BACKGROUND: Lymph node ratio (LNR) is increasingly reported as a potential prognostic tool. The purpose of this review was to analyze the available literature on the prognostic significance of LNR in head and neck squamous cell carcinoma (HNSCC). METHODS: A PubMed internet search was performed and articles meeting selection criteria were reviewed. RESULTS: Twenty-eight studies were identified in the literature dealing with the prognostic value of LNR. The published results are variable with a range of cutoff values of LNR associated with prognosis (overall survival [OS] and/or disease-specific survival [DSS]) between 0.02 and 0.20, with an average of 0.09. CONCLUSION: The LNR is reported to be of value in assessing prognosis in the patients with HNSCC. Although it is easy to calculate and could be considered in the staging of these patients, the currently available evidence in the literature does not yet provide a solid base for implementation.

Prognostic value of lymph node ratio in head and neck squamous cell carcinoma

Several recent studies have indicated that the lymph node ratio (LNR) is an independent prognostic factor for laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC). The purpose of this paper is to assess the prognostic value of LNR and explore appropriate cutoff values by conducting a systematic review and meta-analysis. Pubmed, Embase (via Ovid), and Cochrane library were systematically searched for studies on the prognostic value of LNR in LHSCC up to October 31, 2019. Then, Literature review, data extraction, and quality assessment of eligible studies were performed by two independent reviewers back-to-back. Lastly, Stata 14.0 software was hired to conduct a meta-analysis. A total of 445 articles were retrieved, and 13 studies published in English between 2013 and 2019 were included after the title/abstract and full-text screening. Among the 13 studies contributed to 4197 patients, seven studies were about hypopharyngeal squamous cell carcinoma (HPSCC), four studies about laryngeal squamous cell carcinoma (LSCC), and the remaining two studies about LHSCC. The meta-analysis results showed that shorter overall survival (OS) (HR 1.49; 95%CI: 1.18 to 1.88), disease-specific survival (DSS) (HR 1.66; 95%CI: 1.32 to 2.07) and disease-free survival (DFS) (HR 2.04; 95%CI: 1.54 to 2.71) were significantly correlated with a higher LNR in a random-effect model. The cutoff values of eligible studies were varied from 0.03 to 0.14, and the lowest significant LNR was 0.044. LNR is a valuable prognostic factor in the survival of LHSCC and may be used to improve the tumor staging systems, which, however, requires the solid support of more high-quality studies.

/pdf/prognostic-value-of-lymph-node-ratio-in-laryngeal-and-38ezwdro47.pdf

Prognostic value of lymph node ratio in laryngeal and hypopharyngeal squamous cell carcinoma: a systematic review and meta-analysis.

Study of autophagy-related protein light chain 3 (LC3)-II expression levels in thyroid diseases

This study aimed to investigate the clinicopathological factors that influence recurrence and survival in patients who undergo operations for T3–4 hypopharyngeal squamous cell carcinomas (SCCs). One hundred and five patients who underwent surgery between 2001 and 2008 for advanced hypopharyngeal SCCs were consecutively enrolled and reviewed. The pretreatment neutrophil-to-lymphocyte ratio (NLR; median 3.22, range 0.62–46.50) was associated with disease recurrence and patient survival. A difference in the 5-year cumulative disease recurrence rate between patients with high (≥3.22) and low (<3.22) NLRs was significant (60.4 and 36.5%, respectively; p = 0.004). A multivariate analysis confirmed that an NLR ≥3.22 was an independent indicator of a poor prognosis for advanced hypopharyngeal SCC, as per the following parameters: overall survival (hazard ratio [HR] 2.53, 95% confidence interval [CI] 1.48–4.30, p = 0.001), disease-specific survival (HR 2.45, 95% CI 1.38–4.34, p = 0.002), and disease-free survival (HR 2.18, 95% CI 1.24–3.83, p = 0.007). Additional prognostic factors per the survival analyses included lymph node density, surgical margin, lymphovascular invasion, and perineural invasion. An NLR ≥3.22 is associated with a higher risk of disease recurrence and poor survival in patients with T3–4 hypopharyngeal SCCs. We propose the use of the NLR to broaden the current TNM staging system; the development of a more effective treatment protocol for patients with high NLRs will be essential.

The Pretreatment Neutrophil-to-Lymphocyte Ratio is a Prognostic Determinant of T3-4 Hypopharyngeal Squamous Cell Carcinoma.

BACKGROUND Metastatic thyroid carcinoma to retropharyngeal and parapharyngeal (RP/PP) lymph nodes is rare. Literature suggests previous lateral neck dissection (LND) may alter patterns of lymphatic drainage in the neck, predisposing to these less common sites of spread. METHODS PRISMA-guided systematic search for all published cases detailing RP/PP metastases of well-differentiated thyroid carcinoma from 1970 to 2019. RESULTS Seventy articles were identified and 44 were included, along with seven cases treated at our institution, totaling 239 cases. Cases represented both retropharyngeal (60.7%) and parapharyngeal (39.3%) metastases identified in the initial (27.6%) and recurrent (72.4%) setting. CONCLUSION RP/PP metastases generally present in the recurrent setting. RP/PP metastases often represent high-risk disease, and surgical treatment is recommended.

Metastatic thyroid carcinoma to the parapharyngeal and retropharyngeal spaces: Systematic review with seven newly reported cases describing an uncommon presentation of a common disease.

Background Parapharyngeal lymph node (PPLN) metastasis from thyroid carcinoma is rare.We describe the clinical features,diagnosis,and surgical treatment of this condition.Methods Twenty-five patients with PPLN metastasis from thyroid carcinoma were treated at our institution from January 1999 to December 2010,including 22 patients with papillary carcinoma,two with medullary carcinoma,and one with follicular carcinoma.Of these,16 had a history of surgical treatment prior to PPLN metastasis.Of the nine patients without a history of surgical treatment,five had widespread cervical lymph node metastases and four had occult papillary thyroid carcinoma.PPLN metastasis was diagnosed by enhanced computed tomography in 22 cases.Results Resection of metastases was performed via a transcervical approach in 23 patients and a transmandibular approach in two patients.After a median follow-up time of 31 months (range:6-130 months),nine patients developed distant metastases,and six of these died of their disease.The 5-year survival rate was 63.8％.Conclusions PPLN metastasis from thyroid carcinoma may occur in patients:with previous neck dissection,with widespread metastases to cervical lymph nodes prior to initial treatment,and with occult thyroid carcinoma.Enhanced computed tomography is helpful for diagnosis in the first two presentations.Surgical resection remains the mainstay of treatment for this disease.PPLN metastasis has a tendency to be associated with distant metastases and a poor prognosis.

Surgical management of parapharyngeal lymph node metastasis of thyroid carcinoma: a retrospective study of 25 patients.

OBJECTIVE To discuss the influence of the number of lymph nodes retrieved after selective neck dissection on the prognosis of hypopharyngeal squamous carcinoma. METHODS A retrospective review was performed on 96 patients with hypopharyngeal squamous carcinoma between January 1995 and December 2009, and all cases were accepted initial treatment for selective neck dissection. t test was used for analysis of normally distributed and Mann-Whitney U test for non-normally distributed continuous data in two groups. Comparisons were made by χ(2) analysis for categorical variables. Overall survival, disease-free survival and neck-control rate were calculated by the Kaplan-Meier method. RESULTS The mean number of lymph nodes retrieved in all patients with hypopharyngeal squamous carcinoma was 19.0 ± 11.3. Preoperative radiotherapy significantly decreased the number of retrieved lymph nodes and positive lymph nodes (t = -4.45, P 15 by using Kaplan-Meier analysis (χ(2) = 8.214, P 15 nodes (χ(2) = 7.345, P 15 nodes vs. ≤ 15 nodes;χ(2) = 5.539, P 15 was an independent prognostic factor in patients undergoing selective neck dissection for hypopharyngeal squamous carcinoma (P < 0.05). CONCLUSIONS The number of lymph nodes retrieved is a valuable prognostic factor in patients received selective neck dissection for hypopharyngeal squamous carcinoma. These results suggest that at least 15 nodes should be examined in this setting.

Prognostic value of the number of lymph nodes retrieved after selective neck dissection in hypopharyngeal squamous carcinoma

Objective
To study the clinical characteristic, diagnosis, surgical treatment and prognosis of thyroglossal duct carcinoma （TDCa）. 


Methods
A total of 110 patients with thyroglossal duct remanat in our hospital between 1991 and 2011 was reviewed. Five patients of them were diagnosed with TDCa by pathological examination, including 4 cases of papillary carcinoma and 1 case of squamous cell carcinoma. 


Results
All five patients were men and the median age was 41 years （range from 17-73 years）. Pulmonary metastasis was found preoperatively in one patient with papillary carcinoma. All five patients were managed by surgical treatment. Sistrunk operation was performed with resection of the tumor, thyroglossal remanat and partial hyoid bone in 2 patients, with resection of thyroid nodule in one patient, with total thyroidectomy and central neck dissection in one patient with pulmonary metastasis, with extensive resection of invading tissues in one patient with squamous TDCa. Two patients with papillary carcinoma underwent the treatment with TSH suppression postoperatively, of them one with pulmonary metastasis received radioactive iodine therapy simultaneously. The remaining three patients did not receive any further treatment. With follow-up of 14 -45 months, local recurrence occurred in one patient with squamous TDCa after two months and caused death seven months after surgery, and the other four patients survived. 


Conclusions
TDCa is a rare malignant tumor that is usually diagnosed after surgery. The Sistrunk operation may be adequate for low-risk cases.


Key words: 
Thyroglossal Cyst; Thyroid neoplasms; Diagnosis; Therapy

[Management of thyroglossal duct carcinoma: report of five cases].

OBJECTIVES This study aimed to determine the efficacy and feasibility of preoperative radiotherapy with or without chemotherapy (XRT) followed by surgery of locally advanced pyriform sinus carcinoma. MATERIALS AND METHODS We performed a retrospective study of 482 patients with T3 and T4 pyriform sinus carcinoma treated with curative intent between 1979 and 2008. The patients were divided into 4 groups according to different treatment patterns. RESULTS The 5-year disease-special survival rate was 32%. Survival was best for the patients treated with surgery followed by XRT (41.1%) and with neoadjuvant XRT followed by surgery (39.4%), but it was worse with surgery only (27.1%) and XRT alone (23%). The disease-special survival was significantly different between the patients who accepted multidisciplinary therapy and those who accepted single therapy (P 0.05). CONCLUSIONS The results suggested that neoadjuvant XRT followed by planned surgery was feasible with satisfactory oncological and functional outcomes.

Neoadjuvant treatment combined with planned surgery in laryngeal function preservation for locally advanced pyriform sinus carcinoma.

BACKGROUND Lymph node ratio (LNR) has recently been reported as a potential prognostic marker in many malignant diseases. We aimed to analyze the potential prognostic effect of LNR on hypopharyngeal squamous cell carcinoma (HPSCC) after neoadjuvant therapy in our institution. METHODS We performed a retrospective study of 279 patients with HPSCC who underwent radiotherapy with or without chemotherapy followed by neck dissection between November 1965 and December 2008. Patients were divided into four groups according to quartiles based on LNR. RESULTS The mean LNR was 10.4% (range 0-100%, median 4.3%). Males and advanced clinical N classification significantly increased the LNR (P = 0.014 and P < 0.001, respectively). Compared with those with LNR <0.14, LNR ≥0.14 was associated with reduced overall, disease-specific and disease-free survival (all at P < 0.001). Multivariate analysis revealed that LNR is an independent predictor of prognosis. CONCLUSION Our results suggest that LNR is a strong predictor of HPSCC after chemoradiotherapy.

Prognostic value of lymph node ratio in hypopharyngeal squamous cell carcinoma after chemoradiotherapy.

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