Publications by authors named "Brandon M Lehrich"

35 Publications

The association of frailty, age, and ASA classification with postoperative outcomes in endoscopic sinus surgery.

Int Forum Allergy Rhinol 2021 May 28. Epub 2021 May 28.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA.

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http://dx.doi.org/10.1002/alr.22829DOI Listing
May 2021

Association Between Olfactory Dysfunction and Critical Illness and Mortality in COVID-19: A Meta-analysis.

Otolaryngol Head Neck Surg 2021 May 25:1945998211017442. Epub 2021 May 25.

Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California, USA.

Level Of Evidence: 4.
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http://dx.doi.org/10.1177/01945998211017442DOI Listing
May 2021

Emerging methods in biomarker identification for extracellular vesicle-based liquid biopsy.

J Extracell Vesicles 2021 May 12;10(7):e12090. Epub 2021 May 12.

Department Biomedical Engineering Carnegie Mellon University Pittsburgh Pennsylvania USA.

Extracellular vesicles (EVs) are released by many cell types and distributed within various biofluids. EVs have a lipid membrane-confined structure that allows for carrying unique molecular information originating from their parent cells. The species and quantity of EV cargo molecules, including nucleic acids, proteins, lipids, and metabolites, may vary largely owing to their parent cell types and the pathophysiologic status. Such heterogeneity in EV populations provides immense challenges to researchers, yet allows for the possibility to prognosticate the pathogenesis of a particular tissue from unique molecular signatures of dispersing EVs within biofluids. However, the inherent nature of EV's small size requires advanced methods for EV purification and evaluation from the complex biofluid. Recently, the interdisciplinary significance of EV research has attracted growing interests, and the EV analytical platforms for their diagnostic prospect have markedly progressed. This review summarizes the recent advances in these EV detection techniques and methods with the intention of translating an EV-based liquid biopsy into clinical practice. This article aims to present an overview of current EV assessment techniques, with a focus on their progress and limitations, as well as an outlook on the clinical translation of an EV-based liquid biopsy that may augment current paradigms for the diagnosis, prognosis, and monitoring the response to therapy in a variety of disease settings.
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http://dx.doi.org/10.1002/jev2.12090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114032PMC
May 2021

The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma.

Head Neck 2021 May 17. Epub 2021 May 17.

Department of Otolaryngology - Head and Neck Surgery, University of California, Irvine, California, USA.

Background: This study evaluates the influence of facility case-volume on nasopharyngeal carcinoma (NPC) treatments and overall survival (OS).

Methods: The 2004-2015 National Cancer Database was queried for patients with NPC receiving definitive treatment.

Results: A total of 8260 patients (5-year OS: 63.4%) were included. The 1114 unique facilities were categorized into 854 low-volume (treating 1-8 patients), 200 intermediate-volume (treating 9-23 patients), and 60 high-volume (treating 24-187 patients) facilities. Kaplan-Meier log-rank analysis demonstrated significantly improved OS with high-volume facilities (p < 0.001). On cox proportional-hazard multivariate regression after adjusting for age, sex, income, insurance, comorbidity index, histology, AJCC clinical stage, and treatment type, high-volume facilities were associated with lower mortality risk than low-volume (HR = 0.865, p = 0.019) and intermediate-volume facilities (HR = 0.916, p = 0.004). Propensity score matching analysis confirmed this association (p < 0.001).

Conclusion: Higher facility volume was an independent predictor of improved OS in NPC, suggesting a possible survival benefit of referrals to high-volume medical centers.
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http://dx.doi.org/10.1002/hed.26739DOI Listing
May 2021

Determinants of Survival in Skull Base Osteosarcoma: A National Cancer Database Study.

World Neurosurg 2021 May 8. Epub 2021 May 8.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, USA; Department of Neurological Surgery, University of California, Irvine, Irvine, California, USA. Electronic address:

Objective: Skull base osteosarcoma is a rare and aggressive tumor that is most commonly treated with primary surgical resection and adjuvant chemoradiation. Using the National Cancer Database, we analyzed demographic and clinical prognosticators for overall survival (OS).

Methods: The National Cancer Database was queried for cases of histologically confirmed skull base osteosarcoma treated between 2004 and 2015, excluding patients receiving palliation or having <1 month of follow-up. A total of 314 patients treated with surgery alone (n = 82), surgery with adjuvant radiotherapy (n = 35), surgery with chemotherapy (n = 114), or trimodality therapy (n = 56) were identified. The χ test for categorical variables, Cox proportional hazards models, and Kaplan-Meier log-rank analysis were used to test associations with treatment, OS, and survival time.

Results: None of the studied demographic characteristics (age, sex, race, overall health) and socioeconomic factors (income and average regional education) were associated with OS (none P < 0.05). Treatment modalities also did not show a significant association with OS (none P < 0.05). Certain tumor characteristics showed an association with OS, with fibroblastic and Paget histologic subtypes (each P = 0.003), poorly differentiated tumor grade (P = 0.03), and tumor size >5 cm (P = 0.045) associated with poorer OS.

Conclusions: Tumor histologic subtype, advanced tumor grade, and greater tumor size are predictors of worse OS in skull base osteosarcoma. No significant differences in OS were identified based on treatment modality, which warrants further investigation.
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http://dx.doi.org/10.1016/j.wneu.2021.04.135DOI Listing
May 2021

Association Between 5-Item Modified Frailty Index and Short-term Outcomes in Complex Head and Neck Surgery.

Otolaryngol Head Neck Surg 2021 May 11:1945998211010443. Epub 2021 May 11.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA.

Objectives: To evaluate the impact of preoperative frailty on short-term outcomes following complex head and neck surgeries (HNSs).

Study Design: Cross-sectional database analysis.

Setting: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

Methods: The 2005 to 2017 ACS-NSQIP was queried for patients undergoing complex HNS. Five-item modified frailty index (mFI) was calculated based on functional status and history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and chronic hypertension.

Results: A total of 2786 patients (73.1% male) with a mean age of 62.0 ± 11.6 years were included. Compared to nonfrail patients (41.2%), patients with mFI ≥1 (58.8%) had shorter length of operation ( = .021), longer length of stay (LOS) ( < .001), and higher rates of 30-day reoperation ( = .009), medical complications ( < .001), discharge to nonhome facility (DNHF) ( < .001), and mortality ( = .047). These parameters remained statistically significant when compared across all individual mFI scores (all < .05). After adjusting for age, sex, race, body mass index, smoking, and American Society of Anesthesiologists score via multivariate logistic regression, patients with mFI ≥1 were significantly more likely to undergo reoperation (odds ratio [OR], 1.39), surgical complications (OR, 1.19), medical complications (OR, 1.55), prolonged LOS (OR, 1.29), and DNHF (OR, 1.56) (all < .05). Multivariate logistic regression also demonstrated that after adjusting for confounders, compared to patients with mFI = 1, patients with mFI = 2-5 (18.7%) were more likely to undergo shorter operations (OR, 0.74), have medical (OR, 1.46) or any complications (OR, 1.27), and have DNHF (OR, 1.62) (all < .05).

Conclusion: The 5-point mFI can independently predict short-term surgical outcomes following complex HNS. This simple and reliable metric can potentially lead to improved preoperative counseling and postoperative planning for complex HNS patients.
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http://dx.doi.org/10.1177/01945998211010443DOI Listing
May 2021

Characteristics and overall survival in pediatric versus adult pituitary adenoma: a National Cancer Database analysis.

Pituitary 2021 Apr 30. Epub 2021 Apr 30.

Department of Otolaryngology-Head and Neck Surgery, University of California, 101 The City Drive South, Irvine, Orange, CA, 92868, USA.

Objective: Pituitary adenomas in the pediatric population are extremely rare, resulting in limited information in the literature on these patients. In this study, data from the National Cancer Database (NCDB) to compare pituitary adenoma clinical presentations, treatment management patterns, and overall survival between pediatric and adult patients.

Methods: The NCDB was queried for all cases of histologically confirmed pituitary adenoma treated between 2004 and 2015. Patients were primarily stratified as either pediatric (< 18 years) or adult (≥ 18 years). Patient demographics/socioeconomics and resulting outcomes were then compared.

Results: 1893 pediatric and 77,993 adult patients with pituitary adenomas were evaluated. Average tumor size for pediatric and adult patients was 13.6 ± 13.2 mm and 20.1 ± 13.1 mm, respectively (p < 0.001). Pediatric patients were more likely to undergo gross total resection, less likely to receive adjuvant radiation, more likely to receive medical therapy, more likely to undergo active surveillance, and exhibited improved 5-year and 10-year overall survival (OS) (all p < 0.001). Temporal analysis demonstrated a significant increase in endoscopic approach over time (from 48 to 65%) in the pediatric population (R = 0.722, p = 0.03). On univariate analysis in the pediatric population, African American race compared to Caucasians (HR: 5.85, 95% CI 1.79-19.2, p < 0.003), patients with government insurance compared to those with private insurance (HR: 5.07, 95% CI 1.31-19.6, p < 0.02) and uninsured patients compared to those with private insurance (HR: 14.4, 95% CI 2.41-86.5, p < 0.003) were associated with decreased OS. Lastly, patients who underwent GTR had improved OS compared to those who underwent subtotal resection (HR: 0.08, 95% CI 0.008-0.93, p < 0.04) in the pediatric population.

Conclusions: Compared to adults, children with pituitary adenomas more commonly underwent GTR, less frequently underwent adjuvant radiotherapy, more frequently underwent medical management and active surveillance, and had improved survival. Temporal analysis demonstrated increasing utilization of the endoscopic approach for surgical treatment of pediatric and adult pituitary adenoma patients.

Level Of Evidence: Level III.
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http://dx.doi.org/10.1007/s11102-021-01146-3DOI Listing
April 2021

Temporal patterns of nasal symptoms in patients with mild severity SARS-CoV-2 infection.

Am J Otolaryngol 2021 Apr 24;42(6):103076. Epub 2021 Apr 24.

Department of Otorhinolaryngology - Head & Neck Surgery, Rush University Medical Center, Chicago, IL, United States of America. Electronic address:

Background: No study to date has analyzed the progression of sinonasal symptoms over time in COVID-19 patients. The purpose of this study is to analyze the progression of sinonasal symptoms and risk factors for olfactory dysfunction in the mild severity COVID-19 patient.

Methods: An internet survey was used to assess sinonasal symptoms in patients with COVID-19. Changes in rhinologic domain and symptom-specific Sinonasal Outcome Test (SNOT-22) scores were compared at five time points: two weeks before diagnosis, at diagnosis, two weeks after diagnosis, four weeks after diagnosis, and six months after diagnosis.

Results: 521 responses were collected. Rhinologic domain SNOT-22 scores increased significantly (p < 0.001) to 8.94 at the time of diagnosis, remained elevated two weeks post-diagnosis (5.14, p = 0.004), and decreased significantly four weeks post-diagnosis (3.14, p = 0.004). Smell-specific SNOT-22 scores peaked at the time of diagnosis (2.05, p < 0.001), remained elevated two weeks after diagnosis (1.19, p < 0.001), and returned to baseline four weeks post-diagnosis (0.64, p > 0.999). Taste-specific SNOT-22 scores also peaked at diagnosis (2.06, p < 0.001), remained elevated two weeks after diagnosis (1.19, p < 0.001), and returned to baseline four weeks after diagnosis (0.71, p > 0.999). There were no significant differences in sense of smell or taste between 1-month and 6-month timepoints.

Conclusion: Sinonasal symptoms, particularly loss of smell and taste, may be important presenting symptoms in the mild severity COVID-19 patient. Our findings support incorporating these symptoms into screening protocols.

Level Of Evidence: 4.
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http://dx.doi.org/10.1016/j.amjoto.2021.103076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064817PMC
April 2021

Treatment Modalities and Survival Outcomes for Sinonasal Diffuse Large B-Cell Lymphoma.

Laryngoscope 2021 Apr 26. Epub 2021 Apr 26.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A.

Objectives/hypothesis: This study utilizes a large population national database to comprehensively analyze prognosticators and overall survival (OS) outcomes of varying treatment modalities in a large cohort of sinonasal diffuse large B-cell lymphoma (SN-DLBCL) patients.

Study Design: Retrospective database study.

Methods: The National Cancer Database was queried for all SN-DLBCL cases diagnosed from 2004 to 2015. Kaplan-Meier log-rank test determined differences in OS based on clinical covariates. Cox proportional-hazards analysis was used to determine clinical and sociodemographic covariates predictive of mortality.

Results: A total of 2,073 SN-DLBCL patients were included, consisting of 48% female with a mean age of 66.0 ± 16.2 years. Overall, 82% of patients were Caucasian, 74% had early-stage disease, and 49% had primary tumors in the paranasal sinuses. Early-stage patients were more likely to receive multi-agent chemoradiotherapy compared to multi-agent chemotherapy alone (P < .001). Multivariable Cox proportional-hazards analysis revealed chemoradiotherapy to confer significantly greater OS improvements than chemotherapy alone (hazard ratio [HR]: 0.61; P < .001). However, subset analysis of late-stage patients demonstrated no significant differences in OS between these treatment modalities (P = .245). On multivariable analysis of chemotherapy patients treated post-2012, immunotherapy (HR = 0.51; P = .024) demonstrated significant OS benefits. However, subset analysis showed no significant advantage in OS with administering immunotherapy for late-stage patients (P = .326). Lastly, for all patients treated post-2012, those receiving immunotherapy had significantly improved OS compared to those not receiving immunotherapy (P < .001).

Conclusions: Treatment protocol selection differs between early- and late-stage SN-DLBCL patients. Early-stage patients receiving chemotherapy may benefit from immunotherapy as part of their treatment paradigm.

Level Of Evidence: III Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29584DOI Listing
April 2021

Characteristics and overall survival in pediatric versus adult esthesioneuroblastoma: A population-based study.

Int J Pediatr Otorhinolaryngol 2021 May 28;144:110696. Epub 2021 Mar 28.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA; Department of Neurological Surgery, University of California, Irvine, CA, USA. Electronic address:

Background: Esthesioneuroblastoma (ENB) is an uncommon sinonasal malignancy and is even less common in the pediatric population.

Objective: The purpose of this study is to compare characteristics and outcomes of ENB between adult and pediatric patients.

Methods: The National Cancer Database was queried for patients with histologically proven ENB of the nasal cavity and paranasal sinuses, and then baseline characteristics, treatment, and survival data compared between the pediatric (age < 18 years) and adult (age ≥ 18 years) populations.

Results: 1411 patients were identified, with 45 in the pediatric cohort and 1366 in the adult cohort. Ten-year overall survival (OS) in the pediatric cohort was improved compared to the adult cohort, 87% and 66%, respectively (p < 0.05). Adjuvant chemotherapy was more commonly utilized in the pediatric cohort (p < 0.001). Race was associated with decreased OS in the pediatric cohort (p = 0.013). Pediatric patients had shorter length of stay (p = 0.009) and lived closer to their provider (p = 0.044) than adult ENB patients.

Conclusion: Treatment of ENB in pediatric patients more commonly includes chemotherapy and more commonly occurs at academic medical centers. OS is improved in pediatric ENB compared to adults as well, but larger studies are necessary.
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http://dx.doi.org/10.1016/j.ijporl.2021.110696DOI Listing
May 2021

Characteristics and overall survival in pediatric versus adult craniopharyngioma: a population-based study.

Childs Nerv Syst 2021 May 28;37(5):1535-1545. Epub 2021 Feb 28.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 101 The City Drive South, Orange, CA, 92868-3201, USA.

Purpose: This study uses a large-population national database to describe the presenting clinical, sociodemographic, treatment, and clinical outcome differences between pediatric and adult craniopharyngiomas.

Methods: This study utilized the 2004-2015 National Cancer Database and was queried for all cases of craniopharyngioma. Multivariate Cox proportional-hazards analysis was used to determine clinical and sociodemographic factors associated with mortality. Kaplan-Meier log-rank test determined differences in overall survival (OS) time.

Results: The cohort consisted of 3638 patients, with 816 (22.4%) pediatric (≤ 18 years) patients. Pediatric patients presented with significantly higher frequency of large tumors (> 3 cm, 54.1 vs. 31.8%, p < 0.001), lower frequency of papillary subtype (0.9 vs. 11.5%, p < 0.001), and were exclusively treated at academic centers (100 vs. 73.4%, p < 0.001). Pediatric patients had significantly higher rates of adjuvant radiation (34.3 vs. 22.3%; p < 0.001), and had significantly lower 90-day mortality (1.6 vs. 4.9%; p < 0.001); however, no significant differences in extent of resection (p = 0.93), length of hospital stay (p = 0.53), and 30-day readmissions (p = 0.06) were observed between pediatric and adult patients. On Kaplan-Meier log-rank test, there were no significant differences in OS in pediatric patients receiving gross total resection (GTR), subtotal resection (STR), or STR + adjuvant radiation (p = 0.68). Lastly, when comparing endoscopic and open surgical approaches in pediatric patients, there were no significant differences in extent of surgical resection (p = 0.81), length of hospital stay (p = 0.54), 30-day readmissions (p = 0.22), and 90-day mortality (p = 0.80).

Conclusion: Craniopharyngioma has improved OS in pediatric compared to adult patients. Pediatric craniopharyngioma patients are best managed within multidisciplinary teams at academic centers with an individualized approach.
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http://dx.doi.org/10.1007/s00381-021-05094-yDOI Listing
May 2021

Foetal bovine serum influence on in vitro extracellular vesicle analyses.

J Extracell Vesicles 2021 Jan 25;10(3):e12061. Epub 2021 Jan 25.

Brain Neurotherapy Bio, Inc Oakland California USA.

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http://dx.doi.org/10.1002/jev2.12061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830136PMC
January 2021

Characteristics and overall survival in pediatric versus adult skull base chordoma: a population-based study.

Childs Nerv Syst 2021 Jun 18;37(6):1901-1908. Epub 2021 Jan 18.

Department of Neurosurgery, University of California, Irvine, CA, USA.

Purpose: Less than 5% of chordomas occur in pediatric patients. While many studies have explored the treatment and outcomes of skull base chordomas, few have focused on the differences between pediatric and adult populations. The aim of this study is to analyze the epidemiological variables and clinical outcomes between pediatric and adult skull base chordomas using a large-sample, population-based cancer database.

Methods: The National Cancer Database was queried between 2004 and 2015 for skull base chordomas. We stratified patients as pediatric (<18 years) and adults (≥18 years). We compared several clinical covariates between the two groups.

Results: Our cohort consisted of 658 patients, 61 pediatric (9.3%), and 597 adults (90.7%). Pediatric patients were more likely to have larger tumor size (41.4 ± 15.7 mm versus 34.1 ± 15.8 mm, p < 0.01) and universally treated at academic facilities. There was no significant difference in overall survival.

Conclusions: Pediatric skull base chordomas are rare tumors that are managed with aggressive surgical resection, followed by radiation. While there may be difference between tumor presentation, outcomes between pediatric and adult patients are similar.
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http://dx.doi.org/10.1007/s00381-021-05046-6DOI Listing
June 2021

Predictors of Patient Satisfaction in Spine Surgery: A Systematic Review.

World Neurosurg 2021 02 28;146:e1160-e1170. Epub 2020 Nov 28.

Department of Neurosurgery, University of California, Irvine, Irvine, California, USA.

Background: Recently, there has been increased interest in patient satisfaction measures such as Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. In this systematic review, the spine surgery literature is analyzed to evaluate factors predictive of patient satisfaction as measured by these surveys.

Methods: A thorough literature search was performed in PubMed/MEDLINE, Google Scholar, and Cochrane databases. All English-language articles from database inception to July 2020 were screened for study inclusion according to PRISMA guidelines.

Results: Twenty-four of the 1899 published studies were included for qualitative analysis. There has been a statistically significant increase in the number of publications across years (P = 0.04). Overall, the studies evaluated the relationship between patient satisfaction and patient demographics (71%), preoperative and intraoperative clinical factors (21%), and postoperative factors (33%). Top positive predictors of patient satisfaction were patient and nursing/medical staff relationship (n = 4; 17%), physician-patient relationship (n = 4; 17%), managerial oversight of received care (n = 3; 13%), same sex/ethnicity between patient and physician (n = 2; 8%), and older age (n = 2; 8%). Top negative predictors of patient satisfaction were high Charlson Comorbidity Index/high disability/worse overall health functioning (n = 7; 29%), increased length of hospital stay (n = 4; 17%), high rating for pain/complications/readmissions (n = 4; 17%), and psychosocial factors (n = 3; 13%).

Conclusions: There is heterogeneity in terms of different factors, both clinical and nonclinically related, that affect patient satisfaction ratings. More research is warranted to investigate the role of hospital consumer surveys in the spine surgical patient population.
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http://dx.doi.org/10.1016/j.wneu.2020.11.125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897306PMC
February 2021

A Comprehensive Analysis of Treatment Management and Survival Outcomes in Nasopharyngeal Carcinoma.

Otolaryngol Head Neck Surg 2020 Nov 24:194599820973241. Epub 2020 Nov 24.

Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Orange, California, USA.

Objectives: To comprehensively investigate nasopharyngeal carcinoma (NPC) treatment, overall survival (OS), and the influence of clinical/sociodemographic factors on outcome.

Study Design: Retrospective database study.

Setting: National Cancer Database.

Methods: The 2004-2015 National Cancer Database was queried for all patients with NPC receiving definitive treatment. Log-rank tests and Cox proportional hazards models were used for statistical analyses.

Results: A total of 8260 patients with NPC were included (71.4% male; 42.5% with keratinizing histology; mean ± SD age, 52.1 ± 15.1 years), with a 5-year OS of 63.4%. Multivariate predictors of mortality included age ≥65 years (hazard ratio [HR], 1.81; < .001), Charlson/Deyo score ≥1 (HR, 1.27; = .001), American Joint Committee on Cancer clinical stage III to IV (HR, 1.85; < .001), and government insurance or no insurance (HR, 1.53; < .001). Predictors of survival included female sex (HR, 0.82; = .002), Asian/Pacific Islander race (HR, 0.74; < .001), nonkeratinizing/undifferentiated histology (HR, 0.79; = .004), and receiving treatment at academic centers (HR, 0.87; = .02). Chemoradiotherapy (CRT) demonstrated improved OS as compared with radiotherapy (RT) only for stage II ( = .006) and stage III ( = .005) and with RT or chemotherapy only in stage IVA NPC ( < .001). When compared with CRT alone, surgery plus CRT provided OS benefits in keratinizing ( = .013) or stage IVA ( = .030) NPC. When compared with RT, CRT provided OS benefits in keratinizing ( = .005) but not nonkeratinizing ( = .240) or undifferentiated ( = .390) NPC. Substandard radiation dosing of <60 Gy and <30 fractions were associated with inferior OS (both < .001).

Conclusions: NPC survival is dependent on a variety of clinical/sociodemographic factors. Stage-specific treatments with optimal OS include CRT or RT for stages I to II and CRT for stage III to IV. The large representation of nonendemic histology is valuable, as these cases are not well characterized.
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http://dx.doi.org/10.1177/0194599820973241DOI Listing
November 2020

Short-Term Morbidity and Predictors of Adverse Events Following Esthesioneuroblastoma Surgery.

Am J Rhinol Allergy 2021 Jul 29;35(4):500-506. Epub 2020 Oct 29.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California.

Introduction: The short-term adverse events and predictors of morbidity in surgical resection of esthesioneuroblastoma (ENB) are largely unknown, and investigating these variables can help direct planning for at-risk patients.

Methods: The 2005-2017 National Surgical Quality Improvement Program database was queried to identify patients with a diagnosis of ENB undergoing skull base surgery for tumor resection. Information regarding demographics, patient morbidity score, pre-operative and intra-operative data, and post-operative outcomes were extracted. Cox proportional hazard analysis was utilized to assess complication and readmission/reoperation rates.

Results: A total of 95 patients undergoing skull base surgery for resection of ENB were included. Mean age, BMI, operation time, and post-operative length of stay (LOS) of the cohort were 53.6 ± 16.2 years, 29.1 ± 6.5, 392.0 ± 204.6 minutes, and 5.8 ± 4.6 days, respectively. In total, 31 patients (32.6%) experienced at least one 30-day adverse event, which included blood transfusion intra-operatively or within 72 hours from the operation (22.1%), readmission (10.7%), intubation >48 hours (7.4%), reintubation (4.2%), organ or space infection (4.2%), reoperation (4.0%), superficial or deep surgical site infection (2.1%), sepsis (2.1%), pulmonary embolism (1.1%), and myocardial infarction (1.1%). Patients who experienced at least one adverse event had significantly higher operation time (486.8 ± 230.4 vs. 347.5 ± 176.2 minutes,  = 0.002), LOS (9.2 ± 5.6 days vs. 4.2 ± 3.0,  < 0.001), and lower hematocrit (37.3 ± 5.9 vs. 41.2 ± 3.8,  < 0.001) and albumin levels (3.8 ± 0.6 vs. 4.2 ± 0.3,  = 0.009). Patients with a higher American Society of Anesthesiologists (ASA) score (HR = 2.39;  = 0.047) or longer operation time (HR = 1.004;  = 0.001) had a significantly higher risk for experiencing adverse events. Obesity was not associated with different intra- or post-operative outcomes, but older patients had shorter operations ( = 0.002) and LOS ( = 0.0014).

Conclusion: Longer operation time and lower pre-operative hematocrit and albumin levels may all increase complication rates in ENB resection. Patients with high ASA score or more advanced age may have different short-term outcomes.
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http://dx.doi.org/10.1177/1945892420970468DOI Listing
July 2021

Treatment modalities and overall survival outcomes for sinonasal extranodal natural killer/T-cell lymphoma.

Leuk Lymphoma 2021 03 15;62(3):727-730. Epub 2020 Oct 15.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA.

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http://dx.doi.org/10.1080/10428194.2020.1834097DOI Listing
March 2021

Translational Approaches to Electrical Stimulation for Peripheral Nerve Regeneration.

Neurorehabil Neural Repair 2020 11 10;34(11):979-985. Epub 2020 Oct 10.

University of California, San Diego, La Jolla, CA, USA.

Background: Achieving functional repair after peripheral nerve injury (PNI) remains problematic despite considerable advances in surgical technique. Therein, questions lie regarding the variable capacity of peripheral nerves to regenerate based on environmental influence. In-depth analyses of multiple therapeutic strategies have ensued to overcome these natural obstacles. Of these candidate therapies, electrical stimulation has emerged a frontrunner. Extensive animal studies have reported the ability of brief intraoperative electrical stimulation (BES) to enhance functional regeneration after PNI. Despite these reports, the exact mechanisms by which BES enhances regeneration and its effects on long nerve lesions are largely unknown. Indeed, clinical translation of this seemingly simple therapeutic has not been so simple, but a few studies performed in humans have yielded highly encouraging results.

Objective: We aimed to help bridge this translational gap by presenting the latest clinical trials on electrical stimulation for PNIs in combination with relevant etiologies, treatments and nonclinical findings.

Methods: To do so, a systematic search was performed on PubMed, IEEE, and Web of Science databases up to February 2020 using keywords significant to our study. References of each manuscript were screened for additional manuscripts of relevance to our study.

Results: We found multiple BES clinical studies reporting enhanced functional recovery or increased nerve regeneration. Although improved outcomes were reported, high variability after BES is seen between and within species likely due to injury severity, location and timeline along with other factors.

Conclusion: Further clinical studies and introduction of novel delivery platforms are vital to uncover the true regenerative potential of electrical stimulationtherapy.
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http://dx.doi.org/10.1177/1545968320962508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7655605PMC
November 2020

The role of frailty in geriatric cranial neurosurgery for primary central nervous system neoplasms.

Neurosurg Focus 2020 10;49(4):E15

8Department of Neurological Surgery, University of California, San Diego, La Jolla, California.

Objective: Frailty is a clinical state of increased vulnerability due to age-associated decline and has been well established as a perioperative risk factor. Geriatric patients have a higher risk of frailty, higher incidence of brain cancer, and increased postoperative complication rates compared to nongeriatric patients. Yet, literature describing the effects of frailty on short- and long-term complications in geriatric patients is limited. In this study, the authors evaluate the effects of frailty in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm.

Methods: The authors conducted a retrospective cohort study of geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm between 2010 and 2017 by using the Nationwide Readmission Database. Demographics and frailty were queried at primary admission, and readmissions were analyzed at 30-, 90-, and 180-day intervals. Complications of interest included infection, anemia, infarction, kidney injury, CSF leak, urinary tract infection, and mortality. Nearest-neighbor propensity score matching for demographics was implemented to identify nonfrail control patients with similar diagnoses and procedures. The analysis used Welch two-sample t-tests for continuous variables and chi-square test with odds ratios.

Results: A total of 6713 frail patients and 6629 nonfrail patients were identified at primary admission. At primary admission, frail geriatric patients undergoing cranial neurosurgery had increased odds of developing acute posthemorrhagic anemia (OR 1.56, 95% CI 1.23-1.98; p = 0.00020); acute infection (OR 3.16, 95% CI 1.70-6.36; p = 0.00022); acute kidney injury (OR 1.32, 95% CI 1.07-1.62; p = 0.0088); urinary tract infection prior to discharge (OR 1.97, 95% CI 1.71-2.29; p < 0.0001); acute postoperative cerebral infarction (OR 1.57, 95% CI 1.17-2.11; p = 0.0026); and mortality (OR 1.64, 95% CI 1.22-2.24; p = 0.0012) compared to nonfrail geriatric patients receiving the same procedure. In addition, frail patients had a significantly increased inpatient length of stay (p < 0.0001) and all-payer hospital cost (p < 0.0001) compared to nonfrail patients at the time of primary admission. However, no significant difference was found between frail and nonfrail patients with regard to rates of infection, thromboembolism, CSF leak, dural tear, cerebral infarction, acute kidney injury, and mortality at all readmission time points.

Conclusions: Frailty may significantly increase the risks of short-term acute complications in geriatric patients receiving cranial neurosurgery for a primary CNS neoplasm. Long-term analysis revealed no significant difference in complications between frail and nonfrail patients. Further research is warranted to understand the effects and timeline of frailty in geriatric patients.
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http://dx.doi.org/10.3171/2020.7.FOCUS20426DOI Listing
October 2020

Enhancing peripheral nerve regeneration with neurotrophic factors and bioengineered scaffolds: A basic science and clinical perspective.

J Peripher Nerv Syst 2020 12 23;25(4):320-334. Epub 2020 Sep 23.

Department of Neurological Surgery, University of California, San Diego, California, USA.

Despite the peripheral nervous systems (PNS) capacity to regenerate, functional restoration is highly variable following peripheral nerve injury (PNI), oftentimes leading to persistent functional deficits. In the preclinical arena, advances in the therapeutic use of exogenous neurotrophic factors and synthetic neural scaffold technology hold promise in augmenting endogenous PNS regeneration following PNI. Clinical trials utilizing neurotrophic factors for other indications (eg, peripheral neuropathy) may provide insight into their role in PNI. Here we provide an updated review of progress made toward enhancing regeneration after PNI with a focus on neurotrophic factors and bioengineered scaffolds.
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http://dx.doi.org/10.1111/jns.12414DOI Listing
December 2020

Extraprimary Local Recurrence of Esthesioneuroblastoma: Case Series and Literature Review.

World Neurosurg 2020 12 8;144:e546-e552. Epub 2020 Sep 8.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA; Department of Neurological Surgery, University of California, Irvine Medical Center, Orange, California, USA. Electronic address:

Objectives: Esthesioneuroblastoma (ENB) is a rare sinonasal malignancy arising from olfactory neuroepithelium. Recurrence typically occurs locoregionally at the primary site or in the form of cervical metastasis. Delayed local recurrence away from the initial primary site is exceedingly rare.

Methods: Retrospective review of 4 patients with histologically confirmed extraprimary local recurrence of ENB was performed with review of the literature.

Results: All cases initially presented with ENB isolated to the cribriform plate(s) treated with primary surgical resection and adjuvant radiotherapy. The first patient had ENB recurrence 8 years posttreatment involving the right orbit. She later developed metastases to the spine, neck, and mandible requiring composite resection and 4 courses of radiotherapy. The second patient had ENB recurrence of the dorsal septum 9 years posttreatment with cervical metastases requiring septectomy, bilateral neck dissection, and radiotherapy. The third patient had ENB recurrence 7 years posttreatment in the posterior nasopharynx requiring endonasal nasopharyngectomy. Finally, the fourth patient had ENB recurrence 12 years posttreatment in the sphenopalatine foramen, which was endoscopically resected. At the time of this review, all 4 patients were disease free at 32, 21, 4, and 24 months posttreatment follow-ups, respectively.

Conclusions: This case series describes the rare phenomenon of delayed extraprimary local recurrence of histologically confirmed ENB. Treatment of extraprimary recurrences, analogous to other forms of ENB, should include primary surgical resection with adjuvant radiotherapy for generally favorable outcomes. Long-term close follow-up based on symptoms, endoscopy, and imaging is essential because of the risk of delayed recurrence.
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http://dx.doi.org/10.1016/j.wneu.2020.08.227DOI Listing
December 2020

Academic Rhinologists' Online Rating and Perception, Scholarly Productivity, and Industry Payments.

Am J Rhinol Allergy 2021 May 11;35(3):341-347. Epub 2020 Sep 11.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California.

Introduction: The emergence of popular online rating websites, social media platforms, and public databases for industry payments and scholarly outputs provide a complete physician online presence which may guide choice and satisfaction.

Methods: Websites of all U.S. otolaryngology academic institutions were queried for fellowship-trained rhinologists. Additional well-known and academically active rhinologists were identified by the senior author. Online ratings and comments were collected from Google, Healthgrades, Vitals, and RateMD websites, and weighted rating scores (RS) were calculated on a 1-5 scale.

Results: A total of 210 rhinologists with 16 ± 9 years of practice were included, where 6901 online ratings (33 ± 47 per rhinologist) provided an average RS of 4.3 ± 0.6. RS was not different according to gender ( = 0.58), geographic quartile ( = 0.48), social media presence ( = 0.41), or attending top-ranked medical school ( = 0.86) or residency programs ( = 0.89). Years of practice negatively correlated with RS (R = -0.22, <0.01), and academic ranking significantly influenced RS, with professors, associate professors, and assistant professors scoring 4.1 ± 0.6, 4.3 ± 0.4, and 4.4 ± 0.6, respectively ( = 0.03). Of the 3,304 narrative comments analyzed (3.1 ± 11.6 per rhinologist), 76% (positive) and 7% (negative) had elements of clinical knowledge/outcomes, 56% (positive) and 7% (negative) of communication/bedside manner, and 9% (positive) and 7% (negative) of office staff, cost, and wait-time. All negative comment categories had moderate negative correlation with RS, while positive comment categories regarding knowledge/competence and bedside manner weakly correlated with higher RS. Number of publications (48 ± 54) positively correlated with 2018 industry payments ($11,384 ± $19,025) among those receiving industry compensation >$300 (n = 113). Attending a top-ranked medical school was associated with higher industry payments (<0.01) and H-index ( = 0.02).

Conclusion: Academic rhinologists' online RS was not associated with gender, geographic location, or attending a top-ranked training program, and their scholarly productivity was significantly correlated with total industry payments.
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http://dx.doi.org/10.1177/1945892420958366DOI Listing
May 2021

Outcomes of Primary Versus Salvage Surgery for Sinonasal Malignancies: A Population-Based Analysis.

Laryngoscope 2021 03 24;131(3):E710-E718. Epub 2020 Jul 24.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A.

Objectives/hypothesis: There exists a lack of consensus on the optimal sequence of treatment for many sinonasal malignancies (SNMs). This study compares the overall survival (OS) outcomes for primary surgery (PS) versus salvage surgery (SS) in SNM patients across stage, histology, and primary site.

Study Design: Retrospective database review.

Methods: The National Cancer Database was queried for all SNM cases treated with multimodal surgical and nonsurgical therapy between 2004 and 2015. Logistic regression identified predictors of SS. Cox proportional hazards models evaluated predictors of mortality, and Kaplan-Meier log-rank test assessed OS outcomes.

Results: Our SNM cohort consisted of 3,011 patients (PS = 2,804; SS = 207). SS patients had significantly longer postoperative hospital stays (P = .009) and increased rates of 30-day (P < .001) and 90-day mortality (P < .001) compared to PS. On multivariate logistic regression, predictors of undergoing SS included sinonasal undifferentiated carcinoma histology (odds ratio = 2.72; 95% confidence interval [CI]: 1.16-6.66; P = .024). On multivariate Cox proportional hazards analyses among SS patients, late-stage disease (hazard ratio [HR] = 4.80; 95% CI: 1.46-15.8; P = .01) and positive surgical margins (HR = 2.31; 95% CI: 1.29-4.13; P = .005) portended significantly worse OS. In the propensity score-matched cohort controlling for stage and histology, PS had significantly improved OS compared to SS (P = .007). Compared to SS, PS also had improved OS in subgroup analyses for patients with late-stage disease (P = .026) and squamous cell carcinoma histology (P = .006).

Conclusions: In our SMN cohort, PS resulted in improved OS outcomes compared to SS independent of stage and histology. Consideration may be given to primary surgical resection for SMN whenever feasible, though a targeted, individualized approach is warranted.

Level Of Evidence: 3 Laryngoscope, 131:E710-E718, 2021.
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http://dx.doi.org/10.1002/lary.28925DOI Listing
March 2021

James T. Goodrich, MD, PhD, 1946-2020: a historical perspective and his contributions to craniopagus separation.

J Neurosurg Pediatr 2020 Jun 19:1-7. Epub 2020 Jun 19.

5Department of Neurosurgery, UCI Health, School of Medicine, Irvine, California.

Dr. James Tait Goodrich was an internationally renowned pediatric neurosurgeon who pioneered the neurosurgical procedures for the multistage separation of craniopagus twins. As of March 2020, 59 craniopagus separations had been performed in the world, with Goodrich having performed 7 of these operations. He was the single most experienced surgeon in the field on this complex craniofacial disorder. Goodrich was a humble individual who rapidly rose through the ranks of academic neurosurgery, eventually serving as Director of the Division of Pediatric Neurosurgery at the Children's Hospital at Montefiore Medical Center in the Bronx, New York. In this historical vignette, the authors provide context into the history of and sociocultural attitudes toward conjoined twins; the epidemiology and classification of craniopagus twins; the beginnings of surgery in craniopagus twins; Goodrich's neurosurgical contributions toward advancing treatment for this complex craniofacial anomaly; and vignettes of Goodrich's unique clinical cases that made mainstream news coverage.
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http://dx.doi.org/10.3171/2020.5.PEDS20371DOI Listing
June 2020

Aggregate Prevalence of Chemosensory and Sinonasal Dysfunction in SARS-CoV-2 and Related Coronaviruses.

Otolaryngol Head Neck Surg 2020 07 19;163(1):156-161. Epub 2020 May 19.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA.

Much of the published literature regarding the novel coronavirus disease 2019 (COVID-19) constitutes lower respiratory system symptomatology, while there exists a paucity of data describing the complicated sequelae of the upper respiratory system, including chemosensory and/or sinonasal dysfunction. This study utilized the National Library of Medicine's PubMed/MEDLINE database to query for articles describing COVID-19, SARS-CoV-2, SARS-CoV-1, MERS-CoV, and other coronaviruses, with any mention of smell, taste, or other chemosensory or sinonasal dysfunction. Aggregate analysis demonstrated an incidence of 49.6% (n = 497 of 1002; 95% CI, 46.5%-52.7%), 47.9% (n = 480 of 1002; 95% CI, 44.8%-51.0%), and 17.9% (n = 880 of 4909; 95% CI, 16.9%-19.0%) for smell loss, taste loss, and smell or taste loss, respectively, in patients infected with SARS-CoV-2. Additionally, there were significantly higher incidences of runny nose/rhinorrhea/rhinitis and nasal congestion/obstruction/blockage in other coronaviruses as compared with SARS-CoV-2 ( < .001). Understanding these less well-characterized symptoms may help develop measures for estimating early markers of disease prevalence and/or resolution. Level of evidence: 4.
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http://dx.doi.org/10.1177/0194599820929278DOI Listing
July 2020

Endoscopic Anterior Skull Base Reconstruction: A Meta-Analysis and Systematic Review of Graft Type.

World Neurosurg 2020 07 21;139:460-470. Epub 2020 Apr 21.

Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Irvine, California, USA; Department of Neurological Surgery, University of California Irvine, Irvine, California, USA. Electronic address:

Objective: The influence of graft type (nonautologous vs. autologous) on surgical outcomes in endoscopic anterior skull base (EASB) reconstruction is not well understood. This review systematically evaluated rates of postoperative complications of EASB repairs that utilized autologous or nonautologous grafts.

Methods: Original studies reporting EASB reconstruction outcomes were extracted from PubMed, Ovid, and the Cochrane Library from database inception to 2019. Risk ratios, risk differences, χ tests, and multivariate logistic regression were used to evaluate outcome measures: postoperative cerebrospinal fluid (CSF) leaks, meningitis, and other major complications (OMCs).

Results: A total of 2275 patients from 29 studies were analyzed. Rates of postoperative CSF leaks, meningitis, and OMCs were 4.0%, 1.6%, and 2.3%, respectively, using autologous grafts, and 5.0%, 0.3%, and 1.0%, respectively, using nonautologous grafts. Multivariate analysis of 118 patients demonstrated no significant differences in age, CSF flow rate, single or multilayer reconstruction, and presence of intraoperative CSF leak or lumbar drain. Meta-analyses of 6 studies yielded a risk ratio of 0.64 (95% confidence interval [CI], 0.19-2.14; P = 0.47) for postoperative CSF leakage, and risk differences of -0.01 (95% CI, -0.06 to 0.05; P = 0.80) and -0.02 (95% CI, -0.09 to 0.05; P = 0.51) for postoperative meningitis and OMCs, respectively. There were no significant differences in postoperative CSF leakage (P = 0.95) and OMCs (P = 0.41) between graft types among cases with intraoperative CSF leaks. However, meningitis rates were lower (P = 0.04) in the nonautologous group.

Conclusions: EASB reconstructions utilizing autologous and nonautologous grafts are associated with similar rates of postoperative CSF leakage and OMCs. In cases with intraoperative CSF leakage, nonautologous grafts were associated with reduced postoperative meningitis.
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http://dx.doi.org/10.1016/j.wneu.2020.04.089DOI Listing
July 2020

Peer-to-Peer Contact Tracing: Development of a Privacy-Preserving Smartphone App.

JMIR Mhealth Uhealth 2020 04 7;8(4):e18936. Epub 2020 Apr 7.

Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States.

Background: The novel coronavirus disease 2019 (COVID-19) pandemic is an urgent public health crisis, with epidemiologic models predicting severe consequences, including high death rates, if the virus is permitted to run its course without any intervention or response. Contact tracing using smartphone technology is a powerful tool that may be employed to limit disease transmission during an epidemic or pandemic; yet, contact tracing apps present significant privacy concerns regarding the collection of personal data such as location.

Objective: The aim of this study is to develop an effective contact tracing smartphone app that respects user privacy by not collecting location information or other personal data.

Methods: We propose the use of an anonymized graph of interpersonal interactions to conduct a novel form of contact tracing and have developed a proof-of-concept smartphone app that implements this approach. Additionally, we developed a computer simulation model that demonstrates the impact of our proposal on epidemic or pandemic outbreak trajectories across multiple rates of adoption.

Results: Our proof-of-concept smartphone app allows users to create "checkpoints" for contact tracing, check their risk level based on their past interactions, and anonymously self-report a positive status to their peer network. Our simulation results suggest that higher adoption rates of such an app may result in a better controlled epidemic or pandemic outbreak.

Conclusions: Our proposed smartphone-based contact tracing method presents a novel solution that preserves privacy while demonstrating the potential to suppress an epidemic or pandemic outbreak. This app could potentially be applied to the current COVID-19 pandemic as well as other epidemics or pandemics in the future to achieve a middle ground between drastic isolation measures and unmitigated disease spread.
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http://dx.doi.org/10.2196/18936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144575PMC
April 2020

Endoscopic versus nonendoscopic surgery for resection of pituitary adenomas: a national database study.

J Neurosurg 2020 Mar 13:1-9. Epub 2020 Mar 13.

1Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California.

Objective: For symptomatic nonsecreting pituitary adenomas (PAs), resection remains a critical option for treatment. In this study, the authors used a large-population national database to compare endoscopic surgery (ES) to nonendoscopic surgery (NES) for the surgical management of PA.

Methods: The National Cancer Database was queried for all patients diagnosed with histologically confirmed PA who underwent resection between 2010 and 2016 in which the surgical approach was specified. Due to database limitations, microsurgery and craniotomy were both categorized as NES.

Results: Of 30,488 identified patients, 16,373 (53.7%) underwent ES and 14,115 (46.3%) underwent NES. There was a significant increase in the use of ES over time (OR 1.16, p < 0.01). Furthermore, there was a significant temporal increase in ES approach for tumors ≥ 2 cm (OR 1.17, p < 0.01). Compared to NES, patients who underwent ES were younger (p = 0.01), were treated at academic centers (p < 0.01), lived a greater distance from their treatment site (p < 0.01), had smaller tumors (p < 0.01), had greater medical comorbidity burden (p = 0.04), had private insurance (p < 0.01), and had a higher household income (p < 0.01). After propensity score matching to control for age, tumor size, Charlson/Deyo score, and type of treatment center, patients who underwent ES had a shorter length of hospital stay (LOS) (3.9 ± 4.9 days vs 4.3 ± 5.4 days, p < 0.01), although rates of gross-total resection (GTR; p = 0.34), adjuvant radiotherapy (p = 0.41), and 90-day mortality (p = 0.45) were similar. On multivariate logistic regression, African American race (OR 0.85, p < 0.01) and tumor size ≥ 2 cm (OR 0.89, p = 0.01) were negative predictors of receiving ES, whereas diagnosis in more recent years (OR 1.16, p < 0.01), greater Charlson/Deyo score (OR 1.10, p = 0.01), receiving treatment at an academic institution (OR 1.67, p < 0.01) or at a treatment site ≥ 20 miles away (OR 1.17, p < 0.01), having private insurance (OR 1.09, p = 0.01), and having a higher household income (OR 1.11, p = 0.01) were predictive of receiving ES. Compared to the ES cohort, patients who started with ES and converted to NES (n = 293) had a higher ratio of nonwhite race (p < 0.01), uninsured insurance status (p < 0.01), longer LOS (p < 0.01), and higher rates of GTR (p = 0.04).

Conclusions: There is an increasing trend toward ES for PA resection including its use for larger tumors. Although ES may result in shorter LOS compared to NES, rates of GTR, need for adjuvant therapy, and short-term mortality may be similar. Factors such as tumor size, insurance status, facility type, income, race, and existing comorbidities may predict receiving ES.
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http://dx.doi.org/10.3171/2020.1.JNS193062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080843PMC
March 2020

Impact of induction chemotherapy and socioeconomics on sinonasal undifferentiated carcinoma survival.

Int Forum Allergy Rhinol 2020 05 27;10(5):679-688. Epub 2020 Feb 27.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA.

Background: Sinonasal undifferentiated carcinoma (SNUC) is an uncommon malignancy of the nasal cavity and accessory sinuses with limited available studies evaluating role of induction chemotherapy (IC), demographics, and socioeconomic factors on overall survival (OS).

Methods: The 2004-2015 National Cancer Database was queried for patients with histologically confirmed SNUC. IC was defined as chemotherapy administered 6 months to 2 weeks before surgery or ≥45 days before radiotherapy.

Results: Of 440 identified patients, 70 (16%) underwent treatments involving IC. This consisted of 52 (12%), 15 (3%), and 3 (1%) patients receiving IC before definitive radiation therapy, surgery and adjuvant radiotherapy, or surgery only, respectively. On univariate analysis, IC (p = 0.34) did not affect OS, whereas having government insurance (hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.37-2.34; p < 0.001) and living in regions with ≥13% of the population without a high school diploma (HR, 1.38; 95% CI, 1.06-1.79; p = 0.02) were associated with worse OS. On log-rank test, patients with advanced stage had similar OS regardless of whether or not they received IC (p = 0.96). Patients who received IC lived closer to their treatment site (p = 0.02) and had worse overall health, with more comorbidities (p = 0.02). The timing of IC before definitive surgery or radiation did not affect OS (p = 0.69).

Conclusion: In this SNUC population-based analysis, IC did not appear to provide additional OS benefit regardless of disease stage or timing before definitive treatment. Distance to treatment and level of comorbidities may be associated with receiving IC, whereas type of insurance and residence education level may impact SNUC OS, regardless of treatment.
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http://dx.doi.org/10.1002/alr.22536DOI Listing
May 2020

Response to "Is there a role for hydrogel spacer in post-prostatectomy radiotherapy setting?"

Radiol Med 2019 12 19;124(12):1304-1305. Epub 2019 Aug 19.

Department of Radiation Oncology, Cancer Center of Irvine, 16100 Sand Canyon Ste #130, Irvine, CA, 92618, USA.

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http://dx.doi.org/10.1007/s11547-019-01071-3DOI Listing
December 2019