Carcinoma, Squamous Cell ; secondary ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Mouth Neoplasms ; pathology ; Prognosis

Objective:To understand the clinical features of osteonecrosis of the jaw after bisphospho-nates use for therapy of breast cancer patients with bone metastasis.Methods:The cases diagnosed as bisphosphonates-related osteonecrosis of the jaws (BRONJ)were retrospectively analyzed from January 201 1 to August 201 5 in the Peking University School and Hospital of Stomatology,and those breast cancer patients with bone metastasis were selected.The clinical symptoms,imaging characteristics and treatment results were summarized.Results:A total of 1 4 cases of breast cancer patients with bone me-tastasis were selected,with an average age of 60.21 years.The average time of suffering from breast cancer was 9 .77 years,and the average time of bone metastasis and bisphosphonates drugs use was 5 .67 and 3 .29 years individually.There was no patient with systemic application history of hormone therapy, and no history of diabetes.There were 9 patients with tooth extractions history,and the mean time of bone necrosis symptoms was 8.58 months.There were 1 0 cases with bone necrosis occurring on mandi-ble,3 cases on maxilla,and one case with both upper and lower jaws involved.Among the 1 0 patients with surgical treatment,there were 3 cases cured,and 6 cases improved.However,the clinical symp-toms of 2 cases with conservative treatment were significantly aggravated.Conclusion:The medication time between the bisphosphonates use beginning and the occurrence of BRONJ is relatively long.The his-tory of diabetes and long-time hormone use did not exist in this group.Tooth extraction itself does not de-termine the severity of BRONJ.Mandible is the most common site involved by BRONJ.Surgical treatment can alleviate the clinical symptoms of BRONJ with breast cancer to some extent.

OBJECTIVETo investigate the cutoff value and significance of lymph node ratio (LNR) in oral squamous cell carcinoma.

METHODSThis retrospective study included 286 patients with oral cancer and pathological positive lymph nodes. Used time-dependent receiver operating characteristic (ROC) curves to determine which LNR best defines different risk groups of oral squamous cell carcinoma (OSCC) patients. All the variables were subjected to the univariate analysis, then only the variables that had prognostic potential were subjected to multivariate analysis by the COX proportional hazards regression model.

RESULTSThe cutoff value of LNR was 0.092. When LNR was greater than 0.092, the overall survival rate was 24.2%, when LNR was less than 0.092, the overall survival rate was 45.8% (P<0.05).

CONCLUSIONSLymph node ratio is a predictor of outcome in patients with oral squamous cell carcinoma, and the cutoff value is 0.092.

Analysis of Variance ; Carcinoma, Squamous Cell ; mortality ; pathology ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Mouth Neoplasms ; mortality ; pathology ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; ROC Curve ; Retrospective Studies ; Survival Rate

Objective To retrospectively analyze the data of the patients with Bisphosphonate-related osteonecrosis of the jaw over the past five years in our hospital.Methods Twenty-four patients with bisphosphonate-related osteonecrosis of the jaw treated in our hospital from 2009 to 2013 were included.The medication,bisphosphonate types,clinical signs and symptom,treatment methods and results were also analyzed.Results Of the 24 cases,20 cases suffered from malignant tumors and received intravenous infusion of bisphosphonates and 4 cases took oral bisphosphonates.Three of the 4 cases with osteoporosis had history of glucocorticoid (rheumatoid arthritis).All patients had oral clinical symptoms for an average of 11.6 months,and 19 patients had the history of tooth extraction.There were 11 cases with mandible involved,10 cases with maxilla involved,and 3 cases with both mandible and maxilla involved.After conservative treatment(3 cases) or operation(21 cases),10 cases had wound healing,6 cases were stable with bone exposure,and 4 cases with died bone needed reoperation.During the follow-up period,there was one patient died of primary disease(renal carcinoma).Conclusions Both intravenous and oral application routes of bisphosphonates can induce osteonecrosis of the jaw.Bisphosphonate-related osteonecrosis of the jaw can be caused by alveolar trauma.The treatment modality is to relieve the clinical symptoms of bisphosphonate-related osteonecrosis of the jaw.

Objective:To investigate and analyze the characteristics of M2 macrophage infiltration and the clinical significance in patients with multiple primary cancers (MPCs) of head and neck in order to explore its role in the diagnosis and prognosis for patients with MPCs.Methods:RNA-seq data were downloaded from the Genomic Data Commons data portal (TCGA) and the R software v4.0.3 was used to statistically analyze the differences. A retrospective analysis was conducted by screening the clinical data of 44 patients (17 males and 27 females) with MPCs in head and neck from July 1998 to February 2016 in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. Clinical data from a batch of 41 patients (28 males and 13 females) with gingival cancer and without MPCs from August 2013 to December 2015 were collected and analyzed. The number of CD163 positive cells and the expression patterns in immunohistochemically panoramic slices were observed under high magnification. Chi-square test and Spearman correlation analysis were used to compare the difference and correlation between the CD163 positive counts and/or depths of invasion and the number of incidences. The descriptive statistics on the clinical features was performed by SPSS 25.0.Results:TCGA database analysis showed that the infiltration of macrophage in patients with squamous cell carcinoma of head and neck (HNSCC) was increased compared to the para-cancer sites. A total of 142 tissue samples from 44 patients with MPCs were selected in the present single-center retrospective research. The number of CD163-positive cells in MPCs patients [90.9% (40/44)] was significantly increased compared to single gingival cancer patients [61.0%(25/41)] ( r=0.353, P=0.001), which was related to the number of occurrence ( r=0.368, P=0.001). The ratio of the CD163 counts in primary tumor to the depths of invasion was positively correlated with the number of onsets ( r=0.331, P=0.03). In terms of clinical features, the 44 patients with MPCs were mainly female, non-smoking, no alcohol addiction, no systemic history, Tis-T2 stage and N0 stage squamous cell carcinoma. The number of incidences ranged from two to eight. The incidence of cancer relative to synchronous cancer increased with the increased occurrence of MPCs. The primary cancer mainly occurred in tongue, gingiva and buccal sites, while the proportion of onset sites in gingiva, buccal and palate areas increased with the increased occurrence. Conclusions:M2 type macrophage counts and/or ratio to depth of infiltration were associated with the occurrence of MPCs, which could be used as a clinical indicator to distinguish single and MPCs in HNSCC. For early stage of HNSCC, patients with clinical characters of women, non-smoking, no alcohol addiction, no systemic medical history and sites of tongue, gingiva, and buccal should be paid more attention on their follow-up plan. The findings in the present study was also helpful to explore new treatment methods for the patients with MPCs.

Objective:To evaluate the preliminary clinical effect of flap-raising and cortical-perforation based extraction method in patients with potential risk of medication-related osteonecrosis of the jaw (MRONJ).Methods:Eighteen patients, who needed teeth extraction in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from February 2016 to November 2020, with a history of using anti-resorption/anti-angiogenesis medication were included in this retrospective study. According to the characteristics of the patient′s medication history, patients were stratified into three categories, low-dose anti-resorption drug group, high-dose anti-resorption drug group, and high-dose anti-resorption combined with anti-angiogenesis targeted drug group. There were 15 females and 3 males, the average age was 62.4 years (range from 27 to 87 years) old. A total of 31 teeth were indicated for extraction due to chronic infection. The flap-raising and cortical-perforation techniques were used to extract the affected teeth, and the patients were followed up closely. By observing the healing status and swelling degree of the mucosa of tooth extraction sites, whether there was a fistula, pus and bone exposure of jaw bone,the healing of the tooth extraction sites were evaluated.Results:Among the 18 patients, there were 9 cases of osteoporosis and 9 cases of malignant tumors. Classified by medication-using history, 10 cases were treated with low-dose anti-resorption drugs, 5 cases were high-dose anti-resorption drugs, and 3 cases were high-dose anti-resorption drugs combined with anti-angiogenesis drugs. A total of 31 teeth of the patients were extracted by flap-raising and cortical-perforation based extraction method. Thirteen patients completed treatment underwent local anesthesia and five cases were performed under general anesthesia. The shortest follow-up period was 3 months with an average of 13.2 months. Seventeen patients recovered well after the tooth extraction. One patient had the mandible exposed at one extraction site one month after the surgery, resulting in MRONJ.Conclusions:In patients with potential risks of MRONJ, the application of flap-raising and cortical-perforation based teeth extraction method could safely and effectively alleviate the dental inflammation in the oral cavity.