Publications by authors named "Jatin P Shah"

331 Publications

Mucoepidermoid carcinoma: Evaluating the prognostic impact of primary tumor site.

Oral Oncol 2021 Nov 9;123:105602. Epub 2021 Nov 9.

Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address:

Mucoepidermoid carcinoma (MEC) is one of the most common salivary gland malignancies. Our aim was to evaluate the prognostic impact of primary tumor site in patients with MEC.

Material And Methods: This cohort identified 308 patients with MEC who underwent primary surgery between 1985 and 2015. Survival outcomes were determined using the Kaplan-Meier method. Hazard ratios for primary site were determined using the Cox proportional-hazards model.

Results: One hundred eighty (58%) patients were diagnosed with minor and 128 (42%) with major salivary gland cancer. Primary site in the minor salivary gland group included 137 (44%) oral cavity, 38 (12%) pharynx, 3 (0.9%) nasal cavity, and 2 (0.6%) trachea and larynx. The major salivary gland group included 118 (38%) parotid, 8 (3%) submandibular, and 2 (0.6%) sublingual. With a median follow-up of 73 months, 5-year overall survival and disease-specific survival were 84% and 91%, respectively. Patients with tumors located in the hard palate and retromolar trigone had the best survival, while patients with tumors located in the paranasal sinuses and submandibular gland had the poorest survival. After controlling for tumor grade and stage, MEC primary site was not predictive of survival or recurrence. On multivariate analysis, worse DSS was associated with stage III-IV tumors (HR: 7,11; 95% CI: 1.19-26.43; p = 0.0034) and high-grade tumors (HR: 19.12; 95% CI: 2.26-162.77; p = 0.0068).

Conclusions: While high grade and advanced overall stage were found to be independent predictors of worse survival, primary tumor site was not predictive of poor outcome.
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http://dx.doi.org/10.1016/j.oraloncology.2021.105602DOI Listing
November 2021

Predictors of distant metastases in sinonasal and skull base cancer patients treated with surgery.

Oral Oncol 2021 11 21;122:105575. Epub 2021 Oct 21.

Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. Electronic address:

Objectives: Sinonasal and skull base tumors comprise a heterogeneous group of malignancies with a significant rate of distant recurrence (DR). The aim of this study was to analyze tumor and host factors, including pretreatment neutrophil-to-lymphocyte ratio (NLR), that predict DR in these patients.

Materials And Methods: We retrospectively reviewed sinonasal tumors and/or tumors involving the skull base treated with surgery between 1973 and 2015 (n = 473). We stratified NLR using the top 5 percentile as cutoff. Factors predictive of outcome were determined by Cox proportional hazards model.

Results: Most tumors were primary (81%) and 67% had skull base resection. The most common site was the nasal cavity (37%) and the most common histology was squamous cell carcinoma (34%). Most patients presented with advanced primary tumor stage (pT3/T4; 80%) and most had no regional neck disease (pNx/N0; 93%). A total of 104 patients developed DR. The 5-year overall and disease-specific survival for patients who developed DR were 36.4% and 35.8%, compared to 69.0% and 74.9% for patients who did not. Patients with DR had a higher percentage of NLR-high patients compared patients without DR (11% vs 3%, p = .006). In a multivariable analysis, melanoma histology (HR = 5.469, 95% CI 3.171-9.433), pT3/T4 (HR = 2.686, 95% CI 1.150-6.275), pN+ (HR = 6.864, 95% CI 3.450-13.653), and NLR-high (HR = 3.489, 95% CI 1.593-7.639) were independent predictors of DR.

Conclusion: Melanoma histology, pT, pN, and high NLR predict DR, suggesting that both tumor and host factors need to be considered. NLR may act as a surrogate marker of the host́s immune system.
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http://dx.doi.org/10.1016/j.oraloncology.2021.105575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8596462PMC
November 2021

Staging of human papilloma virus related cancers of the oropharynx.

J Surg Oncol 2021 Nov;124(6):931-934

Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

For the past two decades an increasing number of oropharyngeal cancers have been found to be associated with the human papilloma virus (HPV). These tumors are a biologically distinct entity with better prognosis and excellent response to therapy. Therefore, a separate staging system has been introduced for HPV-related oropharyngeal tumors in the latest edition of the American Joint Committee on Cancer (AJCC eighth Ed).
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http://dx.doi.org/10.1002/jso.26584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8514047PMC
November 2021

Does macroscopic extrathyroidal extension to the strap muscles alone affect survival in papillary thyroid carcinoma?

Surgery 2021 Sep 29. Epub 2021 Sep 29.

Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address:

Background: Macroscopic extrathyroidal extension to structures adjacent to the thyroid gland is one of the most important predictors of survival in papillary thyroid carcinoma. However, the prognostic significance of macroscopic extrathyroidal extension to strap muscles alone is unknown. The aim of this study is to determine the impact on survival in patients with macroscopic extrathyroidal extension to strap muscles alone compared to those with no macroscopic extrathyroidal extension and macroscopic extrathyroidal extension involving other adjacent structures.

Methods: After institutional review board approval, adult papillary thyroid carcinoma patients were identified from an institutional database of 6,259 patients undergoing initial surgery for well-differentiated thyroid carcinoma from 1986 to 2015. Patients were classified as having no macroscopic extrathyroidal extension, macroscopic extrathyroidal extension to strap muscles alone, or macroscopic extrathyroidal extension to other adjacent structures. Disease-specific survival was calculated using the Kaplan-Meier method and groups were compared using the log-rank test. A P value < .05 was considered statistically significant and significant factors were used in a Cox proportional hazard model to predict disease-specific survival.

Results: There were 5,880 patients included in the analysis; 5,485 patients (93.3%) in the no macroscopic extrathyroidal extension group, 179 (3.0%) in the macroscopic extrathyroidal extension to strap muscles alone group and 216 (3.7%) in the macroscopic extrathyroidal extension involving other adjacent structures group. With a median follow-up of 64 months, the estimated 10-year disease-specific survival for patients with no macroscopic extrathyroidal extension, macroscopic extrathyroidal extension to strap muscles alone, and macroscopic extrathyroidal extension involving other adjacent structures were 98.9%, 95.7%, and 83.7%, respectively (P < .0001). In the ≥55-year-old cohort, the estimated 10-year disease-specific survival for patients with no macroscopic extrathyroidal extension, macroscopic extrathyroidal extension to strap muscles alone, and macroscopic extrathyroidal extension involving other adjacent structures were 97.6%, 89.3%, and 68.1%, respectively (P <.0001). After controlling for pathological nodal stage and distant metastasis stage, extent of extrathyroidal extension remained an independent predictor of disease-specific survival; patients with macroscopic extrathyroidal extension to strap muscles alone had a 3.3-fold increased likelihood of a disease-specific death compared to no macroscopic extrathyroidal extension patients (hazard ratio 3.294; 95% confidence interval 1.076-10.086, P < .0368).

Conclusion: In our study, patients aged ≥55 years with papillary thyroid carcinoma and macroscopic extrathyroidal extension to strap muscles alone appear to have an increased likelihood of a disease-specific death compared to patients with no macroscopic extrathyroidal extension.
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http://dx.doi.org/10.1016/j.surg.2021.08.041DOI Listing
September 2021

Current therapeutic options for low-risk papillary thyroid carcinoma: A scoping evidence review.

Head Neck 2021 Sep 30. Epub 2021 Sep 30.

Coordinator of International Head and Neck Scientific Group, Padua, Italy.

Most cases of thyroid carcinoma are classified as low risk. These lesions have been treated with open surgery, remote access thyroidectomy, active surveillance, and percutaneous ablation. However, there is lack of consensus and clear indications for a specific treatment selection. The objective of this study is to review the literature regarding the indications for management selection for low-risk carcinomas. Systematic review exploring inclusion and exclusion criteria used to select patients with low-risk carcinomas for treatment approaches. The search found 69 studies. The inclusion criteria most reported were nodule diameter and histopathological confirmation of the tumor type. The most common exclusions were lymph node metastasis and extra-thyroidal extension. There was significant heterogeneity among inclusion and exclusion criteria according to the analyzed therapeutic approach. Alternative therapeutic approaches in low-risk carcinomas can be cautiously considered. Open thyroidectomy remains the standard treatment against which all other approaches must be compared.
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http://dx.doi.org/10.1002/hed.26883DOI Listing
September 2021

Seminar issue on human papillomavirus-related head and neck cancer.

J Surg Oncol 2021 Nov 24;124(6):919. Epub 2021 Sep 24.

Memorial Sloan Kettering Cancer Center, New York, USA.

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http://dx.doi.org/10.1002/jso.26693DOI Listing
November 2021

Hürthle Cell Carcinoma of the Thyroid Gland: Systematic Review and Meta-analysis.

Adv Ther 2021 10 22;38(10):5144-5164. Epub 2021 Aug 22.

Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

Introduction: Hürthle cell carcinoma (HCC) comprises about 5% of thyroid carcinoma cases. Partly because of its rarity there is much we still need to know about HCC as compared to other histological cancer subtypes.

Methods: We conducted a systematic literature review following PRISMA guidelines and meta-analysis, from 2000 to 2020, to investigate the main characteristics of HCC and clarify information concerning tumor behavior and treatment.

Results: Our review included data from 9638 patients reported in 27 articles over the past 20 years. This tumor occurred more frequently in women (67.5%). The mean age was 57.6 years, and the mean size of the neoplasm at diagnosis was 30 mm. Extrathyroidal extension was common (24%) but lymph node metastasis was not (9%). Total thyroidectomy was the most common surgical approach, with neck dissection usually performed in cases with clinically apparent positive neck nodes. Radioiodine therapy was frequently applied (54%), although there is no consensus about its benefits. The mean 5- and 10-year overall survival was 91% and 76%, respectively.

Conclusion: This review serves to further elucidate the main characteristics of this malignancy. HCC of the thyroid is rare and most often presents with a relatively large nodule, whereas lymph node metastases are rare. Given the rarity of HCC, a consensus on their treatment is needed, as doubts remain concerning the role of specific tumor findings and their influence on management.
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http://dx.doi.org/10.1007/s12325-021-01876-7DOI Listing
October 2021

Flexible fiber-based CO laser vs monopolar cautery for resection of oral cavity lesions: A single center randomized controlled trial assessing pain and quality of life following surgery.

Laryngoscope Investig Otolaryngol 2021 Aug 10;6(4):690-698. Epub 2021 Jul 10.

Department of Surgery Head and Neck Service, Memorial Sloan Kettering Cancer Center New York New York USA.

Importance: This study reports the impact of laser surgery on quality of life in patients with oral cavity lesions.

Objective: To compare postoperative pain and quality of life in patients treated with flexible fiberoptic CO laser vs electrocautery in patients with oral cavity precancerous lesions and early stage cancers.

Design: Randomized controlled trial.

Setting: Single center.

Participants: Patients with premalignant oral cavity lesions and early stage oral cancer.

Intervention: Patients were randomized to have surgical resection using either flexible fiber carbon dioxide laser (Laser) or electrocautery (EC). The patients were then followed over a period of 28 days to assess for outcomes including pain, quality of life, performance status, return to work, and return to diet. Quality of life was measured by the University of Washington Quality of Life (UWQOL) questionnaire and the performance status score (PSS).

Main Outcome Measure: The primary endpoint for this study was the numerical pain rating on postoperative day (POD) 7.

Results: Sixty-two patients were randomized (32 laser and 30 electrocautery). Lesions excised were carcinoma in 30(48%), dysplasia in 31(50%) and benign in 1(2%). There was no difference in the location of lesion, size of lesion, defect size, type of closure, resection time, and blood loss between Laser and EC arms. Patients who had Laser had less pain compared to EC (mean pain score on POD 7 L = 2.84 vs EC = 3.83,  = 0.11). better UW QOL scores and PSS scores, quicker return to normal diet (median days L = 26.0 vs EC = 28.5,  = 0.17) and faster return to work (median days L = 13.0 vs EC = 16.5,  = 0.14). However, these results were not statistically significant.

Conclusion: There was a trend for patients treated with laser to have less pain and better quality of life scores but these result were not statistically significant. Based on the actual observed difference, a large multicenter RCT with 90 patients in each arm is required to determine the clinical relevance of our results.
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http://dx.doi.org/10.1002/lio2.572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356859PMC
August 2021

John Wayne Clinical Research Lecture: New Avenues for Uplifting the Global Quality of Care in Surgical Oncology.

Authors:
Jatin P Shah

Ann Surg Oncol 2021 Oct 17;28(11):5820-5828. Epub 2021 Jun 17.

Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Health care equality is an idealistic goal that is difficult to achieve. However, uplifting the quality of care in surgery for cancer is achievable through several means, the most important of which is training of surgeons through properly structured training programs. However, such programs vary greatly, and no uniformity of curriculum exists throughout the world. On the other hand, several avenues are available for uplifting the quality of care through education and dissemination of knowledge at an individual level, an institutional level, a national level, and an international level. Efforts to uplift the quality of surgical care at an individual level can be by direct delivery of care or by dissemination of knowledge and experiences through personal interactions, lectures, and published works. Conferences, webinars, and travel grants are effective means offered by several institutions and national professional organizations. At an international level, however, much more can be done. For example, in the specialty of head and neck surgery, the International Federation of Head and Neck Oncologic Societies (IFHNOS) has done extraordinary work through world congresses, world tour programs, master courses on operative techniques, and its most impactful program, the Global On Line Fellowship in head and neck surgery and oncology. The programs offered by IFHNOS have had a huge impact on the quality of surgical care for head and neck cancer worldwide. This prototype can be used in many other specialties of surgical oncology to uplift the quality of care globally.
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http://dx.doi.org/10.1245/s10434-021-10215-7DOI Listing
October 2021

Occlusion of the internal jugular vein in differentiated thyroid carcinoma: Causes and diagnosis.

Eur J Surg Oncol 2021 Jul 22;47(7):1552-1557. Epub 2021 Feb 22.

International Head and Neck Scientific Group, Padua, Italy.

Occlusion of the internal jugular vein (IJV) can be observed in thyroid cancer either on preoperative imaging with ultrasound or cross-sectional imaging, particularly contrast-enhanced CT-scan, and can be detected during follow-up when using these same imaging modalities. For thyroid cancer, four different causes of occlusion of the IJV can be identified: venous thrombosis associated with a hypercoagulable state, tumor thrombus in the vein, compression or invasion of the IJV by thyroid disease or lymph node metastases, and fibrotic collapse of the IJV following lateral neck dissection. Clinicians managing patients with thyroid cancer need to be aware of and able to diagnose each of these conditions. The overall patient impact and appropriate management of each will be discussed.
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http://dx.doi.org/10.1016/j.ejso.2021.02.021DOI Listing
July 2021

Pretreatment neutrophil-to-lymphocyte ratio and mutational burden as biomarkers of tumor response to immune checkpoint inhibitors.

Nat Commun 2021 02 1;12(1):729. Epub 2021 Feb 1.

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Treatment with immune checkpoint inhibitors (ICI) has demonstrated clinical benefit for a wide range of cancer types. Because only a subset of patients experience clinical benefit, there is a strong need for biomarkers that are easily accessible across diverse practice settings. Here, in a retrospective cohort study of 1714 patients with 16 different cancer types treated with ICI, we show that higher neutrophil-to-lymphocyte ratio (NLR) is significantly associated with poorer overall and progression-free survival, and lower rates of response and clinical benefit, after ICI therapy across multiple cancer types. Combining NLR with tumor mutational burden (TMB), the probability of benefit from ICI is significantly higher (OR = 3.22; 95% CI, 2.26-4.58; P < 0.001) in the NLR low/TMB high group compared to the NLR high/TMB low group. NLR is a suitable candidate for a cost-effective and widely accessible biomarker, and can be combined with TMB for additional predictive capacity.
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http://dx.doi.org/10.1038/s41467-021-20935-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851155PMC
February 2021

Unambiguous advanced radiologic extranodal extension determined by MRI predicts worse outcomes in nasopharyngeal carcinoma: Potential improvement for future editions of N category systems.

Radiother Oncol 2021 04 28;157:114-121. Epub 2021 Jan 28.

Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China. Electronic address:

Background And Purpose: To explore the prognostic value of different radiologic extranodal extension (rENE) grades and their potential improvement for the 8th edition N category in nasopharyngeal carcinoma (NPC).

Materials And Methods: From 2009 to 2013, a cohort of 1887 patients with NPC was retrospectively enrolled and randomized to the training (n = 955) and validation (n = 932) groups. rENE was categorized as follows: grade 0, nodes without rENE; grade 1, nodes with rENE infiltrating the surrounding fat only; grade 2, matted nodes; grade 3, nodes with rENE infiltrating adjacent structures.

Results: The percentage of patients with MRI-positive cervical nodes was 66.5% (1254/1887), of whom grade 0, 1, 2 and 3 rENE cases accounted for 33.2% (416/1254), 14.9% (187/1254), 36.5% (458/1254) and 15.4% (193/1254), respectively. The kappa coefficients for the inter-rater and intra-rater assessments were 0.63, 0.51, 0.65 and 0.93, and 0.76, 0.69, 0.72 and 1.0 in grade 0, 1, 2 and 3 rENE, respectively. Grade 3 rENE rather than grades 0-2 rENE was an independent unfavorable predictor of overall survival and disease-free survival (P < 0.001). Recursive partitioning analysis was applied to refine the N category: eN0 (N0), eN1 (N1 without grade 3), eN2 (N2 without grade 3), and eN3 (N1/N2 with grade 3, N3). Compared to the current system, the proposed N category performed better in hazard consistency, hazard discrimination, sample size balance and outcome prediction.

Conclusion: Grade 3 rENE was an independent unfavorable indicator of NPC. Upstaging patients in N1-2 with grade 3 rENE to N3 led to a superior prognostic performance.
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http://dx.doi.org/10.1016/j.radonc.2021.01.015DOI Listing
April 2021

ThyroidEx: Development and Preliminary Validation of a Thyroid Surgery Expectations Measure.

Otolaryngol Head Neck Surg 2021 08 15;165(2):267-274. Epub 2020 Dec 15.

Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

Objective: To address the lack of validated patient-reported outcome (PRO) instruments that define and quantify patient expectations in thyroid cancer surgery, we developed and initially validated ThyroidEx, a novel disease-specific PRO instrument.

Study Design: Survey study.

Setting: Single-institution tertiary care cancer center.

Methods: An expert panel drafted an initial set of thyroid cancer-specific concepts, which was used in semistructured concept elicitation interviews with patients with thyroid cancer 4 weeks before and 8 weeks after surgery. Candidate items were generated per patient responses and refined via cognitive interviewing and additional review by the expert panel. The draft ThyroidEx was then preoperatively administered to a separate cohort undergoing thyroid cancer surgery to establish a final item set and initial psychometric evidence.

Results: Prospective concept elicitation interviews generated 358 patient-elicited concepts (n = 15 patients). These were then placed into 70 unique subcategories from which 41 items were generated for cognitive interviews with 20 patients preoperatively and 28 postoperatively. After expert panel review, ThyroidEx included 18 items across 2 scales (Expectations and Concerns), with an additional item about beliefs. In the preoperative cohort in phase 2 (n = 67), internal consistency Cronbach's α values ranged from 0.81 to 0.89. Descriptive analysis showed significant differences between patients' concerns and expectations and clinicians' perceptions.

Conclusion: Defining expectations represents an important modifier in the measurement of PROs. Preliminary validation of ThyroidEx revealed incongruent expectations between expert opinion and patients. Future development and implementation of ThyroidEx may affect preoperative consultation and the consent process.
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http://dx.doi.org/10.1177/0194599820976317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203758PMC
August 2021

Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer: Management in the HPV Era.

Front Oncol 2020 10;10:593164. Epub 2020 Nov 10.

International Head and Neck Scientific Group, Padua, Italy.

Background: Patients with metastases in the lymph nodes of the neck and no obvious primary tumor, neck cancer with unknown primary (NCUP), represent a management challenge. A majority of patients have metastatic squamous cell carcinoma (SCC), although other histologies do occur.

Methods: We comprehensively reviewed the literature, compared available guidelines, and conferred with an international team of experts.

Results: Positron emission tomography-computed tomography (PET-CT) and fine needle aspiration (FNA) under ultrasound guidance increase accuracy of diagnosis. Immunohistochemistry (IHC), determination of human papilloma virus (HPV) status, by p16 staining or by hybridization (ISH), and next-generation gene sequencing can guide us regarding probable primary sites and tumor biology. Narrow Band Imaging (NBI) has been introduced for the early detection of subtle mucosal lesions. Direct laryngoscopy (DL) and tonsillectomy have long been procedures used in the search for a primary site. More recently, TransOral Robotic Surgery (TORS) or Transoral LASER Microsurgery (TLM) have been introduced for lingual tonsillectomy.

Conclusions: New technologies have been developed which can better detect, diagnose, and treat occult primary tumors. Decisions regarding therapy are based on the primary tumor site (if discovered) and N stage. Options include neck dissection with or without postoperative adjuvant therapy, primary irradiation, or combined chemotherapy with irradiation. The preferred treatment of patients whose primary remains unidentified is controversial.
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http://dx.doi.org/10.3389/fonc.2020.593164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685177PMC
November 2020

Management of the Neck in Well-Differentiated Thyroid Cancer.

Curr Oncol Rep 2020 11 14;23(1). Epub 2020 Nov 14.

International Head and Neck Scientific Group, Padua, Italy.

Purpose Of Review: In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer.

Recent Findings: Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant.
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http://dx.doi.org/10.1007/s11912-020-00997-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500240PMC
November 2020

Comparison of different guidelines for oral cancer.

Eur Arch Otorhinolaryngol 2021 Aug 15;278(8):2961-2973. Epub 2020 Oct 15.

Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Rua Professor Antônio Prudente, 211, São Paulo, SP, CEP 01509-010, Brazil.

Background: Guidelines should provide accessible and reliable information for decision-making. Also, they should be translatable to multiple settings, allowing their use in diverse situations.

Methods: We searched in GOOGLE, PUBMED, SCIELO, and SCOPUS for guidelines on oral squamous cell carcinoma. They were evaluated using the AGREE II protocol.

Results: We identified 16 guidelines that fulfilled inclusion criteria. The mean score and range for each AGREE II domain were: "scope and purpose" 74.1% (6-100.0%); "stakeholder" 78.6% (0-100.0%); "rigor of development" 71.4% (0-100.0%); "clarity of presentation" 71.4% (6-100.0%); "applicability" 50.0% (0-85.7%); "editorial independence" 57.1% (14.3-85.7%) and "overall assessment" 57.1% (14.3-100.0%).

Conclusion: Guidelines for oral cancer present variable quality. Among those available, only four surpassed the 70% AGREE II score threshold.
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http://dx.doi.org/10.1007/s00405-020-06423-8DOI Listing
August 2021

Nodal characteristics associated with adverse prognosis in oral cavity cancer are linked to host immune status.

J Surg Oncol 2021 Jan 24;123(1):141-148. Epub 2020 Sep 24.

Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

Background And Objective: Nodal metastasis is one of the strongest predictors of outcomes in oral cavity squamous cell carcinomas (OSCC). The aim was to analyze the interplay of nodal characteristics in OSCC prognosis.

Methods: In this retrospective cohort study we included OSCC patients treated with primary surgery including neck dissection between 2005 and 2015 (n = 619). Disease-specific survival (DSS) was the primary endpoint. Optimal cutoffs were identified using recursive-partitioning analysis (RPA). A novel characteristic-metastatic focus-to-lymph node size ratio (MLR)-was introduced. We compared the American Joint Committee on Cancer, Eighth Edition (AJCC8) pN categories to a new categorization.

Results: Patients with higher neutrophil-to-lymphocyte ratio had more adverse nodal characteristics. All nodal characteristics were significant predictors of DSS in univariable analysis. In multivariable analysis, only number of positive nodes and MLR remained significant. An RPA including all nodal covariates confirmed the results. Compared with AJCC8, our RPA categorization had better hazard discrimination (0.681 vs. 0.598), but poorer balance value (0.783 vs. 0.708).

Conclusion: Patients with higher neutrophil-to-lymphocyte ratio had more adverse nodal characteristics. Total number of metastatic lymph nodes is the strongest predictor of outcomes in OSCC. MLR is a more powerful predictor than metastatic lymph node size or metastatic focus size alone.
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http://dx.doi.org/10.1002/jso.26235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7770005PMC
January 2021

Primary tumor volume as a predictor of distant metastases and survival in patients with sinonasal mucosal melanoma.

Head Neck 2020 11 1;42(11):3316-3325. Epub 2020 Aug 1.

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

Background: Sinonasal mucosal melanoma (SNMM) is an aggressive cancer with high mortality. Identifying patients at risk of distant metastasis assists with management and prognostication. We aimed to define the relationship between volume, survival, and risk of distant metastases.

Methods: A retrospective review of all patients with SNMM treated at a single institution over a 21-year period was conducted. Tumor volume was calculated using cross-sectional imaging and survival analysis was performed.

Results: Sixty-one patients were included. Tumor volume was predictive of local progression-free survival (P = .03), distant metastases-free survival (DMFS) (P = .002), and overall survival (OS) (P = .02). It was a better predictor than AJCC stage and T-classification. Tumor volume equal to or greater than 5 cm was associated with a significantly worse DMFS and OS (P = .02 and .009, respectively).

Conclusion: Calculation of tumor volume assists in quantifying the risk of distant metastases and death in SNMM.
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http://dx.doi.org/10.1002/hed.26380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722123PMC
November 2020

Squamous Cell Carcinoma and Its Variants.

Adv Otorhinolaryngol 2020 30;84:124-136. Epub 2020 Jul 30.

Department of Head and Neck Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA,

Squamous cell carcinoma (SCC) is one of the most common malignant neoplasms involving the anterior skull base, resulting from local invasion from an adjacent anatomical region. The primary sites of origin are most frequently the nasal cavity and paranasal sinuses, and less often the skin and orbit. Treatment strategies for these tumors have evolved, although management remains challenging due to the proximity to critical structures and their location at the intracranial-extracranial interface. The rarity of these tumors, and limited numbers at any one institution, has meant that most published series have grouped together different histologies in reporting outcomes. Data on SCC alone are thus limited. Treatment of SCC involving the anterior skull involves a multidisciplinary team approach. A number of potential treatment options exist, dependent on tumor, patient, and institutional factors. Current treatment strategies commonly involve multimodality therapy using a combination of surgery, radiotherapy, and chemotherapy. Primary surgery is considered the mainstay of initial treatment in those tumors which are deemed resectable, followed by adjuvant radiotherapy with or without chemotherapy. Preoperative assessment includes confirmation of the tissue diagnosis, and imaging to assess resectability, guide the surgical approach, and to plan the extent of surgery and method of reconstruction. Analysis of our institutional database for patients undergoing surgery with SCC involving the anterior skull base showed a 5-year disease-specific survival of 65% for sinonasal SCC and 71% for cutaneous SCC. The surgical margin status as well as dural and pterygopalatine fossa involvement were predictors of a poor prognosis.
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http://dx.doi.org/10.1159/000457932DOI Listing
June 2021

Is a Prophylactic Central Compartment Neck Dissection Required in Papillary Thyroid Carcinoma Patients with Clinically Involved Lateral Compartment Lymph Nodes?

Ann Surg Oncol 2021 Jan 17;28(1):512-518. Epub 2020 Jul 17.

Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Background: The 2015 American Thyroid Association guidelines state that a prophylactic central compartment neck dissection (PCND) should be considered for patients with papillary thyroid carcinoma (PTC) and clinically involved lateral neck lymph nodes (cN1b). The purpose of our study was to determine the rate of central neck recurrence in select cN1b patients, with no evidence of clinically involved central compartment lymph nodes, treated without a PCND.

Methods: After institutional review board approval, adult PTC patients with cN1b disease who were treated with a total thyroidectomy and lateral neck dissection were identified from an institutional database of 6259 patients who underwent initial surgery for well-differentiated thyroid carcinoma from 1986 to 2015. Patients with gross extrathyroidal extension, distant metastases, or no preoperative imaging were excluded. Patients with evidence of clinically involved central compartment lymph nodes, on preoperative imaging or intraoperative evaluation, also were excluded. A total of 152 cN1b patients were included and categorized into non-PCND and PCND groups. Central neck recurrence-free probability (CNRFP) was calculated using the Kaplan-Meier method and log-rank tests.

Results: One hundred three patients (67.8%) did not have a PCND. With a median follow-up of 65 months, the 5- and 10-year CNRFP was 98.4% in the non-PCND group and 93.6% in the PCND group (p = 0.133).

Conclusions: Select PTC patients with cN1b disease but no evidence of clinically involved central compartment lymph nodes, on preoperative imaging and intraoperative evaluation, appear to have a low rate of central neck recurrence. These patients may not require or benefit from a PCND.
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http://dx.doi.org/10.1245/s10434-020-08861-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315382PMC
January 2021

The 3 Bs of cancer care amid the COVID-19 pandemic crisis: "Be safe, be smart, be kind"-A multidisciplinary approach increasing the use of radiation and embracing telemedicine for head and neck cancer.

Cancer 2020 09 8;126(18):4092-4104. Epub 2020 Jul 8.

Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.

Because of the national emergency triggered by the coronavirus disease 2019 (COVID-19) pandemic, government-mandated public health directives have drastically changed not only social norms but also the practice of oncologic medicine. Timely head and neck cancer (HNC) treatment must be prioritized, even during emergencies. Because severe acute respiratory syndrome coronavirus 2 predominantly resides in the sinonasal/oral/oropharyngeal tracts, nonessential mucosal procedures are restricted, and HNCs are being triaged toward nonsurgical treatments when cures are comparable. Consequently, radiation utilization will likely increase during this pandemic. Even in radiation oncology, standard in-person and endoscopic evaluations are being restrained to limit exposure risks and preserve personal protective equipment for other frontline workers. The authors have implemented telemedicine and multidisciplinary conferences to continue to offer standard-of-care HNC treatments during this uniquely challenging time. Because of the lack of feasibility data on telemedicine for HNC, they report their early experience at a high-volume cancer center at the domestic epicenter of the COVID-19 crisis.
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http://dx.doi.org/10.1002/cncr.33031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361524PMC
September 2020

Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology.

J Natl Compr Canc Netw 2020 07;18(7):873-898

16The University of Texas MD Anderson Cancer Center.

Treatment is complex for patients with head and neck (H&N) cancers with specific site of disease, stage, and pathologic findings guiding treatment decision-making. Treatment planning for H&N cancers involves a multidisciplinary team of experts. This article describes supportive care recommendations in the NCCN Guidelines for Head and Neck Cancers, as well as the rationale supporting a new section on imaging recommendations for patients with H&N cancers. This article also describes updates to treatment recommendations for patients with very advanced H&N cancers and salivary gland tumors, specifically systemic therapy recommendations.
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http://dx.doi.org/10.6004/jnccn.2020.0031DOI Listing
July 2020

Global On Line Fellowship in head and neck surgery and oncology.

Head Neck 2020 11 3;42(11):3125-3132. Epub 2020 Jul 3.

Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

The International Federation of Head and Neck Oncologic Societies and Memorial Sloan Kettering Cancer Center in New York have partnered to create the Global On Line Fellowship program, a postgraduate fellowship training opportunity for candidates all around the world who are not able to get on-site fellowship training at centers of excellence. This article delineates the successes, challenges, and future goals for the program.
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http://dx.doi.org/10.1002/hed.26352DOI Listing
November 2020

Host Factors Independently Associated With Prognosis in Patients With Oral Cavity Cancer.

JAMA Otolaryngol Head Neck Surg 2020 08;146(8):699-707

Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.

Importance: The association and interaction of host characteristics with prognosis in patients with oral cavity squamous cell carcinoma (OSCC) are poorly understood. There is increasing evidence that host characteristics are associated with treatment outcomes of many cancers.

Objectives: To examine the host factors associated with prognosis in patients with OSCC and their interactions to create a numerical index that quantifies the prognostic capacity of these host characteristics.

Design, Setting, And Participants: This retrospective cohort study included patients with OSCC treated surgically at a tertiary care center from January 1, 1998, to December 31, 2015. From a departmental OSCC database of 1377 previously untreated patients, 68 patients with missing data on any host variable of interest within a month before the start of treatment were excluded, leaving 1309 patients. Data analysis was performed from October 21, 2019, to December 10, 2019.

Exposure: Primary surgery for OSCC.

Main Outcomes And Measures: Overall survival (OS) was the primary end point, and disease-specific survival (DSS) was the secondary end point. Optimal cutoffs for each variable were identified using recursive-partitioning analysis with the classification and regression tree method using OS as the dependent variable. Body mass index (BMI) and pretreatment peripheral blood leukocyte count, platelet count, hemoglobin level, and albumin level were analyzed. A host index (H-index) was developed using independent factors associated with OS.

Results: A total of 1309 patients (731 [55.8%] male; mean [SD] age, 62 [14.3] years) participated in the study. When including all the host-related factors in a multivariable analysis, all except BMI (hazard ratio [HR], 1.14; 95% CI, 0.80-1.63) were independently associated with outcomes. For example, compared with a hemoglobin level of 14.1 g/dL or greater, the HR for a level of 12.9 to 14.0 g/dL was 1.42 (95% CI, 1.13-1.77) and for a level of 12.8 g/dL or less was 1.51 (95% CI, 1.18-1.94), and compared with an albumin level of 4.3 g/dL or greater, the HR for a level of 3.7 to 4.2 g/dL was 1.18 (95% CI, 0.95-1.45) and for a level of 3.6 g/dL or less was 3.64 (95% CI, 2.37-5.58). An H-index of 1.4 or less was associated with a 74% 5-year OS, an H-index of 1.5 to 3.5 with a 65% 5-year OS, and an H-index of 3.6 or higher with a 38% 5-year OS; for DSS, the 5-year survival was 84%, 80%, and 64%, respectively. Compared with patients with an H-index score of 1.4 or less, patients with H-index scores of 1.5 to 3.5 (hazard ratio, 1.474; 95% CI, 1.208-1.798) and 3.6 or higher (hazard ratio, 3.221; 95% CI, 2.557-4.058) had a higher risk of death.

Conclusions And Relevance: The findings suggest that pretreatment values of neutrophils, monocytes, lymphocytes, hemoglobin, and albumin are independently associated with prognosis in patients with OSCC. The interactions between these host factors were incorporated into a novel H-index that quantified the prognostic capacity of host characteristics associated with OSCC.
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http://dx.doi.org/10.1001/jamaoto.2020.1019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290709PMC
August 2020

Papillary Thyroid Cancer-Aggressive Variants and Impact on Management: A Narrative Review.

Adv Ther 2020 07 1;37(7):3112-3128. Epub 2020 Jun 1.

Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

Introduction: Aggressive variants of papillary thyroid cancer (PTC) have been described with increasing frequency. These variants include diffuse sclerosing variant, tall cell variant, columnar cell variant, solid variant, and hobnail variant.

Methods: We have performed a review of the more aggressive variants of PTC with respect to main characteristics, histological and molecular features, and the consequences that the knowledge of these variants should have in the treatment of the patients.

Results: At the present time, we do not know the prognostic value of these aggressive PTC variants. The extent of the surgical treatment and adjuvant therapy necessary should be decided on the basis of the extent of the tumor at presentation and the opinion of experienced clinicians.

Conclusion: These aggressive variants should be known by clinicians, to avoid underdiagnosis, and treated according to the latest recommendations in the literature.
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http://dx.doi.org/10.1007/s12325-020-01391-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467416PMC
July 2020

Head and neck paragangliomas: 30-year experience.

Head Neck 2020 09 19;42(9):2486-2495. Epub 2020 May 19.

Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.

Background: We aimed to review our experience and the changing trends in the management of head and neck paragangliomas (HNPG) over the last three decades.

Methods: We retrospectively reviewed 103 patients with HNPG treated at our center (1986-2017). We included patients treated with surgery, radiotherapy, and patients maintained under active surveillance.

Results: Of the surgically treated patients (n = 79), 20% (12/59) of the carotid body tumors (CBT) had a cranial nerve deficit as sequela compared to 95% (19/20) of the non-CBT. Radiotherapy controlled growth in all tumors treated with this modality (n = 10). Of the initially observed patients, 70% (14/20) remained stable and did not require additional treatment. Stratifying by decades, there was a progressive increase in patients initially attempted to be observed and a decrease in upfront surgery. No deaths attributable to the HNPG were encountered.

Conclusions: Surgery is an effective treatment for CBT. Nonsurgical treatment should be considered for non-CBT.
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http://dx.doi.org/10.1002/hed.26277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725473PMC
September 2020

Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review.

Cancers (Basel) 2020 Apr 24;12(4). Epub 2020 Apr 24.

International Head and Neck Scientific Group, 35100 Padua, Italy.

Background: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved.

Methods: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis.

Results: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4-23.4) and 8.0% (95% CI 2.7-13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0-6.1%), 2.0% (95% CI 0.9-3.1) and 0.4% (95% CI 0-1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0-1.3).

Conclusions: The incidence of occult lymph node metastasis is higher in supraglottic and T3-4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.
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http://dx.doi.org/10.3390/cancers12041059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225965PMC
April 2020

The impact of COVID-19 on Head and Neck surgery, education, and training.

Authors:
Jatin P Shah

Head Neck 2020 06 25;42(6):1344-1347. Epub 2020 Apr 25.

Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

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http://dx.doi.org/10.1002/hed.26188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264554PMC
June 2020

Sowing the Seeds of Surgical Oncology.

Authors:
Jatin P Shah

Ann Surg Oncol 2020 Jul 15;27(7):2139-2140. Epub 2020 Apr 15.

Memorial Sloan Kettering Cancer Center, New York, NY, USA.

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http://dx.doi.org/10.1245/s10434-020-08449-yDOI Listing
July 2020
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