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ABSTRACT: The first International Union Against Cancer (UICC) TNM classification for aerodigestive malignant mucosal melanoma was not published until 2009, and since then, only a few studies have evaluated the accuracy of this staging system. Our aim was to evaluate the accuracy of this UICC staging system for sinonasal malignant mucosal melanoma (SMMM) in a nationwide survey.
Retrospective, population-based, multicenter study.
The hospital surgical and discharge registries were used to identify the patients. A database including demographic and clinicopathologic variable was created.
Altogether, 50 SMMM patients diagnosed in Finland from 1990 to 2004 were evaluated. Three- and 5-year overall survival rates were 44% and 27%, respectively. Significant differences in overall survival according to T classification (P = .028, log rank) and stage (P = .02, log rank) were found. Tumor extension to the sphenoid sinus had a significant negative impact on survival (n = 11, P = .03, log rank).
The current UICC staging system for mucosal melanoma provides a useful format for staging SMMMs in clinical settings.
The Laryngoscope 04/2012; 122(8):1734-8. · 1.75 Impact Factor
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ABSTRACT: Epithelial-mesenchymal transition (EMT) is a crucial process in tumorigenesis since tumor cells attain fibroblast-like features enabling them to invade to surrounding tissue. Two transcription factors, TWIST and SNAI1, are fundamental in regulating EMT.
Immunohistochemistry was used to study the expression of TWIST and SNAI1 in 109 pharyngeal squamous cell carcinomas.
Tumors with intense stromal staining of TWIST relapsed more frequently (p = 0.04). Tumors with both positive TWIST and SNAI1 immunoreactivity in the stroma were at least Stage II (p = 0.05) and located more often in hypopharynx (p = 0.035). Tumors with negative immunostaining of TWIST and SNAI1 in the stromal compartment were smaller (T1-2) (p = 0.008), less advanced (SI-II) (p = 0.031) and located more often in the oropharynx (p = 0.007). Patients with negative SNAI1 and TWIST immunostaining in tumor stroma had a better 5-year disease-specific and overall survival (p = 0.037 and p = 0.014 respectively).
TWIST and SNAI1 expression in stromal cells is associated with clinical and histopathological characteristics that indicate progressive disease. Negative expression of these EMT-promoting transcription factors predicts a better outcome.
BMC Cancer 08/2011; 11:350. · 3.01 Impact Factor
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ABSTRACT: Sinonasal cancer is still a somewhat controversial entity because most series are single-center studies. The aim of this study was to give more accurate and generalisable information about treatment of the neck and prognosis of sinonasal cancer. Retrospective, population-based, multicentre study. Altogether 244 patients diagnosed in 1990-2004 were evaluated. The 3- and 5-year disease-specific survival (DSS) rates after treatment with curative intent were 68 and 57%, respectively. Regional status at the time of the diagnosis (P < 0.001, log rank) and local recurrence (P = 0.02, log rank) during the follow-up had a statistically significant effect on DSS. Initially 13% of the patients were diagnosed with neck metastasis. The proportion of regional recurrences during the follow-up was 9%, but it did not have a statistically significant impact on DSS (P = 0.68, log rank). Histopathology had no statistically significant impact on survival in this material of 244 patients. In conclusion, routine elective neck treatment of all sinonasal cancer patients is not recommended, but the importance of the treatment of the primary location is emphasised.
Archives of Oto-Rhino-Laryngology 05/2011; 269(2):615-21. · 1.29 Impact Factor
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ABSTRACT: In Finland over the past few years approximately 100 new cases of oro- and hypopharyngeal cancer have been diagnosed annually. Most of these are squamous cell carcinomas. The incidence of these diseases increases after age 45. Minor and nonspecific local symptoms caused by the primary tumor are common to pharyngeal cancers at the initial stage of the disease. Often the diagnosis is delayed and the search for the primary tumor is begun only after detection of neck metastases. They occur in 60 to 80% at the time of diagnosis. Among the risk factors, smoking and heavy drinking are most important.
Duodecim; lääketieteellinen aikakauskirja 01/2011; 127(18):1971-7.
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ABSTRACT: Patients with mild obstructive sleep apnoea (OSA) depict the disease as being detrimental to their health, causing significant symptoms. These patients were found to achieve significant improvements in OSA-related symptoms after surgical intervention.
Although the effects of surgical treatment on OSA have been encouraging in many previous studies, little is known about its effects in patients with mild OSA. The aim of our study was to assess the evolution of symptoms experienced by mild OSA patients after surgical intervention.
This was an observational follow-up study in a university hospital in Finland. The change in daytime and night-time symptoms was assessed by a standardized questionnaire before treatment and after a mean follow-up time of 3 years in both operative and control groups in 81 adult patients with mild OSA.
At the follow-up, the control group experienced significantly more daytime sleepiness (p<0.001) compared with the operative group. Adjusted odds ratio (OR) for daytime sleepiness was 0.05 (95% CI 0.01-0.25, p<0.001) in operatively treated patients as compared with control patients, with improvement of witnessed apnoeas (p<0.001) and sleep quality (p=0.033). The OR for intensive snoring was 0.06 (95% CI 0.02-0.22) in the operative group as compared with the control group.
Acta oto-laryngologica 11/2009; 129(11):1266-73. · 0.98 Impact Factor
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ABSTRACT: To investigate whether reduced expression of alpha-, beta-, or gamma-catenin predicts poor survival in oral squamous cell carcinoma (OSCC).
Immunohistochemical analyses of a retrospective cohort.
University-affiliated hospital.
One hundred twenty-four patients with OSCC.
The prognostic value of gamma-catenin expression on disease-specific survival in different T and N category groups in patients with OSCC.
Reduced expression of gamma-catenin correlated with poor tumor differentiation of OSCC (P = .04). Patients with reduced gamma-catenin expression in the primary tumor had significantly more frequent lymph node metastasis than did patients with normal gamma-catenin expression (P = . 03). Reduced expression of gamma-catenin (004) but not of alpha-catenin (P = .25) or beta-catenin (P = .48) correlated with poor clinical outcome. Reduced gamma-catenin expression predicted poor disease-specific survival also in the 92 patients with T1 or T2 tumors (P = . 02). In multivariate analysis, advanced T category (P = . 04), neck lymph node metastases (P = . 01), and reduced gamma-catenin expression (P = . 05) were independently related to poor survival.
Reduced expression of gamma-catenin was associated with poor differentiation of OSCC, with neck lymph node metastases, and, more importantly, with poor disease-specific survival. Loss of gamma-catenin expression seems to contribute to metastatic properties of OSCC. Evaluation of the expression pattern of gamma-catenin may be useful for predicting outcome in patients with OSCC.
Archives of otolaryngology--head & neck surgery 10/2009; 135(10):1035-40. · 1.92 Impact Factor
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ABSTRACT: To evaluate the prognosis of mild obstructive sleep apnea in relation to different treatment modalities.
An open, retrospective, longitudinal follow-up study.
Fifty adult patients diagnosed and treated for mild obstructive sleep apnea at the Department of Otorhinolaryngology at Kuopio University Hospital between 1998 and 2004 had a control polysomnography in 2005. The changes in apnea-hypopnea index (AHI) were observed in untreated (n = 28), operative (n = 11), and continuous positive airway pressure (n = 11) treatment groups at a long-term follow-up visit.
The mean follow-up period was 4 (range, 1.3-9.0; SD, 1.9) years. The untreated patients had a statistically significant increase in AHI (13.3, SD 18.3) at the follow-up. Half of these patients developed a moderate or severe degree of sleep apnea, and only 11% were cured. In patients who were treated with continuous positive airway pressure, the degree of obstructive sleep apnea became worse in 64% of cases, and in 27% of patients, the AHI returned to normal (<5). The degree of obstructive sleep apnea in operated patients deteriorated only in 18%, and in 27% of the patients, the AHI returned to normal (<5).
Mild obstructive sleep apnea has a natural tendency to worsen with time. Active treatment of mild obstructive sleep apnea appears, therefore, to be advisable.
The Laryngoscope 06/2007; 117(6):1107-11. · 1.75 Impact Factor
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ABSTRACT: Versican, an extracellular matrix proteoglycan, has been noted to be expressed in several malignant tumours and has been suggested to play an important role in cancer development and tumour growth.
To investigate whether the versican expression level in the peritumoural stromal tissue of primary oral squamous cell carcinoma (OSCC) predicts relapse-free or disease-specific survival. Also, to study the associations between versican expression and several other clinicopathological variables, as well as tumour cell proliferation.
Immunohistochemistry was used to study the expression of versican and tumour cell proliferative activity in 139 OSCCs. All pertinent clinical data were collected retrospectively from the hospital records.
In this cohort, versican expression did not correlate with the clinicopathological factors or tumour cell proliferation. In univariate analyses, higher risk for disease recurrence was associated with higher stromal versican expression score (p = 0.02), positive neck node status (p = 0.02), lower Karnofsky performance status (p = 0.03) and higher tumour cell proliferation index (p = 0.04). Increased disease-specific risk of death was associated with high stromal versican expression score (p = 0.005) higher T class (p = 0.002), positive neck node status (p<0.001), higher stage (p<0.001), poorer histological differentiation (p = 0.005), worse general condition of the patient (p = 0.049) and increased tumour cell proliferative index (p = 0.02). In multivariate disease-specific survival analysis, high stromal versican expression score (p = 0.048), poorer histological differentiation (p = 0.047) and higher stage (p = 0.002) independently predicted poorer disease outcome.
In this cohort, increased stromal versican expression correlated with both increased risk for disease recurrence and shortened survival. High stromal versican expression may thus be considered an independent and adverse prognostic marker in OSCC.
Journal of Clinical Pathology 03/2007; 60(3):267-72. · 2.31 Impact Factor
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Antti A Mäkitie,
Petri Koivunen,
Harri Keski-Säntti,
Jyrki Törnwall, Matti Pukkila,
Jussi Laranne,
Marjaana Luukkaa,
Jyrki Vuola,
Timo Joensuu,
Mikael Kajanti,
Reidar Grénman
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ABSTRACT: Management of oral tongue squamous cell cancer (OTSCC) remains a challenge. This nationwide study reports the used treatment approach and the outcome of OTSCC in Finland. Retrospective study of OTSCC patients in 1995-1999 with a 5-year follow-up. The corresponding data from 1980 to 1989 is also included. About 235 patients (125 M, 110 F; mean age 61.6 years; range 24-90 years) were included, 77% had SCC of lateral border of the tongue and 25% were N+. Treatment with curative intent was given to 224 (95%) patients. Surgery of the primary tumour was performed in 218 (97%) patients and with a reconstruction in 69 (31%) patients. A neck dissection was performed ipsilaterally in 114 (51%) and bilaterally in 9 (4%) cases. Irradiation was given to 131 (58%) patients. The rate for locoregional recurrence was 28%. The 3- and 5-year overall survival (OS) rates were 66 and 47%, respectively. The corresponding disease specific survival (DSS) rates were 74 and 64%, respectively. The mean DSS for patients younger than 40 years and older than 40 years was 111 and 88 months, respectively (P < 0.02). The 3- and 5-year DSS rates were: Stage I, 88 and 74%; Stage II, 74 and 62%; Stage III, 79 and 71% and Stage IV, 36 and 33%, respectively. In the present study the surgical treatment approach seems effective in controlling early stage OTSCC but the modest survival, in spite of combination of radiotherapy and surgery, points out the need to consider new strategies in the management of advanced stage disease.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 03/2007; 264(3):263-7. · 1.29 Impact Factor
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ABSTRACT: The survival figures for advanced stage oropharyngeal carcinoma (OPC) have remained moderate in spite of radical combined modality treatments. The purpose of this study was to investigate the used treatment approach and the outcome of OPC in a nationwide study. Retrospective clinicopathological data of all patients diagnosed with OPC between 1995 and 1999 at the five university hospitals in Finland were reviewed. All patients had a minimum 4-year follow-up. A total of 168 patients (145 men and 23 women, mean age 59 years; range 28 - 89 years) were included. The T categories were as follows: T1, n =34; T2, n =55; T3, n =40; T4, n =39. One hundred and seventeen (69.6%) patients presented with neck node metastases and three (1.8%) patients with distant metastases. In the majority (61.3%) of the patients the tumor was located in the lateral wall of the oropharynx. In 144 (85.7%) patients the treatment was performed with curative intent. Of these, surgery of the primary tumor was performed in 123 (85.4%) patients, and the defect was reconstructed with a pedicled flap or free tissue transfer in 66 (53.7%) of these patients. A neck dissection (ND) was performed in 86 (69.9%) out of these 123 cases. Surgery was the only treatment modality in 10 (6.9%) patients. Radiation therapy (RT) only (with or without chemotherapy) was given to 21 (14.6%), combined treatment with surgery + radiation therapy (S + RT) to 110 (76.4%) and surgery + chemoradiotherapy (S + CRT) to 3 (2.1%) patients. Overall (OS) 3- and 5-year survival rates were 58 and 45%, respectively. Disease-specific (DSS) 5-year survival rates by T-class for the patients treated with curative intent were as follows: T1, 77%; T2, 70%; T3, 66%; T4, 53%. The variable treatment approach, the frequent locoregional recurrences and the moderate survival point out the need to consider new strategies in the management of OPC.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 03/2006; 263(2):139-43. · 1.29 Impact Factor
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ABSTRACT: Data concerning the diagnosis, treatment and clinical course of patients with hypopharyngeal carcinoma (HPC) in all five university hospitals in Finland between 1 January 1990-31 December 1999 were retrospectively analysed. During the study period, 149 HPC cases were diagnosed in 111 men and 38 women (74%/26%), with a mean age of 64.5 years. At the time of diagnosis, 6 patients (4%) had stage I, 11 (7%) stage II, 32 (22%) stage III and 100 (67%) stage IV disease. In 74 (49%) cases, the primary treatment was surgery. Pre- or postoperative radiation therapy was given to 67 patients. Radiation therapy was the primary treatment in 47 (32%) patients, and 12 patients (8%) received concomitant chemoradiation. The overall 5- and 10-year disease specific survival (DSS) was 22 and 13%, respectively. The 5-year DSS was 66% for stage I, 59% for stage II, 31% for stage III and 12% for stage IV disease. In the three major treatment groups, i.e., surgery and radiation therapy, radiation therapy alone and concomitant chemoradiation, the 5-year DSS were 32% for surgery and radiation therapy, 7% for radiation therapy alone and 38% for concomitant chemoradiation. Prognosis of HPC remains poor, especially in the more advanced stages of the disease. In addition to traditional surgery and radiation therapy, concomitant chemoradiotherapy seems to give equal results in tumor control, thus making organ preservation possible in the primary treatment of HPC.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 06/2005; 262(5):374-8. · 1.29 Impact Factor
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ABSTRACT: Background: Epithelial-mesenchymal transition (EMT) is a crucial process in tumorigenesis since tumor cells attain fibroblast-like features enabling them to invade to surrounding tissue. Two transcription factors, TWIST and SNAI1, are fundamental in regulating EMT.
