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González-Arriagada WA, Coletta RD, Lozano-Burgos C, García C, Maripillán J, Alcayaga-Miranda F, Godínez-Pacheco B, Oyarce-Pezoa S, Martínez-Flores R, García IE. CR5/CCL5 axis is linked to a poor outcome, and inhibition reduces metastasis in oral squamous cell carcinoma. J Cancer Res Clin Oncol 2023; 149:17335-17346. [PMID: 37831273 DOI: 10.1007/s00432-023-05443-1] [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: 07/19/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE The CCR5/CCL5 axis is essential for interactions between malignant cells and microenvironment components, promoting tumor progression in oral squamous cell carcinoma (OSCC). This study aims to evaluate the association of CCL5 and CCR5 with the behavior of oral cancer and assess the therapeutic potential of a CCR5 antagonist. METHODS A retrospective study to analyze CCR5 and CCL5 expression on paraffin-embedded tissues was performed. In cell lines, rhCCL5 was added to induce CCR5-related pathways, and Maraviroc and shRNA against CCR5 were used to neutralize the receptor. Finally, an in vivo murine orthotopic xenograft model of tongue cancer was used to evaluate Maraviroc as an oncologic therapy. After 15 days, the mice were killed, and the primary tumors and cervical lymph nodes were analyzed. RESULTS The expression of CCR5 was associated with clinical stage and metastasis, and CCL5 was related to overall survival. Adding rhCCL5 induced cell proliferation, while shRNA and Maraviroc reduced it in a dose-dependent manner. Maraviroc treatment also increased apoptosis and modified cytoskeletal organization. In vivo, Maraviroc reduced neck metastasis. CONCLUSIONS The effects of CCR5 antagonists in OSCC have been poorly studied, and this study reports in vitro and in vivo evidence for the effects of Maraviroc in OSCC. Our results suggest that the CCR5/CCL5 axis plays a role in oral cancer behavior, and that its inhibition is a promising new therapy alternative.
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Affiliation(s)
- Wilfredo Alejandro González-Arriagada
- Facultad de Odontología, Universidad de los Andes, Santiago, Chile.
- Centro de Investigación e Innovación Biomédica, Universidad de los Andes, Santiago, Chile.
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile.
| | - Ricardo D Coletta
- Oral Pathology and Graduate Program in Oral Biology, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | | | - Cynthia García
- PhD Program in Biomedicine, Universidad de los Andes, Santiago, Chile
| | - Jaime Maripillán
- Laboratorio de Fisiología Molecular y Biofísica, Facultad de Odontología, Universidad de Valparaíso, Valparaíso, Chile
- Centro Interdisciplinario de Neurociencias de Valparaíso, Universidad de Valparaíso, Valparaíso, Chile
| | - Francisca Alcayaga-Miranda
- Centro de Investigación e Innovación Biomédica, Universidad de los Andes, Santiago, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile
| | | | | | - René Martínez-Flores
- Facultad de Odontología, Unidad de Patología y Medicina Oral, Universidad Andres Bello, Santiago, Chile
| | - Isaac E García
- Laboratorio de Fisiología Molecular y Biofísica, Facultad de Odontología, Universidad de Valparaíso, Valparaíso, Chile
- Centro Interdisciplinario de Neurociencias de Valparaíso, Universidad de Valparaíso, Valparaíso, Chile
- Centro de Investigación Interoperativa en Ciencias Odontológicas y Médicas, Universidad de Valparaíso, Valparaíso, Chile
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Mehta N, Jakhetiya A, Patel D, Pandey A, Patel T, Patidar N, Mehta FS. Prevalence and Patterns of Nodal Metastasis Among Oral Cavity Cancer Patients: A Prospective Observational Study. J Maxillofac Oral Surg 2023; 22:245-251. [PMID: 36703656 PMCID: PMC9871083 DOI: 10.1007/s12663-022-01739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 05/24/2022] [Indexed: 01/29/2023] Open
Abstract
Introduction Lip and oral cavity cancer remains the most common cancer among Indian males and third most common cause of cancer-related deaths in India. Cervical lymph node metastasis is one of the most important prognostic factors in oral cavity cancer. The aim of present study was to estimate the prevalence of nodal involvement and analyse patterns of nodal metastasis in oral cavity cancer patients. Methods This prospective observational study was conducted between January 2019 and June 2020. Patients of oral cavity squamous cell carcinoma undergoing surgery with simultaneous neck dissection were included. Data pertaining to the clinical profile, treatment and histology details were collected and analysed. Results A total of 63 patients were included in present study. Out of 63 patients, unilateral neck dissection was performed in 47 (75%), while 16 (25%) underwent bilateral neck dissection. Overall clinical and pathological nodal positivity rates were 75% and 52%, respectively. Level I (48%) followed by IIa (20%) were most commonly involved stations. Combined involvement of level IV and V was seen in only 5%, and no skip metastasis was reported in level IV and V. Conclusion Level I and II are the most commonly involved stations in oral cavity squamous cell carcinoma (SCC). Oral SCC has a predictable nodal spread pattern with no skip metastasis to level IV/V noted in present study. There is a need for good quality randomised control trials to optimise the treatment protocols in clinically node-positive patients with respect to level IIB and V dissection.
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Affiliation(s)
- Nilesh Mehta
- General Surgery, Geetanjali Medical College and Hospital, Udaipur, Rajasthan India
| | - Ashish Jakhetiya
- Surgical Oncology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan India
| | - Dev Patel
- MS Post Graduate, General Surgery, Geetanjali Medical College and Hospital, Udaipur, Rajasthan India
| | - Arun Pandey
- Surgical Oncology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan India
| | - Tarang Patel
- Geetanjali Medical College and Hospital, Udaipur, Rajasthan India
| | - Naveen Patidar
- Geetanjali Medical College and Hospital, Udaipur, Rajasthan India
| | - Fateh singh Mehta
- General Surgery, Geetanjali Medical College and Hospital, Udaipur, Rajasthan India
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Hashmi SS, Abbas A, Bukhari A, Saeed J, Shafqat A, Siddique AH, Buksh AR, Murtaza G. Selective Neck Dissection for Node-Positive Oral Cavity Squamous Cell Carcinoma: A Retrospective Cohort Study. Int Arch Otorhinolaryngol 2022; 26:e630-e635. [PMID: 36405475 PMCID: PMC9668421 DOI: 10.1055/s-0041-1741437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/04/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction
Selective neck dissection in clinically node-negative neck is considered the standard of care for oral squamous cell carcinomas (SCCs). Controversy still prevails in node-positive disease regarding the extent of neck dissection. In our part of the world, comprehensive neck dissection is mostly considered to be the minimal optimal treatment for palpable neck disease.
Objective
To compare regional control and disease-specific survival between clinically node-positive and node-negative patients undergoing selective neck dissection for oral SCC.
Methods
This was a retrospective cohort study conducted in the department of ENT, Head and Neck surgery at a tertiary care hospital. All patients with biopsy-proven oral and lip SCC, with or without nodal disease, who underwent selective neck dissection between April 2006 and July 2015 were included in the study.
Results
During the study period, 111 patients with oral SCC underwent selective neck dissection, of whom 71 (62%) were clinically node-negative and 40 (38%) patients had clinically positive nodes in the neck. The mean follow-up was 16.62 months (standard deviation [SD]: 17.03). The overall regional control rates were 95 versus 96% for clinical negative versus positive nodes, respectively (
p
= 0.589). The disease-specific survival was 84.5% in the node negative group versus 82.5% in the node-positive group (
p
= 0.703).
Conclusion
Selective neck dissection in node-positive neck oral SCC has similar regional control rates when compared with node-negative neck SCC. The difference in disease-specific survival between the two groups is also not significant.
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Affiliation(s)
- Syed Salman Hashmi
- ENT Department, Peterborough City Hospital, Northwest Anglia NHS Foundation Trust, Peterborough , England
| | - Akbar Abbas
- Department of ENT, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Amna Bukhari
- Department of ENT and Head and Neck Surgery, Patel Hospital, Karachi, Sindh, Pakistan
| | - Javeria Saeed
- Department of Orthopedics, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Ali Shafqat
- Department of ENT and Head and Neck Surgery, Patel Hospital, Karachi, Sindh, Pakistan
| | - Atif Hafeez Siddique
- Department of Otolaryngology, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Ahmed Raheem Buksh
- Department of Pathology and Laboratory of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Ghulam Murtaza
- Department of General Surgery, Patel Hospital, Karachi, Sindh, Pakistan
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Singh V, Dwivedi SN, Deo SVS. Ordinal logistic regression model describing factors associated with extent of nodal involvement in oral cancer patients and its prospective validation. BMC Med Res Methodol 2020; 20:95. [PMID: 32336269 PMCID: PMC7183690 DOI: 10.1186/s12874-020-00985-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/20/2020] [Indexed: 01/09/2023] Open
Abstract
Background Oral cancer is the most common cancer among Indian men, and has strong tendency of metastatic spread to neck lymph node which strongly influences prognosis especially 5 year survival-rate and also guides the related managements more effectively. Therefore, a reliable and accurate means of preoperative evaluation of extent of nodal involvement becomes crucial. However, earlier researchers have preferred to address mainly its dichotomous form (involved/not-involved) instead of ordinal form while dealing with epidemiology of nodal involvement. As a matter of fact, consideration of ordinal form appropriately may increase not only the efficiency of the developed model but also accuracy in the results and related implications. Hence, to develop a model describing factors associated with ordinal form of nodal involvement was major focus of this study. Methods The data for model building were taken from the Department of Surgical Oncology, Dr.BRA-IRCH, AIIMS, New Delhi, India. All the OSCC patients (duly operated including neck dissection) and confirmed histopathologically from 1995 to 2013 were included. Further, another data of 204 patients collected prospectively from 2014 to 2015 was considered for the validation of the developed model. To assess the factors associated with extent of nodal involvement, as a first attempt in the field of OSCC, stepwise multivariable regression procedure was used and results are presented as odds-ratio and corresponding 95% confidence interval (CI). For appropriate accounting of ordinal form, the ordinal models were assessed and compared. Also, performance of the developed model was validated on a prospectively collected another data. Results Under multivariable proportional odds model, pain at the time of presentation, sub mucous fibrosis, palpable neck node, oral site and degree of differentiation were found to be significantly associated factors with extent of nodal involvement. In addition, tumor size also emerged to be significant under partial-proportional odds model. Conclusions The analytical results under the present study reveal that in case of ordinal form of the outcome, appropriate ordinal regression may be a preferred choice. Present data suggest that, pain, sub mucous fibrosis, palpable neck node, oral site, degree of differentiation and tumor size are the most probable associated factors with extent of nodal involvement.
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Affiliation(s)
- Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - S V S Deo
- Department of Surgical Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India
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Clinical Spectrum, Pattern, and Level-Wise Nodal Involvement Among Oral Squamous Cell Carcinoma Patients - Audit of 945 Oral Cancer Patient Data. Indian J Surg Oncol 2020; 11:86-91. [PMID: 32205977 DOI: 10.1007/s13193-019-01011-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/06/2019] [Indexed: 02/06/2023] Open
Abstract
Oral Squamous cell carcinoma (OSCC) is a locoregionally aggressive malignancy. Timely management of neck node dissemination, an important prognostic factor, impacts survival. The aim of the current study was to obtain comprehensive data on patterns or level-wise involvement of neck nodes to optimize neck management in OSCC. It was a retrospective analysis of a prospectively maintained database in a hospital-based setting. The current study evaluated patterns of spread to neck nodes in 945 pathologically proven OSCC patients who underwent neck dissection between 1995 and 2013. Clinical, surgical, pathological, level-wise information of neck nodes was available, and records of these patients were analyzed in relation to the pattern of involvement. Absolute/relative frequency distribution was used to describe the distribution of categorical variables. Continuous measures were organized as mean (standard deviation) and/or median (range). Buccal mucosa (28.78%) was the most common, whereas lip (5.08%) was the least common oral subsite. Modified neck dissection (69.75%) was the most common type of neck dissection. Pathological node positivity was documented in 39.8% patients and Level I(62.54%) and level II(57.33%) are the most common neck levels for nodal involvement. Involvement of Level III to V was seen less often (7.17%). There was no significant association between node positivity among different subsites of oral cancer. Neck level I and II are the most commonly involved levels. Sensitivity and specificity of clinical assessment are 83.51% and 30.05%, respectively. In view of this void in clinical assessment and a predictable nodal spread, alternate node assessment methodology must be explored.
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A Study on Neck Nodes in Oral Cancers, with Special Reference to Skip Metastasis. Indian J Otolaryngol Head Neck Surg 2019; 71:474-481. [PMID: 31742006 DOI: 10.1007/s12070-018-1360-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 04/10/2018] [Indexed: 11/26/2022] Open
Abstract
To analyse the distribution of Neck metastases (NM) and to study frequency of skip metastases in oral squamous cell carcinoma (SCC) of oral cavity. From September 2012 to April 2013, 30 previously untreated patients with SCC of oral cavity underwent primary surgical treatment in our institution. From pathological report of Neck dissection specimen prevalence and distribution of NM were ascertained. All patients were classified according to American Joint Committee on Cancer 2005 TNM classification. Overall frequency of NM was 36.7%. Frequency of occult metastases was 33.3%. N+ metastases found in 37% cases. The overall frequency of NM in level IV and V was 9.5%. Isolated level III involvement was found in 3.3%. No isolated level IV and V involvement was found. Skip metastases to level III LN was 6.7%. We did not find any skip metastases to level IV in our study. Neck nodes at greater risk for metastases were level I and II (50 and 28.6%). Level III (11.9%), IV (7.14%), V (2.38%). The risk of skip metastases to level IV was nil in our study.
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7
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Shukla NK, Deo SVS, Jakhetiya A, Nml M, Sreenivas V, Thulkar S, Bhasker S, Sharma A. Clinical Spectrum, Treatment and Relapse Patterns in 353 Patients with Squamous Cell Carcinoma of the Alveobuccal Complex Treated with a Curative Intent: A Retrospective Study. J Maxillofac Oral Surg 2016; 17:24-31. [PMID: 29382990 DOI: 10.1007/s12663-016-0970-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/17/2016] [Indexed: 11/30/2022] Open
Abstract
Aims and Objectives Oral cancer is one of the most common cancers in Indian subcontinent with alveobuccal complex as most common cancer sub site. Cancers of Alveobuccal complex provides maximum challenge and management guidelines are not clear. The aim of the present study is to provide comprehensive demographic, clinical and treatment outcome data of alveobuccal squamous cell carcinoma (SCC) patients treated at a tertiary care cancer center in North India. Materials and Methods An analysis of prospectively maintained database in department of surgical oncology at Dr BRA-IRCH, AIIMS, Delhi, India was performed. All alveobuccal cancer patients who had undergone surgery from 1995 to 2010 were included for analysis. Results A total of 353 patients were included for analysis. Mean age was 49.75 years (SD ±12.04) with male and female ratio of 4:1. Composite resection without mandible was done in 25 % patients and 75 % underwent mandibular resection. Neck dissection was performed in 347 patients. Nodal deposits were identified in 124 (35.73 %) neck dissection specimens. Margin negative resection was performed in 89.5 % cases. After a median follow up of 30 months, 87 (24.64 %) patients developed disease relapse and 25 (7.08 %) patients developed second primaries. Overall 5-year disease free survival (DFS) was 57.65 % and 5 year overall survival (OS) was 59.86 %. Conclusion Among Indian oral cancer patients alveobuccal complex is most common sub site. Majority presents in locally advanced stage and reasonably good outcomes can be achieved with quality control surgery and judicious use of radiotherapy.
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Affiliation(s)
- Nootan Kumar Shukla
- 1Department of SURGICAL Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - S V Suryanarayana Deo
- 1Department of SURGICAL Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Ashish Jakhetiya
- 1Department of SURGICAL Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Manjunath Nml
- 1Department of SURGICAL Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Vishnubhatla Sreenivas
- 2Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Sanjay Thulkar
- 3Department of Radio Diagnosis, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Suman Bhasker
- 4Department of Radiation Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
| | - Atul Sharma
- 5Department of Medical Oncology, Dr BRA-IRCH, All India Institute of Medical Sciences, Ansari Nagar, New Delhi India
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Huang SF, Tung-Chieh Chang J, Liao CT, Kang CJ, Lin CY, Fan KH, Wang HM, Chen IH. The role of elective neck dissection in early stage buccal cancer. Laryngoscope 2014; 125:128-33. [DOI: 10.1002/lary.24840] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 06/04/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Shiang-Fu Huang
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - Hung-Ming Wang
- Department of Internal Medicine; Division of Hematology/Oncology; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
| | - I-How Chen
- Department of Otolaryngology; Head and Neck Surgery; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
- Head and Neck Oncology Group; Chang Gung Memorial Hospital at Linkou and Chang Gung University; Taipei Taiwan
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