bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disfigurement and Mental Health in Head and Neck Cancer
Authors: Fundakowski Christopher E. , Jean‐Pierre Pascal , Sargi Zoukaa 
Published: February 2015

ObjectiveEvaluate the relationship between physician‐rated patient disfigurement and mental health status and quality of life variables in a 1‐year posttreatment head and neck cancer population.MethodCross‐sectional study, academic, tertiary referral center. One hundred fifty patients with a diagnosis of head and neck cancer at least 1 year status posttreatment completed a series of mental health and quality of life intake questionnaires. A single physician completed an observer‐rated disfigurement scale for all patients.ResultsRacial stratification included: 61% Caucasian, 33% Hispanic, 4% African American, and 2% other. Gender stratification included: 69% male and 31% female. Mean age: 63 (range 20‐89). Thirteen percent of the patient population was noted to have untreated depression/anxiety, 100% of which had undergone some type of surgical intervention. No anxiety/depression was noted in patients who had only undergone chemo and/or radiotherapy and no surgery. Physician rated disfigurement was higher in the surgical treatment group, though the highest physician‐rated disfigurement scores did not correlate to the highest anxiety/depression scores, nor the lowest quality of life scores.ConclusionWhile physician‐rated disfigurement is higher in surgically treated patients, the most disfigured patients did not report the worst quality of life. Therefore all head and neck patients should be assessed for adverse mental health and quality of life outcomes posttreatment, not only the most disfigured.
Endoscopic Skull Base Reconstruction: Lesson from 420 Cases
Authors: Gallo Stefania , Karligkiotis Apostolos , Turri‐Zanoni Mario , Volpi Luca , Ferreli Fabio , Pistochini Andrea , Castelnuovo Paolo 
Published: February 2015

ObjectiveThe ability to repair skull base defects resulting from the treatment of different skull base diseases has been a major challenge over the past decade. Aims of the study are to define different endoscopic techniques of reconstruction, focusing on their evolution, and evaluate their efficacy and indications, analyzing their failures.MethodAll cases submitted to endoscopic skull base reconstruction from 1995 to 2011 were divided into group A: patients treated for traumatic or non‐traumatic CSF‐leaks and group B: patients treated for skull base tumors. Patients were fully investigated prior to surgery with endoscopic evaluations and neuroimaging, eventually associated to other in‐depth examinations.Results420 patients underwent endoscopic skull base reconstruction: 263 in group A and 157 in group B. Primary closure was achieved in 251/263 cases of group A (95.4%) and in 143/157 cases of group B (91.1%). In 26/420 failures (6.2%) revision surgery reached an effective secondary closure of the defect in 100% of cases. Autologous materials were preferred for grafting in both groups, with prevalence for intranasal epithelial and connective tissues (mucoperiostium, bone, cartilage) in group A and for extranasal connective tissue (fascia lata) in group B. Vascularized flaps were employed in selected cases. Indications and details of each technique are provided.ConclusionThe endoscopic technique should be considered a favorable, safe, and minimally invasive procedure for skull base reconstruction with effectiveness rates comparable to external approaches. Failures were related to mistakes in the choice of materials and reconstructive technique, based on the site of the defect and the biology of treated lesions.
Gene Markers as Predictors of Nodal Metastasis and Outcome
Authors: Mattos Jose L. , Trivedi Sumita , Ferris Robert L. 
Published: February 2015

Objective1) Investigate the correlation between percentage of metastatic tumor in lymph nodes from patients with squamous cell carcinoma (SCC) of the head and neck and level of expression of 3 marker genes: pemphigus vulgaris antigen (PVA), parathyroid hormone related peptide (PTHrP), and tumor‐associated calcium signal transducer (TACSTD1). 2.) Understand the relation of these markers and clinical outcomes.MethodFour hundred forty‐eight grossly negative lymph nodes from 92 patients with SCC were evaluated for expression of the gene markers PVA, PTHrP, and TACSTD1 using real‐time PCR. Confirmation of metastasis was determined by histological examination. The expression of these markers was analyzed versus tumor percentage using correlation and linear regression.ResultsAll 3 markers were studied independently and were statistically significant predictors of tumor percentage in the lymph nodes at a significance level of 0.05. PVA had the strongest correlation with tumor percent with a correlation coefficient of 0.68, an r squared of 0.46, and a P value <.001. PTHrP had a correlation coefficient of 0.39, r squared of 0.16, and a P value of. 003. TACSTD1 had a correlation coefficient of 0.38, r squared of 0.15, and a P value of. 004.ConclusionAll 3 markers are statistically significant predictors of percent tumor in grossly negative lymph nodes. PVA had the strongest correlation. Further analysis will include a multivariate regression to account for possible confounding. Since expression correlates with tumor percent, we expect that expression levels will also correlate with clinical outcomes.
HPV E6 and E7 Mediated Regulation of HPV(–) HNSCC Cell Lines
Authors: Peters Robert D. , Graham Martin P. , Komarck Chris M. , Walline Heather M. , Prince Mark E. , Carey Thomas E. 
Published: February 2015

Objective1) Determine the capacity of HPV16 E6 and E7 viral oncoproteins to regulate cellular levels of p53 and Rb in the absence of the complete viral genome. 2) Understand the interaction between viral E6 and endogenous p53 by observing the effect of E6 on mutant p53.MethodTwo HPV negative HNSCC cell lines with DNA binding domain mutations of p53 were infected with lentiviral vectors containing either HPV16 E6, E7, and luciferase or luciferase alone. Naturally infected HPV16 and18 positive cell lines were evaluated as controls. Expression of p53 and Rb was evaluated with PCR and immunohistochemistry. Cell proliferation was monitored by time to confluence.ResultsPCR analysis of cDNA confirmed expression of E6 and E7 in the transduced and naturally infected cell populations and the absence of E6 and E7 expression in the HPV negative cell lines. E6 and E7 transduced cell lines demonstrated reduced staining intensity for p53 and Rb compared to the HPV negative parental cells. Naturally infected HPV positive cell line controls stained weakly for Rb and p53 as expected. Cell proliferation was modestly decreased in E6 and E7 transduced cell lines compared to the parental controls.ConclusionE6 and E7 viral oncoproteins affect cellular levels of p53 and Rb in the absence of a complete HPV genome. Viral E6 maintains the capacity to target p53 for degradation in HPV negative HNSCC cell lines with mutant p53. Individual oncoproteins can modify the behavior of HPV negative cell lines.
HPV Prevalence in a Multi‐ethnic Screening Population
Authors: Chen Kang Mei , Worsham Maria J. , Stephen Josena K. , Divine George , Ghanem Tamer A. , Stachler Robert J. , Gardner Glendon M. 
Published: February 2015

ObjectiveFor optimal feasibility using saliva rinse screening of HPV for head and neck cancer (HNC), the prevalence should be 5% or higher in the population screened. The aim of our study was to determine the prevalence of HPV16 infection in a screening population in Detroit, MI.MethodReal time quantitative PCR was applied to detect HPV16 in saliva DNA from 349 screening subjects without HNC, 157 HNC, and 19 controls. Cut points for HPV positivity were: >0 and >0.001 copy/cell. Proportions were compared between groups using exact chi‐square or Fisher’s exact tests as appropriate (set at P <. 05).ResultsAt cut point >0, each group had an overall HPV prevalence of over 5%, with a much higher prevalence of 31.2% in the HNC patient group. At cut point >0.001, the prevalence was lower in each group, 0% in the control, 1.2% in the screening, and 17.2% in the HNC group. At >0, females in the screening group had a higher prevalence of HPV than males (P =. 010), and at >0.001, prevalence was higher for males in the HNC group than females (P =. 043). In the screening group, at >0, only AA had higher prevalence than CA (P =. 025).ConclusionIn the screening group, a 5% and 1.2% screening rate was noted at cut‐points >0 and >0.001, respectively. The results provide data to inform public health considerations of the feasibility of saliva as a screening tool in at‐risk populations with the long term goal of prophylactic vaccination against oral HPV.
Knowledge Regarding HPV and Head and Neck Cancer
Authors: Hapner Edie R. , White Laura , Creighton Francis P. , Wise Justin C. , Berg Carla 
Published: February 2015

ObjectiveCompare the knowledge of the relationship between HPV and head and neck cancer (HNCA) in 3 unique populations: NASCAR race attendees, undergraduates, and medical students. Compare the self‐reported level of information disseminated by healthcare providers regarding HPV and HNCA, respectively.MethodA 21‐item questionnaire was administered to 490 NASCAR race attendees, 186 undergraduate students, and 158 medical students. The survey assessed their knowledge regarding the relationship between HPV and HNCA using a Likert scale. The survey also assessed the level of information disseminated by healthcare providers regarding HPV and HNCA.ResultsNASCAR attendees evidenced significantly (P <. 001, η2 =. 10) lower levels of knowledge of the relationship between HPV and cervical cancer than college or medical students. NASCAR attendees evidenced significantly (P <. 001, η2 =. 02) lower levels of knowledge regarding relationship between HPV and HNCA than medical students or undergraduates. NASCAR attendees reported receiving significantly (P <. 001, η2 =. 10) higher levels of information regarding HNCA compared to college or medical students. Undergraduates and medical students reported receiving significantly (P <. 001, η2 =. 02) higher levels of information from healthcare providers about HPV than NASCAR attendees.ConclusionSignificant group differences concerning knowledge of the relationship between HPV and cervical cancer and between HPV and HNCA were detected. However, all 3 groups demonstrated higher levels of knowledge of the relationship between HPV and cervical cancer compared to HPV’s relationship with HNCA.
Modified Brief Fatigue Inventory in Head and Neck Cancer
Authors: Aynehchi Behrad B. , Obourn Chelsea , Sundaram Krishnamurthi , Bentsianov Boris L. , Rosenfeld Richard M. 
Published: February 2015

ObjectiveThe aim of this study is to validate the Modified Brief Fatigue Inventory (MBFI). This is the first instrument designed to measure intensity and frequency of fatigue specifically in head and neck cancer patients, potentially allowing objective measurement in addressing this common symptom in a concise yet thorough fashion.MethodThe 9‐item MBFI was administered to 52 consecutive cancer patients and 57 consecutive controls from the outpatient otolaryngology clinic of an academic tertiary medical center. Subject demographics, co‐morbidities, cancer site, and cancer stage were recorded. Psychometric properties and predictors of the MBFI were analyzed.ResultsMBFI 1‐week test‐retest reliability was excellent (r = 0.800, P <. 001). Internal consistency was also excellent (Cronbach’s α =. 938). Construct validity of the MBFI compared to the previously validated Multidimensional Fatigue Symptom Inventory Short Form was excellent (r = 0.814, P <. 001). Discriminant validity of cancer versus controls was significant (P =. 027). Predictors of increased MBFI score included 1) American Society of Anesthesiologists (comorbidity) score (bivariate analysis r = 0.287, P =. 039), 2) cancer stage (analysis of variance P =. 007), and 3) adjuvant radiotherapy (t test P =. 016). No significant relationship was found with age, gender, marital status, education, ethnicity, feeding tube, tracheostomy, or laryngectomy.ConclusionThe MBFI is a reliable and valid tool for measuring fatigue levels in head and neck cancer patients. In the context of initial assessment or posttreatment trending, this brief survey can be rapidly administered, providing valuable objective data on a very common and potentially debilitating symptom.
Optimal Timing for PTH Assay in Parathyroidectomy
Authors: Kanotra Sohit P. , Kuriloff Daniel B. , Vyas Priyam K. 
Published: February 2015

Objective1) To assess the feasibility of a novel criterion for intraoperative parathyroid hormonal assay (iPTH) based on a single 10‐minute postexcision PTH level and using the workup PTH (wPTH) level as the baseline. 2) To compare the predictive value of this criterion with other recommendations for the timing of PTH acquisition.MethodsA review of a single surgeon prospectively maintained parathyroidectomy database over a 2‐year period. Patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy were included in the study.ResultsA total of 77 patients with a mean age of 54 ± 13.6 years met the inclusion criterion. The mean preoperative calcium was 11.12 ± 0.42 mg/dL. There was no correlation between the wPTH (mean = 138.33 ± 29.36 pg/mL) and the preincision (mean = 201 ± 90.7 pg/mL) and the preexcision (114 ± 82.5 pg/dL) PTH values. The sensitivity, specificity, PPV, NPV, and accuracy of using the wPTH level as the baseline and a normal 10‐minute postexcision level as a criterion was 98.6%, 66.6%, 98.6%, 66.6%, and 97.4%, which was comparable to the already defined criterion.ConclusionThe pre‐excision and the pre‐incision values do not seem to change the overall accuracy of predicting surgical success if a single 10‐minute postexcision normal level is taken into consideration. A single normal 10‐minute postexcision iPTH assay is a feasible criterion that avoids multiple PTH samples and provides an acceptable predictive value for surgical success in minimally invasive parathyroidectomy.
Partial Laryngeal Surgery for Intermediate Larynx Cancer
Authors: Beswick Daniel M. , Caicedo‐Granados Emiro E. , Cunningham Diana E. , Christopoulos Apostolos , Kubicek Gregory J. , Heron Dwight E. , Ferris Robert L. 
Published: February 2015

ObjectiveChemoradiation trials over the past 2 decades have assumed that the primary surgical option for intermediate stage laryngeal cancer (T2‐T3/N0‐N1) was total laryngectomy. However, partial laryngeal surgery (PLS), including transoral laser microsurgery (TLM) and supracricoid partial laryngectomy (SCL), can provide sound oncologic and functional outcomes, often without adjuvant therapy.MethodWe retrospectively evaluated oncologic and functional outcomes in laryngeal squamous cell carcinoma (LSCC) patients who underwent TLM or SCL from 1998‐2010. Overall survival (OS) and recurrence‐free survival (RFS) were calculated. The Communication Scale (CS) and Functional Outcome Swallowing Scale (FOSS) were used to evaluate speech and swallowing, respectively.ResultsEighty‐one patients were analyzed with median follow‐up of 31 months. Eighty‐four percent were T2‐T3/N0‐N1. Two‐ and 5‐year OS probabilities were 84.2% (95% CI: 73.0‐91.0%) and 59.3% (95% CI: 41.4‐73.3%), respectively. There was no difference between the TLM and SCL cohorts in OS (P =. 781) or RFS (P =. 456). Ninety‐four percent of patients still had a larynx at median 31 months. Seventy‐five percent of patients avoided adjuvant therapy, including 67% of TLM and 84% of SCL patients. CS and FOSS were 2‐or‐better in 95% and 88%, respectively, designating functional postoperative voice and swallowing. TLM patients were more likely to have a CS of 2‐or‐better postoperatively (P =. 041).ConclusionPLS can provide good oncologic and functional outcomes for intermediate stage LSCC and is an alternative to chemoradiation or total laryngectomy in select patients.
Predicting Quality of Life in Oral and Oropharyngeal Cancer
Authors: Moubayed Sami P. , Sampalis John S. , Gologan Olga , Ayad Tareck , Guertin Louis , Christopoulos Apostolos 
Published: February 2015

Objective1) To evaluate p16 status as a predictor of quality of life (QOL) in oral and oropharyngeal squamous cell carcinoma (OSCC). 2) To identify independent predictive factors of QOL in OSCC.Methods1) We conducted a cross‐sectional study on 156 OSCC patients. Patients were evaluated using 3 validated QOL questionnaires (EORTC QLQ‐C30, EORTC QLQ‐HN35, HADS). HPV status was determined using p16 status on immunohistochemistry staining on paraffin blocks. Using chi‐square and t test analyses, we identified the value of p16 as a predictor of QOL. 2) Patient factors, tumor factors, risk factors, and treatment factors were then identified on medical record review. Bivariate analyses identified predictors of QOL, and multivariate regression analyses identified factors with independent significance.ResultsQOL data were collected for 156 patients. Mean and median follow‐up times were 63.2 and 35.0 months. Pretreatment tumor p16 status was available for 88 patients. Pretreatment p16 status did not significantly predict QOL as evaluated by our questionnaires. However, anemia at diagnosis independently predicted long‐term global QOL. T classification predicted long‐term depression, pain, function, and social contact. Number of medications was used as a surrogate of comorbidities, and predicted long‐term pain and depression. Mandibulectomy predicted long‐term pain.ConclusionThis is the first study in the literature to evaluate the impact of p16 status on prediction of QOL in OSCC. Pretreatment anemia is an independent predictive factor of QOL. Number of medications is used as a surrogate of comorbidities in this study and is an independent and significant predictor of long‐term QOL in OSCC.
Prognostic Factors of Sinonasal Tumors in the Young and the Elderly
Authors: Halmos Gyorgy B. , Peters Thomas T. , Van Der Laan Bernard F. 
Published: February 2015

ObjectiveSinonasal malignancies are uncommon neoplasms with several histological subtypes, most commonly treated with surgery and postoperative radiotherapy. The aim of this study was to evaluate complications and survival, focusing on differences between elderly and younger patients undergoing surgery.MethodMedical charts of 107 surgically treated patients (73 under 70 years and 34 aged 70 years or older) in a tertiary referral center with sinonasal malignancy were retrospectively analyzed. Comorbidity was scored according to the ACE‐27 system. Treatment outcomes were analyzed by collecting treatment‐related complications scores and survival data.ResultsAlthough comorbidity was more common in elderly patients, no significant difference was found in complications. In multivariate analysis length of surgery was the only predictor for complication. Furthermore, no significant difference was seen in survival or recurrence of young and elderly patients. Young patients with squamous cell carcinoma and melanoma had a worse overall survival than patients with other histological subtypes. However, in elderly patients no significant difference was detected in survival between histological subtypes.ConclusionFor complications, survival, and recurrence no difference was seen between young and elderly patients. Therefore, based on this study, elderly sinonasal cancer patients should not be treated differently than younger counterparts.
Anastomotic Systems in Head and Neck Reconstruction
Authors: Frederick John W. , Magnuson J. Scott , Carroll William R. , Clemons Lisa , Peters Glenn E. , Rosenthal Eben L. 
Published: February 2015

ObjectiveTo assess the advantages of using mechanical anastomotic systems in head and neck free tissue transfer.MethodA review of mechanical venous coupler devices in head and neck reconstruction performed at a university‐based tertiary care facility from 2004 to 2006. A total of 261 venous anastomosis performed in 234 consecutive patients. Five types of flaps were performed, and outcomes measured were flap survival and microvascular complications.ResultsA total of 261 venous anastomosis were performed, size ranging from 2.0 to 4.0 mm, with the majority being 3.0 mm (56%) followed by 3.5 mm (23%). The most common vein used for anastomosis was a stump of the internal jugular vein (75%), followed by the external jugular (18%). Microvascular complications were experienced in 8 patients (3%). The series produced 7 total flap failures (2.6%), 4 (1.5%) classified as acute failure (<5 days) and 3 as late unspecified failure. Of the acute failures, there was 1 confirmed venous congestion and 3 confirmed arterial insufficiencies. The venous coupler used in the 7 failures was 3.0 mm in diameter. The 3 flap failures resulting from arterial insufficiency involved coupling to the external jugular vein, while the remaining 4 failures used the internal jugular. The flap failure secondary to venous congestion involved a 3.0 mm coupler anastomosing the internal jugular vein to the inferior epigastric vessels of the rectus abdominus tissue transfer.ConclusionWith an early venous failure rate of 0.38%, mechanical anastomosis is an adequate alternative to hand‐sewn anastomotic techniques.
Prognostic Impact of Age in Differentiated Thyroid Cancer
Authors: Oyer Samuel L. , Smith Valerie A. , Lentsch Eric J. 
Published: February 2015

Objective1) Determine the impact of age on disease‐specific survival in differentiated thyroid cancer. 2) Compare the impact of age on survival between follicular and papillary thyroid cancer subtypes.MethodThe SEER Database was searched for patients with differentiated thyroid cancer between 1988‐2003. Patient age, gender, tumor type, size, extension, and metastases were collected. Kaplan‐Meier analyses were used to estimate disease specific survival based on age ranges. A multivariate analysis was performed to determine hazard ratios of death for various age cutoffs.ResultsA total of 42,209 patients were identified. Patients 45 years and older had significantly worse survival than younger patients (P <. 001). A significant decrease in disease specific survival was first seen in patients aged 35 years and older, and survival continued to steadily decrease with each additional decade of age (P <. 001). Patients aged 35 years and older were 14 times more likely to die from differentiated thyroid cancer than patients younger than 35. Age played a stronger prognotic role in death among patients with papillary carcinoma compared to follicular carcinoma.ConclusionIncreasing age is associated with poorer survival in differentiated thyroid cancer. This relationship represents a continuum with an initial decrease in survival starting at age 35 that continues to decline with advancing age.