Adoption and adherence to the MMA protocol increased substantially over the study period for patients undergoing thyroid and parathyroid surgery and was associated with a simultaneous significant decline in prescription of postoperative opioid analgesics. Use of nonopioid multimodal agents, incorporating NSAIDs, was safe and did not lead to increased incidence of bleeding. Availability of effective nonopioid MMA pathways may favorably influence physician prescribing practices and avoid unnecessary opioid prescriptions.

Background: Verrucous carcinoma of the larynx (VCL) is a rare form of laryngeal squamous cell carcinoma. We analyzed the National Cancer Database (NCDB) to examine national treatment pattern, identify factors associated with primary radiation therapy (RT), and compare outcomes in patients with Tis-T2 N0 VCL treated primary surgery and primary RT. Methods: We accessed the NCDB from 2004 to 2015 for patients with Tis-T2 N0 VCL and recorded the treatment modality employed. Multivariable logistic regression was used to identify predictors for radiation therapy. Cox regression was used to calculate hazard ratios for survival. A propensity score matched Kaplan–Meier analysis compared primary surgical treatment to definitive radiation. Results: We identified 732 patients with laryngeal verrucous carcinoma from the NCDB. The majority were cTis-T2 (87%) N0 (96%). We identified 286 vs. 110 Tis-T2N0 patients treated primary surgery and with definitive radiation, respectively, for the purpose of this study. Predictors of radiation were treatment at a community center, no insurance, and higher T stage. Cox regression identified increased age, higher comorbidity score, and government insurance as predictive of worse survival. Propensity matching revealed a trend toward worse survival with definitive radiation, with a median survival of 98 months compared to 143 months ( p = 0.02). When including only T1-2 lesions, that is, invasive disease, the trend toward increased survival with surgery [98 months vs. 135 months ( p = 0.08)] persisted. Conclusion: The results of the present study support the use of surgery in the management of Tis-T2 N0 VCL when organ preservation is possible.

Gelatin degradation assay, invadopodia characterization, and microscopy Cells were plated on Oregon Green 488-conjugated gelatin (G13186; Invitrogen) coated coverslips (29). In cases of inhibitor treatment, cells were allowed to attach for 1 hour, then incubated Markwell et al.

the United States Appalachian region harbors a higher cancer burden than the rest of the nation, with disparate incidence of head and neck squamous cell carcinomas (HnScc), including oral cavity and pharynx (oc/p) cancers. Whether elevated HnScc incidence generates survival disparities within Appalachia is unknown. To address this, HNSCC survival data for 259,737 tumors from the North American Association for Central Cancer Registries 2007-2013 cohort were evaluated, with ageadjusted relative survival (RS) calculated based on staging, race, sex, and Appalachian residence. tobacco use, a primary HnScc risk factor, was evaluated through the Behavioral Risk factor Surveillance System from Appalachian states. Decreased oc/p RS was found in stage iV Appalachian white males within a subset of states. The survival disparity was confined to human papillomavirus (HPV)-associated oropharyngeal cancers, specifically the oropharynx subsite. This correlated with significantly higher smoking and male smokeless tobacco use in most Appalachian disparity states. Lower survival of Appalachian males with advanced-stage HpV-associated oropharyngeal cancers suggests pervasive tobacco consumption likely generates more aggressive tumors at HpV-associated oropharynx subsites than national averages. comprehensive tobacco and HpV status should therefore be evaluated prior to considering treatment de-intensification regimens for HPV-associated oropharyngeal cancers in populations with high tobacco consumption. HNSCC involves the epithelium of the oral cavity, pharynx and larynx. OC/P cancers are a major HNSCC subset, with nearly 11,000 deaths predicted in the US in 2020 1. Risk factors include tobacco and alcohol use, and highrisk human papillomavirus (HPV) infection 2,3. OC/P cancers are subdivided into HPV-associated oropharynx (HPV-associated) and non-HPV-associated oral cavity, hypopharynx, and nasopharynx (non-HPV-associated) cancers 4. These designations are supported by studies indicating that non-HPV-associated cancers are primarily tobacco/alcohol induced, whereas HPV-associated cancers are predominantly caused by HPV infection 5. Furthermore, HPV-negative or non-HPV-associated cancers consistently have poorer outcomes than HPV-positive or HPV-associated cancers, segregating these cancers as distinct diseases with differential clinical management 6,7. While national incidence of non-HPV-associated cancers is decreasing due to tobacco cessation, HPV-associated cancers are increasing due to rising infection rates 8. Regarding race, blacks with HNSCC present with more advanced disease, are older and have worse survival than whites, denoting a racial disparity 9-11. Increased screening for HPV coupled with subsite analysis indicates that blacks with HNSCC have less HPV-positive cancer than whites, explaining differences in survival 12,13. Consistent with this, HPV-associated cancers continue to increase in white males and in rural areas 4,14,15. The Appalachian region encompasses 205,000 square miles across 420 counties in 13 contiguo...