担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES/HYPOTHESIS: To assess the ability of near-infrared fluorescence imaging (NIFI) to identify parathyroid glands (PGs) among histologically proven PG/non-PG specimens compared with a surgeon's visual acumen, and to determine NIFI sensitivity in detecting incidentally resected PGs from thyroidectomy specimens, compared to the surgeon's visual inspection. STUDY DESIGN: Prospective study. METHODS: With mean age of 61 years, 36 patients with various thyroid diseases were enrolled. Possible PGs (n = 28) and lymph nodes (n = 32) were identified by the experienced surgeon's visual inspection. Using NIFI, 15 PGs were further identified from thyroidectomy specimens. For these 75 specimens, the surgeon's judgments (PG vs. non-PG) were recorded. Histological evaluation was performed after examining the NIFI auto-fluorescence of each specimen. RESULTS: There were no significant differences in sensitivity, specificity, positive predictive value, and negative predictive value between the surgeon's visual inspection and NIFI in identifying PGs, with values of 100%/97.1%, 85.0%/87.5%, 85.4%/87.2%, and 100%/97.2%, respectively. The sensitivity of NIFI (82.9%) for detection of PGs from thyroidectomy specimens was significantly higher than that of the surgeon's visual inspection (61.0%). False negative specimens contained bleeding/congestion and/or encapsulation by thick tissues, whereas false positive specimens contained electrocoagulated tissues. CONCLUSIONS: NIFI showed results comparable to the experienced surgeon's visual inspection in identifying PGs. This could benefit novice surgeons. NIFI may be useful for experienced surgeons to locate incidentally resected PGs within thyroidectomy specimens for auto-transplantation. Prevention of intra-gland bleeding and congestion, careful removal of thick capsules, and bloodless surgeries without electrocoagulation are important for reducing false positive and false negative results. Laryngoscope, 131:1188-1193, 2021.

DOI： 10.1002/lary.29163

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(NPO)日本頭頸部外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

末梢挿入型中心静脈カテーテル(peripherally inserted central catheter、PICC)は安全性が高く頭頸部癌の薬物療法でも用いられるが、留置側の左右差に着目した報告は少ない。PICC留置後の先端位置移動と合併症発生率の左右差について検討した。PICC留置を行った頭頸部癌145例172件を対象とし後方視的な調査を行った。留置側は右36件、左136件で、留置期間中央値は65日であった。121例137件でX線による留置時・留置後の先端位置評価が可能であった。先端位置をZone A:上大静脈下半分と右心房上部、Zone B:上大静脈上半分と左腕頭静脈合流部、Zone C:左腕頭静脈に分類し、Zone A・Bを適正位置とした。右側では留置時33件(100%)、留置後30件(91%)が適正位置であったのに対し、左側では留置時97件(93%)、留置後82件(79%)が適正位置で、留置時と留置後では有意な変化を認めた(p=0.001)。そのほかの合併症発生率に左右差は認めなかった。左側からのPICC留置では上大静脈右側壁にカテーテル先端が当たり、Zone Aへの留置率が低い。さらに留置後の体位・肢位の変化により先端が移動し、適正位置であるZone A・Bに留まりにくい。不適正な先端位置は遅発性の上大静脈壁損傷や血栓症を招くため、右側からのPICC留置が望ましいと考えられた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01099&link_issn=&doc_id=20210226330006&doc_link_id=10.3950%2Fjibiinkoka.124.122&url=https%3A%2F%2Fdoi.org%2F10.3950%2Fjibiinkoka.124.122&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: We aimed to compare the outcomes and safety of chemoradiotherapy (CRT) between elderly and non-elderly patients with head and neck squamous cell carcinoma (HNSCC). It is difficult to assess the causal effect of age because of possible differences in general conditions among individuals. Therefore, we adjusted the background factors of elderly and non-elderly patients using propensity score matching (PSM). Methods: A total of 146 patients with HNSCC who received CRT were divided into an elderly (≥70 years, n = 35) and non-elderly group (<70 years, n = 111). Pre-treatment characteristics, including the performance status, Charlson comorbidity index, body mass index, primary site, and TNM stage were adjusted by PSM. We compared the outcomes and safety of CRT with high-dose single-agent cisplatin (CDDP) as well as outcomes following recurrence between the groups, before and after PSM. Results: The total dose of CDDP administered during CRT was significantly lower in the elderly group before PSM. However, it became comparable to the non-elderly group and adverse events did not differ between the groups following PSM, resulting in a comparable CRT completion rate. Overall-, disease specific-, and progression-free survivals of elderly patients were comparable to those of non-elderly patients following PSM. In contrast, elderly patients with recurrence could receive fewer salvage treatments than their non-elderly counterparts, resulting in worse survival. Conclusions: CRT with high-dose CDDP is safe and effective for the treatment of elderly patients with HNSCC. However, salvage treatments can be rarely conducted for elderly patients with a recurrence, considering a deterioration of their general condition.

DOI： 10.3389/fsurg.2021.753049

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined the role of lateral temporal bone resection (LTBR) in the treatment of external ear canal (EAC) carcinoma between 2007 and 2018. The estimated 3-year disease-free survival (DFS) and disease-specific survival (DSS) according to the tumor stage and treatments were investigated in 36 patients with EAC squamous cell carcinoma. T stage classification according to the University of Pittsburgh staging system was as follows: 14 patients in T1, four patients in T2, nine patients in T3, and nine patients in T4. The 3-year DFS rate was 77.4% for T1 tumors, 100% for T2, 44.4% for T3 tumors, and 11.1% for T4 tumors (p < 001). The 3-year DSS rate was 100% for T1/T2 tumors, 87.5% for T3 tumors, and 11.1% for T4 tumors (p < 0.01). T1/T2 patients received mostly LTBR. Among nine T3 tumors, five patients (56%) received LTBR combined with preoperative chemotherapy and/or postoperative radiation (RT). Four of them had negative surgical margin and survived with no evidence of disease. The DFS of T3 patients who underwent concurrent chemoradiotherapy and LTBR was 0 and 80%, respectively (p = 0.048). For T1/T2 tumors, surgery achieved an excellent outcome. For T3 tumors, LTBR achieved negative surgical margin and showed good survival when combined with preoperative chemotherapy and/or postoperative RT. In contrast, the prognosis of T3 patients who could not undergo surgery was as poor as that of T4 patients. Therefore, in addition to subtotal temporal bone resection, LTBR-based treatment strategy may be a treatment option for limited cases of T3 patients.

DOI： 10.3389/fsurg.2021.708245

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Early detection of head and neck carcinoma (HNC) as superficial HNC (SHNC) identified using recently developed optical techniques, such as magnifying endoscopy and narrow-band imaging (NBI), in combination with endoscopic surgeries enables minimally invasive treatment with favorable outcomes for HNC. This study aimed to identify the predictive factors for the rare but important clinical issue of SHNC, namely cervical lymph node metastasis (CLNM), following endoscopic resection. METHODS: Sixty-nine patients with SHNC who underwent endoscopic resection were enrolled in the study. Clinical data, preoperative endoscopic findings, pathological findings, and treatment outcomes were retrospectively reviewed. Because the pharyngeal mucosa lacks the muscularis mucosa, we measured tumor thickness in permanent pathology as an alternative to the depth of invasion. Correlations with the occurrence of CLNM were statistically examined. RESULTS: The 5-year disease-specific survival rate was 100%. Of 69 patients, 3 (4.3%) developed CLNM. All had subepithelial but not epithelial tumors. The 0-IIa type in the macroscopic findings, type B2/B3 vessels in narrow-band imaging, tumors ≥ pathological stage T2, lymphatic invasion, positive surgical margins, and tumor thickness >1,000 μm showed significant correlations with CLNM following endoscopic resection. Furthermore, the classification of type B vessels was significantly associated with tumor thickness. CONCLUSION: The treatment outcomes following endoscopic resection for SHNC were favorable. The risk of CLNM following endoscopic resection in SHNC can be predicted by several preoperative endoscopic and postoperative pathological findings. Among them, the classification of type B vessels, which correlated with both tumor thickness and CLNM, might be a useful predictive factor.

DOI： 10.3389/fsurg.2021.813260

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: It was reported that treatment outcomes of the salvage chemotherapy (SCT) following nivolumab are fairly good compared with those of nivolumab itself. However, predictive factors of SCT for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) were not determined. METHODS: Twenty-one R/M HNSCC patients received SCT following nivolumab. The treatment outcome and predictive factors for the favorable response to SCT were investigated. RESULTS: The objective response rate (ORR) and the disease control rate of SCT were 52.4% and 81.0%, respectively. The median progression-free survival and the median overall survival time were 5.4 and 12.9 months, respectively. Patients with positive programmed death-ligand 1 (PD-L1) expression showed greater tumor shrinkage evaluated by the response evaluation criteria in solid tumors and higher ORR than those with negative PD-L1 expression. CONCLUSIONS: Treatment outcome of SCT following nivolumab in R/M HNSCC was favorable. PD-L1 expression may be a predictive factor of SCT.

DOI： 10.1002/hed.26374

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Endoscopic submucosal dissection (ESD) has gained wide acceptance as a minimally invasive and curative surgery for superficial head and neck carcinoma. However, the safety of ESD for superficial pharyngeal carcinoma after radiotherapy has not been elucidated. Superficial hypopharyngeal carcinoma of the left pyriform sinus developed in a 76-year-old man who had undergone concurrent chemoradiotherapy for T2N2bM0 pyriform sinus carcinoma on the opposite side 12 months before. He underwent ESD without complications. Because tumor invasion into the muscular layer was a concern, the muscular layer was partially resected with the tumor. Twelve days after discharge, he presented with a sore throat and difficulty in swallowing. Endoscopy and computed tomography revealed necrosis due to wound infection with abscess formation around the left carotid artery. The common carotid artery subsequently ruptured. Although the surgical intervention was performed, he passed away 46 days after ESD due to carotid blowout. ESD is a minimally invasive treatment for superficial head and neck carcinoma, but carotid blowout can occur in cases after radiation. Prior radiotherapy and deeper dissection into the muscular layer may hamper wound epithelization, resulting in infection-induced necrosis and carotid blowout. Diligent monitoring of wound healing is essential in patients who have previously undergone irradiation.

DOI： 10.1016/j.anl.2020.08.020

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Sarcopenia, defined as a decrease in the skeletal muscle mass and its function, is associated with a poor clinical outcome in several malignancies. We aimed to examine whether sarcopenia can be a predictor of incompletion of concurrent chemoradiotherapy (CCRT) and survival for head and neck cancer (HNC) patients. METHODS: Forty-one male HNC patients who received CCRT were enrolled in the study. Cross-sectional muscle areas at the third lumbar vertebral level were normalized by the squared height of the patients and were termed the lumbar skeletal muscle index (LSMI, cm2/m2), a marker of sarcopenia. Patients were divided into high (30/41, 73%) and low (11/41, 27%) LSMI groups. The LSMI cut-off value was set at 39.7 cm2/m2 based on a receiver operating characteristic curve for incompletion of CCRT. The groups were compared for survival rate by the Kaplan-Meier method. Factors predicting incompletion of CCRT were investigated among several variables. RESULTS: Multivariate analysis showed that a pre-treatment low LSMI (P = 0.033) and age over 70 years (P = 0.023) were the only significant predictors for incompletion of CCRT. The 2-year disease-specific survival (DSS) rate was significantly lower in the low LSMI group (61%) than in the high LSMI group (97%, P = 0.012), whereas there were no differences in the DSS rate between the low and high body mass index groups. CONCLUSION: The prevalence of sarcopenia in HNC patients receiving CCRT was 27%. Its presence before treatment was a significant predictor of incomplete CCRT and poor DSS rate in HNC patients.

DOI： 10.1007/s00405-020-06273-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The importance of nivolumab for recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) is rapidly increasing. However, prognostic factors have not been determined for predicting treatment outcome. We aimed to investigate the prognostic factors in R/M HNSCC patients treated with nivolumab. METHODS: This retrospective study included 42 patients with R/M HNSCC who received nivolumab therapy. Correlations of overall survival (OS) with various patient characteristics including age, recurrent/metastatic site, performance status (PS), programmed death-ligand 1 positivity, body mass index, neutrophil-to-lymphocyte ratio, modified Glasgow prognostic score (mGPS), previous cetuximab administration, and immune-related adverse events were investigated. RESULTS: The overall response rate and disease control rate were 16.7% and 45.2%, respectively. Estimated 1-year OS and progression-free survival (PFS) were 56.4% and 24.5%, respectively. Multivariate analysis revealed that PS = 2 (hazard ratio 0.147; 95% CI 0.041-0.527; p = 0.003) and mGPS = 2 (hazard ratio 0.188; 95% CI, 0.057-0.620; p = 0.006) were independent predictors of poor OS. Given that the PS and mGPS were independent prognostic factors, we classified patients into three groups according to PS and mGPS: Group 1, both PS and mGPS were 0 or 1 (n = 30); Group 2, either PS or mGPS was 2 (n = 9); Group 3, both PS and mGPS were 2 (n = 3). The OS curves were significantly stratified among the three groups. CONCLUSION: The combination of PS and mGPS accurately predicted OS after nivolumab therapy. Preventive intervention to maintain general condition without simultaneously exceeding level 2 of PS and mGPS might be important for improving treatment outcomes of nivolumab.

DOI： 10.1007/s00405-020-05945-5

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記述言語：日本語   出版者・発行元：(一社)日本内分泌外科学会  

症例は71歳女性で、血液検査にてPTH-intactが1246pg/mlと著明高値であったため当院代謝内分泌内科を紹介初診となった。頸胸腹部CT上、甲状腺左葉背側の腫瘍性病変と硬化性、溶骨性の混在した多発性骨病変が指摘され、副甲状腺癌および多発骨転移が疑われた。高カルシウム血症の補正目的にシナカルセトが開始されたが改善が得られず、手術目的に当科紹介となった。術前画像所見からは副甲状腺腫瘍と甲状腺左葉の境界が不明瞭であったことから、副甲状腺腫瘍摘出の際に甲状腺左葉も合併切除した。病理所見では線維性の被膜を有し、好酸性細胞がシート状に増殖する像を認めた。核異型は軽度であるものの、脈管侵襲を認めること、Ki-67 indexは10%でhot spotを認めることから副甲状腺癌の診断となった。骨病変に対する治療については、腰椎病変に対してのみ病的骨折予防目的に放射線治療を行い、臨床経過から副甲状腺癌にBrown tumorを合併したものと判断した。

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記述言語：日本語   出版者・発行元：(一社)日本内分泌外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01099&link_issn=&doc_id=20190926390015&doc_link_id=%2Fdz0jibik%2F2019%2F012209%2F017%2F1269-1270%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdz0jibik%2F2019%2F012209%2F017%2F1269-1270%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本耳鼻咽喉科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Recent data indicated that concurrent chemoradiotherapy (CCRT) using high dose cisplatin (CDDP) is the most useful treatment for advanced head and neck squamous cell carcinoma (SCC). Regarding the dose of CDDP, 100mg/m2 is most recommended in Western countries. However, in terms of a balance of efficacy and adverse events, appropriate dose of cytotoxic drugs such as CDDP may be different among the different ethnic groups. In this multicenter phase I/II study, we aimed to identify the optimal dose of CDDP in CCRT for patients with advanced head and neck SCC in the Japanese. METHODS: Patients were eligible for inclusion if they had head and neck SCC that was treated with radical CCRT comprising whole-neck irradiation of the primary lesion and level II-IV lymph nodes on both sides. For the phase I study, a CDDP dose was 70mg/m2 for level 0, 80mg/m2 for level 1, and 100mg/m2 for level 2. Maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) were examined by phase I trial, by which CDDP dose for phase II was determined. The primary endpoint for the phase II was CCRT completion rate, and the secondary endpoint was full-dose-CCRT completion rate, the percentage of patients receiving a total CDDP dose of ≥200mg/m2, response rate, and incidences of adverse events. RESULTS: A CDDP dose of 100mg/m2 was the MTD for phase I, and the recommended dose for phase II was 80 mg/m2. Forty-seven patients were evaluated in the phase II trial. CCRT completion rate, full-dose-CCRT rate, and the percentage of patients receiving a total CDDP dose of ≥200mg/m2, were 93.6%, 78.7%, and 93.6%, respectively. One patient (2.1%) developed grade 2 renal dysfunction, and no patient developed febrile neutropenia or a grade 4 adverse event. CONCLUSION: The present phase I study indicated that a CDDP dose of 80mg/m2 is the optimal dose in terms of safety. The phase II study revealed that CCRT completion rate, response rate, and rates of adverse events were not inferior for a CDDP dose of 80mg/m2 as compared with a dose of 100mg/m2, and a dose of 80mg/m2 is therefore recommended in CCRT for the Japanese. This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; identification No. UMIN000010369).

DOI： 10.1016/j.anl.2018.02.008

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(NPO)日本頭頸部外科学会  

(化学)放射線治療後の原発残存・再発に対し救済手術を施行した下咽頭癌症例について、救済手術法の選択と合併症、予後につき、自験例について検討を行った。2005年から2014年に下咽頭扁平上皮癌新鮮例のうち、170例に初回治療として根治的(化学)放射線治療を施行し、45例に原発残存・再発を認め、32例に救済手術を施行した。救済術式は下咽頭喉頭全摘出術/下咽頭部分切除術/経口的切除:17/8/7例であり、術後観察期間は中央値23ヵ月、術後3年生存率は71.3%であった。一方、術後合併症は18例(56.3%)で起きていた。救済手術は生命予後の改善に有用であり、症例を吟味し、各術式の得失を理解した上で、最適な術式を選択するべきと考えた。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J04210&link_issn=&doc_id=20180309480004&doc_link_id=10.5106%2Fjjshns.27.277&url=https%3A%2F%2Fdoi.org%2F10.5106%2Fjjshns.27.277&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

新潟県には県内の癌治療施設が一堂に会する新潟県頭頸部癌悪性腫瘍登録委員会があり、県内の頭頸部悪性腫瘍症例のデータを四半世紀にわたって登録してきた。癌登録に関しては有用なデータではあるが、放射線療法や化学療法の進歩とともに施設間の治療内容および治療成績の格差が目立ってきて、全体の予後調査という点において信頼性が低下してしまった。そこでわれわれは県内の癌治療施設が一堂に会する利点を利用して「頭頸部扁平上皮癌に対する高用量CDDP+RTの県内多施設共同研究phase I/II study」を立ち上げた。phase Iにおいては12例が登録され、最大耐用量や用量限界毒性、化学療法減量・中止基準、phase IIにおけるCDDP推奨投与量などが検討され、その結果CDDP推奨投与量は80mg/m2となった。今後はCCRT完遂率などをendpointとしたphase IIを開始する予定である。地方における治療の一つのモデルケースとして、現状の経過を報告する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J04195&link_issn=&doc_id=20160518480012&doc_link_id=10.5981%2Fjjhnc.42.70&url=https%3A%2F%2Fdoi.org%2F10.5981%2Fjjhnc.42.70&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：日本語   出版者・発行元：新潟市民病院  

症例は84歳の女性で、右側胸部痛を主訴に当院救急外来を受診し、高カルシウム血症、腎機能低下を認め内分泌内科に緊急入院となった。原因検索のため、血液検査、超音波検査、単純CTを施行、甲状腺左葉下極に接した石灰化を伴う20mm大の腫瘤と、i-PTHの高値を認めた。さらに副甲状腺シンチグラムで異常集積がみられ、原発性副甲状腺機能亢進症と診断した。保存的治療をおこなったが、高カルシウム血症及び腎機能が徐々に増悪したため、手術目的に当科紹介となった。全身麻酔下に副甲状腺腫瘍摘出術を施行し、術中所見で周囲への浸潤は認めず、迅速病理診断は腺腫であったが、最終的な永久病理診断は副甲状腺癌となった。副甲状腺癌は非常に稀な疾患であり、術前診断が困難な事も多い。本例も手術後に診断が確定したが、術前から副甲状腺癌に特徴的な症状を念頭に置き治療にあたる必要があると思われた。(著者抄録)

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