Valoración de un método de clasificación y estadiaje de la segunda neoplasia de cabeza y cuello

Introducción. La aparición de segundos tumores metacrónicos tras el diagnóstico de un carcinoma escamoso de cabeza y cuello es uno de los principales obstáculos para la supervivencia a largo plazo de estos pacientes. El pronóstico de los segundos tumores es significativamente peor que el de los tumores índice de la misma localización. No existe unanimidad en la literatura sobre las causas de este fenómeno, aunque algunos autores lo relacionan a los tratamientos aplicados al tumor índice. Objetivos. Se pretende comprobar la influencia pronóstica de la aparición de una neoplasia metacrónica en la supervivencia final de una cohorte de pacientes diagnosticados y tratados de un carcinoma escamoso de cavidad oral, faringe o laringe. Asimismo se plantea la evaluación de diferentes factores relacionados con el tumor índice en el pronóstico del paciente tras su segundo tumor de cabeza y cuello. Pacientes y Métodos. Se realizó una revisión retrospectiva de la información contenida en la base de datos de tumores del servicio de ORL del Hospital de la Santa Creu i Sant Pau de Barcelona en el periodo 1985-2006. Esta base de datos constituye un registro prospectivo de todos los casos de tumores malignos diagnosticados y tratados en el propio centro, y recoge información referente a la localización, extensión y tratamiento de los tumores, así como de su evolución. La muestra de estudio se compone de 3676 pacientes diagnosticados de carcinomas escamosos de cavidad oral, oro e hipofaringe y laringe, con un mínimo de 12 meses de seguimiento. En 301 casos se diagnosticaron segundos tumores de las mismas localizaciones (8% del total) Se emplearon técnicas de regresión de Cox multivariante para el estudio de los factores pronósticos, así como técnicas de generación de árboles de decisión (C5.0, C&RT, QUEST y CHAID). Resultados. Se observó una disminución de la supervivencia de los pacientes desde el diagnóstico del segundo tumor de vías aerodigestivas superiores (cavidad oral, orofaringe, hipofaringe o laringe) de un 10% respecto a la de los pacientes con un único tumor de dichas localizaciones. El análisis uni y multivariante convencional no consiguió detectar factores pronósticos relevantes relacionados con el tumor índice. Por el contrario, las técnicas de generación de árboles permitieron destacar la relevancia de la extensión del tumor índice y el uso de radioterapia en su tratamiento como factores pronósticos de supervivencia tras el diagnóstico de una segunda neoplasia. Esta información ha servido de base para la propuesta de un sistema de clasificación pronóstica de las segundas neoplasias. Conclusiones. La aparición de segundas neoplasias reduce la supervivencia de los pacientes afectos de carcinomas de cabeza y cuello. La extensión del tumor índice y el empleo de radioterapia en el tratamiento del mismo condicionan la supervivencia de los pacientes que presentan una segunda neoplasia. La naturaleza de estas relaciones es compleja y escapa a los métodos estadísticos tradicionales.Introduction Metacrhonous second primary tumors are amongst the main obstacles that hamper long term survival after a head and neck squamous cell carcinoma. When compared with index tumors of the same stage and location, prognosis of second tumors is significantly worse. Medical literature remains controversial regarding the causes of this phenomenon, while some authors point to the use of certain treatment options for the index tumor as a plausible cause. Objectives We studied the prognostic influence of a metachronous tumor in the survival of a cohort of patients diagnosed of a squamous cell carcinomoa of the oral cavity, pharynx or larynx. Secondly, we evaluated the contribution of diverse variables related to the index tumor in the prognosis of the patient after diagnosis of the second neoplasm. Patients and Methods A retrospective review was carried out using the tumor database of the Otolaryngology Department of the Hospital de la Santa Creu i Sant Pau between 1985 and 2006. This database prospectively collects information regarding the localization, extension and treatment of all tumors diagnosed and treated in the department. The study sample was composed of 3676 patients diagnosed of a squamous cell carcinoma of the oral cavity, oro- or hypopharynx or larynx with a minimal follow-up of 12 months. In 301 cases a second primary tumor of the mentioned locations was found (8% of the total number of cases). Multivariate Cox analysis and classification tree algorithms (C5.0, C&RT, QUEST y CHAID) were used to assess prognostic factors. Results. Second primary tumors of the oral cavity, oropharynx, larynx or hypopharynx showed a 10% decrease in survival with respect to patients with a single tumor of such locations. Conventional uni and multivariate analysis failed to detect relevant prognostic index tumor-related factors. On the other hand, classification tree algorithms highlighted the relevance of index tumor extension and radiotherapy use as relevant predictors of survival after diagnosis of a second malignancy. This information has served as basis for the proposal of a second neoplasms prognostic classification system. Conclusions. Metachronous second neoplasms reduce the survival of patients suffering from head and neck carcinomas. Index tumor extension and the use of radiotherapy in the treatment of the index significantly affect survival of patients with a second malignancy. The nature of these relationships is complex and escapes traditional statistical methods

Use of video and 3D scenario visualisation to rate vegetation screens for integrating buildings into the landscape

Las acciones humanas en el medio natural crean un impacto visual. El objetivo principal de este estudio fue examinar la aceptación de pantallas de vegetación para integrar edificios en el paisaje utilizando nuevas técnicas de visualización en tres dimensiones (3D), videos y participación pública. El status quo de dos áreas de estudio representativas del clima mediterráneo en España (una tierra adentro y otra costera) se modeló, colocando pantallas de vegetación alrededor de un edificio típico de la zona y variando la densidad, las especies y el diseño de las plantas. Después de establecer una serie de escenarios, se crearon videos que muestran una simulación de actividades de turismo al aire libre realizadas a diferentes velocidades para analizar cómo el movimiento afecta la percepción de la combinación de un edificio y una pantalla de vegetación en las versiones creadas. Los modelos 3D generados fueron sometidos a una encuesta para la participación del público y para permitir que los encuestados califiquen sus preferencias de los videos creados. Los resultados muestran que agregar vegetación siempre mejora la integración de los edificios en el paisaje. La pantalla de vegetación con la calificación más alta colocada alrededor de los edificios en los dos escenarios fue la vegetación de alta densidad, independientemente de la distribución o la especie.Human actions in the natural environment create a visual impact. The main objective of this study was to examine the acceptance of vegetation screens for integrating buildings into the landscape using new techniques of visualization in three dimensions (3D), videos and public participation. The status quo of two study areas representative of the Mediterranean climate in Spain (one inland and one coastal) was modelled, placing vegetation screens around a building typical of the area and varying the density, species, and layout of plants. After establishing a series of scenarios, videos showing a simulation of outdoor tourism activities performed at varying speeds were created to analyse how movement affects the perception of the combination of a building and vegetation screen in the versions created. The 3D models generated were subjected to a survey for public participation and to allow respondents to rate their preferences of the videos created. The results show that adding vegetation always improves the integration of buildings into the landscape. The most highly rated vegetation screen placed around the buildings in the two scenarios was high density vegetation, irrespective of the layout or species.• Gobierno de Extremadura y Fondo Europeo Regional de Desarrollo. Ayuda GR15179peerReviewe

Expression of IL-1α correlates with distant metastasis in patients with head and neck squamous cell carcinoma

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER)The presence of IL-1 in human cancers is associated with aggressive tumor biology but its prognostic value is unknown. We studied whether IL-1α expression is a prognostic marker of distant metastasis in patients with head and neck squamous cell carcinoma (HNSCC). IL-1α mRNA and protein levels were determined in tumor samples and cancer cell lines using RT-PCR and ELISA. The effects of constitutive IL-1α expression by tumor lines were characterized. IL-1α mRNA and protein secretion were higher in tumor samples from patients who later developed distant metastasis than in patients who did not. By using distant metastasis as a dependent variable, patients were classified into two categories of IL-1α transcript-levels. The high-IL-1α group had a significantly lower five-year distant metastasis-free survival than the low-IL-1α group [70.0% (CI 95%: 55.9-84.1%) vs 94.7% (CI 95%:90.2-99.2%)]. When IL-1α transcript-levels were combined with clinical factors related to tumor metastasis, the predictive power of the model increased significantly. Additionally, transcript levels of IL-1α correlated significantly with those of the IL-1 family genes and genes related to the metastatic process. IL-1 treatment of microvascular endothelial cells increased adhesion of HNSCC cells but no differences were found based on constitutive IL-1α expression by tumor cells. Nevertheless, IL-1α produced by tumor cells effectively increased their transmigration across the endothelium. We found a significant relationship between IL-1α expression and development of distant metastasis in HNSCC patients. IL-1α expression could help to define a subset of patients at high risk of distant metastasis who could benefit from adjuvant treatment

Is There A Role for Limited Parotid Resections for Primary Malignant Parotid Tumors?

Background: Lateral or total parotidectomy are the standard surgical treatmentsfor malignant parotid tumors. However, some authors have proposed a more limited procedure.(2) Methods: We performed a review of the literature on this topic. Studies were included that metthe following criteria: malignant parotid tumors, information about the extent of surgical resection,treated with less than a complete lateral lobectomy, and information on local control and/or survival.Nine articles fulfilled the inclusion criteria. (3) Results: Eight of the nine series reported favorableresults for the more limited approaches. Most used them for small, mobile, low-grade cancers inthe lateral parotid lobe. Most authors have used a limited partial lateral lobectomy for a presumedbenign lesion. The remaining study analyzed pediatric patients treated with enucleation with poorlocal control. (4) Conclusions: There is weak evidence for recommending less extensive proceduresthan a lateral parotid lobectomy. In the unique case of a partial lateral parotidectomy performed fora tumor initially thought to be benign but pathologically proved to be malignant, close follow-upcan be recommended for low grade T1 that has been excised with free margins and does not haveadverse prognostic factors

Valoración de un método de clasificación y estadiaje de la segunda neoplasia de cabeza y cuello

Introducción. La aparición de segundos tumores metacrónicos tras el diagnóstico de un carcinoma escamoso de cabeza y cuello es uno de los principales obstáculos para la supervivencia a largo plazo de estos pacientes. El pronóstico de los segundos tumores es significativamente peor que el de los tumores índice de la misma localización. No existe unanimidad en la literatura sobre las causas de este fenómeno, aunque algunos autores lo relacionan a los tratamientos aplicados al tumor índice. Objetivos. Se pretende comprobar la influencia pronóstica de la aparición de una neoplasia metacrónica en la supervivencia final de una cohorte de pacientes diagnosticados y tratados de un carcinoma escamoso de cavidad oral, faringe o laringe. Asimismo se plantea la evaluación de diferentes factores relacionados con el tumor índice en el pronóstico del paciente tras su segundo tumor de cabeza y cuello. Pacientes y Métodos. Se realizó una revisión retrospectiva de la información contenida en la base de datos de tumores del servicio de ORL del Hospital de la Santa Creu i Sant Pau de Barcelona en el periodo 1985-2006. Esta base de datos constituye un registro prospectivo de todos los casos de tumores malignos diagnosticados y tratados en el propio centro, y recoge información referente a la localización, extensión y tratamiento de los tumores, así como de su evolución. La muestra de estudio se compone de 3676 pacientes diagnosticados de carcinomas escamosos de cavidad oral, oro e hipofaringe y laringe, con un mínimo de 12 meses de seguimiento. En 301 casos se diagnosticaron segundos tumores de las mismas localizaciones (8% del total) Se emplearon técnicas de regresión de Cox multivariante para el estudio de los factores pronósticos, así como técnicas de generación de árboles de decisión (C5.0, C&RT, QUEST y CHAID). Resultados. Se observó una disminución de la supervivencia de los pacientes desde el diagnóstico del segundo tumor de vías aerodigestivas superiores (cavidad oral, orofaringe, hipofaringe o laringe) de un 10% respecto a la de los pacientes con un único tumor de dichas localizaciones. El análisis uni y multivariante convencional no consiguió detectar factores pronósticos relevantes relacionados con el tumor índice. Por el contrario, las técnicas de generación de árboles permitieron destacar la relevancia de la extensión del tumor índice y el uso de radioterapia en su tratamiento como factores pronósticos de supervivencia tras el diagnóstico de una segunda neoplasia. Esta información ha servido de base para la propuesta de un sistema de clasificación pronóstica de las segundas neoplasias. Conclusiones. La aparición de segundas neoplasias reduce la supervivencia de los pacientes afectos de carcinomas de cabeza y cuello. La extensión del tumor índice y el empleo de radioterapia en el tratamiento del mismo condicionan la supervivencia de los pacientes que presentan una segunda neoplasia. La naturaleza de estas relaciones es compleja y escapa a los métodos estadísticos tradicionales.Introduction Metacrhonous second primary tumors are amongst the main obstacles that hamper long term survival after a head and neck squamous cell carcinoma. When compared with index tumors of the same stage and location, prognosis of second tumors is significantly worse. Medical literature remains controversial regarding the causes of this phenomenon, while some authors point to the use of certain treatment options for the index tumor as a plausible cause. Objectives We studied the prognostic influence of a metachronous tumor in the survival of a cohort of patients diagnosed of a squamous cell carcinomoa of the oral cavity, pharynx or larynx. Secondly, we evaluated the contribution of diverse variables related to the index tumor in the prognosis of the patient after diagnosis of the second neoplasm. Patients and Methods A retrospective review was carried out using the tumor database of the Otolaryngology Department of the Hospital de la Santa Creu i Sant Pau between 1985 and 2006. This database prospectively collects information regarding the localization, extension and treatment of all tumors diagnosed and treated in the department. The study sample was composed of 3676 patients diagnosed of a squamous cell carcinoma of the oral cavity, oro- or hypopharynx or larynx with a minimal follow-up of 12 months. In 301 cases a second primary tumor of the mentioned locations was found (8% of the total number of cases). Multivariate Cox analysis and classification tree algorithms (C5.0, C&RT, QUEST y CHAID) were used to assess prognostic factors. Results. Second primary tumors of the oral cavity, oropharynx, larynx or hypopharynx showed a 10% decrease in survival with respect to patients with a single tumor of such locations. Conventional uni and multivariate analysis failed to detect relevant prognostic index tumor-related factors. On the other hand, classification tree algorithms highlighted the relevance of index tumor extension and radiotherapy use as relevant predictors of survival after diagnosis of a second malignancy. This information has served as basis for the proposal of a second neoplasms prognostic classification system. Conclusions. Metachronous second neoplasms reduce the survival of patients suffering from head and neck carcinomas. Index tumor extension and the use of radiotherapy in the treatment of the index significantly affect survival of patients with a second malignancy. The nature of these relationships is complex and escapes traditional statistical methods

Visual Analysis of the Height Ratio between Building and Background Vegetation. Two Rural Cases of Study: Spain and Sweden

The perception of apparent sizes of buildings in a rural environment depends on the height ratio between the building and its surrounding vegetation, and it is this parameter which is currently used to assess the built landscapes. The impact of a contrasting height is less strong if the building does not exceed the horizon line. For buildings overshooting the skyline, the building’s level of sharpness and number of lines in contrast to the sky determines the impact of the scales, and vegetation in the background helps to reduce impact. The specific objectives of the present study were: (1) finding height–ratio thresholds between building and background vegetation, which may improve the integration of rural buildings in sky-sensitive locations, and; (2) comparing the results in two rural contexts with very different climatic conditions: Spain and Sweden. A survey of eighteen scenarios (nine Spanish and nine Swedish), all digitally modified with different relative height ratios between vegetation and buildings, was performed. The survey was evaluated by the public from both countries. Regardless of the country of origin, integration of the building was good or very good when the vegetation in background did not exceed one half of the height of the construction. These results may be translated to technical criteria for planning assessment

Prognostic value of transcriptional expression of fibronectin type III domain-containing 4 (FNDC4) in head and neck carcinoma patients treated with chemoradiotherapy

Purpose: FNDC4 gene encodes the fibronectin type III domain-containing 4 protein. Elevated expression of FNDC4 has been associated with poor prognosis in several types of cancer. There are no studies that have evaluated the prognostic capacity of FNDC4 in patients with head and neck cancer (HNSCC). The aim of our study was to analyze the relationship between the transcriptional expression of FNDC4 and prognosis in HNSCC patients. Methods: we determined the transcriptional expression of FNDC4 in 67 patients with advanced-stage HNSCC (III-IV) treated with chemoradiotherapy. The FNDC4 expression was categorized according to the disease-specific survival with a recursive partitioning analysis. Results: there were significant differences in disease-specific survival as a function of the level of FNDC4 transcriptional expression. The 5-year disease-specific survival for patients with high FNDC4 expression (n = 44, 65.7%) was 32.9% (95% CI: 16.5-49.3%), and for patients with low expression (n = 23, 34.3%) it was 85.4% (95% CI: 70.2-100%) (P = 0.0001). Patients with a high FNDC4 expression had poorer local (P = 0.097), regional (P = 0.008), and distant (0.034) recurrence-free survival. The results of a multivariate analysis showed that patients with a high FNDC4 expression had a 6.15-fold increased risk of death as a consequence of the HNSCC (95% CI: 1.71-22.06). Conclusion: FNCF4 transcriptional expression was significantly related to the disease-specific survival of HNSCC patients treated with chemoradiotherapy. Patients with elevated FNDC4 expression had a significant decrease in disease-specific survival

Using Native Vegetation Screens to Lessen the Visual Impact of Rural Buildings in the Sierras de Béjar and Francia Biosphere Reserve: Case Studies and Public Survey

Tree screens have a demonstrated role in lessening the visual impact of buildings nonintegrated aesthetically by means of filtering façades. This is particularly useful on village fringes and in areas bordering urban green spaces. However, the role of other vegetal structure such as climber species, and their optimal percentage for façade filtering, have not been measured yet. The main objectives of present study were: (1) To guess if climber species have a similar positive role to lessen the visual impact of a façade than tree species, and (2) to compare optimal percentage of coverage for both vegetal structures. To explore them, we designed three percentages of partial-concealment vegetation screens (0% none, 40−50% medium, 70−80% high), comprising tree or climber native species from a study area, in eight buildings from the same region. As a result, 24 final infographics were evaluated by two groups of interviewees: 27 local people and 39 non-local university students. Respondents had to assess the integration of the building in terms of visual preference using an ascending scale with 5 options from “Very poor” = 1 to “Very good” = 5. The results show a clear linear positive response of participants when increasing the percentage of coverage by both types of vegetal screens. However, positive significant valuation over 3 points on average was reached before in tree species screens (3.06, in 40−50% of façade coverage) than in climbing species screens (3.02 in 70−80% of façade coverage). Finally, there was a high consensus in responses when both groups polled were compared

Visual Impact Assessment in Rural Areas: The Role of Vegetation Screening in the Sustainable Integration of Isolated Buildings

Rural tourism has led to an increase in the number of buildings, meaning that visual integration of these buildings into the landscape is not always achieved. The silhouettes of buildings in rural areas are always recognisably simple but can be visually discordant if their sharpness is high. The literature provides analyses of how the visual impact of a given construction can be minimised by vegetation screening. The main objective of this study was to propose a method of quantifying the visual impact of isolated buildings (1 (low visual impact)–5 (high visual impact)). The method combines a measurement of the sharpness of building silhouette lines and vegetation screening (Scr) percentage (high or low) using theories based on the cognitive aspects of visual perception and digital image processing. The method was validated through a survey in which photos were shown to a wide range of respondents. A second objective was to analyse the combined effect on the visual perception of Scr and building colour (C), which is broadly analysed in the literature. The main result is that the required percentage of vegetation screening for a building with sharp lines and discordant colours to be accepted was determined to be around 40%. The proposed method can be applied by landscape planners; it is easy to use, and the cognitive principles on which it is based do not depend on the working environment

Low skeletal muscle mass assessed directly from the 3rd cervical vertebra can predict pharyngocutaneous fistula risk after total laryngectomy in the male population

Purpose: Skeletal muscle mass (SMM) loss and sarcopenia have been identified as risk factors for postoperative complications. The aim of this study was to investigate the relationship between pharyngocutaneous fistula (PCF) formation after total laryngectomy (TL) and SMM assessed from a computed tomography image of the 3rd cervical vertebra (C3). Methods: Retrospective study of 86 male patients who underwent TL between 2013 and 2019 in a single institution. We excluded women from the analysis due to our limited sample. SMM was determined from cross-sectional muscle area (CSMA) measurement at C3 using the ImageJ software. Results were compared with those for the skeletal muscle mass index (SMMI) calculated from the estimated measure at 3rd lumbar vertebra (L3). Results: PCF formation occurred in 21/86 patients. According to the CSMA at a C3 cut-off of 35.5cm2, of 18 patients (20.9%) with low SMM, 9 developed PCFs (50.0%). Among patients with normal SMM (n = 68, 79.1%), 12 developed PCFs (17.6%). The CSMA at C3 was the only variable significantly associated with PCF risk, which was 4.7 times greater in patients with low SMM (p = 0.007). Sarcopenia was more frequent in underweight patients (p = 0.0001), patients undergoing extended surgeries (p = 0.003), or presenting preoperative anaemia (p = 0.009) or hypoalbuminemia (p = 0.027). Conclusion: Measuring the CSMA at C3 obtained results equivalent to those obtained by calculating the SMMI at L3, suggesting that direct SMM assessment from C3 is a useful approach to evaluating PCF formation risk after TL