Chen-Chi Wang

Background/Objectives: The prognostic significance of pre-existing diabetes mellitus (DM) in surgically treated oral cavity cancer remains uncertain. We evaluated the association between recorded pre-existing DM and 5-year overall survival. Methods: Adults with a first recorded oral cavity cancer diagnosis who underwent cancer-directed surgery within 6 months were identified in the TriNetX Research Network. The recorded DM was defined by ICD-10-CM codes E08–E13 before cancer diagnosis. Survival was evaluated from cancer diagnosis and, in a complementary analysis addressing guarantee-time bias, from the first qualifying surgery. Multivariable Cox regression and 1:1 propensity score matching were applied. Results: The diagnosis-indexed cohort included 2304 patients with recorded DM and 25,195 without recorded DM. DM was not associated with mortality in the unmatched analysis (HR 1.05, 95% CI 0.953–1.146), after multivariable adjustment (adjusted HR 1.081, 95% CI 0.977–1.196), or after matching (2242 patients per group; HR 0.997, 95% CI 0.878–1.131). In the surgery-indexed matched analysis (2298 patients per group), recorded DM was associated with a lower observed mortality hazard (HR 0.83, 95% CI 0.734–0.934). An E11-only sensitivity analysis yielded consistent findings. Conclusions: Recorded pre-existing DM was not associated with inferior 5-year overall survival. DM alone should not justify withholding or delaying surgery in otherwise appropriate candidates, although metabolic and systemic comorbidities should be optimized. The lower surgery-indexed mortality hazard likely reflects selection and residual confounding and should not be interpreted as a protective effect of DM.

Transoral robotic surgery (TORS) with neck dissection has emerged as an organ-preserving treatment for hypopharyngeal squamous cell carcinoma (HPSCC), but long-term evidence remains limited. This retrospective study evaluated oncologic outcomes, prognostic factors, mortality patterns, and organ preservation in patients with T1–T3 HPSCC. From October 2010 to August 2023, 48 patients without prior upper aerodigestive tract malignancy or irradiation underwent TORS with neck dissection, with or without cisplatin-based neoadjuvant chemotherapy and adjuvant chemoradiation. Tumor stages included T1 (37.5%), T2 (45.8%), and T3 (16.7%), and en bloc resection was achieved in all cases. Pathologic analysis revealed lymph node metastasis in 46.8% and extranodal extension in 17%. Radiotherapy to the primary hypopharynx was omitted in 60% of patients; when administered, the mean dose was approximately 60 Gy. After a mean follow-up of 5.9 ± 3.5 years, 5- and 10-year recurrence-free survival rates were both 69%, while disease-specific survival rates were 77%. Overall survival at 5 and 10 years was 77% and 59%, respectively. Survival and recurrence were significantly associated with extranodal extension in multivariable analysis ( p < 0.05). Of 15 deaths, distant metastases (46.7%) and second primary malignancies (33.3%) were predominant, whereas local recurrence accounted for only 13.3%. TORS with neck dissection provides durable disease control and excellent organ preservation for T1–T3 HPSCC, allowing radiotherapy omission in selected patients, although distant metastases and secondary cancers remain major causes of late mortality.

This study compares the retro-auricular robotic-assisted approach using two or three robotic instruments with conventional open neck dissection in patients with early N stage oral cavity cancer. Twenty-six patients with T1-3N0-1M0 disease underwent supraomohyoid neck dissection between 2018 and 2023 (13 robotic, 13 open). Perioperative outcomes, including hospital stay, drainage duration, complications, and lymph node yield, showed no significant differences (median lymph nodes: 20 vs. 21; p = 0.950). During a median follow-up of 743 days, no recurrences or deaths occurred. In the last five robotic cases, a third instrument (ProGrasp Forceps) was added without increasing operative time ( p = 0.803). Robotic-assisted neck dissection via the retro-auricular route is a safe and effective alternative for early stage oral cavity cancer patients, particularly those with clinical N0 disease, preserving oncologic outcomes while improving cosmetic appearance.

Purpose People with head and neck cancer face changes in appearance, difficulties swallowing, and communication challenges, which can limit their social functioning and impact interpersonal relationships, self-esteem, and work performance. The literature on how post-treatment changes affect social functioning remains limited. This study aims to explore the social functioning experiences of people with head and neck cancer after treatment. Method A qualitative research design with purposive sampling was employed to recruit head and neck cancer patients from a medical center in central Taiwan. Face-to-face in-depth interviews were conducted using semi-structured interview guides. Data were analyzed through qualitative content analysis. Results Twenty participants were recruited, with treatment completion ranging from 10 months to 8 years and 9 months prior. Five themes were identified: (1) influence on willingness to participate in society, (2) interpersonal relationships and interaction, (3) giving back to society, (4) taking care of oneself, and (5) challenges in maintaining employment. Conclusions Post-treatment adjustments in behavior and communication are necessary for social reintegration. Treatment-related changes reduce patients' willingness to participate socially, but community involvement and personal adjustments help rebuild self-worth. Tailored support programs are recommended.

Introduction: Gustatory function is a crucial component of human physiology, yet it is usually overlooked by the physician. We aimed to determine risk factors for dysgeusia in oral cavity cancer patients after comprehensive treatment.Methods: We prospectively enrolled oral cavity cancer patients scheduled to undergo surgical intervention from August 2017 until December 2023. A solution‐based taste test was used to examine patients' taste sensation before and 6 months after comprehensive treatment. Demographic data, along with treatment‐related features, were collected and analyzed.Results: In total, 104 patients with oral cavity cancer were included in the final analysis. The average age was 55.0 ± 9.0 years and males accounted for 83.7% (n = 87) of all participants. In addition, 21 patients (20.2%) received total glossectomy and 46 patients (44.2%) underwent partial glossectomy. Furthermore, 65 patients (62.5%) received postoperative radiotherapy and 53 patients (51.0%) had induction or postoperative chemotherapy. After adjusting for other variables, radiotherapy was shown to be a risk factor for dysgeusia after comprehensive treatment (relative risk [RR], 13.90; 95% confidence interval [CI], 1.57–122.85), followed by total glossectomy (RR, 6.20; 95% CI, 1.49–25.75). Chemotherapy had a marginal effect on dysgeusia in oral cavity cancer patients after comprehensive treatment (RR, 3.40; 95% CI, 0.95–12.14).Conclusion: Taste disorders are not life‐threatening events, but they still deserve the physician's attention. Patients with oral cavity cancer should be made aware that their sensation of taste may be affected during and after comprehensive treatment.Level of Evidence: 3.

BackgroundFor R/M HNSCC, the differences in prognosis and treatment options between distant metastasis (DM) and locoregional recurrence, especially in the DM group, remain unclear.MethodsFrom the Taiwan Head Neck Society registry database, patients who were diagnosed with R/M HNSCC and received cetuximab-based frontline therapy were collected for analysis.ResultsAmong the enrolled patients, 59.3% (491/827) belonged to the DM group. The DM group had less primary site of oral cavity, less betel nut chewing, higher lactate dehydrogenase (LDH) levels, and higher LDH/albumin ratio compared with the non-DM group. For the patients with primary site of oral cavity and current smokers, DM coexisted with poorer outcomes. In the DM group, EXTREME-like regimen was more suitable for older patients, those with elevated LDH, and those with higher LDH/albumin ratio than TPExtreme-like regimen.ConclusionDM coexisted with poorer prognosis in certain groups. LDH-associated biomarkers may aid treatment options for DM patients.