Clinical and pathological determinants in tonsillar cancer

Chuang, Hui‐Ching; Fang, Fu‐Min; Huang, Chao‐Cheng; Huang, Hsuan‐Ying; Chen, Han-Ku; Chen, Chang‐Han; Chien, Chih‐Yen

doi:10.1002/hed.21662

Cited by 5 publications

(6 citation statements)

References 37 publications

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“…[36][37][38][39][40][41] However, the significance of LVI in head and neck cancer is less well documented with some articles reporting it to be significant 17,42 and others not. 28 Interestingly, patients who were p16-negative were more likely to have LVI compared to p16-positive patients (27.8% vs 14.6%; p 5 .18). When LVI was stratified by p16 status, patients who had LVI had a statistically significant poorer DSS in both p16-positive (60% vs 94%; p 5 .022) and p16-negative tumors (30% vs 86%; p 5 .023).…”

Section: Discussionmentioning

confidence: 89%

“…The 5‐year local, regional, and locoregional controls rates were also excellent at 89%, 98%, and 88%, respectively. Table is a summary of studies published in the literature evaluating tonsillar SCC managed by primary surgery, radiation, or both . Some series have reported superior results, but these were primarily on patients with T1 and T2 primaries in which transoral tonsillectomies were carried out .…”

Section: Discussionmentioning

confidence: 99%

“…Table 5 is a summary of studies published in the literature evaluating tonsillar SCC managed by primary surgery, radiation, or both. [7][8][9][10]12,16,17,[26][27][28][29][30][31][32][33][34] Some series have reported superior results, but these were primarily on patients with T1 and T2 primaries in which transoral tonsillectomies were carried out. 22,23 In comparison to these studies, 48% of our patients had T3/T4 tonsil tumors.…”

Section: Discussionmentioning

confidence: 99%

“…The importance of LVI in other tumor types (eg, breast, gastric, cervical, prostate, and bladder tumors) as a prognostic factor is well documented . However, the significance of LVI in head and neck cancer is less well documented with some articles reporting it to be significant and others not . Interestingly, patients who were p16‐negative were more likely to have LVI compared to p16‐positive patients (27.8% vs 14.6%; p = .18).…”

Section: Discussionmentioning

confidence: 99%

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Squamous cell carcinoma of the tonsil managed by conventional surgery and postoperative radiation

et al. 2014

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Background The purpose of this study was to report the long-term outcome of patients with squamous cell cancer (SCC) of the tonsil managed by surgery followed by postoperative radiotherapy (PORT). Methods Eighty-eight patients treated between 1985 and 2005 were analyzed. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined by the Kaplan–Meier method. Factors predictive of outcome were determined by univariate and multivariate analysis. Results Forty-eight percent of patients had T3 to T4 disease and 75% had a positive neck. Five-year OS, DSS, and RFS were 66%, 82%, and 80%, respectively. The status of the neck was not predictive of outcome (DSS 80% for N0 vs 82% for N+; p = .97). Lymphovascular invasion was an independent predictor of OS, DSS, and RFS on multivariate analysis. Conclusion Lymphovascular invasion but not pathological stage of the neck is an independent predictor of outcome in patients with tonsillar SCC.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Squamous cell carcinoma of the tonsil managed by conventional surgery and postoperative radiation

et al. 2014

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“… 20 The tumor thickness is also found to be an independent predictor of the 5-year DSS in tonsillar cancer. 21 Noninvasive tools for evaluating tumor thickness by MRI 22 and ultrasound 23 have proven to reliably identify patients who are likely to have a worse clinical outcome at the time of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of neutrophil-to-lymphocyte ratio in clinical early-stage tongue (cT1/T2N0) cancer

Wu¹,

Chuang²,

Lin³

et al. 2017

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BackgroundInflammation plays a role in the development of cancer. This study aims to analyze the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and other clinicopathological determinants in early-stage (cT1/T2N0) tongue cancer.Materials and methodsA total of 262 patients were selected from our institute’s cancer database between 2004 and 2011. Optimal cutoff value of NLR and lymph node density (LND) were determined statistically using receiver operating characteristic curve analysis for survival prediction. The 5-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) rates were estimated using the Kaplan–Meier method.ResultsThe results showed that, in this cohort, the optimal cutoff value of NLR was 2.95 and for LND, it was 0.031. Patients with NLR ≥2.95 correlated significantly with positive N classification (P=0.011), T2 classification (P=0.007), positive perineural invasion (P<0.001), and a tumor thickness of >5 mm (P=0.005). The 5-year OS among patients with NLR <2.95 was much higher than that in patients with NLR ≥2.95 (P<0.001). Similarly, the 5-year DSS among patients with NLR <2.95 was much higher than that in patients with NLR ≥2.95 (P=0.002). The 5-year DFS among patients with NLR <2.95 was much higher than that in patients with NLR ≥2.95 (P=0.004). The 5-year OS, DSS, and DFS were significantly reduced among patients with LND >0.031 compared to those with LND <0.031, respectively. In multivariate analysis, NLR, LND, and tumor thickness were independent prognostic factors for OS.ConclusionPretreatment NLR ≥2.95 is significantly correlated with a larger tumor, positive neck lymph node metastasis, and positive perineural invasion. Importantly, it indicates reduced survival rate. Therefore, if the NLR ≥2.95 in early-stage (cT1/T2N0) tongue cancer is noted preoperatively, it reveals more invasive tumor behavior clinically. Then, aggressive treatments, including elective neck dissection, become necessary.

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Tumor thickness as an independent risk factor of early recurrence in oral cavity squamous cell carcinoma

Pinto

Matos

Palermo

et al. 2013

Eur Arch Otorhinolaryngol

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The aim is to determine if tumor thickness is a risk factor related to the development of early recurrences in surgically treated oral cavity squamous cell carcinoma (SCC). Retrospective cohort study conducted at Instituto do Câncer do Estado de São Paulo (ICESP). Fifty-seven patients with oral cavity SCC (excluding lip tumors and patients previously submitted to any treatment) were analyzed regarding the occurrence of an early disease progression (locoregional or distant metastasis) within the first 12 months after initial treatment. Tumor thickness and other histological characteristics related to the development of recurrence up to 1 year after treatment were tested. Results demonstrated that tumor thickness greater than 10 mm (P = 0.034), as well as angiolymphatic invasion (P = 0.001), perineural invasion (P = 0.041) and lymph-node metastasis (P = 0.021) was associated with a worse 12-month disease-free survival (Log-Rank test). In multivariate analysis, tumor thickness greater than 10 mm emerged as an independent risk factor for early recurrence in oral cavity tumors (HR = 3.4, 95% CI: 1.005-11.690; P = 0.049--Cox regression). Post-operative radiotherapy seems to be a protective factor for early recurrences in patients with tumor thickness greater than 10 mm (P = 0.017--Log-Rank test; HR = 0.32, 95% CI: 0.12-0.87, P = 0.026--Cox regression). The results of the present research suggest that tumor thickness greater than 10 mm may be an independent adverse factor for early progression of surgically treated oral cavity SCC. Adjuvant therapies, in particular post-operative radiotherapy, should be advocated in this group of patients, regardless of the co-existence of other well-described histological risk factors.

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Clinical and pathological determinants in tonsillar cancer

Abstract: Patients with tonsillar SCC with stage IVa/b and metastasis to 3 or more lymph nodes have poorer clinical outcomes. Novel therapeutic strategies are necessary for these patients.

Cited by 5 publications

References 37 publications

Squamous cell carcinoma of the tonsil managed by conventional surgery and postoperative radiation

Squamous cell carcinoma of the tonsil managed by conventional surgery and postoperative radiation

Prognosis of neutrophil-to-lymphocyte ratio in clinical early-stage tongue (cT1/T2N0) cancer

Tumor thickness as an independent risk factor of early recurrence in oral cavity squamous cell carcinoma

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