T1 Carcinoma Research Articles

Outcome in squamous cell carcinoma of the nasal vestibule: a single center experience.

The purpose of this study was to analyze the outcome of squamous cell carcinomas (SCCs) of the nasal vestibule and to identify factors predicting recurrence. All patients treated between 1995 and 2012 were included in this study. Outcome was analyzed with respect to modality of therapy, age, sex, tobacco consumption, staging, surgical margins, and histological differentiation pattern. Thirty patients were included. Fourteen patients (47%) were found with T4, 1 patient (3%) with T3, 7 patients (23%) with T2, and 8 patients (27%) with T1 disease. Twenty-one patients (70%) were treated surgically. Six patients (29%) needed postoperative radiation because of insufficient surgical margins. Radiation was the first-line treatment in 9 patients (30%). Surgically treated patients with surgical margins <3 mm had significantly more locoregional recurrence compared to those with sufficient resections. Advanced T4 carcinomas show a high recurrence rate. Insufficient surgical margins are the main predictor for a locoregional recurrence and should be avoided.

616 The Indication for Additional Surgical Colectomy With Lymph Node Dissection After Endoscopic Treatment in T1 Colorectal Carcinomas

The Indication for Additional Surgical Colectomy With Lymph Node Dissection After Endoscopic Treatment in T1 Colorectal Carcinomas Hideyuki Miyachi*, Shin-Ei Kudo, Shigeharu Hamatani, Katsuro Ichimasa, Tomokazu Hisayuki, Yuta Kouyama, Hiromasa Oikawa, Shingo Matsudaira, Yuichi Mori, Masashi Misawa, Toyoki Kudo, Shunpei Mukai, Kenta Kodama, Kunihiko Wakamura, Takemasa Hayashi, Eiji Hidaka, Shogo Ohkoshi, Haruhiro Inoue, Fumio Ishida Digestive Disease Center, Showa Univercity Northern Yokohama Hospital, Yokohama, Japan; Department of Pathology, Showa University Northern Yokohama Hospital, Yokohama, Japan Background: Recent advances in EMR or ESD technology has enabled easier and safer endoscopic treatment. A lot of T1 colorectal carcinomas are resected endoscopically with negative margins. Therefore, additional surgical colectomy with lymph node dissection should be considered according to the pathological analysis. Although it is critical to determine the criteria for curative endoscopic resection, there is only a few data pursuing a large number of samplings in terms of the indication for additional surgical colectomy. Aims: The aim is to clarify pathological risk factors for lymph node metastasis of T1 colorectal carcinomas and to establish the indication for additional surgical colectomy with nodal dissection after endoscopic treatment. Methods: A total of 20072 colorectal neoplasms excluding advanced cancers have been resected endoscopically or surgically at our unit from April 2001 to May 2013. Of these, 853 T1 carcinomas were included. Initial or additional surgical colectomy with nodal dissection was performed in 563 cases, and of which lymph node metastasis was found in 52 cases (9.2%). We analyzed the pathological risk factors for nodal metastasis as follows: vessel permeation, tumor budding, poorly-differentiated/mucinous carcinoma (POR/MUC) component, desAbstracts

Tumor classification for early oral cancer: Re‐evaluate the current TNM classification

We hypothesized that incorporation of tumor thickness into the tumor-node-metastasis (TNM) system will provide better prognostic information. Tumors were reclassified as T1 if ≤5-mm thick/≤4-cm diameter, and T2 if >5-mm thick/≤4-cm diameter. A retrospective analysis was conducted of 322 patients with T1 and T2 oral squamous cell carcinoma (SCC) between 1987 and 2012. Univariable survival analysis was performed using the log-rank test and multivariable analysis using the Cox proportional hazards model. Multivariable analysis confirmed that tumor thickness is the most important predictor of disease-specific survival (DSS; hazard ratio [HR], 2.7; p = .03) and overall survival (OS; HR, 2.9; p = .001). Using the current TNM classification system, there is no significant difference in survival between the T1 and T2 groups for DSS (p = .13) or OS (p = .66). The revised staging system was superior at stratifying patients according to the T classification for both DSS (p = .016) and OS (p < .001). Tumor thickness is an important prognostic indicator in early oral SCC and should be incorporated in the TNM classification system.

The Natural History of Clinically Complete Responders to Neoadjuvant Chemotherapy for Urothelial Carcinoma of the Bladder

We describe the clinical course of patients who achieved cT0 status after neoadjuvant chemotherapy for muscle invasive bladder cancer. There is noestablished treatment paradigm for these patients. We retrospectively reviewed the records of 109 patients with muscle invasive bladder cancer (T2 or greater urothelial carcinoma of thebladder) who underwent platinum based neoadjuvant chemotherapy at our institution from 1988 to 2012. Post-chemotherapy assessment of the response included cytology, cystoscopy with biopsy and cross-sectional imaging. Of 109 patients 32 (29.4%) achieved cT0 status after neoadjuvant chemotherapy. Mean ± SD age of the cohort was 68.3 ± 9.6 years. Of the patients 21 received MVAC, 8 received gemcitabine and cisplatin, and 3 received another regimen. Seven complete responders elected immediate radical cystectomy after the completion of neoadjuvant chemotherapy. Of 25 patients who refused radical cystectomy after achieving cT0 status 7 experienced relapse after the completion of neoadjuvant chemotherapy and proceeded to radical cystectomy. The remaining 18 patients (72%) retained the bladder, including 6 (18.8% of the cohort) in whom nonmuscle invasive relapses were managed conservatively and 12 (37.5%) with no recurrence. In the 25 patients who elected bladder preservation after achieving cT0 status following neoadjuvant chemotherapy 5-year cancer specific survival was 88%. With proper counseling and identification of treatment goals patients with cT0 after neoadjuvant chemotherapy for muscle invasive bladder cancer may have the option to retain the bladder with durable survival. Larger studies are needed to identify possible predictors of response on the clinical, pathological and molecular levels.

The Use of Chromothyrolymphography for Selection of Surgical Volume in Patients with Thyroid Cancer

Indirect chromothyrolymphography (ICTLG) utilizes injection of the dye into the Thyroid (T) in order to visu- alize intraorganic lymphatic network, and extra-T lymphatic vessels and regional lymph nodes, as well. In1980- ies we performed a study using either 2-3 ml of 1% Methylene blue in water or alcohol, or 0.4% solu- tion of indigo carmine, or 1% Brilliant green in alcohol to 197 patients. Comparative light microscopic study of 457 stained and unstained cervical lymph nodes was performed. An inexpensive and simple technique, indirect ICTLG gave us an evidence to solve a number of essential questions, such as whether to perform hemithyroidectomy in T1 carcinoma located in the middle of the T gland, or not; to follow the routs of the lymph flow, that are involved in metastasizing of T cancer; and to control parathyroid glands and the recur- rent nerve during resection of the T.

Quelle place pour l’évaluation endoscopique avec fluorescence après traitement d’attaque par instillations endovésicales de BCG

The objective of this retrospective study was to assess the usefulness of fluorescence during cystoscopy after BCG-therapy in the management of non-invasive bladder tumors. Fifty-four patients were enrolled: Ta (15 cases), T1 (27 cases) carcinoma in situ (CIS) alone (12 cases) or associated (14 cases). Urine cytology was of high grade and a second look was systematically performed in case of lamina propria infiltration. Initial therapy with 6 intravesical BCG instillations (81 mg) was performed with histologic and endoscopic bladder evaluation 3 months after initial resection using hexylaminolevulinate fluorescence (Hexvix(®) 85 mg). Urine cytology was negative in 27 cases, suspicious in 12 cases and positive in 15 cases. With standard endoscopy under white light, mucosal bladder was normal in 32 cases, the use of fluorescence detected 8 tumour lesions confirmed with histology (CIS). When mucosal bladder was suspect under white light (22 patients), fluorescence was positive in 16 cases with 10 matching histological analysis (CIS and/or residual tumoral lesion). Therefore, despite high false positive rate with persistent mucosal bladder inflammation (38%), fluorescence guided endoscopy has allowed the diagnosis of suspect lesions not detected with white light with negative urine cytology. Hexvix(®) fluorescence after intravesical BCG instillations may improve persistent carcinoma in situ detection when performed 3 months after induction treatment. However, a multicenter prospective study will be necessary in future to confirm these preliminary results. 5.

Mid-term results of frontovertical partial laryngectomy for early glottic carcinoma with anterior commissure involvement

Conclusion: Frontovertical partial laryngectomy is useful for treatment of T1 and T2 glottic squamous cell carcinoma with anterior commissure involvement. Objective: To evaluate the efficiency of frontovertical partial laryngectomy for T1 and T2 glottic carcinoma with anterior commissure involvement. Methods: This was a retrospective review of 58 cases of glottic squamous cell carcinoma with anterior commissure involvement (T1, n = 28; T2, n = 30) that were treated by frontovertical partial laryngectomy between August 2000 and August 2010. Results: Postoperative pathology reports confirmed negative tumor margins in every case. All patients were followed postoperatively, with a median follow-up interval of 55 months. Three patients had local recurrence; there were no patients who had cervical or distant metastases. The 3-year local control rate was 94% according to life tables curves. There were no reports of laryngostenosis or dysphagia in any patients, and mean Voice Handicap Index (VHI) questionnaire scores were 32.9.

The value of TRUS in the staging of rectal carcinoma before and after radiotherapy and comparison with the staging postoperative pathology

To compare the effectiveness of transrectal ultrasonography (TRUS) with that of postoperative pathological examination in staging rectal carcinoma before surgery and before and after radiotherapy. A prospective study was undertaken comprising 62 patients with stage T3 or T4 rectal carcinoma confirmed by endoscopic biopsy. TRUS showed significant differences (p < 0.01) in tumour echogenicity and volume, border delineation, local invasion, and draining lymph node involvement before and after radiotherapy, and significant reduction in blood flow resistance index after radiotherapy but no difference (p > 0.05) in the classification of tumour blood flow. In ultrasonographic assessments, 53 of the 62 cases (85.5%) showed lower T stages after radiotherapy. TRUS showed an accuracy of 94.1% for T2 cases, 77.3% for T3 cases, and 83.3% for T4 cases, and an overall accuracy of 87.1% in comparison with the results of postoperative pathological examination. TRUS is expected to play a vital role in the accurate preoperative staging of rectal carcinoma with the increasing utilization of adjuvant radiotherapy in rectal carcinoma and to contribute to the assessment of treatment.

Comparison of Early Oncological Results of Diode Laser Surgery with Radiotherapy for Early Glottic Carcinoma

To evaluate the oncologic results of transoral endolaryngeal microscopic diode laser surgery (MDLS) and radiotherapy (RT) for T1 and T2 glottic carcinoma. Case series with planned chart review. Ankara Oncology Education and Research Hospital. The study was conducted on a series of 140 cases of early glottic carcinoma (T1, T2) treated with MDLS or RT. The tumors were defined according to T stage and the involvement of the anterior commissure (AC). The 3-year locoregional control rate of MDLS and RT groups was 93.1% and 89.7%, respectively (P = .434). There was no difference in 3-year disease-free survival when comparing T1 and T2 tumors treated with MDLS and those treated with RT (P = .618 for T1, P = .084 for T2). There was no difference in disease-free survival when comparing AC- and AC+ tumors treated with MDLS and those treated with RT (P = .291 for AC- and P = .530 for AC+ tumors). Microscopic diode laser surgery in early glottic cancer seems to be an oncologically safe procedure that has similar oncological results with RT. In T2 glottic tumors and AC involvement, the results with either treatment are less satisfactory.

Thyroid Ablation with 1.1 GBq (30 mCi) Iodine-131 in Patients with Papillary Thyroid Carcinoma at Intermediate Risk for Recurrence

Little is known about the medium- and long-term outcomes of thyroid ablation with 1.1 GBq (30 mCi) ¹³¹I in patients with papillary thyroid carcinoma who have a tumor >4 cm or accompanied by extrathyroid invasion or clinically detected lymph node metastases (cN1). The objective of this study was to evaluate the efficacy of ablation with 30 mCi ¹³¹I in this subgroup of patients and to report the medium-term outcomes. We studied 152 patients with papillary thyroid carcinoma submitted to total thyroidectomy with apparently complete tumor resection, who had a tumor >4 cm or 2-4 cm accompanied by extrathyroid invasion or lymph node metastases, or ≤2 cm accompanied by both extrathyroid invasion and lymph node metastases. Patients with extensive extrathyroid invasion by the primary tumor were excluded. Lymph node involvement was detected by ultrasonography or palpation (cN1). Forty-two patients were prepared by administration of recombinant human thyrotropin and 110 by levothyroxine withdrawal. Posttherapy whole-body scanning revealed unequivocal ectopic uptake in three patients. When evaluated 9-12 months after ablation, 123 patients had achieved complete ablation (stimulated thyroglobulin [Tg] <1 ng/mL, negative anti-Tg antibodies, and neck ultrasonography); a new posttherapy whole-body scanning revealed persistent disease in 2 patients whose initial posttherapy whole-body scanning (obtained at the time of ablation) had already shown ectopic uptake; 12 patients presented with a Tg >1 ng/mL and 14 had positive anti-Tg antibodies without apparent metastases; 1 patient had metastases not detected at the time of ablation. Recurrence was observed in an additional 6 patients during follow-up (median 76 months). There was no case of death related to the disease. Therefore, an activity of 30 mCi failed in only 9 (6%) patients with persistent disease or recurrence after ablation. None of the variables analyzed (sex, age, tumor size, multicentricity, extrathyroid invasion, lymph node metastases, preparation [recombinant human thyrotropin or levothyroxine withdrawal]) was a predictor of ablation failure. An activity of 30 mCi ¹³¹I is effective in thyroid ablation in patients with stage T3 and/or N1 papillary thyroid carcinoma.

Cancer-Associated Lymphatic and Venous Vessels in Colonic Carcinomas

Objective: Colonic carcinomas spread to regional lymph nodes and liver. There are cancer-associated lymphatic and venous vessels at the margin of colonic carcinomas, which facilitate spreading carcinoma through lymphatic and venous vessels. This study aimed to examine cancer-associated lymphatic and venous vessels in TNM T1 to T3 carcinomas using lymphatic vessel hyaluronan receptor for lymphatic vessels and von Willebrand factor for venous vessels by immunocytochemical staining. Materials and Methods: A total of 40 cases of moderately differentiated colonic carcinoma were studied using routinely formalin-fixed and paraffin-embedded sections. The cases consisted of 10 cases of TNM T1, 15 cases each of T2 and T3 cases. Immunocytochemical staining was performed using goat antihuman LYVE-1for lymphatic vessels and rabbit antihuman von Willebrand factor for venous vessels. Results: In TNM T1 carcinoma, increased, irregular and narrow lymphatic and venous vessels were present in the adjacent normal mucosa to the carcinoma, some of which penetrated cancerous lesion. There were no tumor emboli in lymphatic and venous vessels. In TNM T2 carcinoma, there were few lymphatic and venous vessels in midst of the carcinoma whereas numerous small lymphatic and venous vessels were present within muscle layers adjacent to the invading carcinoma. Extramural tumor embolus was present in submucosa in one case. In TNM T3 carcinoma, cancer has invaded through the muscle layers where dilated lymphatic and venous vessels were present adjacent to cancerous nests. Tumor emboli were identified in two cases by immunocytochemical staining. Conclusion: The current study showed cancer-associated lymphatic and venous vessels at the interface in TNM T1 carcinoma to dilated intramuscular lymphatic and venous vessels adjacent to invading cancerous nests in TNM T3 carcinoma, and supports cancerous cells spread via lymphatic and venous vessels through muscle layers to subserosa as supported by tumor emboli in the lymphovascular system.

Intracholecystic Papillary Tubular Neoplasm of the Gallbladder With Microinvasive Carcinoma

For the intramucosal mass-forming preinvasive neoplasms (tumoral intraepithelial neoplasms) of the gallbladder, the term intracholecystic papillary tubular neoplasm (ICPN) has been proposed as a unifying category to embrace all the entities described in the World Health Organization 2010 classification as “adenoma,” “intracystic papillary neoplasm,” and “papillary adenocarcinoma.” In essence, this category represents the gallbladder counterpart of the tumors known as intraductal papillary and intraductal tubulopapillary neoplasms in the pancreas and bile ducts. They are distinguished from nontumoral (“flat”) dysplasia by their exophytic tumor formation. They show a spectrum of dysplastic changes (adenoma-carcinoma sequence), various growth patterns, often in a mixture (papillary, tubular, and tubulopapillary), and a variety of cell lineages including biliary (MUC1+), pyloric-mucinous (MUC6+), complex-tubular (pyloric nonmucinous; MUC6+; with morule formation and β-catenin nuclear positivity), gastric-foveolar, occasionally intestinal (MUC2/CDX2), and even more rarely oncocytic, often but not always with corresponding immunophenotypic changes. Invasive carcinoma is often encountered in association with these tumors (65% of the cases), and an estimated 6% to 8% of invasive carcinomas arise from ICPNs. Invasion is common in papillary examples and those with biliary or gastric-foveolar appearance, whereas it is very low, if at all, in complex tubular-pyloric examples (although the latter often shows striking cytoarchitectural atypia as well). Extensive sampling is warranted to rule out invasive carcinoma. Carcinomas confined to above the tunica muscularis (early gallbladder carcinomas, which correspond to Tis/T1a/T1b cases) have a fairly good prognosis, especially if the possibility of T2 carcinoma (invasion through the muscularis) is ruled out by thorough sampling. More invasive examples have an aggressive behavior but still appear to be better behaving than ordinary adenocarcinomas without ICPNs, presumably partly due to early discovery of invasive carcinomas, but also partly due to differences in biologic behavior.

Response to “Sentinel lymph node biopsy versus elective neck dissection in patients with cT1-2N0 oral tongue squamous cell carcinoma”

Objective This study aimed to compare the value of sentinel lymph node biopsy (SLNB) with that of elective neck dissection (END) for the prediction of cervical lymph node metastasis in patients with clinically diagnosed T1-2N0 (cT1-2N0) oral tongue squamous cell carcinoma (OTSCC), and it aimed to examine the prognostic value of individualized treatment in sentinel lymph node (SLN)-negative patients. Study Design The study entailed a retrospective review of 82 patients with cT1-2N0 OTSCC. Thirty patients underwent SLNB, and 52 patients underwent END. Results There was a significant difference between the SLNB and END groups in the incidence of occult cervical lymph node metastasis in initial specimens (30% vs 11.5%; P = .037). However, there were no significant differences between the groups for 10-year overall and cervical recurrence-free survival rates and 10-year overall survival rate. Conclusions SLNB is superior to END for the prediction of cervical lymph node metastasis in patients with cT1-2N0 OTSCC. Neck dissection may be reduced for SLN-negative patients, owing to the comparable prognosis of SLNB.

A Randomized Phase III Trial Exploring the Prognostic Value of Extensive Intraoperative Peritoneal Lavage in Addition to Standard Treatment for Resectable Advanced Gastric Cancer: CCOG 1102 Study

A randomized controlled trial has started in Japan to evaluate the efficacy of extensive intraoperative peritoneal lavage in the treatment of resectable advanced gastric cancer. Patients with T3 or deeper carcinoma of the stomach are intraoperatively randomized to either extensive intraoperative peritoneal lavage + arm or extensive intraoperative peritoneal lavage- arm. A total of 300 patients will be accrued from 20 institutions. The primary endpoint is disease-free survival, and secondary end-points are overall survival, peritoneal recurrence-free survival and incidence of adverse events.

Thyroid gland invasion in total laryngectomy and total laryngopharyngectomy: a systematic review and meta‐analysis of the English literature

Advanced laryngeal and hypopharyngeal squamous cell carcinomas carry an inherent risk of invading thyroid parenchyma leading to the incorporation of a hemithyroidectomy or total thyroidectomy as part of a total laryngectomy. In some centres, thyroid gland removal occurs routinely during surgery for T3 and T4 laryngopharyngeal carcinoma. However, the incidence of invasion is low, and therefore, thyroid-sparing surgery must be considered for select cases. The primary goal of the review is to assess the true incidence of thyroid gland invasion in laryngopharyngeal carcinoma. Utilising this data we aim to identify risk factors and clinical predictors of thyroid gland invasion to facilitate in a more targeted approach in the surgical management of advanced laryngopharyngeal carcinoma. A systematic review and meta-analysis of all published data and review of case series at Newcastle upon Tyne Hospitals (NuTH). MEDLINE (1946-2012) and EMBASE (1980-2012) were searched. A single reviewer conducted the systematic review with a follow-up ancestry search. Studies publishing case series of T3 and T4 laryngeal and hypopharyngeal carcinoma treated by total laryngectomy or laryngopharyngectomy and partial or total thyroidectomy, with pathological assessment for thyroid gland invasion rates were selected. Articles published prior to 1977 were excluded due to the advent of whole organ sectioning. The literature search identified 16 studies suitable for inclusion, with 1180 cases. The NuTH case series identified 107 patients. The overall pooled incidence of thyroid gland invasion in 1287 patients is 10.7% (95% CI 7.6-14.2). Patients with primary subglottic tumours (relative risk 7.5; 95% CI 4.3-13.0) and disease extension into the subglottis (relative risk 4.3; 95% CI 2.5-7.2) have a significantly higher relative risk of thyroid gland invasion. Radiorecurrent tumours and hypopharyngeal tumours did not have an increased risk of thyroid gland invasion. Advanced laryngeal and hypopharyngeal carcinomas involving the subglottis carry a significantly elevated risk of thyroid gland invasion compared with those that spare this subsite. The overall incidence of thyroid gland invasion is low, and therefore, thyroidectomy should be reserved for cases considered to be at risk as opposed to a being a routine measure for all total laryngectomies.

The Mushroom-Shaped Anterolateral Thigh Perforator Flap for Subtotal Tongue Reconstruction

Reconstruction of a functional tongue with proper motility and sensation after subtotal resection is a demanding procedure. The authors describe the reinnervated mushroom-shaped anterolateral thigh perforator flap for subtotal tongue reconstruction. Thirteen patients (mean age, 54.8 years; range, 49 to 71 years) diagnosed with T3 and T4 squamous cell carcinomas were allocated prospectively to anterior total mobile (n = 7) or subtotal tongue resection (n = 6). All patients received the mushroom-shaped anterolateral thigh perforator flap. A Likert scale ranging from 1 to 4 was used to assess speech intelligibility, swallowing function, and cosmetic results. Epicritic and proprioceptive sensitivity testing was performed with the Pressure-Specified Sensory Device on the tip of the tongue preoperatively, on the neotongue at the donor site preoperatively, and at the recipient site 12 months postoperatively; protopathic thermoreceptor and nociceptors were clinically investigated. Outcomes were analyzed, and values of p < 0.05 were considered significant. All flaps healed uneventfully (mean follow-up, 18 months). Six patients (46.2 percent) recovered a nearly natural deglutition, whereas seven (53.8 percent) had mild impairment (p = 0.274). Normal intelligible speech was achieved in seven cases (53.8 percent), and acceptable intelligible speech was achieved in six (46.2 percent) (p = 0.286). Aesthetic results were excellent in eight patients (61.5 percent) and good in five (38.5 percent) (p = 0.592). All patients recovered epicritic, proprioceptive, and protopathic sensitivity; cortical upgrading phenomena of the recipient nerve were observed. The reinnervated mushroom-shaped anterolateral thigh perforator flap was found to be an innovative and effective option for subtotal tongue reconstruction.

Incidence of Synchronous Bilateral Tonsillar Carcinoma in a Cohort of T1/T2 Primary Tonsil Cancer

Objectives: The most recent review of bilateral synchronous tonsillar carcinoma published in 2012 identified 12 previously described cases in the literature. It has been estimated that there is a 10% incidence of contralateral nodal metastasis from tonsillar carcinoma. However, the true incidence of bilateral synchronous occult disease is unknown. This study aims to describe the incidence of bilateral tonsillar carcinoma in early stage disease. Methods: The study design consisted of a retrospective cohort study of 120 patients with T1 or T2 primary tonsillar squamous cell carcinoma treated between 1995 to 2012. All patients were treated with primary radical surgical therapy and had the contralateral tonsil removed at the time of surgery. Data was extracted from an institutional review board approved department database. All cases were reviewed for evidence of an occult tumor in the contralateral tonsil. Results: Out of 120 patients, 3 patients were identified to have an occult primary cancer in the contralateral tonsil. This resulted in a 2.5% incidence of disease in this cohort of patients. Compared to the incidence of tonsillar carcinoma in the general population 2.1 x 10-5, (95% CI: 2 x 10-5, 2.2 x 10-5) this is significantly elevated. Conclusions: This is the first study attempting to establish the incidence of bilateral tonsillar carcinoma in a large cohort of early stage tonsillar carcinoma patients. Given the increasing use of transoral robotic surgery to treat these patients, it is important to be aware that there is likely a small but slightly elevated risk of contralateral occult disease.

Endonasal resection of early stage squamous cell carcinoma of the nasal vestibule

The squamous cell carcinoma of the nasal vestibule (SCCNV) is a comparatively rare malignant disease. It occurs in the transition zone at the limen nasi. The choice of treatment for small tumors is a matter of controversy. Due to better cosmetic results, radiation therapy is usually recommended, however some recent reports have suggested that early stage tumors are equally or even more effectively managed by surgery. There was no standardized surgical procedure applied in these studies, though. The goal of our investigation was the retrospective evaluation of patients with a T1 or T2 carcinoma of the nasal vestibule who were treated surgically with an endonasal, endoscope-controlled approach at our ENT clinic between 2008 and 2010. Given the rarity of SCCNV, the 10 included cases represent the largest group of patients with early stage SCCNV treated primarily surgically by an endonasal approach so far. Our study shows that the endonasal resection of an early stage vestibular carcinoma seems adequate as a possible therapy. In the follow-up observation period no local or loco-regional recurrence was observed. The external cosmetic damage and endonasal scarring do not appear to be pronounced even following cartilage resection and were regarded as not seriously disadvantageous.

GSTT1 null genotype contributes to hepatocellular carcinoma risk: a meta-analysis

Studies investigating the association between genetic polymorphism of glutathione S-transferase T1 (GSTT1) and hepatocellular carcinoma (HCC) risk have reported conflicting results. Therefore, we conducted this meta-analysis to provide more precise evidence. Databases including PubMed, Embase, SCOPUS, ISI Web of Science, and Wangfang were searched for relevant studies. Potential sources of heterogeneity were also assessed by subgroup analysis. Funnel plots and Egger's linear regression were used to test publication bias among the articles. Finally, a total of 28 studies involving 3,897 HCC patients and 6,117 controls were included in this meta-analysis. In a combined analysis, the summary odds ratio for HCC of the GSTT1 null genotype was 1.43 (95% confidence interval (CI) 1.22–1.68, P < 10(−5)). In the subgroup analysis by ethnicity, significantly increased risks were found in East Asians for GSTT1 null polymorphism, while no significant associations were found among Caucasian, South Asian, and African populations. When stratified by a source of controls, both population- and hospital-based studies get consistent positive results. By pooling data from 10 studies (1,639 cases and 2,224 controls) that considered combinations of GSTT1 and GSTM1 genotypes, a statistically significant increased risk for HCC (odd ratio = 1.85, 95% CI 1.37–2.49) was detected for individuals with combined deletion mutations in both genes compared with positive genotypes. No evidence of publication bias was observed. Our result suggests that the GSTT1 null genotype contributes to an increased risk of HCC in East Asians and that interaction between unfavorable GSTs genotypes may exist.

Transoral robotic surgery for the treatment of T1–T2 carcinoma of the larynx: Preliminary study

To determine the feasibility and the preliminary oncological results of transoral robotic surgery (TORS) for the treatment of early stage laryngeal tumors. Retrospective single center study. We reviewed the medical records of 23 patients who underwent TORS for the treatment of T1 or T2 laryngeal squamous cell carcinoma between August 2009 and March 2012. Laryngeal tumors were involving the glottis (13 cases) and the supraglottis (10 cases). They were classified T1 N0 in 16 cases, T2 N0 in four cases, and T2 N+ in three cases. The median TORS operative time was 60 minutes (ranging from 30 to 118 minutes). The median hospitalization time was 7.5 days. Histopathological examination of the resected tumors confirmed 14 cases in which the margins were clear, four cases in which the surgical margins were close (less than 1 mm), one case in which the margins were microscopically positive, and in four cases margins status were not able to be recorded. A tracheostomy was carried out for three patients, and 11 patients got a nasogastric feeding tube postoperatively. The local recurrence rate was 8.7% (2/ 23 cases), and in both cases the recurrence occurred in the anterior commissure area only. The overall larynx preservation rate was 95,7% (22/ 23 cases). In this preliminary study, we demonstrated that laryngeal TORS is feasible and may result in oncological results comparable with other treatment strategies, including laser CO2 surgery. This innovative approach needs to be evaluated through randomized multi-institutional trial. 4.