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Hsuan-Yeh Fang,
Xin Yong Huang,
Huei-Tzu Chien,
Joseph Tung-Chieh Chang, Chun-Ta Liao,
Jung-Ju Huang,
Fu-Chan Wei,
Hung-Ming Wang,
I-How Chen,
Chung-Jan Kang,
Shiang-Fu Huang
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ABSTRACT: OBJECTIVES/HYPOTHESIS: Elevated inflammatory biomarkers such as C-reactive protein (CRP) and the recently identified neutrophil/lymphocyte ratio (NLR) were demonstrated to be associated with prognosis in human cancers. The aim of our present study is to analyze the relationship of preoperative levels of CRP and NLR with clinicopathological factors and prognosis in oral squamous cell carcinoma (OSCC) patients. STUDY DESIGN: Retrospective study. METHODS: This study was performed on 226 OSCC patients between July 2007 and April 2012. Their serum CRP levels and NLR were measured preoperatively. RESULTS: CRP level ≥ 5.0 mg/L was significantly associated with NLR ≥ 2.44 (linear regression, P < .001). Elevated CRP and NLR were significantly associated with pathological tumor status (P < .001), pathologic nodal metastasis (P < .001), tumor depth (≥10 mm vs. <10 mm, P < .001), disease-free survival (P < .001), and overall survival (P = .001). The influence of CRP level and NLR on disease-free survival (hazard ratio [HR] = 2.259, 95% confidence interval [CI] = 1.170-4.361) and overall survival (HR = 2.176, 95% CI = 1.116-4.245]) still existed after adjusting for tumor status, lymph node metastasis, and tumor cell differentiation. CONCLUSIONS: The present study demonstrates that elevated CRP is an independent prognostic factor in OSCC. Elevated NLR in the high CRP group identifies patients at high risks of recurrence and shorter survival. Incorporating NLR into CRP level therefore has significant potential as a biomarker for risk stratification in OSCC. LEVEL OF EVIDENCE: 4. Laryngoscope, 2013.
The Laryngoscope 04/2013; · 1.75 Impact Factor
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ABSTRACT: OBJECTIVES/HYPOTHESIS: The impact of margin status on the outcomes of early glottic cancer after endoscopic resection is controversial; second look laryngoscopy has shown a low rate of residual cancer, even in margin positive patients. Intraoperative frozen section analysis has been suggested as an alternative to routine second look procedures. The aim of this study was to evaluate and search for predictors of outcomes in patients following endoscopic resection based on intraoperative frozen section margin analysis. STUDY DESIGN: Retrospective chart review. METHODS: Records of consecutive patients treated for early glottic cancer by endoscopic resection with the CO2 laser were evaluated for margin status at the time of intervention, disease recurrence rate, and survival data. Kaplan-Meir survival rates were determined and subgroups were compared with log-rank test and Chi-square test. RESULTS: From February 2004 to September 2011, 75 consecutive patients with complete records were identified. The 5-year overall survival rate and the disease-specific survival rate are 84 and 98%, respectively. Recurrence within 12 months (P = 0.019) and initially positive frozen section margins, despite enlarging the cordectomy field to obtain negative margins (P = 0.001), were determined to be predictors for poor overall survival. CONCLUSIONS: In endoscopic resection of early glottic cancer with the CO2 laser, initial intraoperative frozen section margin involvement during the primary resection and early local recurrence are poor signs for overall survival. LEVEL OF EVIDENCE: 4.
The Laryngoscope 02/2013; · 1.75 Impact Factor
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ABSTRACT: The levels of squamous cell carcinoma antigen (SCC-Ag) and C-reactive protein (CRP) can be used to predict tumor invasion, lymph node metastasis, staging and survival in patients with oral cavity cancer. The present study analyzed the relationship between pre-treatment levels of SCC-Ag and CRP in relation to clinicopathological factors in patients with pharyngolaryngeal cancer (PLC) and determined whether elevated levels of CRP and SCC-Ag were associated with tumor metabolic activity via [18F] fluorodeoxyglucose positron emission tomography (FDG-PET). We retrospectively recruited one hundred and six PLC patients between June 2008 and December 2011. All patients received computed tomography (CT)/magnetic resonance imaging (MRI) and FDG-PET staging analyses, and the serum levels of SCC-Ag and CRP in these patients were measured prior to treatment. A SCC-Ag level ≥2.0 ng/ml and a CRP level ≥5.0 mg/L were significantly associated with clinical stage (P<0.001), clinical tumor status (P<0.001), and clinical nodal status (P<0.001). The elevation of both SCC-Ag and CRP levels was correlated with the standardized uptake value (SUV) max of the tumor (≥8.6 mg/L) and lymph nodes (≥5.7 ng/ml) (P = 0.019). The present study demonstrated that the presence of high levels of both pre-treatment SCC-Ag and CRP acts as a predictor of clinical stage, clinical tumor status, and clinical nodal status in patients with PLC. Moreover, elevated levels of SCC-Ag and CRP were associated with a high metabolic rate as well as the proliferative activity measured according to the SUVmax of the tumor and lymph nodes. Therefore, elevated levels of these two factors have the potential to serve as biomarkers for the prediction of tumor aggressiveness in cases of PLC.
PLoS ONE 01/2013; 8(1):e55327. · 4.09 Impact Factor
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ABSTRACT: BACKGROUND: The aim of this study was to compare the outcomes of postoperative adjuvant concomitant chemoradiotherapy using two different schedules of cisplatin for patients with high-risk oral squamous cell carcinoma (OSCC). METHODS: From Feb. 2008 to Aug. 2010, 55 patients with high-risk OSCC were included in this study. Patients were randomized into treatment groups that either received 100 mg/m2 cisplatin once every 3 weeks (arm A) or 40 mg/m2 cisplatin once per week (arm B). All patients were irradiated with 66 Gy in 33 fractions. RESULTS: Of the 50 eligible patients, 26 were assigned to arm A, and 24 were assigned to arm B. Both groups of patients received the same mean doses of radiotherapy and cisplatin. However, 88.5% of patients in arm A and 62.5% of those in arm B (p = 0.047) received >= 200 mg/m2 of cisplatin in total. The overall toxicity was significantly greater in arm B (p = 0.020), and all of the grade 4 toxicities occurred in patients in arm B. CONCLUSIONS: Three-weekly high-dose cisplatin treatment showed higher compliance, and lower acute toxicity compared to weekly low-dose cisplatin treatment.
Radiation Oncology 12/2012; 7(1):215. · 2.32 Impact Factor
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Chun-Ta Liao,
Li-Yu Lee,
Chuen Hsueh,
Chien-Yu Lin,
Kang-Hsing Fan,
Hung-Ming Wang,
Shu-Hang Ng,
Chih-Hung Lin,
Chung-Kan Tsao,
I-How Chen,
Kai-Ping Chang,
Shiang-Fu Huang,
Chung-Jan Kang,
Ku-Hao Fang,
Yu-Chien Wang,
Yu-Liang Chang,
Yu-Chen Huang,
Chi-Ying Tsai,
Tzu-Chen Yen
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ABSTRACT: OBJECTIVES: We have previously shown that the resection outcomes of cT4a and cT4b oral cavity squamous cell carcinoma (OSCC) are comparable, but whether similar conclusions can be applied for the pathological stage of this disease needs investigation. In this study, we sought to compare the outcomes and to identify the risk factors for both pT4a and pT4b tumors. METHODS: We retrospectively examined 181 pT4 OSCC patients who had radical resections between 2003 and 2010. The 5-year control and survival rates were the main outcome measures. RESULTS: Of the 181 resected pT4 OSCC patients, 133 (73%) had pT4a disease, and 48 (27%) had pT4b disease. All of the resected T4b tumors were below the mandibular notch (infra-notch pT4b). The 5-year outcomes of the patients with infra-notch pT4b and pT4a were comparable: local control, 80% vs. 78%, p=0.7275; neck control, 87% vs. 82%, p=0.4798; distant metastases, 22% vs. 23%, p=0.8871; disease-free survival, 63% vs. 55%, p=0.2813; disease-specific survival, 68% vs. 60%, p=0.3526; and overall survival, 62% vs. 44%, p=0.2643, respectively. Extracapsular spread was the only independent prognostic factor for 5-year survival rates in pT4a patients. Poor tumor differentiation and pN2 status were the independent 5-year survival prognostic factors for the infra-notch pT4b tumor patients. CONCLUSIONS: Infra-notch pT4b had outcomes comparable with those of pT4a tumors, although they displayed different risk factors. We therefore recommend that resectable infra-notch pT4b tumors should be classified as pT4a disease in the AJCC tumor staging.
Oral Oncology 10/2012; · 2.86 Impact Factor
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Tsung-Min Hung,
Hung-Ming Wang,
Chung-Jan Kang,
Shiang-Fu Huang, Chun-Ta Liao,
Sheng-Chieh Chan,
Shu-Hang Ng,
I-How Chen,
Chien-Yu Lin,
Kang-Hsing Fan,
Joseph Tung-Chieh Chang
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ABSTRACT: OBJECTIVES: To evaluate the prognostic value of maximum standardized uptake value (SUVmax) measured in [(18)F]-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) for patients with non-disseminated nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: From January 2002 to July 2008, 371 NPC patients who underwent (18)F-FDG-PET before radical intensity-modulated radiotherapy (IMRT) were recruited. The SUVmax was recorded for the primary tumor (SUVmax-T) and neck lymph nodes (SUVmax-N). RESULTS: The median follow-up was 64months. The optimal cutoff value was 9.3 for SUVmax-T and 7.4 for SUVmax-N. Patients with a lower SUVmax-T or SUVmax-N had a significantly better 5-year distant metastasis-free survival (DMFS), but showed no significant difference in local control or regional control. Patients were divided into four groups by SUVmax, as follows: (a) both lower SUVmax-T and SUVmax-N, (b) higher SUVmax-T only, (c) higher SUVmax-N only, and d) both higher SUVmax-T and SUVmax-N. There were significant differences between these four groups in 5-year DMFS: (a) 95.5%, (b) 90.0%, (c) 83.3%, and (d) 79.9%, respectively (p=0.004). When looking at the stage of disease, the 5-year DMFSs in group a, b, c, d were 96.9%, 94.6%, 97.4%, and 84.3%, respectively in stage I-III patients (p=0.037) and were 91.6%, 82.9%, 68.5%, and 76.7% in stage IVA-B patients (p=0.145). Using multivariate analysis, the SUVmax grouping, gender, and stage were independent factors for DMFS. CONCLUSION: The SUVmax of the primary tumor and neck lymph nodes were independent prognostic factors for DMFS in NPC patients treated with IMRT.
Oral Oncology 10/2012; · 2.86 Impact Factor
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ABSTRACT: BACKGROUND:: Caregivers of oral cavity cancer patients report stress during caregiving time. OBJECTIVE:: This study aimed to examine changes in social support and predictors in caregivers of oral cavity cancer patients over the 3 months after patients' first discharge. METHODS:: This was a prospective longitudinal study. Caregivers of oral cavity cancer patients with planned discharge were recruited from inpatient wards and the outpatient department at a major medical center in Taiwan. Caregivers' needs and satisfaction with available social support were assessed at 4 time points: before discharge and at 1 week, 1 month, and 3 months after the first discharge. The generalized estimating equation was used to determine predictive factors of social support. RESULTS:: Caregivers had mild-to- moderate levels of needs and were satisfied with available social support during the first 3 months after discharge. The peak for both overall and individual needs of social support was before discharge. Caregivers overall and individual satisfaction with social support peaked at 3 months after discharge. Spouse caregivers had greater overall needs for social support. Caregivers with longer caregiving time were associated with dissatisfaction during the first 3 months after discharge. CONCLUSIONS:: Caregivers of oral cavity cancer patients had unmet needs of social support, especially wife caregivers. IMPLICATIONS FOR PRACTICE:: A comprehensive assessment of caregiver needs and satisfaction with available social support is necessary to improve caregiving for oral cavity cancer patients and address the concerns of caregivers in a timely manner.
Cancer nursing 10/2012; · 1.88 Impact Factor
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ABSTRACT: OBJECTIVES: We sought to determine potential prognostic value of total lesion glycolysis (TLG) calculated from combined positron emission tomography/computed tomography (PET/CT) in patients with oral cavity squamous cell carcinoma (OSCC). MATERIALS AND METHODS: We prospectively studied 126 patients with OSCC who underwent PET/CT before definitive treatment by radical surgery. The metabolic tumor volume (MTV) was calculated for the primary tumor according to an absolute standardized uptake value (SUV) of 3. TLG was calculated as MTV×the average SUV. The nodal SUVmax was also recorded. The median value of SUVmax and TLG were used to divide the patients into two categories (high and low). Patients were followed up until death or for at least 24months from their surgery. Disease-free (DFS) and disease-specific survivals (DSS) were the main outcome measures. RESULTS: The median TLG of the primary tumor ((T)TLG) was 71.4, and the median nodal SUVmax ((N)SUV) was 7.5. Patients with high (T)TLG (⩾median) had a 2-year DFS of 52% whereas the DFS was 74% for those with a low (T)TLG (P=0.007); the 2-year-DSS rates were 53% vs. 84%, respectively (P<0.001). Similarly, patients with high (N)SUVmax (⩾median) had a 2-year DFS of 42% vs. 70% for patients with a low (N)SUVmax (P=0.001); the 2-year-DSS rates were 39% vs. 78%, respectively (P<0.001). In multivariate analyses, (T)TLG, (N)SUVmax, and pathological nodal status were independent prognostic factors for the 2-year DSS. A 3-point prognostic scoring system was formulated based on the presence or absence of the independent factors. Patients with positive neck nodes, high (N)SUVmax, and high (T)TLG (score 3) had a 32-fold higher risk of cancer death compared with those lacking such risk factors (2-year-DSS=26% vs. 97%, P<0.001). CONCLUSION: Primary tumor TLG is an independent prognostic factor for cancer control and survival in patients with OSCC. A prognostic scoring system that includes primary tumor TLG, nodal SUVmax, and pathological neck status may be useful for risk stratification in this group of patients.
Oral Oncology 10/2012; · 2.86 Impact Factor
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ABSTRACT: This study compared the diagnostic accuracy of (18)F-FDG PET/CT with that of (18)F-fluoride PET/CT in the detection of bony metastases in heightened-risk head and neck cancer patients. METHODS: The study participants underwent (18)F-FDG PET/CT and (18)F-fluoride PET/CT within 2 wk of each another. RESULTS: A total of 98 bony metastases were found in 18 of our 80 patients. (18)F-fluoride PET/CT and (18)F-FDG PET/CT showed similar lesion-based sensitivity (69.4% vs. 57.1%, P = 0.126) and areas under the curve (0.7561 vs. 0.7959, P = 0.149). Their combined interpretation demonstrated a significantly greater sensitivity and areas under the curve than that obtained with either modality alone (P < 0.001) in lesion-based analysis but not in patient-based analysis, with a treatment strategy change in 2 patients. CONCLUSION: (18)F-fluoride PET/CT is a feasible modality for detecting bony metastases in patients with head and neck cancers, with similar sensitivity to (18)F-FDG PET/CT. Their combined use may not be justifiable.
Journal of Nuclear Medicine 09/2012; · 6.38 Impact Factor
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ABSTRACT: OBJECTIVES: To investigate the role of PET-derived imaging markers in predicting metastatic nasopharyngeal carcinoma (NPC) outcomes. MATERIALS AND METHODS: A total of 56 patients with metastatic NPC were enrolled. Before treatment, all of the participants underwent (18)F-FDG PET/CT. The following (18)F-FDG PET parameters were assessed: standardised uptake value, metabolic tumour volume (MTV), and total lesion glycolysis. Multivariate Cox proportional hazards models were used to identify the independent predictors of survival. RESULTS: The multivariate analysis showed that performance status>1 (P=0.007), Epstein-Barr virus (EBV) DNA titre>5000copies/mL (P=0.001), and MTV>110mL (P=0.013) were independent risk factors for progression-free survival (PFS). Male sex (P=0.004), performance status>1 (P<0.0001), EBV DNA level>5000copies/mL (P<0.0001), and MTV>110mL (P=0.003) independently predicted overall survival (OS). The 2-year PFS and OS rates of the patients with MTV⩽110mL were 23.2% and 43%, respectively, compared with 0% and 9.1%, respectively, for those with MTV>110mL. Combining the MTV with the EBV DNA titre allowed further survival stratification by dividing the patients into three groups with distinct PFS (2-year rates=30.8%, 7.1%, and 0%, P<0.0001) and OS (2-year rates=68.4%, 40%, and 0%, P<0.0001) rates. CONCLUSION: The MTV appears to be an independent risk factor in metastatic NPC patients. This factor is complementary to the EBV DNA titre for predicting survival in metastatic NPC.
Oral Oncology 09/2012; · 2.86 Impact Factor
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Chun-Ta Liao,
Chien-Yu Lin,
Kang-Hsing Fan,
Chuen Hsueh,
Li-Yu Lee,
Hung-Ming Wang,
Shiang-Fu Huang,
I-How Chen,
Chung-Jan Kang,
Shu-Hang Ng,
Chih-Hung Lin,
Yu-Chen Huang,
Tzu-Chen Yen
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ABSTRACT: AIM: To understand the frequency, clinical significance, and benefits of salvage therapy in oral cavity squamous cell carcinoma (OSCC) patients with regional nodal recurrence at unusual sites (prelaryngeal area, parotid area, and retropharyngeal area). METHODS: We examined 178 patients with neck recurrence at levels I-V (usual group) and 26 patients outside levels I-V (unusual group). The 5-year survival rates served as the main outcome measure. RESULTS: Of the 26 unusual group patients, the neck recurrence sites were as follows: 5 at the prelaryngeal area, 13 at the parotid area, and 8 at the retropharyngeal area. Multivariate analyses demonstrated that poor differentiation, pN2, extracapsular spread (ECS), tumor depth ≥10 mm, relapse time ≤10 months, local recurrence, neck recurrence at unusual sites, and distant metastases were independent prognostic factors for 5-year disease-specific survival (DSS), whereas pN2, ECS, tumor depth ≥10 mm, relapse time ≤10 months, neck recurrence at unusual sites, and distant metastases were independent prognostic factors for 5-year overall survival (OS). The 6-month and 18-month survival rates after the N-relapse date for the salvaged-usual group, the salvaged-unusual group, and the nonsalvaged patients were 73 %/46 %, 40 %/0 %, and 10 %/0 % (P < 0.0001), respectively [DSS: salvaged-unusual group (hazard ratio/95 % confidence interval), 2.060/1.058-4.008, P = 0.033; salvaged-usual group, 6.420/4.340-9.496, P < 0.001; OS: salvaged-unusual group, 2.100/1.080-4.081, P = 0.029; salvaged-usual group, 6.514/4.418-9.606, P < 0.001]. CONCLUSIONS: Our findings demonstrate that OSCC patients with regional nodal recurrence at unusual sites had poor outcomes.
Annals of Surgical Oncology 08/2012; · 4.17 Impact Factor
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ABSTRACT: Human papillomavirus type 16 (HPV-16) positivity is associated with favourable survival in oropharyngeal squamous cell carcinoma (OPSCC). We report here a study of the prognostic significance of (18)F-FDG PET/CT functional parameters and HPV-16 infection in OPSCC patients.
We retrospectively analysed 60 patients with stage III or IV OPSCC who had had a pretherapy (18)F-FDG PET/CT scan and had completed concurrent chemoradiotherapy (n = 58) or curative radiotherapy (n = 2). All patients were followed up for ≥24 months or until death. We determined total lesion glycolysis (TLG) and the maximal standardized uptake values (SUV(max)) of the primary tumour and neck lymph nodes from the pretherapy (18)F-FDG PET/CT scan. Optimal cut-offs of the (18)F-FDG PET/CT parameters were obtained by receiver operating characteristic (ROC) curve analyses. Pretherapy tumour biopsies were studied by polymerase chain reaction to determine HPV infection status.
The pretherapy tumour biopsies were positive for HPV-16 in 12 patients (20.0 %). Cox regression analyses revealed HPV-16 positivity and tumour TLG >135.3 g to be independently associated with overall survival (p = 0.027 and 0.011, respectively). However, only tumour TLG >135.3 g was independently associated with progression-free survival, disease-free survival and locoregional control (p = 0.011, 0.001 and 0.034, respectively). A scoring system was formulated to define distinct overall survival groups using tumour TLG and HPV-16 status. Patients positive for HPV-16 and with tumour TLG ≤135.3 g experienced better survival than those with tumour TLG >135.3 g and no HPV infection (p = 0.001).
Tumour TLG was an independent predictor of survival in patients with locally advanced OPSCC. A scoring system was developed and may serve as a risk stratification strategy for guiding therapy.
European Journal of Nuclear Medicine 08/2012; 39(11):1673-84. · 4.53 Impact Factor
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Jy-Ping Tsai,
Meng-Hua Lee,
Shu-Ching Hsu,
Mei-Yu Chen,
Shih-Jen Liu,
Joseph T Chang, Chun-Ta Liao,
Ann-Joy Cheng,
Pele Chong,
Ching-Liang Chu,
Chia-Rui Shen,
Hsin-Wei Chen
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ABSTRACT: Previous studies have shown that TGF-β acts cooperatively with IL-6 to elicit a high frequency of IL-17-secreting CD4(+) T cells (termed Th17) and an elevated CD8(+)IL-17(+) T cell population (termed Tc17). These CD8(+) cells fail to behave like most cytotoxic T lymphocytes that express IFN-γ and granzyme B, but they exhibit a noncytotoxic phenotype. Although a significant increase in the number of these Tc17 cells was found in tumors, their role and interaction with other cell types remain unclear. In this study, we demonstrate that the presence of CD4(+)CD25(-) T cells, but not the CD4(+)CD25(+) (regulatory T [Treg]) cell population, significantly reduced the elicitation of Tc17 cells, possibly as a result of the induction of apoptotic signals. Importantly, these signals may be derived from soluble mediators, and the addition of anti-IL-2 restored the reduction of Tc17 cells in the presence of CD4(+)CD25(-) T cells. Finally, the elicited Tc17 and Treg cells exhibited a close association in patients with head and neck cancer, indicating that the surrounding Treg cells might maintain the survival of the Tc17 cells. Taken together, these results reveal an intriguing mechanism in which Tc17 cells are controlled by a finely tuned collaboration between the different types of CD4(+) T cells in distinct tumor microenvironments.
The Journal of Immunology 07/2012; 189(4):1671-9. · 5.79 Impact Factor
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ABSTRACT: OBJECTIVE: This study aimed to examine changes in physical symptom severity, functional status, supportive care needs, and related factors in oral cavity cancer patients during 6 months after beginning radiation therapy (RT) or concurrent chemotherapy and radiation therapy (CCRT). METHODS: A prospective longitudinal study was conducted involving oral cavity cancer patients from an RT clinic at a medical center in northern Taiwan. Patients were assessed for supportive care needs and physical symptoms at five time points: before the beginning of RT or CCRT and at 1, 2, 3, and 6 months after beginning RT or CCRT. The generalized estimating equation was used to identify predictors of overall needs as well as six specific dimensions of needs. RESULTS: A total of 82 patients completed the 6 months of follow-up. Patients had moderate to high levels of supportive care needs over the 6 months. Although the highest information need was at the pretreatment phase, in general, the peak for overall and individual care needs was at 2 months since first receiving RT or CCRT. Patients without religious beliefs as well as those with higher educational level, functional level, overall physical symptom severity, and baseline anxiety reported more supportive care needs. Anxiety level before treatment was the most common factor across most supportive care needs. Individual physical symptoms, including fatigue, swallowing difficulty, and oral mucositis, were significantly related to higher physical and daily living needs. CONCLUSIONS: A systematic clinical assessment to detect patients' care needs is necessary to improve the provision of timely cancer care and meet patients' healthcare needs. Copyright © 2012 John Wiley & Sons, Ltd.
Psycho-Oncology 06/2012; · 3.34 Impact Factor
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Shiang-Fu Huang,
Fu-Chan Wei, Chun-Ta Liao,
Hung-Ming Wang,
Chien-Yu Lin,
Steven Lo,
Jung-Ju Huang,
I-How Chen,
Chung-Jan Kang,
Huei-Tzu Chien,
Hsuan-Ho Chen
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ABSTRACT: Squamous cell carcinoma antigen (SCC-Ag) level and C-reactive protein (CRP) have been shown to be associated with tumor invasion, lymph node metastasis, staging and survival in patients with oral squamous cell carcinoma (OSCC). The purpose of the present study was to analyze the relationship between preoperative levels of both SCC-Ag and CRP, with clinicopathologic factors and prognosis in OSCC patients.
A retrospective study was performed on 142 OSCC patients between March 2008 and March 2011. Their serum SCC-Ag and CRP levels were measured preoperatively.
SCC-Ag level of ≥2.0 ng/ml and CRP level ≥5.0 mg/L were significantly associated with pathologic tumor status (P < 0.001), pathologic nodal metastasis (P = 0.001), tumor depth (≥10 mm vs. <10 mm, P < 0.001), disease-free survival (P ≤ 0.001) and overall survival (P ≤ 0.001). The influence of SCC-Ag and CRP level on disease-free survival (hazard ratio 4.046, 95 % confidence interval 1.698-9.692) and overall survival (hazard ratio 3.655, 95 % confidence interval 1.464-9.130) still existed after adjusting for tumor status, lymph node metastasis and tumor cell differentiation.
Concurrent high levels of both preoperative SCC-Ag and CRP levels act as a predictor for lymph node metastasis, advanced tumor stage and tumor recurrence. It therefore has significant potential as a biomarker for risk stratification in OSCC.
Annals of Surgical Oncology 05/2012; 19(12):3856-64. · 4.17 Impact Factor
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ABSTRACT: To evaluate the long-term voice characteristics and quality of life of early glottic cancer patients after definitive treatment.
Case series with chart review in a tertiary care medical center in Taiwan.
Forty-two consecutive patients who received radiation therapy (RT) or transoral laser microsurgery (TLM) for early glottic cancer over 12 months were evaluated for voice laboratory data and quality-of-life measurements.
Twenty-four patients received RT, and 18 underwent TLM. There was no difference between the two groups on acoustic and aerodynamic voice measures except for modal fundamental frequency in males. In the Functional Assessment of Cancer Therapy-Head and Neck survey, the TLM group had better communication than the RT group, but there were no differences in voice quality and strength. There was also no significant difference in the Voice Handicap Index 10 evaluation.
Male patients who received TLM have higher modal fundamental frequency than male patients who received RT and norms. Voice-related life quality is similar in patients regardless of RT or TLM treatment for early glottic cancer, but those who receive TLM have better communication abilities than those who receive RT.
Journal of voice: official journal of the Voice Foundation 04/2012; 26(5):596-601. · 0.95 Impact Factor
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Chun-Ta Liao,
Kang-Hsing Fan,
Chien-Yu Lin,
Hung-Ming Wang,
Shiang-Fu Huang,
I-How Chen,
Chung-Jan Kang,
Shu-Hang Ng,
Chuen Hsueh,
Li-Yu Lee,
Chih-Hung Lin,
Tzu-Chen Yen
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ABSTRACT: Extracapsular spread (ECS) to the cervical lymph nodes is a major adverse prognostic factor in oral cavity squamous cell carcinoma (OSCC). We prospectively examined the value of FDG PET immediately before postoperative radiotherapy/concurrent chemoradiotherapy (pre-RT/CCRT PET) to detect residual/relapsing disease in the early postsurgical follow-up period in high-risk OSCC patients with ECS.
We examined 183 high-risk OSCC patients with ECS who underwent preoperative FDG PET/CT for staging purposes. Of these patients, 29 underwent a second pre-RT/CCRT FDG PET/CT scan. The clinical utility of the second FDG PET/CT was examined using Kaplan-Meier curve analysis.
Patients who underwent the second FDG PET/CT scan had baseline clinicopathological characteristics similar to those who did not undergo a second scan. Of the patients who underwent the second scan, seven (24 %) had unexpected, newly discovered lesions. Five eventually died of the disease, and two had no evidence of recurrence after a change in RT field and dose. In an event-based analysis at 2 months, rates of neck control (6/29 vs. 6/154, p = 0.001), distant metastases (3/29 vs. 4/154, p = 0.046), and disease-free survival (7/29 vs. 10/154, p = 0.003) were significantly higher in patients who received a second PET scan than in those who did not. The second pre-RT/CCRT PET scan was of particular benefit for detecting new lesions in OSCC patients with both ECS and lymph node standardized uptake value (SUV) of ≥ 5.2 in the first PET scan.
The present findings support the clinical value of pre-RT/CCRT FDG PET for defining treatment strategy in OSCC patients with both ECS and high nodal SUV, even when FDG PET had already been performed during the initial staging work-up.
European Journal of Nuclear Medicine 03/2012; 39(6):944-55. · 4.53 Impact Factor
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ABSTRACT: Direct suspension laryngoscopic biopsy of neoplasms in larynx, oropharynx, and hypopharynx was an arduous procedure in patients with a history of head and neck cancer and difficult airways. This preliminary study was aimed to report the efficacy and safety of a narrow band imaging-guided biopsy of this category by flexible laryngoscopy. This is a retrospective chart review study conducted in setting of tertiary referral centre. Nineteen consecutive head and neck cancer patients with difficulty in general anesthesia and rigid endoscopic approach due to trismus, craniofacial deformities, and/or limited neck extension after cancer therapy were referred for endoscopic biopsy of their suspicious lesions in larynx, hypopharynx, or parts of oropharynx. Following topical anesthesia, a flexible laryngoscope was introduced through the nose into the pharynx. Under narrow band imaging magnified view, the specified tumor foci were biopsied in an office-based setting. All of the lesions were reached and biopsied to obtain sufficient tissue samples. The procedure took <20 min in every case. Twelve of the 19 pathologic examinations disclosed the malignancies at the first biopsy, and another underwent a second biopsy to prove cancer recurrence. The other six patients with benign lesions received further follow-up for at least 6 months and showed no recurrence. There were no complications associated with the technique. This study introduced that flexible laryngoscopy with narrow band imaging has the advantages of nimbleness, precision, and minimal morbidity. This combined technique may be a safe and promising method for tissue sampling of suspicious recurrence in head and neck cancer patients with difficult airways.
Archives of Oto-Rhino-Laryngology 03/2012; · 1.29 Impact Factor
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ABSTRACT: To investigate the association of pretreatment body mass index (preT BMI) with outcomes of head-and-neck cancer in patients treated with radiotherapy (RT).
All 1,562 patients diagnosed with head-and-neck cancer and treated with curative-intent RT to a dose of 60 Gy or higher were retrospectively studied. Body weight was measured both at entry and at the end of RT. Cancer-specific survival (CSS), overall survival (OS), locoregional control (LRC), and distant metastasis (DM) were analyzed by preT BMI (<25 kg/m(2) vs. ≥25 kg/m(2)). The median follow-up was 8.6 years.
Patients with lower preT BMI were statistically significantly associated with poorer CSS and OS than those with higher preT BMI. There was no significant difference between preT BMI groups in terms of LRC and DM. Body weight loss (BWL) during radiation did not influence survival outcomes. However, in the group with higher preT BMI, CSS, OS, and DM-free survival of patients with less BWL during radiation were statistically longer when compared with greater BWL.
This study demonstrates that higher preT BMI positively influenced survival outcomes for patients with head-and-neck cancer. Patients with higher preT BMI who were able to maintain their weight during radiation had significantly better survival than patients with greater BWL.
International journal of radiation oncology, biology, physics 02/2012; 83(1):e93-e100. · 4.59 Impact Factor
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ABSTRACT: Cyclin D1 gene regulates cell cycle and plays an important role in the tumorigenesis of human cancers. The association between cyclin D1, clinicopathologic parameters and prognosis in oral cavity squamous cell carcinoma (OSCC) is inconclusive.
A total of 264 male OSCCs were examined for cyclin D1 protein expression using immunohistochemistry (IHC). The expression levels of cyclin D1 were defined as overexpression when more than 10% of tumor cells displayed nuclear staining with moderate to strong intensity.
Overexpression of cyclin D1 was found in 97 (36.7%) OSCCs. Cyclin D1 protein overexpression was significantly associated with lymph node metastasis (P = 0.002), tumor cell differentiation (P = 0.031) and tumor stage (P = 0.051), but not associated with age onset, cigarette smoking, alcohol drinking, or areca quid chewing. Overexpression of cyclin D1 was also significantly associated with poor clinical outcomes in terms of disease-free survival (DFS, P = 0.002) and overall survival (OS, P < 0.001). The effects of cyclin D1 protein overexpression on DFS (hazard ratio (HR) = 1.540; 95% confidence interval (CI), 1.068 - 2.222) and OS (HR = 1.702; 95% CI, 1.168 - 2.480) were still existed after adjusting for clinicopathological parameters (such as age, primary tumor status, tumor cell differentiation, and lymph node metastasis) using logistic multivariate analysis.
Cyclin D1 protein worked as an independent prognostic factor and can be as a biomarker for the aggressiveness of OSCC.
World Journal of Surgical Oncology 02/2012; 10:40. · 1.12 Impact Factor
