Clinicopathologic evaluation of prognostic factors for squamous cell carcinoma of the buccal mucosa

Role of Imaging in Predicting the Deep Surgical Margin in Gingivobuccal Complex Cancers: A Pilot Study

Cancers arising from the gingivobuccal complex are one of the most common types of cancer in the oral cavity and are associated with poor prognosis. Among the various prognostic factors, positive surgical margin is the most important one that can be controlled by the operating surgeon. The deep surgical margins for buccal mucosa cancers is normally assessed by palpating the skin for induration and skin pinchability. The present study evaluates the role of imaging in assessing the deep surgical margin and its efficacy for skin preservation in buccal mucosa/ gingivobuccal carcinomas. The patients of gingivobuccal complex squamous cell carcinomas after histopathological confirmation were selected for the study. In imaging, the distance between the base of the tumour and skin (epidermis) of the cheek was measured by a senior radiologist preoperatively. The frozen section findings were confirmed by histopathological examination and the depth of invasion of the tumour was measured and the clearance of the deep surgical margin was confirmed. The correlation between imaging, skin pinch test and histopathological examination of the specimen was assessed. The sensitivity and specificity of imaging to predict the skin preservation (deep surgical margin more than 5 mm) is 100% and 75% respectively compared to sensitivity and specificity of skin pinch test of 82.6% and 50% respectively. Imaging is an effective tool in predicting the skin preservation and skin excision compared to skin pinch test. Compared to the skin pinch test, imaging appears to be a useful tool for advising surgeons on skin preservation vs excision.

Positive Outcomes of Physiotherapy in a Post-operative Case of Squamous Cell Carcinoma of Tongue and Buccal Mucosa Along With Transfemoral Amputation

Oral cancer is a type of malignant neoplasia that develops in the oral cavity or lips and is commonly referred to as squamous cell carcinoma (SCC) because of its histopathology. In this report, we present to you a case of a 35-year-old male patient operated on for moderately differentiated SCC of the lateral border of the tongue and right buccal mucosa with a two-year-old case of trans-femoral amputation. Postoperatively, the patient faced issues with breathing, mouth opening and closing limitations, and painful movements of the neck and right shoulder. An intensive physiotherapy care regimen was designed and consistently implemented for two weeks to tackle the surgical results that were compromising the patient's quality of life. At the two-week evaluation, enhancements in tongue movement, mouth opening, shoulder and cervical joint movement, thoracic mobility, lower limb strength, and gait were seen, confirming the efficacy of the intended therapy. The patient was assessed before and after the rehabilitation using range of motion, manual muscle testing, the Mallampati scale, the numerical pain rating scale, the amputee mobility predictor assessment tool, and the Royapettah scoring system.

Nomogram predicting long-term overall and cancer-specific survival of patients with buccal mucosa cancer

BACKGROUND

Few models about the personalized prognosis evaluation of buccal mucosa cancer (BMC) patients were reported. We aimed to establish predictive models to forecast the prognosis of BMC patients.

METHODS

The complete clinicopathological information of BMC patients from the surveillance, epidemiology and end results program was collected and reviewed retrospectively. Two nomograms were established and validated to predict long-term overall survival (OS) and cancer-specific survival (CSS) of BMC patients based on multivariate Cox regression survival analysis.

RESULTS

1155 patients were included. 693 and 462 patients were distributed into modeling and validation groups with 6:4 split-ratio via a random split-sample method. Based on the survival analysis, independent prognostic risk factors (variables that can be used to estimate disease recovery and relapse chance) influencing OS and CSS were obtained to establish nomograms. Then, we divided the modeling group into high- and low-risk cohorts. The low-risk cohort had improved OS and CSS compared to the high-risk cohort, which was statistically significant after the Log-rank test (p < 0.05). Furthermore, we used the concordance index (C-index), calibration curve to validate the nomograms, showing high accuracy. The decision curve analyses (DCA) revealed that the nomograms had evident clinical value.

CONCLUSIONS

We constructed two credible nomogram models, which would give the surgeons reference to provide an individualized assessment of BMC patients.

Palate Squamous Cell Carcinomas:A Ten-Year Single Institute Experience

The literature date estimated that about 5% of all oral cavity cancers are hard palate cancers while soft palate cancers account for about 5-12% of oropharyngeal cancers. Although rare, usually these tumors had a more aggressively behavior than other oral cancer sites. That is why our study aimed to investigate comparatively the epidemiological, clinical and histopathological peculiarities of the two palatal sites of oral squamous cell carcinomas. We conducted a retrospective study limited to a period of 10 years in a single medical institution to investigate the morphoclinical profile of such tumors. We found that patients with hard palate SCCs had an average age slightly larger compared to those who developed soft palate tumors. Also, those with hard palate tumors are mostly diagnosed in less advanced stages compared to those at the level of the soft palate, and implicitly the former had a longer survival time. Histopathologically the most encountered hard palate SCC were the conventional well-differentiated tumor, and from the peculiar SCC variant the papillary and verrucous forms while for the soft palate SCC prevailed the moderate and poor differentiated conventional SCC and from the peculiar SCC variant the basaloid and acantholytic forms. In conclusion hard palate tumors differ in many aspects from those of the soft palate, and thus specification of the origin tumor site become important for the assessment of prognosis, treatment and survival outcome of such patients.

Squamous cell carcinoma of buccal mucosa: An analysis of prognostic factors

Introduction:

Carcinoma of the buccal mucosa is the most common oral cavity cancer in the Indian subcontinent. The aim of this study was to analyze the outcome and evaluate prognostic factors in surgically treated buccal mucosa squamous cell carcinoma (BMSCC) patients.

Materials and Methods:

A retrospective study was performed by reviewing the medical records of 409 pathologically proven buccal mucosa cancer patients, who were diagnosed and surgically treated in Tata Memorial Hospital between January 1, 2006, and December 31, 2008.

Results:

The overall 5-year survival of the cohort was found to be 54.1%. The stage-wise survival rate for tumor, node, metastasis (TNM) Stage I, II, III, and IV patients was found to be 85.2%, 82.9%, 56.3%, and 42.6% (P < 0.00), respectively. On multivariate Cox proportional hazard analysis, the presence of comorbidity, histological tumor size, pathological lymph node status, tumor differentiation, perineural invasion, and extracapsular spread were found to be independently associated with overall survival.

Conclusion:

BMSCC is an aggressive malignant tumor. In addition to TNM classification, other clinical and pathological factors also have a significant role in BMSCC prognostication. Hence, there is a need to move beyond TNM and develop a more inclusive, flexible, and easy to use prognostic system.

Role of Heterotypic Neutrophil-in-Tumor Structure in the Prognosis of Patients With Buccal Mucosa Squamous Cell Carcinoma

Objective

To analyze the role of frequency of heterotypic neutrophil-in-tumor structure (FNiT) in the prognosis of patients with buccal mucosa squamous cell carcinoma (BMSCC).

Methods

In vitro, we cocultured BMSCC cell line-H157 with neutrophils to form heterotypic neutrophil-in-tumor structures, which were then subject to fluorescence staining. Clinically, 145 patients were retrospectively enrolled. Associations between FNiT and clinicopathological variables including age, sex, smoking history, drinking history, betel nut chewing, tumor stage, node stage, metastasis, disease stage, lymphovascular invasion, extranodal extension, perineural invasion, and tumor grade were analyzed by chi-square test, and the main endpoints of interest were recurrence-free survival (RFS) and disease-specific survival (DSS) which were analyzed by the Kaplan-Meier method and Cox model.

Results

Fluorescent staining results of typical heterotypic neutrophil-in-tumor structure showed that well-differentiated H157 cells had a stronger ability to internalize more neutrophils than poorly-differentiated H157 cells, with the latter often internalizing only one neutrophil or nothing. The mean FNiT was 4.2‰, with a range from 2.3‰ to 7.8‰. A total of 80 patients relapsed and 84 patients died of the disease. The 5-year RFS and DSS rate was 42% and 42%, respectively. Patients with an FNiT≥4.2‰ had a significantly higher risk for locoregional recurrence and cancer-caused death than those with an FNiT<4.2‰ (p=0.001 and p<0.001, respectively). The FNiT alone was independently significant in predicting poor RFS, and the FNiT along with tumor grade was an independent predictor for DSS.

Conclusion

The FNiT as a novel predictor is significantly negatively associated with both the RFS and DSS of patients with BMSCC.

Analysis of primary oral and oropharyngeal squamous cell carcinoma in inhabitants of Beijing, China-a 10-year continuous single-center study

Background

This study aimed to describe some of the characteristics of the inhabitants of Beijing with oral and oropharyngeal squamous cell carcinoma (OSCC) who had received treatment at the Stomatology Hospital of Peking University and to analyze the survival rate and the prognostic factors of patients following surgical treatment.

Methods

Data for 603 consecutive cases with primary OSCC between 2004 and 2013 were obtained from the Stomatology Hospital of Peking University. Clinical data including age, sex, living district, primary tumor site, TNM stage, history of drinking and smoking, pathological differentiation, treatment, and survival were retrospectively analyzed.

Results

The male:female ratio was 1.1:1. The frequency of site involvement in descending order was tongue (34.3%), gingiva (25.0%), buccal mucosa (13.8%), oral floor (9.0%), oropharynx (8.5%), lip (6.3%) and palate (3.2%). Female OSCC patients tended to be significantly older than men with OSCC (P < 0.05). The percentage of patients with TNM stage III–IV OSCC was 52.4%. The results revealed that 65.3% of male patients and only 6.3% of female patients smoked or drank. The overall 5-year survival rate was 64%. Female patients had a worse prognosis than male patients. Among the patients who received surgery, tumor size and lymph node involvement were independent prognostic factors. Smoking and drinking were not prognostic factors.

Conclusion

Among the Beijing inhabitants who were diagnosed with OSCC and treated in our hospital in the past 10 years, more than half were in the advanced stage, and the cancer stage was the main prognostic factor of oral cancer. Therefore, the recognition of oral cancer should be strengthened, and early detection and treatment of OSCC should be achieved to improve the survival rate.

Do betel quid and areca nut chewing deteriorate prognosis of oral cancer? A systematic review, meta-analysis, and research agenda

OBJECTIVE

To explore the correlations between the habit of betel quid and areca nut (BQ-AN) chewing and the prognosis of oral cancer (OC).

METHODS

We performed a systematic review and meta-analysis to clarify this issue. Data searches were performed using PubMed, Web of Science, Epistemonikos, and Embase databases through November 2019. The primary outcome was the difference in the prognosis of OC between BQ-AN chewers and non-chewers, measured in terms of 5-year overall survival (OS) and 5-year disease-specific survival (DSS) log (HR) reported in articles. The pooled HR with 95% CI of 5-year OS and 5-year DSS was calculated using a fixed-effects model.

RESULTS

Ten articles with eleven OS or DSS survival studies (one of the articles contained two studies), which were published between 2003 and 2017, were eligible for inclusion in the present study. All the 11 studies were observational studies, among which 10 were retrospective and 1 was prospective. One study measured both OS and DSS. Eight studies, with a total of 2,761 patients, used 5-year OS as the primary endpoint and four studies, with a total of 2,551 patients, used 5-year DSS. Overall, the pooled HR evaluating BQ-AN chewers was 1.26 (95% CI: 1.09-1.46) for 5-year OS and 1.40 (95% CI: 1.15-1.70) for 5-year DSS, compared with non-chewers. There was a significant association between BQ-AN chewing and OC survival.

CONCLUSIONS

Betel quid and areca nut chewing is significantly associated with poor prognosis in patients with OC.

Distant metastasis from oral cavity-correlation between histopathology results and primary site

OBJECTIVES

Oral cancer is the eighth most common type of cancer worldwide and a significant contributor to the global burden caused by this disease. The principal parameters considered to influence prognosis, and thus treatment selection, are size and location of the primary tumor, as well as assessment of the presence and extent of lymph node and distant metastasis (DM). However, no known report regarding the relationship between the primary site and DM has been presented. For effective treatment selection and good prognosis, the correlation of DM with anatomic site and histopathology results of the primary malignancy is important. In the present study, we performed a systematic review of published reports in an effort to determine the relationship between the anatomic site of various types of oral cavity cancer and DM.

METHODS

A systematic review of articles published until the end of 2018 was performed using PubMed/MEDLINE.

RESULTS

A total of 150 studies were selected for this review. The percentage of all cases reported with DM was 6.3%, ranging from 0.6% to 33.1% in the individual studies. The rate of incidence of tongue occurrence was 9.3%. A frequent DM site was the lungs, with adenoid cystic carcinoma the most commonly involved histopathological factor. Malignant melanoma was most frequent (43.4%) in all histopathology findings, whereas there were no cases with an acinic cell carcinoma or cystadenocarcinoma.

CONCLUSIONS

We found that the occurrence of DM from the primary site as well as rate of incidence was dependent on histopathological factors.

Clinicopathologic Determinants of Outcome in Pathologic T4a (pT4a) Squamous Cell Carcinoma of the Gingivobuccal Subsite of the Oral Cavity

Carcinoma of the gingivobuccal complex is one of the most common cancers in India and patients usually present in an advanced stage. There is limited data in literature regarding the factors predicting outcome in pathological T4a patients. In this study, we aimed to study the clinic-pathological factors which may influence treatment outcomes in pT4a patients. This is a retrospective study of 121 patients who underwent surgery for oral squamous cell carcinoma between August 2011 and December 2016, staged pT4a. Overall survival (OS) and disease-free survival (DFS) were analyzed for variables including age, depth of invasion, margin status, differentiation, nodal status, extranodal spread, lymphovascular and perineural spread, and adjuvant treatment. The study cohort comprised 93 males with mean age 60.28 years (S.D. 11.25). Median DFS was 21 months (range 9 to 2374 days) whereas median OS was 24.5 months (range 9 to 2374 days). On univariate analysis, lymphovascular invasion, perineural invasion, cervical nodal metastasis, and extranodal extension had a statistically significant effect on both DFS and OS. On multivariate analysis, age (p = 0.014) and adjuvant radiotherapy (p = 0.010) were the statistically significant factors affecting OS. None of the factors affected DFS on multivariate analysis. Patients staged pT4a with cervical nodal metastasis, extranodal extension, lymphovascular invasion, and perineural invasion have reduced OS and DFS. On multivariate analysis, lower age at presentation and adjuvant radiation improved patient outcome.

Oral Cavity Cancer

Management of oral cavity squamous cell carcinoma has become increasingly driven by emerging evidence as a result of the improved quality of clinical research associating clinicopathologic risk factors with oncologic and survival outcomes. Multiple significant recent changes to treatment guidelines and staging algorithms for oral cavity squamous cell carcinoma reflect evolving understanding of tumor biology and the need for adequately extensive treatment of aggressive disease. This article provides clinicians with a synopsis of the most contemporary management strategies for oral cavity squamous cell carcinoma, framed within the context of historical treatment philosophies.

Patients with head and neck cancer may need more intensive pain management to maintain daily functioning: a multi-center study

PURPOSE

The purpose of this study is to investigate the prevalence of pain, pain management, and impact of recent pain on daily functioning in patients with head and neck cancer (HNC) and patients with other cancers.

METHODS

This multi-center survey was conducted by using Brief Pain Inventory questionnaire to evaluate pain status and its impact on daily functioning.

RESULTS

A total of 3289 patients were analyzed including 708 HNC patients and 2581 patients with other cancers. The overall pain prevalence was 69.17%. A higher percentage of HNC patients had recent pain (60.59 vs. 44.01%, P < 0.001), required pain management (86.29 vs. 72.03%, P < 0.001), and used any analgesics (53.81 vs. 34.52%, P < 0.001). HNC patients with pain management had a higher prevalence of recent pain (85.83 vs. 81.14%, P = 0.044) and a slightly lower satisfaction rate (74.00 vs. 79.70%, P = 0.070). Regarding the impact of pain on daily functioning, HNC patients had a lower mean interference score for general activity such as walking, normal work, sleep, and life enjoyment.

CONCLUSIONS

The HNC patients may need more intensive pain management to achieve optimal pain control and maintain daily functioning.

Subcellular localization and expression of E-cadherin and SNAIL are relevant since early stages of oral carcinogenesis

The biological process of epithelial-to-mesenchymal transition (EMT) has been studied in oral squamous cell carcinoma (OSCC) metastasis, but it is rarely evaluated at several stages of oral carcinogenesis. This study aimed to analyze the presence of SNAIL and E-cadherin proteins, markers of EMT, in the development and progression of OSCC, evaluating excised specimens of potentially malignant lesions (oral leukoplakia with and without dysplasia-OL and OLD, respectively), tumor tissues (OSCC), metastatic lymph nodes (LN), and normal oral mucosa (NOM) by immunohistochemistry, considering subcellular localization. Additionally, SNAIL and E-cadherin transcripts were evaluated in vitro by qPCR, using SCC-9 cell line in comparison to human keratinocytes (HPEC). There was a significant increase in nuclear expression of SNAIL from NOM to OLD followed by a noticeable decrease in nuclear expression accompanied by increased cytoplasmic expression in OSCC (p<0.05). The E-cadherin cytoplasmic expression was remarkable and statistically significant higher in OSCC and LN, both compared to NOM (p< 0.0001), OL (p<0.01) and OLD (p< 0.0001 and p<0.001, respectively). In vitro, E-cadherin and SNAIL transcripts were lower in SCC-9 compared to HPEC cells, although only the decrease of E-cadherin was statistically significant (p<0.05). Regarding the association of E-cadherin and SNAIL expression with the clinical findings, the analysis revealed an association between the cytoplasmic expression of SNAIL and the invasion pattern (p=0.05) in OSCC. The increased nuclear SNAIL expression may be characteristic of OLD, and the presence of E-cadherin in cell cytoplasm a marker of transformation to malignancy of potentially malignant oral leukoplakias into OSCC.

In-Continuity Neck Dissection: Long-Term Oncological Outcomes in Squamous Cell Carcinoma of the Buccal Mucosa

PURPOSE

To introduce in-continuity neck dissection (ND) in squamous cell carcinoma of the buccal mucosa (BMSCC) and to determine its impact on the oncologic outcomes of these patients.

MATERIALS AND METHODS

A retrospective review of patients treated for BMSCC from 2006 through 2016 was performed. Kaplan-Meier analysis and log-rank test were used to evaluate local control, regional control (RC), distant metastasis (DM), and disease-specific survival (DSS) of in-continuity ND versus discontinuous ND in 220 previously untreated patients with BMSCC, followed by a multivariate Cox regression that included all relevant variables.

RESULTS

Fifty-three patients received discontinuous ND and 167 patients received in-continuity ND. The 2 groups were comparable. Univariate Kaplan-Meier analysis showed that 5-year DSS rates for the discontinuous ND and in-continuity ND groups were 38 and 62% (P = .023), respectively. The 5-year RC rate for the in-continuity ND group (81%) was significantly better (P = .004) than for the discontinuous ND group (54%). At Cox regression analysis, in-continuity ND meaningfully contributed to a higher RC rate and subsequently better DSS.

CONCLUSION

Compared with discontinuous ND, in-continuity ND predicted favorable oncologic outcomes in patients with BMSCC. In-continuity ND could be a practical approach in the surgical management of BMSCC.

Fascin promotes migration and invasion and is a prognostic marker for oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) prognosis is related to clinical stage and histological grade. However, this stratification needs to be refined. We conducted a comparative proteome study in microdissected samples from normal oral mucosa and OSCC to identify biomarkers for malignancy. Fascin and plectin were identified as differently expressed and both are implicated in several malignancies, but the clinical impacts of aberrant fascin and plectin expression in OSCCs remains largely unknown. Immunohistochemistry and real-time quantitative PCR were carried out in ex vivo OSCC samples and cell lines. A loss-of-function strategy using shRNA targeting fascin was employed to investigate in vitro and in vivo the fascin role on oral tumorigenesis. Transfections of microRNA mimics were performed to determine whether the fascin overexpression is regulated by miR-138 and miR-145. We found that fascin and plectin are frequently upregulated in OSCC samples and cell lines, but only fascin overexpression is an independent unfavorable prognostic indicator of disease-specific survival. In combination with advanced T stage, high fascin level is also an independent factor of disease-free survival. Knockdown of fascin in OSCC cells promoted cell adhesion and inhibited migration, invasion and EMT, and forced expression of miR-138 in OSCC cells significantly decreased the expression of fascin. In addition, fascin downregulation leads to reduced filopodia formation and decrease on paxillin expression. The subcutaneous xenograft model showed that tumors formed in the presence of low levels of fascin were significantly smaller compared to those formed with high fascin levels. Collectively, our findings suggest that fascin expression correlates with disease progression and may serve as a prognostic marker and therapeutic target for patients with OSCC.

Outcome and cervical metastatic spread of squamous cell cancer of the buccal mucosa, a retrospective analysis of the past 25 years

OBJECTIVES

Because of the low proportion of squamous cell carcinomas (SCCs) of the buccal mucosa within the carcinomas of the oral cavity in the Western population, data concerning metastatic pattern are sparse. Therefore, this retrospective study is focusing on the occurrence of cervical metastases (CM) and the overall outcome of this tumor entity.

MATERIALS AND METHODS

From January 1988 to October 2013, 113 patients were treated in the Department of Oral and Maxillofacial Surgery, Mainz, for an oral SCC of the cheek. Metastatic pattern and clinical parameters that are possibly associated with an increased risk for CM as well as overall outcome were analyzed.

RESULTS

The average follow-up was 48 months (range: 1-248 months). A total of 55 (49%) patients were female and 58 (51%) male, with an average age of 65 ± 13 years (♀68 ± 14 years; ♂63 ± 11 years). In total, 55% of the patients either smoked and/or consumed alcohol. In total, 34% of the patients had a stage III or IV tumor, with overall 23% having CM at the time of diagnosis. During the follow-up, 50% (n = 56) of the patients developed a relapse after 12 months (median). Tumor size (P = 0.002*) and grading (P < 0.001*) are significantly associated with the occurrence of CM. Metastases (P = 0.008*) and advanced tumor size (P = 0.018) had an influence on the survival, whereas the relapse had no significant influence (P = 0.928). Five-year survival rate was 80%.

CONCLUSIONS

SCC of the buccal mucosa shows aggressive behavior with a considerably high proportion of relapse. Since overall outcome is significantly decreased by the cervical metastatic pattern, a selective, ipsilateral neck dissection for this patient group is recommended as the primary management.

Comparative clinical outcomes of Taiwanese patients with resected buccal and tongue squamous cell carcinomas

OBJECTIVES

Although patients with buccal squamous cell carcinoma (SCC) usually show acceptable outcomes, local control and survival rates are generally lower than those observed for tongue SCC. This study was designed to compare the clinical outcomes of Taiwanese patients with these two common oral cavity malignancies.

METHODS

Patients with first primary buccal or tongue SCC who were included in the Taiwanese Cancer Registry Database between 2004 and 2012 were eligible. The study sample consisted of 16,379 patients (7870 buccal SCC and 8509 tongue SCC) who received surgery with or without adjuvant therapy. The 5-year disease-specific survival (DSS) and overall survival (OS) rates served as the outcome measures.

RESULTS

Compared with tongue SCC, patients with buccal SCC had a higher prevalence of males (95.7% vs. 86.4%, p<0.0001), pT4 disease (21.4% vs. 12.7%, p<0.0001), and p-Stage IV (30.4% vs. 24.8%, p<0.0001) but a lower frequency of pN2 disease (15.2% vs. 18.5%, p<0.0001). The 5-year DSS and OS rates of buccal SCC patients were slightly higher than those of tongue SCC (78% vs. 77%, p=0.0297; and 71% vs. 69%, p=0.0231, respectively). Multivariate analysis identified tumor site (tongue vs. buccal SCC), sex (male vs. female), age (≥65 vs. <65years), pT classification (T4/T3/T2 vs. T1), and pN classification (N3/N2/N1vs. N0) as independent prognostic factors in the entire study cohort.

CONCLUSIONS

The survival advantage of buccal SCC over tongue SCC appears significant in large clinical samples, despite a higher prevalence of p-Stage IV disease in the former.

Mast Cells: Key Players in the Shadow in Oral Inflammation and in Squamous Cell Carcinoma of the Oral Cavity

Although mast cells (MCs) have been discovered over 130 years ago, their function was almost exclusively linked to allergic affections. At the time being, it is well known that MCs possess a great variety of roles, in both physiologic and pathologic conditions. In the oral tissues, MCs release different proinflammatory cytokines, tumor necrosis factor alpha (TNF-α), that promote leukocyte infiltration in various inflammatory states of the oral cavity. These cells play a key role in the inflammatory process and, as a consequence, their number changes in different pathologic conditions of the oral cavity, like gingivitis, periodontitis, and so on. MCs also represent a rich source of proteases, especially of mast cell tryptase and chymase, which directly degrade the extracellular matrix through their proteolytic activity and thus indirectly stimulate angiogenesis and facilitate invasion and metastasis. It may be stated that mast cells could have an impact on primary tumor development, progression, and metastases in oral squamous cell carcinoma. By understanding the role of mast cells in the pathogenesis of different inflammatory and tumor diseases of the oral cavity, these cells may become therapeutic targets that could possibly improve the prognosis and survival of these patients.

The prognostic value of histopathological grading systems in oral squamous cell carcinomas

OBJECTIVE

This study evaluated the association of four histopathological grading systems (WHO grading system, malignancy grading of the deep invasive margins (MG), histological risk (HR) model, and tumor budding and depth of invasion (BD) model) with clinicopathological parameters and outcome of 113 oral squamous cell carcinomas to identify their roles in prognosis.

METHODS

Demographic and clinical features were obtained from patients' records. Sections from all paraffin-embedded blocks were evaluated according to the four grading systems. Demographic and clinical associations were analyzed using chi-square test, and correlations between the grading systems were established with the Spearman's rank correlation test. Survival curves were performed with Kaplan-Meier method, and multivariate analysis based on Cox proportional hazard model was calculated.

RESULTS

Significant associations with survival were observed for WHO grading system and BD model in the univariate analysis, but only the BD model was significantly associated with disease outcome as an independent prognostic marker. Age, tumor size, and presence of regional metastasis were also independent markers of reduced survival.

CONCLUSION

A significant association between the BD model and outcome of OSCC patients was observed, indicating this new histopathological grading system as a possible prognostic tool.

A meta-analysis of margin size and local recurrence in oral squamous cell carcinoma

OBJECTIVES

Excision margins for oral squamous cell carcinoma (OSCC) are poorly understood. Close (<5mm) and involved (<1mm) pathological margins are key indicators of the need for adjuvant treatment. This review aimed to assess the impact of pathological margin size on local recurrence rates.

METHODS

MEDLINE and EMBASE were searched for studies that looked at local recurrence following excision of primary OSCC without adjuvant therapy. Five studies met the inclusion criteria.

RESULTS

Recurrence rates were pooled to give a 21% absolute risk reduction (95% confidence interval 12-30%, p=<0.00001) in local recurrence with margins clear by more than 5mm. Unweighted pooled recurrence rates were 20% in patients with margins clear by more than 5mm.

CONCLUSION

These findings suggest that a 5mm pathological margin is the minimum acceptable margin size in OSCC.

A study on assessment of mast cells in oral squamous cell carcinoma

Background:

Apart from the role of mast cells in maintenance of homeostasis and inflammation, their association with tumors has been described recently. In several malignancies, mast cell density has been found to correlate with angiogenesis, increased risk of metastasis and poor prognosis.

Aim:

The aim of the following study is to compare the number, topography and distribution of mast cells between normal oral mucosa and oral oral squamous cell carcinoma (SCC) and study the significance of mast cells in development of oral SCC.

Subjects and Methods:

A prospective case-control study including 100 patients was conducted after obtaining informed consent and ethical committee clearance. Forty cases were normal controls and 60 cases had oral SCC. Biopsy was performed and both qualitative and quantitative study of mast cells was done. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) 17.0 version (SPSS Inc., Chicago, IL, USA).

Results:

Buccal/labial mucosa was the most common site of lesion in SCC. Total mast cells count was a higher in SCC when compared with controls, which was a statistically significant (P < 0.001). SCC had significantly (P < 0.001) higher levels of degranulated mast cell.

Conclusion:

Role of mast cells in tumors may have direct clinical relevance and consequently, important clinical implications. Mast cells serves as a novel therapeutic target for cancer treatment and that inhibiting mast cell function may inhibit tumor growth.

Squamous cell carcinoma of the buccal mucosa: Analysis of clinical presentation, outcome and prognostic factors

Squamous cell carcinoma (SCC) of the buccal mucosa is a common malignancy in Southeast Asia. The purpose of this study was to present our clinical experience with buccal SCC over a period of 7 years and to analyze the factors associated with surgical outcome. We conducted a retrospective review on 67 buccal SCC patients (between September, 2005 and May, 2011) with tumors restricted to or originating from the buccal mucosa. In a univariate model, nodal stage, degree of tumor differentiation and composite resection were associated with recurrence, while in a multivariate model, the degree of differentiation was the only factor affecting locoregional control. In a survival analysis, recurrence, nodal stage and degree of differentiation were considered as significant factors. Buccal SCC is an aggressive malignant tumor and the degree of differentiation is the most significant factor affecting prognosis and survival. An adequate systemic treatment is required in the case of poorly differentiated tumors. Neck dissection (ND) exerts a positive effect on the locoregional control of buccal SCC staged as cT1-2N0. In the case of identification of positive lymph nodes during surgery, postoperative radiation is recommended in order to improve locoregional control.

Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience

PURPOSE

Squamous cell carcinoma (SCC) of the buccal mucosa accounts for 23% to 37% of all intraoral cancer cases in Taiwan. Because of the high recurrence rate and invasive tumor behavior, the prognosis is generally poor. The aim of this study was to evaluate the prognostic significance of clinicopathologic factors on survival rates for patients with buccal SCC in a medical center in central Taiwan.

MATERIALS AND METHODS

Between March 1995 and December 2002, patients admitted to hospital and diagnosed as having buccal SCC were enrolled in the study. There were 415 patients (406 men and 9 women) 25 to 84 years old (mean age, 51.1 ± 11.4 years). The chart records were retrospectively reviewed. Relevant clinical features in each patient, such as primary tumor size, tumor stage, initial treatment modalities, surgical margin status, cervical nodal metastasis status, and histopathologic grade, were compared for survival analysis.

RESULTS

Three hundred ninety-four patients received surgical intervention. Univariate analysis of relevant prognostic factors showed that positive surgical margin, positive cervical nodal metastasis, positive extracapsular spread, larger tumor, and advanced tumor stage were associated with poor prognosis. Multivariate analysis identified the factors that independently influenced the survival rate as advanced stage disease (stage III: relative risk [RR], 3.09; P = .006; stage IV: RR, 4.64; P < .001), positive surgical margin (RR, 2.02; P = .001), and extracapsular spread of cervical lymph node metastasis (RR, 6.89; P < .001).

CONCLUSIONS

This study represents the largest series in the literature and highlights the importance of tumor stage, surgical margin status, and extracapsular spread of cervical nodal metastasis as the most important prognostic factors in patients with buccal SCC.

Histological Differentiation of Primary Oral Squamous Cell Carcinomas in an Area of Betel Quid Chewing Prevalence

OBJECTIVES: This study evaluated associations between the histological differentiation of oral squamous cell carcinoma and additional clinicopathological manifestations, adverse events after treatment, and the outcomes of patients in a region prevalent for betel quid chewing.

STUDY DESIGN: Case series with chart review.

SETTING: Tertiary referral center.

SUBJECTS AND METHODS: A total of 150 patients with primary oral squamous cell carcinomas who underwent surgery with or without adjuvant therapy were enrolled.

RESULTS: Well, moderate, and poorly differentiated oral squamous cell carcinomas were reported in 54 (36%), 84 (56%), and 12 (8%) patients, respectively. There were no significant differences among different histological differentiations in age, sex, tumor, node, metastasis stage, bone invasion, depth of invasion, and history of carcinogen exposure. However, we found significant associations between tumor histological differentiation and nodal metastasis ( P < 0.0001), extracapsular spread ( P = 0.002), and perineural invasion ( P < 0.0001). In the analysis of adverse events for survival during patient follow-up, oral squamous cell carcinomas with poor differentiation had a higher probability of developing neck recurrence ( P = 0.001) and distant metastasis ( P = 0.019), but not local recurrence or a second primary cancer. For survival analysis, univariate analysis showed that patient age, tumor stage, extracapsular spread, presence of perineural invasion, and tumor differentiation were significant factors. Multivariate analysis further demonstrated that poor differentiation ( P = 0.007) was still a statistically significant factor.

CONCLUSION: The current study demonstrates that poorer tumor histological classifications of oral squamous cell carcinoma are significantly associated with positive nodal status, extracapsular spread, perineural invasion of primary tumors, and the probability of developing neck recurrence and distant metastasis after treatment.

Oral carcinoma epidemiology in Paraná State, Southern Brazil

Oral carcinoma is the sixth most frequent type of cancer in the world and the seventh most common in Brazil (the country with the highest incidence in Latin America). Mean five-year survival remains one of the lowest among the main cancers, thus justifying studies that contribute to the development of preventive strategies. The aim of this study was to compare the epidemiological, clinical, and histological characteristics of 91 patients with oral carcinoma. Mean age was 58.62 +/- 10.46 years, and male-to-female ratio was 6.6:1.0 (79 men and 12 women). European descendants predominated with 79 patients (86.8%). Eighty-five individuals (93.4%) smoked and 70 (76.9%) consumed alcohol regularly. Anatomical distribution of tumors was: 27 (29.7%) tongue; 18 (19.8%) floor of mouth; 11 (12.1%) oropharynx; and 11 (12.1%) oral mucosa. Fifty-seven patients (62.6%) presented lymph node involvement and three (3.3%) had distant metastases. Surgery and radiotherapy were used in 43.2% of patients. With the exception of the male/female ratio (which was higher), our data are consistent with previous studies on oral carcinoma patients.

Cancer of the buccal mucosa: a tale of two continents

Squamous cell carcinoma (SCC) of the buccal mucosa in North America is thought to be different from that in the Indian subcontinent. This study compared the treatment outcomes and prognostic factors in 64 patients with SCC of the buccal mucosa treated at Cancer Care Manitoba (CCMB), Canada, and 64 similar patients treated at the Tata Memorial Hospital (TMH), India. Overall, cause-specific and disease-free survival for the two geographical groups were calculated and the impact of individual prognostic factors on survival was assessed. CCMB patients were significantly older (p<0.001), had less differentiated tumour (p=0.053) and had higher chances of positive or close surgical margins (p=0.012). At 5 years, they had lower 5-year overall survival (57.4% versus 80.1%; p<0.001), cancer-specific survival (76.4% versus 85.0%; p=0.043) and disease-free survival (42.9% versus 66.4%; p=0.004). Age had an independent influence on overall survival and cause-specific survival. After adjusting for age there was no difference in cause-specific survival between the two groups (HR=1.20; 95% CI=0.46,3.17; p=0.710). The apparent survival difference between the CCMB and TMH patients was due to the difference in the age of presentation and not because of different biological behaviour.

When does skin excision allow the achievement of an adequate local control rate in patients with squamous cell carcinoma involving the buccal mucosa?

BACKGROUND

The role of cheek skin excision in patients with squamous cell carcinoma of the buccal mucosa (BSCC) remains controversial. We sought to investigate when skin excision is needed to achieve an adequate local control.

METHODS

A total of 331 patients with BSCC were reviewed. Skin preservation was pursued when the distance between the tumor and the skin as determined by imaging was >or=13 mm (1 cm surgical margin plus 0.3 cm skin preservation). Two hundred and thirty patients (69.5%) underwent skin excision. Postoperative adjuvant radiotherapy (n = 182) was performed in patients with pathological T4 disease, metastases in cervical lymph nodes or close pathological margins (<or=4 mm). The 5-year local control rate was plotted by Kaplan-Meier analysis.

RESULTS

Twenty-four patients (7.3%) had close pathological margins. The 5-year local control rate did not differ significantly between patients treated either with or without skin excision. This was verified both in subjects who received surgery alone (94% versus 91%) and in those who received surgery plus adjuvant therapy (82% versus 86%).

CONCLUSION

In patients with BSCC, a good 5-year local control rate may be equally achieved either with or without skin excision. In patients with pT3 disease, postoperative radiotherapy is not recommended in the absence of close pathological margins. Our findings may guide clinical decision-making on skin excision in this patient group.