p53 Mutation in histologically normal mucosa of the aero-digestive tract is not a marker of increased risk for second primary carcinoma in head and neck cancer patients. Eur Arch Otorhinolaryngol. 2009;266:547-551. [PMID: 18688630 DOI: 10.1007/s00405-008-0780-z]

Locally Advanced Laryngeal Squamous cell Carcinoma in a Patient with a Synchronous Second Primary Thyroid Carcinoma

Laryngeal squamous cell carcinoma (SCC) is one of the most common primary tumors of the head and neck region. Unfortunately, patients with laryngeal SCC tend to develop second primary tumors (SPTs), accounting for increased mortality. The lung is the predominant site of a second presentation, followed by the mucosa of the upper aerodigestive tract. In contrast, the thyroid gland rarely hosts an SPT. Our study describes the management and treatment of a 69-year-old female who presented with a rare combination of synchronous laryngeal and thyroid carcinomas.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03968-y.

Clinical characteristics and overall survival nomogram of second primary malignancies after prostate cancer, a SEER population-based study

Prostate cancer (PCa) is the most prevalent cancer among males and the survival period of PCa has been significantly extended. However, the probability of suffering from second primary malignancies (SPMs) has also increased. Therefore, we downloaded SPM samples from the SEER database and then retrospectively analyzed the general characteristics of 34,891 PCa patients diagnosed between 2000 and 2016. After excluding cases with unknown clinical information, 2203 patients were used to construct and validate the overall survival (OS) nomogram of SPM patients after PCa. We found that approximately 3.69% of PCa patients were subsequently diagnosed with SPMs. In addition, the three most prevalent sites of SPM were respiratory and intrathoracic organs, skin, and hematopoietic system. The top three histological types of SPMs were squamous cell carcinoma, adenoma and adenocarcinoma, nevi and melanoma. Through univariate and multivariate Cox regression analysis, we found that the site of SPM, age, TNM stage, SPM surgery history, and PCa stage were associated with the OS of SPM. By virtue of these factors, we constructed a nomogram to predict the OS of SPM. The C-index in the training set and validation set were 0.824 (95CI, 0.806-0.842) and 0.862 (95CI, 0.840-0.884), respectively. Furthermore, we plotted the receiver operating characteristic curve (ROC) and the area under curve (AUC) which showed that our model performed well in assessing the 3-year (0.861 and 0.887) and 5-year (0.837 and 0.842) OS of SPMs in the training and validation set. In summary, we investigated the general characteristics of SPMs and constructed a nomogram to predict the prognosis of SPM following PCa.

Molecular events in relapsed oral squamous cell carcinoma: Recurrence vs. secondary primary tumor

Relapses have a great impact on both the morbidity and mortality rates of oral squamous cell carcinoma (OSCC) patients. Current classification criteria are imprecise and need improvements. Recent advances in understanding of OSCC relapses on a molecular level provide new possibilities to better classify true recurrences and second primary tumors. This review discusses the limitations of the current OSCC relapse classification method and presents possible alternatives to improve this classification based on molecular techniques. Moreover, these molecular techniques add to the further understanding of these lesions and may provide tools for clinical management.

Multiple Second Primary Oral Squamous Cell Carcinomas in a Nonsmoker and Nondrinker Woman: Case Report and Review of the Literature

AIM

This manuscript aims to describe an unusual case of multiple second primary squamous cell carcinomas (SCCs) in several sites of the oral mucosa in a nonsmoker and nondrinker woman and to discuss the diagnostic criteria, clinicopathological aspects and outcome of second primary tumor (SPT).

BACKGROUND

Patients treated for SCC of the head and neck are at high risk for developing SPT arising from the same dysplastic mucosal feld. Currently, there is no reliable method to predict which of the patients will develop SPT.

CASE DESCRIPTION

A 64-year-old nonsmoker and nondrinker woman developed several second primary oral SCCs in 7 years of follow-up, most of them being synchronic, treated by surgery without and with chemotherapy and radiotherapy.

CONCLUSION

Patients treated for SCC require a long-term and careful follow-up as the development of SPT contributes with significantly negative impact on the prognosis.

CLINICAL SIGNIFICANCE

This report describes the diagnosis and management of a very unusual case of several SPTs affecting different sites of the oral mucosa in the same patient. Moreover, the patient had no apparent risk factors associated with the development of the oral cancer. Therefore, a brief update concerning SPT and its diagnosis and management is also provided.

Telomere shortening in mucosa surrounding the tumor: biosensor of field cancerization and prognostic marker of mucosal failure in head and neck squamous cell carcinoma

OBJECTIVES

The aim of the present study was to investigate the pattern of telomere length and telomerase expression in cancer tissues and the surrounding mucosa (SM), as markers of field cancerization and clinical outcome in patients successfully treated for with head and neck squamous cell carcinoma (HNSCC).

MATERIALS AND METHODS

This investigation was a prospective cohort study. Telomere length and levels of telomerase reverse transcriptase (TERT) transcripts were quantified by real-time PCR in cancer tissues and SM from 139 and 90 patients with HNSCC, respectively.

RESULTS

No correlation was found between age and telomere length in SM. Patients with short telomeres in SM had a higher risk of mucosal failure (adjusted HR=4.29). Patients with high TERT levels in cancer tissues had a higher risk of regional failure (HR=2.88), distant failure (HR=7.27), worse disease-specific survival (HR for related death=2.62) but not mucosal failure. High-risk patients having both short telomeres in SM and high levels of TERT in cancer showed a significantly lower overall survival (HR=2.46).

CONCLUSIONS

Overall these findings suggest that telomere shortening in SM is a marker of field cancerization and may precede reactivation of TERT. Short telomeres in SM are strongly prognostic of mucosal failure, whereas TERT levels in cancer tissues increase with the aggressiveness of the disease and are prognostic of tumor spread.

Multifocal epithelial tumors and field cancerization: stroma as a primary determinant

It is increasingly evident that cancer results from altered organ homeostasis rather than from deregulated control of single cells or groups of cells. This applies especially to epithelial cancer, the most common form of human solid tumors and a major cause of cancer lethality. In the vast majority of cases, in situ epithelial cancer lesions do not progress into malignancy, even if they harbor many of the genetic changes found in invasive and metastatic tumors. While changes in tumor stroma are frequently viewed as secondary to changes in the epithelium, recent evidence indicates that they can play a primary role in both cancer progression and initiation. These processes may explain the phenomenon of field cancerization, i.e., the occurrence of multifocal and recurrent epithelial tumors that are preceded by and associated with widespread changes of surrounding tissue or organ "fields."

Expression of WWOX and p53 in gastric cancer

AIM: To examine the expression of WWOX and p53 proteins in gastric cancer, and to analyze the possible mechanisms behind the malignant growth of gastric cancer.

METHODS: The expression of WWOX and p53 proteins was detected by immunohistochemistry in 70 paraffin-embedded samples of gastric cancer and 20 tumor-adjacent normal tissue samples. Statistical analyses were then performed to analyze the relationship between WWOX and p53 expression and clinicopathologic parameters of gastric cancer.

RESULTS: The positive rate of expression of p53 protein in gastric cancer was significantly higher than that in normal gastric tissue (51.42% vs 0.00%, P < 0.05). Expression of p53 protein in gastric cancer was related with depth of invasion, lymph node metastasis, and tumor clinical stage (all P < 0.05). The positive rate of expression of WWOX protein was significantly lower in gastric cancer than in normal gastric tissue (41.43% vs 90.00%, P < 0.05). Expression of WWOX protein in gastric cancer was related with depth of invasion and clinical stage, but not with lymph node metastasis. There is a negative correlation between WWOX and p53 expression in gastric cancer.

CONCLUSION: Detection of expression of p53 protein and WWOX proteins might be useful for early diagnosis and evaluation of prognosis of gastric cancer.

Assessment of p53 functional activity in tumor cells and histologically normal mucosa from patients with head and neck squamous cell carcinoma

BACKGROUND

The purpose of this study was to investigate the value of p53 functional analysis of separated alleles in yeast (FASAY) as a witness of p53/p21 pathway alteration in head and neck squamous cell carcinoma (HNSCC).

METHODS

The p53 transcriptional activity was prospectively analyzed in 82 newly diagnosed patients with HNSCC. FASAY and p53 immunostaining were carried out on paired tumoral and histologically normal tissues. The predictive value of FASAY for locoregional recurrence was assessed by Cox survival analysis.

RESULTS

Loss of p53/p21 transcriptional activity was encountered in 88% tumoral and 18% histologically normal samples, associated with mutations (79%) and insertions/deletions (21%). The p53 overexpression underestimated p53 transcriptional abnormalities. FASAY-positive histologically normal mucosa was significantly associated with locoregional recurrence.

CONCLUSION

FASAY positivity indicates field cancerization in a subgroup of patients with HNSCC, in which nonfunctional p53 was significantly associated with locoregional recurrence. This prompted us to pursue the study on the p53 functional status of normal mucosa in patients with HNSCC.

The association between CBS 844ins68 polymorphism and head and neck squamous cell carcinoma risk - a case-control analysis

INTRODUCTION

Susceptibility to head and neck squamous cell carcinoma may be modified by functional polymorphisms in genes involved in the folate pathway, such as cystathionine beta-synthase (CBS). The CBS 844ins68 polymorphism is associated with DNA methylation changes and cancer development.

MATERIAL AND METHODS

A case-control retrospective study was conducted in 322 patients with head and neck squamous cell carcinoma and in 531 control subjects without cancer. The polymerase chain reaction-restriction fragment length polymorphism technique was used to genotype the polymorphism. For statistical analysis, χ(2) test was conducted to examine whether the genotypic frequency of CBS 844ins68 was in Hardy-Weinberg equilibrium and multiple logistic regression was used for comparisons between groups, and for interactions between the polymorphism and risk factors and clinical histopathological parameters.

RESULTS

No significant difference in CBS 844ins68 genotypic distribution was observed between the groups. Age > 50 years, male gender and tobacco consumption were predictors of the disease with increased risk of 7.89 (95% CI: 5.56-11.21), 2.49 (95% CI: 1.72-3.62), 6.44 (95% CI: 4.63-8.96) and 2.29 times (95% CI: 1.71-3.06) respectively. There was no association between the distribution of the CBS 844ins68 genotype and risk factors for this disease. According to clinical histopathological parameters, CBS 884ins68 polymorphism presented high frequency in oral cavity (p < 0.05) and patients with the polymorphism presented less survival time (p < 0.05).

CONCLUSIONS

We concluded that the CBS 844ins68 polymorphism is not associated with HNSCC risk and there is increased risk of this disease in male gender individuals smokers aged over 50 years. In adittion, the polymorphism is more frequent in patients with oral cavity as primary site and in patients with less survival time.

A dynamic oral cancer field: unraveling the underlying biology and its clinical implication

Oral cancer is a complex disease that is characterized by histologic and genetic heterogeneity. The evolution and progression of this disease is thought to result from the accumulation of alterations in molecular pathways. Although the oral cavity is accessible for routine screening of suspicious lesions, gene alterations are known to accrue in histologically normal tissues. Therefore, some cancer forerunners may remain undetected clinically or histologically. Recently emerging optical and molecular technologies have provided a powerful means for redefining the extent of the field of alteration. Often this means expanding upon regions detectable with standard white light approaches. In this report, we used a newly developed optical technique, direct fluorescence visualization, to define a contiguous field that extended beyond the margins of a clinically visible oral squamous cell carcinoma. Multiple biopsies were taken within this contiguous optically altered field. Genome alterations detected for each specimen were compared to define whether each lesion arose independently or as a consequence of a shared progenitor cell. Our results indicate that the field effect of oral cancer is extremely dynamic, with different genetic alterations present in different biopsies within a field. This case study also demonstrated that 2 genetically unrelated squamous cell carcinoma could be developed within 10 mm at the right lateral tongue of this patient. These findings provide evidence for the importance to implement optical technologies in defining surgical margins and support the use of whole genome technologies in the diagnosis of clonal versus independent lesions of the oral cavity, which may have implications on treatment strategies.