Background
Our objective was to determine the effect of post‐diagnosis aspirin use on survival in veterans with head and neck squamous cell carcinoma.
Methods
Retrospective cohort study of 584 veterans with head and neck squamous cell carcinoma treated at the Washington DC VA Medical Center between 1995 and 2015. Charts were queried for clinical‐pathologic data, aspirin prescriptions, and outcome. The Kaplan–Meier method was used to determine overall survival (OS) and disease‐specific survival (DSS) among aspirin users and nonusers.
Results
A total of 329 patients met inclusion criteria. Primary subsites included oropharynx (n = 143), larynx (n = 105), oral cavity (n = 62), and hypopharynx (n = 19). Eighty‐four patients were aspirin users (25.5%). Aspirin users demonstrated significantly better 3‐year OS and DSS (78.6% and 88.1%) compared to nonaspirin users (OS: 55.9% and DSS: 70.2%; P = .0003 and P = .0019, respectively). On multivariate analysis, aspirin use remained independently associated with improved survival.
Conclusion
Aspirin use following diagnosis and curative treatment of head and neck squamous cell carcinoma is associated with improved OS and DSS.
Despite advances in multimodal treatment for oral cavity squamous cell carcinoma, recurrence rates remain high, providing an opportunity for new therapeutic modalities that may improve oncologic outcomes. Much recent attention has been paid to the molecular interactions between the tumor cells with the adjacent peritumoral microenvironment, in which immunosuppressive molecular changes create a landscape that promotes tumor progression. The rationale for the introduction of immunotherapy is to reverse the balance of these immune interactions in a way that utilizes the host immune system to attack tumor cells. In the preoperative setting, immunotherapy has the advantage of priming the unresected tumor and the associated native immune infiltration, supercharging the adaptive anti-tumor immune response. It also provides the basis for scientific discovery where the molecular profile of responders can be interrogated to elucidate prognostic markers to aid in future patient selection. Preoperative immunotherapy is not without limitations. The risk of surgical delay due to immune adverse events must be carefully discussed by members of a multidisciplinary treatment team and patient selection will be critical. One day, the discovery of predictive biomarkers may allow for algorithms where pre-surgical immunotherapy decreases the size of surgical defect and impacts the intensity of adjuvant therapy leading to improved patient survival and decreased morbidity. With further study, immunotherapy could become a key component of future treatment algorithm.
Objective
To evaluate how pediatric indications for tonsillectomy or adenotonsillectomy relate to gender, race/ethnicity, and age.
Methods
Included consecutive pediatric patients who underwent tonsillectomy or adenotonsillectomy from a single tertiary academic institution between 2012 and 2019. Logistic regression analysis was used to measure association between the indication for tonsillectomy and the demographic variables gender, race/ethnicity, and age.
Results
Of the 1106 children included in this study, 53% were male and 47% were female. Half of the children were White, 40% were African American, 6% were Hispanic and 4% were other. The most common indication for surgery was upper airway obstruction alone (66%), followed by obstruction and infection (22%), and recurrent infections (12%). We found that male gender (OR 1.59, 95% CI 1.24–2.04), African American race (OR 2.76, 95% CI 2.08–3.65), and younger age were associated with greater odds of presenting with upper airway obstruction as the indication for tonsillectomy. Conversely, male gender (OR 0.63, 95% CI 0.44–0.92), African American race (OR 0.4, 95% CI 0.26–0.61), and younger age were associated with lower odds of presenting with recurrent infection as the indication for tonsillectomy.
Conclusions
Male gender, African American race, and young age are risk factors for tonsillar surgery due to airway obstruction. Female gender, White race, and older age are risk factors for tonsillar surgery due to recurrent throat infections.
Level of Evidence
3
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.