Submandibular Gland Cancer Research Articles

Novel decision tree models predict the overall survival of patients with submandibular gland cancer.

While the accurate prediction of the overall survival (OS) in patients with submandibular gland cancer (SGC) is paramount for informed therapeutic planning, the development of reliable survival prediction models has been hindered by the rarity of SGC cases. The purpose of this study is to identify key prognostic factors for OS in SGC patients using a large database and construct decision tree models to aid the prediction of survival probabilities in 12, 24, 60 and 120 months. We performed a retrospective cohort study using the Surveillance, Epidemiology and End Result (SEER) program. Demographic and peri-operative predictor variables were identified. The outcome variables overall survival at 12-, 24-, 60, and 120 months. The C5.0 algorithm was utilized to establish the dichotomous decision tree models, with the depth of tree limited within 4 layers. To evaluate the performances of the novel models, the receiver operator characteristic (ROC) curves were generated, and the metrics such as accuracy rate, and area under ROC curve (AUC) were calculated. A total of 1,705, 1,666, 1,543, and 1,413 SGC patients with a follow up of 12, 24, 60 and 120 months and exact survival status were identified from the SEER database. Predictor variables of age, sex, surgery, radiation, chemotherapy, tumor histology, summary stage, metastasis to distant lymph node, and marital status exerted substantial influence on overall survival. Decision tree models were then developed, incorporating these vital prognostic indicators. Favorable consistency was presented between the predicted and actual survival statuses. For the training dataset, the accuracy rates for the 12-, 24-, 60- and 120-month survival models were 0.866, 0.767, 0.737 and 0.797. Correspondingly, the AUC values were 0.841, 0.756, 0.725, and 0.774 for the same time points. Based on the most important predictor variables identified using the large, SEER database, decision tree models were established that predict OS of SGC patients. The models offer a more exhaustive evaluation of mortality risk and may lead to more personalized treatment strategies.

A phase I/II open label, multicenter study to assess the safety, tolerability, pharmacokinetics, and efficacy of HB0028 in patients with advanced solid tumors.

2528 Background: HB0028 is a bifunctional fusion protein consisting of an anti-PD-L1 IgG1 single domain antibody and TGF-β RII receptor extracellular domain (TGFβRII-ECD). This is the first dose escalation and expansion phase I/II study to evaluate the safety and preliminary anti-tumor activity of HB0028 in advanced solid tumors. Methods: In the phase I portion of the study, the patients (pts) with advanced solid tumor were enrolled, and an accelerated titration followed by a standard 3+3 design was applied to dose escalation. The objectives were toxicity evaluation, maximum tolerable dose (MTD), and recommended phase 2 dose (RP2D). Eligible pts with advanced solid cancers of any histologic subtype, and ECOG performance status ≤ 1 were treated with HB0028 (0.3mg, 1mg, 3mg, 10mg, 20mg, Q3W), until unacceptable toxicity or disease progression. Radiologic tumor assessments (by RECIST v1.1) were performed every 6 weeks while on treatment. Results: 16 pts [12 females and 4 males; ECOG 0/1, 9/7; median age 52 years (range 36 – 60)] were enrolled in phase I (0.3 mg/kg [n = 1], 1 mg/kg [n = 3], 3 mg/kg [n = 3], 10 mg/kg [n = 3], 20 mg/kg [n = 6]). Median number of prior lines of systemic therapy was 2 (range 1-4). 8(50%) pts received and progressed upon prior anti-PD-1/L1 therapy. All pts had measurable metastatic disease. No DLT and Death occurred. MTD was not reached. As of DEC 25,2023, among 16 patients' safety data are evaluable for toxicity. Any grade treatment‐related adverse events (TRAEs) occurred in 15 subjects (93.8%), with 2 subjects (12.5%) reported with ≥ Grade 3 (G3 Anemia and G3 γ-glutamyltransferase). The most common TRAEs (all grades) were AST increased (n = 4, 25%), anemia (n = 7, 43.8%) and infusion-related response (n = 5, 31.3%). Two SAEs (G2 AST increased and G3 Neoplastic fevers) were reported, only AST increased was considered as possibly related to study drug, but recovered shortly. The efficacy data cutoff date of DEC 25,2023, 16 patients are evaluable for radiologic response. 1 subject with cervical cancer in HB0028 20 mg/kg group had a partial response (PR), 3 subjects (liver cancer, lung cancer, left submandibular gland cancer) had stable disease (SD) and 12 subjects had progressive disease (PD). The ORR per RECIST 1.1 by investigator was 6.25% (1/16; 95% CI, 0%-30.2%), and the DCR was 25% (4/16; 95% CI, 7.3%-52.4%). Durable clinical benefit (SD for > 32 weeks) was seen in 1 subject with malignant tumor in the left submandibular gland. To date, 2 responders are still on treatment. Conclusions: HB0028 was generally well tolerated, and therapy provided modest antitumor activity in patients with heavily pretreated advanced solid tumors. Based on these data, a phase II prospective clinical trial is being planned in specific cancer. Clinical trial information: NCT06223308 .

Prognostic factors and novel prediction models for overall survival of patients with submandibular gland cancer: A population-based retrospective cohort study

BackgroundAccurately predicting the survival rate of submandibular gland cancer (SGC) is of significant importance for guiding treatment decision-making and improving patient outcomes. This study was aimed to identify the independent prognostic factors of overall survival (OS) in SGC patients, and develop novel prediction models to aid clinicians in predicting the survival probability. Materials and methodsPatients diagnosed with primary SGC after the year 2010 were extracted from SEER database and then randomly allocated into training and test samples in a 7:3 ratio. Uni- and multi-variable COX analyses were employed using the training sample to ascertain independent prognostic factors for OS. Subsequently, graphic and online dynamic nomograms were established basing on the independent prognostic factors. We utilized C-index, calibration curve, receiver operating characteristic (ROC) curve, and area under ROC curve (AUC) value to evaluate the discrimination capacity and the consistency between predicted and actual survival. ResultsA total of 527 SGC patients were included (369 assigned to training group and 158 assigned to test group). The multivariable COX analysis showed that age, sex, marital status, tumor histology, summary stage, metastases to bone, and tumor size were independently associated with OS. Novel graphical and online dynamic (URL: https://yangxg1209.shinyapps.io/overall_survival_submandibular_gland_tumor/) nomograms were established. The C-indices (training: 0.77, 95%CI 0.71–0.84; test: 0.77, 95%CI 0.68–0.85) indicate favorable discrimination ability of the model, and the calibration curves demonstrated favorable consistency between the predicted and actual survival rates. ConclusionsOur study identified the independent prognostic factors influencing OS in patients with SGC, and successfully established and validated novel nomograms, which provide accurate prediction of survival rates and allows for personalized risk assessment.

Clinical Outcomes of Treatment for Submandibular Gland Cancer at Osaka Medical and Pharmaceutical University: A 24-year Experience

Clinical Outcomes of Treatment for Submandibular Gland Cancer at Osaka Medical and Pharmaceutical University: A 24-year Experience

Number and ratio of metastatic lymph nodes impacts the prognosis of submandibular gland cancer.

This study aimed to assess the impact of the number and ratio of metastatic lymph nodes (LNs) on prognosis in submandibular gland cancer. To this end, patients were selected from the Surveillance, Epidemiology, and End Results database retrospectively. The effect of the number and ratio of metastatic LNs and the American Joint Committee on Cancer (AJCC) N stage on disease-specific survival (DSS) and overall survival (OS) was analyzed. In addition, prognostic models based on LN evaluation methods were developed to predict the OS and DSS. A total of 914 patients were included. Binary recursive partitioning analysis determined the optimal cut-off number of metastatic LNs (0 vs. 1-2. vs. 3+). The presence of 3+ metastatic LNs carried the greatest impact on prognosis, followed by 1-2 positive LNs occurrences. The ratio of metastatic LNs was an independent factor for DSS and OS. The model had a higher likelihood ratio and C-index than those in the Cox model based on the AJCC N stage. Quantitative LN burden and ratio of metastatic LNs provides better survival stratification than the AJCC N stage.

Metastatic lymph node burden impacts overall survival in submandibular gland cancer.

To assess the effect of the number of positive lymph nodes (LNs) on the overall survival (OS) of patients with submandibular gland cancer (SmGC). Patients who had undergone neck dissection for SmGC were retrospectively enrolled in this study. The effect of the American Joint Committee on Cancer (AJCC) N stage, the number of positive LNs, LN size, LN ratio, and extranodal extension (ENE) on OS and recurrence-free survival (RFS) was evaluated using Cox analysis. Prognostic models were proposed based on the identified significant variable, and their performance was compared using hazard consistency and discrimination. In total, 129 patients were included in this study. The number of positive LNs rather than LN ratio, LN size, and ENE was associated with OS. A prognostic model based on the number of positive LNs (0 vs. 1-2 vs. 3+) demonstrated a higher likelihood ratio and Harrell's C index than those according to the 7th/8th edition of the AJCC N stage in predicting OS and RFS. The effect of LN metastasis on OS and RFS was mainly determined by the number of positive LNs. A validation of this finding is warranted in adenoid cystic carcinomas that were not included in this study.

Hybrids of 1,4-Naphthoquinone with Thymidine Derivatives: Synthesis, Anticancer Activity, and Molecular Docking Study.

One of the most essential health problems is cancer, the first or second cause of death worldwide. Head and neck cancers are hard to detect due to non-specific symptoms. The treatment often relies on a combination of radio and chemotherapy. For this reason, the research of new anticancer compounds is fundamental. The natural and synthetic compounds with 1,4-naphthoquinone scaffold is characterized by high anticancer activity. The study aimed to evaluate the synthesis and anticancer activity of hybrids 1,4-naphthoquinone with thymidine derivatives. The series of compounds allows us to check the influence of the substituent in the C3' position of the thymidine moiety on the cytotoxicity against squamous cancer cell lines (SCC-9 and SCC-25) and submandibular gland cancer (A-253). An annexin V/propidium iodide (PI) co-staining assay shows that derivatives cause the apoptotic in SCC-25 and A-253 cell lines. The molecular docking study examined the interaction between the active site of the BCL-2 protein and the hybrids.

Incidence and spread pattern of lymph node metastasis from submandibular gland cancer

ObjectivesTo clarify the indication of neck dissection (ND) for patient with submandibular gland (SMG) cancer.MethodsA total of 43 patients with SMG cancer were retrospectively analyzed. Forty-one patients underwent ND: Levels I–V in 19 patients, Levels I–III in 18 patients, and Level Ib in 4 patients. The other two patients did not undergo ND, since preoperative diagnoses were benign. Postoperative radiotherapy was performed in 19 patients with positive surgical margin, high grade cancer or stage IV disease.ResultsLN metastases were pathologically confirmed in all patients with cN + and 6 out of 31 patients with cN–. No patients developed regional recurrence during follow-up periods. Ultimately, LN metastases were pathologically confirmed in 17 of 27 high grade, one out of 9 intermediate grade, but not in 7 low grade.ConclusionsProphylactic neck dissection should be considered in T3/4 and high grade SMG cancers.

Clinical Analysis of Cases of Submandibular Gland Cancer Treated by Radical Surgery

Clinical Analysis of Cases of Submandibular Gland Cancer Treated by Radical Surgery

Submandibular gland cancers: prognostic factors and survival analysis.

The aim of this study is to evaluate prognosis and prognostic factors affecting oncological outcome. Records of the subjects managed for a submandibular gland cancer (SGC) between January 1997 and June 2014 were retrospectively reviewed. Survival outcomes were analyzed. All subjects had a minimum follow up of 5years or until death. Of 24 subjects (13male, 11 female), 16 (64.6%) were adenoid cystic carcinoma (ACC). Eight patients had clinically positive neck nodes and 2 of the 16 clinically negative necks were also positive histologically. None of the subjects had distant metastases at presentation. The Kaplan-Meier 5-year estimated locoregional control (LRC), distant metastasis free survival (DMFS), disease free survival (DFS) and overall survival (OS) were 62.5%, 83.3%, 58.3% and 66.7%, respectively. American Joint Committee on Cancer (AJCC) overall stage and extra glandular extension (EGE) proved to be significant predictors of LRC. Only smoking was found to be a significant factor related with lower DMFS and only EGE significantly lowered DFS. Positive nodal stage and positive surgical margin were proved to be significant predictors of OS. Surgery alone is effective in subjects with early stage, noninvasive and low-grade cancers. Despite aggressive treatment, locoregional recurrence was common in subjects who were at advanced stage.

Examined and positive lymph nodes counts and lymph nodes ratio are associated with survival in major salivary gland cancer

We aimed to investigate the prognostic role of examined (dissected) lymph nodes (ELNs), negative LNs (NLNs), and positive (metastatic) LNs (PLNs) counts and LN ratio (LNR = PLNs/ELNs×100) in patients with major salivary gland cancer (SGC). Data were retrieved for major SGC patients diagnosed between 1988 and 2011 from Surveillance, Epidemiology, and End Results program. We have included 5446 patients with major SGC. Most patients had parotid gland cancer (84.61%). Patients having >18 ELNs, >4 PLNs, and >33.33% LNR were associated with a worse survival. Moreover, older age, male patients, grade IV, distant stage, unmarried patients, submandibular gland cancer, and received chemotherapy but not received surgery were significantly associated with a worse survival. We demonstrated that patients with >18 ELNs and >4 PLNs counts, and >33.33% LNR were high-risk group patients. We strongly suggest adding the ELNs and PLNs counts and/or LNR into the current staging system.

Nodal Stage: Is It a Prognostic Factor for Submandibular Gland Cancer?

Submandibular gland cancer is relatively rare. The purpose of this study was to estimate 5-year overall survival (OS) and disease-free survival (DFS) and to identify prognostic factors associated with OS and DFS for submandibular cancer. The authors implemented a retrospective cohort study and enrolled a sample of patients with submandibular gland cancer. The predictor variables were age, gender, tumor stage, nodal stage, margin status, and extracapsular spread. The outcome variables were 5-year OS and 5-year DFS. Kaplan-Meier methods were used to estimate survival and Cox hazards models were used to identify prognostic variables. The sample was composed of 52 patients with submandibular gland cancer (mean age, 47.4yr; 51.9% men). The median follow-up was 81months (range, 11 to 159months). The 5-year OS and DFS rates were 76.9 and 67.3%, respectively. Fixed mass, positive neck node, and positive margin status were relevant predictors of OS and DFS. Nodal stage was the relevant independent predictor affecting the disease outcome of submandibular gland cancer. These results identified several important prognostic factors associated with survival rate in patients with submandibular gland cancer. These prognostic variables include symptoms at presentation, pathologic nodal status, and margin status. These outcomes suggest that heightening vigilance of clinical characteristics for this disease might provide the impetus for improving the survival rate.

Submandibular gland cancer: Specific features and treatment considerations.

In the absence of unified treatment protocol, we evaluated the management and outcomes of submandibular gland cancers in an unselected patient series. We included all patients with resected submandibular gland cancer treated at the Helsinki University Hospital from 2000 to 2010 with a 5-year minimum follow-up. Twenty-five patients with cancer represented 30% of submandibular gland neoplasms, and most were adenoid cystic carcinomas (ACCs; 56%). At presentation, 3 patients showed clinical signs of probable malignancy. Of 22 neck dissection specimens, 5 patients (20%) had metastases with an occult metastasis rate of 4%. Cancer recurred in 11 patients (44%), of which 7 (28%) were only at a distant site. The 5-year disease-specific survival (DSS) and overall survival (OS) rates were 76%, and disease-free survival (DFS) was 68%. Most tumors were ACCs differing from the histological pattern of parotid gland cancers. Occult metastases were rare. The rarity of submandibular gland cancer, its variable histological pattern, and varying biological behavior warrant centralized management.

Comparison of Ultrasonography with CT, MRI and Pet in Cervical Lymph Node Staging of Head and Neck Cancer

The correct preoperative N staging is crucial for the patients with head and neck cancer to determine if the neck dissection is necessary or not. This study aims to compare imaging modalities for staging the neck of patients evaluated by CT/MRI/PET and ultrasonography with the histopathologicl findings of the neck dissection specimens. Between April 2015 and March 2017, 150 newly diagnosed head and neck patients received regular pretreatment images with CT/MRI/PET and Ultrasonography in one tertiary medical center were enrolled. There are 80 patients received the surgical treatment. Neck dissections were performed on 60 patients. In these patients, 26 received computed tomography (CT) examination, 46 have magnetic resonance image (MRI) images and all of them accepted cervical ultrasonography preoperatively. Meanwhile, Positron Emission Tomography (PET) was also done on 23 patients in the preoperative status. There are 55 cases of oral cavity cancer, 9 cases of hypopharyngeal cancers, 4 cases of oropharyngeal cancers, 2 cases of laryngeal cancer, 5 cases of parotid cancer, 3 cases of submandibular gland cancer, 2 cases of sinunasal cancer and one case of sublingual cancer. And one patient got synchronous palate and hypopharyngeal cancer. Understaging of the N stage of nasopharyngeal carcinoma (NPC) by Ultrasonography was noted due to the limitation of evaluating of retropharyngeal space lymph nodes. Based on histopathologyical findings of neck specimens or the N0 neck was confirmed after more than 6 months clinical follow-up, ultrasonography, MRI, CT and PET correctly identified cervical lymph node metastases with a sensitivity of 85.19% (specificity 81.13%), 71.43% (specificity 81.25%), 80% (specificity 100%) and 75% (specificity 80%) respectively. The accuracy of ultrasonography, MRI, CT and PET were 82.5%, 92.3%, 78.26% and 78.26%. Ultrasonography has the highest sensitivity of preoperative N staging in the image modalities in this study. It also has comparable specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy with MRI and PET. Since the ultrasound is convenient, has high approachability and is a noninvasive technique in the clinical practice, it should be considered to add in the preoperative survey of head and neck cancers routinely. The ultrasonography has the significant dominance to help head and neck surgeons to realize the disease more comprehensively before the operation and may change the decision making of the surgical plan.

Robotic-Assisted Neck Dissection in Submandibular Gland Cancer: Preliminary Report

Robot-assisted neck dissection (ND) in patients with head and neck cancer has been developed as a plausible substitute for conventional surgery and it provides an excellent cosmetic outcome. The authors hypothesized that surgery for submandibular gland (SMG) cancer could be achieved with a gasless retroauricular (RA) approach using the robotic system. This study evaluated the feasibility of robot-assisted ND using an RA approach for SMG cancer. Primary tumor resection with robot-assisted ND using an RA incision was performed in 6 patients with SMG cancer. All cases of robot-assisted ND combined with primary tumor resection were conducted successfully without any significant intraoperative complication, need for an additional incision, or conversion to open conventional ND. The amount and duration of drainage, length of hospital stay, number of retrieved lymph nodes, and complications were generally acceptable. The postoperative scar was completely hidden by the auricle and hair. Robot-assisted ND with primary tumor excision using an RA approach is a feasible and useful method, with excellent cosmetic results, for surgical treatment of selected cases of SMG cancer.

A case of double cancer with epithelial-myoepithelial carcinoma in the submandibular gland and lung cancer

上皮筋上皮癌は，全唾液腺腫瘍の1%を占めるまれな唾液腺悪性腫瘍である。その大部分は耳下腺に好発する。今回われわれは，顎下腺に生じた上皮筋上皮癌と，肺癌の重複癌の1例を経験したので報告する。患者は57歳の女性。約10年前からの左顎下部の腫脹を主訴に当科を受診した。左顎下腺部に拇指頭大の弾性硬の腫瘤を触知した。CTにて，左顎下腺体内ならびに左上葉肺野に腫瘍性病変を認めた。左顎下腺腫瘍と左転移性肺癌の診断にて，2008年4月に左顎下腺腫瘍摘出術を施行，その後同年5月に当院呼吸器外科にて左肺上葉切除術が施行された。術後の病理検査では，顎下腺腫瘍は導管上皮成分と淡明筋上皮成分からなる二層構造の特徴的な上皮筋上皮癌と診断された。また左肺腫瘍は細気管支肺胞上皮癌の診断で，相互の関連性はなかった。術後経過に異常なく，術後3年目であるが，経過は良好で腫瘍の再発も認められない。

Risk of Parotid Malignant Tumors in Israel (1970–2006)

To the Editors: Major salivary gland cancers are rare and with few known risk factors. We have analyzed the incidence and epidemiologic features of major salivary gland cancer (ICD.C07–C091) using data from the Israel National Cancer Registry, 1970–2006. The annual incidence of major salivary gland cancer was 0.8 cases per 100,000. The most common subtype of salivary gland tumor was salivary gland carcinoma (60% of all cases) followed by squamous cell carcinoma (18%) and lymphoma (10%). Of 1924 cases (1039 men, 885 women), 60% were in the parotid gland, 7% in the submandibular gland, and fewer than 1% in the sublingual gland; the remaining 33% were recorded as overlapping or not otherwise specified (ICD.C 08.8, 08.9).1 Our results for sex, age, site, tumor type, and rate per year are similar to those reported in the literature. Comparing the parotid gland tumors with all other salivary gland locations, there were no important differences in risk by sex, age, or ethnicity. Trends for parotid gland cancers have seldom been reported, and have not been compared with other types of salivary gland tumors. The total number of parotid gland cancers in Israel increased 4-fold from 1970 to 2006 (from 16 to 64 cases per year), whereas other major salivary gland cancers remained stable (Fig. 1). The steepest increase occurred after 2001, with an average of 37 cases of parotid gland cancer annually before that date and 61 cases per year subsequently. The distribution of cases by age, sex, or tumor type did not change substantially during this time. The population of Israel increased 2.1-fold from 1970 to 2001, but only 1.1-fold from 2001 to 2006.2 Population growth could not, therefore, explain the increased number of parotid gland cancers.FIGURE.: For trend analyses, we added regression lines and calculated R 2 values. Parotid gland cancer: R 2 = 0.83; Submandibular gland cancer: R 2 = 0.36; Sublingual gland cancer: R 2 = 0.02.The proportion of major salivary gland cancers “not otherwise specified” declined from 36% before 2001 to 13% during 2001–2006. This shift may have contributed to changes over time in specific diagnoses. Nevertheless, even if we assume that all cases not-specified were parotid gland cancers, there remains a substantial increase of parotid gland cancers with time (72 cases per year after 2001 compared with 44 cases per year before). Published data have suggested possible etiologies for major salivary gland cancers, including exposure to radiation (therapeutic and diagnostic), aging, and other factors.3–5 The marked increase of parotid gland cancers in the last decade may reflect differences in an external risk factor specific to the parotid region. The INTERPHONE study6 has investigated parotid gland tumors and other tumors that originate in tissues most exposed and proximal to cellular phones. Israelis are heavy users of cellular phones, with a 6-fold increase in usage (by minutes) from 1997 to 2006.7,8 Investigators have previously suggested a potential association of parotid gland tumors with cell phones in an Israeli case-control study.7 Data on individual exposures to cell phones are not available in the registry data, and no causal association with parotid malignant tumors can be ascertained from these ecologic data. Further research is required to investigate the spectrum of possible etiological factors. Rakefet Czerninski Department of Oral Medicine Hebrew University-Hadassah School of Dental Medicine Jerusalem, Israel [email protected] Avi Zini Harold D. Sgan-Cohen Department of Community Dentistry Hadassah School of Dental Medicine Hebrew University Jerusalem, Israel

Prognostic Factors and Outcome Analysis of Submandibular Gland Cancer: A Clinical Audit

To retrospectively review a long-term, single-institution experience of subjects with submandibular gland malignancies treated with definitive locoregional therapy with an aim to identify clinicopathologic variables that correlate with outcomes. A comprehensive chart review of 47 patients presenting to the institute from 1993 to 2005 with a histologic diagnosis of submandibular salivary gland cancer was performed to extract demographic data, clinicopathological characteristics, and treatment details. Clinical and pathologic factors were correlated with locoregional control, distant metastases free survival, and disease-free survival using log-rank test and Cox proportional hazards model for univariate and multivariate analysis, respectively. With a median follow-up of 29 months (interquartile range, 13 to 64 months), the actuarial 5-year locoregional control, distant metastasis-free survival, and disease-free survivals of the entire cohort were 80.5%, 86.1%, and 71.8%, respectively. Overall stage grouping (P = .008), perineural invasion (P = .04), and radiotherapy dose (P = .033) were significant predictors of locoregional control. Overall stage grouping (P = .014) and T stage (P = .05) also affected disease-free survival. Extraglandular involvement showed a trend toward poorer outcome. Submandibular gland cancer is a rare disease with histologic diversity and variable clinical behavior. Overall stage grouping and perineural invasion remain the most significant predictors of outcome. Adequate doses of adjuvant radiotherapy improve locoregional control in high-risk patients.

Positive Sentinel Lymph Nodes are a Negative Prognostic Factor for Survival in T1–2 Oral/Oropharyngeal Cancer: A Long-Term Study on 103 Patients

Detection and treatment of occult nodal metastasis and management of the clinically N0 neck have posed a challenge in head and neck squamous cell carcinoma (HNSCC). In an attempt to translate successful staging strategies employed in breast carcinoma and melanoma, sentinel node biopsy (SNB) has been investigated in the context of HNSCC over the past decade. The concept of sentinel node biopsy relies on the theory that the firstechelon node/s (sentinel node) will harbor the lymphatic flow from the tumor, and pathologic evaluation of this node will accurately reflect the nodal staging. In particular, early-stage oral-cavity and oropharyngeal cancers have been targeted for studies evaluating the utility of sentinel node biopsy, and the incidence of occult metastatic disease to the cervical lymph nodes is approximately 20–30% in low-stage oral-cavity cancers. Most investigations have focused on the possibility that accurate SNB may facilitate avoidance of staging neck dissections, particularly in patients with low-stage T1–2 oral-cavity cancer that would avoid postoperative radiotherapy with low-risk primary tumor and pathologically negative neck. In this issue, Kovacs et al. address the prognostic value of sentinel lymph node biopsy in oral/oropharyngeal squamous cell carcinoma. With a moderate sample size of 103 patients, they reported no false negatives, and poor prognostic associations with patients that had a positive sentinel node. Although encouraging, there are several unique characteristics of this study that make it difficult to extrapolate these findings to routine clinical practice: (1) the use of intra-arterial high-dose chemotherapy given 3–4 weeks prior to surgery for primary cancer is not widely adopted, and may have variable effects on clinical disease outcomes, lymphatic drainage patterns, or impacted micrometastatic spread to draining lymph nodes, (2) uniform use of fluorodeoxyglucose positron emission tomography (FDG-PET) may have stage-shifted patients such that the study population was enriched for pathologic N0 neck disease, and resulted in the low upstaging rate reported by these authors as compared with other published data. The prognostic significance of a positive sentinel node reported in this study is difficult to assess in a larger context as well because: (1) planned postoperative radiation was employed for patients with a T2 primary tumor with an N0 neck, a practice not uniformly applied, (2) only 1/9 patients who were upstaged by positive SNB actually received postoperative radiation, a usual standard of care, and (3) the reported diameter of all the positive nodes was C10 mm and the diameter of the metastasis averaged 4.6 mm; it is unclear why these nodes did not fulfill computed tomography (CT) size criteria (1.0 cm) that designate a pathologic node. A recent large meta-analysis in HNSCC conducted by Paleri et al. estimated a detection rate of 90% and a falsenegative rate of 10% for SNB. Although a false-negative rate of zero is reported by Kovacs et al., there were two patients who developed contralateral neck metastasis and one patient with submandibular gland cancer of unreported histology, reflecting a lack of consensus regarding the definition of a false-negative SNB in HNSCC. Of note, in two recent series evaluating SNB it was demonstrated that unanticipated contralateral sentinel lymph nodes can occur in 15–20% of patients. Society of Surgical Oncology 2008

Various Applications of Sliding Genioplasty

An adequately balanced proportion and symmetry of all facial features are the requisites for a beautiful face, and the chin plays an important role on facial aesthetics. Sliding genioplasty (SG) is a well-established method for changing the position, size or shape of the mandibular symphysis using autogenous material. We report our result from a 10-year review of our experience with SG. 18 patients (11 retrognathia/microgenia, 3 asymmetry, 1 mucoepidermal cancer of submandibular gland s/p free iliac bone flap reconstruction, 1 cleft lip and palate, 1 Treacher-Collins syndrome, 1 class Ⅲ malocclusion ), aged 19 to 65 years (mean age, 30.3 years), underwent SG alone (9 patients) or with concomitant facial contouring procedures (9 patients) during the year 1994 to 2004. Mean value of chin advancement was 8 mm. Unilateral mental nerve injury was noted in 2 patients and immediate repair was performed. Paresthesia in the involved area resolved in few months. All patients were very satisfied with the cosmetic result. By performing SG, the chin can be moved not only in the sagittal plane but also in the vertical and transverse planes of space. Our experience demonstrates the versatility and excellent esthetic results with the procedure.