OBJECTIVE: To explore the differences between clinical features and computed tomography (CT) findings of early-stage glottic cancer (EGC) with or without recurrence after transoral laser microsurgery (TLM) and to establish a preoperative nomogram to predict postoperative recurrence.
METHODS: The clinical and CT features of 168 consecutive patients with EGC with or without recurrence were analyzed retrospectively. Multivariate logistic regression analysis was used to determine the independent predictors of recurrence. A nomogram was constructed to preoperatively predict recurrence. To assess the nomogram\'s performance, the C-index and calibration plot were used.
RESULTS: EGCs with and without recurrence differed significantly in T-stage, depth, and normalized CT values in the arterial phase (NCTAP) and venous phase (NCTVP) (all P < 0.05). T-stage, depth, and NCTVP were independent predictors of recurrence in EGCs (all P < 0.05). The C-index (0.765, 95% confidence interval: 0.703-0.827) and calibration plot showed that the nomogram has good prediction accuracy. Nomograms based on T-stage and CT variables provided numerically predicted recurrence rates and were better than those based on only T-stage (C-index of 0.765 vs. 0.608).
CONCLUSIONS: Using clinical and CT variables, we developed a novel nomogram to predict the recurrence of EGC before TLM, which may be a potential noninvasive tool for guiding personalized treatment.

患者，女，16岁，因“进行性声嘶加重、呼吸道乳头状瘤反复复发15年”入院。患者自1岁时出现声嘶外院就诊，喉镜示：喉肿物（复发性喉乳头状瘤？），遂行支撑喉镜下喉肿物切除术（具体术式不详），术后病理：喉乳头状瘤。术后4个月余复发，再次手术治疗；后每间隔1~4个月复发并给予手术治疗，直至10岁；10~12岁手术间隔为1年；12~14岁时手术间隔约半年；14~15岁时手术间隔约3个月；共计接受手术40余次。15岁后乳头状瘤病变范围逐渐扩大，于2022年5月我院就诊。查体：喉部多发乳头状瘤，声带黏连，喉狭窄，肺内乳头状瘤播散。入院后，为患者制订阶梯治疗方案：先行全身贝伐珠单抗治疗（4次），喉部及肺内乳头状瘤病灶均明显缩小；后行经支撑喉镜CO2激光喉乳头状瘤切除术+光动力治疗（3次），至今术后19个月喉部乳头状瘤未复发。目前进一步定期随访中。.

Nursing and physical examination early screening of multiple tumors is helpful to find tumors early, so as to improve the cure rate. Studying its molecular mechanisms is urgent. By logging into gene expression omnibus database, we found laryngeal cancer dataset GSE127165, bladder cancer dataset GSE65635, oral cancer dataset GSE146483, obtain differentially expressed genes, subsequently, weighted gene co-expression network analysis, protein-protein interaction networks, functional enrichment analysis, immune infiltration analysis, survival analysis, comparative toxicogenomics database analysis were conducted. Draw a heatmap of gene expression. Use targetScan to search for miRNA information about core DEG. Got 53 differentially expressed genes. In GOKEGG analysis, they were clustered in cell cycle processes, spindle poles, and protein serine/threonine/tyrosine kinase activity cell cycle, transcriptional dysregulation in cancer, RIG-I-like receptor signaling pathway, P53 signaling pathway. Protein-protein interaction analysis screened out 5 genes (NEK2, BUB1, HMMR, TTK, CCNB2). Cyclin B2 (CCNB2) and budding uninhibited by benzimidazole 1 (BUB1) were highly expressed in laryngeal cancer, bladder cancer, oral cancer. Comparative toxicogenomics database analysis found that core genes (CCNB2, BUB1) are associated with tumors, necrosis, and inflammation. Related miRNA of CCNB2 gene is hsa-miR-670-3p; related miRNAs of BUB1 gene are hsa-miR-5688, hsa-miR-495-3p. CCNB2 and BUB1 exhibit high expression in laryngeal cancer, bladder cancer, and oral cancer, suggesting their potential as molecular targets for precision therapy in these cancers.

OBJECTIVE: To explore the clinical value of narrow band imaging (NBI) endoscopy in the early diagnosis and staging assessment of laryngeal and hypopharyngeal cancer.
METHODS: A total of 78 patients with lesions in the hypopharynx or larynx were examined using endoscopy, observed under both white light and NBI modes, and graded using NBI. Using Lugol\'s iodine solution, laryngeal and hypopharyngeal lesions were graded using iodine staining. Using histopathological examination or postoperative pathological results as the diagnostic criteria, the sensitivity, specificity, and accuracy of endoscopy and iodine staining in diagnosing early cancer and precancerous lesions were evaluated.
RESULTS: Multiple lesions were identified by both methods, and pathological examination confirmed 86 lesions, including early squamous cell carcinoma and precancerous lesions, such as early esophageal cancer, high-grade esophageal intraepithelial neoplasia, and hypopharyngeal cancer. Endoscopy showed significantly higher accuracy, detection rate, sensitivity, and specificity in NBI mode than in white light mode (96.12%, 86.05%, 97.37%, 86.67% vs 86.05%, 76.74%, 86.84%, 80%, respectively; P < 0.05). NBI grading and iodine staining grading showed good consistency with pathological diagnosis, with a Kappa value of 0.684 and 0.622, respectively.
CONCLUSIONS: NBI endoscopy allows for better observation of subtle structural changes on the surface of lesions compared to white light endoscopy. It provides high accuracy in detecting early laryngeal and hypopharyngeal cancer and precancerous lesions, determining biopsy sites, facilitating early diagnosis, and establishing safe surgical margins. NBI endoscopy offers a viable alternative for non-invasive screening and early diagnosis of laryngeal and hypopharyngeal cancer, showing great potential for clinical advancement.

This study investigates the role of M2-exo-mediated HOXC13-AS in laryngeal squamous cell carcinoma (LSCC) by examining its transmission to tumor microenvironment (TME) macrophages. Exosomes from M2 macrophages were isolated and characterized using transmission electron microscopy, nanoparticle tracer analysis and western blot. Expression of HOXC13-AS, miR-485-5p, IGF2BP2, and PD-L1 was analyzed. Different interventions on LSCC cell function and immune escape were detected using molecular biological techniques. The study found that elevated HOXC13-AS were present in LSCC, and M2-exo expression was significantly increased in LSCC cells. Silencing HOXC13-AS in M2-exo inhibited LSCC malignant progression and immune escape in vivo and in vitro. M2-exo-mediated HOXC13-AS also regulated IGF2BP2 expression, impacting cellular biological function and immune escape process. The study concludes that M2-exo-mediated HOXC13-AS promotes LSCC malignancy and immune escape.

Laryngeal squamous cell carcinoma (LSCC) is a prevalent human cancer with a complex pathogenesis that remains incompletely understood. Here, we unveil a long non-coding RNA (lncRNA) associated with LSCC tumorigenesis and progression. LOC730101 exhibits significant overexpression in human LSCC tissues, and elevated LOC730101 levels correlate with malignant clinicopathological characteristics. Moreover, we demonstrate that LOC730101 is encapsulated into exosomes in an hnRNPA2B1-dependent manner, serving as a promising plasma biomarker for discriminating LSCC patients from healthy individuals (AUC = 0.92 with 89.36% sensitivity and 86.36% specificity). Exosomes derived from LSCC cells enhance the viability, DNA synthesis rate, and invasiveness of normal nasopharynx epithelial cells, with pronounced effects observed upon LOC730101 overexpression. Additionally, exosomal LOC730101 promotes tumor growth in vivo. Mechanistically, exosomal LOC730101 internalization by normal nasopharynx epithelial cells leads to increased H3K4me3 levels on the p38 MAPK gamma (p38γ) promoter via direct interaction with hnRNPA2B1. This interaction activates p38γ transcription, ultimately driving LSCC tumorigenesis. Collectively, our findings uncover a novel exosomal lncRNA that mediates communication between normal and LSCC cells during LSCC carcinogenesis, suggesting that targeting LOC730101 may represent a promising therapeutic strategy for LSCC treatment.

Objective:To detect the differences in types and levels of amino acids in the peripheral serum of patients with laryngeal squamous cell carcinoma and non-tumor patients, and explore their relationship with clinical parameters of laryngeal squamous cell carcinoma as well as their clinical value in diagnosis. Methods:High-performance liquid chromatography-tandem mass spectrometry（HPLC-MS） was employed to detect the serum amino acid contents and levels of 62 patients diagnosed with laryngeal carcinoma and 141 non-tumor patients at the First Affiliated Hospital of Jinzhou Medical University between September 2018 and February 2021. The study compared the differences in 22 non-essential and essential amino acids found in the serum between the experimental group and the control group. An ROC curve and risk scoring formula of multivariate linear logic regression model was utilized to evaluate the efficiency of serum amino acids in the early diagnosis of laryngeal carcinoma. Results:There were significant differences in the contents of fourteen types of amino acids between the experimental and control groups, with thirteen amino acids showing higher levels in the experimental group（P<0.05）. Seven of these amino acids were essential, including phenylalanine, threonine, leucine, valine, histidine, tyrosine, and citrulline. The other six amino acids were non-essential, including arginine, asparagine, cysteine, glycine, ornithine, and proline. Interestingly, the content of homocysteine in the experimental group was lower than that in the control group（P=0.024）. Further analysis showed that patients with laryngeal squamous cell carcinoma in TNM stage Ⅰ and Ⅱ had higher serum methionine levels compared to those in stages Ⅲ and Ⅳ（P=0.026）. In addition, the content of serum histidine was higher in patients with poorly differentiated squamous cell carcinoma compared to those with well-differentiated squamous cell carcinoma（P=0.041）. The level of asparagine in the serum of patients with laryngeal squamous cell carcinoma older than 64 years old was lower than that in patients younger than 64 years old（P=0.033）. The level of tryptophan in the serum of patients with a smoking history was lower than that in patients without a smoking history（P=0.033）. The level of citrulline in the serum of patients with a history of alcohol consumption was higher than that in patients with no history of alcohol consumption（P=0.003）. ROC curve analysis showed that out of the 14 different amino acids between the experimental and control groups, citrulline and cysteine were relatively effective as independent factors in the diagnosis of laryngeal squamous cell carcinoma, with an AUC of 0.856 and 0.850, respectively. Arginine was the most sensitive factor in the diagnosis of laryngeal squamous cell carcinoma（AUC=0.855）. However, citrulline alone had the highest specificity（0.830） in the diagnosis of laryngeal squamous cell carcinoma, and the combination of 12 amino acids significantly improved the diagnostic efficiency of laryngeal squamous cell carcinoma, with an AUC of 0.946, sensitivity of 0.887, and specificity of 0.894. A risk score formula for a multivariate logistic regression model was established based on the differential amino acid content in the serum. The risk score of laryngeal squamous cell carcinoma group was higher than that of the non-tumor group（P<0.001）. The AUC of risk score in the diagnosis of laryngeal squamous cell carcinoma was 0.953 with sensitivity and specificity of 0.957 and 0.855. Conclusion:This study found that there are differences in the contents of 14 amino acids among which 13 amino acids were increased in serum of patients with laryngeal squamous cell carcinoma, and were associated with age, clinical stage, pathological differentiation, smoking, and drinking. Combined detection of 12 amino acids can improve the diagnostic efficiency of laryngeal squamous cell carcinoma and serve as potential markers for the auxiliary diagnosis of laryngeal squamous cell carcinoma using peripheral blood samples. Additionally, the established risk score model was found to be more effective in the diagnosis of laryngeal squamous cell carcinoma, indicating its important potential value as an auxiliary diagnostic tool.
目的：检测喉鳞状细胞癌患者与非肿瘤患者外周血清中氨基酸种类及含量差异，探讨他们与喉鳞癌各临床参数之间的关系以及在诊断中的临床价值。 方法：采用高效液相色谱-串联质谱（HPLC-MS）法检测锦州医科大学附属第一医院2018年9月-2021年2月初诊的62例喉鳞癌患者（实验组）和同时期的141例非肿瘤患者（对照组）血清22种非必需氨基酸及必需氨基酸种类与含量差异，应用ROC曲线及多元线性逻辑回归模型对差异性氨基酸在喉鳞癌早期诊断中的效能进行分析。 结果：实验组较对照组血清中有14种氨基酸含量存在差异，其中13种氨基酸含量显著高于对照组（P<0.05），包括7种必需氨基酸：苯丙氨酸、苏氨酸、亮氨酸、缬氨酸、组氨酸、酪氨酸、瓜氨酸，以及6种非必需氨基酸：精氨酸、天冬酰胺、半胱氨酸、甘氨酸、鸟氨酸、脯氨酸。而同型半胱氨酸含量明显低于对照组（P＝0.024）。进一步分析表明临床早期（Ⅰ期+Ⅱ期）喉鳞癌患者血清中甲硫氨酸含量显著高于临床晚期（Ⅲ期+Ⅳ期）患者（P＝0.026）。高分化鳞状细胞癌患者血清中组氨酸含量显著高于低分化鳞状细胞癌患者（P=0.041）。年龄>64岁的喉鳞癌患者血清中天冬酰胺的含量高于≤64岁的喉鳞癌患者（P=0.033），有吸烟史的喉鳞癌患者血清中色氨酸含量均低于无吸烟史患者（P=0.033），有饮酒史的喉鳞癌患者血清中瓜氨酸含量高于无饮酒史的喉鳞癌患者（P=0.003）。ROC曲线分析表明，实验组与对照组间存在差异的14种氨基酸中，除同型半胱氨酸和鸟氨酸不具备统计学意义（P>0.05），瓜氨酸和半胱氨酸作为独立因素诊断喉鳞癌的效能相对较高（AUC数值分别为0.856及0.850）；而精氨酸作为单独诊断喉鳞癌因素时的灵敏度则最高（0.855）；但单独使用瓜氨酸诊断喉鳞癌时其特异度最高（0.830）；将12种氨基酸联合应用于检测可显著提高喉鳞癌的诊断效能，AUC为0.946，灵敏度为0.887，特异度为0.894。基于血清差异氨基酸含量建立多元线性逻辑回归模型的风险评分公式，喉鳞癌组的风险评分高于非肿瘤组（P<0.001），风险评分诊断喉鳞癌的AUC为0.953（敏感度和特异度分别为0.957和0.855）。 结论：喉鳞癌患者与非肿瘤患者比较，14种氨基酸的含量存在差异，其中13种氨基酸的含量在喉鳞癌患者血清中升高，并与年龄、临床分期、病理分化程度、吸烟以及饮酒具有相关性。联合其中12种氨基酸进行检测可提高喉鳞癌的诊断效能，具备外周血辅助诊断喉鳞癌的潜力。同时建立风险评分模型发现其对于喉鳞癌的诊断效能更高，表明该模型对于辅助诊断喉鳞癌有重要潜在价值。.

Objective:To observe the clinical effect of placing heterogeneous acellular dermal matrix membrane for laryngeal cavity wound healing after CO2 laser Type-Ⅴa cordectomy for glottic carcinoma. Methods:Thirty-five patients with bilateral vocal cord laryngeal cancer who underwent endoscopic CO2 laser surgery at the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University from March 2018 to December 2019 were selected and divided into 2 groups, including 18 patients in the study group and 17 patients in the control group. The control group was simply placed silicone tube stent, while in the study group, heterogeneous acellular dermal matrix membrane was coated with silicone tube stent. The postoperative laryngeal wound repair and clinical manifestations were observed and compared between the two groups. Results:Compared postoperative laryngeal wound after 6 months: no patients in the study group had granulation tissue, whereas 4 patients in the control group had granulation tissue; 3 patients in the study group developed moderate to severe tissue adhesion, while 9 patients in the control group; 10 patients in the control group developed 2nd to 4th degree laryngeal obstruction, compared with only 4 patients in the study group. Conclusion:The primary placement of ADM can reduce laryngeal granulation tissue and tissue adhesion after CO2 laser Type-Ⅴa cordectomy for laryngeal cancer, and may reduce the occurrence of postoperative laryngeal obstruction.
目的：观察异种脱细胞真皮基质（acellular dermal matrix, ADM）修复膜植入对声门型喉癌CO2激光Ⅴa型声带切除术后喉腔创面修复的临床疗效。 方法：选择2018年3月-2019年12月在中南大学湘雅二医院耳鼻咽喉头颈外科接受内镜下CO2激光手术的35例双侧声带病变喉癌患者为研究对象并分为2组，其中研究组18例，对照组17例，对照组单纯植入硅胶管喉模支架，研究组则在硅胶管外衬ADM，观察2组患者术后喉腔创面的修复情况及相关临床表现。 结果：术后6个月喉腔创面比较，研究组均无肉芽组织残留，对照组4例患者有肉芽残留；研究组3例患者出现中重度喉粘连，对照组9例患者出现中重度喉粘连；对照组10例患者表现为2～4度喉梗阻，研究组仅4例出现相同情况。 结论：ADM Ⅰ期植入不仅能够减少喉癌CO2激光Ⅴa型声带切除术后喉腔肉芽、喉粘连，还可能减少术后喉梗阻的发生。.

OBJECTIVE: To analyze oncological and functional results of transoral minimally invasive surgery (TMIS) for supraglottic laryngeal carcinoma (SGLC), and investigate independent prognostic factors.
METHODS: Seventy SGLC patients treated with TMIS were included. The overall survival (OS), recurrence-free survival (RFS), and postoperative functions were analyzed.
RESULTS: Sixty-two patients were early-stage (Tis, T1, and T2) and eight patients were T3. Eleven patients received preoperative induction chemotherapy (IC). Sixty patients received transoral laser microsurgery (TLM), and 10 patients received transoral robotic surgery (TORS). Fifty-eight patients were scored Grade-1 by water swallow test, and 49 patients were scored Grade 0 by grade, roughness, breathiness, asthenia, strain. The 1, 3, and 5 year OS of all were 95.450%, 84.877%, and 78.026%, and RFS were 89.167%, 78.052%, and 75.451% respectively. Kaplan-Meier survival analysis showed N stage and clinical stage were associated with OS, smoking, clinical stage, surgical margins, and Ki-67 index were associated with RFS. There were no significant differences in preoperative IC or direct surgery, TLM, or TORS. Cox analyses showed smoking and surgical margins were independent prognosis factors for RFS.
CONCLUSIONS: The positive margin, Ki-67 index ≥40% and P53(+)&Ki-67 index ≥40% are worse factors affecting recurrence for SGLC patients. Both smoking and surgical margins are independent prognostic factors affecting recurrence.

BACKGROUND: HHLA2 (human endogenous retrovirus-H long terminal repeat-associating protein 2) represents a recently identified member of the B7 immune checkpoint family, characterized by limited expression in normal tissues but notable overexpression in various cancer types. Nevertheless, the precise function and interaction with immune cells remain poorly understood, particularly in laryngeal squamous cell carcinoma (LSCC). This investigation endeavored to elucidate the biological significance of HHLA2 within the tumor microenvironment of human LSCC tissues and delineate the clinical relevance and functional roles of HHLA2 in LSCC pathogenesis.
METHODS: Through multiplexed immunohistochemistry analyses conducted on tissue microarrays sourced from LSCC patients (n = 72), the analysis was executed to assess the expression levels of HHLA2, density and spatial patterns of CD68+HLA-DR+CD163- (M1 macrophages), CTLA-4+CD4+FoxP3+ (CTLA-4+Treg cells), CTLA-4+CD4+FoxP3- (CTLA-4+Tcon cells), exhausted CD8+T cells, and terminally exhausted CD8+T cells in LSCC tissues. Survival analysis was conducted to evaluate the prognostic significance of HHLA2 and these immune checkpoints or immune cell populations, employing COX regression analysis to identify independent prognostic factors.
RESULTS: Kaplan-Meier (K-M) survival curves revealed a significant association between HHLA2 expression and overall survival (OS) in LSCC. Elevated levels of HHLA2 were linked to reduced patient survival, indicating its potential as a prognostic marker (HR: 3.230, 95%CI 0.9205-11.34, P = 0.0067). Notably, increased infiltration of CD68+ cells (total macrophages), STING+CD68+HLA-DR+CD163- (STING+M1 macrophages), CTLA-4+CD4+FoxP3+, CTLA-4+CD4+FoxP3-, PD-1+LAG-3+CD8+T cells, and PD-1+LAG-3+TIM-3+CD8+T cells strongly linked to poorer survival outcomes (P < 0.05). A discernible trend was observed between the levels of these immune cell populations, STING+CD68+ (STING+ total macrophages), CD68+HLA-DR+CD163-, STING+CD68+CD163+HLA-DR- (STING+M2 macrophages), PD-1+LAG-3-CD8+T cells, PD-1+TIM-3+CD8+T cells, and PD-1+LAG-3+TIM-3-CD8+T cells and prognosis. Importantly, multivariate COX analysis identified HHLA2 as an independent predictive factor for OS in LSCC patients (HR = 3.86, 95% CI 1.08-13.80, P = 0.038). This underscored the potential of HHLA2 as a critical marker for predicting patient outcomes in LSCC.
CONCLUSIONS: HHLA2 emerged as a detrimental prognostic biomarker for assessing OS in LSCC patients. Relative to other immune checkpoints, HHLA2 exhibited heightened predictive efficacy for the prognosis of LSCC patients.