TILs) in head and neck squamous cell carcinoma (HNSCC) remains controversial. Additionally, there is no standardized approach or cutoff value for evaluating TIL levels. The aim of this study was to establish a feasible method and criterion to assess TIL levels for future clinical practice and research use and to explore the relationship between TIL levels and prognosis. PATIENTS AND METHODS: This retrospective cohort study reviewed the records and pathological sections of 202 patients with HNSCC who were surgically treated at Beijing Stomatological Hospital, Capital Medical University, from January 1998 to January 2011. The predictor variable was the TIL level. The main outcome assessment parameters were disease-free survival (DFS) and disease-specific survival (DSS). RESULT: The T stage (P = .008), smoking history (P = .042), alcohol history (P = .048), need for radiotherapy (P = .012) and microscopic extracapsular spread (ECS) (P = .012) were associated with the TIL level. A cutoff value equal to 70% could be taken as a threshold for TIL assessment, with a TIL level higher than 70% associated with a better prognosis (DFS rate: 51.9%, P = .018; DSS rate: 59.3%, P = .049). The Cox regression model showed that the TIL level was an independent prognostic factor for DFS (hazard ratio (HR): 0.786, 95% CI: 0.618-0.999, P = .049). CONCLUSION: The TIL level is closely related to the prognosis of patients with HNSCC. A threshold value of 70% is appropriate for TIL assessment, as patients with a TIL level higher than 70% show a better prognosis. Thus, the TIL level might serve as an independent predictor for HNSCC recurrence.

Risk factors for patients with multiple synchronous primary cancers involving oral and oropharyngeal subsites

OBJECTIVE To evaluate risk factors and prognosis for multiple synchronous primary cancers (MSPCs) associated with head and neck squamous cell carcinoma. STUDY DESIGN The retrospective study included 1623 patients. RESULTS The most common MSPC site involved was the head and neck region. The presence of multiple oral dysplastic lesions (P < .001) was the sole risk factor for the occurrence of MSPCs. A multivariate survival analysis showed that the pathologic grade (P = .003) was an independent predictive factor for the 5-year disease-specific survival of patients with MSPCs. A Kaplan-Meier analysis showed that the 5-year disease-specific survival of patients who developed MSPCs was worse than that of patients who did not develop MSPCs (P = .020). CONCLUSIONS MSPCs are a significant negative prognostic factor for patients with head and neck squamous cell carcinoma. However, a worse prognosis is predicted for patients with MSPCs with several features: a higher pathologic grade, a more aggressive growth pattern, male gender plus a tobacco or alcohol habit, and no multiple oral dysplastic lesions.

Risk factors for relapse of middle-stage squamous cell carcinoma of the submandibular region and floor of mouth: the importance of en bloc resection.

Our aim was to investigate retrospectively the rate of recurrence in the intervening region for middle-stage squamous cell carcinoma (SCC) of the tongue and identify the factors that predict relapse and prognosis. A total of 204 patients were included, 96 in the en bloc group and 108 in the control group. The groups were comparable. Two patients in the en bloc group (2%) and 12 in the control group (11%) developed recurrences in the intervening region. Kaplan-Meier analysis showed a reduction in the 5-year disease-specific survival once a recurrence had developed after the primary operation (77% compared with 14%, p<0.001). The en bloc group developed significantly fewer recurrences (2%) than the control group (11%) during the five years; p=0.037), and also had better 5-year disease-specific survival (80% compared with 66%, p=0.04). Coxs multivariate regression indicated that the pathological nodal status (p=0.016) and surgical technique (p=0.037) were independent predictive factors for the 5-year recurrence rate, as well as of 5-year disease-specific survival (p=0.001 and p=0.050, respectively). Recurrence in the intervening region is a negative prognostic factor for these patients, and we recommend en bloc resection as the management of choice for middle-stage SCC of the tongue.

Characteristics and surgical management of flap compromise caused by thrombosis of the internal jugular vein

BACKGROUND A principal reason for flap compromise in oral and maxillofacial head and neck surgery, and failure of a free flap transfer, is thrombosis of a drainage vein such as the internal jugular vein. This study characterized flap compromise caused by internal jugular vein thrombosis after a free flap transfer, and its management. PATIENTS AND METHODS A retrospective clinical study was conducted of 306 consecutive microvascular free flaps performed for 305 patients with head and neck cancer from March 2003 to March 2013 at the Department of Oral and Maxillofacial Surgery at Beijing Stomatological Hospital, Capital Medical University. RESULTS Vascular thrombosis developed postoperatively in 18 of the 306 free flaps (5.9%): 1 arterial and 17 venous. Of the latter, in 10 patients the thrombosis occurred at the anastomosis site; in 7 patients internal jugular vein thrombosis was detected during emergent reexploration (4 radial forearm free flaps, 1 fibular flap, and 2 anterior lateral thigh flaps). The 4 cases involving radial forearm free flaps were salvaged successfully by venous transfer to bridge the reflow vein to the anterior jugular vein, or removal of the thrombosis in the internal jugular vein and re-anastomosis. The remaining 3 cases of internal jugular vein thrombosis were not salvaged: 2 defects were reconstructed with major pectoralis myocutaneous flaps, and the other was closed directly without reconstruction. CONCLUSIONS In oral and maxillofacial head and neck cancer surgery, postoperative thrombosis of the internal jugular vein can result in failure of the free flap transfer.

Surgery combined with postoperative 125I seed brachytherapy for the treatment of mucoepidermoid carcinoma of the parotid gland in pediatric patients

This retrospective study was undertaken to analyze the effectiveness and safety of surgery combined with postoperative 125I seed brachytherapy in the treatment of mucoepidermoid carcinoma (MEC) of the parotid gland with risk factors in pediatric patients.

Mandibular lingual release versus mandibular lip-split approach for expanded resection of middle–late tongue cancer: A case-control study

OBJECTIVE The mandibular lingual release (MLR) and mandibular lip-split (MS) approaches are the two common access approaches for resection of malignant tongue tumors. This case-control study aimed to evaluate the effectiveness and safety of these two approaches for the expanded resection of middle-late tongue cancer. MATERIAL AND METHODS A total of 56 matched patients with resectable middle-late squamous cell carcinoma of the tongue body were consecutively hospitalized for expanded resection using the MLR (n = 26) or MS approach (n = 30) between March 2004 and November 2012. Main outcome measures consisted of tumor exposure, surgical morbidity, maxillofacial motor-sensory return, and head/neck-specific quality of life. RESULTS The two approaches achieved similar en bloc R0 resection with similar tumor exposure. The MLR approach was associated with a significantly lower frequency of maxillofacial pain (P < 0.05) and no incidence of mandible nonunion. The MLR approach was also associated with a significantly better quality of life with respect to local pain, facial appearance, and mood. CONCLUSION Compared to the MS approach, the MLR approach was associated with significantly less surgical morbidity and a significantly better quality of life for middle-late tongue cancer patients undergoing expanded resection.

Prognostic value of pathologic grade for patients with oral squamous cell carcinoma

OBJECTIVE The purposes of this study were to explore both the prognostic value of pathologic grade and the relationships between differentiation and clinicopathological characteristics in oral squamous cell carcinoma. METHODS This retrospective cohort study included the records of 2036 patients with oral squamous cell carcinoma who were surgically treated from June 1999 to December 2011. Chi-square test, Kaplan-Meier analysis, and Cox proportional hazards regression model were performed for statistical analysis. RESULTS Many clinicopathological characteristics were associated with pathologic grade. Kaplan-Meier analysis showed that well-differentiated tumors had a better prognosis than the other two grades. Cox regression model showed that differentiation was an independent risk factor for prognosis in patients with early stage, but not with advanced stage. The predictive abilities of pathologic grade, T stage, N status, and lymph node ratio were similar, but the presence of extracapsular spread and perineural invasion were stronger prognostic factors than pathologic differentiation. CONCLUSIONS Pathologic grade was found to be an independent risk factor for early-stage oral squamous cell carcinoma, but not for advanced stage. Many important clinicopathological characteristics were associated with histological classification; however, its prognostic value was limited.

Use of submandibular gland flap for repairing defects after tumor resection in the infratemporal region.

OBJECTIVE To investigate the application of submandibular gland flap with facial artery and vein pedicle, for repairing defects following tumor resection in the infratemporal region. PATIENTS AND METHODS Fifteen patients, including eight males and seven females ranging in age from 21 to 73 years, underwent surgical resection of tumors in the infratemporal region. Tumors were exposed using the submandibular incision approach and completely resected after pulling and rotating the mandible laterally. Mandibular osteotomy was performed for larger tumors or those that were not completely exposed. After tumor resection, the submandibular gland flap was used to fill up the residual defect following tumor resection. RESULTS The incisions healed well without exudation or infection (primary healing) postoperatively in all the patients. Long-term follow-up showed no tumor recurrence in all cases. Seven of the patients who underwent mandibular ramus osteotomy had numbness of the lower lip due to inferior alveolar nerve injury. No other complications were observed postoperatively. CONCLUSION The submandibular gland flap with facial artery and vein pedicle is a reliable, effective, and easy approach for repairing the defects caused by tumor resection in the infratemporal region, and has great potential for application in the clinical setting.

Relationship between body mass index and outcomes for patients with oral squamous cell carcinoma

OBJECTIVE The purpose of our study was to investigate body mass index (BMI) as a prognostic factor and to examine the relationship between pretreatment BMI and oral squamous cell carcinoma (OSCC) outcomes in northern Chinese patients. METHODS This retrospective study enrolled 633 patients with OSCC who underwent surgery between 2004 and 2014. RESULTS Most baseline characteristics (gender, sites, smoking history, comorbidity, hypertension, T stage, clinical features, perineural invasion, flap reconstruction) were differentiated by BMI groups. Overall, the Kaplan-Meier curves indicated no significant relationship between BMI and disease-free survival (DFS) or disease-specific survival (DSS). Interestingly, obese patients exhibited higher risks of recurrence and death than normal-weight patients (DFS: HR: 1.86, 95% CI: 1.16-2.96; DSS: HR: 2.04, 95% CI: 1.08-3.86). However, postoperative complications occurred more frequently in underweight patients than in normal-weight patients. CONCLUSIONS Obesity may contribute to a higher recurrence rate and a worse prognosis in OSCC patients than in normal-weight patients in northern China. However, underweight patients have a higher risk of postoperative complications.

Implant-Supported Hybrid Prosthesis for Severe Mandibular Defects: A Sequence of Treatments From Alveolar Distraction Osteogenesis to Implant Restoration

PURPOSE Although a variety of treatment methodologies for the physiological reconstruction of mandibular defects exist, the use of these methods has often been fragmented and has focused on partial effects of therapy. This article describes a sequence of treatments for a severe mandibular defect. PATIENTS AND METHODS Two patients with severe hard and soft tissue defects had physiological function restored in 4 steps, including alveolar distraction osteogenesis, implant insertion based on a prosthesis, application of dermal matrix membrane in reconstruction of attachment gingiva, and the use of a hybrid prosthesis designed via computer-aided design and computer-aided manufacturing, to produce an adequate bone tissue volume, an adequate amount of attached gingiva, and a reliable prosthesis. RESULTS The sequence of treatments successfully achieved physiological reconstruction. Biological complications around the implants and mechanical complications in the implants or prostheses did not occur within a 4-year follow-up period. CONCLUSIONS On the basis of the current 4-year follow-up, this study shows that a treatment sequence can be predictable and effective for severe mandibular defects, which suggests that it could be considered a potential protocol for patients with severe mandibular defects.