JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Ergonomics in Endoscopic Sinus and Skull Base Surgery.","authors":"Sruti Tekumalla, Emma J Anisman, Benjamin Bitner, Mindy Rabinowitz","doi":"10.1001/jamaoto.2026.3000","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.3000","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109681","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":"Testosterone Inhibition and Risk of Laryngeal and Hypopharyngeal Squamous Cell Carcinoma in Men.","authors":"Eivind Gottlieb-Vedi, Giola Santoni, Lalle Hammarstedt-Nordenvall, Shao-Hua Xie, Jesper Lagergren","doi":"10.1001/jamaoto.2026.3016","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.3016","url":null,"abstract":"<p><strong>Importance: </strong>Laryngeal and hypopharyngeal squamous cell carcinoma most commonly occur in men. It has been hypothesized that testosterone explains this sex difference, but there is a lack of research on the topic. 5α-Reductase inhibitors (5-ARIs) are common medications used for men with benign hyperplasia that inhibit the conversion of testosterone to the bioactive form dihydrotestosterone and, thus, have anti-androgenic properties.</p><p><strong>Objective: </strong>To examine whether use of 5-ARIs is associated with lower risk of laryngeal and hypopharyngeal squamous cell carcinoma in men.</p><p><strong>Design, setting, and participants: </strong>This population-based cohort study included men in the Swedish Prescribed Drugs and Health Cohort from July 1, 2005, to December 31, 2022, with follow-up until December 31, 2023.</p><p><strong>Exposure: </strong>At least 2 dispensations of 5-ARIs within 2 years during the study period. Users of 5-ARIs were compared with 5 times as many age- and date-matched men without history of 5-ARI use.</p><p><strong>Main outcome and measures: </strong>The main outcome was a new diagnosis of laryngeal or hypopharyngeal squamous cell carcinoma during follow-up. Multivariable Cox regression provided hazard ratios with 95% CIs, adjusted for alcohol overconsumption, tobacco smoking, hypertension, hyperlipidemia, and diabetes.</p><p><strong>Results: </strong>A total of 253 010 users of 5-ARIs and 1 265 050 nonusers were included (median [IQR] age, 74 [67-80] years). The median (IQR) follow-up time was 5.8 (2.7-10.1) years among the 5-ARI users and 4.7 (1.0-9.4) years among the nonusers. Laryngeal or hypopharyngeal squamous cell carcinoma was diagnosed in 215 (0.1%) of the 5-ARI users and 1131 (0.1%) of the nonusers. Use of 5-ARIs was associated with a 17% lower risk of laryngeal or hypopharyngeal squamous cell carcinoma compared to nonusers (adjusted hazard ratio, 0.83; 95% CI, 0.72-0.96).</p><p><strong>Conclusions and relevance: </strong>In this cohort study, use of 5-ARIs was associated with a decreased relative risk of hypopharyngeal and laryngeal squamous cell carcinoma. This supports a possible partial role of testosterone in the origin and male predominance of these tumors.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109795","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":"Combined Positive Score and Cost-Effectiveness of Perioperative Pembrolizumab for Head and Neck Cancer.","authors":"Aidan H Coyle, David W Hutton, Marisa R Buchakjian, Keith A Casper, David W Forner, Sarah Hawley, Molly E Heft Neal, Kelly M Malloy, Michelle L Mierzwa, Mark E Prince, Jennifer L Shah, Paul L Sweicicki, Andrew G Shuman, Chaz L Stucken, Christine M Veenstra, Francis P Worden, Pratyusha Yalamanchi","doi":"10.1001/jamaoto.2026.2124","DOIUrl":"10.1001/jamaoto.2026.2124","url":null,"abstract":"<p><strong>Importance: </strong>The KEYNOTE-689 trial demonstrated improved event-free survival with the addition of perioperative pembrolizumab to standard of care for patients with locally advanced head and neck squamous cell carcinoma (HNSCC), yet the cost-effectiveness remains unknown.</p><p><strong>Objective: </strong>To evaluate the cost-effectiveness of the KEYNOTE-689 perioperative pembrolizumab protocol.</p><p><strong>Design, setting, and participants: </strong>A partitioned survival model simulated the KEYNOTE-689 trial cohort with 3 mutually exclusive health states: event-free survival, disease progression, and death. Model inputs included Healthcare Cost and Utilization Project-derived and US Centers for Medicare & Medicaid Services-derived costs for drug acquisition (pembrolizumab and cisplatin), administration, surgery, radiation therapy, supportive care, management of serious adverse events, and disease progression.</p><p><strong>Main outcome and measures: </strong>KEYNOTE-689 Kaplan-Meier survival estimates were digitized and data for the combined positive score (CPS) of 1 to 10 subgroup were derived from the reported CPS of 1 or greater and CPS of 10 or greater subgroups. Quality-adjusted life-year (QALY) values for different health states were sourced from published literature, with the US population preference-weighting algorithm applied to EuroQol 5-Dimension 3-Level health questionnaire data from the CheckMate 141 trial. The primary outcome was the incremental cost-effectiveness ratio (ICER) results stratified by programmed cell death 1 ligand 1 (PD-L1) combined positive score (CPS of 1 to 10 vs greater than 10). A probabilistic sensitivity analysis (PSA) was performed to evaluate parameter uncertainty.</p><p><strong>Results: </strong>Subgroup analyses based on PD-L1 expression yielded divergent results. In the CPS greater than 10 cohort, perioperative pembrolizumab was cost-effective, producing approximately 1.35 additional QALYs at an incremental cost of $181 900, resulting in an ICER of $134 700. PSA showed a 57% probability that the pembrolizumab strategy was cost-effective at a $150 000 willingness-to-pay (WTP) threshold. In the CPS of 1 to 10 cohort, perioperative pembrolizumab resulted in approximately 0.08 additional QALYs at an incremental cost of $166 500, for an ICER of $2 179 400, with the PSA demonstrating an 11% probability of cost-effectiveness at a $150 000 WTP threshold.</p><p><strong>Conclusions and relevance: </strong>In this economic evaluation, addition of perioperative pembrolizumab to standard treatment for locally advanced HNSCC may represent a cost-effective intervention for patients with a PD-L1 CPS greater than 10 if KEYNOTE-689 data are replicable in clinical practice. Perioperative pembrolizumab is not a cost-effective strategy for patients with a CPS less than 10 based on current data. Biomarker stratification may inform the value-based integration of immunotherapy among patients with HNSCC.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"927-934"},"PeriodicalIF":7.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678710","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":"Whether Two Hearing Aids Really Are Better Than One-New Evidence for a Long-Standing Clinical Question.","authors":"Michelle L Arnold, Larry E Humes","doi":"10.1001/jamaoto.2026.2440","DOIUrl":"10.1001/jamaoto.2026.2440","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"978-980"},"PeriodicalIF":7.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840187","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":"Mental Health Screening in Head and Neck Cancer-A Time Point-Based Framework for Longitudinal Care.","authors":"Apurva Parikh, Anuraag S Parikh, Evan Graboyes, Joseph A Califano","doi":"10.1001/jamaoto.2026.2239","DOIUrl":"10.1001/jamaoto.2026.2239","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"925-926"},"PeriodicalIF":7.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13494240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760013","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":"TERT Promoter Variants, Older Age, and Prognosis in Papillary Thyroid Carcinoma.","authors":"Vicente R Marczyk, Sophie Li, Chia Chin Wu, Matthew A Loberg, Ying Henderson, Meghan Martin, Sarah Hamidi, Steven Waguespack, Naifa Busaidy, Ramona Dadu, Priyanka Iyer, Mimi Hu, Victoria Banuchi, Anastasios Maniakas, Stephen Lai, Mark Zafereo, Michelle D Williams, Sayed Mohsen Hosseini, Quanhu Sheng, George J Xu, Eric C Huang, Vivian L Weiss, Maria Cabanillas, Jennifer R Wang","doi":"10.1001/jamaoto.2026.2273","DOIUrl":"10.1001/jamaoto.2026.2273","url":null,"abstract":"<p><strong>Importance: </strong>Older age at diagnosis is associated with worse outcomes in papillary thyroid carcinoma (PTC). The current American Joint Committee on Cancer tumor-node-metastasis staging system incorporates an age of 55 years or older as staging criteria. TERT promoter variants are also associated with aggressive disease.</p><p><strong>Objective: </strong>To evaluate the interplay between age, TERT promoter variants, and survival outcomes in PTC.</p><p><strong>Design, setting, and participants: </strong>This multi-institutional retrospective cohort study was conducted from 1993 to 2020 at 3 academic centers in the US, with integration of publicly available cohorts from The Cancer Genome Atlas (TCGA) and American Association of Cancer Research's Project Genomics Evidence Neoplasia Information Exchange (AACR GENIE). The cohort included 169 patients with PTC from 3 US academic centers, who were integrated with TCGA and AACR GENIE, yielding a combined analytic population of 1555 patients with PTC. The association between age and TERT was examined across all patients. Within the multi-institutional cohort with long-term follow-up (n = 169), the association between TERT and survival was further examined.</p><p><strong>Exposures: </strong>Age at diagnosis and TERT promoter status.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was disease-specific survival (DSS), and the secondary outcome was progression-free survival (PFS).</p><p><strong>Results: </strong>Across all cohorts (N = 1555; 966 female individuals [62.1%] and 589 male individuals [37.9%]), the prevalence of TERT promoter variants increased progressively with age (r = 0.59; 95% CI, 0.54-0.63), being rare in patients younger than 30 years (<2%) and reaching 32% to 70% in those older than 65 years. For survival analyses, 169 patients were included (median follow-up, 13.7 years; 95% CI, 10.4-15.9 years). Among patients younger than 55 years without a TERT promoter variant, 10-year DSS was 100% and 10-year PFS was 83%. Among those 55 years or older, 10-year DSS was 91% for TERT wild-type tumors and 51% for TERT-variant tumors (91% vs 51%, respectively; difference, 40%; 95% CI, 4-68). A similar trend was observed for PFS (10-year PFS of 75% for TERT wild-type vs 23% for TERT variant; difference, 52%; 95% CI, 9-82). In multivariable analysis, TERT promoter variants remained independently associated with worse DSS after adjustment for age and pathologic tumor, node, and metastasis categories.</p><p><strong>Conclusions and relevance: </strong>The findings of this cohort study suggest that the high prevalence of TERT promoter variants in older patients largely explains the association between age and worse prognosis in PTC. TERT promoter status offers more biologically grounded prognostic information than age and may improve risk stratification.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"952-961"},"PeriodicalIF":7.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13494792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792959","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":"Precipitous Nasal Obstruction in a Patient With Acute Vision Loss.","authors":"Rex H Lee, Steven R Long, Patricia A Loftus","doi":"10.1001/jamaoto.2026.2203","DOIUrl":"10.1001/jamaoto.2026.2203","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"1003-1004"},"PeriodicalIF":7.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793019","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":"Subcutaneous Pembrolizumab and the Coordination of Neoadjuvant Immunotherapy in Head and Neck Cancer.","authors":"Lauren E Miller, James W Rocco","doi":"10.1001/jamaoto.2026.2132","DOIUrl":"10.1001/jamaoto.2026.2132","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"923-924"},"PeriodicalIF":7.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678676","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":"Long-Term Opioid Use Following Radiation or Chemoradiation for Head and Neck Cancer.","authors":"Om Desai, Alec Kotler, Jas Virk, Kevin Agner, Jacob Wells, Matthew Nguyen, Darien Reed, Krithik Tella, Daniel Alvarez, Andrew Koempel, Simeng Zhu, Emile Gogineni, David Konieczkowski, Darrion Mitchell, John Grecula, Mateus Trinconi Cunha, Priyanka Bhateja, Lauren Miller, James Rocco, Sachin S Kale, Marcelo Bonomi, Dukagjin Blakaj, Sung Jun Ma","doi":"10.1001/jamaoto.2026.2536","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.2536","url":null,"abstract":"<p><strong>Importance: </strong>Patients with head and neck cancer represent a vulnerable patient population for potential chronic opioid use. Prior institutional studies on chronic opioid use had limited sample sizes, and the incidence of and risk factors for chronic opioid use need further investigation.</p><p><strong>Objective: </strong>To evaluate the proportion of patients with opioid use and factors associated with opioid use 3 months following chemoradiation or radiation treatment for head and neck cancer.</p><p><strong>Design, setting, and participants: </strong>This single-institution cohort study at The Ohio State Comprehensive Cancer Center included patients diagnosed with nonmetastatic head and neck cancer between October 2011 and December 2023 who received definitive radiation or chemoradiation.</p><p><strong>Exposure: </strong>Receipt of definitive radiation or chemoradiation.</p><p><strong>Main outcomes and measures: </strong>The primary end point was opioid use 3 months after completing radiation in the entire cohort. Logistic multivariable analysis was performed to evaluate variables associated with opioid use at this time point. Secondary end points were opioid use at 6 months and time to first opioid use in an opioid-naive patient subgroup.</p><p><strong>Results: </strong>A total of 789 patients met the study's inclusion criteria (639 men [81.0%]; median age, 61 years [IQR, 55-68 years]). Median follow-up was 46.7 months (IQR, 31.1-56.1 months). Between diagnosis and 6 months following radiation, 750 patients (95.1%) received prescription opioids. At 3 and 6 months following radiation, 552 (70.0%) and 373 (47.3%) patients, respectively, continued taking prescription opioids. Patients were more likely to be taking opioids at 3 months following radiation if they were former smokers (adjusted odds ratio [AOR], 1.55; 95% CI, 1.04-2.31), were referred to palliative care (AOR, 3.90; 95% CI, 2.57-6.09), or had taken opioids prior to radiation (AOR, 2.57; 95% CI, 1.82-3.63). Among 296 patients who were opioid-naive prior to radiation (37.5%), time to first opioid use was shorter for those with underweight status (adjusted hazard ratio [AHR], 7.36; 95% CI, 3.40-15.90) and those referred to palliative care (AHR, 1.42; 95% CI, 1.10-1.83). Of the opioid-naive patients, 171 (57.8%) and 112 (37.8%) continued taking opioids at 3 and 6 months following radiation, respectively.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, 70.0% and 47.3% of patients with head and neck cancer continued taking opioids at 3 and 6 months following treatment, respectively. Factors associated with opioid use at 3 months included prior opioid use, former smoking status, and palliative care referral. These findings suggest that targeted opioid stewardship programs that consider both analgesia and long-term dependency risk are merited.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109637","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":"Opioid Use After Head and Neck Cancer Treatment-A Mainstay With Consequences.","authors":"Flavia P Kapos, Linda Sangalli, Nosayaba Osazuwa-Peters","doi":"10.1001/jamaoto.2026.2999","DOIUrl":"https://doi.org/10.1001/jamaoto.2026.2999","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109632","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}