Prognostic factors for T1-T2 squamous cell carcinomas of the mobile tongue: A retrospective cohort study

Significance of Worst Pattern of Invasion-5 in Early-Stage Oral Cavity Squamous Cell Carcinoma

BACKGROUND

There is an ongoing need to identify pathologic prognosticators in early-stage oral cavity squamous cell carcinoma (OCSCC) to aid selection of patients who may benefit from adjuvant treatment. The objective of this study was to evaluate the prognostic ability of worst pattern of invasion-5 (WPOI-5) defined by the presence of satellite nodules, extratumoural perineural invasion (PNI) and/or extratumoural lymphovascular space invasion (LVI) in low-stage, node negative OCSCC.

METHODS

This was a retrospective study of 160 patients with T1/T2N0 tumours staged using TNM7 treated surgically. Histology of the primary tumour was re-reviewed as appropriate to assess for the presence of WPOI-5 parameters. Univariate and multivariate analysis assessing impact of pathological features on survival outcomes was performed.

RESULTS

On univariate analysis, WPOI-5 and its 3 constituent components of satellite nodules, extratumoural PNI and extratumoural LVI were all significantly associated with disease-specific survival (DSS) and overall survival (OS). On multivariate analysis, satellite nodules (odds ratio 6.61, 95% CI 2.83-15.44, p < 0.0001) and extratumoural LVI (odds ratio 9.97, 95% CI 2.19-45.35, p = 0.003) were independently associated with OS. Postoperative radiotherapy (odds ratio 0.40, 95% CI 0.19-0.87, p = 0.02) and non-tongue subsite (odds ratio 3.03, 95% CI 1.70-5.39, p = 0.0002) were also significantly associated with OS on multivariate analysis.

CONCLUSION

Satellite nodules and extratumoural LVI correlated significantly with survival outcomes in our early-stage OSCC cohort. Further study is required to investigate the benefit of adjuvant treatment in these cases and to ascertain if WPOI-5 parameters including satellite nodules should be mandatory reporting data elements.

The Characteristics of Patients with Oral Lichen Planus and Malignant Transformation-A Retrospective Study of 271 Patients

Introduction: Oral lichen planus (OLP) is a chronic inflammatory disease with an unknown etiology rating among oral potentially malignant disorder. The aim of the study was to determine the epidemiological and clinical characteristics of the patients with OLP and rate of malignant transformation. Patients and methods: Data were obtained from the medical records of 271 patients referred to the Oral Medicine Unit at the University Hospital in Hradec Králové diagnosed with oral lichen planus in the period of 2003–2020. The records were retrospectively analyzed. The following clinical data were retrieved from the medical charts: gender, age, systemic diseases, alcohol and tobacco consumption, localization/clinical appearance of lesions, distribution of the lesions, presence of the symptoms, treatment provided and malignant transformation. Results: A total of 271 charts of patients with confirmed diagnosis of OLP were retrospectively analyzed, of whom, 66.4% (180/271) were women and 33.6% (91/271) were men. The mean age of the patients was 56.0 (18.2–85.0) years. The median follow-up of all patients was 15.2 months. Overall, 2 patients (2/271, 0.74%) meeting the above-mentioned criteria for malignant transformation were identified during the follow-up period. Both patients suffered from erosive type OLP and developed squamous cell carcinoma of the tongue. Conclusions: This retrospective study is in concordance with other studies showing the similar profile and clinical features of the patients with OLP. Malignant transformation rate was 0.74%.

The selective toxicity of superparamagnetic iron oxide nanoparticles (SPIONs) on oral squamous cell carcinoma (OSCC) by targeting their mitochondria

In recent years, many researchers have made tremendous efforts into using nanotechnology in biomedical applications and science, such as magnetic resonance imaging, drug delivery, and in particular, oncological therapeutic via superparamagnetic iron oxide nanoparticles (SPIONs). Head and neck squamous cell carcinoma (HNSCC) and especially oral squamous cell carcinoma (OSCC) have been a serious and ongoing concern. There are many strong emphases on the importance of toxic mechanisms due to oxidative stress and specifically, the changed cellular response. Therefore, our study was designed to evaluate the effects of SPIONs on OSCC mitochondria because of the usefulness of the application of these nanoparticles in cancer treatment and diagnosis. An increased level of reactive oxygen species (ROS) is one of the substantial mechanisms found for SPIONs in this study, and initially originated from disruption of the electron transfer chain shown by a decrease in mitochondrial succinate dehydrogenase activity. Increased ROS formation subsequently followed a decline of mitochondrial membrane potential, the release of mitochondrial cytochrome complex, and mitochondrial swelling in the OSCC mitochondria compared with almost no effect in normal mitochondria. In addition, the SPIONs decreased cell viability and increased lipid peroxidation level and caspase-3 activity in OSCC cells. The results represented that the exposure to the SPIONs induced selective toxicity only on the OSCC but not normal mitochondria. Based on our findings, we finally concluded that the SPIONs may be considered as a potential therapeutic candidate for the treatment of OSCC.

Prognostic outcomes of treatment naïve oral tongue squamous cell carcinoma (OTSCC): a comprehensive analysis of 14 years

OBJECTIVES

To analyze the factors predicting survival outcomes in treatment naïve oral tongue squamous cell carcinoma (OTSCC).

MATERIALS AND METHODS

A comprehensive review of 531 oral tongue carcinoma patients treated with upfront surgery followed by adjuvant radiotherapy or chemoradiotherapy was conducted from 2004-2018.

RESULTS

The mean age of presentation was 53 years (11-86) with a male to female ratio of 1.3:1. The associated risk factors were smoking (21%), betel nut (16%), naswar (9%) and alcohol (1%). Most of the cases were either well (45.1%) or moderately (46.2%) differentiated. Surgery was performed in 164 patients alone while 368 were treated with surgery in combination with adjuvant modalities. Overall (OS) and disease free survival (DFS) were 66 and 71%, respectively, with a median follow up of 2.5 years. Cox regression analysis showed nodal positivity, increased depth of invasion (DOI) and higher lymph node ratio (LNR) as significant prognosticators impacting OS and DSS.

CONCLUSION

Nodal volume, DOI and LNR are the most consistent predictors of poor outcome in OTSCC. Nodal positivity, depth of invasion > 5 mm and lymph node ratio > 0.04 adversely affect OS and DSS.

Predictive factors of cervical nodal metastases in N0 squamous cell carcinomas of the mobile tongue - A cohort study

Squamous cell carcinoma (SCC) of the tongue is one of the most common cancers in the oral region, most frequently associated with lymph nodes metastases which influence the most the prognosis. The identification of predictive factors of occult cervical nodal metastases for N0 tumors will allow to adapt the treatment to the patient, avoiding over or under management.

From 2014 to 2019, a cohort of 26 patients with SCC of the mobile tongue was reviewed by analysing the medical history, the epidemiological and clinical parameters, the tumor sites, aspects, diameters, depths of invasion, pathological degree, degree of differentiation, T classification and results of neck dissections.

The incidence of occult cervical nodal metastases was up to 26,92% and a significant correlation was only found with the tumor depth invasion and the muscular invasion (p < 0,05).

Presently, a low differentiated, highly graded tumor with a high depth and muscular invasion should warn from the high incidence of occult cervical nodal metastases and should recommend an elective neck dissection in all cases of N0 tongue SCC.

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The tongue is the most deadly location of oral SCC and most commonly associated with nodal metastases.

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The depth of invasion and muscular infiltration seem to influence the occurrence of nodal metastases.

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Elective dissection (level I, II, III) with tumour excision is the effective treatment of N0 SSC of the tongue.

Prognostic performance of TNM8 staging rules in oral cavity squamous cell carcinoma

BACKGROUND

Two major changes to the staging of oral cavity squamous cell carcinoma (OCSCC) were adopted in TNM8: (1) depth of invasion is now used for T staging and (2) extranodal extension for N staging. The aim of this study was to evaluate if TNM8 stratifies OCSCC patients more accurately than TNM7 based on overall survival (OS) statistics and hazard discrimination.

METHODS

Retrospective study of 297 patients with OCSCC who underwent surgery at our institution. Clinical and pathological data were previously populated from review of medical charts and histological reports. Slides were re-reviewed for depth of invasion measurements. Patients were staged using both TNM7 and TNM8 with overall survival statistics analysed.

RESULTS

Overall 118 patients (39.7%) were upstaged using TNM8. Both TNM7 and TNM8 stage categories were highly significant for OS (all p values < 0.0001). Hazard discrimination analysis showed that TNM7 could only differentiate stage III from stage IV disease with significance (OS p = 0.01). In comparison TNM8 could distinguish between stage II and III disease (OS p = 0.047) and between stage III and IV disease (OS p = 0.004). Subsite analysis suggested that both editions of the staging system perform best for tongue primaries.

CONCLUSIONS

Although TNM8 showed improved hazard discrimination in comparison to TNM7, problems with discriminative ability persisted with 8th edition staging criteria. Large scale validation studies will be required to direct future refinement of the staging rules and to establish if the continued use of a single staging system for all oral cavity subsites is appropriate.

Selective anticancer activity of superparamagnetic iron oxide nanoparticles (SPIONs) against oral tongue cancer using in vitro methods: The key role of oxidative stress on cancerous mitochondria

Today, it has been proven that the nanoparticles such as superparamagnetic iron oxide nanoparticles (SPIONs) have widespread use in biomedical applications, for instance, in magnetic resonance imaging and targeted delivery of drugs. Despite many studies on SPIONs in diagnosing some diseases like cancer, it has not been investigated on the oral tongue squamous cell carcinoma (OTSCC) detection by the NPs. Hence, the present study has been designed to assess the in vitro cytotoxicity of SPIONs on the isolated mitochondria of OTSCC by mitochondrial tests. Isolated mitochondria were removed from the separated cancer and control tissues from the squamous cells of tango in male Wistar rats (6 or 8 weeks) and exposed to the different concentrations of SPIONs (30, 60, and 120 nM). A rise in the production of reactive oxygen species is one of the significant mechanisms of this study, followed by a collapse of mitochondrial membrane potential, the escape of mitochondrial cytochrome c, and mitochondrial swelling in the exposed isolated mitochondria of OTSCC with SPIONs. Furthermore, our results indicated that the exposure to the SPIONs reduced the activity of succinate dehydrogenase in complex II of the mitochondria obtained from cancerous oral tongue squamous. So the SPIONs can induce selective cytotoxicity on the OTSCC mitochondria without significant effects on the control mitochondria. Based on the results and further studies about in vivo experiments in this regard, it is concluded the SPIONs may be a hopeful therapeutic candidate for the treatment of OTSCC.

Clinicopathological and prognostic characteristics of oral squamous cell carcinomas arising in patients with oral lichen planus: A systematic review and a comprehensive meta-analysis

OBJECTIVES

To evaluate current evidence in relation to the prognostic and clinicopathological significance of oral squamous cell carcinomas arising in patients with oral lichen planus (OLP-OSCC).

MATERIAL AND METHODS

We searched PubMed, Embase, Web of Science and Scopus for studies published before May-2019. We evaluated the quality of studies (QUIPS tool). We carried out meta-analyses to fulfill our objective. We examined the between-study heterogeneity and small-study effects, and conducted sensitivity and subgroup analyses.

RESULTS

Inclusion criteria were met by 27 studies (10,505 patients with OLP, of whom 205 developed a total of 247 OSCCs). The combined 5-year mortality rate was 15.48% for OLP-OSCC (95%CI  =  7.34-25.19), clearly lower than the 34.70-50.00% mortality rate for conventional oral cancer communicated in previous official reports. Also, 14.67% (95%CI  =  6.34-24.81) of OLP-OSCC developed N+ status, compared to 47.00% of conventional oral carcinomas. Likewise, most of the OSCCs in the study were T1/T2 (93.57%, 95%CI  =  82.20-99.88) and presented at stage I/II (81.51%, 95%CI = 68.32-92.38) at the time of diagnosis, which contrasts with 50.00% of conventional carcinomas diagnosed in stages I/II. Furthermore, most of the cases were grade I (well differentiated OSCC) (67.79%; 95%CI = 43.50-88.65), in comparison to conventional OSCCs, which present typically in grade II in 90.00% of cases. Our results also show an 11.21% of the OLP-OSCC patients in this study developed multiple tumors.

CONCLUSIONS

Oral squamous cell carcinomas that developed in oral lichen planus show favorable prognostic parameters, especially with regard to the mortality rate. Around 11% of OLP-OSCC patients develop multiple tumors, which confirms that OLP can lead to field cancerization.

Long-term disease-free survival in surgically-resected oral tongue cancer: a 10-year retrospective study

Early and loco-regionally advanced oral tongue squamous cell carcinoma (OTSCC) can be treated by surgery alone or followed by adjuvant radiotherapy or chemoradiotherapy. Nevertheless, up to 40% of patients develop tumour relapse. The aim of our study is to investigate the clinical and pathological features associated with reduced disease-free survival (DFS) in a cohort of surgically-resected OTSCC patients. One hundred and six patients surgically resected for OTSCC were retrospectively identified from clinical records. DFS was calculated according to the Kaplan–Meier method and differences between variables were assessed with Log-Rank test. A multivariable Cox regression model was used to analyse the impact of different prognostic factors on DFS. After a median of follow-up of 8.9 years, 22 events, including 11 deaths, were observed. Overall, the 5-year DFS-rate was 87.4%. The presence of extra-nodal extension (p = 0.023) and perineural invasion (p = 0.003) were significantly correlated with shorter DFS (in univariate analysis). In multivariable analysis, extra-nodal extension and perineural invasion confirmed their role as independent prognostic factors associated with an increased risk of disease recurrence [hazard ratio (HR) 2.87, 95% CI 1.11-7.42, p = 0.03; HR 3.85, 95% CI 1.49-9.96, p = 0.006, respectively]. p16 and p53 expressions in tumour cells were detected in 12% (n = 9) and 46% (n = 40) of cases, respectively. No differences in DFS were observed between p16+ and p16- (p = 0.125) and between p53+ and p53- tumours (p = 0.213). In conclusion, radical surgery, eventually followed by adjuvant radiotherapy or chemo-radiotherapy, can achieve high cure rates in OTSCC. After long-term follow-up, perineural invasion and extra-nodal extension confirmed their role as prognostic factors associated with reduced DFS in OTSCC patients.

Validation of the eighth edition AJCC staging system in early T1 to T2 oral squamous cell carcinoma

BACKGROUND

To validate the newly proposed American Joint Committee on Cancer (AJCC) eighth edition staging in early T1 and T2 oral cavity cancers and its effect in predicting tumour control.

METHODS

Retrospective analysis of treatment outcomes of 441 T1 to T2 oral squamous cell carcinoma (OSCC). Overall survival (OS), disease-specific survival (DSS), and tumour control were calculated and compared between the AJCC 7 and 8 staging systems.

RESULTS

The 5-year OS was 78% and 61% for T1 and T2 tumours, respetively (P < 0.001) (AJCC 7) vs 87% and 67% (P < 0.001) (AJCC 8). The 5-year DSS was 78% and 61% for T1 and T2, respectively (P < 0.001) (AJCC 7) vs 89% and 71% (P < 0.001) (AJCC 8). For stages I and II tumours the 5-year OS was 81% and 76%, respectively (P < 0.302) (AJCC 7) vs 87% and 73% (P < 0.017) (AJCC 8). The 5-year DSS was 83% and 82% (P < 0.222) vs 89% and 77% (P < 0.016). With the AJCC eighth edition the 5-year local, regional, and distant control rates for T1 vs T2 tumours were 85% vs 74% (P = 0.003), 95% vs 77% (P = 0.001), and 95% vs 80% (P = 0.014), respectively.

CONCLUSION

The AJCC 8th staging system provided for more accurate prediction of OS, DSS, and disease control in early oral cavity cancers.

The impact of surgical margin status on the outcomes of locally advanced hypopharyngeal squamous cell carcinoma treated by primary surgery

BACKGROUND

The extent of surgical safety margin remained unclear in hypopharyngeal carcinoma surgery.

AIM

The purpose of this study was to evaluate the influence of surgical margin status on the outcomes of patients with advanced hypopharyngeal carcinoma.

MATERIAL AND METHODS

A retrospective analysis of clinical data was performed in 205 patients with stage III/IV hypopharyngeal carcinoma treated by primary surgery between January 2005 and December 2014. There were 129 patients with clear surgical margins (≥5 mm) and 76 with close surgical margins (<5 mm). The clinical characteristics and treatment outcomes were compared between the two groups.

RESULTS

Close surgical margin (cSM) was found to be a significant risk factor for local recurrence, overall survival (OS) and disease-specific survival (DSS). Analysis by stratification according to pT classification showed that the OS and DSS rates of T1/T2 tumors with clear surgical margins (nSM) were significantly higher than those with cSM (p < .05), while there was no significant difference in the OS and DSS rates between T3/T4 tumors with cSM and nSM (p > .05).

CONCLUSIONS AND SIGNIFICANCE

The tailored extent of surgical resection margin was recommended for locally advanced hypopharyngeal carcinomas according to primary tumor stage.

The importance of margins in head and neck cancer

An estimated 200,000 deaths each year worldwide are due to cancer of the head and neck, mostly mucosal squamous cell carcinoma and nonmelanoma skin cancer. The status of surgical margins is important for prognosis and need for adjuvant therapy. We will discuss how margin status impacts outcomes and therapy, and the conundrum of determining margin status.

hMOF (human males absent on the first), an oncogenic protein of human oral tongue squamous cell carcinoma, targeting EZH2 (enhancer of zeste homolog 2)

OBJECTIVES

MOF (males absent on the first) is a histone acetyltransferase belonging to the MYST (MOZ, Ybf2/Sas3, Sas2 and TIP60) family. In mammals, MOF plays critical roles in transcription activation by acetylating histone H4 at K16. Human MOF (hMOF) essentially participates in behaviour of several human cancers. However, its role in human oral tongue squamous cell carcinoma (OTSCC) remains elusive, but we propose that hMOF regulates OTSCC cell population growth.

MATERIALS AND METHODS

Real time PCR and western blot analysis were applied, and it was found that hMOF level was up-regulated in human OTSCC. High hMOF expression predicted poor overall and disease-free survival. hMOF knockdown attenuated OTSCC cell growth and transformation.

RESULTS

EZH2 (enhancer of zeste homolog 2) was up-regulated in human OTSCC tissues and its level positively correlated with level of hMOF. hMOF knockdown inhibited EZH2 expression by reducing its promoter activity. Moreover, we have demonstrated that EZH2 was critically essential for function of hMOF in human OTSCC.

CONCLUSIONS

Human males absent on the first regulated OSTCC growth through EZH2, thus EZH2 may serve as a candidate for anti-OTSCC therapy.

Postoperative interstitial brachytherapy for resectable squamous cell carcinoma of the tongue

PURPOSE

To evaluate the efficiency and toxicity of postoperative brachytherapy (POBT) in the treatment of resectable mobile tongue squamous cell carcinoma.

PATIENTS AND METHODS

This was a retrospective single-center study of patients with SSC of the mobile tongue who were treated between August 1992 and June 2013 by glossectomy and neck dissection followed by (192)Ir interstitial brachytherapy of the tumor bed. Endpoints were local control, cancer-specific survival (CSS), overall survival (OS), and morbidity. Independent prognostic factors were analyzed in a Cox regression model.

RESULTS

A total of 112 patients were identified (median age, 55 years [range, 15-84]; 76% male). Patient and tumor characteristics were: T1T2N0 (85%), pN+ (13%), positive surgical margins (14%), negative margins <5 mm (29%), dysplasic margins (14%), lymphatic vessel invasion (5%), and perineural spread (5%). Median followup was 6.7 years (1.5 months to 17.7 years). Local control, CSS, and OS rates at 2 years were 79%, 81%, and 72%, respectively. The corresponding 5-year rates were 76%, 67%, and 56%, respectively. After POBT, 22% of patients presented grade ≥2 necrosis and 8% experienced chronic pain. Independent prognostic factors were positive surgical margins for poor local control and tumor recurrence and lymphatic vessel invasion for poor OS.

CONCLUSION

POBT provided good local control and better CSS and OS than reported for surgery alone. Morbidity was higher than that reported for brachytherapy alone but may be considered acceptable in a well-selected patient population at high risk of local recurrence.

Toll-like receptor 9 mediates invasion and predicts prognosis in squamous cell carcinoma of the mobile tongue

BACKGROUND

Toll-like receptor 9 (TLR9) is a cellular receptor, which recognizes bacterial and host-derived DNA. Stimulation of TLR9 induces cellular invasion via matrix metalloproteinase 13 (MMP-13). The aim of this study was to evaluate the role of TLR9 in invasion of oral tongue squamous cell carcinoma (OTSCC).

METHODS

The effects of TLR9 ligands on oral squamous cell carcinoma cell lines were studied with invasion and migration assays, as well as in a myoma organotypic model.

RESULTS

The TLR9 ligand, CpG-ODN, increased invasion and migration in OTSCC lines. These effects were reduced by TLR9 siRNA or inhibition with TLR9 antibodies. Immunohistochemical analysis of tissues from 195 patients with OTSCC revealed that TLR9 was expressed in 181/195 carcinomas. The expression of TLR9 was higher in the malignant cells than in the normal epithelium. High TLR9 expression was associated with high MMP-13 expression and poor differentiation. High TLR9 expression was also identified as an independent predictor of poor prognosis (HR 1.810, 95% CI [1.053-3.112]).

CONCLUSION

Toll-like receptor 9 mediates OTSCC invasion and migration in vitro and is an independent prognostic factor of OTSCC. Inhibition of TLR9 may be a novel therapeutic opportunity in oral cancer.

TNM staging compared with a new clinicopathological model in predicting oral tongue squamous cell carcinoma survival

BACKGROUND

The purpose of this study was to investigate the prognostic impact of comorbidity and of demographic and pathological factors on oral tongue squamous cell carcinoma (SCC) survival, and to compare the prognostic performance of a new clinicopathological model against the routinely used TNM staging.

METHODS

We conducted a retrospective study of demographic, clinical, and pathological information of 166 patients with oral tongue SCC. Cox regression was used for multivariate analysis, model building, and model discriminatory analysis.

RESULTS

Comorbidity had the most significant impact on overall survival (OS; log-rank test, chi-square  =  36.34; p  <  .0001). Comorbidity, tumor dimension >2 cm, and presence of extracapsular spread (ECS) or vascular invasion were independent predictors of survival. A clinicopathological model based on these 4 variables (chi-square  =  60.23; p  <  .0001) was better (c-statistic  =  0.736) at predicting survival compared to pathological TNM staging (c-statistic = 0.645).

CONCLUSION

Comorbidity combined with tumor dimension, ECS, and vascular invasion provide a better prediction of oral tongue SCC survival than TNM staging alone.

Tumor thickness as an independent risk factor of early recurrence in oral cavity squamous cell carcinoma

The aim is to determine if tumor thickness is a risk factor related to the development of early recurrences in surgically treated oral cavity squamous cell carcinoma (SCC). Retrospective cohort study conducted at Instituto do Câncer do Estado de São Paulo (ICESP). Fifty-seven patients with oral cavity SCC (excluding lip tumors and patients previously submitted to any treatment) were analyzed regarding the occurrence of an early disease progression (locoregional or distant metastasis) within the first 12 months after initial treatment. Tumor thickness and other histological characteristics related to the development of recurrence up to 1 year after treatment were tested. Results demonstrated that tumor thickness greater than 10 mm (P = 0.034), as well as angiolymphatic invasion (P = 0.001), perineural invasion (P = 0.041) and lymph-node metastasis (P = 0.021) was associated with a worse 12-month disease-free survival (Log-Rank test). In multivariate analysis, tumor thickness greater than 10 mm emerged as an independent risk factor for early recurrence in oral cavity tumors (HR = 3.4, 95% CI: 1.005-11.690; P = 0.049--Cox regression). Post-operative radiotherapy seems to be a protective factor for early recurrences in patients with tumor thickness greater than 10 mm (P = 0.017--Log-Rank test; HR = 0.32, 95% CI: 0.12-0.87, P = 0.026--Cox regression). The results of the present research suggest that tumor thickness greater than 10 mm may be an independent adverse factor for early progression of surgically treated oral cavity SCC. Adjuvant therapies, in particular post-operative radiotherapy, should be advocated in this group of patients, regardless of the co-existence of other well-described histological risk factors.

Oral Tongue Squamous Cell Carcinoma in Never-Smokers

Objectives

(1) To compare clinical characteristics, survival, and recurrence between never-smokers and ever-smokers with oral tongue squamous cell carcinoma (OTSCC). (2) To assess the relationship between clinicopathologic characteristics and survival/recurrence in OTSCC.

Study Design

Historical cohort study.

Setting

Academic university medical center.

Subjects and Methods

This is a study of 120 patients with OTSCC who were treated from January 1999 to February 2010. Clinicopathologic factors were compared between never-smokers and ever-smokers using t tests and χ2 tests. Cox regression analyses examined their association with survival and recurrence.

Results

Of 120 subjects, 66 (55%) were prior or current smokers. There were no significant differences in clinicopathologic factors between ever-smokers and never-smokers. After adjustment for clinicopathologic factors, multivariate Cox regression analysis demonstrated decreased overall survival for never-smokers, but this difference was not significant (hazard ratio [HR], 2.84; P = .056). Increased depth of tumor invasion (HR per millimter invasion, 1.09; P = .005), nodal metastasis (HR, 7.1; P = .025), and stage III or IV disease (HR, 9.45 and 7.31; P = .026 and .029, respectively) were associated with decreased overall survival. Perineural invasion (HR, 8.56; P = .005) and lymphovascular invasion (HR, 6.01; P = .011) were associated with disease recurrence.

Conclusion

Overall survival may be decreased in never-smokers with OTSCC. Greater depth of tumor invasion and more advanced stage disease are associated with decreased survival. Perineural invasion and lymphovascular invasion are associated with disease recurrence.

Observation as an option for epithelial positive margin after partial glossectomy in stage I and II squamous cell carcinoma: analysis of 365 cases

OBJECTIVE

This study was conducted to assess local recurrence and clinical prognosis in patients diagnosed as having a positive margin in the epithelial layer after a partial glossectomy treated by close observation.

METHODS

A total of 365 cases of squamous cell carcinoma of the tongue diagnosed as clinical Stage I or II, treated by partial glossectomy in the National Cancer Center Hospital East between 1992 and 2006, were studied retrospectively.

RESULTS

Pathological findings showed that 13 cases had positive margins in the epithelial layer, 4 (30.8%) of whom showed up with local recurrence in 4.4 years (3.0-5.0) on average. Lymph node recurrence was not observed and the 5-year overall survival rate was 76.2% in those 13 cases. The treatment for the recurrent cases was an additional partial glossectomy without neck dissection, which resulted in no recurrence and a survival rate of 100% after an average follow-up of 6.7 years.

CONCLUSIONS

We suggest careful observation as one option for cases diagnosed with epithelial positive margin.

Toll-like receptor 5 (TLR5) expression is a novel predictive marker for recurrence and survival in squamous cell carcinoma of the tongue

BACKGROUND

Toll-like receptor 5 (TLR5) is an immune receptor recognising bacterial flagellin. Activation of TLR5 results in cancer invasion and cytokine release. As certain bacteria have been linked to oral cancer, we wanted to study TLR5 expression in oral tongue squamous cell carcinoma (OTSCC).

METHODS

Samples from 119 patients with OTSCC were obtained, including 101 samples of adjacent normal lingual mucosa. The TLR5 histoscore (0-300) was assessed semiquantitatively by immunohistochemistry in a blinded manner.

RESULTS

Toll-like receptor 5 was expressed in 84 normal epithelia and 118 cancer samples. Expression of TLR5 was increased in cancer when compared with normal lingual epithelium (median histoscore 15 vs 135). In cancer, higher TLR5 was associated with age of >70 years at the time of diagnosis, female gender and disease recurrence. No association between TLR5 expression and tumour grade, stage or treatment was found. In multivariate analysis, TLR5 was an independent predictor of cancer mortality (hazard ratio (HR) 3.587, 95% confidence interval (CI) (1.632-7.882)) and disease recurrence (HR 4.455, 95% CI (2.168-9.158)).

CONCLUSION

Toll-like receptor 5 has a previously undescribed role in the pathophysiology of OTSCC and might represent a link between bacteria and cancer. It could be a useful marker for predicting recurrence or survival of OTSCC patients.

The hunting of targets: challenge in miRNA research

MicroRNAs (miRNAs) are small noncoding RNAs that control the expression of around 60% of the human protein-coding genes. In the past decade, deregulation of miRNAs (by expression and/or function) has been associated with the pathogenesis, progression and prognosis of different diseases, including leukemia. The number of discovered genes encoding miRNAs has risen exponentially in this period, but the numbers of miRNA-target genes discovered and validated lag far behind. Scientists have gained more in-depth knowledge of the basic mechanism of action of miRNAs, but the main challenge still remaining is the identification of direct targets of these important 'micro-players', to understand how they fine-tune so many biological processes in both healthy and diseased tissue. Many technologies have been developed in the past few years, some with more potential than others, but all with their own pros and cons. Here, we review the most common and most potent computational and experimental approaches for miRNA-target gene discovery and discuss how the hunting of targets is challenging but possible by taking the experimental limitations in consideration and choosing the correct cellular context for identifying relevant target genes.