Abstract
Objectives:
The number of citations an article receives is an important indication of its impact. The main objectives of this investigation provide readers with a practical guide in evaluating head and neck oncology literature and determine the characteristics of trends in ORL.
Methods:
This was a retrospective bibliometric analysis that did not involve human participant. The Thomson Reuters Web of Science was searched to determine the citations of all published HNO articles. Most cited 300 article analyzed and a total of 100 articles were included in our investigation under the topic search “Head AND NECK AND (cancer OR carcinoma OR oncology).” Articles include malignancies other than head and neck are excluded. The top 100 cited articles were selected and analyzed by 2 independent investigators. Country, Institution, First Author, Journal name, study design, cites per year information gathered and analyzed.
Results:
The journal with the highest number of top 100 cited articles was New England Journal Of Medicine with 19 paper, followed by The Journal of Clinical Oncology(17) and Cancer Research (12). The top article on the list (Radiotherapy plus cetuximab for squamous cell carcinoma of the head and neck-NEJM) has 2243 citations. A statistically significant association was found between the journal impact factor and the number of top 100 cited articles (
Conclusion:
Our analysis provides an insight into the citation frequency of top cited articles published in HNO to help recognize the quality of the works, discoveries and the trends steering the study of HNO. This is also a modern reading list for young HNO scientist.
Introduction
The incidence and prevalence rates of head and neck cancers have been increasing over recent decades. Our experiences with head and neck cancers remain limited, and the indications for surgery or choices of treatment like chemotherapy and radiotherapy are still controversial. Every year a sizable number of articles about head and neck cancers are published, but only a small number of them become well established in the literature. For that reason, bibliometric studies are important tools for understanding trending topics relating to different specialties over the years.
Citation analysis has been widely used for evaluating the academic importance of an article. Bibliometric studies examine the frequency and patterns of citations in articles. The number of times an article is cited provides useful information for evaluating its influence in the field. The greater the number of times an article is cited, the greater the effectiveness and validity we can surmise that the article and its authors have contributed.
The purpose of this article is to identify the 100 most cited articles about head and neck oncology published over the years and to analyze the characteristics of these articles, as to number of citations, citation density, authors, country of origin, institution, journals, topic, and the like. The main objective of this investigation is to provide readers a practical guide for evaluating head and neck oncology literature and help them determine the factors that generate high citation numbers. This will be the first bibliographic study to address head and neck oncology papers according to their ranking by citation numbers.
Material and Methods
In March 2017, ISI Web of Science (Thompson Reuters), a research platform that provides bibliographic database services and ranks journals according to impact factor, was used to search for papers using the search topics “head
The results from 50 629 papers were organized from most cited to least. The first 300 articles were analyzed, and 179 articles related to cancers in regions other than head and neck (nasopharynx, oral cavity, oropharynx, pharynx, hypopharynx, larynx) were excluded from the study. The 100 articles with the highest numbers of the 111 head and neck related articles were included in this study.
The top 100 cited articles were thus selected and analyzed by 2 independent investigators who read the abstracts. The articles were analyzed, and the authors’ country, the publication date, journal name, institution, first and senior authors, study design, or research type (clinical experience, clinical review, meta-analysis, case report, original article) and the total number of citations and citations per year (citation density) were gathered. Either one or more of the major topics of the papers were categorized (radiotherapy, human papillomavirus [HPV], surgery, epidemiology, molecular, survival prognosis, quality of life, and chemotherapy).
Results
The overall number of citations of the top 100 articles ranged from 339 to 2464. The publication years of the top 100 articles spanned from 1980 to 2011, the earliest paper being by Swenberg et al 1 and the most recent, published in November 2011, by Chaturvedi et al. 2 The majority of the articles were published from 1992 to 2008 (87), and only 8 articles were published after 2010 (Table 1).
Top 100 List of Most Cited Papers in HNO.
The 2010s had the greatest mean number of citations per publication (816.6), followed by the 2000s (679.3). Most citations were made after 2010 with 38 106 total, despite only 7 years being included, whereas in the 2000s there were 23 281 citations in those 10 years. Citation density averages of the 2010s were found to be 127.3, and in other decades the averages found were 57.1 in the 2000s, 27.1 in the 1990s, and 11.2 in the 1980s (Figure 1).
Distribution of citation density of papers by publishing year.
The articles were mostly nonspecific as to tumor site (73%), with oropharynx being the most common tumor site in the list (with 9 papers), followed by nasopharynx (n: 7), oral cavity (n: 7), larynx (n: 3), and hypopharynx (n: 1). The predominant topic was survival and prognosis (61), followed by chemotherapy (48) and radiotherapy (36). The other topics of papers in this study were epidemiology (30%), quality of life (23), HPV (13), and surgery (9).
All articles in the top 100 were written in English. The top 100 papers were published in 22 journals, with the top 5 journals publishing 65% of the articles. Most of the articles were published in the New England Journal of Medicine, with 19 papers, followed by the Journal of Clinical Oncology (17) and Cancer Research (12) (Table 2).
Top Journals of Publication.
Articles originated from 14 countries. The number of articles by country of origin was led by the United States with 63 papers, followed by France (n = 9), China (n = 5), Belgium (n = 5), Switzerland (n = 3), and Germany (n = 3; Figure 2). There were 62 institutions responsible for the top cited papers, with Johns Hopkins University accounting for the most papers—15 publications in the top 100, followed by Duke University (4) and the University of Michigan (4). The other 5 institution contributed 3 publications each (Table 3).
Distribution of the articles by countries.
Top Institutions of Origin of Papers.
Eighty-one first authors contributed to the top 100 papers. Fifteen authors contributed more than once, 2 of whom were credited with 3 publications each, and only 1 author, Brizel et al, had 4 publications in the top 100.
Within the 100 articles, there were 94 clinical studies and 6 basic studies. One of 6 basic studies was an animal study about cancer stem cells 11 ; the rest are in vitro experiments.
When the articles are ranked by citation density (total number of citations/years since publication), Ang et al are at the top of the list with their paper about HPV and survival 4 (236.2), followed by Bonner et al 3 (224) and Stransky et al 20 (144.8). Of the top 10 most densely cited articles, 3 of them were published in 2011 and the most recent article was in fourth place (Table 4).
Top 10 Articles With Highest Citation Density Rank.
Discussion
The number of times an article is cited shows the effect of the article on that scientific field. Although number of citations is not the perfect way of gauging a paper’s quality or its contribution to current knowledge, it is an obvious indicator of being read and mentioned in the scientific field. This kind of bibliographic analysis also serves as a modern reading list for junior scientists and residents. 100
The most referenced study includes the evaluation of radiotherapy and the effectiveness of cetuximab on locoregionally advanced squamous cell carcinoma of the head and neck. In this study, Bonner noted that radiotherapy plus cetuximab therapy has a longer duration of control of locoregional disease and prolonged overall survival rates, as compared with patients treated with radiotherapy alone. 3
The second most referenced study published by Ang et al evaluates the effect of HPV status on the survival rates of patients with oropharyngeal cancers. The study reveals that HPV status is a strong and independent prognostic factor for survival among patients with oropharyngeal cancer. 4 The third most cited paper was the meta-analysis of updated data on individuals with the addition of chemotherapy to the locoregional treatment of head and neck squamous cell carcinomas. According to the publication of Pignon, meta-analysis showed only a small but statistically significant survival benefit in favor of chemotherapy; routine use of chemotherapy is controversial. 5
The majority of the articles (n: 63) originated from the United States. The United States being the most productive country among most cited articles is consistent with the literature in other fields, including anesthesia, spine surgery, plastic surgery, and bariatric surgery.101-104 It can be easily speculated that authors from the United States have a better chance of being cited than other authors. The United States has a strong influence on research in the health sciences; this can be attributed to greater financial opportunities for research and scientists in health sciences.
Moreover, Johns Hopkins University, the University of Michigan, and Duke University are the 3 leading institutions in the 100 most cited articles list; this correlates with the United States’ leading position in the field.
Evaluation of the top 100 articles by decade shows considerable differences among decades with respect to citation numbers and citation density. In this study, the majority of the articles published were in the 1990s (n: 35) and 2000s (n: 56).
All of the 100 articles were published in 22 journals and nearly half of them (n: 48) were published in 1 of 3 journals: the New England Journal of Medicine (n: 19), the Journal of Clinical Oncology (n: 17), and Cancer Research (n: 12). High impact journals are attractive to authors for submission of their papers. Publishing in these journals ensures a larger number of citations, and this keeps the impact factor of these journals high. This situation is mentioned in other bibliometric studies and is known as Bradford’s law. 105
Most of the papers in the top 100 articles are not site-specific (73%). Head and neck cancers have a similar histologic type and characteristics of disease. Besides that, researchers who address more than one tumor site have a better chance of being cited more often.
The most common topic was survival and prognosis. It was expected to dominate in an oncologic bibliographic study. Articles on treatment modalities concerning nonsurgical therapies like chemotheraphy and radiotheraphy had an obvious superiority over surgery related papers. Significant improvements have been made in radiotherapy and chemotherapy treatment of head and neck tumors in recent decades, which had an impact on publications. 106
We also looked at citation density, which could be related to how a paper is trending. Our list is not comprehensive for papers with the highest citation density, but the authors believe that sharing citation density with the total citation count is more relevant for demonstrating the impact of papers in the list. The increase of average citation density by decade also shows the effect of advancements in internet access all around the world. Accessibility to the electronic format of articles gets easier all the time, so that circulation of these articles through the scientific community can reach unexpected levels.
It may appear surprising that the studies with the largest number of citations are recent studies; among other factors, this could be attributed to the appearance of scientific journals in electronic format, facilitating access and thus favoring circulation in the scientific community.
Being cited more is not always related to the quality of the paper, but it is a measure of the paper’s impact and/or visibility in the field. 107 Besides a paper’s contribution to current knowledge, there are other factors affecting the frequency a paper will be cited. Self-citation, traction of the topic, and the prestige of the publishing journal can be factors influencing the number of times papers are cited. 108 In the literature, it is argued that having a multidisciplinary team of authors increases the visibility of papers and thereby increases the chance of being presented more and being cited in the different disciplines. 109 Each instance of being cited increases the frequency of citations by increasing the visibility of the research.
Conclusion
To our knowledge, this study is the first to identify the 100 most cited papers in the literature on head and neck cancers. Our analysis provides a summary of the most influential studies on head and neck cancers and highlights areas of research that require further investigation and development.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
