ISSN:1043-3074    

DOI:10.1002/hed.2880170602

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Cervical lymph node metastasis has a major influence on survival in oral cancer. However, the factors influencing its occurrence are uncertain. Our aim was to improve the prognostic efficiency of the histologic assessment of the primary tumor in predicting metastasis in an individual patient.Methods.The relationship between selected clinical and histologic features of the primary tumor of tongue/floor of the mouth and the actual metastatic status was investigated in 45 patients. Invasive cell grading was supplemented by histologic measurements of tumor size and assessments of vascular and perineural invasion.Results.Ten histologic features showed significant differences in relation to metastasis. A logistic regression model with two predictor variables (total histologic malignancy score and vascular invasion) classified correctly 39 (87%) of the 45 cases.Conclusions.Histologic assessment of tumor size and malignancy grade are useful in predicting metastasis. Vascular and perineural invasion are important predictors and should be included in multifactorial malignancy grading schemes. Application of the prognostic index to the biopsy specimen would aid in treatment planning. © 1995 Jons Wiley&Sons, Inc

ISSN:1043-3074    

DOI:10.1002/hed.2880170603

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.The purpose of this study was to investigate the incidence of micrometastases from squamous cell carcinomas of the upper aerodigestive tract in neck dissection specimens, and to determine whether features of the primary tumor might be of prognostic value for metastasizing.Methods.Seventy‐six originally pN0 staged neck dissection specimens from 60 patients were evaluated using serial sectioning in 10‐μm intervals, H&E‐staining and immunostaining with an antibody to pan‐cytokeratin. The influence of the variables pT‐category, cytologic grade, and maximum depth of invasion of the primary tumor on the nodal status was analyzed in 128 patients.Results.The examination of 1020 lymph nodes from 76 neck dissection specimens revealed 8 micrometastases in 6 specimens (7.9%) from 6 patients with oral and pharyngeal primaries, resulting in upstaging. Six micrometastases were located in lymph nodes of 3–6 mm in diameter. Depth of invasion was the only significant risk factor for metastasizing selected in logistic regression.Conclusion.The surgeon should be aware of a relatively high incidence of micrometastases from oral and pharyngeal carcinomas, which are neither detectable preoperatively nor histopathologically by a reasonable effort. The measurement of the maximum depth of invasion of the primary can delineate a group of patients who should be treated by elective neck dissection. © 1995 Jons Wi

ISSN:1043-3074    

DOI:10.1002/hed.2880170604

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Minor salivary gland cancer occurs infrequently and presents a diagnostic and therapeutic challenge. The purpose of this study was to determine prognostic factors for this disease.Methods.The medical records of 95 patients diagnosed and treated at the University of Alabama at Birmingham over a 35‐year period were reviewed. Information concerning patient, disease, and treatment characteristics was compiled for each case. Multivariate analysis was conducted using a rank regression procedure.Results.Stage I or II cancer (p= .022), the absence of cervical lymph node metastases (p= .001), and surgical margins which were free of cancer (p<.001) were predictive of increased 4‐year disease‐free survival by multivariate analysis.Conclusion.Our findings emphasize the need for detection of early‐stage disease combined with complete surgical extirpation of the cancer, which provide the patient with the best chance for locoregional control and long‐term survival. © 1995 Jons Wiley

ISSN:1043-3074    

DOI:10.1002/hed.2880170605

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.The patient with nasopharyngeal carcinoma (NPC) frequently is initially seen with regional node dissemination. Preliminary investigations suggest that the presence of Epstein‐Barr virus (EBV) genomes in neck metastases from an occult primary may be diagnostic and predictive of NPC. The goal of this study was to test this proposition.Methods.The polymerase chain reaction (PCR) was used to detect the presence of EBV DNA in fine‐needle aspirate (FNA) samples obtained from malignant neck nodes. Control samples were obtained from other locations in the head and neck.Patients.The patients in this study were evaluated at the Toronto Princess Margaret Hospital, a province‐wide tertiary care cancer treatment center. Of the 23 patients evaluated with malignant neck masses, 6 had NPC, 5 patients had metastatic squamous cell carcinoma of an unknown primary, and 12 patients served as controls with other known head and neck carcinomas. One of the patients initially diagnosed as an unknown primary later demonstrated NPC. FNA specimens were also obtained from 24 normal parotid, submandibular, or thyroid glands for comparison.Results.In the samples with sufficient DNA for analysis, EBV was detected in 5 of 5 neck nodes from patients with known NPC. EBV was also detected in the neck node of a patient who went on to develop NPC and in a cervical node from 1 of 2 patients in whom the primary tumor remained unknown. None of the evaluable control neck nodes or FNA controls from other sites demonstrated EBV.Conclusions.These results demonstrate the utility of NPC‐diagnostic EBV gene amplification in FNA samples of neck metastases and suggest that the presence of the EBV genome in FNA samples of neck nodes is predictive of the presence of NPC. © 1995 Jons Wiley&S

ISSN:1043-3074    

DOI:10.1002/hed.2880170606

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Penetrating Iaryngotracheal injuries are uncommon; however, these injuries are associated with significant morbidity and mortality. In an attempt to define the management of penetrating laryngotracheal injuries, we reviewed our experience with these injuries.Methods.We retrospectively analyzed the records of all patients admitted to a Level I trauma center who required operative management for penetrating laryngotracheal injuries. During the period of this study all patients with penetrating neck injuries were managed according to a protocol of selective exploration.Results.Of fifty‐seven patients with penetrating laryngotracheal injury 32 patients sustained gunshot wounds and 25 had stab wounds. The injuries were to the larynx in 24 (42%) and trachea in 33 (58%). Forty‐six (81%) had isolated airway injuries and 11 (19%) had combined airway and digestive‐tract injuries. Emergent airway management in 32 (56%) patients included: tracheostomy (15), endotracheal intubation (14), and cricothyroidotomy (3). Respiratory distress and subcutaneous crepitus were the commonest clinical findings. Diagnostic evaluation included: Iaryngoscopy/tracheoscopy (17), esophagoscopy (12), contrast esophagography (9), angiography (8), and bronchoscopy (3). Repair of laryngotracheal and esophageal injury was performed in the majority of patients. Selected patients with milder Iaryngotracheal injury did not have tracheostomy performed, with no increase in morbidity or mortality. There were 2 (3.5%) early deaths from associated major vascular injury.Conclusion.Mortality can be minimized by aggressive airway control. Endotracheal intubation can be accomplished safely in selected patients with penetrating laryngotracheal injuries. Digestive‐tract injuries can often clinically occult and contribute significantly to morbidity and mortality; therefore, early evaluation of the esophagus is vital. Simple repair of Iaryngotracheal and digestive‐tract injuries can be performed safely with good results. In patients with minor injuries, tracheostomy does not appear to be mandatory. © 1995 Jons Wiley

ISSN:1043-3074    

DOI:10.1002/hed.2880170607

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Little is known about the rehabilitation outcomes of long‐term survivors following treatment for head and neck cancer. There are, for example, no studies on physical and psychosocial rehabilitation outcomes of T1 glottic larynx carcinoma, despite the fact that these form the majority of head and neck cancer sites. Thus, this investigation afforded a unique opportunity for examining similarities and differences among T1 glottic larynx patients, laryngectomy patients, and those who had surgery for cancer of the oral cavity and/or oropharynx along a variety of physical and psychosocial dimensions.Methods.To describe the impact of these three types of head and neck cancer and their treatment on the physical and psychosocial functioning of long‐term survivors, a selfreport questionnaire was completed by 110 patients treated between 2 and 6 years previously in a major cancer center.Results.Data indicate that a higher percentage of patients treated with laryngectomy or commando procedures still experience severe psychosocial distress between 2 and 6 years after their last treatment than do patients treated with radiotherapy for a T1 carcinoma of the glottic larynx. Psychosocial and physical complaints are still reported by many laryngectomy patients, apparently the result of problems in effective communication with others. Many commando procedure patients experience problems with respect to food intake, and with disfigurement and its consequences. T1 Iarynx patients mainly experience a considerable number of physical complaints. The greater the time that had elapsed since treatment, the fewer the psychosocial problems associated with head and neck tumors. Open discussion of the illness in the family, social support, and perceptions of adequate information from the specialist are the most important predictors of positive rehabilitation outcomes.Conclusions.This study indicates that T1 Iarynx patients report many physical complaints even though several years had elapsed since treatment. Also, Iaryngectomy patients may need psychosocial guidance for a longer posttreatment period and that health care personnel must involve the partner as much as possible in all communications. Commando procedure patients in particular feel hindered by their disfigurement and its consequences. Future research with respect to validation of the specific head and neck modules is nee

ISSN:1043-3074    

DOI:10.1002/hed.2880170608

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Recent results suggest that some PKC isotypes, when overexpressed, confer to cultured fibroblasts certain proliferative advantages, and enhanced tumorigenicity in nude mice, suggesting their participation in carcinogenic processes. These findings need to be validated through the investigation of potential alterations of these kinases in common forms of human cancers.Material and Methods.In this prospective study we determined levels of different PKC isozymes by Western blot in tissue extracts from 29 human primary squamous cell carcinomas of the oral cavity, and their respective controls. These expressions were correlated with behavior of tumor and histologic characteristics.Results.Dramatic alterations in different PKC isotypes were found. Thus, increased levels of isotypes α, β, or γ, and ε were found in most of the patients, as well as significant correlations between levels of the isotype and survival‐relapse rate and classical PKC isotypes with irregular morphology of tumoral interphase.Conclusions.These results suggest participation of some PKC isotypes (α, β, γ, and δ) in the genesis and behavior (ε) of oral cancers. Levels of PKC could be used as prognostic marker. © 1995 Jons Wile

ISSN:1043-3074    

DOI:10.1002/hed.2880170609

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Recurrence is common after total laryngectomy for advanced laryngeal carcinoma. The aim of the present study was to review the prognosis of recurrent laryngeal carcinoma after total laryngectomy.Methods.The records of 165 patients who developed recurrences after total laryngectomy for laryngeal squamous cell carcinoma between January 1971 and December 1990 were reviewed.Results.Of the 165 patients who developed recurrences, 34 (21%) patients had surgical salvage. The sites of recurrence of these 34 operable patients included 11 pharyngeal, 3 tracheostomal, 15 nodal, 2 pharyngeal with nodal, and 3 pulmonary metastasis. Pharyngeal recurrence had the highest salvage rate, followed by nodal and pulmonary recurrence. All patients with tracheostomal had recurrence after salvage surgery. After the surgical salvage, the tumor recurrence rate was 44% and the 5‐year actuarial survival rate was 42%. Of the other 131 patients who had palliative treatment without surgical salvage, the 5‐year actuarial survival rate was 2%.Conclusions.The present study showed that patients who had surgical salvage for recurrent tumor after total laryngectomy had satisfactory prognosis. Close follow‐up of patients after initial operation is essential to detect recurrence early, while surgical salvage is still fea

ISSN:1043-3074    

DOI:10.1002/hed.2880170610

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Serum liver function tests (LFTs) are used in the initial evaluation of patients with head and neck squamous cell carcinoma (SCC) to evaluate hepatic function and to screen for liver metastases.Methods.One hundred forty patients initially seen with SCC between 1988 and 1991 were followed for a minimum of 2 years to determine the significance of abnormal LFTs at presentation.Results.Abnormal values were found in 69 patients (49%), including elevated alkaline phosphatase in 37 (26%) and lactic dehydrogenase in 25 (18%). Abnormal values were most commonly attributed to alcohol‐related liver disease. No liver metastases were identified at initial screening. LFTs were normal at presentation in all three patients subsequently identified with liver metastases during follow‐up.Conclusions.Abnormal LFTs are commonly encountered but are of little value in identifying patients with liver metastases during initial assessment. Modest elevation of LFTs should not necessitate costly and time‐consuming investigation to exclude hepatic metastasis. © 1995 Jons Wiley&Son

ISSN:1043-3074    

DOI:10.1002/hed.2880170611

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY