OBJECTIVE: To analyze the influence of type 2 diabetes mellitus (DM) on the prognosis of oral squamous cell carcinoma (OSCC) patients with surgical treatment. METHODS: The clinical data of 309 patients, who were diagnosed with OSCC and admitted to the same ward of Peking University Hospital of Stomatology from January 2014 to December 2017 were retrospectively reviewed, of whom, 104 were classified into DM group and 205 into non-DM group. The basic clinical data and follow-up results of the patients were analyzed and compared. Propensity score matching (PSM) was used to reduce confounding bias between the DM group and the non-DM group. Kaplan-Meier was used to calculate the survival rate of the two groups. Proportional hazards model was used to analyze the independent prognostic factors. The effect of glucose level on survival was analyzed. RESULTS: After PSM, 77 patients in each group were matched and the variables were balanced. There were statistically significant differences in postoperative oral dysplasia and local recurrence between the two groups (P < 0.05). There was no significant difference in survival analysis between the two groups, but the survival rate of the DM group had the tendency to be lower than that of the non-DM group after matching. Univariate analysis and multiva-riate analysis both revealed that the tumor stage was an independent factor influencing the overall survival rate and tumor-specific survival rate of the OSCC patients (P < 0.05), while diabetes had no significant influence on the survival of the OSCC patients (P>0.05). Multivariate analysis showed that tumor stage, triglyceride level, preoperative mean capillary fasting blood glucose, postoperative mean postprandial blood glucose were indepen-dent prognostic factors for overall survival in the DM group. Tumor stage and mean postoperative postprandial blood glucose were independent prognostic factors for tumor-specific survival in the DM group. The risk of postoperative complications and distant metastasis in the DM group with poor glycemic control was higher than that in the good glycemic controls. CONCLUSION There is no significant difference in overall survival and tumor-specific survival of the patients with or without DM. However, the possibility of mucosal dysplasia or local recurrence in the DM group is higher than that in the non-DM group. The tumor stage, triglyceride level and glycemic control of the patients with DM may affect their prognosis.
Humans ; Diabetes Mellitus, Type 2/complications* ; Mouth Neoplasms/mortality* ; Retrospective Studies ; Prognosis ; Carcinoma, Squamous Cell/mortality* ; Male ; Female ; Survival Rate ; Neoplasm Recurrence, Local ; Propensity Score ; Proportional Hazards Models ; Blood Glucose/analysis* ; Middle Aged ; Kaplan-Meier Estimate

BACKGROUND: Lung cancer is a leading cause of morbidity and mortality worldwide, and the incidence continues to rise. Although many prognostic factors have been identified, the clinical characteristics and outcomes in Korean lung cancer patients are not well defined. METHODS: Of the 23,254 new lung cancer cases registered at the Korea Central Cancer Registry in 2013, total 489 patients from 19 hospitals were abstracted by the Korean Central Cancer Registry. The clinical data retrospectively analyzed, patients were followed up until December 2015. RESULTS: The median age was 69 years (interquartile range, 60–74 years); 65.4% were male and 62.1% were ever-smokers. Cough was the most common initial symptom (33.5%); 13.1% of patients were asymptomatic. While squamous cell carcinoma was the most common subtype in male patients (37.2%), adenocarcinoma was the most frequent histological type in all patients (48.7%) and females (76.3%). The majority of patients received treatment (76.5%), which included surgery, radiation therapy, and chemotherapy. Older age (hazard ratio [HR], 1.037), lower body mass index (HR, 0.904), ever-smoker (HR, 2.003), small cell lung cancer (HR, 1.627), and distant metastasis (HR, 3.990) were independent predictors of mortality. Patients without symptoms (HR, 0.387) and without treatment (HR, 0.364) were associated with a favorable outcome in multivariate Cox analysis. CONCLUSION: Lung cancer in Korea occurs predominantly in elderly patients, with adenocarcinoma being the most frequent subtype. The prognosis was poorer in ever-smokers and older, malnourished, and untreated patients with advanced lung cancer.
Adenocarcinoma ; Aged ; Body Mass Index ; Carcinoma, Squamous Cell ; Cough ; Drug Therapy ; Epidemiology ; Female ; Humans ; Incidence ; Korea ; Lung Neoplasms ; Lung ; Male ; Mortality ; Neoplasm Metastasis ; Pilot Projects ; Prognosis ; Retrospective Studies ; Small Cell Lung Carcinoma

Although surgical resection is the mainstay of treatment for resectable esophageal cancer, it is associated with considerable morbidity and mortality. Endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection, has been considered as a feasible alternative to surgical resection for superficial esophageal squamous cell carcinoma based on its minimal invasiveness and favorable outcomes in suitable indications. The long-term outcomes of endoscopic resection are comparable to those of surgery when tumors are confined to the intraepithelial or lamina propria layer because these tumors have low or no risk of lymph node metastasis. The results of histopathological examination of the resected specimens should be interpreted thoroughly regarding the requirement of additional treatment. Treatment-related adverse events include bleeding, perforation, and stricture. Preventive measures should be taken during and after the procedure, particularly when the mucosal defects account for more than three-fourths of the circumference. In this review, the indications and outcomes of endoscopic treatment for esophageal squamous cell carcinoma are summarized.
Carcinoma, Squamous Cell ; Constriction, Pathologic ; Esophageal Neoplasms ; Hemorrhage ; Lymph Nodes ; Mortality ; Mucous Membrane ; Neoplasm Metastasis

Esophageal cancer is an aggressive malignant tumor with a poor prognosis because of its typically advanced stage at diagnosis and treatment-related morbidity and mortality. Of the two major subtypes, esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma, ESCC is prevalent in more than 90 percent of esophageal cancer patients in Korea. Both the incidence and mortality of esophageal cancer are declining, and the relative survival rate of patients with esophageal cancer has improved. These epidemiological changes are attributed to increase in the detection rate of esophageal cancer at localized and regional stages before distant spread of the disease. And the most well-known risk factors for esophageal adenocarcinoma are obesity and gastro-esophageal reflux disease. The carcinogenesis of ESCC is associated with chronic irritation caused by smoking, heavy alcohol use, drinking very hot beverages, and a low socioeconomic status. Understanding the risk factors for esophageal cancer can lead to the identification of preventative strategies to reduce the risk of developing esophageal cancer or to improve the long-term prognosis.
Adenocarcinoma ; Beverages ; Carcinogenesis ; Carcinoma, Squamous Cell ; Diagnosis ; Drinking ; Epidemiology ; Esophageal Neoplasms ; Gastroesophageal Reflux ; Humans ; Incidence ; Korea ; Mortality ; Obesity ; Prognosis ; Risk Factors ; Smoke ; Smoking ; Social Class ; Survival Rate

Esophageal cancer incidence rate per 100,000 is 4.7 in 2013, which accounts for 1.1% of the total cancer incidence in Korea. Superficial esophageal squamous cell carcinoma is frequently detected in persons undergoing upper endoscopy for gastrointestinal symptoms or for gastric cancer screening. Esophagectomy with lymph node dissection is the standard treatment for esophageal cancer. However, given the considerable morbidity and mortality of esophagectomy, endoscopic resection has become the standard of care for most cases of superficial esophageal squamous cell carcinoma without metastasis. In addition, endoscopic submucosal dissection has increased the cure rate, even when the tumor is large, compared to endoscopic mucosal resection. Thus, endoscopic submucosal dissection is the treatment of choice for superficial esophageal squamous cell carcinoma with a negligible risk of lymph node metastasis. Endoscopic resection is usually associated with a low risk of morbidity and no mortality, and has also shown favorable long-term outcomes. However, the long-term risk of metastasis remains after endoscopic resection, which varies according to the characteristics of tumor. This review describes the indication and outcomes of endoscopic resection, complications of endoscopic resection, and management after treatment.
Carcinoma, Squamous Cell ; Endoscopy ; Esophageal Neoplasms* ; Esophagectomy ; Humans ; Incidence ; Korea ; Lymph Node Excision ; Lymph Nodes ; Mass Screening ; Mortality ; Neoplasm Metastasis ; Standard of Care ; Stomach Neoplasms

BACKGROUND: Surgery was not standard-of-care of patients with advanced lung cancer. However, a serial of retrospective studies demonstrated that thoracic dissemination (M1a) patients could benefit from contraindicated surgery. After non-standard treatment, how should these patients choose following treatment approaches? Herein, we conducted this retrospective study to explore subsequent optimal treatment approaches. METHODS: Different therapeutic approaches were evaluated by comparing progression-free survival (PFS), overall survival (OS), time to treatment interval (TTI) using the Kaplan-Meier method and Log-rank test. A Cox proportional hazards regression model was used for multivariate analysis. RESULTS: 141 eligible were enrolled. The median PFS of chemotherapy group, targeted therapy group and observation group were 14.7, 41.0 and 31.0 months, respectively (95%CI: 19.01-26.01; P<0.001). There was no significantly statistically difference between median PFS of targeted group and observation group (P=0.006). The median OS were 39.0, 42.6 and 38.1 months (95%CI: 32.47-45.33; P=0.478). The median PFS and OS of TTI<3 months and TTI ≥3 months were 15.2 months versus 31.0 months (95%CI: 19.01-26.06; P<0.001) and 41.7 months versus 38.7 months (95%CI: 32.47-45.33; P=0.714). Multivariate analyses revealed gender (P=0.027), lymph node status (P=0.036) and initial therapy (P<0.001) were independent prognostic factors for PFS. CONCLUSIONS Observation did not shorten survival of thoracic dissemination patients with lung adenocarcinoma or squamous carcinoma, therefore, it could be an favorable option. But prospective randomized controlled study was needed to confirm its validity.
Adenocarcinoma ; drug therapy ; mortality ; pathology ; surgery ; Adenocarcinoma of Lung ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Squamous Cell ; drug therapy ; mortality ; pathology ; surgery ; Disease-Free Survival ; Female ; Humans ; Lung Neoplasms ; drug therapy ; mortality ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Young Adult

Esophageal squamous cell carcinoma (ESCC) is a deadly malignancy with regard to mortality and prognosis, and the 5-year survival rate for all patients diagnosed with ESCC remains poor. A better understanding of the biological mechanisms of ESCC tumorigenesis and progression is of great importance to improve treatment of this disease. In this study, we demonstrated that the glutathione metabolism pathway is highly enriched in ESCC cells compared with normal esophageal epithelial cells in an in vivo mouse model. In addition, treatment with L-buthionine-sulfoximine (BSO) to deplete glutathione decreased the ESCC tumor burden in mice, thus demonstrating the critical role of glutathione metabolism in ESCC progression. BSO treatment also led to decreased cell proliferation and activation of cell apoptosis in ESCC. Finally, BSO treatment blocked NF-κB pathway activation in ESCC. Our study reveals a new pathway that regulates ESCC progression and suggests that inhibition of glutathione metabolism may be a potential strategy for ESCC treatment.
Animals ; Apoptosis ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cell Proliferation ; Epithelial Cells ; Esophageal Neoplasms* ; Glutathione* ; Humans ; Metabolism* ; Mice ; Mortality ; Prognosis ; Survival Rate ; Tumor Burden

BACKGROUND: Skin cancer is the most common type of cancer. Of the 4 million skin lesions excised annually worldwide, approximately 2 million are considered cancerous. In this study, we aimed to describe a regional experience with skin cancers treated by a single senior surgeon and to provide a treatment algorithm. METHODS: The medical records of 176 patients with head and neck non-melanocytic skin cancer (NMSC) who were treated by a single surgeon at our institution between January 2010 and May 2016 were retrospectively reviewed, and their data (age, sex, pathological type, tumor location/size, treatment modality) were analyzed. Patients with cutaneous squamous cell carcinoma (cSCC) who were classified as a high-risk group for nodal metastasis underwent sentinel node mapping according to the National Comprehensive Cancer Network guidelines. RESULTS: Among the patients with NMSC who were treated during this period, basal cell carcinoma (BCC; n=102, 57.9%) was the most common pathological type, followed by cSCC (n=66, 37.5%). Most lesions were treated by complete excision, with tumor-free surgical margins determined via frozen section pathology. Thirty-one patients with high-metastasis-risk cSCC underwent sentinel node mapping, and 17 (54.8%) exhibited radiologically positive sentinel nodes. Although these nodes were pathologically negative for metastasis, 2 patients (6.5%) later developed lymph node metastases. CONCLUSION: In our experience, BCC treatment should comprise wide excision with tumor-free surgical margins and proper reconstruction. In contrast, patients with cSCC should undergo lymphoscintigraphy, as nodal metastases are a possibility. Proper diagnosis and treatment could reduce the undesirably high morbidity and mortality rates.
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Frozen Sections ; Head* ; Humans ; Lymph Nodes ; Lymphoscintigraphy ; Medical Records ; Mortality ; Neck* ; Neoplasm Metastasis ; Pathology ; Retrospective Studies ; Skin Neoplasms* ; Skin*

OBJECTIVES: The author analyse the impact of extracapsular lymph node spread and bone engagement in the ipsilateral neck of patients suffering squamous cell carcinoma (SCC) of the lower lip. METHODS: The data of 56 neck dissections performed in patients suffering SCC of the lower lip between January 2000 and December 2008 were retrospectively analysed. Statistical analysis was performed with the Kaplan-Meier life table method, and the survival rate was investigated with the log rank statistic and significance test. The values were considered statistically significant at p<0.05. RESULTS: Nine patients took advantage from simultaneous treatment of tumor and prophylactic neck dissection (level I-III), reaching 100% survival rate. Patients suffering metastasized disease, who received radical neck dissection at the time of tumor treatment, presented 83.3% survival rate. Patients who underwent previous surgery and radiotherapy presented worse prognosis although radical neck dissection in case of extra-capsular spread only (24.7%) and osseous engagement (22.2%). CONCLUSION: Prophylactic neck dissection (level I–III) is recommended in T3–T4 N0 SCC. Simultaneous treatment of tumor and cervical lymph nodes provides a better prognosis as respect to delayed nodal management. Extra-capsular spread with or without bone engagement represents independent risk factor responsible for high mortality rate of SCC of the lower lip.
Carcinoma, Squamous Cell* ; Epithelial Cells* ; Humans ; Life Tables ; Lip* ; Lymph Nodes ; Mortality ; Neck ; Neck Dissection ; Prognosis ; Radiotherapy ; Retrospective Studies ; Risk Factors ; Survival Rate*

PURPOSE: The current study was undertaken to examine the trends in the lung cancer incidence, mortality, and survival after a diagnosis in Korea. MATERIALS AND METHODS: Lung cancer incidence data according to the histologic type and mortality data were obtained from the Korea Central Cancer Registry and the Statistics Korea, respectively. The age-standardized incidence and mortality rates were calculated, and the Joinpoint model and age-period-cohort analyses were used to describe the trends in the rates. The 5-year relative survival rates of lung cancer were also calculated. RESULTS: Although the number of new lung cancer cases increased between 1999 and 2012, the age-standardized incidence rate decreased by 0.9% per year in men, whereas the incidence in women increased by 1.7% per year over the same time. Until 2010, the most common histologic type in men was squamous cell carcinoma, then adenocarcinoma prevailed thereafter. Since 1999, the most frequent histological type in women was adenocarcinoma. The lung cancer mortality started to decrease in 2002, with a more apparent decline for the younger age groups in both men and women. Overall, the 5-year relative survival rates have improved significantly from 11.2% for men and 14.7% for women among patients diagnosed between 1993 and 1997 to 19.3% for men and 28.2% for women among patients diagnosed between 2008 and 2012, respectively. An improvement in survival rate was observed for all major histology groups. CONCLUSION: The epidemiology of lung cancer in Korea has changed over a short time span, with decreasing mortality and improving survival rates. Further study is warranted to determine the cause of these changes.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Diagnosis ; Epidemiology* ; Female ; Humans ; Incidence ; Korea* ; Lung Neoplasms* ; Lung* ; Male ; Mortality ; Survival Rate