A growing incidence of differentiated thyroid cancer (DTC) has been reported in most developed countries, corresponding mainly to incidentally discovered small papillary thyroid carcinomas. Given the excellent prognosis of most patients with DTC, optimal therapeutic management, minimizing complications, and preserving patient quality of life are essential. Thyroid surgery has a central role in both the diagnosis, staging, and treatment of patients with DTC. Thyroid surgery should be integrated into the global and multidisciplinary management of patients with DTC. However, the optimal surgical management of DTC patients is still controversial. In this review article, we discuss the recent advances and current debates in DTC surgery, including preoperative molecular testing, risk stratification, the extent of thyroid surgery, innovative surgical tools, and new surgical approaches.

The selection of patients for the constitution of a cohort is a major issue for clinical research (prospective studies and retrospective studies in real life). Our objective was to validate in real life conditions the use of a Deep Learning process based on a neural network, for the classification of patients according to the pathology involved in a head and neck surgery department. 24,434 Electronic Health Records (EHR) from the first visit between 2000 and 2020 were extracted. More than 6000 EHR were manually classified in ten groups of interest according to the reason for consultation with a clinical relevance. A convolutional neural network (TensorFlow, previously reported by Hsu et al.) was then used to predict the group of patients based on their pathology, using two levels of classification based on clinically relevant criteria. On the first and second level of classification, macro-average performances were: 0.95, 0.83, 0.85, 0.97, 0.84 and 0.93, 0.76, 0.83, 0.96, 0.79 for accuracy, recall, precision, specificity and F1-score versus accuracy, recall and precision of 0.580, 580 and 0.582 for Hsu et al., respectively. We validated this model to predict the pathology involved and to constitute clinically relevant cohorts in a tertiary hospital. This model did not require a preprocessing stage, was used in French and showed equivalent or better performances than other already published techniques.

Hypopharyngeal cancer (HC) is an aggressive and life-threatening malignancy that requires a complex multimodal treatment. The aims of the present study were to analyze, in locally advanced HC patients, the oncologic and swallowing outcomes and their predictive factors according to the therapeutic strategy. All patients with locally advanced HC (T3/T4, N0-3, M0) treated at our institution between 2000 and 2020 were included in this retrospective study. Patients were classified in 3 groups according to the therapeutic strategy: primary radical surgery (RS), induction chemotherapy (ICT) or definitive (chemo)-radiation therapy ((C)RT). Predictive factors of oncologic outcomes (overall, cause-specific and recurrence-free survival: OS, CSS and RFS) and swallowing outcome (dysphagia outcome and severity scale: DOSS) were investigated in univariate and multivariate analysis. A total of 217 patients were included in this study (RS: 40; ICT: 106; (C)RT: 71). 5-year OS, CSS and RFS rates were 36, 38 and 32%, respectively. ICT was associated with improved oncologic and swallowing outcomes in univariate analysis. After multivariate analysis, patient age ≥ 70 years (p = 0.0002) was the only factor significantly associated with a worse OS, whereas patient age ≥ 70 years (p = 0.002) and N stage ≥ 2 (p = 0.01) were significantly associated with a worse CSS. Comorbidity level (KFI ≥ 2; p = 0.01) and N stage (≥ 2; p = 0.02) were significantly associated with worse swallowing outcomes. In selected locally advanced HC patients, an ICT-based therapeutic strategy offers acceptable oncologic and functional outcomes. Patient age, N stage and comorbidity level are the main determinants of oncologic and functional outcomes.

Abstract Background: Health-related quality of life (HRQoL) is an important outcome in oncology. In our previous work, the specific questionnaire to evaluate the HRQoL for thyroid cancer, the THYCA-QoL, has been translated into French. In this work we aimed to validate the psychometric properties of the French version of the THYCA-QoL questionnaire (F-THYCA-QoL). Methods: The F-THYCA-QoL is composed of 24 items and is divided into 7 dimensions and 6 single items. The F-THYCA-QoL and QLQ-C30 of the European Organisation for Research and Treatment of Cancer (EORTC) were mailed to thyroid cancer patients undergoing surgery. Data from responders obtained was used to test acceptability, reliability and validity of the F-THYCA-QoL questionnaire. Results: Among contacted patients, 280 patients of the University Institute of Face and Neck of Nice responded to the questionnaire between January 2015 and January 2019. The low number of missing data (0.007%) showed a good acceptability of the questionnaire. Six of the 7 items exhibited a good internal consistency with a Cronbach’s alpha ≥ 0.70. No floor or ceiling effects were observed. Factorial validity was demonstrated for 5 scales out of 7, using a multitrait-multimethod analysis and an exploratory factor analysis. Criterion validity assessed between the F-THYCA-QoL and QLQ-C30 was satisfactory. Conclusion: The F-THYCA-QoL questionnaire is a reliable and valid assessment tool that used with the EORTC QLQ-C30 allows to evaluate the HRQoL of thyroid cancer patient in France.

OBJECTIVE:To assess long-term functional and quality of life (QoL) outcomes and their predictive factors in laryngectomized patients after successful voice restoration using tracheoesophageal prostheses (TEP). METHODS:This cross-sectional study was conducted in alive and disease-free patients at least 1 year after total laryngectomy ± partial pharyngectomy. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) Core (QLQ-C30) and Head and Neck Cancer (QLQ-H&N35) QoL questionnaires, the Voice Handicap Index (VHI-10) questionnaire and the Hospital Anxiety and Depression Scale (HADS). The level of dysphagia was evaluated using the Dysphagia Handicap Index (DHI) and the Dysphagia Outcomes and Severity Scale (DOSS). Predictive factors of these clinical outcomes were determined in univariate and multivariate analysis. RESULTS:A total of 48 patients were included in this study. Long-term QoL and functioning scales scores were all superior to 70%. Main persistent symptoms were fatigue, dyspnea, senses, speech and coughing problems. A DOSS score ≥6, indicating normal/subnormal swallowing function, and a VHI-10 score ≤20, representing light to medium voice disorders, were found in at least 75% of patients. An anxiodepressive disorder (HADS global score ≥ 15) was reported by 15 (31%) patients and represented the main predictor of QoL and voice outcomes. A strong correlation was found between VHI-10 and global QoL scores. CONCLUSIONS:After successful voice restoration, laryngectomized patients achieved satisfactory QoL and functional outcomes. Psychological distress was the main determinant of long-term QoL and is therefore of critical importance in the multidisciplinary management of laryngectomized patients.

Introduction > The aim of this study was to translate into French the 24 items of the THYCA-QoL questionnaire used in thyroid cancers and then to study its psychometric properties. Materials and methods > The THYCA-QoL is a specific questionnaire for evaluating the quality of life of patients undergoing thyroid cancer surgery. It consists of 24 items and is divided into seven dimensions and six isolated questions. The translation hos been carried out according to the recommendations of the EORTC. Validation of the translated version was obtained by finding a consensus of experts for each of the items. Results > All the original questions of the questionnaire have been adapted into French. The translated questionnaire, named THYCA-Cot-fr, was tested on 60 patients (65 % female), mean age 54.5 years. All questions were well accepted and understood and no missing data were reported. Eight patients (13 %) proposed an item correction to the questionnaire. No attenuation effects (floor or ceiling) were detected. The internal structure was comparable to the original questionnaire: Cronbach alpha coefficients varied from 0.53 for the oropharyngeal dimension to 0.88 for the voice dimension. The scree-plot highlighted the seven dimensions of the English version. Conclusion > THYCA-QoL-fr is the first specific French language questionnaire to evaluate the quality of life in thyroid cancer patients undergoing surgery. These first exploratory psychometric results confirmed the conceptual similarity of the French translation and the English version.

Le but de cette étude était de traduire en français les 24 items du questionnaire THYCA-QoL évaluant la qualité de vie des patients atteints de cancers de la thyroïde puis d’en étudier les propriétés psychométriques. Le THYCA-QoL est un questionnaire spécifique d’évaluation de la qualité de vie des patients opérés d’un cancer de la thyroïde. Il se compose de 24 items (sept dimensions et six questions isolées). La traduction a été réalisée selon les recommandations de l’EORTC. Pour chaque item, la validation de la version traduite, a fait l’objet d’un consensus d’experts. Toutes les questions originales du questionnaire ont pu être adaptées en français. Le questionnaire traduit, nommé THYCA-QoL-fr, a été testé sur 60 patients (65 % de femmes) d’âge moyen 54,5 ans. Les questions ont été bien acceptées et comprises, aucune donnée manquante n’a été reportée. Huit patients (13 %) ont proposé une modification d’un item du questionnaire. Aucun effet de saturation (planché, plafond) n’a été détecté. La structure interne était comparable à celle du questionnaire original. Les coefficients α de Cronbach variaient de 0,53 pour la dimension oro-pharyngée à 0,88 pour la dimension vocale. Le diagramme des valeurs propres mettait en évidence les sept dimensions de la version originale. THYCA-QoL-fr est le premier questionnaire spécifique d’évaluation de la qualité de vie des patients opérés d’un cancer de la thyroïde en langue française. Les premiers résultats psychométriques exploratoires confirment la similarité des qualités psychométriques de cette adaptation française du THYCA-QoL. The aim of this study was to translate into French the 24 items of the THYCA-QoL questionnaire used in thyroid cancers and then to study its psychometric properties. The THYCA-QoL is a specific questionnaire for evaluating the quality of life of patients undergoing thyroid cancer surgery. It consists of 24 items and is divided into seven dimensions and six isolated questions. The translation has been carried out according to the recommendations of the EORTC. Validation of the translated version was obtained by finding a consensus of experts for each of the items. All the original questions of the questionnaire have been adapted into French. The translated questionnaire, named THYCA-CoL-fr, was tested on 60 patients (65 % female), mean age 54.5 years. All questions were well accepted and understood and no missing data were reported. Eight patients (13 %) proposed an item correction to the questionnaire. No attenuation effects (floor or ceiling) were detected. The internal structure was comparable to the original questionnaire: Cronbach α coefficients varied from 0.53 for the oropharyngeal dimension to 0.88 for the voice dimension. The scree-plot highlighted the seven dimensions of the English version. THYCA-QoL-fr is the first specific French language questionnaire to evaluate the quality of life in thyroid cancer patients undergoing surgery. These first exploratory psychometric results confirmed the conceptual similarity of the French translation and the English version.

Objectives To assess patient needs and concerns after head and neck squamous cell carcinoma (HNSCC) treatment and their possible correlations with long-term quality of life (QoL) and to examine the potential impact of psychological distress on these results. Methods Alive and disease-free HNSCC patients at least 1 year after treatment were enrolled in this cross-sectional multicentric study and completed the EORTC QLQ-C30 and H&N35 QoL questionnaires, the head and neck cancer-specific patient concerns inventory (PCI-HN) questionnaire and the hospital anxiety and depression scale (HADS). Correlations between QoL outcomes and patient needs and concerns were investigated using Spearman’s correlation tests. Results Seventy-two patients were enrolled in the study. Fear of cancer recurrence was the main patient concern followed by dental, salivary, fatigue, speech, and eating problems. The leading patient needs in terms of consultation were to be referred to the surgeon, the speech, and swallow therapist and the oral rehabilitation team. The number of patient concerns correlated negatively ( r < .40) with functioning scales score and positively ( r > .40) with general and head and neck symptoms. Psychological distress was the main determinant of QoL outcomes ( p < .0001). We found a significant impact of gender ( p = .002) on the number of patient concerns, and of patient age ( p = .003) on the number of staff members selected by patients. Conclusion Identification of patient needs and concerns along with multidisciplinary management of persistent symptoms and psychological distress seem essential steps towards improving QoL of HNSCC patients.

INTRODUCTION:The proportion of elderly patients with head and neck cancer is increasing. However, predictive factors of postoperative outcomes are insufficiently explored in this population. In this study, we aimed to determine predictive factors of postoperative outcomes in elderly patients undergoing head and neck free-flap reconstructive surgery in order to determine criteria on which patient selection could be based. METHODS:All patients aged 65 years or over who underwent head and neck free-flap reconstructive surgery at our institution, between 2000 and 2016, were included in this retrospective study. Predictive factors of postoperative outcomes were investigated in uni- and multivariate analysis. RESULTS:Two-hundred patients were included in the study. Older age (>70, >75 or > 80 yrs) had no significant impact on postoperative outcomes. Free flap failure local and general complications rates were 11%, 34% and 43%, respectively. Oromandibular reconstruction (p = 0.04) was significantly associated with free flap failure and salvage surgery (p = 0.04) with local complications. A high comorbidity level (Charlson Comorbidity Index score ≥ 4; p = 0.02) was associated with a higher risk of general complications. A G8 (Geriatric 8 questionnaire) score < 15 (p = 0.004), a high comorbidity level (Kaplan-Feinstein Index score ≥ 2; p = 0.04) and oromandibular reconstruction (p = 0.04) were associated with poor swallowing function at 6 months. CONCLUSION:Head and neck free flap reconstruction should be offered to fit (G8 score ≥ 15) elderly patients without severe comorbidities (KFI < 2 or CCI < 4), particularly when oral/pharyngeal soft-tissue reconstruction is planned.

La qualité de vie est un sujet très important dans la prise en charge des cancers de la thyroïde, d'où la nécessité d'un instrument de mesure valide. Le but de cette étude était de traduire en français les 24 items du questionnaire THYCA-QoL utilisé dans les cancers de la thyroïde et ensuite de valider les propriétés psychométriques de l'instrument dans une population de patients français. La première étape fut de faire traduire en français la version originale anglaise par deux personnes de langue maternelle française, puis de réaliser une rétro-traduction avec deux personnes de langue maternelle anglaise. Nous avons ensuite soumis le questionnaire traduit à un groupe pilote afin de corriger la version initiale pour obtenir une version finale claire et compréhensible après conciliation. Les propriétés psychométriques de l'instrument sont en cours de validation (analyse des items, étude de la structure dimensionnelle (diagramme des valeurs propres, analyse factorielle, matrice multitrait–multiméthode), consistance des dimensions (coefficient alpha de Cronbach), test de la validité convergente/divergente. Nous avons effectué une revue de la littérature et contacté l'auteur principal du questionnaire THYCA-QoL pour d'une part, s'assurer qu'il n'existait pas de version française de ce questionnaire, ou en cours de traduction. Et d'autre part, obtenir son autorisation de disposer et de travailler sur ce questionnaire de qualité de vie. Nous avons revu dans le détail l'ensemble des questions traduites pour bien saisir le sens de chacune et éviter toute erreur de traduction ou de perte du sens propre de la question d'une culture à une autre. Nous avons testé la traduction sur un groupe pilote d'une quinzaine de personnes afin de mettre en évidence des potentiels problèmes de compréhension. Puis nous validerons la version finale sur une cohorte multicentrique de patients atteints de cancer de la thyroïde. La version française du questionnaire THYCA-QoL est traduite. Dans un second temps, nous allons valider les propriétés psychométriques de notre questionnaire chez un groupe de patients français opérés d'un cancer de la thyroïde. Les résultats définitifs seront présentés dans la version finale de cette communication.