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Wongpattaraworakul W, Choi A, Buchakjian MR, Lanzel EA, Kd AR, Simons AL. Prognostic Role of Tumor-Infiltrating Lymphocytes in Oral Squamous Cell Carcinoma. BMC Cancer 2024; 24:766. [PMID: 38926643 PMCID: PMC11201865 DOI: 10.1186/s12885-024-12539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND In oral squamous cell carcinoma (OSCC), the tumor-node-metastasis (TNM) staging system is a significant factor that influences prognosis and treatment decisions for OSCC patients. Unfortunately, TNM staging does not consistently predict patient prognosis and patients with identical clinicopathological characteristics may have vastly different survival outcomes. Host immunity plays an important role in tumor progression but is not included in the TNM staging system. Tumor-infiltrating lymphocytes (TILs) are part of the host immune response that recognizes tumor cells; and the presence of TILs has emerged as potential candidates for prognostic markers for many types of cancers. The present study aims to determine the association of T cell-specific markers (CD3, CD4, CD8, and FOXP3) with clinicopathological characteristics and survival outcomes in OSCC patients. The prognostic value of CD3, CD4, and CD8 will also be evaluated based on tumor stage. METHODS Tissue microarrays were constructed containing 231 OSCC cases and analyzed by immunohistochemical staining for the expression of CD3, CD4, CD8, and FOXP3. The expression scores for each marker were correlated with clinicopathological parameters and survival outcomes. The prognostic impact of CD3, CD4 and CD8 were further analyzed based on tumor stage (early or advanced). RESULTS CD3, CD4, and CD8 were found to be significantly associated with both overall survival and progression-free survival using univariate analysis. However, none of these markers were found to independently predict the survival outcomes of OSCC using multivariate analysis. Only conventional factors such as nodal status, tumor differentiation and perineural invasion (PNI) were independent predictors of survival outcomes, with nodal status being the strongest independent predictor. Additionally, low CD4 (but not CD3 or CD8) expression was found to identify early-stage OSCC patients with exceptionally poor prognosis which was similar to that of advanced staged OSCC patients. CONCLUSIONS TIL markers such as CD3, CD4, CD8, and FOXP3 can predict the survival outcomes of OSCC patients, but do not serve as independent prognostic markers as found with conventional factors (i.e. nodal status, tumor differentiation and PNI). CD4 expression may assist with risk stratification in early-stage OSCC patients which may influence treatment planning and decision making for early-stage OSCC patients.
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Affiliation(s)
- Wattawan Wongpattaraworakul
- Department of Oral Pathology, Radiology, and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, United States
- Department of Pathology, College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Allen Choi
- Department of Pathology, College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Marisa R Buchakjian
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Emily A Lanzel
- Department of Oral Pathology, Radiology, and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, United States
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Anand Rajan Kd
- Department of Pathology, College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Andrean L Simons
- Department of Oral Pathology, Radiology, and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, United States.
- Department of Pathology, College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, B180K Medical Laboratories Iowa City, IA, 52242, Iowa City, United States.
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Horvat I, Lončar-Brzak B, Andabak Rogulj A, Cigić L, Pezelj Ribarić S, Sikora M, Vidović-Juras D. How Much Do We Know about Oral Cancer?-An Online Survey. Dent J (Basel) 2023; 11:268. [PMID: 38132406 PMCID: PMC10743054 DOI: 10.3390/dj11120268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Oral cancer (OC) is a disease with a high mortality rate due to its late recognition. Since the oral cavity is easily accessible for visual inspection, enabling early diagnosis, the education of healthcare workers about preventive oral examinations is critical. This research aimed to assess the level of participants' OC knowledge, as well as to raise awareness about this diagnosis. MATERIALS AND METHODS The research was conducted as an online survey among students of dental medicine, students of medicine, doctors of dental medicine and doctors of medicine. The questionnaire was designed solely for the purpose of this study and consisted of 29 questions. The first part of the questionnaire consisted of general questions about the participants, whereas the questions in the second part addressed their knowledge and attitudes towards OC. RESULTS The surveyed population comprised of 140 dental students, 105 medical students, 159 doctors of dental medicine and 100 medical doctors. The level of knowledge about OC among the participants is not yet satisfactory. The group of dental medicine students scored highest, while medical doctors showed the weakest knowledge. CONCLUSION Additional education about OC for doctors of dental medicine and medical doctors is needed. This step will improve prevention and increase chances for early detection.
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Affiliation(s)
- Iva Horvat
- Private Dental Clinic Zagreb, 10000 Zagreb, Croatia;
| | - Božana Lončar-Brzak
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia; (B.L.-B.)
- Croatian Society for Oral Medicine and Pathology, Croatian Medical Association, 10000 Zagreb, Croatia
- Croatian Association of Hospital Dentistry/Special Care Dentistry, Croatian Medical Association, 10000 Zagreb, Croatia
| | - Ana Andabak Rogulj
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia; (B.L.-B.)
- Croatian Society for Oral Medicine and Pathology, Croatian Medical Association, 10000 Zagreb, Croatia
- Croatian Association of Hospital Dentistry/Special Care Dentistry, Croatian Medical Association, 10000 Zagreb, Croatia
- Department of Oral Diseases, University Dental Clinic, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Livia Cigić
- Department of Oral Medicine and Periodontology, School of Medicine, University of Split, 21000 Split, Croatia
| | - Sonja Pezelj Ribarić
- Department of Oral Medicine, Faculty of Dental Medicine, University of Rijeka, Krešimirova 40, 51000 Rijeka, Croatia
- Department of Dental Medicine, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia
- Clinic of Dental Medicine, Clinical Hospital Center Rijeka, Krešimirova 40, 51000 Rijeka, Croatia
| | - Miroslav Sikora
- School of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Danica Vidović-Juras
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia; (B.L.-B.)
- Croatian Society for Oral Medicine and Pathology, Croatian Medical Association, 10000 Zagreb, Croatia
- Croatian Association of Hospital Dentistry/Special Care Dentistry, Croatian Medical Association, 10000 Zagreb, Croatia
- Department of Oral Diseases, University Dental Clinic, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
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Silva LC, Faustino ISP, Ramos JC, Colafemina ACE, Di Pauli-Paglioni M, Leite AA, Santos-Silva AR, Lopes MA, Vargas PA. The importance of early treatment of oral squamous cell carcinoma: Case report. Oral Oncol 2023; 144:106442. [PMID: 37356209 DOI: 10.1016/j.oraloncology.2023.106442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is frequently diagnosed at an advanced stage, with the five-year survival rate varying around 50%, however, ifs the sooner OSCC in early-stage is treated, the lower the chances of recurrence and death. In this study, we described an OSCC diagnosed early, highlighting how the early surgical excision prevents the morbidity. CASE REPORT A 74-year-old man presented a whitish and symptomatic plaque and a discreet ulcerated area on the right lateral border of the tongue. Due to close contact with the second inferior molar, a clinical diagnosis of a frictional keratosis was suspected, however as the lesion persisted after two weeks of follow-up, an incisional biopsy was performed and the microscopic features revealed an OSCC. Early surgical resection was performed, preventing the morbidity and improve benefits to patient. CONCLUSION OSCC can manifest of several clinical forms, including indolent appearances, which can delay the diagnosis, and consequently the prognosis. Further, it is important to recognize and not neglect any intraoral lesions, in order to avoid the far more invasive surgery that a more advance disease would imply.
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Affiliation(s)
- Luan César Silva
- Oral Semiology and Oral Pathology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Isabel Schausltz Pereira Faustino
- Oral Semiology and Oral Pathology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Joab Cabral Ramos
- Oral Semiology and Oral Pathology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Ana Carolina Evangelista Colafemina
- Oral Semiology and Oral Pathology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Mariana Di Pauli-Paglioni
- Oral Semiology and Oral Pathology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Amanda Almeida Leite
- Oral Semiology and Oral Pathology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Semiology and Oral Pathology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Márcio Ajudarte Lopes
- Oral Semiology and Oral Pathology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
| | - Pablo Agustin Vargas
- Oral Semiology and Oral Pathology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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Gandhi V, Mahajan A, Kansal YP. An Immunohistochemical Analysis for Evaluating the Diagnostic Role of Myofibroblasts in Oral Squamous Cell Carcinoma using α-Smooth Muscle Actin Antibody. Adv Biomed Res 2023; 12:123. [PMID: 37434928 PMCID: PMC10331533 DOI: 10.4103/abr.abr_160_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 07/13/2023] Open
Abstract
Background One of the most common types of malignancies affecting the head and neck region is oral squamous cell carcinoma (OSCC). Little less is known about the role of myofibroblasts in the pathogenetic process of OSCC. Hence, we assessed the involvement of myofibroblasts in the invasive process of OSCC using α-SMA (α-smooth muscle actin) antibody. Materials and Methods Four study groups in total were organized as follows: 40 cases each of well-differentiated OSCC (WDOSCC), moderately differentiated OSCC (MDOSCC), poorly differentiated OSCC (PDOSCC), and controls make up Group 1, Group 2, Group 3, and Group 4, respectively. The percentage of α-SMA immunopositive cells and staining intensity (A) multiplied together to determine the final staining score (B). The final staining index was produced by multiplying staining intensity (A) by the proportion of immunopositive cells that were stained with α-SMA (B) (FSI). Score Zero was graded as Index Zero by FSI while scores One and Two received an Index Low rating, scores Three and Four an Index Moderate rating, and scores Six and Nine an Index High rating. Results Significantly higher expression of myofibroblast was observed in OSCC group in comparison with the control group. However; no significant difference in myofibroblast expression was observed while comparing different grades of OSCC. Conclusion We recommend using myofibroblasts as a stromal marker to track the severity and development of OSCC.
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Affiliation(s)
- Vaishali Gandhi
- Department of Human Anatomy, SGRD University of Health Sciences, Amritsar, Punjab, India
| | - Anupama Mahajan
- Department of Human Anatomy, SGRD Medical College and Hospital, Amritsar, Punjab, India
| | - Yash Pal Kansal
- Department of General Pathology, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
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