Prognostic features, human papillomavirus status, and epidermal growth factor receptor expression in oral squamous cell carcinoma in young adults

Association of Surgical Margins and Pathological Staging with Epidermal Growth Factor Receptor Expression in Oral Squamous Cell Carcinoma- A Prospective Cohort Study

Oral squamous cell carcinoma (SCC) is one among the most frequent cancers across the globe. The postoperative overall survival (OS) has not improved over years much despite of advanced surgical techniques and various anticancer drugs. A better and good understanding of molecular mechanisms and identification of potential oncogenes in OSCC may provide new therapeutic decisions such as target therapy in management of these cancer patients. To find whether there is any association between surgical margins and pathological staging with epidermal growth factor receptor expression affecting the prognosis in oral squamous cell carcinomas. A prospective cohort study was performed in 25 patients with biopsy proven oral squamous cell carcinoma who presented to our hospital from July 2017 to June 2019. The data collected from their report were pTNM staging, surgical margins (anterior, posterior, superior and inferior) and scoring of EGFR expression. Surgical margins with EGFR expression was found to have p-value of 0.023 and pTNM staging with EGFR expression was found to have p-value of 0.051 which were statistically significant. This study concludes that there is strong association of EGFR expression with pTNM and surgical margins which may influence the prognosis of the patient. This study helps us to understand the need of adding EGFR targets like cetuximab along with radiation instead of conventional cisplatin therapy.

A systematic review and meta-analysis of the prognostic role of age in oral tongue cancer

While evidence suggests an increasing incidence of tongue cancer in young adults, published findings regarding the prognostic role of age at diagnosis are inconsistent. We performed a meta-analysis of the literature to highlight key points that might help in understanding the association between age of oral tongue cancer patients at diagnosis and their prognosis. According to age at diagnosis, a systematic literature review of all published cohort studies assessing the recurrence risks and mortality associated with tongue cancer was conducted. We compared the risk estimates between patients aged >45 years and those aged <45 years at diagnosis. Random-effects models were used to calculate summary relative risk estimates (SRRs) according to different clinical outcomes and sources of between-study heterogeneity (I2 ) and bias. We included 31 independent cohort studies published between 1989 and 2019; these studies included a total of 28,288 patients. When risk estimations were not adjusted for confounders, no significant association was found between age at diagnosis and overall survival (OS). Conversely, after adjustment for confounders, older age at diagnosis was associated with a significantly increased risk of mortality. The difference between SRRs for adjusted and unadjusted estimates was significant (p < 0.01). Younger patients had a significantly higher risk of local recurrence. Younger patients with oral tongue cancer have better OS but a greater risk of recurrence than older patients. These findings should be validated in a large prospective cohort study which considers all confounders and prognostic factors.

Clinical features and outcomes in young adults with oral tongue cancer

OBJECTIVE

To evaluate outcomes and survival in young patients with oral tongue cancer (OTC).

METHODS

Retrospective chart review of patients aged 18-40 with OTC treated between 2000 and 2016. Tumor characteristics of p16 expression, perineural invasion (PNI), and lymph-vascular invasion (LVI) were evaluated. Recurrence-free (RFS) and overall survival (OS) data were analyzed according to Kaplan-Meier method with univariate analysis.

RESULTS

A total of 23 patients were identified: 12 with early stage disease (ESD, stage I), and 11 with advanced stage disease (ASD, stage III or IV), (17 men and 6 women). Mean age at presentation was 34.5 years (±5 months) and mean follow-up was 46.6 months. For all patients, 5-year RFS was 62% and OS 66%. RFS for ESD was 73% and ASD 25% (log rank p = 0.011). OS for ESD was 100% and ASD 55% (log rank p = 0.012). 22% indicated tobacco use >5 pack-years and 9% heavy alcohol use. Factors associated with worse OS were neck disease (log rank p = 0.073), positive margins (log rank p = 0.001), and LVI (log rank p = 0.002). Factors associated with worse RFS were chemotherapy or radiation therapy prior to surgery (log rank p = 0.002), neck disease (log rank p = 0.047), positive margins (log rank p = 0.039), and PNI (log rank p = 0.001). Expression of p16 was observed in five cases and was not significantly associated with OS or RFS.

CONCLUSION

In young patients with OTC, factors associated with worse outcomes are similar to known predictors in older patients. Expression of p16 was not statistically associated with improved OS. OS in patients with ESD was excellent (100%), and significantly worse for ASD.

Immunohistochemical comparative analysis of lymphatic vessel density and VEGF-C expression in squamous cell carcinomas of the tongue between young and old patients

BACKGROUND

Squamous cell carcinoma (SCC) of the oral cavity is a malignant epithelial tumor that most commonly involves the tongue, and mainly affects men between the fifth and seventh decades of life. This study compared the lymphatic vessel density and VEGF-C expression in SCCs of the tongue between young and old patients.

METHODS

Thirty-four SCCs of the tongue, 17 diagnosed in young patients (≤40y) and 17 diagnosed in old patients (>50y), were evaluated by immunohistochemistry. Lymphatic microdensity was determined based on the number of vessels immunoreactive to anti-D2-40 antibody. The percentage of neoplastic cells exhibiting cytoplasmic staining for VEGF-C was established for each case.

RESULTS

Assessment of intratumoral lymphatic microdensity (ILMD) disclosed a median number of 6.20 lymphatic vessels in young patients and of 6.60 in old patients (p=0.809). Analysis of peritumoral lymphatic microdensity (PLMD) revealed a median number of 3.60 lymphatic vessels in young patients and of 3.40 in old patients (p=0.769). In the tumor core, analysis of the percentage of immunopositive cells for VEGF-C revealed a median number of 95.95% in young patients and of 55.48% in old patients (p<0.001). In the deep invasive front, the median number of immunopositive cells for VEGF-C was 97.93% in young patients and 66.09% in old patients (p<0.001).

CONCLUSIONS

The results of this study suggest that the more aggressive biological behavior of SCC of the tongue in young patients may be related to a higher expression of VEGF-C.

Oral tongue squamous cell carcinoma in young women: a matched comparison-do outcomes justify treatment intensity?

Background. The incidence of oral tongue squamous cell carcinoma (OTSCC) in young women is increasing with uncertain outcomes compared to traditional patients. Published outcomes data are at odds in this cohort of young women. Methods. Retrospective analysis comparing demographic, clinicopathologic, and outcomes data of women OTSCC patients younger than 45 years old matched 1 : 2 by stage with men both younger and older than 45 and women older than 45. Results. No disease-free or overall survival differences were found between cohorts. Young women were significantly more likely to receive radiation therapy, particularly in stage I disease, even when controlling for common pathologic indications. Conclusions. OTSCC in young women was not associated with worse outcomes compared to a matched cohort of other patients. Increased frequency of radiation treatment for this cohort may not be justified.

Oral cavity and oropharyngeal squamous cell carcinoma in young adults: a review of the literature

BACKGROUND

Head and neck squamous cell carcinoma (HNSCC) is a disease of middle-aged to elderly adults. However, an increased incidence of HNSCC in young people under 45 years of age has been reported recently. In the present review, we focused on the epidemiology and aetiology of HNSCC in adults under 45 years of age.

METHODS

We reviewed literature related to HNSCC in adult patients less than 45 years of age and discussed current treatment options and prognosis.

RESULTS

HNSCC in young adults is associated with a higher incidence rate in nonsmokers, lower female-to-male ratio, a higher percentage of oral cavity and oropharynx tumours, and fewer second primary tumours. However, aside from traditional risk factors of tobacco and alcohol exposure, the causes of these cancers in young adults remain unclear. Agents that might contribute to risk include infection with high-risk human papillomavirus subtypes as well as genetic factors or immunodeficiency status. The expected increase in incidence and mortality of the young with HNSCC may become a major public health concern if current trends persist, particularly lifestyle habits that may contribute to this disease.

CONCLUSIONS

Given the younger age and potential long-term adverse sequelae of traditional HNSCC treatments, young adults should be treated on a case-by-case basis and post-therapy quality of life must be considered in any treatment-decision making process.

The effect of epiregulin on epidermal growth factor receptor expression and proliferation of oral squamous cell carcinoma cell lines

Background

Epiregulin (EPR) is a novel member of the epidermal growth factor (EGF) family. It has been shown to promote wound healing in oral epithelium, enhance proliferation of other epithelial tissues, and is involved in several epithelial-related malignancies such as colorectal, lung, and bladder carcinoma. More recently, EPR transcripts were found to be high in a study on archival oral squamous cell carcinoma (OSCC) specimens. This implies that EPR may be responsible for the progression of OSCC. The aim of this was to elucidate the effects of EPR on (i) cell morphological changes, (ii) cell proliferation and (iii) receptor expression of the H-series OSCC cell lines.

Methods

The clinicopathological origin and the expression of the epidermal growth factor receptor (EGFR) and ErbB4 receptors of the H-series cell lines were initially characterised. Based on these parameters, two of the H-series cell lines, namely H103 and H357 were selected for downstream experiments. The cell lines were treated with 1 ng/ml, 10 ng/ml, and 20 ng/ml of EPR for 24 and 48 hours in all subsequent experiments. Untreated cells acted as the control which was used for comparison with each treated group. The cell morphological changes, cell proliferation and receptor expression of the OSCC cell lines were evaluated using phase contrast microscopy, 5-bromo-2’-deoxy-uridine (BrdU) assays and flow cytometry respectively. The results were compared and analysed using the student t-test.

Results

There were no appreciable morphological changes in the cells regardless of the dose of EPR tested nor between the different timelines. There were no significant changes in cell proliferation after EPR treatment. As for the effect of EPR on receptor expression, 20 ng/ml of EPR significantly reduced the density of EGFR expression (p value = 0.049) in the H103 cell line after the 24-hour treatment. No other statistically significant changes were detected.

Conclusions

The results show that EPR had no effect on the morphology and proliferativity of OSCC cells. However, the significant decline in EGFR expression after EPR treatment suggests that EPR might play an important role in the regulation of EGFR expression and hence OSCC progression.