Implications of Tumor Size, Subsite, and Adjuvant Therapy on Outcomes in pT4aN0 Oral Cavity Carcinoma

2020 ◽  
Vol 162 (5) ◽  
pp. 683-692
Author(s):  
Arya W. Namin ◽  
Craig A. Bollig ◽  
Brette C. Harding ◽  
Laura M. Dooley
Keyword(s):  
Overall Survival ◽  
Oral Cavity ◽  
Subgroup Analysis ◽  
Tumor Size ◽  
Hard Palate ◽  
Adjuvant Radiation ◽  
Entire Cohort ◽  
Floor Of Mouth ◽  
Oral Cavity Carcinoma ◽  
Retromolar Trigone

Objective To determine if tumor size, subsite, and adjuvant radiation therapy (AXRT) are associated with overall survival (OS) in patients with pT4aN0 oral cavity squamous cell carcinoma (OSCC) who underwent mandibulectomy with negative surgical margins (NSMs). Study Design Retrospective cohort study. Setting National Cancer Database (NCDB). Subjects and Methods Retrospective analysis of the NCDB that included patients diagnosed with pT4aN0 OSCC who underwent mandibulectomy with NSMs between 2004 and 2015. The association of age, Charlson-Deyo score (CDS), tumor size, subsite, and AXRT with OS was analyzed. The cases were divided into 3 subgroups based on maximal tumor dimension for subgroup analysis; tumors ≤2.0 cm, tumors 2.1 to 4.0 cm, and tumors >4.0 cm. Results For the entire cohort; age ( P < .001; hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.02-1.03), CDS ( P = .013; HR, 0.57; 95% CI, 0.37-0.89), tongue subsite ( P = .003; HR, 2.01; 95% CI, 1.27-3.40), floor of mouth subsite ( P = .001; HR, 1.76; 95% CI, 1.28-2.42), tumor size ( P < .001; HR, 0.57; 95% CI, 0.45-0.72), and AXRT ( P < .001; HR, 1.46; 95% CI, 1.24-1.72) were associated with OS on multivariate analysis. On subgroup analysis, AXRT not significantly associated with OS in patients with gingival, hard palate, retromolar trigone, and not specified tumors ≤2.0 cm ( P = .323; HR, 1.29; 95% CI, 0.78-2.15). Conclusions In patients with pT4aN0 OSCC who underwent mandibulectomy with NSMs, age, CDS, tongue subsite, floor of mouth subsite, tumor size, and AXRT are associated with OS. AXRT was not significantly associated with overall survival in patients with gingival, hard palate, retromolar trigone, and not specified tumors ≤2.0 cm.

A retrospective study of primitive neuroectodermal tumor (PNET) of the kidney in a tertiary cancer center in India.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 361-361
Author(s):  
Nandini Sharrel Menon ◽  
Devanshi Kalra ◽  
Kumar Prabhash ◽  
Vanita Noronha ◽  
Santosh Menon ◽  
...  
Keyword(s):  
Overall Survival ◽  
Retrospective Study ◽  
Metastatic Disease ◽  
Tumor Size ◽  
Progression Free Survival ◽  
Adjuvant Radiation ◽  
Pathological Feature ◽  
Free Survival ◽  
Rare Tumours ◽  
Multimodality Approach

361 Background: Primitive neuroectodermal tumours (PNET) of the kidney are rare tumours with aggressive behaviour. This study was conducted to review the diagnosis and management of patients with renal PNET at our centre. Methods: This was a retrospective study conducted at a tertiary cancer care centre in Mumbai, India. The demographic and clinical data of 17 patients treated by the uro-oncology services were retrieved from electronic medical records. Descriptive analysis was performed for baseline characteristics.Overall & progression-free survival was determined using the Kaplan Meier method. Cox regression was used for multivariate analysis. Results: There were 12 male and 5 female patients in this cohort with a median age of 27 years. At diagnosis 2 patients had metastatic disease and 15 patients had non-metastatic disease. Median follow up in this cohort was 22 months (range 2-30 months). Presenting complaints were hematuria, abdominal pain, flank pain, fever, bone pain, and incidentally detected renal mass. All patients were Mic -2 positive and 13 were FLI-1 positive on immunohistochemistry. Fourteen patients underwent radical nephrectomy. One (5.9%) patient received both neoadjuvant and adjuvant chemotherapy, 8 (47.1%) received adjuvant and 2 (11.8%) received palliative chemotherapy upfront. Eight patients received adjuvant radiation to the renal bed.There was disease progression in12 patients,10 of 15 patients with non metastatic disease at diagnosis eventually developed metastasis.The median progression free survival (PFS) was 10.55 months.The pathological feature that was associated with a shorter PFS was tumor size ⩾10 cm(p = 0.044).The median overall survival was 20.04 months (95% CI 9.49 -not reached). The presence of metastasis and treatment received significantly impacted overall survival (OS). Median OS in patients with non-metastatic disease was not reached versus 14.1 months in those with metastatic disease (p = .019).The median OS in patients treated with multimodality approach was 20.11 months. Patients did not undergo surgery had a median OS of 5.45 months (p < .001) and those who did not receive any chemotherapy had a median OS of 4.57 months (p = .024).Thus, patients who received multimodality treatment had better outcomes. Conclusions: PNET kidney is an aggressive tumor which should be treated with a multimodality approach. Tumor size ⩾10 cm was an adverse prognostic factor.

TCGA data reveal a transcriptomic signature of Sox2 and Nanog targets associated with survival in head and neck cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17546-e17546
Author(s):  
Nikol Mladkova ◽  
Dukagjin Blakaj
Keyword(s):  
Oral Cavity ◽  
Head And Neck ◽  
Subgroup Analysis ◽  
Regulatory Elements ◽  
Head And Neck Tumors ◽  
Oral Tongue ◽  
Expression Levels ◽  
Floor Of Mouth ◽  
Neck Tumors ◽  
Rnaseq Data

e17546 Background: Head and neck cancers represent a diverse group of tumors linked with HPV infection, alcohol and smoking that contribute to cancer morbidity and mortality globally. Sox2 and Nanog are transcription factors that maintain pluripotency in embryonic stem cells, and their individual expression has been associated with prognosis in head and neck tumors previously. Methods: TCGA dataset containing 522 tumor samples with RNAseq data, clinical information (anatomically classified as 133 oral tongue, 117 laryngeal, 73 oral cavity, 63 floor of mouth, 45 tonsillar, 27 base of tongue and 70 other samples) and 44 normal samples with RNAseq data available was used to detect differentially expressed genes in head and neck tumors. The levels of each gene were then transformed to z-score per patient and classified as over- or under-expressed if those were 2 SD away from the mean. The expression levels were then correlated with survival in individual patients for all tumor combined. Subgroup analysis of oral tongue, laryngeal, oral cavity, floor of mouth, tonsillar cancers was carried out separately. Results: A total of 233 genes were significantly correlated with survival in head and neck tumors ( < 0.01). This geneset was subsequently analyzed for enrichment of common pathway dysregulation or for enrichment of shared regulatory elements. The expression level of a set of a total of 15 genes that represent targets of Nanog and Sox2 was shown to either increase or decrease survival directly dependent on either up- or down-regulated expression levels. Of note, neither Nanog nor Sox2 expression levels individually impacted survival. Subgroup analysis revealed individualized prognostic signatures in each anatomic location, with an overlap of individual genes with Nanog and Sox2 targets signature ranging from 6.25-20%. Conclusions: We describe a prognostic signature in head and neck tumors derived from a TCGA data consisting of genes that represent targets of critical stem cell regulators Sox2 and Nanog. On a subgroup analysis, we also derived prognostic signatures for five anatomic locations and head&neck tumors with various ranges of overlap with Sox2 and Nanog targets signature. Pending validation in additional datasets, those represent an attractive target for further mechanistic evaluation in tumorigenesis in this group of tumors.

Oral Cavity, Oropharynx, Lip, and Salivary Glands

2017 ◽  
Author(s):  
Mia Hashibe ◽  
Erich M. Sturgis ◽  
Jacques Ferlay ◽  
Deborah M. Winn
Keyword(s):  
Oral Cavity ◽  
Salivary Glands ◽  
Hard Palate ◽  
Betel Quid ◽  
Tobacco Products ◽  
Floor Of Mouth ◽  
Heavy Alcohol Consumption ◽  
Oral Cavity Cancers ◽  
Prior Infection ◽  
Base Of The Tongue

Cancers of the oral cavity, oropharynx, lip, and salivary glands are malignancies of the head and neck. Some of these cancer sites share risk factors, although each has distinctive anatomic, epidemiologic, and clinical features. Oral cavity cancers arise on the inner lip and buccal mucosa, anterior two-thirds of the tongue, gum, hard palate, and floor of mouth. These cancers are strongly associated with the use of smoked and smokeless tobacco products, heavy alcohol consumption, and chewing of betel quid or pan, but only minimally associated with prior infection with human papillomavirus (HPV). In contrast, oropharyngeal cancers affect the posterior one-third (base) of the tongue, tonsils, soft palate, and other oropharyngeal tissues and are strongly associated with HPV-16 infection as well as with the use of tobacco, alcohol, and betel quid. In principle, tumors of the oral cavity, oropharynx, and lip are among the most preventable forms of cancer.

Stage IIA1 Versus Stage IIA2 Cervical Cancer: Does the New Staging Criteria Predict Survival?

2011 ◽  
Vol 21 (4) ◽  
pp. 711-716 ◽  
Author(s):  
Gunjal Garg ◽  
Jay P. Shah ◽  
Eugene P. Toy ◽  
Carl Christensen ◽  
Gunter Deppe ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Radical Hysterectomy ◽  
Tumor Size ◽  
International Federation ◽  
Primary Radiation ◽  
Adjuvant Radiation ◽  
Patient Age ◽  
Gynecology And Obstetrics ◽  
Patient Âgé

Objective:(1) To determine the correlation of 2008 International Federation of Gynecology and Obstetrics staging system with survival in patients with stage IIA cervical cancer, (2) to elucidate the treatment patterns in stage IIA1 and stage IIA2 cervical cancer, and (3) to investigate whether radical hysterectomy or radiation influenced overall survival.Methods:Data were extracted from the Surveillance, Epidemiology and End Results database between 1988 and 2005. Statistical analysis usedχ2test, Kaplan-Meier method, Cox regression, and logistic regression.Results:Of the 560 women, 271 (48.4%) had stage IIA1, and 289 (51.6%) had stage IIA2 cervical cancer. Stage IIA2 patients were younger than stage IIA1 patients (mean age, 49 years vs 54 years;P= 0.01). Stage IIA1, compared with stage IIA2, differed significantly regarding the administration of primary radiation (47.2% vs 64.7%,P< 0.001) and adjuvant radiation (60.5% vs 77.5%,P= 0.006). The following variables were significantly associated with the performance of radical hysterectomy: patient age, 65 years or younger, tumor size, ≤2 cm or lesser, high tumor grade, and nonsquamous tumor histology. The incidence of adjuvant radiation after radical hysterectomy was high (48% [tumor size, ≤2 cm] to 86% [tumor size, >6 cm]). The 5-year overall survival was not significantly different between stages IIA1 and IIA2 (65.8% vs 59.5%,P= 0.2). Only patient age (P= 0.01), tumor size (P= 0.02), and lymph node status (P= 0.002) were independent predictors of survival. When controlled for other contributing factors, there was no significant difference in survival between patients treated by radical hysterectomy and primary radiation.Conclusions:The 2008 International Federation of Gynecology and Obstetrics staging criteria is not an independent predictor of survival in stage IIA cervical cancer. Given the equivalent efficacy of radical hysterectomy and radiation, attention should be paid to the high risk of adjuvant radiation in these patients.

Stage II Oral Tongue Cancer: Survival Impact of Adjuvant Radiation Based on Depth of Invasion

2018 ◽  
Vol 160 (1) ◽  
pp. 77-84 ◽  
Author(s):  
Samuel J. Rubin ◽  
Ellen B. Gurary ◽  
Muhammad M. Qureshi ◽  
Andrew R. Salama ◽  
Waleed H. Ezzat ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Oral Cavity ◽  
Tongue Cancer ◽  
Univariate Analysis ◽  
Adjuvant Radiation ◽  
Depth Of Invasion ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Significant Difference

Objective To determine if adjuvant radiation therapy for patients with pT2N0 oral cavity tongue cancer affects overall survival. Study Design Retrospective cohort study. Setting National Cancer Database. Subjects and Methods Cases diagnosed between 2004 and 2013 with pathologic stage pT2N0 oral cavity tongue cancer with negative surgical margins were extracted from the National Cancer Database. Data were stratified by treatment received, including surgery only and surgery + postoperative radiation therapy. Univariate analysis was performed with a 2-sample t test, chi-square test, or Fisher exact test and log-rank test, while multivariate analysis was performed with Cox regression models adjusted for individual variables as well as a propensity score. Results A total of 934 patients were included in the study, with 27.5% of patients receiving surgery with postoperative radiation therapy (n = 257). In univariate analysis, there was no significant difference in 3-year overall survival between the patient groups ( P = .473). In multivariate analysis, there was no significant difference in survival between the treatment groups, with adjuvant radiation therapy having a hazard ratio of 0.93 (95% CI, 0.60-1.44; P = .748). Regarding tumors with a depth of invasion >5 mm, there was no survival benefit for the patients who received postoperative radiation therapy as compared with those who received surgery alone (hazard ratio = 0.93; 95% CI, 0.57-1.53; P = .769). Conclusion An overall survival benefit was not demonstrated for patients who received postoperative radiation therapy versus surgery alone for pT2N0 oral cavity tongue cancer, irrespective of depth of tumor invasion.

scholarly journals Recurrence Rates in Patients With Cervical Cancer Treated With Abdominal Versus Minimally Invasive Radical Hysterectomy: A Multi-Institutional Retrospective Review Study

2020 ◽  
Vol 38 (10) ◽  
pp. 1030-1040 ◽  
Author(s):  
Shitanshu Uppal ◽  
Paola A. Gehrig ◽  
Katherine Peng ◽  
Kristin L. Bixel ◽  
Koji Matsuo ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Radical Hysterectomy ◽  
Tumor Size ◽  
Disease Free Survival ◽  
Adjuvant Radiation ◽  
Recurrence Rates ◽  
Invasive Group ◽  
Final Pathology ◽  
Entire Cohort ◽  
Increased Risk

PURPOSE To compare the disease-free survival (DFS) between open and minimally invasive radical hysterectomies (RH) performed in academic medical institutions METHODS Retrospective multi-institutional review of patients undergoing RH for stage IA1 (with lymphovascular invasion), IA2, and IB1 squamous, adenocarcinoma, or adenosquamous carcinoma between January 1, 2010 and December 31, 2017. RESULTS Of 815 patients, open RH was performed in 255 cases (29.1%) and minimally invasive RH in 560 cases (70.9%). There were 19 (7.5%) recurrences in the open RH and 51 (9.1%) recurrences in the minimally invasive group ( P = .43). Risk-adjusted analysis revealed that minimally invasive RH was independently associated with an increased hazard of recurrence (aHR, 1.88; 95% CI, 1.04 to 3.25). Other factors independently associated with an increased hazard of recurrence included tumor size, grade, and adjuvant radiation. Conization before surgery was associated with lower recurrence risk (aHR, 0.4; 95% CI, 0.23 to 0.71). There was no difference in OS in the unadjusted analysis (HR, 1.14; 95% CI, 0.61 to 2.11) or after risk adjustment (aHR, 1.01; 95% CI, 0.5 to 2.2). Of 264 patients with tumors ≤ 2 cm on final pathology (excluding those with no residual tumor on final pathology), 2/82 (2.4%) recurred in the open RH group and 16/182 (8.8%) in the minimally invasive RH group ( P = .058). In propensity score matching analysis, 7/159 (4.4%) recurrences were noted in the open RH group and 18/156 (11.5%) in the minimally invasive RH group ( P = .019). Survival analysis revealed an increased risk of recurrence in the minimally invasive group in propensity-matched cohort (HR, 2.83; 95% CI, 1.1 to 7.18) CONCLUSION In this retrospective series, patients undergoing minimally invasive radical hysterectomy, including those with tumor size ≤ 2 cm on final pathology, had inferior DFS but not overall survival in the entire cohort.

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