135 results on '"Giacomarra V"'
Search Results
52. The use of the temporalis muscle flap in oral reconstruction
- Author
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RUSSOLO M, GIACOMARRA V, VARINI A., TIRELLI, GIAN CARLO, Russolo, M, Giacomarra, V, Tirelli, GIAN CARLO, and Varini, A.
- Published
- 1993
53. La ricostruzione con lembo di muscolo temporale nella chirurgia oncologica della cavità orale e dell'orofaringe
- Author
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Giacomarra, V, Tirelli, GIAN CARLO, Varini, A, Russolo, M., Giacomarra, V, Tirelli, GIAN CARLO, Varini, A, and Russolo, M.
- Published
- 1993
54. Oncological and functional results by horizontal glottectomy in laryngeal carcinomas
- Author
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Russolo, M., Giacomarra, V., giancarlo tirelli, Russolo, Mario, Giacomarra, Vittorio, and Tirelli, GIAN CARLO
- Subjects
Supraglottic laryngeal cancer ,glottic laryngeal cancer ,Supraglottic laryngeal cancer, glottic laryngeal cancer ,"laryngectomy" - Abstract
orizzontal glottectomy is a variant of a partial laryngectomy; the approach would be performed by external and the results confirm that the procedure is safe and offers good oncological survival rates.
- Published
- 1999
55. Catecholamines contents in experimental microvascular anastomoses
- Author
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Luigi Valdatta, Faga, A., Rasini, E., Cortinovis, U., Thione, A., Giacomarra, V., Arnez, Z. M., L., Valdatta, A., Faga, E., Rasini, U., Cortinovi, A., Thione, V., Giacomarra, and Arnez, ZORAN MARIJ
- Subjects
Microsurgery ,Anastomosi ,Anastomosis ,catecholamine ,microvascular - Abstract
The Authors present the results of an immunohistochemical-chromatographic study for the evaluation of the catecholamine content in experimental microvascular anastomoses on rat femoral arteries. Immunohistochemistry showed perivascular TH immunoreactive autonomic nerve fibers and, within the vascular wall, the presence of enzymes of the catecholamine biosynthetic pathway which has been confirmed by chromatography. The data, after statistical analysis, proved a significant reduction of catecholamine levels within operated patent or thrombosed vessels compared to non operated on control vessels; these data proved also a non significant increase of catecholamine levels within operated thrombosed vessels compared to operated patent vessels. The reasons and the potential clinical repercussions of these experimental data are analyzed, underlying the importance of neurogenic factors in the pathogenesis of microvascular thrombosis.
- Published
- 1999
56. Predictive factors of nodal metastases in oral cavity and oropharynx carcinomas.
- Author
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Giacomarra V, Tirelli G, Papanikolla L, Bussani R, Giacomarra, V, Tirelli, G, Papanikolla, L, and Bussani, R
- Abstract
Objective: To estimate the value of tumor (T)-related parameters (singly or in association) in predicting the presence of occult metastases in oral cavity and oropharynx carcinomas.Study Design: We considered tumor size (T size), Broders' grading of histologic differentiation (G), invasive cell grading (ICG), and thickness. For every single factor, we evaluated the correlation between the parameter and occult metastases in N0 neck disease, the correlation between the parameter and metastases independently from node (N) class, and the relation between the parameter and extracapsular spread. On the basis of previous results, we gave a score to each parameter that showed higher significativity the sum of which we called global score (GS). We compared the predictivity of metastasis of the GS to that of the single parameters to obtain a more efficacious index.Methods: Sixty-one patients with carcinomas of the oral cavity and oropharynx who underwent surgery on T and N were examined.Results: Our preliminary results have highlighted a significant correlation between G, ICG, and the presence of occult metastases. No correlation between T size and metastases was highlighted. The GS obtained from G and ICG turned out to be highly significant. A strong correlation was found between the ICG score and extracapsular spread: a high risk of extracapsular spread was found in patients with an ICG score > or =13.Conclusion: We perform elective neck dissection in T1-T2 N0 neck disease with ICG > or =13 and GS1 > or =9. [ABSTRACT FROM AUTHOR]- Published
- 1999
57. Usefulness of Virtual Endoscopic Three-dimensional Reconstructions of the Middle Ear
- Author
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Morra, A., primary, Tirelli, G., additional, Rimondini, A., additional, Cioffi, V., additional, Russolo, M., additional, Giacomarra, V., additional, and Pozzi-Mucelli, R., additional
- Published
- 2002
- Full Text
- View/download PDF
58. RECONSTRUCTION OF COMPOSITE MANDIBULAR DEFECTS
- Author
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Arnez, Z. M., primary, Giacomarra, V., additional, Valdatta, L., additional, and Tyler, M., additional
- Published
- 1995
- Full Text
- View/download PDF
59. The radial forearm-lateral arm mega free flap
- Author
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Arnezˇ, Z., primary, Tyler, M., additional, Giacomarra, V., additional, and Planinsˇek, F., additional
- Published
- 1995
- Full Text
- View/download PDF
60. Prognostic indicators of occult metastases in oral cancer.
- Author
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Russolo M, Giacomarra V, Papanikolla L, Tirelli G, Russolo, Mario, Giacomarra, Vittorio, Papanikolla, Ledia, and Tirelli, Giancarlo
- Abstract
Objective: We evaluated the importance of several tumor factors related to predicting the presence of occult metastases in the oral cavity.Study Design: Retrospective case study.Methods: The study comprises 29 patients treated at the Department of Otorhinolaryngology (University of Trieste, Cattinara Hospital, Trieste, Italy) between January 1990 and December 2000, who had T1-T2 carcinoma of the oral cavity that had or had not extended to the oropharynx and were clinically evaluated as N0 neck. The patients all underwent surgery with removal of tumor and neck dissection. Four tumor-related parameters were examined with the aim of evaluating their predictivity of metastasis tumor class, degree of keratinization, degree of differentiation according to Brooler's histopathological grading, and invasive cell grading (ICG). With the exception of tumor class, these parameters were evaluated both in the biopsy and in the surgical specimen and the findings were then compared. We evaluated existing correlations between each individual parameter and the histopathological presence of micrometastases (pN+) and extracapsular spread revealed when specimens from the neck were examined.Results: There was a highly significant correlation between ICG equal to or greater than 13 (range, 5-20) and the presence of occult metastases (P = .0017). On the basis of our findings, the ICG parameter correctly identified 9 of 10 (pN+) patients and could have reduced overtreatment from 65.5% to 17.2% in histopathological necks (pN0).Conclusion: It would appear that with a delay in programming a neck dissection so as to consider ICG in combination with thickness, as in seven recent patients, identification of locoregional occult metastases (pN+) might be more precise. [ABSTRACT FROM AUTHOR]- Published
- 2002
61. Surgical treatment of tracheostomal stenosis.
- Author
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Giacomarra V, Russolo M, Tirelli G, and Bonini P
- Published
- 2001
62. Benign positional vertigo without detectable nystagmus.
- Author
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Tirelli G, D'Orlando E, Giacomarra V, and Russolo M
- Published
- 2001
63. Modified particle repositioning procedure.
- Author
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Tirelli G, D'Orlando E, Zarcone O, Giacomarra V, and Russolo M
- Published
- 2000
- Full Text
- View/download PDF
64. Pre-operative evaluation of cervical adenopathies in tumours of the upper aerodigestive tract
- Author
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giancarlo tirelli, Palmieri, A., Giacomarra, V., Russolo, M., Tirelli, GIAN CARLO, Palmieri, A., Giacomarra, V., and Russolo, Mario
- Subjects
upper aerodigestive tract tumors - Abstract
Carcinomas of the upper aerodigestive tract are characterized by a high incidence of local metastasis in the neck. The presence of lymph node metastasis represents the most unfavorable prognostic factor for these tumors. A diagnostic routine is needed in order to identify the highest number of neck metastasis, thereby optimizing the selection of patients eligible for surgical neck treatment and reduce costs and length of hospital stay. Our study analyzes the sensibility, specificity, and diagnostic accuracy of clinical examination, echography (US), computed tomography (CT) in cervical metastasis detection by comparing them with the histopathological examination of the neck dissection specimens (pN) in 53 patients suffering from carcinoma of the upper aerodigestive tract. Clinical examination: sensibility 82.1%; specificity 80%; diagnostic accuracy 81.1%; US with a cut off point for minimal adenopathy diameter of 0.5 cm 92.8% sensibility, 60% specificity, 77.3% diagnostic accuracy; US with cut off point 1 cm 82.1% sensibility, 80% specificity, 81.1% diagnostic accuracy; US with cut off point 1 cm, also considering round shape or multiplicity of the adenopathy: 82.1 sensibility, 80% specificity, 81.1% diagnostic accuracy; CT with cut off point 0.5 cm: 92.8% sensibility, 32% specificity, 64.1% diagnostic accuracy; CT with cut off point 1 cm: 85.7% sensibility, 64% specificity, 75.4% diagnostic accuracy; CT with cut off point 1 cm, also considering central necrosis, extracapsular spread, multiplicity of the adenopathy 89.2 sensibility, 60% specificity, 75.5% diagnostic accuracy. By relating the results obtained from preoperative methods to the anatomopathological analysis of the surgical specimens we can draw the following conclusions: a) a neck positive to palpation in a subject with carcinoma of the upper aero digestive tract must be submitted to neck dissection. Such patients have an 81.1% likelihood of having a metastasis. In these patients the use of radiologic studies of the neck must be restricted to cases with uncertain involvement of retropharingeal, mediastinic, paratracheal lymph nodes or in the follow-up after treatment; b) a neck negative to palpation in a subject with carcinoma of the upper aero digestive tract, must be further investigated. The US and the CT must use a cut-off point of 1 cm to consider a neck positive. Radiologic criteria for malignancy, i.e., multiplicity, roundish shape, central necrosis and capsular invasion do not significantly increase the diagnostic accuracy of the radiographic methods; c) the combined use of US and CT does not offer significant advantages in the detection of metastasis, in any case CT is preferable when primary tumor has to be evaluated; d) the assessment of patients that are negative to palpation and to US and to CT must consider the parameters linked with primary tumor, such as site and size, Broder's grading, Invasive Cell Grading, and thickness.
65. Test-retest reliability of the VOR as measured via Vorteq in healthy subjects
- Author
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giancarlo tirelli, Bigarini, S., Russolo, M., Giacomarra, V., and Sasso, F.
- Subjects
Adult ,Male ,Time Factors ,Rotation ,Data Interpretation, Statistical ,Head Movements ,Vertigo ,Electronystagmography ,Humans ,Female ,Reflex, Vestibulo-Ocular ,Middle Aged ,Vestibular Function Tests - Abstract
To determine the reliability of the vestibolo-ocular reflex test measured via Vorteq, 16 subjects underwent head-autorotation test at the frequencies 1-5 Hz. All patients underwent the re-test. No linear correlation was observed between the measurements, i.e., no repeatability of the same measurements at the various frequencies. The Head Auto-Rotation Test by Vorteq has demonstrated advantages: patients are not disturbed by the active head movements; the full test protocol, lasts only a few minutes; the method enables the vestibolo-ocular reflex to be evaluated at high head-rotation frequencies. However, the test has disadvantages: poor test-retest inter-individual repeatability, wide standard deviations of results with heterogeneous inter-individual spread with regard to phase and asymmetry values especially at high rotation frequencies. In the light of the above findings, it can be seen that the test-retest of the Vorteq system is not sufficiently reliable and hence cannot be used in clinical practice.
66. The radial forearm-lateral arm mega free flap
- Author
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Arnez@?, Z., Tyler, M., Giacomarra, V., and Planins@?ek, F.
- Abstract
We report the clinical use of the free radial forearm-lateral arm mega flap to cover a large degloving injury of the leg with a compound fracture of the fibula.
- Published
- 1995
- Full Text
- View/download PDF
67. Predictive Value of CD8 Expression and FoxP3 Methylation in Nasopharyngeal Carcinoma Patients Treated with Chemoradiotherapy in a Non-endemic Area
- Author
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Damiana Antonia Faè, Riccardo Dolcetti, Debora Martorelli, Luigi Barzan, Carlo Gobitti, E. Comaro, F. Navarria, C. Furlan, Giuseppe Fanetti, Sandro Sulfaro, Elena Muraro, Agostino Steffan, Giovanni Franchin, Chiara Pratesi, Stefania Zanussi, Emanuela Vaccher, Valentina Lupato, Jerry Polesel, Michela Cangemi, Vittorio Giacomarra, Vincenzo Canzonieri, C. Scaini, Giuseppe Grando, Elisabetta Fratta, Muraro, E., Vaccher, E., Furlan, C., Fratta, E., Fanetti, G., Fae', D. A., Martorelli, D., Cangemi, M., Polesel, J., Navarria, F., Gobitti, C., Comaro, E., Scaini, C., Pratesi, C., Zanussi, S., Lupato, V., Grando, G., Giacomarra, V., Sulfaro, S., Barzan, L., Dolcetti, R., Steffan, A., Canzonieri, V., and Franchin, G.
- Subjects
Male ,0301 basic medicine ,Oncology ,Epstein-Barr Virus Infections ,Cancer Research ,medicine.medical_treatment ,Radiation Tolerance ,0302 clinical medicine ,Tumor Microenvironment ,CD8 ,Chemoradiotherapy ,EBV-specific immunity ,FoxP3 ,Immunosuppression ,Nasopharyngeal carcinoma ,ELISPOT ,FOXP3 ,Forkhead Transcription Factors ,General Medicine ,Middle Aged ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Adult ,medicine.medical_specialty ,Adolescent ,CD8 Antigens ,T cell ,Pathology and Forensic Medicine ,Viral Proteins ,Young Adult ,03 medical and health sciences ,Immune system ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,business.industry ,Nasopharyngeal Neoplasms ,DNA Methylation ,medicine.disease ,030104 developmental biology ,Drug Resistance, Neoplasm ,business - Abstract
Undifferentiated Nasopharyngeal Carcinoma (UNPC) is associated with Epstein-Barr Virus (EBV) and characterized by an abundant immune infiltrate potentially influencing the prognosis. Thus, we retrospectively assessed the significance of immunosuppression in the UNPC microenvironment as prognostic biomarker of treatment failure in a non-endemic area, and monitored the variation of systemic EBV-specific immunity before and after chemoradiotherapy (CRT). DNA and RNA were extracted from diagnostic biopsies obtained by tumor and adjacent mucosa from 63 consecutive EBV+ UNPC patients who underwent radical CRT. Among these patients 11 relapsed within 2 years. The expression of the EBV-derived UNPC-specific BARF1 gene and several immune-related genes was monitored through quantitative RT-PCR and methylation-specific PCR analyses. Peripheral T cell responses against EBV and BARF1 were measured in 14 patients (7 relapses) through IFN-γ ELISPOT assay. We found significantly higher expression levels of BARF1, CD8, IFN-γ, IDO, PD-L1, and PD-1 in UNPC samples compared to healthy tissues. CD8 expression was significantly reduced in both tumor and healthy tissues in UNPC patients who relapsed within two years. We observed a hypomethylated FOXP3 intron 1 exclusively in relapsed UNPC patients. Finally, we noticed a significant decrease in EBV- and BARF1-specific T-cells after CRT only in relapsing patients. Our data suggest that a high level of immunosuppression (low CD8, hypomethylated FoxP3) in UNPC microenvironment may predict treatment failure and may allow an early identification of patients who could benefit from the addition of immune modulating strategies to improve first line CRT.
- Published
- 2020
68. Advanced lung cancer inflammation index and its prognostic value in HPV-negative head and neck squamous cell carcinoma: a multicentre study
- Author
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Marco Benazzo, Roberto Di Carlo, Andrea Ciorba, Anna Menegaldo, Daniele Marchioni, Paolo Bossi, Chiara Bianchini, Piergiorgio Gaudioso, Giancarlo Tirelli, Gabriele Molteni, Jerry Polesel, Vittorio Giacomarra, Stefano Pelucchi, Daniele Borsetto, Piero Nicolai, Margherita Tofanelli, Mantegh Sethi, Cristoforo Fabbris, Fiordaliso Cragnolini, Simone Mauramati, Jonathan Fussey, Paolo Boscolo-Rizzo, Boscolo-Rizzo, Paolo [0000-0002-4635-7959], Apollo - University of Cambridge Repository, Gaudioso, P., Borsetto, D., Tirelli, G., Tofanelli, M., Cragnolini, F., Menegaldo, A., Fabbris, C., Molteni, G., Marchioni, D., Nicolai, P., Bossi, P., Ciorba, A., Pelucchi, S., Bianchini, C., Mauramati, S., Benazzo, M., Giacomarra, V., Di Carlo, R., Sethi, M., Polesel, J., Fussey, J., and BOSCOLO RIZZO, Paolo
- Subjects
Oncology ,Male ,Inflammatory indexes ,medicine.medical_specialty ,Lung Neoplasms ,Survival ,medicine.medical_treatment ,Advanced lung cancer inflammation index ,Head and neck cancer ,Nutrition ,Inflammatory indexe ,Inflammation ,Head and neck cancer, Nutrition, Advanced lung cancer inflammation index, Inflammatory indexes, Survival ,NO ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,HPV Negative ,medicine ,Humans ,Lung cancer ,030304 developmental biology ,Aged ,Retrospective Studies ,0303 health sciences ,business.industry ,Squamous Cell Carcinoma of Head and Neck ,Retrospective cohort study ,Pneumonia ,Middle Aged ,medicine.disease ,Prognosis ,Head and neck squamous-cell carcinoma ,Progression-Free Survival ,Female ,030220 oncology & carcinogenesis ,Cohort ,Original Article ,medicine.symptom ,business ,Adjuvant - Abstract
Funder: Università degli Studi di Trieste, PURPOSE: The aim of this study is to evaluate the prognostic value of pre-treatment advanced lung cancer inflammation index (ALI) in patients with HPV-negative HNSCC undergoing up-front surgical treatment. METHODS: The present multi-centre, retrospective study was performed in a consecutive cohort of patients who underwent upfront surgery with or without adjuvant (chemo)-radiotherapy for head and neck squamous cell carcinoma (HNSCC). Patients were stratified by ALI, and survival outcomes were compared between groups. In addition, the prognostic value of ALI was compared with two other indices, the prognostic nutritional index (PNI) and systemic inflammatory index (SIM). RESULTS: Two hundred twenty-three patients met the inclusion criteria (151 male and 72 female). Overall and progression-free survival were significantly predicted by ALI < 20.4 (HR 3.23, CI 1.51-6.90 for PFS and HR 3.41, CI 1.47-7.91 for OS). Similarly, PNI < 40.5 (HR = 2.43, 95% CI: 1.31-4.51 for PFS and HR = 2.40, 95% CI: 1.19-4.82 for OS) and SIM > 2.5 (HR = 2.51, 95% CI: 1.23-5.10 for PFS and HR = 2.60, 95% CI: 1.19-5.67 for OS) were found to be significant predictors. Among the three indices, ALI < 20.4 identified the patients with the worst 5-year outcomes. Moreover, patients with a combination of low PNI and low ALI resulted to be a better predictor of progression (HR = 5.26, 95% CI: 2.01-13.73) and death (HR = 5.68, 95% CI: 1.92-16.79) than low ALI and low PNI considered alone. CONCLUSIONS: Our results support the use of pre-treatment ALI, an easily measurable inflammatory/nutritional index, in daily clinical practice to improve prognostic stratification in surgically treated HPV-negative HNSCC.
- Published
- 2021
69. CDKN1B mutation and copy number variation are associated with tumor aggressiveness in luminal breast cancer
- Author
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Giovanni Franchin, Martina Cusan, Luigi Barzan, Giorgio Giorda, Samuele Massarut, Maura Sonego, Andrea Vecchione, Alessandra Dall'Acqua, Francesca Russo, Lorena Musco, Monica Schiappacassi, Gustavo Baldassarre, Lorenzo Gerratana, Tiziana Perin, Vincenzo Canzonieri, Fabio Puglisi, Roberto Sorio, Francesca Citron, Filippo Vit, Giorgia Mungo, Sandro Sulfaro, Jerry Polesel, Emilio Lucia, Vittorio Giacomarra, Sara D'Andrea, Milena S. Nicoloso, Maria Chiara Mattevi, Davide Viotto, Ilaria Anania, Ilenia Segatto, Barbara Belletti, Gian Luca Rampioni Vinciguerra, Federica Toffolutti, Riccardo Bomben, V. Gattei, Viotto, D., Russo, F., Anania, I., Segatto, I., Rampioni Vinciguerra, G. L., Dall'Acqua, A., Bomben, R., Perin, T., Cusan, M., Schiappacassi, M., Gerratana, L., D'Andrea, S., Citron, F., Vit, F., Musco, L., Mattevi, M. C., Mungo, G., Nicoloso, M. S., Sonego, M., Massarut, S., Sorio, R., Barzan, L., Franchin, G., Giorda, G., Lucia, E., Sulfaro, S., Giacomarra, V., Polesel, J., Toffolutti, F., Canzonieri, V., Puglisi, F., Gattei, V., Vecchione, A., Belletti, B., and Baldassarre, G.
- Subjects
Male ,0301 basic medicine ,DNA Copy Number Variations ,CNV ,Breast Neoplasms ,Neuroendocrine tumors ,medicine.disease_cause ,head and neck squamous cell carcinoma ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,breast cancer ,Intestinal Neoplasms ,medicine ,Humans ,Copy-number variation ,CDKN1B ,copy number variation ,liquid biopsy ,mutation ,ovarian cancer ,p27 ,young breast cancer patients ,Original Paper ,Mutation ,copy number variation, CNV ,business.industry ,Prostatic Neoplasms ,medicine.disease ,Original Papers ,Head and neck squamous-cell carcinoma ,Squamous carcinoma ,Neuroendocrine Tumors ,030104 developmental biology ,030220 oncology & carcinogenesis ,MCF-7 Cells ,Cancer research ,Female ,business ,Ovarian cancer ,Cyclin-Dependent Kinase Inhibitor p27 ,CDK inhibitor - Abstract
The CDKN1B gene, encoding for the CDK inhibitor p27kip1, is mutated in defined human cancer subtypes, including breast, prostate carcinomas and small intestine neuroendocrine tumors. Lessons learned from small intestine neuroendocrine tumors suggest that CDKN1B mutations could be subclonal, raising the question of whether a deeper sequencing approach could lead to the identification of higher numbers of patients with mutations. Here, we addressed this question and analyzed human cancer biopsies from breast (n = 396), ovarian (n = 110) and head and neck squamous carcinoma (n = 202) patients, using an ultra‐deep sequencing approach. Notwithstanding this effort, the mutation rate of CDKN1B remained substantially aligned with values from the literature, showing that essentially only hormone receptor‐positive breast cancer displayed CDKN1B mutations in a relevant number of cases (3%). However, the analysis of copy number variation showed that another fraction of luminal breast cancer displayed loss (8%) or gain (6%) of the CDKN1B gene, further reinforcing the idea that the function of p27kip1 is important in this type of tumor. Intriguingly, an enrichment for CDKN1B alterations was found in samples from premenopausal luminal breast cancer patients (n = 227, 4%) and in circulating cell‐free DNA from metastatic luminal breast cancer patients (n = 59, 8.5%), suggesting that CDKN1B alterations could correlate with tumor aggressiveness and/or occur later during disease progression. Notably, many of the identified somatic mutations resulted in p27kip1 protein truncation, leading to loss of most of the protein or of its C‐terminal domain. Using a gene‐editing approach in a luminal breast cancer cell line, MCF‐7, we observed that the expression of p27kip1 truncating mutants that lose the C‐terminal domains failed to rescue most of the phenotypes induced by CDKN1B gene knockout, indicating that the functions retained by the C‐terminal portion are critical for its role as an oncosuppressor, at least in luminal breast cancer. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.
- Published
- 2020
70. Modified Particle Repositioning Procedure
- Author
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Elena D'Orlando, Oscar Zarcone, M. Russolo, Giancarlo Tirelli, Vittorio Giacomarra, Tirelli, GIAN CARLO, D'Orlando, E, Zarcone, O, Giacomarra, V, and Russolo, Mario
- Subjects
medicine.medical_specialty ,Benign paroxysmal positional vertigo ,Benign paroxysmal vertigo ,Labyrinth Diseases ,Posture ,cupulolithiasi ,canalithiasi ,Dizziness ,Calculi ,Repositioning (procedure) ,Nystagmus, Physiologic ,Vertigo ,canalithiasis ,Prone Position ,Supine Position ,Humans ,Medicine ,BPPV ,cupulolithiasis ,liberatory maneuver ,repositioning maneuver ,Longitudinal axis ,Chi-Square Distribution ,biology ,business.industry ,medicine.disease ,biology.organism_classification ,Semicircular Canals ,Head shaking ,Surgery ,Otorhinolaryngology ,Prospective trial ,Head Movements ,business ,Head - Abstract
Objectives To evaluate the efficacy of modifications to traditional particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo. Study Design Prospective trial of 118 patients with cupolocanalithiasis of the posterior canal treated with three different canal-repositioning techniques. Methods Results were compared with the maneuvers employed and the statistical importance of rotating patients by 360° along their longitudinal axis and head shaking on reaching each single position were evaluated. Results Treatment of patients with our maneuver, which, in comparison with traditional repositioning maneuvers, was modified by breaking the procedure up into seven positions and rotating patients by 360° along their longitudinal axis, gives a higher, but not statistically significant, number of treatment successes (84.5%) than the traditional Parnes maneuver (60%) (P = .154); treatment of a third group of patients with our modified particle repositioning maneuver with the addition of head-shaking on reaching each single position gives a higher (95.6%), statistically significant number of treatment successes than traditional Parnes maneuver (P = .00011). Conclusions The success rates achieved from modified particle repositioning maneuvers are statistically significant. Onset or persistence of dizziness, which patients frequently complain of after liberatory maneuvers, affects only 5.6% of the patients treated. This low incidence is statistically correlated to head-shaking.
- Published
- 2000
71. Predictive factors of nodal metastases in oral cavity and oropharynx carcinomas
- Author
-
Giancarlo Tirelli, Vittorio Giacomarra, Rossana Bussani, Ledia Papanikolla, Giacomarra, V, Tirelli, GIAN CARLO, Papanikolla, L, and Bussani, Rossana
- Subjects
medicine.medical_specialty ,genetic structures ,medicine.medical_treatment ,Oral cavity ,Metastasis ,medicine ,Carcinoma ,Humans ,Neoplasm Invasiveness ,metastases ,Grading (tumors) ,Lymph node ,oropharynx carcinomas ,business.industry ,Neck dissection ,Prognosis ,medicine.disease ,Occult ,eye diseases ,Surgery ,Oropharyngeal Neoplasms ,medicine.anatomical_structure ,Otorhinolaryngology ,metastase ,Lymphatic Metastasis ,Neck Dissection ,Mouth Neoplasms ,Radiology ,Complication ,business ,Neck - Abstract
OBJECTIVE: To estimate the value of tumor (T)-related parameters (singly or in association) in predicting the presence of occult metastases in oral cavity and oropharynx carcinomas. STUDY DESIGN: We considered tumor size (T size), Broders' grading of histologic differentiation (G), invasive cell grading (ICG), and thickness. For every single factor, we evaluated the correlation between the parameter and occult metastases in N0 neck disease, the correlation between the parameter and metastases independently from node (N) class, and the relation between the parameter and extracapsular spread. On the basis of previous results, we gave a score to each parameter that showed higher significativity the sum of which we called global score (GS). We compared the predictivity of metastasis of the GS to that of the single parameters to obtain a more efficacious index. METHODS: Sixty-one patients with carcinomas of the oral cavity and oropharynx who underwent surgery on T and N were examined. RESULTS: Our preliminary results have highlighted a significant correlation between G, ICG, and the presence of occult metastases. No correlation between T size and metastases was highlighted. The GS obtained from G and ICG turned out to be highly significant. A strong correlation was found between the ICG score and extracapsular spread: a high risk of extracapsular spread was found in patients with an ICG score > or =13. CONCLUSION: We perform elective neck dissection in T1-T2 N0 neck disease with ICG > or =13 and GS1 > or =9.
- Published
- 1999
72. Reconstruction of composite mandibular defects
- Author
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V. Giacomarra, Luigi Valdatta, M. Tyler, Z. M. Arnez, Arnez, ZORAN MARIJ, Giacomarra, V, Valdatta, L, and Tyler, M.
- Subjects
Orthodontics ,head and neck ,business.industry ,Composite number ,Medicine ,Surgery ,mandibular defect ,mandibular reconstruction ,free flaps ,business ,free flap - Published
- 1995
73. The radial forearm-lateral arm mega free flap
- Author
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M P Tyler, Z. M. Arnez, V Giacomarra, F Planinsek, Arnez, ZORAN MARIJ, Tyler, M, Giacomarra, V, and Planinek, Franci
- Subjects
Male ,medicine.medical_specialty ,free flaps ,lateral arm ,Forearm ,microsurgery ,medicine.medical_treatment ,Free flap ,Mega ,Surgical Flaps ,Fractures, Open ,Medicine ,Humans ,Fibula ,free flap ,Degloving ,Radial forearm ,business.industry ,Anatomy ,Microsurgery ,Middle Aged ,medicine.disease ,Surgery ,body regions ,medicine.anatomical_structure ,Otorhinolaryngology ,business ,Leg Injuries - Abstract
We report the clinical use of the free radial forearm-lateral arm mega flap to cover a large degloving injury of the leg with a compound fracture of the fibula.
- Published
- 1994
74. Gli artificieri, in AA. VV., Le forme del lavoro, introd. di A. Buttitta, red. e bibliograf. di M. Giacomarra, revis. di V. Petrarca, Palermo, Libreria Dante, 1990, pp. 298-308
- Author
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PETRARCA, VALERIO, M. Giacomarra, V. Petrarca, and Petrarca, Valerio
- Abstract
Si descrivono le tecniche tradizionali della preparazione dei fuochi artificiali in area siciliana e si sottolineano gli usi simbolici del fuoco in età moderna e contempiranea.
- Published
- 1990
75. Effectiveness of bismuth subgallate for preventing bleeding following adenotonsillectomy: A multicentre study.
- Author
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Trombetta A, Sanson I, Barbi E, Zamagni G, Fabbris C, Dall'Amico R, Orzan E, Giacomarra V, and Grasso DL
- Subjects
- Child, Humans, Retrospective Studies, Adenoidectomy adverse effects, Adenoidectomy methods, Postoperative Hemorrhage epidemiology, Postoperative Hemorrhage etiology, Postoperative Hemorrhage prevention & control, Tonsillectomy adverse effects, Tonsillectomy methods, Gallic Acid analogs & derivatives, Organometallic Compounds
- Abstract
Background: Tonsillectomy and adenotonsillectomy are surgical procedures routinely performed worldwide, with various complications, including postoperative bleeding (PTH). Among haemostatic agents, bismuth subgallate (BS) has been employed in the past decades, but its use is controversial in children., Objective: This retrospective, multicentre study aims to evaluate the effectiveness and safety of BS in preventing PTH following tonsillectomy and adenotonsillectomy., Materials and Methods: Two cohorts of children between 0 and 18 years of age were compared in two different hospitals. The first (active) group of patients included children who underwent tonsillectomy/adenotonsillectomy performed using BS added to gauze swabs, whereas this agent was not administered to the second (control) group. The following variables were analysed: age, gender, degree of tonsillar hyperplasia, length of hospital stay, acute complications (including bleeding and infection), further admissions to the Paediatric Emergency Department (PED), and further hospital admissions in the 30 days postoperatively., Results: Four-thousand- seven hundred forty-four children were included in the study, 2598 in the active group and 2146 in the control group. The cases included in the active treatment group displayed a significantly reduced PTH prevalence, 1.4 versus 2.6 % (p < 0.05). No cases of neurological complications or aspiration pneumonia were detected., Conclusions: This study supports BS as a safe and reliable option for preventing severe PTH following tonsillectomy/adenotonsillectomy., Competing Interests: Declaration of competing interest We declare that there are no prior publications or submission with any overlapping information, including studies and patients. We declare that the manuscript has not been and will not be submitted to any other journal while under consideration by American Journal of Otolaryngology--Head and Neck Medicine and Surgery. We declare that there is no competing interest in the submission we have made. We declare that none of the authors received any honorarium, grant, or other form of payment for this study. We declare that each author listed on the manuscript has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2024
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76. Blood Markers Predicting Clinically Occult Lymph Node Metastasis in Head and Neck Squamous Cell Carcinoma.
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Gaudioso P, Borsetto D, Polesel J, Tirelli G, Emanuelli E, Menegaldo A, Molteni G, Nicolai P, Tomasoni M, Montenegro C, Piazza C, Bossi P, Ciorba A, Canzi P, Giacomarra V, Giudici F, Fussey J, and Boscolo-Rizzo P
- Subjects
- Humans, Squamous Cell Carcinoma of Head and Neck pathology, Lymphatic Metastasis pathology, Retrospective Studies, Prognosis, Lymph Nodes pathology, Lymphocytes pathology, Head and Neck Neoplasms pathology
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Introduction: The presence of cervical lymph node metastases is an unfavorable prognostic factor in head and neck squamous cell carcinoma (HNSCC) and a potential cause of treatment failure. Occult lymph node metastasis occurs in approximately 15-20% of HNSCC patients with a clinically negative neck (cN0), greatly impacting on their prognosis. The present study aimed to investigate the role of pre-treatment peripheral blood markers in predicting clinically occult cervical lymph node metastasis., Methods: This multicenter, retrospective study was performed in a cohort of 472 patients diagnosed with cN0 HNSCC who underwent up-front surgery. Baseline neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic inflammatory marker (SIM), and systemic immune-inflammation index (SII) were calculated from available blood parameters., Results: Oro-hypopharyngeal and oral cancers, locally advanced stage, moderately (G2), and poorly (G3) differentiated grade were associated with an increased risk of pathological lymph node involvement. NLR, LMR, PLR, SIM, and SII were significantly associated at multivariable analysis. NLR >2.12 was the most reliable at predicting occult lymph node metastasis (OR = 5.22; 95% CI: 2.14-12.75). We describe a predictive score integrating cancer site, local stage, and NLR which is effective at predicting positive lymph node pathological status., Conclusions: The present study provides evidence that pre-treatment peripheral blood markers, in particular NLR, represent reliable predictors of clinically occult cervical lymph node metastasis in cN0 HNSCC. Therefore, the present study provides a novel useful predictive score for directing the elective management of the neck in patients with cN0 HNSCC., (© 2023 S. Karger AG, Basel.)
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- 2024
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77. The prognostic-nutritional index in HPV-negative head and neck squamous cell carcinoma treated with upfront surgery: a multi-institutional series.
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Tomasoni M, Piazza C, Deganello A, Bossi P, Tirelli G, Nicolai P, Da Mosto MC, Molteni G, Giacomarra V, Canzi P, Pelucchi S, Polesel J, Borsetto D, and Boscolo-Rizzo P
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- Humans, Squamous Cell Carcinoma of Head and Neck surgery, Nutrition Assessment, Prognosis, Retrospective Studies, Neoplasm Recurrence, Local, Papillomavirus Infections, Head and Neck Neoplasms surgery
- Abstract
Objectives: To evaluate the prognostic value of pre-treatment prognostic-nutritional index (PNI) in patients with HPV-negative head and neck squamous cell carcinoma (HNSCC)., Methods: A multi-institutional retrospective series of HPV-negative, Stages II-IVB, HNSCCs treated with upfront surgery was evaluated. Correlation of pre-operative blood markers and PNI with 5-year overall (OS) and relapse-free (RFS) survival was tested using linear and restricted cubic spline models, as appropriate. The independent prognostic effect of patient-related features was assessed with multivariable models., Results: The analysis was conducted on 542 patients. PNI ≥ 49.6 (HR = 0.52; 95% CI, 0.37-0.74) and Neutrophil-to-Lymphocyte Ratio (NLR) > 4.2 (HR = 1.58; 95% CI, 1.06-2.35) confirmed to be independent prognosticators of OS, whereas only PNI ≥ 49.6 (HR = 0.44; 95% CI, 0.29-0.66) was independently associated with RFS. Among pre-operative blood parameters, only higher values of albuninaemia and lymphocyte count (> 1.08 x 10
3 /microL), and undetectable basophile count (= 0 103 /microL) were independently associated with better OS and RFS., Conclusions: PNI represents a reliable prognostic tool providing an independent measure of pre-operative immuno-metabolic performance. Its validity is supported by the independent prognostic role of albuminaemia and lymphocyte count, from which it is derived., (Copyright © 2023 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)- Published
- 2023
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78. Rising Trend in the Prevalence of HPV-Driven Oropharyngeal Squamous Cell Carcinoma during 2000-2022 in Northeastern Italy: Implication for Using p16 INK4a as a Surrogate Marker for HPV-Driven Carcinogenesis.
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Boscolo-Rizzo P, Polesel J, Del Mistro A, Fratta E, Lazzarin C, Menegaldo A, Lupato V, Fanetti G, Zanconati F, Guido M, Giacomarra V, Emanuelli E, Tofanelli M, and Tirelli G
- Abstract
Background: The prevalence and incidence of oropharyngeal squamous cell carcinomas (OPSCCs) driven by human papillomavirus (HPV) infection are increasing worldwide, being higher in high-income countries. However, data from Italy are scanty. p16
INK4a overexpression is the standard in determining HPV-driven carcinogenesis, but disease prevalence impacts on its positive predictive value., Methods: This is a multicenter retrospective study enrolling 390 consecutive patients aged ≥18 years, diagnosed with pathologically confirmed OPSCC in Northeastern Italy between 2000 and 2022. High-risk HPV-DNA and p16INK4a status were retrieved from medical records or evaluated in formalin-fixed paraffin-embedded specimens. A tumor was defined as HPV-driven when double positive for high-risk HPV-DNA and p16INK4a overexpression., Results: Overall, 125 cases (32%) were HPV-driven, with a significant upward temporal trend from 12% in 2000-2006 to 50% in 2019-2022. The prevalence of HPV-driven cancer of the tonsil and base of the tongue increased up to 59%, whereas it remained below 10% in other subsites. Consequently, the p16INK4a positive predictive value was 89% for the former and 29% for the latter., Conclusions: The prevalence of HPV-driven OPSCC continued to increase, even in the most recent period. When using p16INK4a overexpression as a surrogate marker of transforming HPV infection, each institution should consider the subsite-specific prevalence rates of HPV-driven OPSCC as these significantly impact on its positive predictive value.- Published
- 2023
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79. LINE-1 hypomethylation is associated with poor outcomes in locoregionally advanced oropharyngeal cancer.
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Casarotto M, Lupato V, Giurato G, Guerrieri R, Sulfaro S, Salvati A, D'Angelo E, Furlan C, Menegaldo A, Baboci L, Montico B, Turturici I, Dolcetti R, Romeo S, Baggio V, Corrado S, Businello G, Guido M, Weisz A, Giacomarra V, Franchin G, Steffan A, Sigalotti L, Vaccher E, Boscolo-Rizzo P, Jerry P, Fanetti G, and Fratta E
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- Humans, Tumor Suppressor Protein p53 genetics, Tumor Suppressor Protein p53 metabolism, Long Interspersed Nucleotide Elements, DNA Methylation, Retrospective Studies, Neoplasm Recurrence, Local genetics, Squamous Cell Carcinoma of Head and Neck genetics, Prognosis, Papillomavirus Infections complications, Oropharyngeal Neoplasms, Carcinoma, Squamous Cell metabolism, Head and Neck Neoplasms genetics
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Background and Purpose: Currently, human papillomavirus (HPV) positivity represents a strong prognostic factor for both reduced risk of relapse and improved survival in patients with oropharyngeal squamous cell carcinoma (OPSCC). However, a subset of HPV-positive OPSCC patients still experience poor outcomes. Furthermore, HPV-negative OPSCC patients, who have an even higher risk of relapse, are still lacking suitable prognostic biomarkers for clinical outcome. Here, we evaluated the prognostic value of LINE-1 methylation level in OPSCC patients and further addressed the relationship between LINE-1 methylation status and p53 protein expression as well as genome-wide/gene-specific DNA methylation., Results: In this study, DNA was extracted from 163 formalin-fixed paraffin-embedded tissue samples retrospectively collected from stage III-IVB OPSCC patients managed with curative intent with up-front treatment. Quantitative methylation-specific PCR revealed that LINE-1 hypomethylation was directly associated with poor prognosis (5-year overall survival-OS: 28.1% for LINE-1 methylation < 35% vs. 69.1% for ≥ 55%; p < 0.0001). When LINE-1 methylation was dichotomized as < 55% versus ≥ 55%, interaction with HPV16 emerged: compared with hypermethylated HPV16-positive patients, subjects with hypomethylated HPV16-negative OPSCC reported an adjusted higher risk of death (HR 4.83, 95% CI 2.24-10.38) and progression (HR 4.54, 95% CI 2.18-9.48). Tumor protein p53 (TP53) gene is often mutated and overexpressed in HPV-negative OPSCC. Since p53 has been reported to repress LINE-1 promoter, we then analyzed the association between p53 protein expression and LINE-1 methylation levels. Following p53 immunohistochemistry, results indicated that among HPV16-negative patients with p53 ≥ 50%, LINE-1 methylation levels declined and remained stable at approximately 43%; any HPV16-positive patient reported p53 ≥ 50%. Finally, DNA methylation analysis demonstrated that genome-wide average methylation level at cytosine-phosphate-guanine sites was significantly lower in HPV16-negative OPSCC patients who relapsed within two years. The subsequent integrative analysis of gene expression and DNA methylation identified 20 up-regulated/hypomethylated genes in relapsed patients, and most of them contained LINE-1 elements in their promoter sequences., Conclusions: Evaluation of the methylation level of LINE-1 may help in identifying the subset of OPSCC patients with bad prognosis regardless of their HPV status. Aberrant LINE-1 hypomethylation might occur along with TP53 mutations and lead to altered gene expression in OPSCC., (© 2022. The Author(s).)
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- 2022
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80. Tissue and circulating PD-L2: moving from health and immune-mediated diseases to head and neck oncology.
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Muraro E, Romanò R, Fanetti G, Vaccher E, Turturici I, Lupato V, La Torre FB, Polesel J, Fratta E, Giacomarra V, Franchin G, Steffan A, Spina M, and Alfieri S
- Subjects
- B7-H1 Antigen metabolism, Humans, Prognosis, Squamous Cell Carcinoma of Head and Neck, Head and Neck Neoplasms diagnosis, Programmed Cell Death 1 Receptor
- Abstract
Amongst the chief targets of immune-checkpoint inhibitors (ICIs), namely the Programmed cell death protein 1 (PD-1)/PD-Ligands (Ls) axis, most research has focused on PD-L1, while to date PD-L2 is still under-investigated. However, emerging data support PD-L2 relevant expression in malignancies of the head and neck area, mostly in head and neck squamous cell carcinoma (HNSCC) and salivary gland cancers (SGCs). In this context, ICIs have achieved highly heterogeneous outcomes, emphasizing an urgent need for the identification of predictive biomarkers. With the present review, we aimed at describing PD-L2 biological significance by focusing on its tissue expression, its binding to PD-1 and RGMb receptors, and its impact on physiological and anti-cancer immune response. Specifically, we reported PD-L2 expression rates and significant clinical correlates among different head and neck cancer histotypes. Finally, we described the biology of soluble PD-L2 form and its potential application as a prognostic and/or predictive circulating biomarker., (Copyright © 2022 Elsevier B.V. All rights reserved.)
- Published
- 2022
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81. Multicentre study on resection margins in carcinoma of the oral cavity, oro-hypopharynx and larynx.
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Barzan L, Montomoli C, Di Carlo R, Bertinazzi M, Colangeli R, Martini A, Nicolai P, Gaio E, Artico R, Lupato V, Giacomarra V, Boscolo Nata F, Tirelli G, Lora L, Politi D, Spinato R, Menegaldo A, Boscolo Rizzo P, Da Mosto MC, Fiorino F, Herman I, Benazzo M, La Boria A, Grandi C, Fanetti G, Franchin G, Canzonieri V, Sulfaro S, Mazzoleni G, and Vaccher E
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- Humans, Hypopharynx pathology, Margins of Excision, Mouth, Neoplasm Recurrence, Local surgery, Prognosis, Prospective Studies, Retrospective Studies, Carcinoma, Squamous Cell surgery, Larynx pathology
- Abstract
Objective: The prognostic significance of the resection margins is still subject of conflicting opinions. The purpose of this paper is to report the results of a study on the margins in carcinoma of the oral cavity, oro-hypopharynx and larynx., Methods: A multicentre prospective study was carried out between 2015 and 2018 with the participation of 10 Italian reference hospitals. The primary objective was to evaluate local control in patients with well-defined clinical characteristics and comprehensive histopathological information., Results: During the study period, 455 patients were enrolled; the minimum follow-up was 2 years. Previous treatment, grading and fresh specimen examination were identified as risk factors for local control in multivariate analysis. On the basis of these results, it seems possible to delineate "risk profiles" for different oncological outcomes., Discussion: The prognostic significance of the margins is reduced, and other risk factors emerge, which require diversified treatment and follow-up., Conclusions: Multidisciplinary treatment with adjuvant therapy, if indicated, reduces the prognostic importance of margins. Collaboration with a pathologist is an additional favourable prognostic factor and quality indicator., An appendix with literature review is present in the online version., (Copyright © 2022 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)
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- 2022
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82. Different inflammatory blood markers correlate with specific outcomes in incident HPV-negative head and neck squamous cell carcinoma: a retrospective cohort study.
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Boscolo-Rizzo P, D'Alessandro A, Polesel J, Borsetto D, Tofanelli M, Deganello A, Tomasoni M, Nicolai P, Bossi P, Spinato G, Menegaldo A, Ciorba A, Pelucchi S, Bianchini C, Cazzador D, Ramaciotti G, Lupato V, Giacomarra V, Molteni G, Marchioni D, Fabbris C, Occhini A, Bertino G, Fussey J, and Tirelli G
- Subjects
- Aged, Biomarkers, Tumor blood, Female, Head and Neck Neoplasms mortality, Humans, Male, Middle Aged, Retrospective Studies, Risk Assessment methods, Squamous Cell Carcinoma of Head and Neck mortality, Blood Cell Count, Head and Neck Neoplasms blood, Health Status Indicators, Inflammation Mediators blood, Squamous Cell Carcinoma of Head and Neck blood
- Abstract
Background: Inflammatory blood markers have been associated with oncological outcomes in several cancers, but evidence for head and neck squamous cell carcinoma (HNSCC) is scanty. Therefore, this study aims at investigating the association between five different inflammatory blood markers and several oncological outcomes., Methods: This multi-centre retrospective analysis included 925 consecutive patients with primary HPV-negative HNSCC (median age: 68 years) diagnosed between April 2004 and June 2018, whose pre-treatment blood parameters were available. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), systemic inflammatory marker (SIM), and systemic immune-inflammation index (SII) were calculated; their associations with local, regional, and distant failure, disease-free survival (DFS), and overall survival (OS) was calculated., Results: The median follow-up was 53 months. All five indexes were significantly associated with OS; the highest accuracy in predicting patients' survival was found for SIM (10-year OS = 53.2% for SIM < 1.40 and 40.9% for SIM ≥ 2.46; c-index = 0.569) and LMR (10-year OS = 60.4% for LMR ≥ 3.76 and 40.5% for LMR < 2.92; c-index = 0.568). While LMR showed the strongest association with local failure (HR = 2.16; 95% CI:1.22-3.84), PLR showed the strongest association with regional (HR = 1.98; 95% CI:1.24-3.15) and distant failure (HR = 1.67; 95% CI:1.08-2.58)., Conclusion: Different inflammatory blood markers may be useful to identify patients at risk of local, regional, or distant recurrences who may benefit from treatment intensification or intensive surveillance programs., (© 2022. The Author(s).)
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- 2022
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83. Prognostic factors in salvage surgery for recurrent head and neck cancer: A systematic review and meta-analysis.
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Lupato V, Giacomarra V, Alfieri S, Fanetti G, and Polesel J
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- Humans, Middle Aged, Neoplasm Staging, Prognosis, Retrospective Studies, Salvage Therapy, Head and Neck Neoplasms surgery, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local surgery
- Abstract
Introduction: Although salvage surgery (SS) is considered the best curative choice in recurrent head and neck cancer, the identification of patients who can benefit the most from this treatment is challenging., Methods: We systematically reviewed the prognostic role of pre- and post-surgery factors in patients undergoing SS for recurrent head and neck cancer (oral cavity, oropharynx, hypopharynx, and larynx)., Results: Twenty-five studies met the inclusion criteria out of 1280 screened citations. Pre-surgery factors significantly associated with worse overall survival were age>60 years, advanced initial stage, early recurrence, and regional recurrence; no heterogeneity between study emerged. Among post- surgery factors, worse survival emerged for positive surgical margins, extracapsular extension and perineural invasion., Conclusion: The identification of pre-surgery factors associated with poor outcomes may help the selection of the best candidate to SS; alternative treatments should be considered for high-risk patients. Post-surgery predictors of worse prognosis may guide clinicians in tailoring patients' surveillance., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2022
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84. Prognostic Significance of PD-L1 Expression In Patients With Primary Oropharyngeal Squamous Cell Carcinoma: A Meta-Analysis.
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Polesel J, Menegaldo A, Tirelli G, Giacomarra V, Guerrieri R, Baboci L, Casarotto M, Lupato V, Fanetti G, Boscolo-Rizzo P, and Fratta E
- Abstract
Background: At present, the prognostic significance of programmed cell death receptor ligand 1 (PD-L1) expression in oropharyngeal squamous cell carcinoma (OPSCC) patients is still controversial. In this study, we aim to synthesize relevant studies that have assessed the prognostic value of PD-L1 in patients with primary OPSCC treated according to the current standard-of-care., Methods: A systematic search of Medline/PubMed, Cochrane, Embase, Web of Science, and Scopus was conducted to define the prognostic role of PD-L1 expression in OPSCC. All studies published before July 31, 2021 were screened. Summary hazard ratios (sHR) with 95% confidence intervals (CIs) were calculated using a random-effects model., Results: A total of 1522 OPSCC patients from 12 studies were included. PD-L1 expression in OPSCC tumor cells (TCs) was significantly associated with longer overall survival (sHR=0.63, 95% CI 0.50-0.79), and progression-free survival (sHR=0.62, 95% CI 0.49-0.79). A benefit in survival was also observed in PD-L1-positive OPSCC patients who underwent surgery (sHR=0.34, 95% CI 0.18-0.65). Finally, although PD-L1-positive expression was related to better outcomes both in HPV-negative and HPV-positive OPSCC, the difference reached the statistical significance only in the HPV-positive subgroup (sHR=0.37, 95% CI 0.19-0.73). No heterogeneity emerged between studies for all considered outcomes, with I
2 ranging from 0% for progression-free survival to 11% for overall survival., Conclusions: PD-L1 expression on TCs associated with improved survival in OPSCC. In particular, HPV-positive OPSCC most benefited from PD-L1 expression when compared to the PD-L1 negative counterpart. Thus, PD-L1 might represent a useful biomarker to stratify prognosis in OPSCC in addition to HPV status., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Polesel, Menegaldo, Tirelli, Giacomarra, Guerrieri, Baboci, Casarotto, Lupato, Fanetti, Boscolo-Rizzo and Fratta.)- Published
- 2021
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85. Corrigendum to "Cetuximab in locally advanced head and neck squamous cell carcinoma: Biological mechanisms involved in efficacy, toxicity and resistance" [Crit. Rev. Oncol./Hematol. 164 (2021) 1-11/103424].
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Muraro E, Fanetti G, Lupato V, Giacomarra V, Steffan A, Gobitti C, Vaccher E, and Franchin G
- Published
- 2021
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86. Continuous Intraoperative Nerve Monitoring in Thyroid Surgery: Can Amplitude Be a Standardized Parameter?
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Mazzone S, Esposito A, and Giacomarra V
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- Female, Follow-Up Studies, Humans, Intraoperative Neurophysiological Monitoring methods, Male, Middle Aged, Postoperative Complications etiology, Prognosis, Prospective Studies, Thyroid Diseases pathology, Vocal Cord Paralysis etiology, Intraoperative Neurophysiological Monitoring standards, Postoperative Complications prevention & control, Thyroid Diseases surgery, Thyroidectomy adverse effects, Vagus Nerve physiology, Vocal Cord Paralysis prevention & control
- Abstract
The objective of this study is to evaluate electromyographic waveforms related to vagus monitoring. We collected data from patients undergoing thyroidectomy with CIONM, regardless of vocal cord response amplitude initially measured. We divided data of 193 nerves into three groups, according to initial amplitude value: ≥500 µV (Group 1,110 pt.), between 100 and 500 µV (Group 2, 79 pt.), and <100 µV (Group 3, 4 pt.). ROC curve showed a high diagnostic accuracy of final amplitude absolute value in vocal cord paralysis detection in both groups (89 and 86%). An increase of vocal cord paralysis risk was associated with progressive amplitude reduction (Group 1: OR=1.05, CI=1.02-1.09, p=0.001; Group 2: OR=1.05, CI=1.02-1.08, p=0.002). Cut-off values for amplitude reduction with optimal sensitivity and specificity were -77% in Group 1 and -15% in Group 2. In Group 3 signals showed an amplitude <100 µV for all monitoring, with no loss of a recognizable signal and normal postoperative cordal functionality. The use of a strict amplitude signal cut-off value ≥500 µV could be too restrictive. Also, signal with baseline amplitude <500 µV may be considered equally adequate. Setting the alarm for a reduction of 77% in patients with initial amplitude ≥500 µV and of 15% for those <500 µV could make monitoring safe and an effective aid for surgeons. In conclusion, there are cases in which initial amplitude is lower than that considered as adequate by current literature but with well recognizable and stable EMG waveforms. How those cases should be approached and what should the surgeon's attitude be are a matter of discussion., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Mazzone, Esposito and Giacomarra.)
- Published
- 2021
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87. Advanced lung cancer inflammation index and its prognostic value in HPV-negative head and neck squamous cell carcinoma: a multicentre study.
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Gaudioso P, Borsetto D, Tirelli G, Tofanelli M, Cragnolini F, Menegaldo A, Fabbris C, Molteni G, Marchioni D, Nicolai P, Bossi P, Ciorba A, Pelucchi S, Bianchini C, Mauramati S, Benazzo M, Giacomarra V, Di Carlo R, Sethi M, Polesel J, Fussey J, and Boscolo-Rizzo P
- Subjects
- Aged, Female, Humans, Lung Neoplasms pathology, Male, Middle Aged, Pneumonia pathology, Prognosis, Progression-Free Survival, Retrospective Studies, Lung Neoplasms complications, Lung Neoplasms secondary, Pneumonia complications, Squamous Cell Carcinoma of Head and Neck complications
- Abstract
Purpose: The aim of this study is to evaluate the prognostic value of pre-treatment advanced lung cancer inflammation index (ALI) in patients with HPV-negative HNSCC undergoing up-front surgical treatment., Methods: The present multi-centre, retrospective study was performed in a consecutive cohort of patients who underwent upfront surgery with or without adjuvant (chemo)-radiotherapy for head and neck squamous cell carcinoma (HNSCC). Patients were stratified by ALI, and survival outcomes were compared between groups. In addition, the prognostic value of ALI was compared with two other indices, the prognostic nutritional index (PNI) and systemic inflammatory index (SIM)., Results: Two hundred twenty-three patients met the inclusion criteria (151 male and 72 female). Overall and progression-free survival were significantly predicted by ALI < 20.4 (HR 3.23, CI 1.51-6.90 for PFS and HR 3.41, CI 1.47-7.91 for OS). Similarly, PNI < 40.5 (HR = 2.43, 95% CI: 1.31-4.51 for PFS and HR = 2.40, 95% CI: 1.19-4.82 for OS) and SIM > 2.5 (HR = 2.51, 95% CI: 1.23-5.10 for PFS and HR = 2.60, 95% CI: 1.19-5.67 for OS) were found to be significant predictors. Among the three indices, ALI < 20.4 identified the patients with the worst 5-year outcomes. Moreover, patients with a combination of low PNI and low ALI resulted to be a better predictor of progression (HR = 5.26, 95% CI: 2.01-13.73) and death (HR = 5.68, 95% CI: 1.92-16.79) than low ALI and low PNI considered alone., Conclusions: Our results support the use of pre-treatment ALI, an easily measurable inflammatory/nutritional index, in daily clinical practice to improve prognostic stratification in surgically treated HPV-negative HNSCC.
- Published
- 2021
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88. Cetuximab in locally advanced head and neck squamous cell carcinoma: Biological mechanisms involved in efficacy, toxicity and resistance.
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Muraro E, Fanetti G, Lupato V, Giacomarra V, Steffan A, Gobitti C, Vaccher E, and Franchin G
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- Cetuximab therapeutic use, Cisplatin, Combined Modality Therapy, Humans, Squamous Cell Carcinoma of Head and Neck drug therapy, Tumor Microenvironment, Head and Neck Neoplasms drug therapy
- Abstract
Since its introduction, the use of cetuximab in the treatment of head and neck squamous cell carcinoma (HNSCC) has experienced an evolution. Currently, cetuximab associated with radiotherapy is limited to the treatment of patients affected by a locally advanced malignancy and unfit for cisplatin. However, reliable biomarkers of cetuximab efficacy in this cancer setting are still lacking. This review focuses on the mechanisms of action of cetuximab, highlighting, in particular, the consequences of the binding to EGFR, and the pathways involved in the development of adverse events or acquired resistance. Indeed, adverse events, such as skin rash, have been associated with cetuximab efficacy in HNSCC several times. Acquired resistance is associated with microenvironment plasticity, which is, in turn, characterized by an increased immune infiltrate. The better definition of patients eligible for this kind of therapy could improve HNSCC management, possibly proposing a combined treatment with radiotherapy, cetuximab and immune checkpoint inhibitors as recently investigated., (Copyright © 2021. Published by Elsevier B.V.)
- Published
- 2021
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89. miR-9 modulates and predicts the response to radiotherapy and EGFR inhibition in HNSCC.
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Citron F, Segatto I, Musco L, Pellarin I, Rampioni Vinciguerra GL, Franchin G, Fanetti G, Miccichè F, Giacomarra V, Lupato V, Favero A, Concina I, Srinivasan S, Avanzo M, Castiglioni I, Barzan L, Sulfaro S, Petrone G, Viale A, Draetta GF, Vecchione A, Belletti B, and Baldassarre G
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- Cell Line, Tumor, Cetuximab pharmacology, ErbB Receptors genetics, Humans, Squamous Cell Carcinoma of Head and Neck drug therapy, Squamous Cell Carcinoma of Head and Neck genetics, Squamous Cell Carcinoma of Head and Neck radiotherapy, Head and Neck Neoplasms drug therapy, Head and Neck Neoplasms genetics, Head and Neck Neoplasms radiotherapy, MicroRNAs genetics
- Abstract
Radiotherapy (RT) plus the anti-EGFR monoclonal antibody Cetuximab (CTX) is an effective combination therapy for a subset of head and neck squamous cell carcinoma (HNSCC) patients. However, predictive markers of efficacy are missing, resulting in many patients treated with disappointing results and unnecessary toxicities. Here, we report that activation of EGFR upregulates miR-9 expression, which sustains the aggressiveness of HNSCC cells and protects from RT-induced cell death. Mechanistically, by targeting KLF5, miR-9 regulates the expression of the transcription factor Sp1 that, in turn, stimulates tumor growth and confers resistance to RT+CTX in vitro and in vivo. Intriguingly, high miR-9 levels have no effect on the sensitivity of HNSCC cells to cisplatin. In primary HNSCC, miR-9 expression correlated with Sp1 mRNA levels and high miR-9 expression predicted poor prognosis in patients treated with RT+CTX. Overall, we have discovered a new signaling axis linking EGFR activation to Sp1 expression that dictates the response to combination treatments in HNSCC. We propose that miR-9 may represent a valuable biomarker to select which HNSCC patients might benefit from RT+CTX therapy., (© 2021 The Authors. Published under the terms of the CC BY 4.0 license.)
- Published
- 2021
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90. The risk of recurrence in surgically treated head and neck squamous cell carcinomas: a conditional probability approach.
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Borsetto D, Sethi M, Polesel J, Tomasoni M, Deganello A, Nicolai P, Bossi P, Fabbris C, Molteni G, Marchioni D, Tofanelli M, Cragnolini F, Tirelli G, Ciorba A, Pelucchi S, Corazzi V, Canzi P, Benazzo M, Lupato V, Giacomarra V, Cazzador D, Bandolin L, Menegaldo A, Spinato G, Obholzer R, Fussey J, and Boscolo-Rizzo P
- Subjects
- Humans, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local surgery, Probability, Retrospective Studies, Squamous Cell Carcinoma of Head and Neck surgery, Head and Neck Neoplasms surgery
- Abstract
Background: Over 50% of patients with head-and-neck squamous cell carcinoma (HNSCC) experience locoregional recurrence, which is associated with poor outcome. In the course of follow-up for patients surviving primary surgery for HNSCC, one might ask: What is the probability of recurrence in one year considering that the cancer has not yet recurred to date?, Materials and Methods: To answer this question, 979 patients surgically treated for HNSCC (i.e. cancer of the oral cavity, oropharynx, hypopharynx or larynx) between March 2004 and June 2018 were enrolled in a multicenter retrospective cohort study, followed up for death and recurrence over a 5 year period. The conditional probability of recurrence in 12 months - i.e. the probability of recurrence in the next 12 months given that, to date, the patient has not recurred - was derived from the cumulative incidence function (Aalen-Johansen method)., Results: Overall, the probability of recurrence was the highest during the first (17.3%) and the second years (9.6%) after surgery, declining thereafter to less than 5.0% a year thereafter. The probability of recurrence was significantly higher for stage III-IV HNSCCs than for stage I-II HNSCCs in the first year after surgery (20.4% versus 10.0%; p < 0.01), but not thereafter. This difference was most pronounced for oral cavity cancers. No significant differences were observed across different tumor sites., Conclusion: This dynamic evaluation of recurrence risk in patients surgically treated for HNSCC provides helpful and clinically meaningful information, which can be useful to patients in planning their future life, and to clinicians in tailoring post-treatment surveillance according to a more personalized risk stratification.
- Published
- 2021
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91. Prognostic value of H-index in patients surgically treated for squamous cell carcinoma of the larynx.
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Boscolo-Rizzo P, Zanelli E, Giudici F, Boscolo-Nata F, Cristalli G, Deganello A, Tomasoni M, Piazza C, Bossi P, Spinato G, Menegaldo A, Emanuelli E, Nicolai P, Bandolin L, Ciorba A, Pelucchi S, Lupato V, Giacomarra V, Molteni G, Marchioni D, Canzi P, Mauramati S, Fortunati A, Tofanelli M, Borsetto D, Fussey J, and Tirelli G
- Abstract
Objective: Recently, a novel host-related index, the Host-index (H-index), including both inflammatory and nutritional markers, has been described and observed to stratify prognosis in patients with squamous cell carcinoma (SCC) of the oral cavity more accurately than other host-related indexes This study aimed to investigate the prognostic performance of the H-index using pretreatment blood tests in patients receiving up-front surgery for SCC of the larynx., Methods: This retrospective observational study included a multicenter series of consecutive patients with SCC of the larynx diagnosed between 1 January 2009 and 31 July 2018, whose pretreatment blood tests were available and included the parameters necessary for the calculation of neutrophil to lymphocyte ratio (NLR) and the H-index. Their association with disease-free survival (DFS) and overall survival (OS) was measured., Results: A total of 231 patients were eligible for the present analysis (median [range] age, 68 [37-96] years; 191 [82.7%] men). The median follow-up was 73 months. In multivariable Cox proportional hazards regression models, increasing age (adjusted hazard ratio [aHR], 1.07 per year; 95% CI, 1.04-1.09), advanced pT stage (aHR = 1.71 95% CI: 1.07-2.71), and having close or positive surgical margins (aHR = 2.01; 95% CI: 1.21-3.33) were significantly associated with poor OS. Among blood parameters, a higher neutrophil count was a strong predictor of both worse DFS (aHR for recurrence/death = 2.34; 95% CI: 1.24-4.40) and OS (aHR for death = 2.67; 95% CI: 1.51-4.71). Among inflammatory blood indexes, while NLR was not significantly associated with DFS or OS, patients with H-index ≥8.37 showed a higher aHR for both recurrence/death (2.82; 95% CI: 1.65-4.79) and death (2.22; 95% CI: 1.26-3.89)., Conclusion: In conclusion, the present study confirms the prognostic value of pretreatment H-index, an easily measurable inflammatory and nutritional index, in patients with SCC of the larynx., Level of Evidence: III., Competing Interests: The authors declare that there is no potential conflict of interest., (© 2021 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC. on behalf of The Triological Society.)
- Published
- 2021
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92. Prognostic Nutritional Index Predicts Toxicity in Head and Neck Cancer Patients Treated with Definitive Radiotherapy in Association with Chemotherapy.
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Fanetti G, Polesel J, Fratta E, Muraro E, Lupato V, Alfieri S, Gobitti C, Minatel E, Matrone F, Caroli A, Revelant A, Lionello M, Zammattio Polentin V, Ferretti A, Guerrieri R, Chiovati P, Bertolin A, Giacomarra V, Paoli A, Vaccher E, Sartor G, Steffan A, and Franchin G
- Subjects
- Aged, Chemoradiotherapy methods, Disease-Free Survival, Dose Fractionation, Radiation, Female, Follow-Up Studies, Head and Neck Neoplasms mortality, Humans, Induction Chemotherapy adverse effects, Kaplan-Meier Estimate, Male, Middle Aged, Mucositis etiology, Predictive Value of Tests, Prognosis, Radiodermatitis etiology, Radiotherapy, Intensity-Modulated adverse effects, Radiotherapy, Intensity-Modulated methods, Retrospective Studies, Risk Assessment, Weight Loss drug effects, Weight Loss radiation effects, Chemoradiotherapy adverse effects, Head and Neck Neoplasms therapy, Mucositis epidemiology, Nutrition Assessment, Radiodermatitis epidemiology
- Abstract
Background: The Prognostic Nutritional Index (PNI) is a parameter of nutritional and inflammation status related to toxicity in cancer treatment. Since data for head and neck cancer are scanty, this study aims to investigate the association between PNI and acute and late toxicity for this malignancy., Methods: A retrospective cohort of 179 head and neck cancer patients treated with definitive radiotherapy with induction/concurrent chemotherapy was followed-up (median follow-up: 38 months) for toxicity and vital status between 2010 and 2017. PNI was calculated according to Onodera formula and low/high PNI levels were defined according to median value. Odds ratio (OR) for acute toxicity were calculated through logistic regression model; hazard ratios (HR) for late toxicity and survival were calculated through the Cox proportional hazards model., Results: median PNI was 50.0 (interquartile range: 45.5-53.5). Low PNI was associated with higher risk of weight loss > 10% during treatment (OR = 4.84, 95% CI: 1.73-13.53 for PNI < 50 versus PNI ≥ 50), which was in turn significantly associated with worse overall survival, and higher risk of late mucositis (HR = 1.84; 95% CI:1.09-3.12). PNI predicts acute weight loss >10% and late mucositis., Conclusions: PNI could help clinicians to identify patients undergoing radiotherapy who are at high risk of acute and late toxicity.
- Published
- 2021
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93. CDKN1B mutation and copy number variation are associated with tumor aggressiveness in luminal breast cancer.
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Viotto D, Russo F, Anania I, Segatto I, Rampioni Vinciguerra GL, Dall'Acqua A, Bomben R, Perin T, Cusan M, Schiappacassi M, Gerratana L, D'Andrea S, Citron F, Vit F, Musco L, Mattevi MC, Mungo G, Nicoloso MS, Sonego M, Massarut S, Sorio R, Barzan L, Franchin G, Giorda G, Lucia E, Sulfaro S, Giacomarra V, Polesel J, Toffolutti F, Canzonieri V, Puglisi F, Gattei V, Vecchione A, Belletti B, and Baldassarre G
- Subjects
- Breast Neoplasms pathology, Cyclin-Dependent Kinase Inhibitor p27 genetics, Female, Humans, Intestinal Neoplasms pathology, MCF-7 Cells, Male, Mutation, Neuroendocrine Tumors pathology, Prostatic Neoplasms pathology, Breast Neoplasms genetics, Cyclin-Dependent Kinase Inhibitor p27 metabolism, DNA Copy Number Variations, Intestinal Neoplasms genetics, Neuroendocrine Tumors genetics, Prostatic Neoplasms genetics
- Abstract
The CDKN1B gene, encoding for the CDK inhibitor p27
kip1 , is mutated in defined human cancer subtypes, including breast, prostate carcinomas and small intestine neuroendocrine tumors. Lessons learned from small intestine neuroendocrine tumors suggest that CDKN1B mutations could be subclonal, raising the question of whether a deeper sequencing approach could lead to the identification of higher numbers of patients with mutations. Here, we addressed this question and analyzed human cancer biopsies from breast (n = 396), ovarian (n = 110) and head and neck squamous carcinoma (n = 202) patients, using an ultra-deep sequencing approach. Notwithstanding this effort, the mutation rate of CDKN1B remained substantially aligned with values from the literature, showing that essentially only hormone receptor-positive breast cancer displayed CDKN1B mutations in a relevant number of cases (3%). However, the analysis of copy number variation showed that another fraction of luminal breast cancer displayed loss (8%) or gain (6%) of the CDKN1B gene, further reinforcing the idea that the function of p27kip1 is important in this type of tumor. Intriguingly, an enrichment for CDKN1B alterations was found in samples from premenopausal luminal breast cancer patients (n = 227, 4%) and in circulating cell-free DNA from metastatic luminal breast cancer patients (n = 59, 8.5%), suggesting that CDKN1B alterations could correlate with tumor aggressiveness and/or occur later during disease progression. Notably, many of the identified somatic mutations resulted in p27kip1 protein truncation, leading to loss of most of the protein or of its C-terminal domain. Using a gene-editing approach in a luminal breast cancer cell line, MCF-7, we observed that the expression of p27kip1 truncating mutants that lose the C-terminal domains failed to rescue most of the phenotypes induced by CDKN1B gene knockout, indicating that the functions retained by the C-terminal portion are critical for its role as an oncosuppressor, at least in luminal breast cancer. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland., (© 2020 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.)- Published
- 2021
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94. A pre-operative prognostic score for the selection of patients for salvage surgery after recurrent head and neck squamous cell carcinomas.
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Lupato V, Polesel J, La Torre FB, Fanetti G, Fratta E, Gobitti C, Baldassarre G, Vaccher E, Franchin G, and Giacomarra V
- Subjects
- Aged, Female, Head and Neck Neoplasms surgery, Humans, Male, Middle Aged, Neoplasm Recurrence, Local surgery, Prognosis, Quality of Life, Retrospective Studies, Squamous Cell Carcinoma of Head and Neck surgery, Survival Rate, Head and Neck Neoplasms pathology, Neoplasm Recurrence, Local pathology, Patient Selection, Preoperative Care, Salvage Therapy methods, Squamous Cell Carcinoma of Head and Neck pathology
- Abstract
Salvage surgery in recurrent head and neck squamous cell carcinoma has a poor outcome, both in terms of survival and quality of life. Therefore, the identification of pre-operative prognostic factors to improve the selection of patients who could benefit the most from salvage surgery is clinically relevant. The present study is a single-center retrospective analysis of 164 patients treated with salvage surgery after recurrence of head and neck cancer. Progression free survival and overall survival were calculated through Kaplan-Meier method. Hazard risk (HR) and corresponding confidence intervals (CI) were estimated through Cox proportional hazard model, adjusting for potential confounders. Significant predictors were combined into a prognostic score, attributing one point to each factor. Progression-free survival and overall survival were respectively 50.3% and 56.5% at 2 years, and 36.6% and 44.2% at 5 years. Four pre-operative factors were independently associated with poor prognosis: age > 70 years (HR = 2.18; 95% CI 1.27-3.73), initial stage IV (HR = 2.37; 95% CI 1.18-4.76), disease free interval < 12 months (HR = 1.72; 95% CI 1.01-2.94), and loco-regional recurrence (HR = 2.22; 95% CI 1.22-4.04). No post operative factor was associated with oncologic outcomes. Patients with 3-4 unfavorable factors showed a 5-year overall survival of 0.0% compared to 65.7% in those with 0-1 unfavorable factors (HR = 5.61; 95% CI 2.89-10.92). Despite the low number of patients, 3-4 unfavorable factors were associated to worse prognosis in all sub-sites. In conclusion, age > 70 years, initial stage IV, disease-free interval < 12 months, and loco-regional recurrence are strong independent pre-operative predictors of poor outcome in patients undergoing salvage surgery. Patients with two or more of these factors should be informed about the low success rate after salvage surgery and alternative treatments should be considered.
- Published
- 2021
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95. Prognostic significance of neutrophil-to-lymphocyte ratio in HPV status era for oropharyngeal cancer.
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Fanetti G, Alterio D, Marvaso G, Gandini S, Rojas DP, Gobitti C, Minatel E, Revelant A, Caroli A, Francia CM, Alessandro O, Pepa M, Gugliandolo SG, Starzyńska A, Polesel J, Vaccher E, Cossu Rocca M, Tagliabue M, Ansarin M, Lupato V, Giacomarra V, De Paoli A, Orecchia R, Franchin G, and Jereczek-Fossa BA
- Subjects
- Humans, Lymphocytes, Neutrophils, Prognosis, Retrospective Studies, Oropharyngeal Neoplasms therapy, Papillomavirus Infections complications
- Abstract
Aim: To evaluate the role of baseline neutrophil-to-lymphocyte ratio (NLR) as prognostic marker in squamous cell carcinoma of the oropharynx (OPC) treated with definitive chemoradiotherapy (CRT) in the era of HPV status., Patients and Methods: A retrospective analysis of 125 patients (pts) affected with locally advanced OPC was performed. Inclusion criteria were age >18 years, stage III or IV (TNM 7th ed.) and definitive CRT. Haematological marker for their independent role as prognostic biomarkers for progression-free survival (PFS) and overall survival (OS). Logistic models were used to assess the association with downstage in TNM 8th ed., Results: Seventy-seven (61.6%) pts had HPV/p16 + related OPC. Therapeutic choice consisted in sequential and concurrent CRT. Median follow-up was 50 months. A value of NLR ≥3 was associated with poorer OS. Two-year OS was 91% and 81% in pts with NLR <3 and ≥3, respectively., Conclusion: A baseline NLR ≥ 3 at treatment initiation represented a negative prognostic marker for OPC treated with definitive CRT. These results are in line with literature data, and prognostic value of NLR has been confirmed restaging our cohort with new TNM staging (8th ed.). Therefore, NLR could be considered a valuable biomarker for risk stratification in pts with OPC., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)
- Published
- 2020
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96. Direct health-care cost of head and neck cancers: a population-based study in north-eastern Italy.
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Polesel J, Lupato V, Collarile P, Vaccher E, Fanetti G, Giacomarra V, Palazzari E, Furlan C, Matrone F, Navarria F, Gobitti C, Minatel E, Serraino D, Birri S, and Franchin G
- Subjects
- Adolescent, Adult, Aged, Female, Head and Neck Neoplasms diagnosis, Humans, Italy, Male, Middle Aged, Retrospective Studies, Squamous Cell Carcinoma of Head and Neck diagnosis, Young Adult, Head and Neck Neoplasms economics, Head and Neck Neoplasms therapy, Health Care Costs, Squamous Cell Carcinoma of Head and Neck economics, Squamous Cell Carcinoma of Head and Neck therapy
- Abstract
Improvements in prognosis of head-and-neck squamous cell carcinoma (HNSCC) have paralleled with an increase in health-care costs, so that an economic evaluation is of growing importance. Presently, most of the evidence is from insurance-based studies in the USA. Between 2007 and 2010, 879 HNSCC patients were identified through the population-based cancer registry of the Friuli Venezia Giulia region, including 266 oral, 187 oropharyngeal, 136 hypopharyngeal, and 290 laryngeal cancers. Health-care costs from diagnosis to treatment initiation and in the following 2 years were retrieved through a record linkage with the regional health data warehouse. This database collected comprehensive health information on all resident citizens. Generalized linear models with a gamma distribution and log-link function were applied to model costs. The average health-care cost from diagnosis up to 2 years after treatment initiation was €20,184 (95% confidence interval: €19,634 - 20,733). Heterogeneity emerged according to cancer site, elective treatment, and retreatment for cancer persistence/recurrence (no: €13,896; yes: €24,599; p < 0.001). An advanced stage was associated with increased costs stage (I: €12,969; II: €18,276; III: €26,229; IV: €25,574; p < 0.001) as the result of treatment complexity and elevated frequency of patients retreatment due to recurrence. These findings further support strategies to diagnose patients at an earlier cancer stage and the accurate definition of diagnostic and treatment pathways, to start treating patients when radical unimodal approach is still feasible. Besides the advantage in prognosis due to timely curative treatments, this would reduce the economic burden of cancer treatment.
- Published
- 2019
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97. Unusual presentation of recurrent papillary thyroid microcarcinoma with neck muscles and skin dissemination [corrected].
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Sindoni A, Gobitti C, Sulfaro S, Giacomarra V, and Borsatti E
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- Carcinoma, Papillary diagnostic imaging, Humans, Male, Middle Aged, Muscle Neoplasms secondary, Neck diagnostic imaging, Neck Muscles diagnostic imaging, Neoplasm Metastasis, Skin diagnostic imaging, Skin Neoplasms secondary, Thyroid Neoplasms diagnostic imaging, Carcinoma, Papillary pathology, Muscle Neoplasms pathology, Neck pathology, Neck Muscles pathology, Skin pathology, Skin Neoplasms pathology, Thyroid Neoplasms pathology
- Published
- 2018
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98. Correction to: Unusual presentation of recurrent papillary thyroid microcarcinoma with neck muscles and skin dissemination.
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Sindoni A, Gobitti C, Sulfaro S, Giacomarra V, and Borsatti E
- Abstract
The original version of this article unfortunately contained a mistake. The title of this article was rendered incorrectly; the correct title is as follows: Unusual presentation of recurrent papillary thyroid microcarcinoma with neck muscles and skin dissemination.
- Published
- 2018
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99. Prognostic significance of LINE-1 hypomethylation in oropharyngeal squamous cell carcinoma.
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Furlan C, Polesel J, Barzan L, Franchin G, Sulfaro S, Romeo S, Colizzi F, Rizzo A, Baggio V, Giacomarra V, Dei Tos AP, Boscolo-Rizzo P, Vaccher E, Dolcetti R, Sigalotti L, and Fratta E
- Subjects
- Carcinoma, Squamous Cell pathology, Epigenesis, Genetic, Female, Humans, Logistic Models, Male, Mouth Neoplasms, Neoplasm Staging, Oropharyngeal Neoplasms pathology, Prognosis, Recurrence, Carcinoma, Squamous Cell genetics, DNA Methylation, Long Interspersed Nucleotide Elements, Oropharyngeal Neoplasms genetics
- Abstract
Background: Inclusion of new biomarkers to improve a personalized treatment approach for oropharyngeal squamous cell carcinoma (OPSCC) is urgently needed. Hypomethylation of the Long interspersed nucleotide element-1 (LINE-1) repetitive elements, a widely accepted surrogate of overall genomic DNA methylation content, was found to be associated with a poor prognosis in several cancers. At present, no studies have investigated the influence of LINE-1 methylation levels on OPSCC relapse. The main goal of this study was the evaluation of the prognostic value of LINE-1 methylation status in predicting early tumor relapse in locally advanced OPSCC., Methods: We retrospectively reviewed a cohort of 77 patients with stage III-IVB OPSCC. Methylation of LINE-1 repetitive sequences was evaluated by real-time quantitative methylation-specific PCR in formalin-fixed paraffin-embedded tissues. The prognostic relevance of LINE-1 methylation was assessed by comparing patients who relapsed within 2 years from the end of treatment (cases) with those who did not (controls). Results were validated in an independent cohort of 33 patients with OPSCC., Results: With respect to early OPSCC relapse, the mean LINE-1 methylation level was significantly lower in relapsed cases than in control group ( p < 0.01). Interestingly, LINE-1 methylation was lower in relapsed cases than in controls in both HPV16-negative and HPV16-positive OPSCC patients, even if statistical significance was reached only for the former group ( p = 0.01). LINE-1 methylation levels were also significantly reduced in relapsed cases with respect to the controls in OPSCC current smokers ( p = 0.02). Consistently, in HPV16-negative current smokers, OPSCC relapse was significantly associated with decreased levels of LINE-1 methylation ( p = 0.02). Using logistic regression model, we found that patients with hypomethylated LINE-1 were associated with a 3.5 higher risk of early relapse than hypermethylated ones (OR = 3.51; 95% CI 1.03-12.00). Adjustment for potential confounders did not substantially change the risk magnitude. Results from the validation cohort confirmed the lower LINE-1 methylation in patients who early relapsed compared to relapse-free patients., Conclusions: LINE-1 hypomethylation is associated with higher risk of early relapse in stage III-IVB OPSCC. Further validation in a prospective study is needed for its application in daily clinical practice.
- Published
- 2017
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100. The impact of time to treatment initiation on survival from head and neck cancer in north-eastern Italy.
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Polesel J, Furlan C, Birri S, Giacomarra V, Vaccher E, Grando G, Gobitti C, Navarria F, Schioppa O, Minatel E, Bidoli E, Barzan L, and Franchin G
- Subjects
- Adolescent, Adult, Aged, Carcinoma, Squamous Cell pathology, Female, Head and Neck Neoplasms pathology, Humans, Italy, Male, Middle Aged, Squamous Cell Carcinoma of Head and Neck, Survival Analysis, Young Adult, Carcinoma, Squamous Cell therapy, Head and Neck Neoplasms therapy
- Abstract
Objectives: To evaluate the impact of time to treatment initiation (TTI) on overall survival in patients with head-and-neck squamous cell carcinoma (HNSCC)., Materials and Methods: In the period 2003-2009, 1616 HNSCC patients were diagnosed in Friuli Venezia Giulia Region, Northeastern Italy, including 462 oral, 346 oropharyngeal, 212 hypopharyngeal, and 596 laryngeal cancers. Clinical information, including date and type of first treatment, and follow-up were retrieved from the regional Cancer Registry and a population-based health database collecting comprehensive health information on people living in the Region. Multivariate hazard ratio (HR) and confidence intervals (CI) were calculated through Cox model., Results: Overall, the median TTI was 28days, (Q1-Q3: 13-45days), but significant variations emerged according to anatomical site, cancer stage, treatment approach, and care transition to specialized centers. Five-year overall survival decreased with increasing treatment delay from 62% for TTI<30days to 39% for TTI≥90days (p<0.01). HR of death was 1.13 (95% CI: 0.92-1.39) for TTI between 45-89days, and 1.47 (1.05-2.05) for TTI≥90days. The association between TTI and poor prognosis was stronger for laryngeal cancers and early-stage HNSCCs. Further, care transition from community hospitals to specialized centers was associated to a better prognosis (HR=0.73; 95% CI: 0.60-0.88)., Conclusion: Our study findings suggest that HNSCC patients treated within 45days from diagnosis have increased survival probabilities and that early-stage patients suffered the most from treatment delay. Furthermore, care transition to specialized centers -though competitive to timely treatment- improves survival by providing the most innovative technologies and treatment approaches., (Copyright © 2017. Published by Elsevier Ltd.)
- Published
- 2017
- Full Text
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