Laryngeal Cancer Patients Research Articles

Enhancing quality of life in head and neck cancer patients: a comparative analysis of 3D exoscope-assisted surgery vs. traditional approaches.

The increasing population of survivors of head and neck carcinomas is becoming more conspicuous. Consequently, the pivotal role of quality of life, particularly elucidated through the assessment of dysphagia and dysphonia, is progressively influencing the decision-making process. The current study aims to assess whether VITOM 3D could offer a comparable post-treatment quality of life to traditional approaches for patients with laryngeal cancer and oro-hypopharyngeal cancer. A case series of laryngeal cancer and oro-hypopharyngeal cancer patients treated either with an exoscopic-assisted surgical setup and with conventional treatments (transoral microsurgery and radio-chemotherapy) at the Otolaryngology Unit of IRCCS San Martino Hospital, Genoa, is presented. The post-treatment quality of life of the two cohorts were compared through the administration of the University of Washington Quality of Life Questionnaire, Voiceik Handicap Index-10, M.D. Anderson Dysphagia Inventory were administrated to both cohorts of patients. In the laryngeal cancer group, a total of 79 patients were included. Of these, 50.1% underwent transoral exoscope-assisted surgery, while 49.9% underwent primary transoral microscopic-assisted surgical approach. No significant differences were observed in terms of the University of Washington Quality of Life Questionnaire and Voice Handicap Index-10 between the two subgroups. Conversely, in the oro-hypopharyngeal cancer group, 43 patients were included. Of these, 37.2% underwent primary transoral exoscope-assisted surgery, while 62.8% received (chemo)radiotherapy. No notable differences were reported in terms of the University of Washington Quality of Life Questionnaire and M.D. Anderson Dysphagia Inventory between the transoral exoscope-assisted surgery and (chemo)radiotherapy subgroups. Assessments of quality of life, conducted through the University of Washington Quality of Life Questionnaire questionnaire, dysphonia evaluations using the Voice Handicap Index-10, and dysphagia assessments employing the M.D. Anderson Dysphagia Inventory questionnaire, demonstrate analogous outcomes between conventional treatment modalities and transoral interventions utilizing the 3D exoscope.

The impact of margins in laryngeal cancer patients treated with transoral laser microsurgery: a systematic review and meta-analysis.

In laryngeal squamous cell carcinoma (LSCC) treated with transoral laser microsurgery (TOLMS), the status of margins significantly affected local control. When a positive or close margin is present, there is no ubiquitous consensus regarding further treatments. The rationale of the present systematic review and meta-analysis is to investigate the survival impact of the status of the margins in patients affected by LSCC treated with TOLMS. PubMed, EMBASE, and Cochrane Library. We performed a systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were: patients affected by LSCC, staged according to the American Joint Committee on Cancer Staging System and treated by TOLMS without any previous treatment; margins status (close, positive, negative) and the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of overall survival, disease-specific survival, and disease-free survival has to be reported. Nine studies were deemed eligible for the qualitative analysis, and 3 for the quantitative analysis to investigate the association between margin status and OS. The cumulative number of patients was 3130. The sample size ranged from 96 to 747 patients. The follow-up period ranged from 0 to 201months. The meta-analysis results show that positive margins have an aHR of 1.30 yet with CI range (0.56 to 2.97). Our current meta-analysis results are unable to definitively assess the real impact of resection margins on OS. Few authors provide accurate data regarding position and types of margins. Further prospective or high-quality studies are required.

Risk factors and healing factors for pharyngocutaneous fistula after total laryngectomy for laryngeal cancer: An epidemiological study.

To analyse the risk factors and healing factors of pharyngocutaneous fistula (PCF) in patients with laryngeal cancer after total laryngectomy, and to explore the relevant epidemiology. A retrospective analysis was conducted on laryngeal cancer patients who underwent total laryngectomy in our hospital from January 2010 to December 2022. The 349 patients included in the study were divided into a PCF group of 79 and a non-PCF group of 270. Perform one-way analysis of variance and multivariate logistic analysis on various data of patients included in the statistics, and analyse the risk factors and healing factors of PCF. Smoking, history of radiation therapy for laryngeal cancer, history of chemotherapy for laryngeal cancer, tumour location (larynx, pharynx, oesophagus), preoperative albumin, postoperative proteinaemia, <99 haemoglobin, postoperative haemoglobin, postoperative C-reactive protein (CRP) level are the risk factors for PCF. Also, radiation therapy and postoperative proteinaemia were the main reasons for preventing PCF healing. Smoking history, laryngeal cancer, radiation therapy, albumin, haemoglobin and CRP are risk factors for postoperative PCF after total laryngectomy, while radiation therapy and postoperative hypoalbuminaemia are key factors affecting PCF healing.

Abstract 5060: Role of molecular driver mutations in recurrence of early stage laryngeal cancer following narrow field definitive radiotherapy

Abstract PURPOSE/OBJECTIVES Recurrent early-stage laryngeal cancer poses profound clinical and prognostic dilemmas. The primary endpoint of this study was to identify patient exome differences between early-stage laryngeal cancer patients who responded or rapidly progressed following definitive, narrow field radiotherapy. Our study offers the first exploration of mutation patterns in early-stage laryngeal head and neck squamous cell carcinoma (HNSCC) patients receiving curative radiation therapy. MATERIALS/METHODS We identified 36 early-stage laryngeal (T1 = 8, T1a = 4, T1b = 2, T1c = 1, T2 = 20, NA =1) HNSCC patients from the University of Kansas Medical Center treated with definitive narrow field radiotherapy to 63-70 Gray (gy) dose. Whole exome sequencing was performed in all patients. Patients were stratified into “responders” (never failed, N=14) and “non-responders” (recurrence &amp;lt;12 months, N=21). Most non-responder patients with local recurrence underwent total salvage laryngectomy (TSL, N=18). All patients underwent whole exome sequencing. The Genome Analysis Toolkit (GATK) was used for pre-processing and functional annotation of variants. Cancer driver genes were detected for each group using the OncodriveCLUST algorithm. Differentially mutated genes were assessed using Fisher’s exact or exact McNemar’s test at P &amp;lt; 0.05. Tumor mutational burden (TMB) comparisons employed the Wilcoxon rank-sum test with the same threshold. For pathway analysis in Reactome and Ingenuity, a P &amp;lt; 0.1 was used for exploratory significance. RESULTS Mutation analysis identified distinct cancer driver genes between responders, (N=3), non-responders (N=36), and post-TSL (N=4). Among 75 genes with significant pre-treatment mutation differences between responders and non-responders, KCNT2 and AGAP6 were exclusively mutated in non-responders (OR=0, P=0.005 and OR=0, P=0.027, respectively), ADAMTS7 was solely mutated in responders (OR=inf, P=0.019), and PLEC showed more mutations in responders (OR=11.6, P=0.006). Pathway analysis showed these genes were involved in the RND2 GTPase cycle, protein O-glycosylation related diseases, and apoptotic pathways. Post-treatment analysis indicated an enrichment of mutations in apoptosis regulation pathways, with genes like PLEC being more frequently mutated in responders than in non-responders or TSL patients. In addition, we observed in non-responders that they trended towards higher median pre-treatment TMB compared to responders (7.98 vs 6.16, P=0.072). There was no significant difference in TMB between TSL patients and responders or non-responders pre-treatment. CONCLUSION Our analysis reveals distinct mutation patterns in early-stage laryngeal cancer patients by response to radiotherapy and the potential role of these mutated genes in apoptosis related pathways. Citation Format: Aaron Segura, Emily Nissen, Chris Lominska, Ryan Morse, Deri Morgan, Prakash Neupane, Dong Pei, Devin Koestler, Randall Kimple, Umamaheswar Duvvuri, Kevin Sykes, Sufi Thomas, Rohit Nallani, Lisa Shnayder, Kiran Kakarala, Emrullah Yilmaz, Andres Bur. Role of molecular driver mutations in recurrence of early stage laryngeal cancer following narrow field definitive radiotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5060.

High Expression of Sphingosine-1-Phosphate Phosphatase 1 Inversely Correlates with p16 Expression and Is Associated with Poor Prognosis in Laryngeal Cancer Patients

High Expression of Sphingosine-1-Phosphate Phosphatase 1 Inversely Correlates with p16 Expression and Is Associated with Poor Prognosis in Laryngeal Cancer Patients

Repairing partial suprahyoid epiglottis-preserved circumferential defect in near total laryngectomy with anterior medial thigh flap in advanced laryngeal cancer

To explore the feasibility to restore pronunciation function by repairing partial suprahyoid epiglottis-preserved circumferential defect in near total laryngectomy with anterior medial thigh flap in advanced laryngeal cancer. A retrospective study of 5 male patients with advanced laryngeal cancer between August 2019 and October 2022, aged 56-73 years, with an average age of 65 years were reviewed. The disease duration ranged from 3 to 24 months, with an average of 8 months. Tumor classification by location: 2 cases of glottic type, 2 cases of supraglottic type, and 1 case of subglottic type; TNM staging: 3 cases of T 4N 0M 0 stage, 1 case of T 4N 1M 0 stage, and 1 case of T 4N 2M 0 stage; American Joint Committee on Cancer (AJCC) staging (2017): stage Ⅳ. Near total laryngectomy with partial suprahyoid epiglottis-preserved and selective bilateral neck dissection were performed before the anterior medial thigh flap was used to repair the circumferential defects. The flap size ranged from 6 cm×5 cm to 8 cm×6 cm. Four patients underwent adjuvant radiotherapy and chemotherapy after operation, while 1 patient did not receive any other adjuvant treatment such as radiochemotherapy. The flaps of all 5 patients survived without obvious neck infection. One patient developed a slight pharyngeal fistula after oral feeding at 1 month after operation, which healed after another week of gastric feeding. Primary healing also achieved in the thigh donor area. One patient had bilateral cervical lymph node metastasis, and 1 patient had lymph node metastasis on one side. The remaining 3 patients had no cervical nodes metastasis on both sides. All 5 patients were followed up 12-36 months, with an average of 27.6 months. Four patients had clear, audible, and hoarse voice while 1 patient (case 3) had pronunciation similar to whispering. Laryngoscopy showed that the reconstructed laryngeal inlet was fissure-shape and the reconstructed laryngo-trachea canal below the laryngeal inlet was gradually enlarged. At 1 month after operation, the gastric tube was withdrawn and the food was taken orally. There was no obvious aspiration pneumonia. The tracheostomy tube could be blocked in 4 patients for from 30 seconds to 3 minutes. Among them, 3 patients were able to make a noticeable pronunciation even when the tube was not blocked, and they were able to engage in barrier-free language communication; the tracheostomy tube could not be blocked in 1 patient who had a pronunciation similar to whispering. Preliminary voice analysis showed that the patients have a relaxed and natural pronunciation, without obvious breath-holding or air-swallowing movement, compared to patients with esophageal pronunciation. Decannulation did not achieved until the last follow-up in all 5 patients. The anterior medial thigh flap can repair circumferential defects after near total laryngectomy in advanced laryngeal cancer patients and achieve satisfactory pronunciation, thus can serve as an effective pronunciation rehabilitation method. The preserved part of epiglottis may play a role to prevent postoperative aspiration.

Autoantibodies in laryngeal cancer: detection and role as a biomarker.

Diagnostic role of autoantibodies (AAb) as serological biomarkers has not been specifically investigated in laryngeal cancer (LC) previously. The study investigates the presence of anti-LC AAbs and their potential as a biomarker for early diagnosis of LC, to improve patient outcome. Anti-LC AAb levels were investigated in LC patients (n = 30) and healthy individuals (n = 30) by indirect enzyme-linked immunosorbent assay (ELISA). Patient AAb levels were analyzed with various clinical factors, primarily tumor stage. AAb levels were significantly higher in LC patients than in the control group (P = .019). The diagnostic performance of AAb-level testing for LC detection presented a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 70% each. The positive likelihood (LR+) and negative likelihood (LR-) ratios were 2.33 and 0.43, respectively. AAb levels were independent of cancer stage (P = .708), duration since first appearance of symptoms (P = .228), duration of medical attention (P = .231), and degree of risk-factor exposure (P = .478). Significant level of AAbs could be detected among LC patients with good diagnostic performance, irrespective of stage. Thus, anti-LC AAbs reflect potential to be utilized as predictive biomarkers in early diagnostics of LC.

Generation of a Realistic Synthetic Laryngeal Cancer Cohort for AI Applications

Background: Obtaining large amounts of real patient data involves great efforts and expenses, and processing this data is fraught with data protection concerns. Consequently, data sharing might not always be possible, particularly when large, open science datasets are needed, as for AI development. For such purposes, the generation of realistic synthetic data may be the solution. Our project aimed to generate realistic cancer data with the use case of laryngeal cancer. Methods: We used the open-source software Synthea and programmed an additional module for development, treatment and follow-up for laryngeal cancer by using external, real-world (RW) evidence from guidelines and cancer registries from Germany. To generate an incidence-based cohort view, we randomly drew laryngeal cancer cases from the simulated population and deceased persons, stratified by the real-world age and sex distributions at diagnosis. Results: A module with age- and stage-specific treatment and prognosis for laryngeal cancer was successfully implemented. The synthesized population reflects RW prevalence well, extracting a cohort of 50,000 laryngeal cancer patients. Descriptive data on stage-specific and 5-year overall survival were in accordance with published data. Conclusions: We developed a large cohort of realistic synthetic laryngeal cancer cases with Synthea. Such data can be shared and published open source without data protection issues.

Oncological and functional outcomes in T3 and T4 laryngeal cancer patients: choice for larynx preservation or total laryngectomy based on expected laryngeal function.

To determine oncological and functional outcomes in patients with T3 and T4 laryngeal carcinoma, in which choice of treatment was based on expected laryngeal function and not T classification. Oncological outcomes (disease-specific survival and overall survival) as well as functional outcomes (larynx preservation and functional larynx preservation) were analysed. In 130 T3 and 59 T4 patients, there was no difference in disease-specific survival or overall survival rates after radiotherapy (RT) (107 patients), chemoradiotherapy (36 patients) and total laryngectomy (46 patients). The five-year disease-specific survival rates were 83 per cent after RT, 78 per cent after chemoradiotherapy and 69 per cent after total laryngectomy, whereas overall survival rates were 62, 54 and 60 per cent, respectively. Five-year larynx preservation and functional larynx preservation rates were comparable for RT (79 and 66 per cent, respectively) and chemoradiotherapy (86 and 62 per cent, respectively). There is no difference in oncological outcome after (chemo)radiotherapy or total laryngectomy in T3 and T4 laryngeal carcinoma patients whose choice of treatment was based on expected laryngeal function.

The Relationship between Cancer Stage, Selected Immunological Parameters, Epstein-Barr Virus Infection, and Total Serum Content of Iron, Zinc, and Copper in Patients with Laryngeal Cancer.

(1) Background: the purpose of the study was to assess the relationship between cancer stage, selected immunological parameters, Epstein-Barr virus (EBV) infection, and total serum content of iron, zinc, and copper in patients with laryngeal cancer (LC). (2) Methods: serum Fe, Zn, and Cu were measured in 40 LC patients and 20 controls. Immunophenotyping of peripheral blood lymphocytes was performed by flow cytometry using fluorescent antibodies against CD3, CD4, CD8, CD19, CD25, CD69, and PD-1. Tumor and lymph node lymphocytes were analyzed by flow cytometry. EBV DNA was quantified by real-time PCR, targeting the EBNA-1 gene. Associations between serum elements, immune markers, and cancer grade/stage were evaluated using ANOVA and appropriate nonparametric tests. (3) Results: levels of Fe, Cu, and Zn were lower, while Cu/Zn was statistically higher, in patients with LC than in the control group. Correlation analysis showed a statistically significant association between the levels of these elements and parameters of the TNM (Tumor, Node, Metastasis) staging system, immunophenotype, and the amount of EBV genetic material in patients with LC who survived for more than 5 years. (4) Conclusion: the results suggest that the total serum levels of the determined micronutrients may significantly affect the immunopathogenesis and progression of LC.

Analysis of swallowing and voice-related quality of life in patients after supracricoid partial laryngectomy

ObjectiveThis study evaluated the swallowing and voice function of laryngeal cancer patients after Supracricoid Partial Laryngectomy(SCPL), and its influence on quality of life to provide a reference for the selection of surgical methods for laryngeal cancer patients.MethodsTwenty-one patients who received SCPL between April 2015 and November 2021 were included. Each patient’s swallowing function and quality of life were assessed through fiberoptic endoscopic examination of swallowing (FEES) and the M.D. Anderson Dysphagia Inventory (MDADI). Fundamental, jitter, shimmer, maximum phonation time (MPT), and voice handicap index-10 (VHI-10) were performed to assess voice function and voice-related quality of life.ResultsThe results of the FEES of the 21 patients were as follows: the rates of pharyngeal residue after swallowing solid, semiliquid, and liquid food were 0%, 28.57%, and 38.09%, respectively; the rates of laryngeal infiltration after swallowing solid, semiliquid, and liquid food were 0%, 28.57%, and 4.76%, respectively; and aspiration did not occur in any of the patients. In the evaluation of swallowing quality of life, the mean total MDADI score was 92.6 ± 6.32. The voice function evaluation showed that the mean F0, jitter, shimmer, and MPT values were 156.01 ± 120.87 (HZ), 11.57 ± 6.21 (%), 35.37 ± 14.16 (%) and 7.85 ± 6.08 (s), respectively. The mean total VHI-10 score was 7.14 ± 4.84.ConclusionSCPL provides patients with satisfactory swallowing and voice function. The patients in this study were satisfied with their quality of life in terms of swallowing and voice. SCPL can be used as a surgical method to preserve laryngeal function in patients with laryngeal cancer.

Survival rate of laryngeal cancer patients treated in Brazil's Unified Health System - SUS, 2002-2010

The scope of this article was to analyze the five-year survival rate among patients with laryngeal cancer treated in the Unified Health System in Brazil and its regions between January 2002 and June 2010. There is still scarce information in Brazil regarding the scale and survival rate of laryngeal cancer patients, which makes it difficult to adopt specific strategies for the control of the condition in the country. A retrospective cohort study based on the National Oncology Database was conducted, and the survival probability rate for laryngeal cancer according to age, sex and Brazilian regions/states was estimated using the Kaplan-Meier method. The log-rank test was used to assess the differences observed, considering a 5% significance level. Survival in Brazil was estimated at 50.8% (95%CI: 49.9%-51.8%), being lower among male patients (49.1%; 95%CI: 48.10%-50.16%); between 50 and 60 years of age (48.4%; 95%CI: 46.7%-50.0%); for residents of the Northern region (45.5%; 95%CI: 39.5%-51.3%). The regional variation in the survival rate for laryngeal cancer in Brazil reveals disparities between Brazilian regions/states that may be linked to inequality of access to diagnosis and/or treatment.

Non-invasive diagnosis of upper airway malignancies based on the analysis of markers in exhaled air

The purpose of the study was to evaluate diagnostic capabilities of the gas analysis sensor device used for the study of exhaled gas samples obtained from patients with oropharyngeal and laryngeal cancers.Material and Methods. Exhaled gas samples from 31 oropharyngeal and laryngeal cancer patients and 31 healthy volunteers were studied using a diagnostic device based on the detection of volatile compounds in inhaled air using semiconductor gas sensors with subsequent neural network analysis.Results. Based on the signals from gas sensors, the neural network classified and identified patients with malignant neoplasms. The sensitivity and specificity of the method were 67.74% and 87.1%, respectively.Conclusion. The gas analysis sensor device and the method for detecting oropharyngeal and laryngeal tumors using the exhaled gas analysis are an accessible and cheap diagnostic tools, and are promising for screening the population in order to select individuals for a comprehensive examination (endoscopic, radiological and morphological) in identifying suspicion of cancer.

Wpływ pandemii COVID-19 na diagnostykę pacjentów z rakiem krtani

IntroductionPatients’ access to public healthcare has been limited during the COVID-19 pandemic. The psychological factor – the fear of patients and medical staff of infection, especially before the introduction of vaccinations – had also a negative impact on the diagnostic and therapeutic procedures.AimThe aim of the study was to assess the impact of the COVID-19 pandemic on the degree of advancement of laryngeal cancer in patients referring for diagnosis and treatment to a IV-level clinical referral hospital.Material and methodsThe medical documentation of patients presenting to IVth level reference clinical hospital was retrospectively analyzed in pre-, during and post-pandemic period of time. The total number of patients presenting to the emergency department (ED), inclusive of those receiving otolaryngological consultation, patients diagnosed with laryngeal cancer and advancement stage of disease was assessed. Additionally the comprehensive count of diagnostic and therapeutic procedures pertaining to the larynx and trachea, during the three above mentioned periods of time was performed.Results and discussionThe study revealed a significant decrease in the number of patients presenting to the ED during the pandemic, with a more pronounced drop among otolaryngological patients. The number of patients with laryngeal tumor treated in our hospital as well as the number of laryngeal diagnostic and therapeutic procedures remained stable throughout analysed periods of time. During pandemic period significant drop of patients with early-stage (T1) laryngeal cancers was observed.ConclusionsDespite maintained surgical activity in level IV reference hospital, fewer patients with early stage of laryngeal cancer (T1) were diagnosed and treated during pandemic.

Effective prognostic risk model with cuproptosis-related genes in laryngeal cancer

ObjectiveLaryngeal cancer, characterized by high recurrence rates and a lack of effective biomarkers, has been associated with cuproptosis, a regulated cell death process linked to cancer progression. In this study, we aimed to explore the roles of cuproptosis-related genes in laryngeal cancer and their potential as prognostic markers and therapeutic targets. MethodsWe collected comprehensive data from The Cancer Genome Atlas and Gene Expression Omnibus databases, including gene expression profiles and clinical data of laryngeal cancer patients. Using clustering and gene analysis, we identified cuproptosis-related genes with prognostic significance. A risk model was constructed based on these genes, categorizing patients into high- and low-risk groups for outcome comparison. Univariate and multivariate analyses were conducted to identify independent prognostic factors, which were then incorporated into a nomogram. Gene Set Enrichment Analysis was employed to explore pathways distinguishing high- and low-risk groups. ResultsOur risk model, based on four genes, including transmembrane 2, dishevelled binding antagonist of β-catenin 1, stathmin 2, and G protein-coupled receptor 173, revealed significant differences in patient outcomes between high- and low-risk groups. Independent prognostic factors were identified and integrated into a nomogram, providing a valuable tool for prognostic prediction. Gene Set Enrichment Analysis uncovered up-regulated pathways specifically associated with high-risk patient samples. ConclusionThis study highlights the potential of cuproptosis-related genes as valuable prognostic markers and promising therapeutic targets in the context of laryngeal cancer. This research sheds light on new avenues for understanding and managing this challenging disease. Level of evidenceLevel 4.

A practical online prediction platform to predict the survival status of laryngeal squamous cell carcinoma after 5 years

ObjectiveCurrently, there are few practical tools for predicting the prognosis of laryngeal squamous cell carcinoma (LSCC). This study aims to establish a model and a convenient online prediction platform to predict whether LSCC patients will survive 5 years after diagnosis, providing a reference for further evaluation of patient prognosis. MethodsThis is a retrospective study based on data collected from two centers. Center 1 included 117 LSCC patients with survival prognosis data, and center 2 included 33 patients, totaling 150 patients. All data were divided into independent training sets (60 %) and testing sets (40 %). Eight machine learning (ML) algorithms were used to establish models with 11 clinical parameters as input features. The accuracy, sensitivity, specificity, and receiver operating characteristic curve (ROC) of the testing set were used to evaluate the models, and the best model was selected. The model was then developed into a website-based 5-year survival status prediction platform for LSCC. In addition, we also used the SHapley Additive exPlanations (SHAP) tool to conduct interpretability analysis on the parameters of the model. ResultsThe LSCC 5-year survival status prediction model using the support vector machine (SVM) algorithm achieved the best results, with accuracy, sensitivity, specificity, and area under the ROC curve (AUC) of 85.0 %, 87.5 %, 75.0 %, and 81.2 % respectively. The online platform for predicting the 5-year survival status of LSCC based on this model was successfully established. The SHAP analysis shows that the clinical stage is the most important feature of the model. ConclusionThis study successfully established a ML model and a practical online prediction platform to predict the survival status of laryngeal cancer patients after 5 years, which may help clinicians to better evaluate the prognosis of LSCC. Level of evidence3.

Risk factors of secondary cancer in laryngeal, oropharyngeal, or hypopharyngeal cancer after definitive therapy.

Our previous research showed that a high rate of secondary carcinogenesis is observed during follow-up after transoral surgery in patients with early-stage laryngeal, oropharyngeal, and hypopharyngeal cancers. We speculate that the contributing factors are alcohol drinking, smoking, and aging; however, we could not provide clear evidence. In this study, we aimed to identify the risk factors for secondary carcinogenesis in patients with these cancers, particularly factors associated with drinking and/or smoking. The medical records of all-stage laryngeal, oropharyngeal, and hypopharyngeal cancer patients who had undergone definitive treatment were retrospectively analyzed. Assessments included visual and endoscopic observations of the primary site, enhanced cervical CT or US of the primary site and regional lymph nodes, PET-CT, and enhanced whole-body CT. Clinical characteristics were compared in patients with and without secondary carcinogenesis and in patients with hypopharyngeal cancer and patients with other cancers. Hypopharyngeal cancer was an independent risk factor for secondary cancer. The 5-year incidence rate of secondary cancer was 25.5%, 28.6%, and 41.2% in laryngeal, oropharyngeal, and hypopharyngeal cancers, respectively. Radiotherapy was defined as an independent risk factor in hypopharyngeal cancer patients with secondary cancers. No direct correlation was found between secondary carcinogenesis and alcohol consumption, smoking, or aging. Patients with hypopharyngeal cancer require close follow-up as they are at high risk of developing secondary cancer, possibly because out-of-field radiation exposure may induce systemic secondary carcinogenesis in hypopharyngeal cancer patients with genetic abnormality induced by alcohol consumption.

Comparison of three nutritional assessment methods associated with the prognostic impact of laryngeal cancer.

Several studies have found that the prognostic nutritional index (PNI), controlling nutritional status (CONUT), and Glasgow Prognostic Score (GPS) of patients with laryngeal cancer accurately predict their prognosis. However, there is no consensus regarding the best assessment tool. Therefore, this study aimed to confirm the predictive value of the three nutritional scoring systems for the prognosis of patients with laryngeal cancer. This study analyzed a cohort of 427 patients with laryngeal cancer who visited our hospital. PNI, CONUT, and GPS were calculated, and the relationship between these indicators and prognosis was examined. The optimal cut-off levels for overall survival (OS) of laryngeal cancer patients determined by PNI, CONUT, and GPS were 45, 3, and 0, respectively. When patients were stratified based on these thresholds, OS and disease-free survival (DFS) were significantly decreased in the malnutrition group (all three, p < 0.05). The OS rates of patients with laryngeal cancer were significantly affected by the three scores according to multivariate analysis. The three scoring methods had a high predictive value for the prognosis of patients with laryngeal cancer, with GPS having the strongest correlation with the prognosis of laryngeal cancer patients.

Endoscopic autofluorescence imaging in the diagnosis of premalignant lesions and laryngeal/hypopharyngeal cancer

The purpose of the study was to assess the diagnostic value of endoscopic autofluorescence imaging (AFI) in patients with premalignant lesions and primary laryngeal/hypopharyngeal cancer.Material and Methods. The diagnostic value of AFI was assessed in 53 patients with chronic hyperplastic laryngeal/hypopharyngeal lesions and 48 patients with laryngeal/hypopharyngeal cancer.Results. The inclusion of video laryngoscopy with AFI in the algorithm for examining patients with chronic diseases of the upper respiratory tract made it possible to significantly improve the diagnostic efficacy of endoscopic examination in patients with premalignant lesions (high grade dysplasia) of the laryngeal mucosa. Video laryngoscopy with AFI was found to achieve higher sensitivity, specificity and accuracy rates than white light video laryngoscopy (87.5, 96.9 and 92.5 vs 50.0, 96.0 and 71.7 %, respectively, p&lt;0.05). The video laryngoscopy with AFI allowed identification of not only pathological changes in the laryngeal and hypopharyngeal mucosa but also their malignant potential, as well as identification of areas for targeted biopsy. In 9 (18.8 %) laryngeal cancer patients, the standard white light video laryngoscopy demonstrated difficulties in the differential diagnosis of laryngeal cancer (n=4) and in assessing the extent of laryngeal cancer (n=5). In 3 out of 4 diagnostically difficult cases, video laryngoscopy with AFI made it possible to confirm the diagnosis of laryngeal cancer and in 5 cases to accurately determine the extent of hypopharyngeal cancer.Conclusion. The addition of standard videolaryngoscopy with a hightech technique of autofluorescence endoscopy makes it possible to accurately diagnose premalignant and malignant lesions of the larynx and hypopharynx.

Comorbidities and Laryngeal Cancer in Patients with Obstructive Sleep Apnea: A Review.

Introductions: The global prevalence of obstructive sleep apnea shows that this disease appears in 1 billion people, with the prevalence exceeding 50% in some countries. Treatment is necessary to minimize negative health impacts. Obstructive sleep apnea (OSA) is defined as a cause of daytime sleepiness, as well as a clinical manifestation of sleep-disordered breathing. In the literature, there are numerous controversial studies regarding the etiology of this condition, but it is universally accepted that reduced activity in the upper airway muscles plays a significant role in its onset. Additionally, OSA has been associated with a series of comorbidities, such as type II diabetes, metabolic syndrome, and cardiovascular and pulmonary conditions, as well as head and neck tumors, especially oropharyngeal and laryngeal tumors. This is a review of the subject of OSA that considers several aspects: an analysis of the comorbidities associated with OSA, the involvement of tumor pathology in the onset of OSA, and the association of OSA with various types of laryngeal cancers. Additionally, it includes an evaluation of postoperative and medical outcomes for patients with OSA and laryngeal tumors treated surgically and medically, including chemotherapy. Relevant Sections: By taking into consideration the stated objective, a systematic analysis of the available literature was conducted, encompassing the PubMed, Medline, and Scopus databases. The evaluation was based on several keywords, including head and neck cancer, diabetes, diabetic, overlap syndrome, cardiovascular conditions, laryngeal neoplasm, radiotherapy, and chemotherapy, as well as the concept of quality of life in laryngectomized patients and patients with OSA. Discussions: The review evaluates the involvement of OSA in the presence of comorbidities, as well as the increased incidence of OSA in patients with laryngeal cancer. It is important to note that surgical and post-surgical treatment can play a significant role in triggering OSA in these patients. Conclusions: The studies regarding the correlations between OSA, comorbidities, and head and neck tumors indicate a significantly increased risk of OSA in association with conditions such as diabetes, metabolic syndrome, cardiovascular diseases, and head and neck tumors, particularly laryngeal tumors. This association has a physio-pathological basis. The various surgical methods followed by radiation and chemotherapy for tumor treatment do not exclude an increased risk of developing OSA after treatment. This significantly influences the quality of life of patients who survive these types of tumors. Future directions: Due to the multiple comorbidities associated with OSA, the extension of polysomnography associated with investigations during sleep, such as drug-induced sleep endoscopy, represents a tendency for the early diagnosis of this pathology, which affects the quality of life of these patients. Patients with head and neck cancer are at high risk of developing obstructive sleep apnea; this is why it is necessary to expand the polysomnographic investigation of these patients after surgical procedures or after radiotherapy and chemotherapy.