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Bagadia RK, Thakur S, Lal R, Verma S, Subash A, Rao VUS. Role of Imaging in Predicting the Deep Surgical Margin in Gingivobuccal Complex Cancers: A Pilot Study. Indian J Otolaryngol Head Neck Surg 2024; 76:3319-3322. [PMID: 39130250 PMCID: PMC11306815 DOI: 10.1007/s12070-024-04680-1] [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: 11/22/2023] [Accepted: 04/01/2024] [Indexed: 08/13/2024] Open
Abstract
Cancers arising from the gingivobuccal complex are one of the most common types of cancer in the oral cavity and are associated with poor prognosis. Among the various prognostic factors, positive surgical margin is the most important one that can be controlled by the operating surgeon. The deep surgical margins for buccal mucosa cancers is normally assessed by palpating the skin for induration and skin pinchability. The present study evaluates the role of imaging in assessing the deep surgical margin and its efficacy for skin preservation in buccal mucosa/ gingivobuccal carcinomas. The patients of gingivobuccal complex squamous cell carcinomas after histopathological confirmation were selected for the study. In imaging, the distance between the base of the tumour and skin (epidermis) of the cheek was measured by a senior radiologist preoperatively. The frozen section findings were confirmed by histopathological examination and the depth of invasion of the tumour was measured and the clearance of the deep surgical margin was confirmed. The correlation between imaging, skin pinch test and histopathological examination of the specimen was assessed. The sensitivity and specificity of imaging to predict the skin preservation (deep surgical margin more than 5 mm) is 100% and 75% respectively compared to sensitivity and specificity of skin pinch test of 82.6% and 50% respectively. Imaging is an effective tool in predicting the skin preservation and skin excision compared to skin pinch test. Compared to the skin pinch test, imaging appears to be a useful tool for advising surgeons on skin preservation vs excision.
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Affiliation(s)
- Ritvi K. Bagadia
- Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu India
| | - Shalini Thakur
- Department of Head and Neck Oncology, Health Care Global Cancer Hospital, Bangalore, Karnataka 560002 India
| | - Radhika Lal
- Manipal Hospital, Bangalore, Karnataka India
| | - Shaurya Verma
- Department of Head and Neck Oncology, Health Care Global Cancer Hospital, Bangalore, Karnataka 560002 India
| | - Anand Subash
- Department of Head and Neck Oncology, Health Care Global Cancer Hospital, Bangalore, Karnataka 560002 India
| | - Vishal U. S. Rao
- Department of Head and Neck Oncology, Health Care Global Enterprises Ltd. Hospital, Bengaluru, Karnataka India
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Alim N, Elsheikh M, Satti AA, Tabassum N, Suleiman AM. Recurrence of oral squamous cell carcinoma in surgically treated patients at Khartoum Teaching Dental Hospital retrospective cross-sectional study. BMC Cancer 2024; 24:781. [PMID: 38943108 PMCID: PMC11214227 DOI: 10.1186/s12885-024-12562-6] [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: 03/22/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND In terms of survival rate, recurrent oral squamous cell carcinoma (OSCC) after primary surgery is considered as a poor prognostic indicator. OBJECTIVE This study aims to determine the incidence of OSCC recurrence among patients treated at Khartoum Teaching Dental Hospital (KTDH) and possible risk factors associated with it. METHODS Records of 303 patients with a history of radical surgery were retrieved from the hospital's archives, and the histopathological records were retrieved from the archival specimens of Professor Ahmed Suleiman Oral Pathology Laboratory, Faculty of Dentistry, and University of Khartoum. RESULTS Advanced stages of OSCC (III, IV) were associated with higher recurrence rates, and the poorly differentiated OSCC was the commonest recurrent type. CONCLUSION The condition of the surgical margin is a significant predictor of OSCC recurrence and tumor stage. The tumor site, the type of surgical resection, and the tumor differentiation were also identified as significant factors influencing the recurrence of OSCC.
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Affiliation(s)
| | | | - Asim A Satti
- Khartoum Teaching Dental Hospital, Khartoum, Sudan
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Bakshi J, Kaur N, Tiwana H, Verma RK, Panda NK, Patro SK. Survival Analysis of Oral Squamous Cell Carcinoma Patients Attending Tertiary Care Centre of North India. Indian J Surg Oncol 2023; 14:234-242. [PMID: 36891418 PMCID: PMC9986144 DOI: 10.1007/s13193-020-01187-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/19/2020] [Indexed: 12/24/2022] Open
Abstract
The cumulative survival for all stages in oral squamous cell cancers (OSCC) in the world remains poor despite the advances in management; hence, we conducted this study to evaluate the survival outcomes. This is a retrospective review and analysis of treatment, follow-up and survival records of 249 OSCC patients treated in our department from April 2010 to April 2014. Telephonic interviews were conducted for survival details for some patients who had not reported. Survival analysis was done using the Kaplan-Meier analysis, comparisons were done using log-rank test and multivariate analysis was conducted using the Cox proportional hazard model to find different variables (site, age, sex, stage and treatment) affecting overall survival (OS)/disease-free survival (DFS). Two-year and 5-year DFS for OSCC were observed to be 72.3% and 58.3% with mean survival of 63.17 months (95% CI: 58.342-68.002). Similarly, OS at 2 years and 5 years were 84.3% and 55.9% with mean survival of 65.143 months (95% CI: 60.143-69.601). Tumour site, patient age, stage of disease and treatment modality had a statistically significant hazardous effect on the overall and disease-free survival rates. The significant influence of age, site of tumour, stage of disease and modality of treatment required based on the clinic-pathologic risk factors on prognosis emphasizes the importance of early diagnosis through regular screening and early treatment which can be ensured with early referral, high clinical suspicion and awareness at the point of primary/secondary care.
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Affiliation(s)
- Jaimanti Bakshi
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Navjot Kaur
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Harsimran Tiwana
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Roshan K. Verma
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Naresh K. Panda
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Sourabha Kumar Patro
- Department of Otolaryngology and Head and Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Panigrahi S, Nanda BS, Bhuyan R, Kumar K, Ghosh S, Swarnkar T. Classifying Histopathological Images of Oral Squamous Cell Carcinoma using Deep Transfer Learning. Heliyon 2023; 9:e13444. [PMID: 37101475 PMCID: PMC10123069 DOI: 10.1016/j.heliyon.2023.e13444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/23/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
Oral cancer is a prevalent malignancy that affects the oral cavity in the region of head and neck. The study of oral malignant lesions is an essential step for the clinicians to provide a better treatment plan at an early stage for oral cancer. Deep learning based computer-aided diagnostic system has achieved success in many applications and can provide an accurate and timely diagnosis of oral malignant lesions. In biomedical image classification, getting large training dataset is a challenge, which can be efficiently handled by transfer learning as it retrieves the general features from a dataset of natural images and adapted directly to new image dataset. In this work, to achieve an effective deep learning based computer-aided system, the classifications of Oral Squamous Cell Carcinoma (OSCC) histopathology images are performed using two proposed approaches. In the first approach, to identify the best appropriate model to differentiate between benign and malignant cancers, transfer learning assisted deep convolutional neural networks (DCNNs), are considered. To handle the challenge of small dataset and further increase the training efficiency of the proposed model, the pretrained VGG16, VGG19, ResNet50, InceptionV3, and MobileNet, are fine-tuned by training half of the layers and leaving others frozen. In the second approach, a baseline DCNN architecture, trained from scratch with 10 convolution layers is proposed. In addition, a comparative analysis of these models is carried out in terms of classification accuracy and other performance measures. The experimental results demonstrate that ResNet50 obtains substantially superior performance than selected fine-tuned DCNN models as well as the proposed baseline model with an accuracy of 96.6%, precision and recall values are 97% and 96%, respectively.
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Oya K, Kokomoto K, Nozaki K, Toyosawa S. Oral squamous cell carcinoma diagnosis in digitized histological images using convolutional neural network. J Dent Sci 2023; 18:322-329. [PMID: 36643248 PMCID: PMC9831840 DOI: 10.1016/j.jds.2022.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 01/18/2023] Open
Abstract
Background/purpose Diagnostic methods of oral squamous cell carcinoma (SCC) using artificial intelligence (AI) and digital-histopathologic images have been developed. However, previous AI training methods have focused on the cellular atypia given by the training of high-magnification images, and little attention has been paid to structural atypia provided by low-power wide fields. Since oral SCC has histopathologic types with bland cytology, both cellular atypia and structural atypia must be considered as histopathologic features. This study aimed to investigate AI ability to judge oral SCC in a novel training method considering cellular and structural atypia and their suitability. Materials and methods We examined digitized histological whole-slide images from 90 randomly selected patients with tongue SCC who attended a dental hospital. Image patches of 1000 × 1000 pixels were cut from whole-slide images at 0.3125-, 1.25-, 5-, and 20-fold magnification, and 90,059 image patches were used for training and evaluation. These image patches were resized into 224 × 224, 384 × 384, 512 × 512, and 768 × 768 pixels, and the differences in input size were analyzed. EfficientNet B0 was utilized as the convolutional neural network model. Gradient-weighted class activation mapping (Grad-CAM) was used to elucidate its validity. Results The proposed method achieved a peak accuracy of 99.65% with an input size of 512 × 512 pixels. Grad-CAM suggested that AI focused on both cellular and structural atypia of SCC, and tended to focus on the region surrounding the basal layer. Conclusion Training AI regarding both cellular and structural atypia using various magnification images simultaneously may be suitable for the diagnosis of oral SCC.
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Affiliation(s)
- Kaori Oya
- Division of Clinical Laboratory, Osaka University Dental Hospital, 1-8 Yamadaoka, Suita, Osaka, Japan
| | - Kazuma Kokomoto
- Division for Medical Informatics, Osaka University Dental Hospital, 1-8 Yamadaoka, Suita, Osaka, Japan
| | - Kazunori Nozaki
- Division for Medical Informatics, Osaka University Dental Hospital, 1-8 Yamadaoka, Suita, Osaka, Japan
| | - Satoru Toyosawa
- Division of Clinical Laboratory, Osaka University Dental Hospital, 1-8 Yamadaoka, Suita, Osaka, Japan,Department of Oral Pathology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka, Japan,Corresponding author. Department of Oral Pathology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Faustino ISP, de Pauli Paglioni M, Mariz BALDA, Normando AGC, Pérez-de-Oliveira ME, Georgaki M, Nikitakis NG, Vargas PA, Santos-Silva AR, Lopes MA. Prognostic outcomes of OSCC derived from proliferative verrucous leukoplakia: a systematic review. Oral Dis 2022; 29:1416-1431. [PMID: 35199416 DOI: 10.1111/odi.14171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to evaluate prognostic outcomes of PVL-derived oral squamous cell carcinomas (P-OSCC) based on recurrence, new primary tumour, metastasis and survival information. STUDY DESIGN Five databases and grey literature were searched electronically with the following main keywords (proliferative verrucous leukoplakia, squamous cell carcinoma and malignant transformation) to answer the following review question: 'Are survival outcomes for P-OSCC worse?' based on the PECOS principle. The Joanna Briggs Institute Critical Appraisal tool was used to identify possible biases and assess the quality of each of the primary studies. RESULTS A total of 21 articles met the inclusion criteria, and the results of this systematic review suggest that P-OSCC can recur and generate new primary tumours; however, metastases are rare. Thus, most patients remain alive for an average period of 5 years. CONCLUSION Apparently, P-OSCC has better clinical prognostic characteristics than conventional OSCC. There is a lack of information on the main prognostic outcomes of P-OSCC; therefore, specific studies must be performed to achieve a better comparison between P-OSCC and conventional OSCC progression.
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Affiliation(s)
| | | | | | | | | | - Maria Georgaki
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Nikolaos G Nikitakis
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Marcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Differential Characteristics of Patients With Squamous Cell Carcinoma of the Head and Neck According to Gender. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:359-369. [PMID: 34844674 DOI: 10.1016/j.otoeng.2020.08.007] [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: 04/06/2020] [Accepted: 08/18/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To analyse the trend in the percentage of patients with squamous cell carcinoma of the head and neck (SCCHN) of female gender over the last decades, and differences in survival according to gender. MATERIAL AND METHODS Retrospective study of 5828 SCCHN diagnosed during the period 1985-2019. In the survival analysis we only included only patients with more than two years of follow-up. RESULTS The proportion of tumours in female patients increased significantly over the study period. There was greater increase of tumours located in the oral cavity, oropharynx and larynx in the percentage of female patients. When considering the total number of patients, there were no significant differences in disease-specific survival according to gender. We observed a variable behaviour of disease-specific survival according to gender depending on the primary location of the tumour. For tumours of the larynx and oropharynx the female patients had a disease-specific survival significantly higher than that of men, while for tumours of the oral cavity, the female patients had a significant reduction of disease-specific survival. CONCLUSIONS In our setting, the percentage of female patients with HNSCC has been increasing steadily over recent decades. There were differences in disease-specific survival according to gender depending on the location of the primary tumour.
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In spite of successful curative surgery for buccal mucosa carcinoma the health-related quality-of-life continues to remain poor. Oral Maxillofac Surg 2021; 26:53-62. [PMID: 33837860 DOI: 10.1007/s10006-021-00959-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In early stage buccal mucosa carcinoma, in spite of successful curative surgery, the health-related quality-of-life (HRQoL) may not improve. We aimed to study HRQoL in these patients who had undergone successful curative surgery and determined factors that influence the HRQoL. METHODS Subjects, aged 18-70 years, who had undergone successful curative surgery for stage I and II buccal mucosa cancer, were assessed for HRQoL using the University of Washington Quality of Life Questionnaire and factors affecting HRQoL were determined. Their scores were compared with normative reference scores. RESULTS 54 patients (stages I 54%, II 46%) aged 44 ± 11 years (87% males) were studied. They had undergone curative surgery a median of 8.5 (IQR 4-13.5) months ago. Their mean global HRQoL score was 77 ± 30, with significantly poorer scores compared to reference in domains of appearance, activity, swallowing, chewing, speech, shoulder, saliva, mood and anxiety. Anxiety, activity, and chewing were considered the most important domains by the patients. Among the factors influencing HRQoL, duration since surgery was the most important factor, and patients with recent surgery had worse performance in chewing, saliva and mood. Patients with stage II had worse performance in shoulder and anxiety compared to stage I. Post-operative radiotherapy worsened swallowing and shoulder function. CONCLUSION In spite of successful curative surgery for buccal mucosa carcinoma, the HRQoL continues to remain sub-optimal with poor scores in most of the domains. These domains must be focused on with appropriate measures in order to improve overall HRQoL in patients after successful curative surgery.
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León X, García J, López M, Holgado A, Llansana A, Quer M. Differential characteristics of patients with squamous cell carcinoma of the head and neck according to gender. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:S0001-6519(20)30173-4. [PMID: 33618830 DOI: 10.1016/j.otorri.2020.08.009] [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: 04/06/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the trend in the percentage of patients with squamous cell carcinoma of the head and neck of female gender over the last decades, and differences in survival according to gender. MATERIAL AND METHODS Retrospective study of 5,828 squamous cell carcinoma of the head and neck diagnosed during the period 1985-2019. In the survival analysis we only included only patients with more than two years of follow-up. RESULTS The proportion of tumours in female patients increased significantly over the study period. There was greater increase of tumours located in the oral cavity, oropharynx and larynx in the percentage of female patients. When considering the total number of patients, there were no significant differences in disease-specific survival according to gender. We observed a variable behaviour of disease-specific survival according to gender depending on the primary location of the tumour. For tumours of the larynx and oropharynx the female patients had a disease-specific survival significantly higher than that of men, while for tumours of the oral cavity, the female patients had a significant reduction of disease-specific survival. CONCLUSIONS In our setting, the percentage of female patients with squamous cell carcinoma of the head and neck has been increasing steadily over recent decades. There were differences in disease-specific survival according to gender depending on the location of the primary tumour.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España.
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Anna Holgado
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Albert Llansana
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
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Bobdey S, Sathwara J, Jain A, Saoba S, Balasubramaniam G. Squamous cell carcinoma of buccal mucosa: An analysis of prognostic factors. South Asian J Cancer 2020; 7:49-54. [PMID: 29600236 PMCID: PMC5865098 DOI: 10.4103/sajc.sajc_317_16] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Carcinoma of the buccal mucosa is the most common oral cavity cancer in the Indian subcontinent. The aim of this study was to analyze the outcome and evaluate prognostic factors in surgically treated buccal mucosa squamous cell carcinoma (BMSCC) patients. Materials and Methods: A retrospective study was performed by reviewing the medical records of 409 pathologically proven buccal mucosa cancer patients, who were diagnosed and surgically treated in Tata Memorial Hospital between January 1, 2006, and December 31, 2008. Results: The overall 5-year survival of the cohort was found to be 54.1%. The stage-wise survival rate for tumor, node, metastasis (TNM) Stage I, II, III, and IV patients was found to be 85.2%, 82.9%, 56.3%, and 42.6% (P < 0.00), respectively. On multivariate Cox proportional hazard analysis, the presence of comorbidity, histological tumor size, pathological lymph node status, tumor differentiation, perineural invasion, and extracapsular spread were found to be independently associated with overall survival. Conclusion: BMSCC is an aggressive malignant tumor. In addition to TNM classification, other clinical and pathological factors also have a significant role in BMSCC prognostication. Hence, there is a need to move beyond TNM and develop a more inclusive, flexible, and easy to use prognostic system.
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Affiliation(s)
- Saurabh Bobdey
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jignasa Sathwara
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Aanchal Jain
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sushma Saoba
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ganesh Balasubramaniam
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Rath S, Gandhi AK, Rastogi M, Khurana R, Hadi R, Singh HB, Nanda SS, Azam M, Srivastava A, Bharati A, Mishra SP. Patterns of failure and clinical outcomes of post-operative buccal mucosa cancers treated with adjuvant ipsilateral radiotherapy. Radiat Oncol J 2020; 38:189-197. [PMID: 33012147 PMCID: PMC7533397 DOI: 10.3857/roj.2020.00458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/24/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose Adjuvant radiotherapy (RT) in buccal mucosa cancers is guided by histopathological factors. The decision to treat ipsilateral or bilateral draining lymph node is on physician discretion and guidelines do not have a defined indication regarding this. We aimed to analyze the failure patterns and survival in buccal mucosa cancers treated with adjuvant ipsilateral RT. Materials and Methods One hundred sixteen cases of post-operative buccal mucosa cancers—pT3 or more, node positive, close margins (1–5 mm), lymphovascular invasion positive, perineural invasion positive, depth of invasion >4 mm—treated with RT to primary and ipsilateral nodes from May 2013 to May 2019 were retrospectively analyzed. Patients were treated to a dose of 60–66 Gy (44 Gy in the first phase and a coned down boost of 16–22 Gy in the second phase) with three-dimensional conformal radiotherapy on a linear accelerator. Primary end point was to assess control rates and secondary end point was to evaluate the overall survival (OS) and disease-free survival (DFS) outcomes. Results Median age was 46 years with male; female ratio of 110:6. The edition of the American Joint Committee on Cancer stage distributions were I (3.4%), II (34.4%), III (24.1%), and IV (37.9%). At a median follow-up of 22 months, crude rates of local failure, regional failure, and contralateral neck failure were 9.4%, 10.3%, and 3.4%, respectively. The 2-year contralateral neck control rate was 94.9%. Pathological positive node portended poorer OS (86.6% vs. 68.6%; p = 0.015) and DFS (86.5% vs. 74.9%; p = 0.01). Conclusion Incidence of contralateral recurrence with ipsilateral irradiation in buccal mucosa cancers is low with descent survival outcomes, particularly in node negative cases.
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Affiliation(s)
- Satyajeet Rath
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajeet K Gandhi
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Madhup Rastogi
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rohini Khurana
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahat Hadi
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Harikesh B Singh
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sambit S Nanda
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mohammad Azam
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anoop Srivastava
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Avinav Bharati
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Surendra Prasad Mishra
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Fang Q, Gao H, Gao Q, Sun J, Li P, Cui M, Zhang E, Yin W, Dong Y. Elective neck dissection versus wait-and-see policy in cT1N0 buccal squamous cell carcinoma. BMC Cancer 2020; 20:537. [PMID: 32517666 PMCID: PMC7285468 DOI: 10.1186/s12885-020-07006-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
Background Our goal was to clarify the comparison between elective neck dissection (END) and the wait-and-see policy in neck management for cT1N0 buccal squamous cell carcinoma (SCC). Methods This was a retrospective comparison of 175 prospectively enrolled patients with cT1N0 buccal SCC. The patients were divided into two groups based on the nonrandomized management of the neck: 125 patients received END, and 50 patients were exposed to the wait-and-see policy. The main study endpoints were locoregional control (LRC) and disease-specific survival (DSS). Patients were asked to complete the shoulder domain in the University of Washington quality of life questionnaire, version 4, 1 year postoperatively. Results Ten of the patients undergoing END developed recurrence, and the 5-year LRC rate was 92%. Five patients undergoing the wait-and-see policy developed recurrence, and the 5-year LRC rate was 90%. The difference was not significant (p = 0.668). There were 6 deaths in patients undergoing END, and the 5-year DSS rate was 94%. There were 3 deaths in patients undergoing the wait-and-see policy, and the 5-year DSS rate was 94%; the difference was not significant (p = 0.777). The mean shoulder scores of patients undergoing END and the wait-and-see policy were 93.9 and 100, respectively, and the difference was not significant (p = 0.284). Conclusion Elective neck dissection does not carry a survival benefit compared to the wait-and-see policy, and it is not suggested for patients with cT1N0 buccal SCC.
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Affiliation(s)
- Qigen Fang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China.
| | - Hua Gao
- Department of Oral Medicine, Central Hospital of Yingkou, Yingkou, Liaoning Province, People's Republic of China
| | - Qing Gao
- Disease Control and Prevention Center, Shenyang, Liaoning, People's Republic of China
| | - Jinlan Sun
- Department of Oral Medicine, Central Hospital of Yingkou, Yingkou, Liaoning Province, People's Republic of China
| | - Peng Li
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Meng Cui
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Enxi Zhang
- Department of Oral Medicine, Kaifeng Central Hospital, Kaifeng, Henan, People's Republic of China
| | - Wenlong Yin
- Department of Oral Medicine, Kaifeng Central Hospital, Kaifeng, Henan, People's Republic of China
| | - Yuanyuan Dong
- Department of Oral Medicine, Kaifeng Central Hospital, Kaifeng, Henan, People's Republic of China
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Das N, Hussain E, Mahanta LB. Automated classification of cells into multiple classes in epithelial tissue of oral squamous cell carcinoma using transfer learning and convolutional neural network. Neural Netw 2020; 128:47-60. [PMID: 32416467 DOI: 10.1016/j.neunet.2020.05.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/01/2020] [Accepted: 05/01/2020] [Indexed: 11/24/2022]
Abstract
The analysis of tissue of a tumor in the oral cavity is essential for the pathologist to ascertain its grading. Recent studies using biopsy images reveal computer-aided diagnosis for oral sub-mucous fibrosis (OSF) carried out using machine learning algorithms, but no research has yet been outlined for multi-class grading of oral squamous cell carcinoma (OSCC). Pertinently, with the advent of deep learning in digital imaging and computational aid in the diagnosis, multi-class classification of OSCC biopsy images can help in timely and effective prognosis and multi-modal treatment protocols for oral cancer patients, thus reducing the operational workload of pathologists while enhancing management of the disease. With this motivation, this study attempts to classify OSCC into its four classes as per the Broder's system of histological grading. The study is conducted on oral biopsy images applying two methods: (i) through the application of transfer learning using pre-trained deep convolutional neural network (CNN) wherein four candidate pre-trained models, namely Alexnet, VGG-16, VGG-19 and Resnet-50, were chosen to find the most suitable model for our classification problem, and (ii) by a proposed CNN model. Although the highest classification accuracy of 92.15% is achieved by Resnet-50 model, the experimental findings highlight that the proposed CNN model outperformed the transfer learning approaches displaying accuracy of 97.5%. It can be concluded that the proposed CNN based multi-class grading method of OSCC could be used for diagnosis of patients with OSCC.
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Affiliation(s)
- Navarun Das
- National Institute of Technology, Silchar, Assam, India
| | - Elima Hussain
- Central Computational and Numerical Sciences Division, Institute of Advanced Study in Science and Technology, Guwahati, Assam, India
| | - Lipi B Mahanta
- Central Computational and Numerical Sciences Division, Institute of Advanced Study in Science and Technology, Guwahati, Assam, India.
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Riju J, George NA. Factors Influencing Locoregional Recurrence and Disease-Free Survival in Buccal Mucosal Squamous Cell Carcinoma. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01894-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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15
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Factor O, Su W, Lazarev S, Miles B, Genden E, Sharma S, Gupta V, Misiukiewicz K, Bakst RL. Rapid in-field failures following adjuvant radiation for buccal squamous cell carcinoma. Laryngoscope 2019; 130:413-417. [PMID: 31021426 DOI: 10.1002/lary.27996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/10/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS Squamous cell carcinoma originating in the buccal mucosa and retromolar trigone (RMT) have historically poor outcomes. Difficulties in discriminating tumor origin often result in these subsites being combined in surgical and pathological reports. We aimed to determine if making this anatomical distinction has implications for treatment design and clinical outcomes. STUDY DESIGN Retrospective case series. METHODS We identified 27 tumors from either the buccal mucosa patients or RMT patients who underwent surgery followed by radiation. For patients who developed a local failure, we fused the pretreatment imaging, simulation computed tomography, and follow-up imaging to determine the location of failures relative to the radiation field. We calculated the 2-year locoregional control and 2-year disease-free survival. RESULTS The median time from surgery to radiation was 50 days (range, 32-133 days). The 2-year locoregional control for buccal mucosa versus RMT, respectively, were 35.9% versus 68.4% (P = .252). The 2-year disease-free survival rates were 32.7% versus 68.4%, respectively (P = .196). The median times to failure were 12.00 months (range, 4.9-115.0 months) versus 18.5 months (range, 4.5-61.0 months), respectively. All buccal mucosa failures occurred within the high-dose planning target volume, with a median dose of 60 Gy within the failure region. Following locoregional failure, 10 of the 12 patients have died, with a median time from local failure to death of 3.6 months (range, 1-17.6 months). CONCLUSIONS Squamous cell carcinomas of the buccal mucosa appear to have a poor prognosis characterized by rapid in-field failure. Therefore, differentiating tumor origin may be important for prognostication and treatment. LEVEL OF EVIDENCE 3 Laryngoscope, 130:413-417, 2020.
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Affiliation(s)
- Oren Factor
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - William Su
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Stanislav Lazarev
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Brett Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Krzysztof Misiukiewicz
- Department of Hematology-Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Zaman SU, Aqil S, Sulaiman MA. Predictors of locoregional recurrence in early stage buccal cancer with pathologically clear surgical margins and negative neck. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Predictors of locoregional recurrence in early stage buccal cancer with pathologically clear surgical margins and negative neck. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:226-230. [DOI: 10.1016/j.otorri.2017.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/02/2017] [Accepted: 09/12/2017] [Indexed: 11/19/2022]
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Xie L, Zhang Y, Huang W, Chen J, Yu J, Zhou X. In-Continuity Neck Dissection: Long-Term Oncological Outcomes in Squamous Cell Carcinoma of the Buccal Mucosa. J Oral Maxillofac Surg 2017; 76:1107-1116. [PMID: 29195080 DOI: 10.1016/j.joms.2017.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To introduce in-continuity neck dissection (ND) in squamous cell carcinoma of the buccal mucosa (BMSCC) and to determine its impact on the oncologic outcomes of these patients. MATERIALS AND METHODS A retrospective review of patients treated for BMSCC from 2006 through 2016 was performed. Kaplan-Meier analysis and log-rank test were used to evaluate local control, regional control (RC), distant metastasis (DM), and disease-specific survival (DSS) of in-continuity ND versus discontinuous ND in 220 previously untreated patients with BMSCC, followed by a multivariate Cox regression that included all relevant variables. RESULTS Fifty-three patients received discontinuous ND and 167 patients received in-continuity ND. The 2 groups were comparable. Univariate Kaplan-Meier analysis showed that 5-year DSS rates for the discontinuous ND and in-continuity ND groups were 38 and 62% (P = .023), respectively. The 5-year RC rate for the in-continuity ND group (81%) was significantly better (P = .004) than for the discontinuous ND group (54%). At Cox regression analysis, in-continuity ND meaningfully contributed to a higher RC rate and subsequently better DSS. CONCLUSION Compared with discontinuous ND, in-continuity ND predicted favorable oncologic outcomes in patients with BMSCC. In-continuity ND could be a practical approach in the surgical management of BMSCC.
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Affiliation(s)
- Li Xie
- Associate Professor, Department of Head and Neck Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
| | - Yuanyuan Zhang
- Resident Doctor, Department of Sexually Transmitted Diseases, Hunan Center for Disease Prevention and Control, Changsha, China
| | - Wenxiao Huang
- Professor, Department of Head and Neck Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jie Chen
- Professor, Department of Head and Neck Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jianjun Yu
- Professor, Department of Head and Neck Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiao Zhou
- Professor, Department of Head and Neck Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Tandon P, Dadhich A, Saluja H, Bawane S, Sachdeva S. The prevalence of squamous cell carcinoma in different sites of oral cavity at our Rural Health Care Centre in Loni, Maharashtra - a retrospective 10-year study. Contemp Oncol (Pozn) 2017; 21:178-183. [PMID: 28947890 PMCID: PMC5611509 DOI: 10.5114/wo.2017.68628] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 09/30/2016] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Oral cancer ranks in the top three of all cancers in India and is quickly becoming a global health priority. More than 90% of oral and oropharyngeal cancers are squamous cell carcinoma. The purpose of this study was to document its incidence depending upon the involvement of different sites of oral cavity, and its variation with age and gender. MATERIAL AND METHODS Histopathologically proven oral squamous cell carcinoma cases were collected from the department of oral and maxillofacial surgery RDC, PIMS. The cases were systematically grouped under three headings: anatomical sub-site of oral cavity, age group, and gender, which were analysed to calculate the prevalence of oral cancer. The study was undertaken after obtaining approval from the institutional Ethical Committee board. RESULTS Among the different sites of oral cavity, the highest incidence (31.47%) of oral squamous cell carcinoma was seen for buccal mucosa in our study. The most affected age group (39.50%) were patients above 50 years old, predominantly involving males. CONCLUSIONS The population in this study were mostly from remote areas, among which a high rate of occurrence of oral cancer was encountered because the people were of low socio-economic class, had a casual attitude towards their health, high rate of tobacco consumption, and limited health care facilities. This study provides valuable data of the prevalence of oral cancer among the rural population.
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Affiliation(s)
- Parul Tandon
- Rural Dental College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Anuj Dadhich
- Rural Dental College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Harish Saluja
- Rural Dental College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Shilpa Bawane
- Rural Dental College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Shivani Sachdeva
- Rural Dental College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
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20
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Liu S, Shi L, Yang X, Ye D, Wang T, Dong C, Guo W, Liao Y, Song H, Xu D, Hu J, Zhang Z, Deng J. Nuclear survivin promoted by acetylation is associated with the aggressive phenotype of oral squamous cell carcinoma. Cell Cycle 2017; 16:894-902. [PMID: 28384094 DOI: 10.1080/15384101.2017.1310352] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Defects in apoptotic pathway contribute to development and progression of oral cancer. Survivin, a member of the inhibitors of apoptosis protein (IAP) family, is increased in many types of cancers. However, it is unclear whether increased survivin is associated with oral squamous cell carcinomas (OSCC), and what mechanisms may involve in. In this study, we examined survivin expression in OSCC compared with normal oral tissues via immunohistochemical staining. The results showed that, not only total survivin is increased in OSCCs, but also the subcellular location of survivin is changed in OSCCs compared with normal oral tissues. In most of normal oral tissues, survivin staining was either negative, or cytoplasmic positive/nuclear negative; whereas in most of OSCC tissues, survivin staining was nuclear positive. Statistic analysis indicates that nuclear survivin, rather than total or cytoplasmic one, correlates with tumor TNM stage and differentiation grade. Consistently, in vitro analysis showed that survivin is in cytoplasm in normal human oral kinotinocyte (HOK) cells; whereas it is in nucleus in OSCC HN6 cells. Importantly, treatment of HOK cells with HDAC inhibitor Trichostatin A (TSA) induces survivin acetylation and promotes its nuclear localization. Moreover, nuclear survivin in OSCC cells was acetylated at K129 in its C-terminal, suggesting that the acetylation is important for nuclear location of survivin. Our study demonstrates that it is nuclear survivin, rather than total or cytoplasmic one, associates with TNM stage and tumor grade of OSCC. Thus, we propose nuclear survivin as a prognostic marker for the progression of OSCC.
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Affiliation(s)
- Shuli Liu
- a Department of Oral and Maxillofacial-Head and Neck Oncology , Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.,b Shanghai Key Laboratory of Stomatology , Shanghai , China
| | - Lei Shi
- c Department of Oral and Maxillofacial Surgery , Gansu Provincial Hospital , Gansu , China
| | - Xi Yang
- a Department of Oral and Maxillofacial-Head and Neck Oncology , Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.,b Shanghai Key Laboratory of Stomatology , Shanghai , China
| | - Dongxia Ye
- a Department of Oral and Maxillofacial-Head and Neck Oncology , Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.,b Shanghai Key Laboratory of Stomatology , Shanghai , China
| | - Tong Wang
- d Key Laboratory of Cell Differentiation and Apoptosis of Chinese Minister of Education , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Cunshan Dong
- e Department of Oral and Maxillofacial Surgery , Double Mineral Hospital , Shuangyashan , Heilongjiang , China
| | - Wenzheng Guo
- d Key Laboratory of Cell Differentiation and Apoptosis of Chinese Minister of Education , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yueling Liao
- d Key Laboratory of Cell Differentiation and Apoptosis of Chinese Minister of Education , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Hongyong Song
- d Key Laboratory of Cell Differentiation and Apoptosis of Chinese Minister of Education , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Dongliang Xu
- d Key Laboratory of Cell Differentiation and Apoptosis of Chinese Minister of Education , Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Jingzhou Hu
- a Department of Oral and Maxillofacial-Head and Neck Oncology , Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.,b Shanghai Key Laboratory of Stomatology , Shanghai , China
| | - Zhiyuan Zhang
- a Department of Oral and Maxillofacial-Head and Neck Oncology , Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China.,b Shanghai Key Laboratory of Stomatology , Shanghai , China
| | - Jiong Deng
- d Key Laboratory of Cell Differentiation and Apoptosis of Chinese Minister of Education , Shanghai Jiao Tong University School of Medicine , Shanghai , China.,f Shanghai Key Laboratory for Tumor Microenvironment and Inflammation , Shanghai Jiao Tong University School of Medicine , Shanghai , China.,g Translation Medicine Center, Shanghai Chest Hospital , Shanghai Jiao Tong University , Shanghai , China
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Dandekar M, Tuljapurkar V, Dhar H, Panwar A, DCruz AK. Head and neck cancers in India. J Surg Oncol 2017; 115:555-563. [PMID: 28120407 DOI: 10.1002/jso.24545] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/27/2016] [Indexed: 01/21/2023]
Abstract
Head and neck cancers constitute a third of the cancer burden in India. These cancers have unique patient characteristics, presentation, and etiological differences from those in the West. Socioeconomic constraints, large patient population, scarcity of trained health workers, and inadequate infrastructure are major challenges faced in the management of these cancers. Despite these constraints, patients are treated with evidence based guidelines that are tailored to the local scenario.
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Affiliation(s)
| | - Vidisha Tuljapurkar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India
| | - Harsh Dhar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India
| | - Aru Panwar
- Department of Otolaryngology- Head and Neck Surgery, 981225 Nebraska Medical Center, Omaha, Nebraska, 68198-1225
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Komolmalai N, Chuachamsai S, Tantiwipawin S, Dejsuvan S, Buhngamongkol P, Wongvised C, Chitapanarux I, Iamaroon A. Ten-year analysis of oral cancer focusing on young people in northern Thailand. J Oral Sci 2015; 57:327-34. [DOI: 10.2334/josnusd.57.327] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
| | | | | | | | | | | | - Imjai Chitapanarux
- Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University
| | - Anak Iamaroon
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University
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Liu CH, Chen HJ, Wang PC, Chen HS, Chang YL. Patterns of recurrence and second primary tumors in oral squamous cell carcinoma treated with surgery alone. Kaohsiung J Med Sci 2013; 29:554-9. [DOI: 10.1016/j.kjms.2013.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 09/20/2012] [Indexed: 11/30/2022] Open
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Siebers TJH, Bergshoeff VE, Otte-Höller I, Kremer B, Speel EJM, van der Laak JAWM, Merkx MAW, Slootweg PJ. Chromosome instability predicts the progression of premalignant oral lesions. Oral Oncol 2013; 49:1121-8. [PMID: 24075955 DOI: 10.1016/j.oraloncology.2013.09.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/29/2013] [Accepted: 09/07/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES One of the main problems in reducing the incidence of oral squamous cell carcinoma (OSCC) is the inability to appropriately deal with leukoplakia. Accurately identifying lesions which will progress to malignancy is currently not possible. The present study aims to establish the value of chromosome instability (CI) detection by DNA image cytometry and FISH analysis for prognosis and monitoring of oral leukoplakia. MATERIALS AND METHODS For this purpose, we included from our archives 102 oral leukoplakia cases, which had been diagnosed between 1991 and 2008. Patient follow-up data were collected and the histopathological diagnosis was revised. CI assessment was carried out on paraffin-embedded tissue sections using both DNA image cytometry (ICM) and dual target FISH for chromosomes 1 and 7. RESULTS 16 of 102 Patients developed carcinoma in situ or OSCC. Both detection methods were found to yield prognostic information independent of the histopathological diagnosis. CI was a strong individual marker of progression, with hazard ratios (HRs) of 7.2 and 6.8 for ICM and FISH respectively. Moreover, this approach seems suitable for monitoring lesions over time (especially ICM). Combining histopathology and CI enables subdivision of patients into three risk groups, with different probabilities of malignant progression. CONCLUSION CI detection seems a reliable method for risk assessment of oral premalignancies and its application may contribute to a better risk-counselling and appropriate treatment regimen or watchfull-waiting approach of patients.
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MESH Headings
- Carcinoma in Situ/genetics
- Carcinoma in Situ/pathology
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/pathology
- Chromosomal Instability
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 7/genetics
- DNA, Neoplasm/genetics
- Female
- Follow-Up Studies
- Humans
- Image Cytometry/methods
- In Situ Hybridization, Fluorescence/methods
- Leukoplakia, Oral/genetics
- Leukoplakia, Oral/pathology
- Male
- Middle Aged
- Mouth Neoplasms/genetics
- Mouth Neoplasms/pathology
- Prognosis
- Retrospective Studies
- Risk Assessment/methods
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Affiliation(s)
- T J H Siebers
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Department of Pathology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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A retrospective evaluation of submandibular gland involvement in oral cavity cancers: a case for gland preservation. Int J Oral Maxillofac Surg 2012; 41:1383-6. [DOI: 10.1016/j.ijom.2012.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/04/2012] [Accepted: 07/26/2012] [Indexed: 11/20/2022]
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Hakeem AH, Pradhan SA, Tubachi J, Kannan R. Outcome of per oral wide excision of T1-2 N0 localized squamous cell cancer of the buccal mucosa-analysis of 156 cases. Laryngoscope 2012; 123:177-80. [DOI: 10.1002/lary.23707] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2012] [Indexed: 11/09/2022]
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28
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Liao CT, Lin CY, Fan KH, Wang HM, Ng SH, Lee LY, Hsueh C, Chen IH, Huang SF, Kang CJ, Yen TC. Identification of a High-Risk Group Among Patients With Oral Cavity Squamous Cell Carcinoma and pT1–2N0 Disease. Int J Radiat Oncol Biol Phys 2012; 82:284-90. [DOI: 10.1016/j.ijrobp.2010.09.036] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 08/02/2010] [Accepted: 09/08/2010] [Indexed: 11/30/2022]
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Matsuzaki H, Takemoto M, Hara M, Unetsubo T, Yanagi Y, Katsui K, Katayama N, Yoshio K, Takenobu T, Kuroda M, Kanazawa S, Asaumi JI. Two-piece customized mold technique for high-dose-rate brachytherapy on cancers of the buccal mucosa and lip. Oral Surg Oral Med Oral Pathol Oral Radiol 2011; 113:118-25. [PMID: 22677692 DOI: 10.1016/j.tripleo.2011.06.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 05/17/2011] [Accepted: 06/21/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE High-dose-rate (HDR) brachytherapy using a customized mold is a minimally invasive treatment for oral cancer; however, it is difficult to use this technique for buccal and lip cancers involving the commissura labiorum, owing to its anatomic form. The purpose of this study was to introduce an improved customized mold consisting of 2 pieces to allow the fixation of molds to these sites. STUDY DESIGN Five patients with buccal carcinoma and 1 patient with lip carcinoma were treated with this technique after external beam radiotherapy. One patient with neck metastasis underwent both neck dissection and partial tumor resection before HDR brachytherapy. RESULTS At the end of the follow-up period, 5 patients had no tumor recurrence, and 1 patient had suffered local recurrence. CONCLUSIONS Our technique is a viable therapeutic option for patients with buccal and lip carcinomas for whom the therapeutic modalities are limited by age, performance status, and other factors.
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Affiliation(s)
- Hidenobu Matsuzaki
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama, Japan
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Johnson NW, Jayasekara P, Amarasinghe AAHK. Squamous cell carcinoma and precursor lesions of the oral cavity: epidemiology and aetiology. Periodontol 2000 2011; 57:19-37. [PMID: 21781177 DOI: 10.1111/j.1600-0757.2011.00401.x] [Citation(s) in RCA: 205] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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31
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Liao CT, Wang HM, Huang SF, Chen IH, Kang CJ, Lin CY, Fan KH, Ng SH, Hsueh C, Lee LY, Lin CH, Yen TC. PET and PET/CT of the Neck Lymph Nodes Improves Risk Prediction in Patients with Squamous Cell Carcinoma of the Oral Cavity. J Nucl Med 2011; 52:180-7. [DOI: 10.2967/jnumed.110.082370] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Prognostic factors for loco-regional failure in early stage (I and II) squamous cell carcinoma of the gingivobuccal complex. Eur Arch Otorhinolaryngol 2010; 267:1135-40. [DOI: 10.1007/s00405-009-1201-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 12/29/2009] [Indexed: 10/20/2022]
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Fang KH, Kao HK, Cheng MH, Chang YL, Tsang NM, Huang YC, Lee LY, Yu JS, Hao SP, Chang KP. Histological Differentiation of Primary Oral Squamous Cell Carcinomas in an Area of Betel Quid Chewing Prevalence. Otolaryngol Head Neck Surg 2009; 141:743-9. [DOI: 10.1016/j.otohns.2009.09.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 08/18/2009] [Accepted: 09/18/2009] [Indexed: 12/19/2022]
Abstract
OBJECTIVES: This study evaluated associations between the histological differentiation of oral squamous cell carcinoma and additional clinicopathological manifestations, adverse events after treatment, and the outcomes of patients in a region prevalent for betel quid chewing. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: A total of 150 patients with primary oral squamous cell carcinomas who underwent surgery with or without adjuvant therapy were enrolled. RESULTS: Well, moderate, and poorly differentiated oral squamous cell carcinomas were reported in 54 (36%), 84 (56%), and 12 (8%) patients, respectively. There were no significant differences among different histological differentiations in age, sex, tumor, node, metastasis stage, bone invasion, depth of invasion, and history of carcinogen exposure. However, we found significant associations between tumor histological differentiation and nodal metastasis ( P < 0.0001), extracapsular spread ( P = 0.002), and perineural invasion ( P < 0.0001). In the analysis of adverse events for survival during patient follow-up, oral squamous cell carcinomas with poor differentiation had a higher probability of developing neck recurrence ( P = 0.001) and distant metastasis ( P = 0.019), but not local recurrence or a second primary cancer. For survival analysis, univariate analysis showed that patient age, tumor stage, extracapsular spread, presence of perineural invasion, and tumor differentiation were significant factors. Multivariate analysis further demonstrated that poor differentiation ( P = 0.007) was still a statistically significant factor. CONCLUSION: The current study demonstrates that poorer tumor histological classifications of oral squamous cell carcinoma are significantly associated with positive nodal status, extracapsular spread, perineural invasion of primary tumors, and the probability of developing neck recurrence and distant metastasis after treatment.
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Affiliation(s)
- Ku-Hao Fang
- Departments of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Huang-Kai Kao
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Hui Cheng
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Liang Chang
- Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ngan-Ming Tsang
- Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Chen Huang
- Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Li-Yu Lee
- Pathology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jau-Song Yu
- Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Po Hao
- Departments of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Departments of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Lin LM, Chen YK, Chen CH, Chen YW, Huang AHC, Wang WC. VX2-induced rabbit buccal carcinoma: A potential cancer model for human buccal mucosa squamous cell carcinoma. Oral Oncol 2009; 45:e196-203. [DOI: 10.1016/j.oraloncology.2009.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 07/16/2009] [Accepted: 07/16/2009] [Indexed: 11/29/2022]
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Determination of deep surgical margin based on anatomical architecture for local control of squamous cell carcinoma of the buccal mucosa. Oral Oncol 2009; 45:605-9. [DOI: 10.1016/j.oraloncology.2008.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 08/12/2008] [Accepted: 08/13/2008] [Indexed: 11/24/2022]
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Pathak KA, Nason R, Talole S, Abdoh A, Pai P, Deshpande M, Chaturvedi P, Chaukar D, D'Cruz A, Bhalavat R. Cancer of the buccal mucosa: a tale of two continents. Int J Oral Maxillofac Surg 2008; 38:146-50. [PMID: 18760901 DOI: 10.1016/j.ijom.2008.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 01/14/2008] [Accepted: 07/18/2008] [Indexed: 10/21/2022]
Abstract
Squamous cell carcinoma (SCC) of the buccal mucosa in North America is thought to be different from that in the Indian subcontinent. This study compared the treatment outcomes and prognostic factors in 64 patients with SCC of the buccal mucosa treated at Cancer Care Manitoba (CCMB), Canada, and 64 similar patients treated at the Tata Memorial Hospital (TMH), India. Overall, cause-specific and disease-free survival for the two geographical groups were calculated and the impact of individual prognostic factors on survival was assessed. CCMB patients were significantly older (p<0.001), had less differentiated tumour (p=0.053) and had higher chances of positive or close surgical margins (p=0.012). At 5 years, they had lower 5-year overall survival (57.4% versus 80.1%; p<0.001), cancer-specific survival (76.4% versus 85.0%; p=0.043) and disease-free survival (42.9% versus 66.4%; p=0.004). Age had an independent influence on overall survival and cause-specific survival. After adjusting for age there was no difference in cause-specific survival between the two groups (HR=1.20; 95% CI=0.46,3.17; p=0.710). The apparent survival difference between the CCMB and TMH patients was due to the difference in the age of presentation and not because of different biological behaviour.
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Affiliation(s)
- K A Pathak
- Tata Memorial Hospital, Parel, Mumbai, India.
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Misra S, Chaturvedi A, Misra NC. Management of gingivobuccal complex cancer. Ann R Coll Surg Engl 2008; 90:546-53. [PMID: 18701010 DOI: 10.1308/003588408x301136] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Squamous cell carcinoma of the oral cavity ranks as the 12th most common cancer in the world and the 8th most frequent in males. It accounts for up to one-third of all tobacco-related cancers in India. Cancer of the gingivobuccal complex is especially common in Indians due to their tobacco habits. This review focuses on the management of lower gingivobuccal complex cancers. PATIENTS AND METHODS References for this review were identified by search of Medline and other bibliographic information available in the PubMed database. The search terms carcinoma oral cavity, and cancer oral cavity, buccal mucosa, gingiva, gingivobuccal complex, and alveolus cancer/carcinoma were used. References from relevant articles and abstracts from international conferences were also included. Only articles published in the English language were used. RESULTS Treatment of gingivobuccal complex cancer is primarily surgical. Radical neck dissection, or its modification, is the standard treatment for the node-positive neck. Supraomohyoid neck dissection is the accepted treatment for the node-negative neck. Radiotherapy is usually not the preferred modality of treatment for early gingivobuccal complex cancer. It is used either as postoperative adjuvant treatment or as definitive treatment for advanced cancer with or without chemotherapy. Chemotherapy has been used as neo-adjuvant, adjuvant or palliative treatment. Advanced cancers are common and continue to pose a challenge to the multidisciplinary team. CONCLUSIONS Gingivobuccal complex cancer remains a major public health problem despite being highly preventable and easily detectable. Advanced cancers constitute a major proportion of patients presenting for treatment. These patients are difficult to treat and have a poor outcome.
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Affiliation(s)
- Sanjeev Misra
- Department of Surgical Oncology, King George's Medical University, Lucknow, India.
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Walvekar RR, Chaukar DA, Deshpande MS, Pai PS, Chaturvedi P, Kakade A, D'Cruz AK. Squamous cell carcinoma of the gingivobuccal complex: predictors of locoregional failure in stage III-IV cancers. Oral Oncol 2008; 45:135-40. [PMID: 18621571 DOI: 10.1016/j.oraloncology.2008.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 04/12/2008] [Accepted: 04/15/2008] [Indexed: 11/25/2022]
Abstract
The purpose of our study was to analyze the indicators of loco-regional failure in a large cohort of patients with gingivobuccal complex tumors treated at a single institution. A retrospective review of 2275 patients diagnosed with tumors of the gingivobuccal complex was conducted from January 1997 to December 1999; 642 patients who fulfilled our inclusion criteria were analyzed. A univariate analysis, multivariate analysis, and disease-free survival are reported. During a median follow up of 2.51 years, there were 228 (35.5%) recurrences with a median post-recurrence survival of 2.7 months. The incidence of occult neck metastasis was 29%. The 2- and 5-year DFS rates were 63.8% and 53.3%, respectively. On multivariate analysis, tumor depth and metastatic lymphadenopathy were found to be independent prognostic factors for disease-free survival. Advanced gingivobuccal cancers fail loco-regionally. Cervical metastasis and tumor depth influence disease-free survival. Elective neck dissection due to a high incidence of occult neck disease is recommended.
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Affiliation(s)
- Rohan R Walvekar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Dr. E. Borges Marg, Parel, Mumbai 400 012, India
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Prognostic influence of gender in patients with oral tongue cancer. Otolaryngol Head Neck Surg 2008; 138:768-71. [PMID: 18503852 DOI: 10.1016/j.otohns.2008.02.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 02/25/2008] [Accepted: 02/10/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the independent role of gender in affecting prognosis in patients with anterior tongue cancer. DESIGN Patients recorded in the head and neck cancer registry of Milano-Bicocca School of Medicine between January 1981 and December 1998 were reviewed. Female patients with squamous cell carcinoma of the tongue were identified and matched to men for year of diagnosis, age, TNM classification, histologic grading, and treatment modalities. For each woman, two men were matched. RESULTS Seventy-one women and 142 men satisfied our selection criteria. The frequency of recurrences was similar in the two study groups. This event occurred in 33 (46%) women and in 78 (55%) men (Fisher exact test, P = 0.25). The survival analysis confirmed that the rate of recurrences did not differ (log-rank test, P = 0.31). The number of cancer-related deaths in women and men was 23 (32%) and 55 (39%), respectively (Fisher exact test, P = 0.45). The survival analysis confirmed that gender did not affect survival (log-rank test, P = 0.34). CONCLUSION In this study, gender does not influence prognosis in patients with oral tongue cancer.
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Liao CT, Huang SF, Chen IH, Chang JTC, Wang HM, Ng SH, Hsueh C, Lee LY, Lin CH, Cheng AJ, Yen TC. When does skin excision allow the achievement of an adequate local control rate in patients with squamous cell carcinoma involving the buccal mucosa? Ann Surg Oncol 2008; 15:2187-94. [PMID: 18506533 DOI: 10.1245/s10434-008-9980-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 04/08/2008] [Accepted: 04/09/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND The role of cheek skin excision in patients with squamous cell carcinoma of the buccal mucosa (BSCC) remains controversial. We sought to investigate when skin excision is needed to achieve an adequate local control. METHODS A total of 331 patients with BSCC were reviewed. Skin preservation was pursued when the distance between the tumor and the skin as determined by imaging was >or=13 mm (1 cm surgical margin plus 0.3 cm skin preservation). Two hundred and thirty patients (69.5%) underwent skin excision. Postoperative adjuvant radiotherapy (n = 182) was performed in patients with pathological T4 disease, metastases in cervical lymph nodes or close pathological margins (<or=4 mm). The 5-year local control rate was plotted by Kaplan-Meier analysis. RESULTS Twenty-four patients (7.3%) had close pathological margins. The 5-year local control rate did not differ significantly between patients treated either with or without skin excision. This was verified both in subjects who received surgery alone (94% versus 91%) and in those who received surgery plus adjuvant therapy (82% versus 86%). CONCLUSION In patients with BSCC, a good 5-year local control rate may be equally achieved either with or without skin excision. In patients with pT3 disease, postoperative radiotherapy is not recommended in the absence of close pathological margins. Our findings may guide clinical decision-making on skin excision in this patient group.
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Affiliation(s)
- Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Pathak K, Nason R, Talole S, Abdoh A. Are buccal cancers in India and Canada any different? J Surg Oncol 2008; 97:529-32. [DOI: 10.1002/jso.21002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Zou H, Zhang WF, Han QB, Zhao YF. Salvage Reconstruction of Extensive Recurrent Oral Cancer Defects With the Pectoralis Major Myocutaneous Flap. J Oral Maxillofac Surg 2007; 65:1935-9. [PMID: 17884518 DOI: 10.1016/j.joms.2006.10.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2006] [Revised: 06/16/2006] [Accepted: 10/31/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aimed to evaluate the usefulness of the pectoralis major myocutaneous flap for reconstruction of oral and facial defects after excision of recurrent oral cancer and the results of salvage surgery. PATIENTS AND METHODS Twenty-four patients with recurrent squamous cell carcinoma of the oral cavity underwent salvage surgical treatment. Pectoralis major flaps were used for reconstruction of the extensive defects caused by excision of the tumors. The complications of the flap and the prognosis of the patients were analyzed with a follow-up from 5 to 65 months (mean = 18.5 months). RESULTS Fourteen flaps were used for mucosal lining of the mouth, and 10 flaps were used for reconstruction of the cutaneous defects. The overall success rate of the flap was 70.8%. Flap-related complications developed in 13 patients (54.2%). Major complications occurred in 7 patients (29.2%), and minor complications occurred in 6 (25.0%). Three patients (12.5%) had complications unrelated to the flap. The reconstruction of the base of the tongue, the floor of the mouth, and the oropharynx emerged as a significant risk factor for flap necrosis on binary logistic regression analysis (P < .05). The overall 1-, 3-, and 5-year overall survival rate was 72.8%, 30.9%, and 20.6%, respectively. CONCLUSION The pectoralis major myocutaneous flap is a reliable choice for reconstruction of extensive soft tissue defects caused by excision of recurrent oral cancer. The major complications correlate with the site of reconstruction. Many patients benefit from salvage surgery, and some of them can survive 2 to 4 years postoperatively.
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Affiliation(s)
- Hao Zou
- Department of Oral and Maxillofacial Surgery, and Research Fellow, Key Laboratory of Oral Biomedical Engineering (Wuhan University), Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, PR China
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Huang CH, Chu ST, Ger LP, Hou YY, Sun CP. Clinicopathologic evaluation of prognostic factors for squamous cell carcinoma of the buccal mucosa. J Chin Med Assoc 2007; 70:164-70. [PMID: 17475598 DOI: 10.1016/s1726-4901(09)70351-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The purpose of this research was to evaluate the prognostic significance of clinicopathologic variables on the survival rate for squamous cell carcinoma of the buccal mucosa (BMSCC). We analyzed the outcomes of surgical therapy for this aggressive cancer and compared these results with those in the literature. METHODS We reviewed the medical charts of 172 patients treated in our institution between 1990 and 2005. There were 22 patients excluded from our studies: 20 patients with advanced tumors who received no treatment or palliative treatment, and 2 patients who had received preoperative radiotherapy (RT). The remaining 150 patients were treated with surgeries and among them, 56 patients had undergone postoperative RT. The influence of clinicopathologic factors on the survival rate was analyzed with the Kaplan-Meier method and log-rank test. Multivariate analysis was assessed with Cox's regression model. RESULTS There were 148 males and 2 females, with a mean age of 53.5 years. The prevalence rate of habitual betel quid chewing documented in charts among 113 patients was 75%. The 5-year overall survival rate and disease-specific survival rate for all patients were 64% and 69%, respectively. For patients with stages I, II, III, and IV disease, the 5-year disease-specific survival rates were 90%, 77%, 52%, and 47%, respectively (p<0.001). According to the multivariate analysis, the pathologic staging and histologic grading of the tumor were independently the important prognostic factors affecting survival rate. There were 80 patients who developed locoregional recurrence in lymph nodes in the follow-up diagnoses. Distant metastases occurred in 14 patients, with 11 of them also having locoregional recurrence. The distant metastases were found in the lungs (8/14), T-spine (3/14), liver (2/14) and brain (1/14). CONCLUSION Pathologic stage and histologic grade are the most important prognostic factors.
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Affiliation(s)
- Cheng-Hui Huang
- Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. R.O.C
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Jane C, Nerurkar AV, Shirsat NV, Deshpande RB, Amrapurkar AD, Karjodkar FR. Increased survivin expression in high-grade oral squamous cell carcinoma: a study in Indian tobacco chewers. J Oral Pathol Med 2006; 35:595-601. [PMID: 17032391 DOI: 10.1111/j.1600-0714.2006.00473.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oral cancer is one of the five leading sites of cancer in the Indian population. In the present study we analyzed the expression of apoptosis regulating genes, viz. survivin, Bcl-2, Bax and p53 in precancerous and cancerous lesions of the buccal mucosa of Indian tobacco chewers. METHOD Paraffin-embedded tissue samples from 38 patients with primary oral squamous cell carcinoma (OSCC) and 17 patients with leukoplakia were used. The expression of survivin, Bcl-2, Bax, and p53 was evaluated using immunohistochemical staining method. RESULTS Thirty-six percent OSCC were found to be positive for nuclear p53 staining while none of the precancerous lesions showed p53 positivity. Survivin, Bcl-2 and Bax expression was found to increase with increased grade of malignancy. Increase in survivin expression was statistically most significant (P < 0.001). CONCLUSION Increased expression of anti-apoptotic survivin in high-grade tumors suggests that survivin is likely to contribute significantly to apoptosis resistance in response to therapy.
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Affiliation(s)
- C Jane
- Department of Biochemistry, T N Medical College, B Y L Nair Hospital, Mumbai
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Coppen C, de Wilde PCM, Pop LA, van den Hoogen FJA, Merkx MAW. Treatment results of patients with a squamous cell carcinoma of the buccal mucosa. Oral Oncol 2006; 42:795-9. [PMID: 16529979 DOI: 10.1016/j.oraloncology.2005.11.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Accepted: 11/24/2005] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to evaluate outcome and value of follow-up of squamous cell carcinoma (SCC) of the buccal mucosa in patients treated at the Radboud University Nijmegen Medical Centre, The Netherlands. A longitudinal cohort study was performed involving 32 patients treated with curative intent (surgery on indication followed by radiotherapy) for SCC of the buccal mucosa from 1987 to 2002, with a minimum follow-up of three years. The prognosis of SCC of the buccal mucosa is comparable to other sites of the oral cavity. The success rate of therapy for a local and/or regional recurrence is very limited. Patients with a second primary tumour (SPT) can be cured if the tumour is detected in an early stage. Routine follow-up used to detect local recurrence or SPT has almost no value after five years and seems of limited value after three years.
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Affiliation(s)
- Casper Coppen
- Radboud University Nijmegen Medical Centre, Department of Oral and Maxillofacial Surgery, 590, P.O. Box 9101, NL 6500, HB Nijmegen, Netherlands
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Ghoshal S, Mallick I, Panda N, Sharma SC. Carcinoma of the buccal mucosa: Analysis of clinical presentation, outcome and prognostic factors. Oral Oncol 2006; 42:533-9. [PMID: 16464632 DOI: 10.1016/j.oraloncology.2005.10.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 10/12/2005] [Indexed: 11/23/2022]
Abstract
Records of 100 consecutive cases of carcinoma of the buccal mucosa treated in our institute between January 2000 and December 2003 were analyzed for clinical presentation, patterns of care, disease-free survival (DFS) and prognostic factors. There were 75 males and 25 females. The mean age was 50 years. Ninety five gave a history of abuse of oral tobacco products. Only 20 patients were in Stage I or II. Sixty one patients had Stage IV disease. Sixty six patients were treated with radical intent while 34 were suitable only for palliative radiation. The 2-year DFS for the entire group was 47.94%. All failures occurred by 12 months. However, the 2-year DFS in radically treated patients was 76.4%. On univariate analysis, late overall stage, T3/T4 disease, node positivity and palliative treatment were significant poor prognostic factors. On multivariate analysis, T3/T4 disease and palliative treatment were independent poor prognostic factors. Early detection can improve outcomes considerably in this disease.
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Affiliation(s)
- Sushmita Ghoshal
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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