Purpose/Objective(s) Reports are conflicting regarding impact of prophylactic PEG tube placement in head and neck cancer patients; we add to the paucity of literature of risk factors for long term PEG tube placement and weight loss in this patient cohort. The objective is to evaluate the impact of prophylactic PEG tube and risk factors for long term PEG tube placement and weight loss in patients undergoing treatment of head and neck cancer Materials/Methods This retrospective study included a total of 502 patients with head and neck cancer who were treated at a single institution. Univariate analyses, such as logistic regression or Cox regression, were performed to determine risk factors for long term PEG tube and weight loss. Outcomes that were significantly associated with prophylactic PEG were selected for a multivariate analysis. The Kaplan-Meier method was used to estimate the time to PEG completion, which was compared between acute and late PEG groups using log-rank tests. The proportion of patients who did not receive acute PEG, but received late PEG was estimated using exact binomial confidence interval. Results Of the 502 patients examined, median overall survival was measured to be 65.8 months, with a 95% confidence interval of 45.9 – 94.3. Progression free survival, which was measured to be the time from diagnosis to local/distant failure, or death, was found to have a median of 42.5 months, with a 95% CI of 31.9 – 64.6. The univariate analysis suggests higher risk of long-term feeding tube in patients received prophylactic PEG tube (p < 0.0001), with higher age (p = 0.0165), and with a cancer site of larynx compared to sites other than pharynx and lip/oral cavity (p = 0.0364). Multivariate tests confirmed that prophylactic PEG tube and the higher age are significantly associated with higher risk of long-term feeding tube, with p < 0.0001 and p = 0.0082, respectively. For weight loss, univariate analysis suggests patients tend to have higher percentage of weight loss if they did not receive prophylactic PEG tube (p < 0.00001) or they are in the lower age (p = 0.0034). In addition, patients also tend to have higher weight loss if they received CCRT treatment relative to Surgery + CCRT (p < 0.0001). Mostly consistent with the univariate analysis, the multivariable analysis suggests no prophylactic PEG tube (p < 0.00001), lower age (p = 0.0032), and surgery + CCRT treatment (p = 0.0005) were found to be significantly associated with higher weight loss. Prophylactic PEG tube was not found to be associated with quality-of-life overall health overall survival, or progression-free survival on univariate analysis. Conclusion This retrospective study found that prophylactic PEG tube and higher age are significantly associated with higher risk of long-term feeding tube. Lower age, no prophylactic PEG tube, and surgery + CCRT treatment were found to be significant associated with higher weight loss. Future studies are necessary to further elucidate optimizing weight loss and outcomes in this tenuous patient population.

Purpose/Objective(s) Recent systematic reviews suggested that hemoglobin (Hgb) level may play a role as biomarker for survival outcome among patients with head and neck cancer. However, the optimal threshold for anemia and its role in a current human papillomavirus (HPV) era remain unclear. To address this knowledge gap, we performed an observational cohort study to investigate pre-treatment Hgb and its association with survival outcomes in patients with head and neck cancer treated with radiation therapy. Materials/Methods A single-institution, retrospective database was queried for patients with non-metastatic head and neck cancer who underwent radiation therapy from January 2005 to April 2021. Pre-radiation Hgb was evaluated as a continuous variable using restricted cubic splines (RCS), and the model-derived threshold was used to stratify patients into low and high Hgb. Cox multivariable analysis (MVA) and Kaplan-Meier method were used to analyze overall survival (OS) and disease-specific survival (DSS). Logistic MVA was performed to identify variables associated with low Hgb level. Propensity score matching was used to construct matched pairs. A subgroup analysis was also performed among patients with available HPV data. Results Among a total of 753 patients, median follow up was 29.7 months (interquartile range 17.8-57.8). Cox MVA based on RCS showed a threshold of Hgb at 12.96, with worsening survival in a continuous fashion without plateau as Hgb decreases. Low Hgb was associated with worse OS (aHR 1.55, 95% CI 1.17-2.05, p=0.002) and DSS (aHR 1.79, 95% CI 1.28-2.51, p<0.001). Similar findings were observed in 178 matched pairs (OS: HR 1.47, 95% CI 1.05-2.06, p=0.03; DSS: HR 1.82, 95% CI 1.19-2.78, p=0.006). On logistic MVA, patients were more likely to have low Hgb if they were female, had a higher T staging, underwent induction chemotherapy or surgery prior to radiation therapy, and had feeding tubes placed. They were less likely to have low Hgb if they had a good performance status and HPV-associated head and neck cancer. Among 466 patients with available HPV data, low Hgb was associated with DSS (aHR 1.84, 95% CI 1.30-2.61, p<0.001), but not OS (aHR 1.32, 95% CI 0.89-1.95, p=0.16). Conclusion In this study, low Hgb was associated with worse survival outcomes even among those with available HPV data. Patients with significant primary disease burden, feeding tube placement, and poor performance status who underwent either induction chemotherapy or surgery were more likely to have low Hgb. Further studies would be warranted to investigate the role of Hgb to identify patients early with poor prognosis and tailor treatments based on their risk factors. Recent systematic reviews suggested that hemoglobin (Hgb) level may play a role as biomarker for survival outcome among patients with head and neck cancer. However, the optimal threshold for anemia and its role in a current human papillomavirus (HPV) era remain unclear. To address this knowledge gap, we performed an observational cohort study to investigate pre-treatment Hgb and its association with survival outcomes in patients with head and neck cancer treated with radiation therapy. A single-institution, retrospective database was queried for patients with non-metastatic head and neck cancer who underwent radiation therapy from January 2005 to April 2021. Pre-radiation Hgb was evaluated as a continuous variable using restricted cubic splines (RCS), and the model-derived threshold was used to stratify patients into low and high Hgb. Cox multivariable analysis (MVA) and Kaplan-Meier method were used to analyze overall survival (OS) and disease-specific survival (DSS). Logistic MVA was performed to identify variables associated with low Hgb level. Propensity score matching was used to construct matched pairs. A subgroup analysis was also performed among patients with available HPV data. Among a total of 753 patients, median follow up was 29.7 months (interquartile range 17.8-57.8). Cox MVA based on RCS showed a threshold of Hgb at 12.96, with worsening survival in a continuous fashion without plateau as Hgb decreases. Low Hgb was associated with worse OS (aHR 1.55, 95% CI 1.17-2.05, p=0.002) and DSS (aHR 1.79, 95% CI 1.28-2.51, p<0.001). Similar findings were observed in 178 matched pairs (OS: HR 1.47, 95% CI 1.05-2.06, p=0.03; DSS: HR 1.82, 95% CI 1.19-2.78, p=0.006). On logistic MVA, patients were more likely to have low Hgb if they were female, had a higher T staging, underwent induction chemotherapy or surgery prior to radiation therapy, and had feeding tubes placed. They were less likely to have low Hgb if they had a good performance status and HPV-associated head and neck cancer. Among 466 patients with available HPV data, low Hgb was associated with DSS (aHR 1.84, 95% CI 1.30-2.61, p<0.001), but not OS (aHR 1.32, 95% CI 0.89-1.95, p=0.16). In this study, low Hgb was associated with worse survival outcomes even among those with available HPV data. Patients with significant primary disease burden, feeding tube placement, and poor performance status who underwent either induction chemotherapy or surgery were more likely to have low Hgb. Further studies would be warranted to investigate the role of Hgb to identify patients early with poor prognosis and tailor treatments based on their risk factors.

IMPORTANCE Given the role of inflammation in cancer progression, neutrophil-lymphocyte ratio (NLR) from peripheral blood has been suggested as a readout of systemic inflammation and a prognostic marker in several solid malignant neoplasms. However, optimal threshold for NLR in US patients with head and neck cancer remains unclear. OBJECTIVE To evaluate the optimal NLR threshold as a potential prognostic biomarker for survival outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted at a single institution. Participants included 496 patients with nonmetastatic head and neck cancer who underwent chemoradiation from April 2007 to March 2021. Statistical analysis was performed from September to December 2021. EXPOSURES High vs low NLR. MAIN OUTCOMES AND MEASURES Overall survival (OS) and cancer-specific survival (CSS). RESULTS A total of 496 patients (411 male patients [82.9%]; 432 White patients [87.1%]; 64 patients with other race or ethnicity [12.9%]; median [IQR] age, 61 [55-67] years) were identified. Median (IQR) follow-up was 44.4 (22.8-74.0) months. Thresholds of NLR for both OS and CSS were 5.71. High NLR above 5.71 was associated with worse OS (adjusted hazard ratio [aHR], 1.97; 95% CI, 1.26-3.09; P = .003) and CSS (aHR, 2.33; 95% CI, 1.38-3.95; P = .002). On logistic multivariable analysis, patients were more likely to have high NLR if they had higher T and N staging (T3-4: aOR, 4.07; 95% CI, 1.92-9.16; P < .001; N2: aOR, 2.97; 95% CI, 1.04-9.17; P = .049; N3: aOR, 11.21; 95% CI, 224-46.97; P < .001), but less likely if they had a good performance status (Karnofsky Performance Status 90-100: aOR, 0.29; 95% CI, 0.14-0.59; P < .001). Among 331 patients (66.7%) with available human pa pilloma virus (HPV) data, high NLR was not associated with OS (HPV-negative: aHR, 2.46; 95% CI. 0.96-6.31; P = .06; HPV-positive: aHR, 1.17; 95% CI, 0.38-3.56; P = .78) and CSS (HPV-negative: aHR, 2.55; 95% CI, 0.81-7.99; P = .11; HPV-positive: aHR, 1.45; 95% CI, 0.44-4.76; P = .54). CONCLUSIONS AND RELEVANCE High NLR was associated with worse survival. Patients with substantial disease burden and poor performance status were more likely to have high NLR. These findings suggest that further studies would be warranted to investigate the role of such prognostic marker to identify patients at risk to tailor interventions.

This article presents the academic qualifications of matriculating dental students (as indicated by overall undergraduate GPA, undergraduate science GPA, average DAT scores, and average PAT scores) and total cost of education for students at U.S. dental schools according to geographic location and funding sources. Dental schools were divided on the basis of geographic location (Northeast, South, Central, or West) and principal means of funding (public versus private). Average four-year total educational expenses as reported in the 1996-97 and 2000-01 matriculation years were compared as well as undergraduate overall GPA, science GPA, DAT academic average, and PAT score. Public dental schools in the southern region cost significantly less than any other region of any funding type. Public dental schools in the western region had significantly higher average GPA, average science GPA, DAT academic average, and PAT scores among their matriculating classes than did any other region. Public dental schools from the western region also had the least amount of increase in projected four-year expenses between the two matriculation years compared. Excluding PAT scores, western public dental schools had the highest academic admission criteria of any region of either funding type.