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Awodutire P, Kattan M, Akadiri OA. Development and validation of accelerated failure time model for cause-specific survival and prognostication of oral squamous cell carcinoma: SEER data analysis. PLoS One 2024; 19:e0309214. [PMID: 39186725 PMCID: PMC11346929 DOI: 10.1371/journal.pone.0309214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Oral Squamous Cell Carcinoma is the most prevalent malignancies affecting the oral cavity. Despite progress in studies and treatment options its outlook remains grim with survival prospects greatly affected by demographic and clinical factors. Precisely predicting survival rates and prognosis plays a role in making treatment choices for the best achievable overall health outcomes. OBJECTIVE To develop and validate an accelerated failure time model as a predictive model for cause-specific survival and prognosis of Oral Squamous Cell Carcinoma patients and compare its results to the traditional Cox proportional hazard model. METHOD We screened Oral cancer patients diagnosed with Squamous Cell Carcinoma from the Surveillance Epidemiology and End Results (SEER) database between 2010 and 2020. An accelerated failure time model using the Type I generalized half logistic distribution was used to determine independent prognostic factors affecting the survival time of patients with oral squamous carcinoma. In addition, accelerated factors were estimated to assess how some variables influence the survival times of the patients. We used the Akaike Information Criterion, Bayesian Information Criterion to evaluate the model fit, the area under the curve for discriminability, Concordance Index (C-index) and Root Mean Square Error and calibration curve for predictability, to compare the type I generalized half logistic survival model to other common classical survival models. All tests are conducted at a 0.05 level of significance. RESULTS The accelerated failure time models demonstrated superior effectiveness in modeling (fit and predictive accuracy) the cause-specific survival (CSS) of oral squamous cell carcinoma compared to the Cox model. Among the accelerated failure time models considered, the Type I generalized half logistic distribution exhibited the most robust model fit, as evidenced by the lowest Akaike Information Criterion (AIC = 27370) and Bayesian Information Criterion (BIC = 27415) values. This outperformed other parametric models and the Cox Model (AIC = 47019, BIC = 47177). The TIGHLD displayed an AUC of 0.642 for discrimination, surpassing the Cox model (AUC = 0.544). In terms of predictive accuracy, the model achieved the highest concordance index (C-index = 0.780) and the lowest root mean square error (RMSE = 1.209), a notable performance over the Cox model (C-index = 0.336, RMSE = 6.482). All variables under consideration in this study demonstrated significance at the 0.05 level for CSS, except for race and the time span from diagnosis to treatment, in the TIGHLD AFT model. However, differences emerged regarding the significant variations in survival times among subgroups. Finally, the results derived from the model revealed that all significant variables except chemotherapy, all TNM stages and patients with Grade II and III tumor presentations contributed to the deceleration of time to cause-specific deaths. CONCLUSIONS The accelerated failure time model provides a relatively accurate method to predict the prognosis of oral squamous cell carcinoma patients and is recommended over the Cox PH model for its superior predictive capabilities. This study also underscores the importance of using advanced statistical models to improve survival predictions and outcomes for cancer patients.
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Affiliation(s)
- Phillip Awodutire
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Michael Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States of America
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Xu XL, Xu JH, He JQ, Li YH, Cheng H. Novel prognostic nomograms for postoperative patients with oral cavity squamous cell carcinoma in the central region of China. BMC Cancer 2024; 24:730. [PMID: 38877437 PMCID: PMC11177417 DOI: 10.1186/s12885-024-12465-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Oral cavity squamous cell carcinoma (OCSCC) is the most common pathological type in oral tumors. This study intends to construct a novel prognostic nomogram model based on China populations for these resectable OCSCC patients, and then validate these nomograms. METHODS A total of 607 postoperative patients with OCSCC diagnosed between June 2012 and June 2018 were obtained from two tertiary medical institutions in Xinxiang and Zhengzhou. Then, 70% of all the cases were randomly assigned to the training group and the rest to the validation group. The endpoint time was defined as overall survival (OS) and disease-free survival (DFS). The nomograms for predicting the 3-, and 5-year OS and DFS in postoperative OCSCC patients were established based on the independent prognostic factors, which were identified by the univariate analysis and multivariate analysis. A series of indexes were utilized to assess the performance and net benefit of these two newly constructed nomograms. Finally, the discrimination capability of OS and DFS was compared between the new risk stratification and the American Joint Committee on Cancer (AJCC) stage by Kaplan-Meier curves. RESULTS 607 postoperative patients with OCSCC were selected and randomly assigned to the training cohort (n = 425) and validation cohort (n = 182). The nomograms for predicting OS and DFS in postoperative OCSCC patients had been established based on the independent prognostic factors. Moreover, dynamic nomograms were also established for more convenient clinical application. The C-index for predicting OS and DFS were 0.691, 0.674 in the training group, and 0.722, 0.680 in the validation group, respectively. Besides, the calibration curve displayed good consistency between the predicted survival probability and actual observations. Finally, the excellent performance of these two nomograms was verified by the NRI, IDI, and DCA curves in comparison to the AJCC stage system. CONCLUSION The newly established and validated nomograms for predicting OS and DFS in postoperative patients with OCSCC perform well, which can be helpful for clinicians and contribute to clinical decision-making.
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Affiliation(s)
- Xue-Lian Xu
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China
| | - Jin-Hong Xu
- Department of Otolaryngology, AnYang District Hospital, Anyang, 455000, Henan, China
| | - Jia-Qi He
- Department of Radiotherapy Oncology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yi-Hao Li
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China
| | - Hao Cheng
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China.
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S D, Ramalingam K, Ramani P, Krishnan M. A Concordance Between Clinical and Pathological Tumor Staging of Oral Squamous Cell Carcinoma: An Institutional Study. Cureus 2024; 16:e61584. [PMID: 38962622 PMCID: PMC11221401 DOI: 10.7759/cureus.61584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Among oral diseases, oral cancer is the primary cause of death and poses a serious health risk. Primary tumor (T) - regional lymph node (N) - distant metastasis (M) comprising (TNM) staging is crucial for planning treatment strategies for patients with oral squamous cell carcinoma (OSCC). AIM This study evaluated the predictive accuracy of clinical TNM staging of OSCC to histopathological staging (pTNM) in an institutional setting. MATERIALS AND METHODS Fifty-four consecutive histologically confirmed, surgically treated OSCC cases were evaluated for TNM staging. The study compared the clinical staging at the time of surgery with the pathological staging obtained from excisional biopsy reports. Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) was used for the data compilation and descriptive analysis. The chi-square test, analysis of variance (ANOVA), and Tukey's Honest Significant Difference (HSD) posthoc test were used to compare the data for statistical significance with p value <0.05 using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 23.0, Armonk, NY). RESULTS The alveolar mucosa (n=22, 40.74%) was the most frequently occurring site, followed by the tongue (n=17, 31.48%). Out of the 54 included cases, based on clinical tumor size, there were T1 (n=6), T2 (n=13), T3 (n=13), T4a (n=16) and T4b (n=6). T2 tumors were usually upstaged (n=7) while T4a (n=8) tumors were most often downstaged. T4a (n=8) had the best concordance between clinical and histopathological staging, followed by T2, T3, and T1. In nodal status, N1 showed the most variation. The chi-squared test showed statistical significance for tumor size comparison (p <0.001) and nodal status comparison (p=0.002). ANOVA test did not show any statistical significance. Tukey's HSD posthoc test showed statistical significance (p=0.034) for N0 and N1 status. The highest concordance was shown by N0 and N1 followed by N2b. CONCLUSION Preoperative radiological and clinical assessments are essential for deciding on a patient's course of treatment. However, not all patients may require radiographs to determine tumor size or nodal status assessment. Accurate diagnosis is vital for the treatment planning of OSCC.
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Affiliation(s)
- Dharini S
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Pratibha Ramani
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Caponio VCA, Zhurakivska K, Mascitti M, Togni L, Spirito F, Cirillo N, Lo Muzio L, Troiano G. High-risk TP53 mutations predict poor primary treatment response of patients with head and neck squamous cell carcinoma. Oral Dis 2024; 30:2018-2026. [PMID: 37501500 DOI: 10.1111/odi.14698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/06/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES Head and neck squamous cell carcinoma (HNSCC) poses a diagnostic and therapeutic challenge worldwide and is associated with a poor survival rate. Due to the variability in the efficacy of treatments for HNSCC, new predictive biomarkers of therapy outcomes are needed. Recently, we developed an algorithm that employs the mutational profile of TP53 as an independent prognostic factor in HNSCC. In this study, we investigated its role as a predictive biomarker of treatment outcomes in HNSCC patients. We also tested the usefulness of two classification systems for TP53 mutational landscapes. MATERIALS AND METHODS Clinical and genomic data were retrieved from The Cancer Genome Atlas database. We built a multivariate stepwise backward binary regression model to assess the role of TP53 mutations in predicting therapeutic outcomes. RESULTS Cases harbouring high-risk-of-death mutations reported an odds ratio of 3.301 for stable or progressive disease compared to wild-type cases, while no significant difference in treatment outcomes was found between cases with low-risk-of-death mutations and wild-type TP53. Our analysis found that older patients with a history of alcohol consumption had a higher risk of stable/progressive disease. CONCLUSIONS This study improves current evidence on the role of TP53 mutations in treatment response in HNSCC patients.
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Affiliation(s)
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Marco Mascitti
- Department of Clinical Specialist and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Lucrezia Togni
- Department of Clinical Specialist and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Francesca Spirito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Nicola Cirillo
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
- School of Dentistry, University of Jordan, Amman, Jordan
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
- C.I.N.B.O. (Consorzio Interuniversitario Nazionale per la Bio-Oncologia), Chieti, Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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O'Gorman C, Willis A. Oral medicine considerations for the older patient. Br Dent J 2024; 236:251-260. [PMID: 38388594 DOI: 10.1038/s41415-024-7060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 02/24/2024]
Abstract
With the proportion of the world population aged over 60 years expected to nearly double to 22% by 2050, health care professionals are faced with the challenge of ensuring they are ready to address this demographic shift. As people age, they are more likely to develop comorbidities which have implications for their oral health. The effects of polypharmacy used to address these underlying health problems can also influence the oral health of older-aged patients. From a clinician's perspective, an awareness of the variety of conditions associated with old age, such as oral-mucosal disease, swellings and manifestations of underlying health conditions, are required to ensure appropriate referral, investigation and management, both in primary and secondary care settings. This article aims to provide the practitioner with an overview of orofacial and oral mucosal conditions commonly encountered with the older patient.
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Affiliation(s)
- Conor O'Gorman
- Specialty Registrar in Oral Medicine, Belfast Health and Social Care Trust, Belfast, UK.
| | - Amanda Willis
- Senior Clinical Lecturer and Consultant in Oral Medicine, Queens University Belfast, Belfast Health and Social Care Trust, Belfast, UK
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Mishra H, Singh S, Mishra R, Pandey A, Mandal A, Prakash E, Patel G, Shah M, Singh TB. Evaluation of survival outcome and prognostic factors for oral cavity cancer treated with volumetric arc therapy. J Cancer Res Clin Oncol 2023; 149:16983-16992. [PMID: 37740764 DOI: 10.1007/s00432-023-05397-4] [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: 07/10/2023] [Accepted: 09/02/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE This study aimed to evaluate the survival outcomes and identify prognostic factors for patients with oral cavity cancer (OCC) who underwent adjuvant treatment with volumetric arc therapy (VMAT) using simultaneous integrated boost (SIB). METHODS Data was collected for post-operated patients of carcinoma of oral cavity who received adjuvant VMAT with SIB between June 2018 and December 2022. The data was entered and analyzed using SPSS software version 20.0. Survival rates were estimated using Kaplan Meier method. To determine survival difference between the groups, log rank test was used. Multivariate analyses were performed with Cox proportional hazard model and p value < 0.05 was considered as significant. RESULTS A total of 178 patients were included in the study. The median follow-up period was 26 months (range 3-56 months). The 3-year OS, DFS, and LRC rates were 78% (95% CI 77-79%), 76% (95% CI 74-77%), and 81% (95% CI 80-82%), respectively. Univariate analysis identified age ≥ 50 years, lymph node involvement, extracapsular extension (ECE), and N2-N3 disease as significant adverse prognostic factors for OS, DFS, and LRC. Multivariate analysis confirmed age ≥ 50 years and nodal involvement as independent predictors of worse OS, DFS, and LRC. Additionally, ECE independently affected OS and DFS. CONCLUSION Adjuvant treatment with VMAT using SIBin patients with OCC is effective. Age and nodal involvement had significant impact on LRC, DFSand OS while ECE on DFSand OS.
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Affiliation(s)
- Himanshu Mishra
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Shreya Singh
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Ritusha Mishra
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India.
| | - Ankita Pandey
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Abhijit Mandal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Ekta Prakash
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Ganeshkumar Patel
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Manav Shah
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - Tej Bali Singh
- N.M.H.P., Centre of Excellence, Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
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Thankappan S, Nedumpillil S, Thomas V. Clinicopathologic features and risk factors associated with oral squamous cell carcinoma (OSCC): A comprehensive descriptive study analyzing the burden of OSCC in a tertiary-level hospital in North Kerala, India. Indian J Cancer 2023; 60:534-541. [PMID: 38195487 DOI: 10.4103/ijc.ijc_203_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/02/2021] [Indexed: 01/11/2024]
Abstract
BACKGROUND Oral cancer is one of the most common types of cancer worldwide, and India shows a high incidence of oral squamous cell carcinoma (OSCC) cases. Kerala accounts for a sizeable number of these cases, most of which can be attributed to the deleterious habits prevalent in a vast majority of the population. A comprehensive descriptive-prospective study was done in our institution over 18 months to identify the possible risk factors, to describe the clinical and sociodemographic variables of OSCC, and to understand the burden of this dreaded disease in the North Kerala population. MATERIALS AND METHODS Data collection was done using a structured pro forma. The data were tabulated and organized; uni- and bivariate analysis were performed along with cross-tabulations for various parameters and relevant variables. A total of 243 histopathologically confirmed cases of OSCC during 18 months comprised the sample in this study. RESULTS Among the 243 cases, 220 patients had deleterious habits. Betel chewing was the most predominant habit. Buccal mucosa was the commonly affected site. Twenty-three patients had no history of any habits. Majority of the patients presented in stage 3 and 4 of the disease. Moderately differentiated squamous cell carcinoma was the major histologic type. CONCLUSION The majority of the patients had clinical lesions corresponding to the habit usage, showing a low awareness of tobacco cessation and intervention programs and a high burden of OSCC in the North Kerala population.
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Affiliation(s)
- Simi Thankappan
- Department of Oral Medicine and Radiology, Govt. Dental College, Calicut, Kerala, India
| | - Sherin Nedumpillil
- Department of Oral Pathology and Microbiology, Govt. Dental College, Calicut, Kerala, India
| | - Valsa Thomas
- Department of Oral Medicine and Radiology, Govt. Dental College, Calicut, Kerala, India
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Babu G, Ravikumar R, Rafi M, Sharafuddin Z, Shankar SA, George PS, Kainickal CT, Kunnambath R. Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes. Singapore Med J 2023:384047. [PMID: 37675674 DOI: 10.4103/singaporemedj.smj-2021-282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Introduction Oral cancer is a major public health concern in India. Both conventional and altered fractionation radiotherapy schedules have been used in curative treatment of oral cancer. This study aimed to retrospectively evaluate the clinical profile and treatment outcomes of patients with carcinoma buccal mucosa who underwent treatment with definitive hypofractionated accelerated radiotherapy. Methods A total of 517 patients treated from January 2011 to December 2016 were eligible for the analysis. All patients were treated with definitive hypofractionated accelerated radiotherapy schedule of 5,250 cGy in 15 fractions over 3 weeks. Survival estimates were generated using the Kaplan-Meier method. Results At a median follow-up of 77.4 months, 473 (91.5%) patients attained complete remission with radiation therapy. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 69% and 80.5%, respectively. The 5-year OS for stage I, II, III and IVa tumours was 80.3%, 84.4%, 81.4% and 73.7%, respectively, and the DFS was 75.7%, 73.2%, 69.6% and 60.2%, respectively. Age >50 years was found to be a significant factor affecting DFS (P = 0.026) and OS (P = 0.048) in multivariate analysis. Fifty-three (10.3%) patients developed osteoradionecrosis of the mandible. Conclusion Excellent outcome could be achieved in less-aggressive, low-volume carcinoma of the buccal mucosa with radical accelerated hypofractionated radiotherapy. A radiotherapy schedule over a 3-week period is useful in high-volume centres.
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Affiliation(s)
- Geethu Babu
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Rejnish Ravikumar
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Malu Rafi
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Zuzaki Sharafuddin
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - S Arun Shankar
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Preethi Sara George
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Trivandrum, Kerala, India
| | | | - Ramadas Kunnambath
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
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Qayyumi B, Bharde A, Aland G, D'Souza A, Jayant S, Singh N, Tripathi S, Badave R, Kale N, Singh B, Arora S, Gore I, Singh A, Vasudevan A, Prabhash K, Khandare J, Chaturvedi P. Circulating tumor cells as a predictor for poor prognostic factors and overall survival in treatment naïve oral squamous cell carcinoma patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:73-83. [PMID: 35595620 DOI: 10.1016/j.oooo.2022.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/10/2022] [Accepted: 02/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the presence of circulating tumor cells (CTCs) and their correlation with prognostic factors and clinical outcomes in treatment-naive patients with oral squamous cell carcinoma. STUDY DESIGN CTCs were isolated using OncoDiscover technique from presurgically obtained peripheral blood of 152 patients with treatment naïve oral squamous cell carcinoma. Sensitivity analysis was performed by including 40 healthy controls. CTCs cutoff values for clinicopathologic factors were obtained from receiver operating characteristic curves. Multivariate models determined the significance of CTC as independent variables. Kaplan-Meier analysis differentiated in overall survival between CTC values corresponding to the stage. RESULTS Sensitivity, specificity, and accuracy of CTC detection were 94.32%, 98%, and 95.17%, respectively. Platform differentiated true positives at >3.5 CTCs (P < .00001). CTCs above 20.5 were suggestive of nodal metastasis (P < .0001) with a linear trend for detecting occult metastasis (P = .061). Early and advanced stages could be differentiated by >13.5 CTCs (P < .0001). Elevated CTCs were significantly associated with extranodal extension (>21.45 CTCs, P = .025), perineural invasion (>19.35 CTCs, P = .049), and depth of invasion (>12.5 CTCs, P = .0038). Median survival was reduced by 19 months when CTCs were >13. CONCLUSIONS Preoperative CTC levels demonstrated a strong correlation with adverse clinicopathology factors and suggested its role as a sensitive prognostic marker to predict survival outcome and disease progress.
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Affiliation(s)
- Burhanuddin Qayyumi
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Atul Bharde
- Department of Microbiology, Savitribai Phule Pune University, Pune, India
| | | | - Alain D'Souza
- Actorius Innovations and Research Pvt. Ltd., Pune, India
| | - Sreeja Jayant
- Actorius Innovations and Research Pvt. Ltd., Pune, India
| | - Nitin Singh
- Actorius Innovations and Research Pvt. Ltd., Pune, India
| | - Swati Tripathi
- Actorius Innovations and Research Pvt. Ltd., Pune, India
| | - Reecha Badave
- Actorius Innovations and Research Pvt. Ltd., Pune, India
| | - Narendra Kale
- Actorius Innovations and Research Pvt. Ltd., Pune, India
| | - Balram Singh
- Actorius Innovations and Research Pvt. Ltd., Pune, India
| | - Smriti Arora
- Actorius Innovations and Research Pvt. Ltd., Pune, India
| | - Isha Gore
- Actorius Innovations and Research Pvt. Ltd., Pune, India
| | - Arjun Singh
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | | | - Kumar Prabhash
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Jayant Khandare
- Actorius Innovations and Research Pvt. Ltd., Pune, India; Actorius Innovations and Research Co, Simi Valley, CA, USA; OneCell Diagnostics Inc, Cupertino, CA, USA; OneCell Diagnostics Pvt. Ltd., Pune, India.
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, India; Homi Bhabha National Institute, Mumbai, India.
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Panda S, Mohanty N, Panda S, Mishra L, Gopinath D, Sahoo A, Nagraj SK, Lapinska B. Are Survival Outcomes Different for Young and Old Patients with Oral and Oropharyngeal Squamous Cell Carcinoma? A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14081886. [PMID: 35454794 PMCID: PMC9029651 DOI: 10.3390/cancers14081886] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Oral cancer was considered a disease of old age. However, there has been a recent surge in the incidence of oral cancer in young individuals. Age dependence on survival outcomes such as overall survival, disease-free survival, recurrence, distant metastasis and second primary in surgically treated oral cancer has been investigated several times and the results differ. This systematic review and meta-analysis has been conducted to address this concern. The results of the present research may facilitate age-dependent prognosis stratification, which would assist in treatment planning in oral cancer patients. Abstract This systematic review and meta-analysis aims to address whether age can be a determinant of overall survival (OS), disease-free survival (DFS), recurrence, distant metastasis (DM) and second primary (SP) in surgically treated oral and oropharyngeal squamous cell carcinoma (OOPSCC). A total of 4981 cases and 44254 controls from 25 comparative observational studies were included in the analysis. A significantly better OS (matched subgroup analysis: OR 1.64; 95% CI 1.31–2.04, overall analysis: OR 1.48; 95% CI 1.09–2.01) was observed in young patients compared to older adults, with heterogeneity ranging from moderate to severe. Worse DFS (unmatched subgroup analysis OR 0.43; 95% CI 0.27–0.68) was observed in young patients compared to older adults with minimal to moderate heterogeneity. The frequency of recurrence (OR 1.49; 95% CI 1.10–2.02) and DM (OR 1.83; 95% CI 1.10–3.03) was significantly higher in the young patients, as found in unmatched and matched subgroup analysis, with the least heterogeneities. Young age can be considered as an independent prognostic factor for recurrence and distant metastases in OOP-SCC. Larger and methodologically robust observational studies with longer follow-up are needed to establish the definitive role of age as an independent prognostic factor on OS and DFS in OOPSCC.
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Affiliation(s)
- Swagatika Panda
- Department of Oral Pathology and Microbiology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar 751030, India; (N.M.); (A.S.)
- Correspondence: (S.P.); (B.L.); Tel.: +91-876-333-4097 (S.P.); +85-42-675-74-61 (B.L.)
| | - Neeta Mohanty
- Department of Oral Pathology and Microbiology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar 751030, India; (N.M.); (A.S.)
| | - Saurav Panda
- Department of Periodontics and Implantology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar 751030, India;
| | - Lora Mishra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar 751030, India;
| | - Divya Gopinath
- Department of Oral Diagnostics and Surgical Sciences, School of Dentistry, International Medical University, Kuala Lumpur 57000, Malaysia;
- Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 602105, India
| | - Alkananda Sahoo
- Department of Oral Pathology and Microbiology, Institute of Dental Sciences, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar 751030, India; (N.M.); (A.S.)
| | - Sumanth Kumbargere Nagraj
- Head of the Department, Oral Medicine and Oral Radiology, Faculty of Dentistry, Manipal University College, Melaka 75150, Malaysia;
| | - Barbara Lapinska
- Department of General Dentistry, Medical University of Lodz, 92-213 Lodz, Poland
- Correspondence: (S.P.); (B.L.); Tel.: +91-876-333-4097 (S.P.); +85-42-675-74-61 (B.L.)
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11
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The World of Oral Cancer and Its Risk Factors Viewed from the Aspect of MicroRNA Expression Patterns. Genes (Basel) 2022; 13:genes13040594. [PMID: 35456400 PMCID: PMC9027895 DOI: 10.3390/genes13040594] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
Oral cancer is one of the leading causes of death worldwide, with a reported 5-year survival rate of around 50% after treatment. Epigenetic modifications are considered to have a key role in oral carcinogenesis due to histone modifications, aberrant DNA methylation, and altered expression of miRNAs. MicroRNAs (miRNAs) are small non-coding RNAs that have a key role in cancer development by regulating signaling pathways involved in carcinogenesis. MiRNA deregulation identified in oral cancer has led to the idea of using them as potential biomarkers for early diagnosis, prognosis, and the development of novel therapeutic strategies. In recent years, a key role has been observed for risk factors in preventing and treating this malignancy. The purpose of this review is to summarize the recent knowledge about the altered mechanisms of oral cancer due to risk factors and the role of miRNAs in these mechanisms.
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12
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Adeoye J, Tan JY, Choi SW, Thomson P. Prediction models applying machine learning to oral cavity cancer outcomes: A systematic review. Int J Med Inform 2021; 154:104557. [PMID: 34455119 DOI: 10.1016/j.ijmedinf.2021.104557] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Machine learning platforms are now being introduced into modern oncological practice for classification and prediction of patient outcomes. To determine the current status of the application of these learning models as adjunctive decision-making tools in oral cavity cancer management, this systematic review aims to summarize the accuracy of machine-learning based models for disease outcomes. METHODS Electronic databases including PubMed, Scopus, EMBASE, Cochrane Library, LILACS, SciELO, PsychINFO, and Web of Science were searched up until December 21, 2020. Pertinent articles detailing the development and accuracy of machine learning prediction models for oral cavity cancer outcomes were selected in a two-stage process. Quality assessment was conducted using the Quality in Prognosis Studies (QUIPS) tool and results of base studies were qualitatively synthesized by all authors. Outcomes of interest were malignant transformation of precancer lesions, cervical lymph node metastasis, as well as treatment response, and prognosis of oral cavity cancer. RESULTS Twenty-seven articles out of 950 citations identified from electronic and manual searching were included in this study. Five studies had low bias concerns on the QUIPS tool. Prediction of malignant transformation, cervical lymph node metastasis, treatment response, and prognosis were reported in three, six, eight, and eleven articles respectively. Accuracy of these learning models on the internal or external validation sets ranged from 0.85 to 0.97 for malignant transformation prediction, 0.78-0.91 for cervical lymph node metastasis prediction, 0.64-1.00 for treatment response prediction, and 0.71-0.99 for prognosis prediction. In general, most trained algorithms predicting these outcomes performed better than alternate methods of prediction. We also found that models including molecular markers in training data had better accuracy estimates for malignant transformation, treatment response, and prognosis prediction. CONCLUSION Machine learning algorithms have a satisfactory to excellent accuracy for predicting three of four oral cavity cancer outcomes i.e., malignant transformation, nodal metastasis, and prognosis. However, considering the training approach of many available classifiers, these models may not be streamlined enough for clinical application currently.
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Affiliation(s)
- John Adeoye
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Jia Yan Tan
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Siu-Wai Choi
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Peter Thomson
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region
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13
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Evaluation of Depth of Invasion in Oral Squamous Cell Carcinoma with Ultra-High Frequency Ultrasound: A Preliminary Study. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11167647] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Intraoral ultrasonography has been widely employed for the preoperative assessment of tumor margins due to its capability to evaluate depth of invasion (DOI) and tumor thickness (TT). Recently, a novel ultrasonographic technique, ultra-high frequency ultrasound (UHFUS) has been increasingly applied to the study of oral lesions. This study evaluates the potential application of intraoral UHFUS to assess DOI and TT parameters of oral squamous cell carcinoma (OSCC) lesions. Patients clinically suspected of OSCC lesions were enrolled and underwent an intraoral UHFUS examination preoperatively. The parameters of TT, DOI, echogenicity, and vascularization were assessed. The parameters of TT and DOI as evaluated by means of UHFUS were compared to histology, which was set as the benchmark. Ten patients in total were enrolled. UHFUS-based DOI and TT measurements were found to positively correlate with histology (p < 0.05), although UHFUS provided a slight overestimation of DOI. No differences were found in terms of echogenicity or vascularization depending on the site of the lesion. According to these preliminary results, UHFUS could support the preoperative assessment of TT and DOI, potentially enhancing the clinical evaluation of OSCC.
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14
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Pre-Therapeutic VEGF Level in Plasma Is a Prognostic Bio-Marker in Head and Neck Squamous Cell Carcinoma (HNSCC). Cancers (Basel) 2021; 13:cancers13153781. [PMID: 34359680 PMCID: PMC8345208 DOI: 10.3390/cancers13153781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary In the context of a growing variety in treatment strategies for patients with cancer, especially approaches based on antiangiogenetic pathways, we aimed to identify a useful biomarker for patients with head and neck squamous cell carcinoma (HNSCC). Our experimental results detected vascular endothelial growth factor (VEGF) in patients’ pre-therapeutic plasma, and not serum, which serves as a suitable biomarker for outcome prognostication. Results were validated in an independent cohort, confirming VEGF as an independent predictor (Pi) of outcomes in HNSCC patients. Therefore, pre-therapeutic VEGF in plasma may be an attractive biomarker in future HNSCC studies. Abstract Vascular endothelial growth factor (VEGF) is centrally involved in cancer angiogenesis. We hypothesized that pre-therapeutic VEGF levels in serum and plasma differ in their potential as biomarkers for outcomes in head and neck squamous cell carcinoma (HNSCC) patients. As prospectively defined in the study protocols of TRANSCAN-DietINT and NICEI-CIH, we measured VEGF in pretreatment serum and plasma of 75 HNSCC test cohort (TC) patients. We analyzed the prognostic value of VEGF concentrations in serum (VEGFSerum) and plasma (VEGFPlasma) for event-free survival (EFS) utilizing receiver-operating characteristics (ROC). Mean VEGF concentrations in plasma (34.6, 95% CI 26.0–43.3 ng/L) were significantly lower (p = 3.35 × 10−18) than in serum (214.8, 95% CI 179.6–250.0 ng/L) but, based on ROC (area under the curve, AUCPlasma = 0.707, 95% CI 0.573–0.840; p = 0.006 versus AUCSerum = 0.665, 95% CI 0.528–0.801; p = 0.030), superiorly correlated with event-free survival (EFS) of TC patients. Youden indices revealed optimum binary classification with VEGFPlasma 26 ng/L and VEGFSerum 264 ng/L. Kaplan–Meier plots demonstrated superiority of VEGFPlasma in discriminating patients regarding outcome. Patients with VEGFPlasma < 26 ng/L had superior nodal (NC), local (LC) and loco-regional control (LRC) leading to significant prolonged progression-free survival (PFS) and EFS. We successfully validated VEGFPlasma according the cut-off <26 ng/L as predictive for superior outcome in an independent validation cohort (iVC) of 104 HNSCC patients from the studies DeLOS-II and LIFE and found better outcomes including prolonged tumor-specific (TSS) and overall survival (OS). Outcomes in TC and iVC combined again was related to VEGFPlasma, and multivariate Cox regression revealed that VEGFPlasma was an independent outcome predictor. In HNSCC, pre-therapeutic VEGFPlasma is prognostic for outcomes.
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15
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Impact of Preoperative Low Prognostic Nutritional Index and High Intramuscular Adipose Tissue Content on Outcomes of Patients with Oral Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12113167. [PMID: 33126582 PMCID: PMC7692578 DOI: 10.3390/cancers12113167] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022] Open
Abstract
The impact of preoperative malnutrition and sarcopenia on survival in oral squamous cell carcinoma (OSCC) patients remains controversial. We investigated the effects of the preoperative nutritional status and abnormalities in body composition on the mortality of OSCC patients. A retrospective study involving 103 patients with OSCC was conducted. Disease-specific survival (DSS) according to the preoperative psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC) was evaluated. Univariate and multivariate analyses were performed to determine the predictive performance of the covariates with respect to DSS. The DSS rate in patients with high IMAC and low PMI was significantly lower than that in controls. Multivariate analysis revealed that a low preoperative Prognostic Nutritional Index (PNI) and high IMAC were independent risk factors. We demonstrated that preoperative malnutrition and abnormal body composition, such as preoperative skeletal muscle quality, are associated with DSS in OSCC patients. Our study suggests that the evaluation of preoperative malnutrition and skeletal muscle quality would be useful for predicting mortality in patients with OSCC.
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16
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Almangush A, Mäkitie AA, Triantafyllou A, de Bree R, Strojan P, Rinaldo A, Hernandez-Prera JC, Suárez C, Kowalski LP, Ferlito A, Leivo I. Staging and grading of oral squamous cell carcinoma: An update. Oral Oncol 2020; 107:104799. [PMID: 32446214 DOI: 10.1016/j.oraloncology.2020.104799] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
Oral squamous cell carcinoma (OSCC) is a common malignancy of the head and neck region. OSCC has a relatively low survival rate and the incidence of the disease is increasing in some geographic areas. Staging and grading of OSCC are established prerequisites for management, as they influence risk stratification and are the first step toward personalized treatment. The current AJCC/UICC TNM staging (8th edition, 2017) of OSCC has included significant modifications through the incorporation of depth of invasion in the T stage and extracapsular spread/extranodal extension in the N stage. Further modifications for AJCC 8 have been suggested. On the other hand, the World Health Organization (WHO) classification (4th edition, 2017) still endorses a simple, differentiation-based histopathologic grading system of OSCC (despite its low prognostic value) and ignores factors such as tumor growth pattern and dissociation, stromal reactions (desmoplasia, local immune response), and tumor-stroma ratio. The various controversies and possible developments of the current staging and grading criteria of OSCC are briefly discussed in this update together with possible applications of artificial intelligence in the context of screening and risk stratification.
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Affiliation(s)
- Alhadi Almangush
- Department of Pathology, University of Helsinki, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Institute of Biomedicine, Pathology, University of Turku, Turku, Finland; Faculty of Dentistry, University of Misurata, Misurata, Libya.
| | - Antti A Mäkitie
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden.
| | - Asterios Triantafyllou
- Department of Pathology, Liverpool Clinical Laboratories and School of Dentistry, University of Liverpool, Liverpool, UK.
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
| | | | | | - Carlos Suárez
- Instituto de Investigacion Sanitaria del Principado de Asturias and (CIBERONC), ISCIII, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo, Brazil; Head and Neck Surgery, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy.
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland.
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