Survival after diagnosis of cancer of the oral cavity

Atypical Case of Highly Mutated h-TERT Promoter in Germline Genome from Buccal Mucosa Cancer

Buccal mucosa cancer has an aggressive nature as it rapidly grows and penetrates with high recurrence rate. Strikingly, carcinoma of buccal mucosa is the most common cancer of oral cavity in India. Recently, telomerase and telomere biology have been implicated in the pathogenesis and progression in various cancers via regulation of telomere maintenance by telomerase expression which is controlled by telomerase reverse transcriptase (TERT) promoter. Strikingly, h-TERT promoter mutations have been incriminated in regulation of telomerase gene expression. Here, we present a 35 years old male with intense coughing, short breathlessness and fever since 15 days, was admitted to the pulmonary unit. He was a chronic smoker and gutka user. The cytopathological analysis of gastric aspirate revealed buccal mucosa carcinoma of IV stage. We identified h-TERT promoter mutations in isolated genomic DNA from whole blood using DNA sequencer. Genetic analysis disclosed that h-TERT promoter region was highly mutated in this patient. Identified mutations include C.-248 del G, C.-272 del G, C.-279 del G, C.-331 del G, C.-349 del G, C.-351 del C, C.-360 G > A, C.-362 T > A, C.-371 del T and C.-372 del T. Further, all identified mutations were subjected to predict the pathologic functional consequences using bioinformatics tools viz TFsitescan and CiiiDER which showed either loss or gain of transcription factors binding sites in h-TERT promoter. This is a unique case in which total 9 mutations were observed in h-TERT promoter in a single case. In conclusion, all together these mutations in h-TERT promoter may alter the epigenetics and subsequently the tenacity of binding transcription factors which are of functional significance.

European-wide forest monitoring substantiate the neccessity for a joint conservation strategy to rescue European ash species (Fraxinus spp.)

European ash (Fraxinus excelsior) and narrow-leafed ash (F. angustifolia) are keystone forest tree species with a broad ecological amplitude and significant economic importance. Besides global warming both species are currently under significant threat by an invasive fungal pathogen that has been spreading progressively throughout the continent for almost three decades. Ash dieback caused by the ascomycete Hymenoscyphus fraxineus is capable of damaging ash trees of all age classes and often ultimately leads to the death of a tree after years of progressively developing crown defoliation. While studies at national and regional level already suggested rapid decline of ash populations as a result of ash dieback, a comprehensive survey at European level with harmonized crown assessment data across countries could shed more light into the population decline from a pan-European perspective and could also pave the way for a new conservation strategy beyond national boarders. Here we present data from the ICP Forests Level I crown condition monitoring from 27 countries resulting in > 36,000 observations. We found a substantial increase in defoliation and mortality over time indicating that crown defoliation has almost doubled during the last three decades. Hotspots of mortality are currently situated in southern Scandinavia and north-eastern Europe. Overall survival probability after nearly 30 years of infection has already reached a critical value of 0.51, but with large differences among regions (0.20–0.86). Both a Cox proportional hazard model as well as an Aalen additive regression model strongly suggest that survival of ash is significantly lower in locations with excessive water regime and which experienced more extreme precipitation events during the last two decades. Our results underpin the necessity for fast governmental action and joint rescue efforts beyond national borders since overall mean defoliation will likely reach 50% as early as 2030 as suggested by time series forecasting.

DMP-1 promoter-associated antisense strand non-coding RNA, panRNA-DMP-1, physically associates with EGFR to repress EGF-induced squamous cell carcinoma migration

Accumulating evidence suggests that specific non-coding RNAs exist in many types of malignant tissues, and are involved in cancer invasion and metastasis. However, little is known about the precise roles of non-coding RNAs in squamous cell carcinoma (SQCC) invasion and migration. Recently, the dentin matrix protein-1 (DMP-1) gene locus was identified as a transcriptionally active site in squamous cell carcinoma (SQCC) tissue and cells. However, it is unclear whether RNA associated with cell migration exist at the DMP-1 gene locus in SQCC cells. We identified a novel promoter-associated non-coding RNA in the antisense strand of DMP-1 gene locus, promoter-associated non-coding RNA (panRNA)-DMP-1, by the RACE method in SQCC cells and tissues, and characterized the functions of panRNA-DMP-1 in EGF-driven SQCC cell migration. The inhibition of endogenous panRNA-DMP-1 expression by specific siRNAs and exogenous over-expression of panRNA-DMP-1 resulted in increased and suppressed cellular migration toward EGF in SQCC cells, respectively, and nuclear expression of panRNA-DMP-1 was induced by EGF stimulation. Mechanistically, suppression of panRNA-DMP-1 expression increased EGFR nuclear localization upon EGF treatment and nuclear panRNA-DMP-1 physically interacted with EGFR, which was confirmed by RNA immunoprecipitation assay using a bacteriophage-delivered PP7 RNA labeling system. Furthermore, co-immunoprecipitation assay revealed that suppression of panRNA-DMP-1 stabilized EGFR interaction with STAT3, a known co-transcription factors of EGFR, to induce migratory properties in many cancer cells. Based on these findings, panRNA-DMP-1 is an EGFR-associating RNA that inhibits the EGF-induced migratory properties of SQCC possibly by regulating EGFR nuclear localization and EGFR binding to STAT3.

Artificial intelligence in dentistry: Harnessing big data to predict oral cancer survival

BACKGROUND

Oral cancer is the sixth most prevalent cancer worldwide. Public knowledge in oral cancer risk factors and survival is limited.

AIM

To come up with machine learning (ML) algorithms to predict the length of survival for individuals diagnosed with oral cancer, and to explore the most important factors that were responsible for shortening or lengthening oral cancer survival.

METHODS

We used the Surveillance, Epidemiology, and End Results database from the years 1975 to 2016 that consisted of a total of 257880 cases and 94 variables. Four ML techniques in the area of artificial intelligence were applied for model training and validation. Model accuracy was evaluated using mean absolute error (MAE), mean squared error (MSE), root mean squared error (RMSE), R² and adjusted R².

RESULTS

The most important factors predictive of oral cancer survival time were age at diagnosis, primary cancer site, tumor size and year of diagnosis. Year of diagnosis referred to the year when the tumor was first diagnosed, implying that individuals with tumors that were diagnosed in the modern era tend to have longer survival than those diagnosed in the past. The extreme gradient boosting ML algorithms showed the best performance, with the MAE equaled to 13.55, MSE 486.55 and RMSE 22.06.

CONCLUSION

Using artificial intelligence, we developed a tool that can be used for oral cancer survival prediction and for medical-decision making. The finding relating to the year of diagnosis represented an important new discovery in the literature. The results of this study have implications for cancer prevention and education for the public.

Prognostic significance of pre-treatment serum Cyfra21-1 as a tumor marker in patients with oropharyngeal squamous cell carcinoma treated with concurrent chemoradiotherapy

Background

Oropharyngeal squamous cell carcinoma (OPSCC) is a kind of squamous cell carcinoma of head and neck, and its incidence is on the rise in recent years. A variety of prognostic markers for OPSCC have been reported in many studies, but they are expensive or difficult to obtain. So, we retrospectively studied the prognostic significance of cytokeratin 19 soluble fragment (Cyfra21-1) in patients with OPSCC, in order to provide theoretical basis for accurate prognosis assessment.

Methods

A retrospective analysis of the clinicopathological data of 85 OPSCC patients with concurrent radiotherapy and chemotherapy (CRT) admitted from January 2010 to June 2017. Serum Cyfra21-1 levels were measured before treatment. Analyze the relationship between Cyfra21-1 and clinical pathological characteristics of patients. The receiver operating characteristic (ROC) curve was used to calculate the cut-off value of Cyfra21-1. The Cox proportional hazard model was used to conduct univariate and multivariate analysis of related prognostic factors, and to determine the factors related to overall survival (OS) and progression-free survival (PFS).

Results

The cutoff value for Cyfra21-1 was 2.93 ng/mL. The baseline data of patients in different Cyfra21-1 groups were balanced and comparable. In the univariate and multivariate analyses, it was found that Cyfra21-1 was associated with OS and PFS. A measurement of Cyfra21-1 ≥2.93 ng/mL indicated poor OS (P<0.001) and PFS (P=0.001). After adjusting for age and disease stage, Cyfra21-1 can independently affect the OS (HR =3.57, 95% CI: 1.60-7.99, P=0.002) and PFS (HR =2.89, 95% CI: 1.41-5.91, P=0.004) of patients with OPSCC treated with CRT.

Conclusions

Pre-treatment Cyfra21-1 can be used as a prognostic marker for patients with OPSCC treated with CRT, which has important clinical significance.

Diverse spectral band-based deep residual network for tongue squamous cell carcinoma classification using fiber optic Raman spectroscopy

The research is to propose a new classification framework, called diverse spectral band-based deep residual network (DSB-ResNet), which can distinguish tongue squamous cell carcinoma (TSCC) from non-cancerous tissue. A fiber optic Raman spectroscopy system is used to collect Raman spectral data of TSCC and normal tissues. DSB-ResNet takes advantage of diverse spectral band-based spectra without processing to derive spectral representations from different spectral bands of Raman spectra, which improves the ability to identify TSCC. To show the superiority of the proposed method, the existing methods are used as the competitive methods to compare with the DSB-RestNet, the results demonstrate our method has the highest performance with 97.38 %, 98.75 %, and 98.25 % for sensitivity, specificity, and accuracy, respectively. The experimental results show that the DSB-ResNet is able to distinguish TSCC from non-cancerous tissue successfully. The proposed method is expected to provide a theoretical and methodological base for accurate detection of TSCC.

Impact of age and comorbidity on survival among patients with oral cavity squamous cell carcinoma

OBJECTIVE

To identify predictors of overall survival (OS) and to stratify patients according to significant prognostic variables.

METHODS

A retrospective study of 274 consecutive patients with primary Oral Cavity Squamous Cell Carcinoma. Kaplan-Meier, Cox proportional hazard models, and recursive partitioning analysis (RPA) were used for analysis of OS. These results were further validated using National Cancer Database cohort of 21 895 patients.

RESULTS

Median OS was 3.65 years. T-classification and N-classification, alcoholic beverages/week, age, and adjuvant treatment were significant predictors of OS. RPA identified high-risk subpopulations: N0-1 patients with CCI ≥ 4.5 and N2-3 patients ordered by those not receiving adjuvant treatment, those with T3-4 disease despite adjuvant therapy, and those having T1-2 disease with adjuvant therapy.

CONCLUSIONS

This study utilized significant prognostic indicators and RPA to highlight the importance of age, N-classification, T-classification, comorbidity, and adjuvant therapy in conjunction with American Joint Committee on Cancer staging to improve preoperative counseling.

Long non-coding RNA SLC16A1-AS1: its multiple tumorigenesis features and regulatory role in cell cycle in oral squamous cell carcinoma

Altered expressions of long non-coding RNAs (lncRNAs) are potential cancer prognostic biomarkers that play a critical role in the development of tumorigenesis and metastasis of cancer. However, the relationship between the expression of lncRNAs in oral squamous cell carcinoma (OSCC) and the diagnosis, progression, and prognosis of OSCC has not been thoroughly elucidated. To identify the differentially expressed lncRNAs between OSCC tissue and normal tissue, RNA-Seq data were used. lncRNA SLC16A1-AS1 was significantly highly expressed in OSCC samples than that in normal samples. Systematic bioinformatics analysis revealed that SLC16A1-AS1 was associated with histological tumor grades and overall survival status, as well as copy number variation, somatic mutation, tumor mutation burden, tumor stemness, tumor microenvironment and infiltrating immune cells. According to three advanced bioinformatic algorithms prediction (WGCNA, GSEA and GSVA), SLC16A1-AS1 played an essential role in OSCC proliferation and its biological function was related to cell-cycle regulation. Loss-of-function experiments were performed to determine the biological functions of SLC16A1-AS in OSCC cells. Silencing SLC16A1-AS1 significantly reduced the cell proliferation rate and colony-forming ability in both CAL27 and SCC25 cell lines. Flow cytometry and western blot analysis revealed that SLC16A1-AS1 silencing induced G0/G1 cell cycle arrest and inhibited the expression of cyclin D1 in both CAL27 and SCC25 cells. In conclusion, our study comprehensively investigated the role of the lncRNA SLC16A1-AS1 in OSCC growth and proved that it may serve as a new diagnostic indicator and a new target for the treatment of OSCC.

The economic burden of oral cancer in Iran

BACKGROUND

Cancer is one of the leading causes of death in the world, among which, oral cancer is associated with significant morbidity, and low survival. A large part of the budget allocated to health care is attributed to cancer. In this study we aim to estimate the economic burden of oral cancer in Iran for the year 2014.

METHODS

In this study, we generated a prevalence-based estimate of the cost-of-illness of oral cancer in Iran. A societal perspective was used for this study, in which the direct costs and productivity losses of oral cancer cases in 2014 were estimated. The human capital approach was adopted for estimating productivity losses. Several data sources contributed to this study, including national cancer registry reports, hospital records, occupational data, and interviews with experts.

RESULT

Nearly 53% of patients were diagnosed in an advanced stage of oral cancer. The economic burden of oral cancer was $64,245,173 most of which (50%) was attributed to productivity losses. The direct medical cost accounted for 42% of the estimated total cost. Treatment expenses for advanced stages were five times higher than the early stages ($10,532 vs. $2,225).

CONCLUSION

The economic burden of oral cancer is high in Iran. Planning an early detection and screening program for oral cancer may potentially decrease health care costs, morbidity, and mortality.

Comparative efficacy of chemiluminescence and toluidine blue in the detection of potentially malignant and malignant disorders of the oral cavity

Context:

Early detection of oral cancer is of paramount importance in determining the prognosis of oral cancer. Literature suggests that several diagnostic modalities have been proposed to aid a clinician in early detection of oral cancer without much conclusive evidence.

Aims:

The present study aims to compare toluidine blue and chemiluminescence screening methods in early detection of carcinoma in North Indian population and also to evaluate these methods with histopathological diagnosis.

Methods:

In this prospective study, 42 patients with clinically visible premalignant lesions were included. Demographic data were collected, and suspicious lesions were examined by chemiluminescence light (Vizilite) and followed by local application of toluidine blue (Mashberg's recommendation). Findings were recorded for each lesion under standard incandescent light as positive or negative. Biopsy and histopathological analysis of the tissues were performed.

Statistical Analysis:

Sensitivity, specificity and positive and negative predictive values for the chemiluminescence technique and toluidine blue were calculated for diagnostic tests.

Results and Conclusions:

In the present study, toluidine blue test was found to be moderately sensitive (63.33%) whereas chemiluminescence test (Vizilite) was found to be highly sensitive (90%); however, the test has limited specificity (50%). Thus, the study concluded that both toluidine blue and Vizilite can be used as an adjunct to simple, conventional visual examination and in screening procedure for oral potentially malignant disorders.

Genome-wide identification of chromatin-enriched RNA reveals that unspliced dentin matrix protein-1 mRNA regulates cell proliferation in squamous cell carcinoma

Chromatin-enriched noncoding RNAs (ncRNAs) have emerged as key molecules in epigenetic processes by interacting with chromatin-associated proteins. Recently, protein-coding mRNA genes have been reported to be chromatin-tethered, similar with ncRNA. However, very little is known about whether chromatin-enriched mRNA is involved in the chromatin modification process. Here, we comprehensively examined chromatin-enriched RNA in squamous cell carcinoma (SQCC) cells by RNA subcellular localization analysis, which was a combination of RNA fractionation and RNA-seq. We identified 11 mRNAs as highly chromatin-enriched RNAs. Among these, we focused on the dentin matrix protein-1 (DMP-1) gene because its expression in SQCC cells has not been reported. Furthermore, we clarified that DMP-1 mRNA was retained in chromatin in its unspliced form in SQCC in vitro and in vivo. As the inhibition of the unspliced DMP-1 mRNA (unspDMP-1) expression resulted in decreased cellular proliferation in SQCC cells, we performed ChIP-qPCR to identify cell cycle-related genes whose expression was epigenetically modified by unspDMP-1, and found that the CDKN1B promoter became active in SQCC cells by inhibiting unspDMP-1 expression. This result was further validated by the increased CDKN1B gene expression in the cells treated with siRNA for unspDMP-1 and by restoration of the decreased cellular proliferation rate by simultaneously inhibiting CDKN1B expression in SQCC cells. Further, to examine whether unspDMP-1 was able to associate with the CDKN1B promoter region, SQCC cells stably expressing PP7-mCherry fusion protein were transiently transfected with the unspDMP-1 fused to 24 repeats of the PP7 RNA stem loop (unspDMP-1-24xPP7) and we found that unspDMP-1-24xPP7 was efficiently precipitated with the antibody against mCherry and was significantly enriched in the CDKN1B promoter region. Thus, unspDMP-1 is a novel chromatin-enriched RNA that epigenetically regulates cellular proliferation of SQCC.

Adjuvant high-dose-rate brachytherapy in the management of oral cavity cancers: 5 years of experience in Iran

Purpose

Brachytherapy is a cost-effective method for the management of oral cavity cancers in low to middle income countries. We aimed to evaluate the clinical outcomes of high-dose-rate interstitial brachytherapy (HDR-IBT) in patients with oral cavity cancer.

Material and methods

From 2009 to 2013, 78 patients (49 combined external beam radiotherapy [EBRT] plus IBT and 29 IBT monotherapy) with oral cavity cancers had been treated in our center. Slightly more than half the patients were male, and the median age was 54 years. The treatment was planned based on the Paris system. The main outcomes were disease-free and overall survival.

Results

The median follow-up duration was 36.5 months (range, 1.17-54.23). The actuarial four-year overall and disease-free survival rates were 83% and 65%, respectively. The local and locoregional control was achieved among 89.74% and 87.17% of patients, respectively. None of the factors including tumor size, node status, gender, and radiation modality (IBT alone vs. IBT + EBRT) had a significant statistical correlation to the local control rate. All the patients tolerated the planned treatment in the IBT alone group. Late complications included a case of trismus and three cases of catheter insertion site fibrosis.

Conclusions

HDR-IBT as a monotherapy or in combination with EBRT is an appropriate option for the management of oral cavity squamous cell carcinomas, and supports the improvement in treatment outcomes and toxicity profiles in adjuvant settings.

Activin B Regulates Adhesion, Invasiveness, and Migratory Activities in Oral Cancer: a Potential Biomarker for Metastasis

Activin B, a homodimer of inhibin beta b (INHBB), is a multifunctional cytokine belonging to the transforming growth factor-β (TGF-β) family. However, the molecular functions and clinical relevance of activin B have not been determined in oral cancer. We investigated the critical roles of activin B in oral squamous cell carcinoma (OSCC). We performed quantitative reverse transcriptase-polymerase chain reaction, Western blotting, and immunohistochemistry to study INHBB expression in OSCC-derived cell lines and OSCC clinical samples. The INHBB expression levels were significantly (P < 0.05) overexpressed in OSCCs compared to normal counterparts in vitro and in vivo. Activin B-positivity in OSCC cases was significantly (P < 0.05) correlated with regional lymph node metastasis. The INHBB knockdown (shINHBB) cells promoted cellular adhesion and suppression of cellular invasiveness and migration. After treatment of shINHBB cells with activin B, those activities were restored similar to the shMock cells. In the processes of invasiveness and metastasis, the cells cause epithelial-mesenchymal transition (EMT). TGF-β and its family members are promoters of the EMT process. To investigate whether activin B is related to EMT, we examined the expressions of EMT-related genes and found that INHBB was related closely to EMT. Our results suggested for the first time that activin B indicates tumoral metastasis in OSCCs and might be a useful biomarker for OSCC metastasis.

Oral Cancer: Awareness and Knowledge Among Dental Patients in Riyadh

More than 50 % of oral cancer cases are diagnosed at advanced stages. Public knowledge about oral cancer can help in prevention and early detection of the disease. The aim of the present study was to assess the levels of awareness and knowledge about signs and risk factors of oral cancer among dental patients in Saudi Arabia. A self-administered questionnaire was used to collect information from 1410 randomly selected patients attending dental departments within public hospitals in Riyadh, Saudi Arabia. The collected data were analyzed using SPSS software. The significance level was set at P < 0.05. The study revealed that only 62.4 % were aware of oral cancer. Some 68.2 and 56.5 %, respectively, were able to correctly identify tobacco and alcohol as risk factors. More than two thirds of subjects had no knowledge about any signs of oral cancer. Participants with lower than university education were significantly less aware, and had much less knowledge, of the signs and risk factors of oral cancer. The knowledge regarding oral cancer among Saudi dental patients is alarmingly low. Interventions to improve public knowledge about oral cancer and attitudes towards early diagnosis and treatment are urgently indicated.

Intraoperative assessment of laryngeal pathologies with optical coherence tomography integrated into a surgical microscope

OBJECTIVE

Endoscopic examination followed by tissue biopsy is the gold standard in the evaluation of lesions of the upper aerodigestive tract. However, it can be difficult to distinguish between healthy mucosa, dysplasia, and invasive carcinoma. Optical coherence tomography (OCT) is a non-invasive technique which acquires high-resolution, cross-sectional images of tissue in vivo. Integrated into a surgical microscope, it allows the intraoperative evaluation of lesions simultaneously with microscopic visualization.

STUDY DESIGN

In a prospective case series, we evaluated the use of OCT integrated into a surgical microscope during microlaryngoscopy to help differentiating various laryngeal pathologies.

METHODS

33 patients with laryngeal pathologies were examined with an OCT- microscope (OPMedT iOCT-camera, HS Hi-R 1000G-microscope, Haag-Streit Surgical GmbH, Wedel, Germany) during microlaryngoscopy. The suspected intraoperative diagnoses were compared to the histopathological reports of subsequent tissue biopsies.

RESULTS

Hands-free non-contact OCT revealed high-resolution images of the larynx with a varying penetration depth of up to 1.2 mm and an average of 0.6 mm. Picture quality was variable. OCT showed disorders of horizontal tissue layering in dysplasias with a disruption of the basement membrane in carcinomas. When comparing the suspected diagnosis during OCT-supported microlaryngoscopy with histology, 79% of the laryngeal lesions could be correctly identified. Premalignant lesions were difficult to diagnose and falsely classified as carcinoma.

CONCLUSION

OCT integrated into a surgical microscope seems to be a promising adjunct tool to discriminate pathologies of the upper aerodigestive tract intraoperatively. However, picture quality and penetration depth were variable. Although premalignant lesions were difficult to diagnose, the system proved overall helpful for the intraoperative discrimination of benign and malignant tumors. Further studies will be necessary to define its value in the future. Lasers Surg. Med. 49:490-497, 2017. © 2017 Wiley Periodicals, Inc.

Gene expression patterns through oral squamous cell carcinoma development: PD-L1 expression in primary tumor and circulating tumor cells

Oral squamous cell carcinoma (OSCC) is the most common tumor of the oral cavity and has been associated with poor prognosis. Scarce prognostic markers are available for guiding treatment and/or sub-classifying patients. This study aims to identify biomarkers by searching for genes whose expression is increased or decreased during tumor progression (through T1 to T4 stages). Thirty-six samples from all tumor size stages (from T1 to T4) were analyzed using cDNA microarrays. Selected targets were analyzed by immunohistochemistry and in circulating tumor cells by immunofluorescence and Nanostring. Correlation was shown between PD-L1 and tumor size and lymph node metastasis, HOXB9 and tumor size, BLNK and perineural invasion, and between ZNF813 and perineural invasion. PD-L1 positivity was an independent prognostic factor in this cohort (p = 0.044, HH = 0.426). In CTCs from patients with locally advanced OSCC, we found a strong cytoplasmatic expression of PD-L1. PD-L1 is a ligand of PD-1 and is believed to limit T cell activity in inflammatory responses and limit autoimmune diseases. We demonstrated an important role for PD-L1 in primary tumors according to tumor size, and in disease specific survival. Therefore, we could further determine individuals with PD-L1+ CTCs, and possibly follow treatment using CTCs.

Diagnostic values of serum tumor markers Cyfra21-1, SCCAg, ferritin, CEA, CA19-9, and AFP in oral/oropharyngeal squamous cell carcinoma

Background

At present, the research on serum tumor markers in the early diagnosis of malignant tumors has aroused widespread concern. The aim of this study was to investigate the diagnostic values of serum tumor markers cytokeratin 19 fragment (Cyfra21-1), squamous cell carcinoma antigen (SCCAg), ferritin, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and α-fetoprotein (AFP) for patients with oral/oropharyngeal squamous carcinoma (OSCC/OPSCC).

Methods

One hundred and sixty-nine cases of patients with OSCC/OPSCC as the experimental group, 86 cases of oral benign tumor patients as the control group, and 30 cases of healthy people as the normal control group were studied. The levels of serum Cyfra21-1, SCCAg, ferritin, CEA, CA19-9, and AFP were measured using electrochemiluminescence immunoassay.

Results

The levels of serum Cyfra21-1, SCCAg, ferritin, and CEA in patients with OSCC/OPSCC were significantly higher than those of benign tumor and healthy control group (P<0.05). The levels of CA19-9 and AFP showed no significant difference between patients with OSCC/OPSCC, benign tumor, and healthy group (P>0.05). The level of serum Cyfra21-1 in patients with early OSCC/OPSCC (stage I + II) was significantly higher than that of benign tumor and healthy control group (P<0.05). However, the levels of serum SCCAg, ferritin, CEA, CA19-9, and AFP showed no significant difference between patients with early OSCC/OPSCC, benign tumor, and healthy control group (P>0.05). The levels of serum Cyfra21-1, SCCAg, ferritin, and CEA in the middle-late stage of patients with OSCC/OPSCC (stage III + IV) were significantly higher than those of patients with the early OSCC/OPSCC, benign tumor, and healthy control group (P<0.05). The diagnostic cutoff levels of Cyfra21-1, SCCAg, ferritin, and CEA were 2.17, 0.72, 109.95, and 1.99 ng/mL, respectively. The sensitivities were 60.36%, 73.37%, 81.66%, and 66.27%, respectively. The specificities were 81.03%, 68.10%, 40.52%, and 61.21%, respectively.

Conclusion

Cyfra21-1, SCCAg, ferritin, and CEA had diagnostic values for patients with OSCC/OPSCC. Meanwhile, Cyfra21-1 had better early diagnostic value for patients with OSCC/OPSCC.

Piperlongumine Suppresses Proliferation of Human Oral Squamous Cell Carcinoma through Cell Cycle Arrest, Apoptosis and Senescence

Oral squamous cell carcinoma (OSCC), an aggressive cancer originating in the oral cavity, is one of the leading causes of cancer deaths in males worldwide. This study investigated the antitumor activity and mechanisms of piperlongumine (PL), a natural compound isolated from Piper longum L., in human OSCC cells. The effects of PL on cell proliferation, the cell cycle, apoptosis, senescence and reactive oxygen species (ROS) levels in human OSCC cells were investigated. PL effectively inhibited cell growth, caused cell cycle arrest and induced apoptosis and senescence in OSCC cells. Moreover, PL-mediated anti-human OSCC behavior was inhibited by an ROS scavenger N-acetyl-l-cysteine (NAC) treatment, suggesting that regulation of ROS was involved in the mechanism of the anticancer activity of PL. These findings suggest that PL suppresses tumor growth by regulating the cell cycle and inducing apoptosis and senescence and is a potential chemotherapy agent for human OSCC cells.

The Effect of Radiotherapy on Ultrasound-Guided Fine Needle Aspiration Biopsy and the Ultrasound Characteristics of Neck Lymph Nodes in Oral Cancer Patients after Primary Treatment

Objectives

To investigate the effect of radiotherapy (RT) on ultrasound-guided fine needle aspiration (USgFNA) and sonographic characteristics in the assessment of cervical lymph nodes (LNs) in oral squamous cell carcinoma (OSCC) patients after primary treatment.

Materials and Methods

88 treated OSCC patients underwent 111 USgFNAs of the neck LNs after US evaluation. Among them, 48 USgFNAs were performed on 40 patients following RT and 63 USgFNAs on 48 patients without previous RT. The results of USgFNA and the US characteristics were compared between these two groups.

Results

USgFNA had a sensitivity of 88.0%, specificity of 91.4%, positive predictive value (PPV) of 88.0%, negative predictive value (NPV) of 91.4% and accuracy of 90.0% in patients without previous RT, and a sensitivity of 97.1%, specificity of 83.3%, PPV of 94.3%, NPV of 90.9% and accuracy of 93.5% in those with previous neck RT. The ranges of the short-axis and long-axis length were 13.3 ± 8.0 mm (mean ± SD) versus 17.8 ± 9.1 mm, and 18.6 ± 9.0 mm versus 24.4 ± 10.9 mm for recurrent LNs from patients with, versus without, previous RT (both ps < 0.05), respectively. 76.5% (26/34) of the recurrent nodes after RT and 48% (12/25) of the recurrent nodes without previous RT exhibited an irregular margin (p < 0.05). Additionally, irradiated recurrent LNs had a significantly decreased percentage of discernable calcification compared with non-irradiated recurrent nodes (48% versus 20.6%, p < 0.05).

Conclusions

RT had influence on sonographic characteristics but no influence on USgFNA in diagnosing recurrent LNs in treated OSCC patients.

Oral Cancer Knowledge and Practice among Dental Patients and their Attitude Towards Tobacco Cessation in Iran

BACKGROUND

One of the main causes of delay in diagnosis of oral cancer is lack of awareness about aetiology and symptoms among the general population. The aim of this study was to assess the knowledge and practice of patients regarding oral cancer and their attitude towards tobacco cessation.

MATERIALS AND METHODS

This study was carried out in Isfahan-Iran in 2014. A 29-item self-administrated questionnaire was designed and piloted and distributed to patients attending dental clinics. Questions were focused on awareness about oral cancer risk factors, signs and symptoms, places in the mouth which are more susceptible and attitude toward tobacco cessation. Chi-square, T-test, ANOVA and logistic regression tests were used for statistical analysis.

RESULTS

A total of 546 valid completed questionnaires were obtained. The mean knowledge score of patients was 4.1(±2.7) out of 13. Some 80% of patients did not know about early manifestations of oral cancer. Only 18% knew the most likely sites of oral cancer. Only 43.1% and 65.2% of patients reported alcohol and tobacco consumption as the main risk factors but they had a fair knowledge about other risk factors. There was no significant difference in Knowledge level between patients regarding their sex, educational levels and age. Most patents (90%) expected their dentists to warn them about the harmful effects of smoking and showed willingness to quit if recommended.

CONCLUSIONS

Knowledge about oral cancer was found to be quite low. It seems necessary to increase the level of public awareness using educational programs with cooperation of dentists in tobacco cessation programs.

Epidemiology of oral cancer in Asia in the past decade--an update (2000-2012)

The prevalence of oral cancers (OC) is high in Asian countries, especially in South and Southeast Asia. Asian distinct cultural practices such as betel-quid chewing, and varying patterns of tobacco and alcohol use are important risk factors that predispose to cancer of the oral cavity. The aim of this review is to provide an update on epidemiology of OC between 2000 and 2012. A literature search for this review was conducted on Medline for articles on OC from Asian countries. Some of the articles were also hand searched using Google. High incidence rates were reported from developing nations like India, Pakistan, Bangladesh, Taiwan and Sri Lanka. While an increasing trend has been observed in Pakistan, Taiwan and Thailand, a decreasing trend is seen in Philippines and Sri Lanka. The mean age of occurrence of cancer in different parts of oral cavity is usually between 51-55 years in most countries. The tongue is the leading site among oral cancers in India. The next most common sites in Asian countries include the buccal mucosa and gingiva. The 5 year survival rate has been low for OC, despite improvements in diagnosis and treatment. Tobacco chewing, smoking and alcohol are the main reasons for the increasing incidence rates. Low socioeconomic status and diet low in nutritional value lacking vegetables and fruits contribute towards the risk. In addition, viral infections, such as HPV and poor oral hygiene, are other important risk factors. Hence, it is important to control OC by screening for early diagnosis and controlling tobacco and alcohol use. It is also necessary to have cancer surveillance at the national-level to collect and utilise data for cancer prevention and control programs.

BRCA1 and γH2AX as independent prognostic markers in oral squamous cell carcinoma

Oral squamous cell carcinomas (OSCC) are believed to originate from sequential mutations that can develop as a consequence of genetic instability acquired over time. BRCA1 are linked to DNA recombination and repair processes, being of importance for its role in regulation of RAD51 and H2AX (γH2AX). The aim of this study was to investigate the relationship between BRCA1 expression status and evaluate its prognostic impact. We selected from 150 OSCC patients, and evaluated BRCA1 expression in OSCC by immunohistochemistry and qRT-PCR, comparing its expression with homologous recombination markers (RAD51, γH2AX and p53), clinicopathological and survival data. Expression of BRCA1 was observed in 61 cases (43.88%) and was related to tumor size (T stage) (p=0.001), and gender (p=0.017). mRNA from BRCA1 showed a borderline relationship with perineural invasion (p=0.053). BRCA1 [p=0.030; HR: 2.334 (C.I.: 1.087-5.012)], γH2AX [p=0.045; HR: 0.467 (C.I.: 0.222-0.628)] and gender [p=0.001; HR: 10.386 [(C.I.: 2.679-10.623)] were independent prognostic factors for DSS. BRCA1 and γH2AX expression by OSCC cells are associated with reduced overall survival time, independent of other variables in patients, as well as gender, and our findings shed some light about DSB markers in OSCC and its role as prognostic factors.

A clinical-pathological and survival study of oral squamous cell carcinomas from a population of the North of Portugal

OBJECTIVES

Our aim was to analyze the clinical, pathological, and outcome characteristics of oral squamous cell carcinomas (OSCC) from a population of the North of Portugal.

MATERIAL AND METHODS

We conducted a descriptive study of 128 OSCC diagnosed between the years of 2000 and 2010 in the Centro Hospitalar do Porto. Through of the review of the clinical records we studied several clinical, pathological, and outcome variables. The overall survival (OS) and disease-free survival (DFS) were analyzed by Kaplan-Meier method and log-rank test. Cox regression method was used for multivariate analysis.

RESULTS

Of 128 patients with OSCC, 83 (64.8%) were male and 45 (35.2%) were female, (mean age of 62.13±15.57 years). The most affected location was the tongue (n=52; 40.6%). The most common cause of reference was a non-healing ulcer (n=35; 28.9%) followed by oral pain (n=27; 22.3%). Sixty (60.6%) patients were tobacco consumers and 55 (57.3%) alcohol consumers. The cumulative 3-years OS rate was 58.6% and DFS was 55.4%. In multivariable analysis for OS, we found an adverse independent prognostic value for advanced tumour size (p<0.001) and for the presence of perineural permeation (p=0.012). For DFS, advanced stage tumours presented adverse independent prognostic value (p<0.001).

CONCLUSION

OSCC occurred most frequently in males, in older patients, and in patients with tobacco and/or alcohol habits. TNM and tumour stage additionally to the perineural permeation were the most important prognostic factor for the survival of these patients, contributing to identify high-risk subgroups and to guide therapy.

CD44+/CD133+ immunophenotype and matrix metalloproteinase-9: Influence on prognosis in early-stage oral squamous cell carcinoma

BACKGROUND

The purpose of this study was to investigate the expression of CD44 and/or CD133 immunophenotypes and the associated effects of matrix metalloproteinase-9 (MMP-9) in early-stage oral squamous cell carcinomas (SCC) to assess their influence on tumor prognosis.

METHODS

The following data were derived from 150 patients: age, sex, primary anatomic site, smoking status, alcohol intake, recurrence, metastases, histological classification, treatment, disease-free survival (DFS), and overall survival (OS). Immunohistochemical study of CD44, CD133, and MMP-9 expression was performed on a tissue microarray of 150 paraffin blocks of oral SCCs.

RESULTS

The predominant immunophenotype identified to exhibit a significant correlation with MMP-9 was the CD44+/CD133+. Multivariate analyses identified a significant correlation of OS with surgical treatment and with CD44+/CD133+ immunophenotype.

CONCLUSION

This investigation demonstrated the prognostic importance of CD44/CD133 expression, which can help improve the prognostic value of surgical treatment for oral SCCs when diagnosed in early stages.

Dentists' knowledge, attitude, and practice regarding oral cancer in Iran

Dentists are usually the first group who can examine patients for oral cancer and the early diagnosis highly depends on their knowledge. In this study, we aim to survey the Iranian dentists' knowledge, attitude, and behaviors regarding oral cancer. A valid and reliable self-administered questionnaire was designed and sent to 150 dentists. Responses to the questionnaires were analyzed using descriptive and analytical statistics. Just one fifth of the dentists reported to perform oral cancer examination for all of their patients in age of 40 and above and about 34 % of them were knowledgeable. They mostly claimed that the lack of knowledge is the main barriers to the provision of routine oral cancer examinations. The opinion of dentists about the effectiveness of continuing education courses supports the development of these courses on oral cancer. Besides, more emphasis should be placed on oral cancer prevention in dental schools.

Salivary basic fibroblast growth factor in patients with oral squamous cell carcinoma or oral lichen planus

OBJECTIVE

The objective of this study was to gather preliminary data concerning the feasibility of using salivary basic fibroblast growth factor (bFGF) for detecting development of oral squamous cell carcinoma (OSCC) in patients with oral lichen planus (OLP), and in patients with OSCC whose disease was in remission.

STUDY DESIGN

Saliva samples were collected from 5 patient groups: patients with newly diagnosed OSCC, patients with OSCC whose disease was in remission, patients with OLP in disease-active state, patients with OLP in disease-inactive state, and healthy controls. Salivary bFGF levels were determined by enzyme-linked immunosorbent assay, and data were analyzed using the Mann-Whitney U test.

RESULTS

Salivary bFGF levels were significantly elevated in patients with newly diagnosed OSCC compared with patients with OSCC in remission, patients with disease-active OLP, and healthy controls. No significant difference was found between patients with newly diagnosed OSCC and patients with disease-inactive OLP.

CONCLUSIONS

Our results suggested that salivary bFGF might be a potential biomarker for detecting OSCC development in patients with OSCC in remission, but not in patients with OLP.

Impact of epidermal growth factor receptor, mesenchymal-epithelial transition factor, and insulin-like growth factor receptor 1 expression on survival of patients with oral and oropharyngeal cancer

The aim of this study was to evaluate the impact of expression of epidermal growth factor receptor (EGFR), mesenchymal-epithelial transition factor (c-Met), and insulin-like growth factor receptor 1 (IGF-1R) protein on response to treatment and survival in patients with oral and oropharyngeal squamous cell carcinoma (SCC). EGFR, c-Met, and IGF-1R immunohistochemical (IHC) scores were generated based on the incidence and intensity of expression of the biomarkers evaluated in paraffin-embedded sections of biopsy specimens taken before treatment from 113 patients given neoadjuvant chemoradiotherapy followed by resection for primary locally advanced oral and oropharyngeal SCC. Correlations were assessed between the IHC of the biomarkers and the patients' clinicopathological variables using Spearman's rank test. Cox's regression models were used to evaluate the impact of EGFR, c-Met, and IGF-1R, expression on survival. Almost all the patients showed expression of EGFR, c-Met, and IGF-1R (99%, 100%, and 100%, respectively). None of the biomarkers examined predicted response to neoadjuvant chemoradiotherapy or were associated with survival. In multivariate analysis, age (p=0.05), alcohol consumption (p=0.03), and pathological size/extent of the primary tumour after neoadjuvant treatment (ypT) status (p=0.009) were significantly associated with recurrence-free survival. Age (p=0.02) and alcohol consumption (p=0.02) were independently associated with overall survival. Although none of the biomarkers evaluated could be used as prognostic indicators, their common expression suggested a strong rationale for targeting EGFR, c-Met, and IGF-1R in the treatment of oral and oropharyngeal SCC.

Trends in incidence, tumour sites and tumour stages of oral and pharyngeal cancer in Northern Germany

PURPOSE

Oral and pharyngeal cancer is the seventh leading tumour in Europe. In Germany, more than 10,000 new cancer cases are diagnosed each year. This population-based project evaluated the available data to develop a more detailed epidemiological profile of oral and pharyngeal cancer.

METHODS

The data on incidence and mortality rates of the population-based Cancer Registry of Schleswig-Holstein were evaluated according to tumour sites, tumour stages and residential areas by age groups and gender from 2000 to 2006 and the tumour stages from 2000 to 2007.

RESULTS

From 2000 to 2006, 3,127 new cases of oral and pharyngeal cancer (72% in men vs. 28% in women) were registered. About 50% of all cases, in men and women, were between 60 and 79 years. This detailed analysis of tumour sites and tumour stages showed interesting differences and revealed considerable variations. The highest incidence rates for both men and women were diagnosed in stage IV for older people, in women for oral cancer and men for pharyngeal cancer. The highest incidence and mortality trends were observed in urban areas.

CONCLUSIONS

Detailed population-based results described important variations with regard to tumour sites, stages and areas. These data play a central role as they provide the epidemiological profile of a tumour. This profile, together with possible targeted knowledge evaluations of the public and the health care providers involved, can be used as a prerequisite for health care activities and for the development of preventive strategies for targeted public awareness campaigns.

Squamous cell carcinoma of the tongue and floor of the mouth: analysis of survival rate and independent prognostic factors in the Amazon region

Oral squamous cell carcinoma (OSCC) accounts for more than 95% of all malignant neoplasms in the oral cavity. Although several studies have shown the epidemiology of this cancer in Brazil, there do not seem to be any studies that describe the prognostic factors related to OSCC in the Amazon region. Therefore, the aim of this study was to determine the survival rate and prognostic significance of different factors in patients from this region affected by OSCC. Data from 85 patients with histologically confirmed squamous cell carcinoma of the tongue and floor of the mouth identified from the Ofir Loyola Hospital archives were collected and analyzed using univariate (log-rank test) and multivariate (Cox proportional hazard model) tests. The overall 5-year survival rate was found to be 27%. Univariate analysis showed that the 5-year survival rate was significantly higher for younger (≤ 45 y) female patients, patients with T1-2 tumors and clinically clear neck nodes (N0), patients with early stage cancers (AJCC stage I-II), and patients treated with surgical procedures. However, multivariate analysis showed that the 5-year survival rate was significantly higher only in the younger patients and those who underwent surgical treatment. The age of the patient at the moment of diagnosis and treatment with surgical procedures were the only independent prognostic factors that affected the 5-year survival rate of the patients in this region.

Dental attendance of oral and oropharyngeal cancer patients in a public hospital in Western Australia

BACKGROUND

Dentists have recently seen the introduction of devices which aim to facilitate early oral cancer detection, sparking interest in opportunistic oral cancer screening. However, concerns have been raised about the lack of regular dental attendance amongst high risk individuals. The purpose of this study was to obtain information pertaining to dental attendance of oral and oropharyngeal cancer patients.

METHODS

All records of patients referred to the Oral Medicine Clinic at the Oral Health Centre of Western Australia, between January 2005 and December 2009, from one major teaching hospital were examined. Information extracted included age, gender, smoking status, referral date, tumour type, tumour site, disease stage (TNM classification), and information on dental attendance. Outcomes measured included time (months) since the patient's last dental visit and information concerning regularity of dental attendance.

RESULTS

No association was found between dental attendance and gender, smoking, disease stage or age at diagnosis. Most patients had not visited a dentist in the preceding 12 months. The mean date of last dental visit was 5.6 years prior.

CONCLUSIONS

More should be done in Australia to encourage patients at high risk of oral cancer to attend the dentist and undergo annual oral soft tissue examination.

Prognostic value of heparanase expression and cellular localization in oral cancer

BACKGROUND

Metastases formation depends on the ability of tumor cells to invade basement membranes in a process involving enzymes capable of degrading extracellular matrix components.

METHODS

We examined the expression of heparanase in oral carcinomas and correlated its staining extent, intensity, and cellular localization with patients' outcome.

RESULTS

Quantitative real-time polymerase chain reaction (PCR) revealed over 4-fold increase in heparanase levels in oral carcinomas compared to adjacent normal tissue. Normal oral epithelium was found negative for heparanase, while all oral carcinomas stained positively for heparanase. Heparanase staining was associated with Ki67 staining, a measure of cell proliferation. Notably, whereas cytoplasmic localization of heparanase was associated with high-grade carcinomas, nuclear localization of the enzyme was found primarily in low-grade, well-differentiated tumors, and in all oral verrucous carcinomas.

CONCLUSION

Expression level and cellular localization of heparanase could serve as an important diagnostic marker in patients with oral cancer.

Two members of the SIBLING family of proteins, DSPP and BSP, may predict the transition of oral epithelial dysplasia to oral squamous cell carcinoma

BACKGROUND

: Patients with oral premalignant lesions (OPL) present with oral squamous cell carcinomas (OSCC) at a much higher rate than the general population. There are currently no useful markers that indicate specifically which OPLs are most likely to progress. Three small integrin binding ligands N-linked glycoprotein (SIBLING) family proteins, bone sialoprotein (BSP), osteopontin (OPN), and dentin sialophosphoprotein (DSPP), have been shown to be up-regulated in many cancers, including OSCC. The status of SIBLING expression in OPLs and their correlation to transition to oral cancer are unknown.

METHODS

: Sixty archival surgical biopsies of dysplastic OPLs were evaluated by immunohistochemistry for expression of BSP, DSPP, and OPN and correlated with local transformation to OSCC at sites adjacent to surgically removed dysplastic OPL.

RESULTS

: The OPL patient population was representative of previous studies with 20% progressing to OSCC, and no correlation between degree of dysplasia and progression. Eighty-seven percent were positive for at least 1 SIBLING protein. OPN expression had no correlation with progression. The BSP+/DSPP- expression pattern however correlated with decreased transformation to OSCC (point prevalence = 0%; 95% confidence interval [CI], 0-20.6), whereas the BSP-/DSPP+ pattern was associated with more frequent progression (point prevalence = 77.8%; 95%CI, 47.8-95.4). Incrementally higher expression scores (0 to 3) of BSP and DSPP were also associated with increased predictive values (odds ratio, 25.53; 95% CI, 2.14-304.7 and 10.13; 95% CI, 2.0-50.0, respectively, for each increment).

CONCLUSIONS

: BSP and DSPP are excellent candidate markers for successful OPL surgical intervention and may be predictors of OPL-OSCC progression. Cancer 2010. (c) 2010 American Cancer Society.

Oral cavity squamous cell carcinoma in 260 patients aged 80years or more

PURPOSE

We report the experience of two French cancer centers in the treatment of oral cavity squamous cell carcinoma (SCC) in patients aged 80 years.

MATERIALS AND METHODS

Two hundred and sixty patients aged 80 years with a primary oral cavity SCC were included in this retrospective analysis.

RESULTS

Sex ratio was near to 1. Tobacco or alcohol intoxication was the main risk factor for 66% of men and 16% of women and leukoplakia, lichen planus, or oral traumatism for 55% of women and 11% of men (p<0.0001). Two hundred patients received a loco-regional (LR) treatment with a curative intent (surgery and/or radiotherapy), 29 with a palliative intent and 31 did not receive a LR treatment. Curative treatments were initially planned to be adapted to age in 118 patients (59%). The median disease-specific survival (DSS) was 29 months. In multivariate analysis, the independent prognostic factors for DSS were stage (HR=0.42 [0.24-0.72]), age (HR=0.43 [0.24-0.75]) and performance status (HR=0.50 [0.27-0.95]). The median overall survival (OS) was 14 months. In multivariate analysis, the independent prognostic factors for OS were age (HR=0.52 [0.35-0.79]), stage (HR=0.56 [0.38-0.84]), tumor differentiation (HR=0.60 [0.33-0.93]) and performance status (HR=0.6 [0.37-0.97]). In patients treated with a curative intent, treatment adapted to age was not associated with a decreased overall survival or disease-specific survival as compared with the standard treatment. However, prophylactic lymph node treatment in stages I-II tumors decreased the rate of nodal recurrence from 38% to 6% (p=0.01).

CONCLUSION

This study emphasizes the need for prospective evaluation of standard and adapted schedules in elderly patients with oral cavity cancer.

Oral cancer cells with different potential of lymphatic metastasis displayed distinct biologic behaviors and gene expression profiles

OBJECTIVE

Oral squamous cell carcinoma (OSCC) often spreads from the primary tumor to regional lymph nodes in the early stage. Better understanding of the biology of lymphatic spread of oral cancer cells is important for improving the survival rate of cancer patients.

METHODS

We established the cell line LNMTca8113 by repeated injections in foot pads of nude mice, which had a much higher lymphatic metastasis rate than its parental cell line Tca8113. Then, we compared the biologic behaviors of cancer cells between them. Moreover, microarray-based expression profiles between them were also compared, and a panel of differential genes was validated using real-time-PCR.

RESULTS

In contrast to Tca8113 cells, LNMTca8113 cells were more proliferative and resistant to apoptosis in the absence of serum, and had enhanced ability of inducing capillary-like structures. Moreover, microarray-based expression profiles between them identified 1341 genes involved in cell cycle, cell adhesion, lymphangiogenesis, regulation of apoptosis, and so on. Some genes dedicating to the metastatic potential, including JAM2, TNC, CTSC, LAMB1, VEGFC, HAPLN1, ACPP, GDF9 and FGF11, were upregulated in LNMTca8113 cells.

CONCLUSION

These results suggested that LNMTca8113 and Tca8113 cells were proper models for lymphatic metastasis study because there were differences in biologic behaviors and metastasis-related genes between them. Additionally, the differentially expressed gene profiles in cancer progression may be helpful in exploring therapeutic targets and provide the foundation for further functional validation of these specific candidate genes for OSCC.

Determinants of outcome following surgery for oral squamous cell carcinoma

The recent changes in incidence and prevalence of oral squamous cell carcinoma in relation to gender and age mirror the changing patterns of exposure to tobacco and alcohol, the main etiological agents. Most cases of oral cancer are managed by surgery, often combined with radiotherapy. Histopathological assessment of the resection specimen provides information vital for postoperative management and prognosis. This review considers the full range of histological determinants of outcome in relation to the primary oral tumor and any metastatic involvement of the cervical lymphatic system, together with an outline of more general patient factors that may also impact on morbidity and mortality rates.