Multiple concomitant oral cavity cancers: Incidence, management, and outcomes

Clinical and prognostic features of multiple primary cancers with oral squamous cell carcinoma

OBJECTIVE

To characterize the epidemiological, clinical, and prognostic features of multiple primary cancers (MPC) following oral squamous cell carcinoma (OSCC).

DESIGN

Data from the Surveillance, Epidemiology, and End Results Program database were analyzed to determine the standardized incidence ratio (SIR) of multiple subsequent sites, difference in clinical and prognostic features between MPC and single primary OSCC.

RESULTS

The sites with the highest SIRs were the oral cavity (SIR = 69.48), other oral cavity and pharynx (SIR=55.46), pharynx (SIR=39.21), tonsils (SIR=33.52), trachea (SIR=33.24), esophagus (SIR=18.00), and larynx (SIR=13.12). The 5- and 10-year survival rates for single primary OSCC were 57.9% (95% CI: 56.7-59.2%) and 47.1% (95% CI: 45.7-48.6%), respectively, while those for MPC were 66.9% (95% CI: 64.6-69.4%) and 42.2% (95% CI: 39.5-45.2%), respectively. The mean age of MPC patients was significantly higher than that of single primary OSCC patients. MPC are more common in the gums and other sites of the oral cavity, and more likely to be detected in early TNM stage and pathological grade. Age, site, T-stage, and N-stage were significantly associated with prognosis of MPC.

CONCLUSIONS

Significant differences in clinical and prognostic features were found between MPC and single primary OSCC. Considering MPC has a poor long-term prognosis, it is necessary to identify MPC and single primary OSCC early.

Oral Squamous Cell Carcinoma and Concomitant Primary Tumors, What Do We Know? A Review of the Literature

Head and neck cancer is among the top ten cancers worldwide, with most lesions in the oral cavity. Oral squamous cell carcinoma (OSCC) accounts for more than 90% of all oral malignancies and is a significant public health concern. Patients with OSCC are at increased risk for developing concomitant tumors, especially in the oral cavity, due to widely genetically susceptible mucosa to carcinogenic factors. Based on fulfilling specific criteria, these concomitant tumors can be called second primary tumors (SPTs), which can be further categorized into metachronous and synchronous tumors. This research reviews the literature that investigated the concurrent OSCC with second or multiple primaries to improve understanding of the definition, classification guidelines, and its effect on cancer survival. It also highlights the current investigation methods, the variation of standard treatment approaches due to such a phenomenon, and preventive measures discussed in the literature.

Antiproliferative and Pro-Apoptotic Effects of a Phenolic-Rich Extract from Lycium barbarum Fruits on Human Papillomavirus (HPV) 16-Positive Head Cancer Cell Lines

The in vitro antiproliferative activity of a phenolic-rich extract from Lycium barbarum fruits against head and neck HPV16 squamous cell carcinoma (OSCC) has been demonstrated, indicating for the first time that L. barbarum extract inhibits human papillomavirus (HPV) type 16 cell lines. Ethanol extract of L. barbarum was used for cell viability evaluation on SCC090, CAL27, and HGnF cell lines. After 24 and 48 h, the cell cycle effect of L. barbarum extract (at 1.0, 10, and 100 µg/mL) was measured via flow cytometry. In addition, the mRNA expression on E6/E7 and p53 via RT-PCR and the expression of p16, p53, Ki-67, and Bcl-2 via immunohistochemistry were also determined. Untreated cells, 20 µM cisplatin, and a Camellia sinensis-derived extract were used as negative and positive controls, respectively. We demonstrated that the studied L. barbarum extract resulted in G0/G1 arrest and S phase accumulation in SCC090 at 1.0 and 10 μg/mL. A reduction in mRNA levels of E6/E7 oncogenes (p < 0.05) with p53 overexpression was also observed through PCR, while immunohistochemical analyses indicated p16 overexpression (p > 0.05) and a decrease in p53 overexpression. The observed effects were associated with anticancer and immunomodulatory phenolics, such as flavonols/flavan-3-ols and tyramine-conjugated hydroxycinnamic acid amides, identified in the studied extract. These findings revealed that the phenolic-rich extract of L. barbarum fruits has promising properties to be considered further for developing new therapies against oral and oropharyngeal HPV lesions.

Synchronous mucosal and intraosseous oral cavity carcinomas: a case of rare occult second primary malignancy

Secondary primary malignancies within the head and neck region are well documented. Within this group, synchronous tumours with an index oral cancer are usually found in the oropharyngeal or laryngeal sites. We present a rare case of an index squamous cell carcinoma in the tongue with a synchronous primary intraosseous squamous cell carcinoma. We discuss the challenges associated with investigation, diagnosis and subsequent management. Treatment aims remain the same; namely, eradicating the disease using surgery, radiotherapy, chemotherapy or a combination of these modalities. It is important to acknowledge the unpredictable pattern of tumour presentation and the need to maintain a high index of suspicion.

Clinical Features of Oral Multiple Primary Carcinomas Compared with Oral Single Primary Carcinoma

Background

Owing to the increase in the older population and the increased life span, the number of patients with oral multiple primary carcinomas will increase. Predicting the second and third carcinoma clinically is difficult, and the presence of second or third carcinomas is a factor that determines the prognosis of oral carcinoma. In this study, we examined the clinical features of oral multiple primary carcinomas treated in our department.

Methods

We retrospectively reviewed the medical records of patients with oral squamous cell carcinoma who underwent radical treatment at and were followed by the Department of Oral and Maxillofacial Surgery, Tottori University Hospital from January 2003 to October 2017.

Results

This study included 261 patients: 241 patients had oral single primary carcinoma and 20 patients had oral multiple primary carcinomas. Oral multiple primary carcinomas showed female predilection and occurred more frequently in the lower gingiva and significantly less frequently in the tongue (P < 0.01). Oral multiple primary carcinomas showed a significantly higher recurrence rate (P < 0.01). The 5-year overall survival of oral single primary carcinoma patients was 88.0% compared with 95% for oral multiple primary carcinomas, with no significant difference (log rank test, P = 0.54). However, the 15-year survival rate dropped to 28.1% in oral multiple primary carcinomas. The cumulative disease incidence rates of metachronous second primary carcinoma from first carcinoma at 5 years and 10 years were 3.45% and 5.36%, respectively.

Conclusion

Oral multiple primary carcinomas rarely occur in the tongue. The 5-year survival rate showed no difference between single and multiple carcinoma patients, but over longer observation, the prognosis of multiple carcinoma was poor owing to a high recurrence rate. Because of the high recurrence rate and risk of further metachronous carcinoma in oral multiple primary carcinomas, longer-term follow-up is required.

Prognostic Stratification of Patients With Advanced Oral Cavity Squamous Cell Carcinoma

PURPOSE OF REVIEW

Prognosis of advanced oral squamous cell carcinoma remains a challenge for clinicians despite progress in its diagnosis and treatment over the past decades. In this review, we assessed clinicopathological factors and potential biomarkers along with their prognostic relevance in an attempt to develop optimal treatment strategies for these patients.

RECENT FINDINGS

In addition to several pathologic factors that have been proposed to improve prognostic stratification and treatment planning in the eighth edition of the American Joint Committee staging manual on cancer, we reviewed some other imaging and clinicopathological parameters demonstrated to be closely associated with patient prognosis, along with the biomarkers related to novel target or immune therapy. Evaluation of current literature regarding the prognostic stratification used in contemporary clinicopathological studies and progress in the development of targeted or immune therapy may help these patients benefit from tailored and personalized treatment and obtain better oncological results.