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Inhestern J.,Jena University Hospital | Oertel K.,Jena University Hospital | Stemmann V.,Jena University Hospital | Schmalenberg H.,University Tumor Center | And 9 more authors.
PLoS ONE | Year: 2015

Background The prognostic role of circulating tumor cells (CTCs) after induction chemotherapy using docetaxel, cisplatin and fluorouracil (TPF) prior to surgery and adjuvant (chemo)radiation in locally advanced oral squamous cell cancer (OSCC) was evaluated. Methods In this prospective study, peripheral blood samples from 40 patients of the phase II study TISOC-1 (NCT01108042) with OSCC before, during, and after treatment were taken. CTCs were quantified using laser scanning cytometry of anti- epithelial cell adhesion molecule- stained epithelial cells. Their detection was correlated with clinical risk factors, recurrencefree (RFS) and overall survival (OS). Results Before starting the treatment CTCs were detected in 32 of 40 patients (80%). The median number at baseline was 3295 CTCs/ml. The median maximal number of CTCs during treatment was 5005 CTCs/ml. There was a significant increase of CTCs before postoperative radiotherapy compared to baseline before 1st cycle of IC (p = 0.011), 2nd cycle of IC (p = 0.001), 3rd cycle of IC (p = 0.004), and before surgery (p = 0.002), but not compared to end of therapy (p = 0.118). CTCs at baseline >median was also associated to risk of recurrence (p = 0.014). Maximal CTCs during therapy >median was more frequently observed in tumors of the oral cavity (p=0.022) and related to higher risk of death during follow-up (p = 0.028). Patients with CTCs at baseline >median value had significant lower RFS than patients with CTCs at baseline median during the complete course of therapy had a significantly lower OS than patients with values


Schiller U.,Jena University Hospital | Inhestern J.,Jena University Hospital | Burger U.,University Tumor Center | Singer S.,Johannes Gutenberg University Mainz | Guntinas-Lichius O.,Jena University Hospital
European Archives of Oto-Rhino-Laryngology | Year: 2016

Predictors for smoking and alcohol drinking behavior were investigated in head and neck cancer survivors (HNCS) with survivorship of ≥6 months. 165 HNCS registered in a regional cancer registry and treated 2005–2014 were included. Patients completed a survey including the Fagerström Test for nicotine dependence and the Alcohol Use Disorders Identification Test. Smoking and drinking cessation rates were 51 and 13 %, respectively. Multinomial logistic regression analyses showed that male patients [odds ratio (OR) 35.4; confidence interval (CI) 7.5–168.1; p < 0.0001], single persons (OR 9.9; CI 2.5–40.0; p = 0.001), and younger patients (OR 1.1; CI 1.0–1.1; p = 0.002) had significantly higher probability to be current smokers. Male gender (OR 48.7; CI 5.0–470.7; p < 0.0001) and younger age (OR 1.1; CI 1.0–1.3; p = 0.003) were predictors of risky alcohol consumption. Male, young, and single smoking and/or drinking HNCS should be stimulated to take part in smoking and/or alcohol drinking cessation programs. © 2016 Springer-Verlag Berlin Heidelberg


Guntinas-Lichius O.,Jena University Hospital | Wendt T.G.,Jena University Hospital | Kornetzky N.,Jena University Hospital | Buentzel J.,Suedharzkrankenhaus Nordhausen | And 6 more authors.
Oral Oncology | Year: 2014

Introduction The objective of this study was to examine patterns of care and survival in a population-based sample of patients with head neck cancer (HNC) who were treated in Thuringia, a federal state in Germany, between 1996 and 2011.Methods Data of 6291 patients with primary HNC from the Thuringian cancer registry were used to evaluate for patient's characteristics, tumor stage, incidence, and trends in treatment and overall survival (OS).Results The distribution between stages I-IV did not change significantly during the observation period. Crude incidences of HNC increased significantly between 1996 and 2011 from 13.77 to 20.39 (relative risk [RR] = 1.34; 95% confidence interval [CI] = 1.25-1.45). This increase was mainly driven by a significant increase of oropharynx cancer (from 3.29 to 5.85; RR = 1.67; 95%CI = 1.49-1.88) and cancer of the oral cavity (3.41-5.90; RR = 1.5; 95%CI = 1.33-1.69). The relative frequency of multimodal therapy increased (RR = 1.42; 95%CI = 1.3-1.55). The use of cetuximab increased (RR = 473.32; 95%CI = 51.57-4344.51). The 5-year and 10-year OS for the entire cohort was 49.1% and 34.1%, respectively. The multivariable analysis has proven that male gender, age ≥60 years, therapy without surgery, and TNM stage were independent significant negative risk factors for OS (all p < 0.0001).Conclusions OS did not improve during the study period. Incidence of oral cancer is significantly increasing. Although modern treatment strategies have been included in routine HNC care over the time, outcome has not improved significantly. © 2014 Elsevier Ltd.


Guntinas-Lichius O.,Jena University Hospital | Wendt T.G.,Jena University Hospital | Buentzel J.,Suedharzkrankenhaus Nordhausen | Esser D.,Helios Klinikum Erfurt | And 6 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2015

Purpose: The objective of this study was to examine patterns of care and survival in a population-based sample of patients with parotid cancer who were treated in Thuringia, a federal state in Germany, between 1996 and 2011. Methods: Data of 295 patients with primary parotid cancer from the Thuringian cancer registry were evaluated for patient’s characteristics, tumor stage, incidence, and trends in treatment, cancer-specific survival (CSS), and overall survival (OS). Results: Stages IV tumors and the amount of tumors in all age cohorts ≥45 years of age increased significantly during the observation period (p = 0.002; age all p < 0.05, respectively). The highest increase in crude incidence was observed for salivary duct carcinomas [relative risk per decade (RR) 5.46; 95 % confidence interval (CI) 1.14–26.14] and rare carcinoma subtypes (RR 9.99; 95 % CI 1.85–53.94). CSS at 5 years and at 10 years for all patients was 82.4 and 82.4 %, respectively. OS at 5 years and at 10 years for all patients was 60.1 and 48.2 %, respectively. CSS and OS did not improve over the time. Salivary duct carcinoma showed the lowest 5-year OS (35.6 %). Acinic cell carcinoma had the highest OS rate (85.3 %). Multivariate Cox models revealed that higher grading (G3/G4) was a more powerful independent predictor of decreased OS than TNM stage. Conclusions: CSS and OS did not improve during the study period. Incidence of parotid cancer increased significantly in elderly patients. It seems that grading is next to patient’s age the better predictor of OS than TNM stage. © 2015, Springer-Verlag Berlin Heidelberg.


Yildiz M.M.,Jena University Hospital | Petersen I.,Jena University Hospital | Eigendorff E.,University Tumor Center | Schlattmann P.,Jena University Hospital | Guntinas-Lichius O.,Jena University Hospital
Journal of Cancer Research and Clinical Oncology | Year: 2015

Purpose: To investigate the best lymph node (LN) metastasis predictor for overall survival (OS) in head neck cancer (HNC): pN classification, number of positive lymph nodes (PNOD), lymph node ratio (LNR), or log odds of positive lymph nodes (LODDS). Methods: In total, 225 surgically treated HNC patients were evaluated for the different LN classifications and OS. Results: Five-year OS was 71.8 %. Mean number of yielded LN and PNOD was 25.3 ± 16.7 and 2.7 ± 5.9, respectively. 64.8 % had a LNR > 0.10 and 64.4 % a LODDS > 10. In univariable analysis, multimodal therapy (p = 0.039), advanced pT (p < 0.0001), advanced UICC stage (p = 0.029), LNR > 0.10 (p = 0.049), and LODDS > −1.0 (p = 0.021) were associated with lower OS. In multivariable analysis, advanced pT [hazard ratio (HR) 2.194; 95 % confidence interval (CI) 1.294–3.722; p = 0.004] and LODDS > −1.0 (HR 1.634; 95 % CI 1.002–2.665; p = 0.059) remained independent predictors for lower OS. Conclusions: It seems useful to analyze the prognostic significance of LODDS in other samples of HNC. © 2015 Springer-Verlag Berlin Heidelberg


PubMed | University of Leipzig, University Tumor Center, Jena University Hospital, University of Marburg and 3 more.
Type: Clinical Trial, Phase II | Journal: PloS one | Year: 2015

The prognostic role of circulating tumor cells (CTCs) after induction chemotherapy using docetaxel, cisplatin and fluorouracil (TPF) prior to surgery and adjuvant (chemo)radiation in locally advanced oral squamous cell cancer (OSCC) was evaluated.In this prospective study, peripheral blood samples from 40 patients of the phase II study TISOC-1 (NCT01108042) with OSCC before, during, and after treatment were taken. CTCs were quantified using laser scanning cytometry of anti- epithelial cell adhesion molecule-stained epithelial cells. Their detection was correlated with clinical risk factors, recurrence-free (RFS) and overall survival (OS).Before starting the treatment CTCs were detected in 32 of 40 patients (80%). The median number at baseline was 3295 CTCs/ml. The median maximal number of CTCs during treatment was 5005 CTCs/ml. There was a significant increase of CTCs before postoperative radiotherapy compared to baseline before 1st cycle of IC (p = 0.011), 2nd cycle of IC (p = 0.001), 3rd cycle of IC (p = 0.004), and before surgery (p = 0.002), but not compared to end of therapy (p = 0.118). CTCs at baseline >median was also associated to risk of recurrence (p = 0.014). Maximal CTCs during therapy >median was more frequently observed in tumors of the oral cavity (p=0.022) and related to higher risk of death during follow-up (p = 0.028). Patients with CTCs at baseline >median value had significant lower RFS than patients with CTCs at baseline median during the complete course of therapy had a significantly lower OS than patients with values


PubMed | University Tumor Center and Jena University Hospital
Type: Comparative Study | Journal: Journal of cancer research and clinical oncology | Year: 2016

To investigate the best lymph node (LN) metastasis predictor for overall survival (OS) in head neck cancer (HNC): pN classification, number of positive lymph nodes (PNOD), lymph node ratio (LNR), or log odds of positive lymph nodes (LODDS).In total, 225 surgically treated HNC patients were evaluated for the different LN classifications and OS.Five-year OS was 71.8 %. Mean number of yielded LN and PNOD was 25.3 16.7 and 2.7 5.9, respectively. 64.8 % had a LNR > 0.10 and 64.4 % a LODDS > 10. In univariable analysis, multimodal therapy (p = 0.039), advanced pT (p < 0.0001), advanced UICC stage (p = 0.029), LNR > 0.10 (p = 0.049), and LODDS > -1.0 (p = 0.021) were associated with lower OS. In multivariable analysis, advanced pT [hazard ratio (HR) 2.194; 95 % confidence interval (CI) 1.294-3.722; p = 0.004] and LODDS > -1.0 (HR 1.634; 95 % CI 1.002-2.665; p = 0.059) remained independent predictors for lower OS.It seems useful to analyze the prognostic significance of LODDS in other samples of HNC.


PubMed | Suedharzkrankenhaus Nordhausen, University Tumor Center, SRH Wald Klinikum Gera, Helios Klinikum Erfurt and 2 more.
Type: Journal Article | Journal: Cancer medicine | Year: 2016

To examine the impact of comorbidity on overall survival (OS) in a population-based study of patients with head and neck cancer who were treated between 2009 and 2011. Data of 1094 patients with primary head and neck carcinomas without distant metastasis from the Thuringian cancer registries were evaluated concerning the influence of patients characteristics and comorbidity on OS. Data on comorbidity prior to head and neck cancer diagnosis was adapted to the Charlson Comorbidity (CCI), age-adjusted CCI (ACCI), head and neck CCI (HNCCI), simplified comorbidity score (SCS), and to the Adult Comorbidity Evaluation-27 (ACE-27). Most patients were male (80%; median age: 60years; 50% stage IV tumors). Smoking, alcohol abuse, and anemia were registered for 38%, 33%, and 23% of the patients, respectively. Predominant therapy was surgery + radiochemotherapy (30%), surgery (29%), and surgery+radiotherapy (21%). Mean CCI, ACCI, HNCCI, SCS and ACE-27 were 1.01.5, 2.62.1, 0.60.8, 4.44.2, and 0.90.9, respectively. Median follow-up was 25.7months. Multivariable analyses showed that higher age, higher UICC stage, no therapy, including surgery or radiotherapy, alcohol abuse, and anemia, higher comorbidity were independent risk factors for worse OS (all P<0.05). According to the discriminatory power analysis none of the five comorbidity scores was superior to the other scores to prognosticate OS. This population-based study showed that comorbidity is frequent in German patients with head and neck cancer and is an important risk factor for poor OS. Comorbidity should be routinely assessed and taken into account in prospective clinical trials.


PubMed | Suedharzkrankenhaus Nordhausen, University Tumor Center, SRH Wald Klinikum Gera, Helios Klinikum Erfurt and 2 more.
Type: Journal Article | Journal: Oral oncology | Year: 2014

The objective of this study was to examine patterns of care and survival in a population-based sample of patients with head neck cancer (HNC) who were treated in Thuringia, a federal state in Germany, between 1996 and 2011.Data of 6291 patients with primary HNC from the Thuringian cancer registry were used to evaluate for patients characteristics, tumor stage, incidence, and trends in treatment and overall survival (OS).The distribution between stages I-IV did not change significantly during the observation period. Crude incidences of HNC increased significantly between 1996 and 2011 from 13.77 to 20.39 (relative risk [RR]=1.34; 95% confidence interval [CI]=1.25-1.45). This increase was mainly driven by a significant increase of oropharynx cancer (from 3.29 to 5.85; RR=1.67; 95%CI=1.49-1.88) and cancer of the oral cavity (3.41-5.90; RR=1.5; 95%CI=1.33-1.69). The relative frequency of multimodal therapy increased (RR=1.42; 95%CI=1.3-1.55). The use of cetuximab increased (RR=473.32; 95%CI=51.57-4344.51). The 5-year and 10-year OS for the entire cohort was 49.1% and 34.1%, respectively. The multivariable analysis has proven that male gender, age 60years, therapy without surgery, and TNM stage were independent significant negative risk factors for OS (all p<0.0001).OS did not improve during the study period. Incidence of oral cancer is significantly increasing. Although modern treatment strategies have been included in routine HNC care over the time, outcome has not improved significantly.


PubMed | Johannes Gutenberg University Mainz, University Tumor Center and Jena University Hospital
Type: Journal Article | Journal: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery | Year: 2016

Predictors for smoking and alcohol drinking behavior were investigated in head and neck cancer survivors (HNCS) with survivorship of 6months. 165 HNCS registered in a regional cancer registry and treated 2005-2014 were included. Patients completed a survey including the Fagerstrm Test for nicotine dependence and the Alcohol Use Disorders Identification Test. Smoking and drinking cessation rates were 51 and 13%, respectively. Multinomial logistic regression analyses showed that male patients [odds ratio (OR) 35.4; confidence interval (CI) 7.5-168.1; p<0.0001], single persons (OR 9.9; CI 2.5-40.0; p=0.001), and younger patients (OR 1.1; CI 1.0-1.1; p=0.002) had significantly higher probability to be current smokers. Male gender (OR 48.7; CI 5.0-470.7; p<0.0001) and younger age (OR 1.1; CI 1.0-1.3; p=0.003) were predictors of risky alcohol consumption. Male, young, and single smoking and/or drinking HNCS should be stimulated to take part in smoking and/or alcohol drinking cessation programs.

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