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Clark J.R.,Sydney Head and Neck Cancer Institute | Rumcheva P.,University of Sydney | Veness M.J.,University of Sydney
Annals of Surgical Oncology | Year: 2012

Background. The American Joint Committee on Cancer (AJCC) substantially changed the staging of cutaneous squamous cell carcinoma (cSCC) in the 7th edition of its staging manual. We aim to compare the 7th edition AJCC staging of nodal metastases from cSCC with the N1S3 staging system. Methods. Analysis of 603 patients from two prospective cancer center databases was performed. Multivariable analysis was performed using a Cox proportional hazards competing risk model adjusting for the effect of immuno-suppression, treating institution, adjuvant radiotherapy, nodal margins, and extracapsular spread. Criteria used for comparing staging systems were distribution of patients, stratification of patients according to risk of death from cSCC, and model performance. Results. The N1S3 staging system functioned well in terms of distribution and stratification of patients. The distribution of patients within the AJCC staging system was problematic with three groups (N2a, N2c, and N3) containing less than 10 % of patients without any prognostic relevance. Stratification of patients within the AJCC staging system was poor in terms of monotonicity (N2c) and distinctiveness (N2a). The performance of the AJCC and N1S3 staging systems was similar despite the AJCC staging being more complex. Conclusions. The N1S3 staging system for cSCC is preferred on the grounds of better distribution, stratification, and parsimony. © 2012 Society of Surgical Oncology.

Khoury S.,University of Technology, Sydney | Tran N.,University of Technology, Sydney | Tran N.,Sydney Head and Neck Cancer Institute
Biomarkers in Medicine | Year: 2015

MicroRNAs (miRNAs) belong to a class of small noncoding RNAs (ncRNAs), which regulate gene expression at the post-transcriptional level. They are approximately 22 nucleotide sequences in length and have been predicted to control expression of up to 30-60% of all protein-coding genes in mammals. Considering this wide involvement in gene control, aberrant miRNA expression has a strong association with the presence and progression of a disease, hence generating much anticipation in using miRNAs as biomarkers for the diagnosis and prognosis of human cancers. The majority of these miRNAs are intracellular, but recently they have been discovered in bodily fluids. This review will provide an insight into these circulatory miRNA molecules and discuss their potential as cancer biomarkers. © 2014 Future Medicine Ltd.

Ebrahimi A.,Sydney Head and Neck Cancer Institute | Zhang W.J.,Royal Prince Alfred Hospital | Gao K.,Sydney Head and Neck Cancer Institute | Clark J.R.,Sydney Head and Neck Cancer Institute
Cancer | Year: 2011

BACKGROUND: Elective neck dissection (END) is commonly used as a staging and therapeutic procedure for oral squamous cell carcinoma (SCC) at high risk of nodal metastases. The authors aimed to determine whether the extent of lymphadenectomy, as defined by nodal yield, is a prognostic factor in this setting. METHODS: A retrospective database review identified 225 patients undergoing END with curative intent for oral SCC between 1987 and 2009. Nodal yield was studied as a categorical variable for association with overall, disease-specific, and disease-free survival in univariate and multivariate analyses. RESULTS: Nodal yield <18 was associated with 5-year overall survival of 51% compared with 74% in those with nodal yield ≥18 (P =.009). Five-year disease-specific survival rates were 69% in those with <18 nodes and 87% in patients with ≥18 nodes (P =.022). Similar results were obtained for disease-free survival, with 5-year rates of 44% with <18 nodes versus 71% with ≥18 nodes (P =.043). After adjusting for the effect of age, nodal status, T stage, and adjuvant radiotherapy on multivariate analysis, nodal yield <18 was associated with reduced overall (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.1-3.6; P =.020), disease-specific (HR, 2.2; 95% CI, 1.1-4.5; P =.043), and disease-free survival (HR, 1.7; 95% CI, 1.1-2.8; P =.040). In the pathologically lymph node-negative subgroup (n = 148), similar results were obtained. CONCLUSIONS: Nodal yield is an independent prognostic factor in patients undergoing END for oral SCC. These results suggest that an adequate lymphadenectomy in this setting should include at least 18 nodes. Copyright © 2011 American Cancer Society.

Ebrahimi A.,Sydney Head and Neck Cancer Institute | Clark J.R.,Sydney Head and Neck Cancer Institute | Lorincz B.B.,Sydney Head and Neck Cancer Institute | Milross C.G.,Sydney Head and Neck Cancer Institute | Veness M.J.,University of Sydney
Head and Neck | Year: 2012

Background The purpose of this study was to determine whether there is a "low-risk" subset of patients with regional metastatic head and neck cutaneous squamous cell carcinoma (SCC) suitable for treatment with surgery alone and omission of adjuvant radiotherapy. Methods We conducted a retrospective analysis of 168 patients with a single parotid gland or neck nodal metastasis ≤3 cm in size from cutaneous SCC treated with curative intent by surgery ± adjuvant radiotherapy. Results Disease-specific survival for the 33 patients treated with surgery alone was 97% at 5 years. In the subset of 19 patients without extracapsular nodal spread (ECS), there was 1 regional recurrence which was successfully salvaged yielding a 5-year disease-specific survival of 100%. Conclusion In head and neck cutaneous SCC, the subset with a single node ≤3 cm in size without ECS are at low risk of regional failure and death from cutaneous cancer. These patients may be suitable for single-modality therapy with surgery alone. Copyright © 2011 Wiley Periodicals, Inc.

Forest V.-I.,Sydney Head and Neck Cancer Institute | Murali R.,Royal Prince Alfred Hospital | Clark J.R.,Sydney Head and Neck Cancer Institute
Journal of Otolaryngology - Head and Neck Surgery | Year: 2011

Background: Thyroglossal duct (TGD) carcinoma occurs in about 1 to 2% of TGD cysts. Preoperative diagnosis is difficult, and consensus on optimal treatment is lacking. Methods: All patients who underwent surgical treatment of a TGD cyst at our institution, a tertiary centre, were reviewed and TGD carcinoma was identified. Clinicopathologic and follow-up information was examined. Results: Among the 139 patients treated for TGD cysts, 9 patients (6.5%) had a TGD carcinoma. All were papillary carcinoma. There was a female predominance, and the median age at diagnosis was 44 years. The median follow-up was 6.7 years. All patients underwent a Sistrunk procedure. A total thyroidectomy was performed in eight of nine patients. The median size of the TGD carcinomas was 10 mm. Two patients underwent therapeutic neck dissection at the time of the total thyroidectomy. Two patients experienced a recurrence regionally on follow-up. Eight of nine patients received radioactive iodine therapy and suppressive doses of thyroxine. Conclusions: Strong conclusions are difficult to draw owing to the rarity of the disease. However, management should be similar to that of differentiated thyroid cancer and based on risk group stratification. An ultrasound-guided fine-needle biopsy is a valuable test in every patient with a suspicion of TGD cyst. A diagnosis of TGD carcinoma should prompt evaluation of the thyroid gland and cervical lymph nodes bilaterally. A Sistrunk procedure is the minimum therapeutic procedure, coupled with a total thyroidectomy for higher-risk cancers. © 2011 The Canadian Society of Otolaryngology-Head & Neck Surgery.

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