Oral cavity and oropharyngeal cancer in a younger population. Review of literature and experience at Yale

Invasive Oral Squamous Cell Carcinoma Mimicking a Dentoalveolar Abscess: Report of a Case in a 14-Year-Old Patient

INTRODUCTION

A diagnosis of oral squamous cell carcinoma in adolescent patients is extremely rare. When an oral squamous cell carcinoma lesion arises near the teeth and/or periodontium, it can be easily misdiagnosed as an inflammatory condition of endodontic or periodontal origin.

METHODS

This is a case report of an otherwise healthy 14-year-old patient who was referred for endodontic evaluation and treatment of a soft-tissue swelling in the anterior maxilla.

RESULTS

The unexpected definitive diagnosis of invasive oral squamous cell carcinoma underscores the importance of proper diagnostic testing.

CONCLUSIONS

Accurate interpretation of pulp testing results, periapical and cone beam computed tomography imaging, timely biopsy, and prompt definitive treatment are critical when a lesion of nonodontogenic origin is suspected.

High incidence of HPV infection in minors with oral squamous cell carcinoma

BACKGROUND

Oral squamous cell carcinoma in minors is considered to be a distinct entity from OSCC in older patients, with an uncertain etiology. Human papillomavirus (HPV) infection may trigger the initiation and promote the progression of OSCC, but these roles have not been firmly established.We aimed to explore the correlation between HPV infection and the development of oral squamous cell carcinoma in minors and know the characteristics of OSCC in young patients more thoroughly.

METHOD

From January 2013 to December 2022,6 cases of OSCC aged < 15 years were selected from the Department of Oral Pathology, Peking University School of Stomatology, Beijing, China. All cases underwent testing for high-risk HPV mRNA infection using the RNA scope technique, and immunohistochemical staining was performed to investigate the expression of p16, pan-cytokeratin (CK), CK5/6, CK7, CK8/18, epidermal growth factor receptor (EGFR), p53, and Ki-67. Furthermore, we reviewed the literature on OSCC in patients aged < 21 years.

CONCLUSIONS

Minors OSCC is associated with HPV infection, and that p16 can serve as an immunohistochemical marker of HPV positivity.

Second Primary Metachronous Malignancies Occurring in Oral Cavity of Young Adult-A Case Report

The incidence of oral cancer in Japan is increasing. Interestingly, the number of young patients with oral cancer is also rising. A 19-year-old man with no history of smoking or drinking alcohol presented with a 20×15-mm elastic, hard, protruding mass with a white surface on the right-hand margin of the tongue. A biopsy resulted in a diagnosis of a well-differentiated squamous cell carcinoma of the tongue, for which a partial resection was subsequently performed. During regular follow-up, the patient demonstrated no clinical or imaging abnormalities until 4 years and 9 months later, when erosion was observed at the right palatoglossal arch. A malignant tumor of the right palatoglossal arch was diagnosed based on cytology and imaging findings, and total resection of the lesion performed. Histopathological examination of the resected lesion revealed a moderately differentiated squamous cell carcinoma. Epithelial dysplasia on the right-hand margin of the tongue was diagnosed 4 years and 9 months after the second surgery and was subsequently resected. The patient's condition has been favorable for 7 years since the diagnosis of the second cancer, with no noted recurrence. This case emphasizes the importance of follow-up after initial treatment, as even young people, who are likely to have to endure long-lasting consequences from treatment, can develop metachronous cancer in the oral cavity.

[Survival of young adults with oral squamous cell carcinoma in a brazilian population]

OBJECTIVE

To analyze the profile and survival in young adults with oral squamous cell carcinoma, attended at the High Complexity in Oncology of Feira de Santana, Brazil, between 2010 and 2016.

METHODS

Retrospective cohort, performed through the information of the medical records of all young patients attended in the referred center. Descriptive analysis of the variables, Fisher's exact test, Kaplan-Meier curve and log-rank test were performed.

RESULTS

A total of 35 patients were registered. The majority were male, smokers and former alcoholics. Tumors were predominantly localized in the tongue, diagnosed at late stages, classified as well differentiated and treated mainly with surgery associated to radiotherapy and chemotherapy. The median survival time was 31 months and 22.8% of the patients died. The variables that presented statistical significance in relation to the survival time were the tumor site and the type of treatment.

CONCLUSION

The profile and low survival time reflect the need for greater attention to the disease in this population.

Influence of Tumor Site on Survival in Young Patients with Head and Neck Squamous Cell Carcinoma

The number of patients under the age of 45 diagnosed with head and neck squamous cell carcinomas (HNSCC) is increasing, probably due to the incidence of oropharyngeal cancers. Comparisons of HNSCC in young and old patients regarding tumor site and survival in sample sizes of relevance are rarely published. The aim of the study was to analyze the differences in survival between age groups dependent on tumor site and the influence of oropharyngeal cancers on the rising rates of HNSCC in the young. The records of 4466 patients diagnosed with HNSCC were reviewed retrospectively. Patients younger than 45 years were divided further into four subgroups for specific age differences in the young. The influences of patient and clinicopathological characteristics on survival were assessed using Kaplan–Meier analyses. Among the patient cohort, 4.8% were younger than 45 years. Overall survival (OS) in these patients was better, with a 5-year OS of 66.1% (vs. 46.4%), while relapse-free survival (RFS) was better in the older patient population, with a 5-year RFS of 74.9% (vs. 68.1%). Decreased RFS in the young was found for advanced tumor stages and tumor sited at the larynx. Hypopharynx and advanced stages were independent risk factors for OS under 45 years. Overall, 44.4% of all HNSCC in patients under 30 years were nasopharyngeal cancers, and incidence decreased with age. The incidence of oropharyngeal cancers increased significantly with age. Better OS in the young may be explained by lower tumor and disease stages, whereas oropharyngeal tumors and HPV were not found to cause rising rates of HNSCC. Laryngeal malignancies in young patients might be related to an increased malignant potential and should, consequently, be treated as such.

Survival Outcomes in Oral Tongue Cancer: A Mono-Institutional Experience Focusing on Age

Objective

The prognostic role of age among patients affected by Oral Tongue Squamous Cell Carcinoma (OTSCC) is a topic of debate. Recent cohort studies have found that patients diagnosed at 40 years of age or younger have a better prognosis. The aim of this cohort study was to clarify whether age is an independent prognostic factor and discuss heterogeneity of outcomes by stage and treatments in different age groups.

Methods

We performed a study on 577 consecutive patients affected by primary tongue cancer and treated with surgery and adjuvant therapy according to stage, at European Institute of Oncology, IRCCS. Patients with age at diagnosis below 40 years totaled 109 (19%). Overall survival (OS), disease-free survival (DFS), tongue specific free survival (TSFS) and cause-specific survival (CSS) were compared by age groups. Multivariate Cox proportional hazards models were used to assess the independent role of age.

Results

The median follow-up time was 5.01 years (range 0–18.68) years with follow-up recorded up to February 2020. After adjustment for all the significant confounding and prognostic factors, age remained independently associated with OS and DSF (respectively, p = 0.002 and p = 0.02). In CSS and TSFS curves, the role of age seems less evident (respectively, p = 0.14 and p = 0.0.37). In the advanced stage sub-group (stages III–IV), age was significantly associated with OS and CSS with almost double increased risk of dying (OS) and dying from tongue cancer (CSS) in elderly compared to younger groups (OS: HR = 2.16 95%, CI: 1.33–3.51, p= 0.001; CSS: HR = 1.76 95%, CI: 1.03–3.01, p = 0.02, respectively). In our study, young patients were more likely to be treated with intensified therapies (glossectomies types III–V and adjuvant radio-chemotherapy). Age was found as a prognostic factor, independently of other significant factors and treatment. Also the T–N tract involved by disease and neutrophil-to-lymphocyte ratio ≥3 were independent prognostic factors.

Conclusions

Young age at diagnosis is associated with a better overall survival. Fewer younger people than older people died from tongue cancer in advanced stages.

A population-based study of the epidemiology of oral squamous cell carcinoma in the Netherlands 1989-2018, with emphasis on young adults

There has been an increasing trend in oral squamous cell carcinoma (OSCC) in patients under 45 years of age. The aim of this study was to evaluate the burden of OSCC in the Netherlands between 1989 and 2018 among young adults (age 20-34 years) when compared to adults (age 35-44 years), and to describe the burden in older groups as well, utilizing cancer registry data to characterize incidence patterns by age, sex, and risk factors. A total of 18,963 cases of OSCC were reported. The overall incidence rate, as measured by annual percentage change (APC), increased significantly from 1989 to 2010 by 1.3% per year (95% confidence interval (CI) 0.9-1.7%) but decreased thereafter by -0.9% (95% CI -2.5% to 0.7%). Annual incidence increased significantly by 2.4% (95% CI 1.1-3.8%) for patients aged 20-34 years, while it decreased for those aged 35-44 years by -0.9% (95% CI -1.7% to 0.0%). In patients older than 60 years, incidence rates increased overall (60-74 years: APC 1.8%, 95% CI 1.5-2.1%; ≥75 years: APC 1.5%, 95% CI 1.2-1.9%). Overall, 66.5% of patients were smokers and 65.3% were alcohol consumers. The marked differences in incidence within the young age subgroups warrants further investigation to elucidate any likely disparity in biological process and clinical outcomes in these populations.

Young age is not a predictor of disease specific survival in oral cancer: A multi-institutional study

BACKGROUND

Over the last few decades evidence has accumulated for increasing incidence of oral cavity squamous cell carcinoma (OSCC) in a younger cohort. Prior studies examining the effect of age at diagnosis on prognosis have produced conflicting data.

METHODS

A multi-institutional cohort study was performed across 6 different sites in Australia, Canada, India and Singapore. Disease-free (DFS), overall (OS) and disease-specific (DSS) survival were analysed. The association of the number of adverse features with survival outcomes was investigated.

RESULTS

From 3179 patients, age was a significant predictor of OS with patients older than 45 years having a 66% increased risk of death (HR 1.66, 95%CI 1.33 - 2.07, p < 0.001). The number of adverse features was a significant predictor of OS with 3 or more adverse features having a 199% increased risk (HR 2.99, 95%CI 2.61-3.43. p < 0.001). The estimate effect was greater in patients ≤ 45 years (HR 3.49 vs HR 2.81). Age was not a significant predictor of DSS with similar rates of death from OSCC in multivariable models. The number of adverse features was a significant predictor of DFS with ≥ 3 adverse features having a 140% increased risk of death. The number of adverse features was a significant predictor of DSS with ≥ 3 adverse features having a 230% increased risk of disease specific death.

CONCLUSIONS

Age is not an independent predictor of disease specific mortality in OSCC. Differences in outcomes are due to the confounding effect of adverse clinicopathological features and the ability to tolerate surgery and adjuvant therapy.

Correlative study of tumor budding, mode of invasion and lymphocytic host response with known clinicopathological prognostic factors in oral squamous cell carcinoma

Background

Oral squamous cell carcinoma (OSCC) is a significant public health problem in India, accounting to 30% of all cancers with a worrying rise in incidence and related mortality. Invasive tumor front (ITF) of OSCC has been an area of histopathologic research interest, where parameters like tumor budding (TB), mode of invasion (MOI) and lymphocytic host response (LHR) are being evaluated extensively.

Objectives

The aim is to study and evaluate the possible association of ITF histological parameters such as TB, LHR and MOI with known clinicopathological prognostic factors in cases of OSCC.

Subjects and Methods

We reviewed and analyzed 69 cases of OSCC for routine clinicopathological parameters, TB, MOI and LHR for any significant correlation (P < 0.05 by Chi-square test) with each other and with outcome in cases where follow-up was available.

Results

TB correlated significantly with histological grade, worst pattern of invasion (WPOI), Lymphnodal involvement (LNI), Lymphovascular invasion (LVI), Perineural invasion (PNI) and age; MOI correlated with WPOI, LNI, LVI and PNI; and LHR significantly correlated with WPOI, PNI, Tumor size (pT) and outcome. TB showed a strong correlation with MOI (P < 0.001) and LHR; and no significant association was noted between LHR and MOI. Among all the clinicopathological parameters, depth of invasion, pT, WPOI, PNI and LHR showed significant correlation with outcome.

Conclusion

TB, MOI and LHR showed good correlation with established parameters and as they are easy and helps in prognostication, they should be included in routine histopathological reporting guidelines.

Squamous Cell Carcinoma of the Tongue in Young Patients: A Case Series and Literature Review

PURPOSE

The purpose of this study was to describe 3 cases of tongue cancer in patients less than 21 years of age. Secondarily, a literature review was performed to examine disease presentation, risk factors, prognosis, and treatment strategies for young persons with tongue cancer.

METHODS

The authors presented 3 cases of childhood tongue cancer between 2009 and 2020 at the University of Michigan Department of Oral and Maxillofacial Surgery (Ann Arbor, MI). An electronic literature review was conducted via PubMed, Embase, Web of Science, and MLibrary.

RESULTS

Including the present case series, 64 studies reporting 108 cases were identified. Age at presentation ranged from newborn to 20 years, with a mean age of 14.5 years. The majority of patients were female (52.2%); 68.1% of patients presented with T1 or T2 disease. Nodal metastases were seen in 56.1% of patients. The most commonly identified predisposing factors included Fanconi anemia (13.9%), bone marrow transplant (9.3%), tobacco use (6.5%), and xeroderma pigmentosum (4.6%). Most patients received surgery alone (37.5%), followed by surgery with adjuvant radiation (33.8%); 60.6% underwent neck dissection. Overall survival was 60.3% at 1 year and 43.6% at 5 years.

CONCLUSIONS

Oral tongue cancer in the young is a rare disease with poorly understood etiology. There is a need for oncologists and maxillofacial surgeons to collaborate in the study of genetic, social, environmental, and medical risk factors contributing to the disease. All patients should undergo high-throughput genetic sequencing to expand our understanding of the disease process and allow for targeted treatment strategies.

Prognostic significance of smoking and alcohol history in young age oral cavity cancer

OBJECTIVE

To assess prognostic factors of patients with operable oral cavity squamous cell carcinoma (OSCC), focusing on the associations with smoking/alcohol exposure and age.

MATERIALS AND METHODS

A total of 247 patients with OSCC who received curative surgery ± adjuvant radiotherapy were analyzed. The patient subgroups were divided according to pretreatment smoking/alcohol exposure. Individuals aged 45 years or less were classified as younger patients.

RESULTS

The median follow-up was 52.2 months. The 5-year locoregional progression-free survival (LRFFS), distant metastasis-free survival (DMFS), overall survival (OS), and cancer-specific survival (CSS) rates were 85.2%, 88.3%, 78.1%, and 83.5%, respectively. An advanced stage, differentiation, and lympho-vascular space invasion were significantly associated with lower OS and CSS. In a subgroup analysis of younger patients (n = 49), more smoking/alcohol exposure was significantly associated with better OS (hazard ratio [HR]: 0.21, 95% confidence interval [CI]: 0.05-0.95, p = .043). With increasing age, the HR for smoking/alcohol exposure with respect to OS increased up to 11.59 (95% CI: 1.49-89.84, p = .019) in older patients.

CONCLUSION

Younger OSCC patients with non- or less smoking/alcohol exposure showed unfavorable outcomes. The prognostic significance of pretreatment smoking/alcohol exposure changed from favorable to detrimental with increasing age in operable OSCC.

Oral cancer in a 5-year-old boy: a rare case report and review of literature

Oral cancer in children is rare. Diagnosis may be delayed as a result of confusion with reactive lesions. Furthermore, cancer staging, with or without bony invasion, can be complicated during tooth eruption. Literature on pediatric oral cancers is lacking, making determination of the possible etiopathology difficult. We describe an exceptional case of a 5-year-old male child who presented with anterior maxillary gingival pseudoepitheliomatous hyperplasia that progressed to carcinoma cuniculatum with invasive oral squamous cell carcinoma (OSCC). Because of the interesting timing of events, we hypothesize that human papillomavirus (HPV) inoculation through cutaneous squamous papilloma played a contributory role. A review of similar case reports in the literature is included. Biopsy of suspicious oral lesions should not be delayed because of the young age of the patient. Atypical hyperplasia should include squamous cell carcinoma (SCC) in the differential diagnoses. For surgical management of aggressive lesions during the mixed dentition, permanent successors should be included in the surgical margins to prevent recurrence.

John MA. The promise of immunotherapy in the treatment of young adults with oral tongue cancer

Historically considered a disease of the older male resulting from cumulative tobacco and alcohol use, more recently we have witnessed a rise in the global incidence of oral tongue squamous cell carcinoma in younger adults, particularly those without any identifiable risk factor exposure. These patients appear to be at higher overall risk for locoregional treatment failure and often experience a more heterogeneous clinical course, with some afflicted with particularly aggressive, rapidly progressive disease. Recent research efforts have supported the idea that although this disease may be genomically similar in these groups, and molecular differences in the tumor immune microenvironment may account for biological differences between young and older patients, as well as patients with and without exposure to alcohol or tobacco. In this review, we seek to summarize current knowledge regarding pathogenesis of oral tongue carcinoma in the young adult patient and examine the potential role of the immune response in disease progression and as a target for novel immunotherapies.

Squamous Cell Carcinoma of the Oral Tongue in Young Patients: Outcomes and Implications for Treatment

Squamous cell carcinoma oral tongue (SCCOT) in patients below 45 years is relatively uncommon in literature; however, there have been increasing trends in incidence. Previous studies showed conflicting data, with no conclusive evidence of differences in outcome compared with older patients. The aim of our study was to determine if younger patients with tongue cancer in India had different clinico-pathological characteristics, prognostic determinants or survival than their older counterparts. Retrospective analysis of 425 adult patients of SCCOT, with 114 patients < 45 years of age (younger group) and 311 patients ≥ 45 years of age (older group), treated with surgery and adjuvant as indicated. Clinical and pathological features were described. Survival analysis was performed using Kaplan Meier's method and multivariate analysis was performed for recurrence and survival using Cox proportional hazards ratio. Younger patients had a higher incidence of adverse pathological features (APFs) like lymphovascular invasion (p = 0.01), perineural invasion (p = 0.009), poorer differentiation (p = 0.044), nodal involvement (p = 0.021), extranodal extension (p = 0.003) and local recurrence (p = 0.008). All of these factors were noted to impact survival. However, on multivariate analysis for APFs, age was not an independent predictor of recurrence or survival. Younger patients with squamous cell carcinoma of tongue have an increased risk of APFs and local recurrence. The clinical observation that young patients have a worse outcome is likely due to the association of APFs rather than age being an independent prognostic factor. Further study is required to show if tumour biology in this cohort is distinct.

A comparative study of treatment outcome in younger and older patients with locally advanced oral cavity and oropharyngeal cancers treated by chemoradiation

Background:

Evidence suggests that older patients with oral cavity and oropharyngeal cancers may behave differently from their younger peers.

Aim:

The aim of this study is to determine if there is difference in responses, survival, and toxicities between young patients (≤40 years of age) with oral cavity and oropharyngeal cancers and older patients (>40 years of age) treated with concurrent chemoradiation.

Materials and Methods:

Sixty-one patients with unresectable, locally advanced oral cavity and oropharyngeal cancers received concomitant chemoradiation to a dose of 70 Gray in 35 fractions over 7 weeks with concomitant weekly cisplatin (40 mg/m²). These patients were then distributed in two arms. Arm-A patients having age ≤40 years and Arm-B patients having age >40 years, and the two arms were assessed for treatment outcome.

Results:

The overall response rate (complete responders + partial responders) evaluated using response evaluation criteria in solid tumors criteria version 1.1 was equivalent in both groups (80.76% in Arm-A and 74.28% in Arm-B; P = 0.93). Older patients (>40 years) experienced more acute mucositis and xerostomia (P < 0.5); although not statistically significant, more acute skin and pharynx toxicities were also observed in this group. Higher late salivary gland toxicity (P < 0.5) was also seen in older patients; however, disease-free survival and progression-free survival were found to be similar in both groups.

Conclusions:

Older patients with locally advanced oral cavity and oropharyngeal cancers have similar response rates and survival as compared to their younger counterparts but may experience higher treatment-related toxicities.

Early onset oral tongue squamous cell carcinoma: Associated factors and patient outcomes

BACKGROUND

Incidence of oral tongue squamous cell carcinoma (OTC) is rising among those under age 50 years. The etiology is unknown.

METHODS

A total of 395 cases of OTC diagnosed and/or treated at Vanderbilt University Medical Center between 2000 and 2017 were identified. Of those, 113 (28.6%) were early onset (age < 50 years). Logistic regression was used to identify factors associated with early onset OTC. Cox proportional hazards models evaluated survival and recurrence.

RESULTS

Compared to typical onset patients, patients with early onset OTC were more likely to receive multimodality treatment (surgery and radiation; adjusted odds ratio [aOR], 2.7; 95% confidence interval [CI], 1.2-6.3) and report a history of snuff use (aOR, 5.4; 95% CI, 1.8-15.8) and were less likely to report a history of cigarette use (aOR, 0.5; 95% CI, 0.2-0.9). Early onset patients had better overall survival (adjusted hazard ratio, 0.6).

CONCLUSIONS

This is the largest study to evaluate factors associated with early onset OTC and the first to report an association with snuff.

Early onset oral tongue cancer in the United States: A literature review

The incidence of early onset oral tongue squamous cell carcinoma (OTC) has been increasing in the United States, and no clear etiology has been identified. Studies on this topic have generally been small and presented varied results. The goal of this review is to analyze and synthesize the literature regarding early onset OTC risk factors, outcomes, and molecular analyses within the US. To date, studies suggest that early onset OTC patients tend to have less heavy cigarette use than typical onset patients, but there may be an association between early onset OTC and smokeless tobacco (chewing tobacco and snuff) use. Early onset OTC is associated with similar or possibly improved survival compared to typical onset OTC. There has been no evidence to support a significant role for human papillomavirus in development of early onset OTC. Further research with larger cohorts of these patients is needed to better characterize this disease entity.

The etiologic spectrum of head and neck squamous cell carcinoma in young patients

Head and neck squamous cell carcinoma (HNSCC), accounting for more than 80% in head and neck malignancies, kills thousands of people a year in the world. Despite most of the patients are more than 45, and the occurrences of head and neck cancer shows a decreasing trend; however, horribly, the incidences of the patients under 45 years old is steadily increasing. Hence, it's of vital importance to get more pathogen information about risk factors of HNSCC in children and young adults. This review outlines the etiologic spectrum of HNSCC, especially oral/oropharyngeal squamous cell carcinoma, in patients under 45 years of age.

Oral and oropharyngeal squamous cell carcinoma in young adults: A retrospective study in Granada University Hospital

Background

This study aims to evaluate and analyze the clinical features and outcomes of oral and oropharyngeal squamous cell carcinoma (SCC) in patients < 45-years old in our center.

Material and Methods

A retrospective analysis was conducted using the records of patients diagnosed with oral and oropharyngeal SCC between 1998 and 2011 in the University Hospital of Granada (Spain). The analysis identified 33 patients with oral and oropharyngeal SCC with an age of <45 years. Moreover, during the years studied, a further 472 patients were diagnosed with oral and oropharyngeal SCC in our center. Thus, 100 SCC patients with an age of >45 years were randomly selected from the same database. A retrospective analysis was conducted to determine specific features including sites of occurrence, risk factors, sex distribution, socio-economic status, T stage at diagnosis, nodal involvement, degree of tumor differentiation, locoregional failure and overall survival at 5 years was. Further, the results of both groups were compared.

Results

The male-female ratio was 1.2:1 in the group of young adults and 2.03:1 in the group of patients with an age of >45 years. No significant differences were found in terms of site, nodal involvement, locoregional failure, and overall survival. However, there were statistically significant differences between the two groups in terms of features such as risk factors, socio-economic status, T stage at diagnosis, and degree of tumor differentiation. The overall 5-year survival rate was 62% for patients >45 years old, whilst for the group of young adults this rate was 48.4% (p= 0.17).

Conclusions

The poor association between the common risk factors and oral and oropharyngeal cancers in young adults suggests that other pathogenic mechanisms should be investigated. For young patients, the data show evidence of poorer outcomes in terms of overall survival (p=0.17), and locoregional failure (p=0.23). Nevertheless, the literature shows that the results in this field are particularly inconsistent, and further research is therefore needed to provide more in-depth knowledge of the disease in this age group.

Key words:Oral and oropharyngeal squamous cell carcinoma, young adults, poor prognosis,risk factors.

Global incidence of oral and oropharynx cancer in patients younger than 45 years versus older patients: A systematic review

Head and neck squamous cell carcinoma (HNSCC) is typically regarded as a disease of elderly people. However, increasing numbers of patients worldwide with HNSCC at younger age (defined as <45 years old) have been reported in recent years. To assess geographical variations and trends worldwide in incidence of oral and oropharyngeal cancer in young patients, a systematic review was conducted in PubMed and Google scholar databases from 1975 to June 2016. Seventy-eight studies were selected for further study. Nineteen population-based studies on incidence rate were available from 13 countries, showing a prominent increase over time except for the Netherlands. A notable rise of oral (mobile) tongue cancer among white women and oropharyngeal cancer in white men was observed. Data suggest that cancer in young patients may be a distinct clinical entity and characterised by different aetiology and pathogenesis. Additionally, the relative proportion of oral and oropharyngeal cancer in young patients to total incidence revealed a significant difference between estimates from North America (5.5%) and both Africa (17.2%) and Middle East (14.5%). It is concluded that (i) a rising trend in oral and oropharynx cancers is observed in young patients worldwide; (ii) incidence studies should properly define outcomes in age cohorts and use a consensus cut-off for young patients; (iii) more population-based studies should be performed in non-Western regions to get accurate global measures of incidence for these cancers in young subpopulations and (iv) there is an urge to identify new aetiological factors in these young patients.

Pediatric head and neck squamous cell carcinoma: Report of 12 cases and illustrated review of literature

INTRODUCTION

Head and neck carcinoma is a very rare entity in pediatric age group. We here present the demography, treatment and outcome of 12 pediatric patients.

METHODOLOGY

We retrieved the treatment charts of pediatric patients with a diagnosis of head and neck squamous cell carcinoma (PHNSCC). We also retrieved the published literature of pediatric HNSCC to present the treatment modalities being delivered across institutes.

RESULTS

We found 12 patients registered with a diagnosis of squamous cell carcinoma. Median age of the entire cohort was 17 years (Range: 8-20). Gender predilection was skewed in favor of male (male:female ratio-11:1). Oral tongue 3(25%) was the commonest sub site followed by soft palate 2(17%) gingiva 2 (17%), supra glottis larynx 2(17%) and one each of hard palate, buccal mucosa, floor of mouth (8.25% each). The most commonly employed modality of treatment was surgery in 6(50%). Radiation was used in seven cases: 7(Adjuvant-4, Radical-3). Two patients received radical chemo-radiation. Neo-adjuvant chemotherapy was used in two cases. Median follow up duration was 2 years (Range: 6 months to 8 years). One patient recurred 6 months post completion of radical chemo-radiation. The patient with recurrent disease had soft palate primary and had isolated local recurrence. The patient was salvaged with surgery and was disease free at the last follow up. At the last follow up all patients were surviving without disease.

CONCLUSION

The treatment and survival are not much different in pediatric patients compared to adult counterpart. However, in the absence of molecular profiling it is difficult to assess the cause of development of SCC in pediatric patients. A detailed study of underlying molecular pathway will further guide the future treatment.

The prognostic value of histopathological grading systems in oral squamous cell carcinomas

OBJECTIVE

This study evaluated the association of four histopathological grading systems (WHO grading system, malignancy grading of the deep invasive margins (MG), histological risk (HR) model, and tumor budding and depth of invasion (BD) model) with clinicopathological parameters and outcome of 113 oral squamous cell carcinomas to identify their roles in prognosis.

METHODS

Demographic and clinical features were obtained from patients' records. Sections from all paraffin-embedded blocks were evaluated according to the four grading systems. Demographic and clinical associations were analyzed using chi-square test, and correlations between the grading systems were established with the Spearman's rank correlation test. Survival curves were performed with Kaplan-Meier method, and multivariate analysis based on Cox proportional hazard model was calculated.

RESULTS

Significant associations with survival were observed for WHO grading system and BD model in the univariate analysis, but only the BD model was significantly associated with disease outcome as an independent prognostic marker. Age, tumor size, and presence of regional metastasis were also independent markers of reduced survival.

CONCLUSION

A significant association between the BD model and outcome of OSCC patients was observed, indicating this new histopathological grading system as a possible prognostic tool.

Tongue squamous cell carcinoma as a possible distinct entity in patients under 40 years old

Much controversy exists in the published literature regarding the clinical course and prognosis of tongue squamous cell carcinoma (SCC) in young patients. The aim of the current study was to evaluate the clinical results of tongue SCC in young patients. A total of 176 patients were included in this retrospective study. The patients were divided into two groups (young and old) according to an age cut-off of 40 years. The χ² test and Kaplan-Meier method were used to analyze the variables. In total, 15 patients were <40 years old and placed into the young group, with five-year recurrence-free survival (RFS) and disease-specific survival (DSS) rates of 30 and 63%, respectively, compared with 47 and 62%, respectively, in the old group. No significant differences were identified between the RFS and DSS rates of the two groups, however, the young patients exhibited a different failure pattern. Overall, nine out of 10 recurrences in the young group occurred at a primary site compared with 18 out of 70 in the old group (P<0.001). Univariate analysis revealed that gender and differentiation were associated with recurrence and neck nodal involvement. In addition, poor differentiation was found to significantly decrease the DSS time. However, the prognosis of tongue SCC in the young patient group did not appear to differ from that of the old patient group. Furthermore, in the young patient group, local recurrence was the most common failure pattern and tumor differentiation was the most important prognostic factor.

Oral cavity and oropharyngeal squamous cell carcinoma in young adults: a review of the literature

BACKGROUND

Head and neck squamous cell carcinoma (HNSCC) is a disease of middle-aged to elderly adults. However, an increased incidence of HNSCC in young people under 45 years of age has been reported recently. In the present review, we focused on the epidemiology and aetiology of HNSCC in adults under 45 years of age.

METHODS

We reviewed literature related to HNSCC in adult patients less than 45 years of age and discussed current treatment options and prognosis.

RESULTS

HNSCC in young adults is associated with a higher incidence rate in nonsmokers, lower female-to-male ratio, a higher percentage of oral cavity and oropharynx tumours, and fewer second primary tumours. However, aside from traditional risk factors of tobacco and alcohol exposure, the causes of these cancers in young adults remain unclear. Agents that might contribute to risk include infection with high-risk human papillomavirus subtypes as well as genetic factors or immunodeficiency status. The expected increase in incidence and mortality of the young with HNSCC may become a major public health concern if current trends persist, particularly lifestyle habits that may contribute to this disease.

CONCLUSIONS

Given the younger age and potential long-term adverse sequelae of traditional HNSCC treatments, young adults should be treated on a case-by-case basis and post-therapy quality of life must be considered in any treatment-decision making process.

Head and neck squamous cell carcinoma in young patients

Epidemiologic analyses have shown disproportional increases of head and neck squamous cell carcinoma (HNSCC) incidence in a younger age group (younger than 45 years old), compared to patients above 45 years old. Although this group is small (5%), it includes a significant subset of the HNSCC patient population, and is characterized by a distinct clinical and etiological phenotype. HNSCC in young patients often presents without significant exposure to alcohol and tobacco and primarily affects the oropharynx and oral cavity. Exposure to human papilloma virus (HPV) has been identified as a major contributor to the pathogenesis of oropharyngeal carcinomas, and explains part of the observed incidence variation. Specific hereditary influences, including genetic predispositions accounting for an increased mutagen sensibility and inherited syndromes like Fanconi Anemia and Bloom's syndrome, have been identified as causative factors in a subgroup of young-onset HNSCC, but their cumulative influence remains at present likely underestimated. Circumstantial evidence suggests that young-onset HNSCC patients have a clinically different phenotype compared to older patients, however, the true impact of young age on HNSCC clinical behavior will remain difficult to determine unless multi-institutional databases will be combined. The rising incidence of young-onset HNSCC mandates intensification of research endeavors into its etiology, clinical phenotype and optimal management.

Impact of young age on the prognosis for oral cancer: a population-based study in Taiwan

Background

Oral cancer leads to a considerable use of health care resources. Wide resection of the tumor and reconstruction with a pedicle flap/ free flap is widely used. This study was conducted to investigate if young age at the time of diagnosis of oral cancer requiring this treatment confers a worse prognosis.

Methods

A total of 2339 patients who underwent resections for oral cancer from 2004 to 2005 were identified from The Taiwan National Health Insurance Research Database. Survival analysis, Cox proportional regression model, propensity scores, and sensitivity test were used to evaluate the association between 5-year survival rates and age.

Results

In the Cox proportional regression model, the older age group (>65 years) had the worst survival rate (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.45-2.22; P<0.001). When analyzed using the propensity scores, the adjusted 5-year survival rates were also poorer for oral cancer patients with older age (>65 years), compared to those with younger age (<45 years) (P<0.001). In sensitivity test, the adjusted hazard ratio remained no statistically elevated in the younger age group (<45 years).

Conclusions

For those oral cancer patients who underwent wide excision and reconstruction, young age did not confer a worse prognosis using a Cox proportional regression model, propensity scores or sensitivity test. Young oral cancer patients may be treated using general guidelines and do not require more aggressive treatment.

Prognostic features, human papillomavirus status, and epidermal growth factor receptor expression in oral squamous cell carcinoma in young adults

PURPOSE

There is still debate in literature about the survival outcomes of patients who have cancer of the oral cavity when young. Hence the aims were (1) to estimate disease-free survival, overall survival, and cause-specific survival in patients who developed oral cavity squamous cell carcinoma between 18 and 40 years of age and (2) to assess the clinicopathologic factors including detection of human papillomavirus and epidermal growth factor receptor (EGFR) overexpression in primary lesions affecting recurrence.

METHODS

This is a retrospective case-note review and reevaluation of histopathologic slides of patients treated more than 25 years. Descriptive statistics, Cox proportional hazard models, and Kaplan-Meier survival curves were used for statistical analysis.

RESULTS

A total of 62 patients were treated, with mean follow-up of 11.4 years. Forty-five were oral tongue tumors and 43 had stage I or II disease. The 5-year disease-free survival was 73.5%. The 10-year overall survival and cause-specific survival rates were 81.8% and 83.4%, respectively. Smoking and alcohol intake were not seen as risk factors in this population. Multivariate modeling identified only nodal involvement as significantly associated with overall survival and only extracapsular spread as significantly associated with locoregional recurrence. At 5 years after treatment, the cause-specific survival was 100% for patients with low EGFR expression and 81.1% for patients with high EGFR expression (hazard ratio for high vs low, 3.1; 95% confidence interval, 0.4-406.9; P = .46). Human papillomavirus was not detected in all but 2 tumor specimens.

CONCLUSIONS

Survival outcomes are quite good in young patients with oral cancer.

pEGFR-Tyr 845 expression as prognostic factors in oral squamous cell carcinoma: a tissue-microarray study with clinic-pathological correlations

The EGFR (epidermal growth factor receptor) a member of the family of transmembrane protein kinase receptors known as the erbB family shows a significant correlation with the presence of metastases and poorly differentiated oral cancer. Aim of the present work is to define the key-role of EGFR in oral cancer prognosis. We have analyzed the EGFR expression on 149 cases of oral squamous cell cancers (OSCC) and we have found that it was poorly expressed in normal oral epithelium, but its expression was significantly increased in OSCCs. Moreover, we have recorded that both pEGFR-Tyr 845 and pEGFR-Tyr 1068 were mainly distributed in high histological grading and in advanced stages. Western blotting has confirmed the total absence of EGFR phosphorylation in normal oral epithelium and the higher level of protein phosphorylation in representative cases of OSCCs. The EGF-R amplification was found by fluorescence in situ hybridization (FISH) in 14% of OSCC; interestingly, EGF-R amplification was mainly observed in OSCC with higher histological grading (G2 and G3) and advanced stage (pT4) sub-groups. Kaplan-Meyer survival analysis suggested that patients with positive pEGFR-Tyr 845 tumors had a worse prognosis and were bad responders to chemotherapy. These results confirm the central role of EGF-R activation status as a prognostic biomarker in OSCC.

Squamous cell carcinoma of the tongue and floor of the mouth: analysis of survival rate and independent prognostic factors in the Amazon region

Oral squamous cell carcinoma (OSCC) accounts for more than 95% of all malignant neoplasms in the oral cavity. Although several studies have shown the epidemiology of this cancer in Brazil, there do not seem to be any studies that describe the prognostic factors related to OSCC in the Amazon region. Therefore, the aim of this study was to determine the survival rate and prognostic significance of different factors in patients from this region affected by OSCC. Data from 85 patients with histologically confirmed squamous cell carcinoma of the tongue and floor of the mouth identified from the Ofir Loyola Hospital archives were collected and analyzed using univariate (log-rank test) and multivariate (Cox proportional hazard model) tests. The overall 5-year survival rate was found to be 27%. Univariate analysis showed that the 5-year survival rate was significantly higher for younger (≤ 45 y) female patients, patients with T1-2 tumors and clinically clear neck nodes (N0), patients with early stage cancers (AJCC stage I-II), and patients treated with surgical procedures. However, multivariate analysis showed that the 5-year survival rate was significantly higher only in the younger patients and those who underwent surgical treatment. The age of the patient at the moment of diagnosis and treatment with surgical procedures were the only independent prognostic factors that affected the 5-year survival rate of the patients in this region.

Increasing Incidence of Oral Tongue Squamous Cell Carcinoma in Young White Women, Age 18 to 44 Years

Purpose

To evaluate the incidence of oral cavity squamous cell carcinoma (OCSCC) and oral tongue squamous cell carcinoma (OTSCC) in young white women, age 18 to 44 years.

Patients and Methods

We analyzed incidence and survival data from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute from 1975 to 2007 for OCSCC and OTSCC. Three cohorts were examined: all ages, age 18 to 44 years (ie, “young”), and age > 44 years. Individuals were stratified by sex and/or race. Percentage change (PC) and annual percentage change (APC) were calculated. Joinpoint regression analyses were performed to examine trend differences.

Results

Overall, incidence of OCSCC was decreasing for all ages. However, incidence was increasing for young white women (PC, 34.8; APC, 2.2; P < .05). Incidence of OTSCC was decreasing for all ages except in the age 18 to 44 years group (PC, 28.8; APC, 1.8; P < .05). Young white individuals had increasing incidence trends of OTSCC (white women: PC, 111.3; APC, 4; P < .05; young white men: PC, 43.7; APC, 1.6; P < .05). The APC of OTSCC was significantly greater in young white women compared with that in young white men (P = .007). Furthermore, incidence of SCC in all other subsites of the oral cavity was decreasing. Nonwhites had a decreasing incidence of OCSCC and OTSCC. Cause-specific survival was similar among whites age 18 to 44 and individuals older than age 44 years.

Conclusion

OTSCC is increasing among young white individuals age 18 to 44 years, particularly among white women. Young white women may be a new, emerging head and neck cancer patient population.

Clinical outcome of squamous cell carcinoma of the tongue in young patients: a stage-matched comparative analysis

Objectives

The reported incidence of tongue cancer in young patients has recently increased. The aim of this study was to analyze the clinical characteristics of tongue cancer in a young group of patients, and to compare them with those of an older group of tongue cancer patients.

Methods

We retrospectively reviewed the records of 85 patients who were diagnosed with squamous cell carcinoma of the tongue. They were divided into two age groups: over 45 years of age and under 45 years. To compare the prognosis of similarly staged patients in the group, each age group was divided into the early (stage I, II) and advanced stage groups (stage III, IV), and then they were compared. The young group consisted of 23 patients and the older group had 62 patients.

Results

At the early stage, the clinical prognosis of the patients in both age groups was good, and no significant difference was observed. However, at the advanced stage, the overall and regional recurrence rates were significantly higher in the younger age group as compared to that in the old age group (P=0.007, P=0.001, respectively). The disease-specific survival rate of the patients in the young group was significantly lower than that in the old age group (P=0.025).

Conclusion

Tongue cancer in young subjects has significantly different clinical outcomes according to the stage. The clinical outcome of the advanced-stage tongue cancer in young subjects was poorer than that in the older subjects. Regional recurrence seemed to be the main cause of the poor prognosis.

The aetiology of upper aerodigestive tract cancers among young adults in Europe: the ARCAGE study

BACKGROUND

The incidence of cancers of the upper aerodigestive tract (UADT) is increasing throughout the world. To date the increases have been proportionally greatest among young people. Several reports have suggested that they often do not have a history of tobacco smoking or heavy alcohol consumption.

OBJECTIVE

To determine the contribution of lifestyle factors to the etiology of UADT cancers occurring in those aged less than 50 years.

METHODS

A case-control study was conducted in 10 European countries. Cases were cancers of the oral cavity and pharynx, larynx and esophagus, and hospital or population controls were age and sex matched.

RESULTS

There were 356 cases younger than 50 years and 419 controls. Risk was strongly related to current smoking [odds ratio (OR) 5.5 95%; confidence interval (CI) (3.3, 9.2)], and risk increased with number of pack-years smoked. Risk was also related to alcohol consumption for both current (OR 1.8; 0.97, 3.3) and past (OR 3.4; 1.6, 7.4) drinkers, and risk increased with number of drink-years. Persons frequently consuming fruits and vegetables were at significantly reduced risk.

CONCLUSIONS

Risk factors already identified as being important for UADT cancers in adults are also important influences on risk in younger adults. The implication of these results is that the public health message in preventing UADT cancers remains the same to young and old alike.

Outcomes of oral cavity squamous cell carcinoma in pediatric patients

Oral cavity squamous cell carcinoma (OCSCC) is uncommon in young patients and rare in the pediatric population. OCSCC is believed to behave aggressively in this age group, but the existing literature is limited to case reports. The objective of this study was to compare survival outcomes in pediatric and adult patients with oral cavity squamous cell carcinoma. We performed a population-based study of 54 pediatric (age < or = 20) and 22,162 adult cases of OCSCC, recorded in the SEER cancer registry. Overall survival (OS) and disease-specific survival (DSS) were analyzed using the Kaplan-Meier method. Cox multivariable regression was used to control for covariates including gender, stage, histologic grade and treatment modality. Pediatric patients with OCSCC experienced significantly better 5 year DSS than adult patients (75.3% vs. 63.5%, p=0.02). Pediatric patients were also more likely to be female (37.0% vs. 31.7%, p=0.04) and to receive surgery (87.0% vs. 68.6%, p<0.001). When these factors, as well as non-significant differences in rates of metastases and histologic grade were controlled for on multivariable analysis, the pediatric and adult groups experienced equivalent DSS (p=0.64). Pediatric patients with OCSCC experience better survival than adult patients. When differences in patient, tumor and treatment-related characteristics are adjusted for, the two groups experience equivalent survival.

Head and neck cancer in young people: a series of 52 SCCs of the oral tongue in patients aged 35 years or less

CONCLUSION

Prognosis was very poor as soon as a local failure developed. Up-front treatment should be optimized to control this rare disease. We propose producing and reporting recommendations via a concerted oncologic physician referral network.

OBJECTIVES

Squamous cell carcinoma (SCC) in young people is rare and the literature is confusing. This study was carried out to assess the demographics, clinical features, and treatment outcome in a cohort of patients aged 35 years or less with SCC of the oral tongue (SCCOT).

PATIENTS AND METHODS

This was a multicenter retrospective study. Fifty-two patients treated between 1990 and 2000 were identified. Descriptive statistics were analyzed to assess demographic and tumor variables.

RESULTS

The WHO performance status was excellent for all patients. Thirty-seven were classified as T1-T2 and 38 were N0. All of them except one were treated with curative intent. Treatment failures were observed in 25 patients (48%). Four patients could be successfully salvaged after SCCOT recurrence or progression. The disease-free survival (DFS) was 52% at 5 years. The 5-year overall survival (OS) rate was 64%. Factors that affected the OS were invasion of the floor (p=0.009), cross over of the midline (p=0.02), positive lymph nodes (p=0.02), and the lack of disease control (p=0.0001).

Oral Cancer: Population Sample of the State of Alagoas at a Reference Hospital

The incidence and mortality of oral cancer in Brazil remains high; the disease manifests varying features throughout the country.

Aim

To analyze the epidemiology of oral cancer, including the prevalence, type and site of lesions, the distribution in the state of Alagoas, staging, treatment, and social and demographic aspects.

Materials and Methods

A descriptive retrospective study was carried out. Data were gathered from records of a hospital in Alagoas from January 2000 to December 2006.

Results

Of 396 cases (100% of the sample), 62.70% were male and 37.30% female. Most tumors were on the tongue. The mean age was 61.95 years (SD=14.56 years), and 95.2% of the sample were aged over 40 years. Most of lesions were stage II (57.04%). Radiotherapy was the most common treatment.

Conclusion

This study revealed the epidemiology of oral cancer patients at a reference hospital in the state of Alagoas. The results showed that oral cancer occurs mostly in males in the sixth decade of life; the most common site is the tongue, followed by the floor of the mouth.

Gingival squamous cell carcinoma in young patients: report of a case and review of the literature

Squamous cell carcinoma is a malignant neoplasm of epithelium, most frequently occurring in intraoral tumors. In this article we describe a rarely reported, because the frequency of oral cancer in young people is extremely low, case of a 16-year-old Chinese girl with squamous cell carcinoma of anterior mandibular gingiva. The clinicopathologic features, etiology, clinical evaluation, management of squamous cell carcinoma of gingiva in young patients are discussed and the applicable literatures are reviewed.

Changing trends in oral squamous cell carcinoma with particular reference to young patients: 1971-2006. The Emory University experience

BACKGROUND

Several recent reports suggest an increasing incidence of oral squamous cell carcinoma (OSCC) among young persons in many regions of the world--a trend which is particularly concerning given the overall stabilization or even decline in incidence rates for head and neck cancer in general. The aim of this study is to determine whether there has been an increase in the number of cases of OSCC diagnosed in patients < 40 years old by our biopsy service from 1971 to 2006.

METHODS

A retrospective review of all OSCC cases diagnosed from 1971 to 2006 by the Emory University Hospital Oral Pathology biopsy service was performed. A comparison of demographic information, frequency, location and histologic grade was made between these cases as a whole and those occurring in a subset of patients < 40 years old. Statistical procedures included chi-square analyses.

RESULTS

From 1971-2006, 1,919 cases of OSCC were diagnosed, and 95 (5.0%) occurred in patients < 40 years old. A total of 8 cases were diagnosed from 1971 to 1980, compared to 36 cases during the period 1981-1990, 31 during the period 1991-2000 and 21 cases from 2001 to 2006. The increase in OSCC incidence from the 1970s when compared to 1981-2000 was statistically significant (P < 0.002). A 1.7:1 male:female ratio was seen in all decades. The mobile (oral) tongue was the most common location in all decades (62.1%) in young patients. In contrast, tongue cancers accounted for 27.4% in patients > or = 40. This difference between the two groups was statistically significant (P < 0.0001). Of great surprise, however, was the significant increase in tongue cancer during the study period in patients > or = 40 which accounted for 37.1% of all OSCC diagnoses from 2001 to 2006, compared to 20.5% of OSCC cases from 1971 to 1980 (P < 0.0001).

CONCLUSIONS

We demonstrated a greater than fourfold increase in the incidence of oral squamous cell carcinoma (OSCC) in young patients < 40 years old beginning in 1974 and peaking in the late 1980s, then remaining stable. The mobile tongue is the most common location for cancer in this age group accounting for 62.1% of cancers. However, the mobile tongue increasingly appears to be the most common site for oral cancer in all age groups.

Oral squamous cell carcinoma in children; review of an unusual entity

Most commonly, squamous cell carcinoma (SCC) of the oral cavity presents during the fifth and sixth decades of life. Less than 4% of these cancers occur in patients younger than 40 years of age. Only a small sample of this subgroup exists of pediatric patients (< or =20 years), making oral SCC in children an extremely rare entity. An 11-year-old boy is presented who developed a SCC of the gingiva. The relevant literature of oral SCC in pediatric patients will be reviewed as well.

Squamous cell carcinoma of the oral tongue in young patients: a matched-pair analysis

CONCLUSIONS

Young patients with squamous cell carcinoma (SCC) of the oral tongue developed fewer locoregional recurrences. The overall survival and disease-specific survival rates were better in the young patient population.

OBJECTIVES

To compare the survival rates of patients under 45 years of age and diagnosed with SCC of the oral tongue with those of patients older than 45 years.

PATIENTS AND METHODS

A retrospective review of 20 patients under 45 years of age with SCC of the oral tongue was performed. These patients were matched to an older population by sex and clinical stage. Overall survival, disease-free survival, disease-specific survival, and rates of local, regional and distant metastases were determined for both populations.

RESULTS

Stage and treatment modality were similar in the two age groups. There were significant differences in overall survival (p=0.013) and disease-specific survival (p=0.046) favoring young patients. Rates of locoregional recurrence and distant metastasis were higher in the older patients.