The presence of tumor-infiltrating lymphocytes (TIL) is increasingly recognized as an important biomarker in head and neck squamous cell carcinoma (HNSCC). Consistent observations using a variety of techniques show that higher levels of T cells in the tumor microenvironment (TME) are associated with improved outcomes.^1-5 Since the discovery of subpopulations of TILs in the 1980s, understanding of the location, functional activity, and cell types has expanded.⁶ Although TILs appear to have some prognostic value in HNSCC, their usefulness as a biomarker to determine treatment type, or impact on outcome in heterogeneous head and neck cancer subsites (oral cavity, oropharynx, larynx) has yet to be elucidated. Thus, a more accurate analysis of the potential benefit of assessing microenvironment T-cell infiltrates requires a homogenous sample of large numbers of patients with tumors of similar site with detailed information regarding other prognostic clinical characteristics, treatment regimens, and specific outcomes. Furthermore, a better understanding of TILs as a biomarker is a necessary prerequisite for improving individualized treatment that limits the intensity and morbidity of conventional treatment, and may be useful in advancing the introduction of new immunotherapy regimens.

Objective: To determine the predictors of success in patients undergoing transoral robotic surgery (TORS) and multilevel procedures for the management of moderate-to-severe obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: A total of 121 patients (83 male, 38 female) underwent TORS between 2010 and 2013. All patients had robotic assisted lingual tonsillectomy, either as stand-alone surgery or in combination with palatal Z-plasty, lateral pharyngoplasty or uvulopalatopharyngoplasty. The apnea-hypopnea index (AHI) and body mass index (BMI) were measured preoperatively and 3 months postoperatively. Success was defined as AHI <20 and a decrease in AHI by 50%. Results: There was a significant difference in the preoperative and postoperative AHI in the entire cohort (42.7 vs. 22.2; p < 0.001). Overall, 84.3% of patients had an improvement in their AHI, 51.2% of patients met the criteria for success, and 14% met the criteria for cure defined as AHI <5. When stratifying by BMI, there was a significant difference in success when comparing patients with a BMI 30 (69.4 vs. 41.7%; p = 0.004). The cure rate was 15.3% in patients with a BMI 30 (p = 0.54). Conclusions: TORS lingual tonsillectomy and multilevel procedures were successful in treating moderate-to-severe OSAHS in selected patients. Preoperative BMI helps the clinician to predict success in these patients, with two thirds of patients having a clinically useful benefit. i 2014 S. Karger AG, Basel