JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Patients With Head and Neck Cancer and High Health Care Costs: A Population-Based Study.","authors":"Noémie Villemure-Poliquin, Rui Fu, Qing Li, Kennedy Ayoo, Kelvin K W Chan, Irene Karam, Frances C Wright, Natalie G Coburn, Julie Hallet, Antoine Eskander","doi":"10.1001/jamaoto.2025.1976","DOIUrl":"10.1001/jamaoto.2025.1976","url":null,"abstract":"<p><strong>Importance: </strong>The care for a small subset of patients is responsible for a disproportionately large share of health care expenditures. Head and neck cancer is associated with significant health care costs due to complex treatment regimens and long-term sequelae. Given this high baseline cost, identifying patients with high care costs within a population with cancer might help inform interventions to optimize resource allocation.</p><p><strong>Objective: </strong>To characterize patients with head and neck cancer with the highest health care costs during the first year after diagnosis.</p><p><strong>Design, setting, and participants: </strong>A population-based, retrospective cohort study was conducted using administrative data from the Institute for Clinical and Evaluative Sciences in Ontario, Canada, and included adults diagnosed with head and neck cancer between January 2007 and October 2020 (identified from the provincial cancer registry) with a full 1.5-year follow-up from the date of diagnosis to the date of death or October 31, 2021. The total 1-year health care costs were estimated using a patient-level algorithm and were collected in 2020 Canadian dollar values. The main analyses were performed in April 2023 and a sensitivity analysis was performed in April 2025.</p><p><strong>Main outcomes and measures: </strong>High health care costs (>75th percentile) during the first year after a head and neck cancer diagnosis. Predictors of high health care costs were identified using a multivariable logistic regression model.</p><p><strong>Results: </strong>The cohort included 13 795 patients (mean age, 63.2 [SD, 11.7] years and 3452 [25.0%] were female), 3448 (25%) of whom had high health care costs. Cancer stage was the strongest predictor of high health care costs. Compared with patients with stage I cancer, those with stage II cancer had 2-fold greater odds for high health care costs (odds ratio [OR], 3.14 [95% CI, 2.56-3.84]), those with stage III cancer had 5-fold greater odds for high health care costs (OR, 6.08 [95% CI, 4.99-7.41]), and those with stage IV cancer had 8-fold greater odds for high health care costs (OR, 8.94 [95% CI, 7.43-10.80]). Receiving multiple treatment modalities also was associated with greater odds for high-cost care.</p><p><strong>Conclusions and relevance: </strong>This cohort study found that more advanced disease stage and receiving multiple treatment modalities were the strongest predictors of high-cost care among patients diagnosed with head and neck cancer. Prioritizing research and implementation of screening programs, earlier cancer diagnoses, and effective treatment deescalation strategies might mitigate a significant portion of these high costs.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cannabis Use and Benign Salivary Gland Neoplasms.","authors":"Tyler J Gallagher, Matthew E Lin, Ian Kim, Daniel I Kwon, Niels C Kokot","doi":"10.1001/jamaoto.2025.1955","DOIUrl":"10.1001/jamaoto.2025.1955","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeon-Performed Transoral Ultrasonography for Detection and Staging of Oropharyngeal Cancers.","authors":"Martin Garset-Zamani, Gitte Bjørn Hvilsom, Thomas Kjærgaard, Padraig O'Leary, Kasper Wennervaldt, Mads Bøgh, Christoffer Holst Hahn, Mikkel Kaltoft, Christina Caroline Plaschke, Ronni Mikkelsen, Rikke Norling, Danijela Dejanovic, Johanna Maria Hall, Tina Klitmøller Agander, Irene Wessel, Annette Kjær Ersbøll, Christian von Buchwald, Tobias Todsen","doi":"10.1001/jamaoto.2025.1954","DOIUrl":"10.1001/jamaoto.2025.1954","url":null,"abstract":"<p><strong>Importance: </strong>Early-stage oropharyngeal squamous cell carcinoma (OPSCC) is challenging to diagnose using clinical examination and cross-sectional imaging. Ultrasonography performed transorally can provide high-resolution images of oropharyngeal structures; however, whether it improves diagnostic evaluation of patients with suspected OPSCC is unknown, and yet there is a need for improved early detection and T staging.</p><p><strong>Objectives: </strong>To compare the accuracy of clinical examination, ultrasonography, and magnetic resonance imaging (MRI) in detection of oropharyngeal tumors.</p><p><strong>Design, setting, and participants: </strong>This multicenter diagnostic clinical trial was conducted in the outpatient clinics of 3 tertiary cancer centers. Consecutive patients with suspected OPSCCs or neck metastases (without visible primary tumors) were screened from February 1, 2023, to June 30, 2024, and those eligible after a clinical examination by a head and neck surgeon were included. Exclusion criteria were a prior head and neck cancer diagnosis or a known histopathologically or imaging-verified oropharyngeal tumor present. Data were analyzed from August 1 to October 31, 2024.</p><p><strong>Intervention: </strong>Surgeon-performed transoral and transcervical ultrasonography of the oropharynx during initial clinical examination followed by cross-sectional imaging (MRI) that was evaluated blinded to results of ultrasonography and histopathologic testing.</p><p><strong>Main outcome and measure: </strong>Oropharyngeal tumor detection with reference to final histopathologic results (presence or absence of an oropharyngeal tumor).</p><p><strong>Results: </strong>The study included 162 participants (median [range] age, 63 [32-85] years; 58 female [35%] and 105 male [65%]), of whom 106 (65%) had an oropharyngeal tumor (OPSCC, 95 [59%]; lymphoma, 7 [4%]; other type, 4 [5%]). Ultrasonography had significantly higher overall accuracy (139 patients [86%]) in correctly diagnosing patients compared to clinical examination (110 [68%]; odds ratio [OR], 0.31; 95% CI, 0.18-0.52) and MRI (123 [76%]; OR, 0.48; 95% CI, 0.28-0.82). The sensitivity of the 3 diagnostic methods to detect oropharyngeal tumors was similar (ultrasonography, 95 patients [90%]; clinical examination, 87 [82%]; MRI, 97 [92%]); however, ultrasonography demonstrated nearly twice the level of specificity in the 56 patients without tumors (44 patients [79%] vs 23 [41%] and 26 [46%], respectively).</p><p><strong>Conclusions and relevance: </strong>This diagnostic clinical trial found that surgeon-performed transoral and transcervical ultrasonography in patients with suspected OPSCC provided higher diagnostic accuracy than clinical examination alone or MRI. Ultrasonography improves the clinical evaluation of suspected oropharyngeal cancers by providing higher diagnostic certainty.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Painful Oral Ulcer in the Buccal Mucosa of a Healthy Adult.","authors":"Ashim Shrestha, Rodolfo Garza, Madhu Shrestha","doi":"10.1001/jamaoto.2025.1946","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.1946","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Methods.","authors":"","doi":"10.1001/jamaoto.2025.2385","DOIUrl":"10.1001/jamaoto.2025.2385","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral vs Bilateral Transoral Robotic Surgery for HPV-Positive Tonsillar Squamous Cell Carcinoma.","authors":"Andrew M Peterson, Spencer R Bockover, Dorina Kallogjeri, Katherine Chang, Theresa Tharakan, R Alex Harbison, Paul Zolkind, Jason T Rich, Patrik Pipkorn, Sidharth V Puram, Ryan S Jackson","doi":"10.1001/jamaoto.2025.1833","DOIUrl":"10.1001/jamaoto.2025.1833","url":null,"abstract":"<p><strong>Importance: </strong>The palatine tonsil is the most common subsite of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC). There is debate on how to manage the contralateral clinically uninvolved tonsil in patients undergoing a primary surgical approach via transoral robotic surgery (TORS).</p><p><strong>Objective: </strong>To assess postoperative complications, functional outcomes, contralateral tonsil second primary rates, and survival in patients undergoing unilateral vs bilateral TORS with pathology-guided adjuvant treatment.</p><p><strong>Design, setting, and participants: </strong>A retrospective cohort study was carried out in a quaternary care academic medical center. All consecutive unilateral tonsillar patients with SCC undergoing TORS as primary treatment from June 2016 to July 2023 were included. Analysis was conducted between October 1, 2024, and January 1, 2025.</p><p><strong>Exposure: </strong>Unilateral TORS (ipsilateral radical tonsillectomy) vs bilateral TORS (ipsilateral radical tonsillectomy and contralateral extracapsular tonsillectomy).</p><p><strong>Main outcomes: </strong>The primary outcome measure was rate of postoperative oropharyngeal hemorrhage. Secondary outcome measures included postoperative emergency department (ED) visit/hospitalization rate, time to nasogastric tube (NGT) removal, rate of discharge with an NGT tube, G-tube dependence rates, second primary rates in the contralateral tonsil, length of stay, and 2-year and 5-year disease-free survival (DFS) and overall survival (OS).</p><p><strong>Results: </strong>A total of 158 (106 unilateral, 52 bilateral TORS) patients with HPV-associated tonsillar SCC were evaluated, including 18 women and 139 men with a mean (SD) age of 60 (10) years. There were clinically meaningful differences in oropharyngeal hemorrhage rates (7% vs 15%; percent difference, -7.8; 95% CI, -18.8% to 3.2%), 30-day ED visit/hospitalization rates (9% vs 21%; percent difference, -11.7%; 95% CI, -24.1 to 0.7), and median length of stay (2 vs 3 days) for unilateral and bilateral TORS, respectively. Swallowing outcomes, DFS, and OS were not significantly different between the 2 groups. A total of 3 patients (1.9%) had a second primary tumor in the contralateral tonsil, including 2 metachronous primary tumors in the unilateral group (1.8%) and 1 synchronous primary tumor incidentally removed at the time of surgery in the bilateral group (1.9%).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that omission of contralateral elective extracapsular tonsillectomy in HPV-positive SCC was safe and associated with a trend toward lower posttonsillectomy hemorrhage, postoperative ED visits for pain control, and hospital length of stay without compromising survival. Prophylactically resecting the contralateral tonsil may add patient harm without any clear benefits.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Text.","authors":"","doi":"10.1001/jamaoto.2025.2378","DOIUrl":"10.1001/jamaoto.2025.2378","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive Tongue Root Mass in a 32-Year-Old Woman.","authors":"Rinor Ajeti, Afrim Ajeti, Jeton Maxharraj","doi":"10.1001/jamaoto.2025.1708","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.1708","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taiwan's Gene Therapy Lessons-Balancing Innovation and Cost.","authors":"Ching-Nung Wu, Wei-Chun Cheng, Chao-Hui Yang","doi":"10.1001/jamaoto.2025.1768","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.1768","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HPV Status and Survival Outcomes in Patients 70 Years and Older After Surgery for Oropharyngeal Carcinoma.","authors":"Paolo Boscolo-Rizzo, Marta Tagliabue, Jerry Polesel, Fabiola Giudici, Vittorio Rampinelli, Giacomo Spinato, Luigi Angelo Vaira, Pawel Golusinski, Didier Dequanter, Carlos Chiesa Estomba, Antonino Maniaci, Mario Lentini, Rita De Berardinis, Laura Iandolo, Daniele Borsetto, Mateusz Szewczyk, Francesco Bussu, Jerome R Lechien, Enzo Emanuelli, Cesare Piazza, Piero Nicolai, Mohssen Ansarin, Giancarlo Tirelli","doi":"10.1001/jamaoto.2025.1722","DOIUrl":"10.1001/jamaoto.2025.1722","url":null,"abstract":"<p><strong>Importance: </strong>The incidence of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) arising from the palatine tonsil and base of the tongue (BOT) is increasing among the older population. However, data on the prognostic impact of HPV status in patients 70 years and older who undergo up-front surgical treatment remain limited.</p><p><strong>Objective: </strong>To evaluate whether HPV status is associated with survival outcomes in patients 70 years or older undergoing surgical treatment for squamous cell carcinoma (SCC) of the tonsil or BOT.</p><p><strong>Design, setting, and participants: </strong>This was a retrospective cohort analysis including patients 70 years or older at the time of diagnosis with biopsy specimen-proven and surgically resectable SCC of the tonsil or BOT treated in 10 comprehensive cancer centers from January 1, 2010, to July 31, 2021, with a minimum follow-up period of 3 years. Data analysis was conducted from August 20 to December 23, 2024.</p><p><strong>Exposure: </strong>HPV status determined by p16 immunohistochemistry.</p><p><strong>Main outcomes and measures: </strong>Overall survival (OS) and disease-free survival (DFS) were compared between p16-positive and p16-negative groups using Cox proportional hazards models.</p><p><strong>Results: </strong>The analysis included 345 patients (mean [SD] age, 75.7 [4.8] years; 241 [69.9%] male), of whom 207 (60.0%) underwent a transoral surgical approach and 138 (40.0%), an open surgical technique. Of these, 155 patients (44.9%) had p16-positive and 190 (55.1%) had p16-negative test results. The median (IQR) follow-up duration was 55 (18-87) months. Patients with p16-positive tumors demonstrated significantly improved survival outcomes. Specifically, the 5-year OS rate was 71.4% for patients who had p16-positive vs 47.7% for p16-negative test results, with an absolute difference of 23.7% (95% CI, 13.0%-34.4%) and an adjusted hazard ratio (HR) for OS of 0.36 (95% CI, 0.23-0.57). Similarly, the 5-year DFS rate was 66.4% for patients who were p16-positive compared to 40.8% for those p16-negative, with an absolute difference of 25.6% (95% CI, 14.9%-36.3%) and an adjusted HR for DFS of 0.42 (95% CI, 0.28-0.63).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that p16 positivity was associated with significantly improved survival outcomes, suggesting that HPV-associated tumors maintain their favorable prognosis even in patients 70 years and older who were surgically treated for SCC of the tonsil or BOT.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}