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Tran Q, Maddineni S, Arnaud EH, Divi V, Megwalu UC, Topf MC, Sunwoo JB. Oral cavity cancer in young, non-smoking, and non-drinking patients: A contemporary review. Crit Rev Oncol Hematol 2023; 190:104112. [PMID: 37633348 PMCID: PMC10530437 DOI: 10.1016/j.critrevonc.2023.104112] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023] Open
Abstract
Oral squamous cell carcinoma (OSCC) in non-smoking and non-drinking (NSND) individuals appears to be distinct from the traditional head and neck squamous cell carcinoma (HNSCC). The incidence of this subset is increasing, as are the number of studies examining its characteristics. NSND OSCC individuals tend to be younger (<45 years) compared to traditional HNSCC patients. The proportion of females in the NSND OSCC cohort is also higher. The tongue is the predominantly affected subsite. Studies have revealed several gene mutations and unique epigenomic profiles but no definitive genetic etiology. Transcriptomic analysis has not found any causative viral agents. Other proposed etiologies include chronic dental trauma, microbiome abnormalities, marijuana consumption, and genetic disorders. There are international efforts to determine the relative prognostic outcome of this unique cohort, but no consensus has been reached. Here, we review the incidence, demographics, subsite, possible etiologies, prognosis, and therapy implications of the NSND OSCC cohort.
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Affiliation(s)
- Quan Tran
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sainiteesh Maddineni
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Ethan Hunter Arnaud
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vasu Divi
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Michael C Topf
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - John B Sunwoo
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, CA, USA.
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2
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Rahadiani N, Habiburrahman M, Handjari D, Stephanie M, Krisnuhoni E. Clinicopathological characteristics predicting advanced stage and surgical margin invasion of oral squamous cell carcinoma: A single‑center study on 10 years of cancer registry data. Oncol Lett 2022; 24:364. [PMID: 36238853 PMCID: PMC9494421 DOI: 10.3892/ol.2022.13484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
The incidence profile of oral squamous cell carcinoma (OSCC) has not previously been comprehensively reported in Indonesia. The present study aimed to identify clinicopathological characteristics of patients with OSCC according to sex and age, to analyze histological differentiation patterns specific to tumor subsites, to highlight the role of lymphovascular invasion (LVI) in metastasis, and to develop a model to predict advanced stage and margin invasion. A retrospective cross-sectional study was performed using 581 medical records and pathological specimens from cancer registry data in the Dr Cipto Mangunkusumo Hospital (Jakarta, Indonesia), between January 2011 and December 2020. Clinicopathological characteristics were analyzed using parametric and non-parametric tests. Multivariate logistic regression analyses were performed for eligible parameters, identified using bivariate analysis, to predict advanced stage and margin invasion. Calibration of the prediction model was evaluated using the Hosmer-Lemeshow test, its discrimination value assessed using the receiver operating characteristic and area under the receiver operating characteristic curve (AUC). Sex-specific patterns in tumor subsites and differences in clinical staging according to age were demonstrated in the patients with OSCC. The proportion of well-differentiated cases was significantly higher in most tumor subsites, except in the buccal mucosa (more moderately differentiated cases) and floor of the mouth (well and moderately differentiated cases being equal). LVI was significantly associated with nodal metastasis but not distant metastasis. Multivariate analysis demonstrated that age ≤45 years [odds ratio (OR), 2.26] and LVI (OR, 8.42) predicted patients having advanced-stage OSCC among general populations (AUC, 0.773); however, LVI (OR, 8.28) was the sole predictor of advanced stage amongst young patients (AUC, 0.737). Margin invasion was predicted solely by tumor subsite, including mouth not otherwise specified (OR, 3.04) and palate (OR, 6.13), in the general population (AUC, 0.711). Furthermore, margin invasion was predicted by the palate subsite (OR, 38.77) and LVI (OR, 11.61) in young patients (AUC, 0.762). Investigating young patients thoroughly when finding SCC in the mouth and palate, and assessing LVI, especially among young patients, is critical to prevent advanced staging and margin invasion.
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Affiliation(s)
- Nur Rahadiani
- Department of Anatomical Pathology, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Muhammad Habiburrahman
- Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Diah Handjari
- Department of Anatomical Pathology, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Marini Stephanie
- Department of Anatomical Pathology, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
| | - Ening Krisnuhoni
- Department of Anatomical Pathology, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Jakarta 10430, Republic of Indonesia
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3
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Jones BM, Villavisanis DF, Lehrer EJ, Dickstein DR, Sindhu KK, Misiukiewicz KJ, Posner M, Liu JT, Gupta V, Sharma S, Roof SA, Teng M, Genden EM, Bakst RL. High Failure Rates in Young Nonsmoker Nondrinkers With Squamous Cell Carcinoma of the Oral Tongue. Laryngoscope 2022; 133:1110-1121. [PMID: 35716359 DOI: 10.1002/lary.30253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE(S) There has been a disproportionate increase in the incidence of young patients with squamous cell carcinoma of the oral tongue (SCCOT). The purpose of this study was to compare young patients to older patients with SCCOT without prior drinking or smoking history as this population is poorly characterized in the literature. METHODS A retrospective review of patients presenting to our institution with SCCOT was performed. The clinical and pathologic characteristics, as well as, outcomes were compared between younger patients (age ≤45) and older patients (age >45). Outcome analysis was performed using Kaplan Meier method. Multivariable Cox proportional hazard models were performed for age and stage. RESULTS Eighty-two patients (38 young, 44 old) were included in this study. Median follow-up was 29.4 months. When compared to the older cohort (age >45), the younger cohort (age ≤45) demonstrated lower rates of 5-year locoregional control (LC) (79.6% vs. 52.5%, p = 0.043) and distant metastasis-free survival (88.1% vs. 61.8%, p = 0.006). Both cohorts demonstrated similar overall survival rates (55.5% vs. 58.1%) and disease-specific survival (66.2% vs. 58.1%). Of patients experiencing locoregional failure with available radiation therapy plans and PET scans in younger cohorts (n = 7), 100% demonstrated in-field failures. Multivariable Cox proportional hazards demonstrated age was an independent predictor of DMFS (p = 0.004) and the advanced stage was a predictor of DSS (p = 0.03). CONCLUSIONS Young, nondrinker, nonsmokers with SCCOT demonstrate high rates of locoregional recurrence, distant metastasis, and in-field failures. Future studies are warranted to determine underlying mechanisms driving pathogenesis in this unique cohort. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Brianna M Jones
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dillan F Villavisanis
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology - Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kunal K Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krzysztof J Misiukiewicz
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marshall Posner
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jerry T Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology - Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marita Teng
- Department of Otolaryngology - Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric M Genden
- Department of Otolaryngology - Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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4
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Kaminagakura E, Tango RN, Cruz-Perez D, Bonan R, Yamamoto de Almeida L, de Almeida Lança ML, Bonan P, Martins H, Takahama A, Ito FA, Coutinho-Camillo CM, Lourenço SV, Caneppele T, Sikora AG, Kowalski LP, Young S. Oral squamous cell carcinoma outcome in adolescent/young adult: Systematic review and meta-analysis. Head Neck 2021; 44:548-561. [PMID: 34808012 DOI: 10.1002/hed.26940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 12/24/2022] Open
Abstract
To perform a systematic review focusing on the prognosis of oral cavity squamous cell carcinoma (OSCC) in young patients (≤40 years old) compared to older (>40 years old). Four databases were used in our search strategy. First, all titles were systematically organized using the Covidence platform online. In the second phase, 118 full texts of potentially eligible studies were analyzed by reviewers independently and in pairs. Twelve studies were considered eligible for data extraction. The relapse was higher in the young than in controls (pooled relative risk (RR) = 1.31; 95% CI [1.10-1.56]). The 5-year disease-free survival (DFS) was worse in young group (pooled hazard ratio (HR) = 0.73; 95% CI [0.63-0.85]) but the 5-year overall survival (OS) estimate was similar between the groups (pooled HR = 0.84; 95% CI [0.70-1.00]). While the 5-year OS was similar between groups, the number of relapses and 5-year DFS were worse in patients with OSCC ≤40 years old.
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Affiliation(s)
- Estela Kaminagakura
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil.,Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rubens Nisie Tango
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Danyel Cruz-Perez
- Department of Clinical and Preventive Dentistry, School of Dentistry, Federal University of Pernambuco, Recife, Brazil
| | - Roberta Bonan
- Department of Clinical and Preventive Dentistry, School of Dentistry, Federal University of Pernambuco, Recife, Brazil
| | - Luciana Yamamoto de Almeida
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Araraquara, Brazil
| | - Maria Letícia de Almeida Lança
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Paulo Bonan
- Department of Clinical and Social Dentistry, School of Dentistry, Federal University of Paraíba, João Pessoa, Brazil
| | - Hélder Martins
- Department of Oral Pathology, School of Dentistry, University Federal do Rio Grande do Norte, Natal, Brazil
| | - Ademar Takahama
- Department of Oral Medicine and Pediatric Dentistry, State University of Londrina, Londrina, Brazil
| | - Fábio Augusto Ito
- Department of Oral Medicine and Pediatric Dentistry, State University of Londrina, Londrina, Brazil
| | | | | | - Taciana Caneppele
- Department of Restorative Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil
| | - Andrew G Sikora
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil.,Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Centre, São Paulo, Brazil
| | - Simon Young
- Department of Oral and Maxillofacial Surgery, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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5
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Lee DS, Ramirez RJ, Lee JJ, Valenzuela CV, Zevallos JP, Mazul AL, Puram SV, Doering MM, Pipkorn P, Jackson RS. Survival of Young Versus Old Patients With Oral Cavity Squamous Cell Carcinoma: A Meta-Analysis. Laryngoscope 2021; 131:1310-1319. [PMID: 33264444 PMCID: PMC8106620 DOI: 10.1002/lary.29260] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE/HYPOTHESIS To assess whether young patients with oral cavity squamous cell carcinoma (OCSCC) demonstrate worse oncologic outcomes than older patients after definitive therapy. STUDY DESIGN Systematic review and meta-analysis. METHODS A medical librarian composed a search strategy to identify relevant studies in Medline, Embase, Scopus, and other major databases (Prospero registration number CRD42019127974). Inclusion criteria were adults with histologically diagnosed OCSCC that underwent treatment, comparator groups with an age cutoff of 40 years old, and reported survival outcomes. Articles were excluded if they contained patients with oropharyngeal squamous cell carcinoma or patients treated for palliative intent. Overall survival hazard ratios were analyzed with a meta-analysis. RESULTS There were 23,382 patients with OCSCC that were treated with definitive therapy from 22 included studies. The pooled cohort contained 2,238 (10%) patients ≤40 years of age. Oral tongue was the most common subsite in both the younger (n = 1,961, 91%) and older (n = 18,047, 88%) cohorts. The majority of OCSCCs were either T1 or T2, representing 859 (80%) malignancies in younger patients and 8,126 (77%) malignancies in older patients. A meta-analysis of nine studies demonstrated that younger patients did not experience worse survival outcomes than older patients (hazard ratio = 0.97, 95% confidence interval = 0.66-1.41). CONCLUSIONS Young adults with OCSCC experienced similar oncologic outcomes as older patients with OCSCC after definitive treatment. Until compelling evidence demonstrates clinically relevant differences between these two cohorts, their approach to management should be similar. Future studies should consider comorbidities and using age 40 as a standard age cutoff to provide more uniform data moving forward. Laryngoscope, 131:1310-1319, 2021.
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Affiliation(s)
- David S. Lee
- Department of Otolaryngology- Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ricardo J. Ramirez
- Department of Otolaryngology- Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jake J. Lee
- Department of Otolaryngology- Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carla V. Valenzuela
- Department of Otolaryngology- Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jose P. Zevallos
- Department of Otolaryngology- Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Angela L. Mazul
- Department of Otolaryngology- Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sidharth V. Puram
- Department of Otolaryngology- Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michelle M. Doering
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology- Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan S. Jackson
- Department of Otolaryngology- Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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6
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Deneuve S, Guerlain J, Dupret-Bories A, Majoufre C, Philouze P, Ceruse P, Perreard M, Sigaud N, Barry B, Ransy P, Schultz P, Malard O, Morinière S, Chatellier A, De Monès E, Folia M, Virard F, Fervers B. Oral tongue squamous cell carcinomas in young patients according to their smoking status: a GETTEC study. Eur Arch Otorhinolaryngol 2021; 279:415-424. [PMID: 33877432 DOI: 10.1007/s00405-021-06793-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Incidence of oral tongue squamous cell carcinoma (OTSCC) is increasing, especially in young adults, despite decreasing tobacco and alcohol consumption. METHODS This multicentric retrospective study of 185 young adults with OTSCC (median follow-up 43 months), investigated risk factors, tumour characteristics and oncological outcomes according to the smoking status. RESULTS Overall, 38% of patients were smokers (S). Non-smokers (NS) were significantly younger than S. Sex ratios were 1.1 for N and 1.8 for S. NS patients were less frequently cannabis or alcohol users than S, but were more likely to have a history of leukoplakia. Second primaries were observed in NS (4.4%) and in S (12.7%). Despite more frequent local relapse in NS (p = 0.018), there was no difference in diagnostic stage and overall survival between groups. CONCLUSION OTSCC affects differently young S and NS patients suggesting the existence of a specific clinical entity of OTSCC in non-smoking young adults.
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Affiliation(s)
- Sophie Deneuve
- Surgical Oncology Department, Léon Bérard Comprehensive Cancer Center, 28 rue Laennec, 69008, Lyon, France. .,INSERM UA8, Radiation: Défense, Santé , Environnement, Lyon, France.
| | - Joanne Guerlain
- Head and Neck Department, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - Agnès Dupret-Bories
- Head and Neck Department, Toulouse University Cancer Institute, Toulouse, France
| | - Claire Majoufre
- Maxillofacial Surgery, CHU Bordeaux Pellegrin, Bordeaux, France
| | | | | | | | - Nicolas Sigaud
- Maxillofacial Surgery, CHU Lyon Sud, Pierre-Bénite, France
| | | | | | | | | | | | | | | | | | - François Virard
- INSERM U1052-CNRS UMR5286, Cancer Research Center, centre Léon Berard, Lyon 1 University, Lyon, France.,Université de Lyon, Faculté d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Béatrice Fervers
- INSERM UA8, Radiation: Défense, Santé , Environnement, Lyon, France.,Cancer and Environnement Department, Léon Bérard Comprehensive Cancer Center, Lyon, France
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7
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Ansarin M, De Berardinis R, Corso F, Giugliano G, Bruschini R, De Benedetto L, Zorzi S, Maffini F, Sovardi F, Pigni C, Scaglione D, Alterio D, Cossu Rocca M, Chiocca S, Gandini S, Tagliabue M. Survival Outcomes in Oral Tongue Cancer: A Mono-Institutional Experience Focusing on Age. Front Oncol 2021; 11:616653. [PMID: 33912446 PMCID: PMC8075362 DOI: 10.3389/fonc.2021.616653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objective The prognostic role of age among patients affected by Oral Tongue Squamous Cell Carcinoma (OTSCC) is a topic of debate. Recent cohort studies have found that patients diagnosed at 40 years of age or younger have a better prognosis. The aim of this cohort study was to clarify whether age is an independent prognostic factor and discuss heterogeneity of outcomes by stage and treatments in different age groups. Methods We performed a study on 577 consecutive patients affected by primary tongue cancer and treated with surgery and adjuvant therapy according to stage, at European Institute of Oncology, IRCCS. Patients with age at diagnosis below 40 years totaled 109 (19%). Overall survival (OS), disease-free survival (DFS), tongue specific free survival (TSFS) and cause-specific survival (CSS) were compared by age groups. Multivariate Cox proportional hazards models were used to assess the independent role of age. Results The median follow-up time was 5.01 years (range 0–18.68) years with follow-up recorded up to February 2020. After adjustment for all the significant confounding and prognostic factors, age remained independently associated with OS and DSF (respectively, p = 0.002 and p = 0.02). In CSS and TSFS curves, the role of age seems less evident (respectively, p = 0.14 and p = 0.0.37). In the advanced stage sub-group (stages III–IV), age was significantly associated with OS and CSS with almost double increased risk of dying (OS) and dying from tongue cancer (CSS) in elderly compared to younger groups (OS: HR = 2.16 95%, CI: 1.33–3.51, p= 0.001; CSS: HR = 1.76 95%, CI: 1.03–3.01, p = 0.02, respectively). In our study, young patients were more likely to be treated with intensified therapies (glossectomies types III–V and adjuvant radio-chemotherapy). Age was found as a prognostic factor, independently of other significant factors and treatment. Also the T–N tract involved by disease and neutrophil-to-lymphocyte ratio ≥3 were independent prognostic factors. Conclusions Young age at diagnosis is associated with a better overall survival. Fewer younger people than older people died from tongue cancer in advanced stages.
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Affiliation(s)
- Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Corso
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Mathematics, DMAT, Politecnico di Milano, Milan, Italy.,Center for Analysis Decisions and Society, CADS, Human Technopole, Milan, Italy
| | - Gioacchino Giugliano
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Bruschini
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luigi De Benedetto
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Zorzi
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fausto Maffini
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabio Sovardi
- Department of Otorhinolaryngology, Policlinico San Matteo, IRCCS, Pavia, Italy
| | - Carolina Pigni
- Department of Otorhinolaryngology, ASST Ovest Milanese, Legnano, Italy
| | - Donatella Scaglione
- Division of Data Manager, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Daniela Alterio
- Division of Radiotherapy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Cossu Rocca
- Department of Medical Oncology, Urogenital and Head and Neck Tumors Medical Treatment, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Susanna Chiocca
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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8
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Clinicopathologic Characteristics of Young Patients with Oral Squamous Cell Carcinoma. Head Neck Pathol 2021; 15:1099-1108. [PMID: 33797696 PMCID: PMC8633158 DOI: 10.1007/s12105-021-01320-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/23/2021] [Indexed: 12/16/2022]
Abstract
Oral squamous cell carcinoma (OSCC) occasionally occurs in young patients and is likely to be distinct from OSCC in older patients. In this retrospective study, we described the clinicopathologic features and outcome of 150 OSCCs that were diagnosed in patients 40-year-old or younger. Most patients (63%) were non-smokers. The most common site of the primary tumor was oral tongue (n = 131, 87%), followed by gingiva (n = 9), buccal mucosa (n = 8) and lip (n = 2). The median patients' age at presentation was 34 (range: 16-40). Seven patients (5%) had Fanconi anemia with the gingiva being the most common location (4/7, 57%). All OSCCs were of keratinizing type. All cases tested for high-risk HPV (n = 34) were negative. On univariate analysis, high tumor budding was associated with decreased overall survival (OS) and distant metastasis free survival (DMFS), pattern of invasion correlated with OS and tumors with high stromal tumor infiltrating lymphocytes (sTIL) were associated with improved locoregional recurrence free survival (LRFS). Compared with patients 31 to 40-year-old, OSCC in the younger group was associated with significant less alcohol consumption (p = 0.011) and decreased DSS (p = 0.003) and DMFS (p = 0.023). On multivariate analysis, younger age (30 years or younger) was an independent prognostic factor for worse OS and DSS, whereas histologic grade was an independent prognostic factor for DSS. In summary, most OSCC in young patients occurred in non-smokers and did not occur in association with Fanconi anemia. Independent prognostic factors included age at presentation (30 years or younger) for OS and DSS, and histologic grade for DSS.
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9
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Tagliabue M, Belloni P, De Berardinis R, Gandini S, Chu F, Zorzi S, Fumagalli C, Santoro L, Chiocca S, Ansarin M. A systematic review and meta-analysis of the prognostic role of age in oral tongue cancer. Cancer Med 2021; 10:2566-2578. [PMID: 33760398 PMCID: PMC8026930 DOI: 10.1002/cam4.3795] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 01/30/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022] Open
Abstract
While evidence suggests an increasing incidence of tongue cancer in young adults, published findings regarding the prognostic role of age at diagnosis are inconsistent. We performed a meta-analysis of the literature to highlight key points that might help in understanding the association between age of oral tongue cancer patients at diagnosis and their prognosis. According to age at diagnosis, a systematic literature review of all published cohort studies assessing the recurrence risks and mortality associated with tongue cancer was conducted. We compared the risk estimates between patients aged >45 years and those aged <45 years at diagnosis. Random-effects models were used to calculate summary relative risk estimates (SRRs) according to different clinical outcomes and sources of between-study heterogeneity (I2 ) and bias. We included 31 independent cohort studies published between 1989 and 2019; these studies included a total of 28,288 patients. When risk estimations were not adjusted for confounders, no significant association was found between age at diagnosis and overall survival (OS). Conversely, after adjustment for confounders, older age at diagnosis was associated with a significantly increased risk of mortality. The difference between SRRs for adjusted and unadjusted estimates was significant (p < 0.01). Younger patients had a significantly higher risk of local recurrence. Younger patients with oral tongue cancer have better OS but a greater risk of recurrence than older patients. These findings should be validated in a large prospective cohort study which considers all confounders and prognostic factors.
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Affiliation(s)
- Marta Tagliabue
- Division of Otolaryngology and Head and Neck SurgeryIEOEuropean Institute of Oncology IRCCSMilanItaly
| | - Pietro Belloni
- Department of Experimental OncologyIEOEuropean Institute of Oncology IRCCSMilanItaly
- Department of Statistical SciencesUniversity of PaduaPaduaItaly
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck SurgeryIEOEuropean Institute of Oncology IRCCSMilanItaly
| | - Sara Gandini
- Department of Experimental OncologyIEOEuropean Institute of Oncology IRCCSMilanItaly
| | - Francesco Chu
- Division of Otolaryngology and Head and Neck SurgeryIEOEuropean Institute of Oncology IRCCSMilanItaly
| | - Stefano Zorzi
- Division of Otolaryngology and Head and Neck SurgeryIEOEuropean Institute of Oncology IRCCSMilanItaly
| | | | | | - Susanna Chiocca
- Department of Experimental OncologyIEOEuropean Institute of Oncology IRCCSMilanItaly
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck SurgeryIEOEuropean Institute of Oncology IRCCSMilanItaly
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10
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Young age is not a predictor of disease specific survival in oral cancer: A multi-institutional study. Oral Oncol 2021; 115:105162. [PMID: 33548861 DOI: 10.1016/j.oraloncology.2020.105162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/18/2020] [Accepted: 12/20/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Over the last few decades evidence has accumulated for increasing incidence of oral cavity squamous cell carcinoma (OSCC) in a younger cohort. Prior studies examining the effect of age at diagnosis on prognosis have produced conflicting data. METHODS A multi-institutional cohort study was performed across 6 different sites in Australia, Canada, India and Singapore. Disease-free (DFS), overall (OS) and disease-specific (DSS) survival were analysed. The association of the number of adverse features with survival outcomes was investigated. RESULTS From 3179 patients, age was a significant predictor of OS with patients older than 45 years having a 66% increased risk of death (HR 1.66, 95%CI 1.33 - 2.07, p < 0.001). The number of adverse features was a significant predictor of OS with 3 or more adverse features having a 199% increased risk (HR 2.99, 95%CI 2.61-3.43. p < 0.001). The estimate effect was greater in patients ≤ 45 years (HR 3.49 vs HR 2.81). Age was not a significant predictor of DSS with similar rates of death from OSCC in multivariable models. The number of adverse features was a significant predictor of DFS with ≥ 3 adverse features having a 140% increased risk of death. The number of adverse features was a significant predictor of DSS with ≥ 3 adverse features having a 230% increased risk of disease specific death. CONCLUSIONS Age is not an independent predictor of disease specific mortality in OSCC. Differences in outcomes are due to the confounding effect of adverse clinicopathological features and the ability to tolerate surgery and adjuvant therapy.
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11
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Squamous Cell Carcinoma of the Oral Tongue in Young Patients: Outcomes and Implications for Treatment. Indian J Surg Oncol 2020; 11:274-280. [PMID: 32523275 DOI: 10.1007/s13193-020-01049-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 01/29/2020] [Indexed: 10/24/2022] Open
Abstract
Squamous cell carcinoma oral tongue (SCCOT) in patients below 45 years is relatively uncommon in literature; however, there have been increasing trends in incidence. Previous studies showed conflicting data, with no conclusive evidence of differences in outcome compared with older patients. The aim of our study was to determine if younger patients with tongue cancer in India had different clinico-pathological characteristics, prognostic determinants or survival than their older counterparts. Retrospective analysis of 425 adult patients of SCCOT, with 114 patients < 45 years of age (younger group) and 311 patients ≥ 45 years of age (older group), treated with surgery and adjuvant as indicated. Clinical and pathological features were described. Survival analysis was performed using Kaplan Meier's method and multivariate analysis was performed for recurrence and survival using Cox proportional hazards ratio. Younger patients had a higher incidence of adverse pathological features (APFs) like lymphovascular invasion (p = 0.01), perineural invasion (p = 0.009), poorer differentiation (p = 0.044), nodal involvement (p = 0.021), extranodal extension (p = 0.003) and local recurrence (p = 0.008). All of these factors were noted to impact survival. However, on multivariate analysis for APFs, age was not an independent predictor of recurrence or survival. Younger patients with squamous cell carcinoma of tongue have an increased risk of APFs and local recurrence. The clinical observation that young patients have a worse outcome is likely due to the association of APFs rather than age being an independent prognostic factor. Further study is required to show if tumour biology in this cohort is distinct.
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12
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Tagliabue M, Gandini S, Maffini F, Navach V, Bruschini R, Giugliano G, Lombardi F, Chiocca S, Rebecchi E, Sica E, Tommasino M, Calabrese L, Ansarin M. The role of the T-N tract in advanced stage tongue cancer. Head Neck 2019; 41:2756-2767. [PMID: 30942940 DOI: 10.1002/hed.25761] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/11/2019] [Accepted: 03/18/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We investigated the role of the soft tissue tract between the primary tumor and the neck lymph nodes, the "T-N tract," in patients with tongue squamous cell carcinoma at an advanced stage. METHODS We performed a compartmental tongue surgery in 233 patients. Cumulative incidence of relapses and overall survival curves were compared by T-N tract involvement. Multivariate Cox proportional hazards models were used to assess the independent role of T-N tract. RESULTS At 4 years of follow-up, patients with disease in the T-N tract experienced a significantly more distant recurrence (40%) than did patients without T-N tract involvement (22%; P = .02). Multivariate Cox models indicate a significant almost triple risk of distant metastases (hazard ratio [HR], 2.70; 95% CI, 1.01-7.19; P = .05) and double risk of death (HR, 2.09; 95%CI, 1.13-3.85; P = .02) in patients with "T-N tract involvement." CONCLUSIONS Our data show that the T-N tract plays an important role in prognosis and survival in patients with tongue cancer.
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Affiliation(s)
- Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Fausto Maffini
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Navach
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Bruschini
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Gioacchino Giugliano
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Lombardi
- Division of Data Manager, European Institute of Oncology IRCCS, Milan, Italy
| | - Susanna Chiocca
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Elisabetta Rebecchi
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Eleonora Sica
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi, Ospedale di circolo Fondazione Macchi, Varese, Italy
| | - Massimo Tommasino
- Infections and Cancer Biology Group, International Agency for Research on Cancer, Course Albert Thomas 150, Lyon, France
| | - Luca Calabrese
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
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13
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Borba Ribeiro KR, Lira Júnior C, Marinho SA, Carvalho SHG, Agripino GG, Sarmento DJDS. Epidemiological profile of young patients with squamous cell carcinoma in northeast Brazil. ACTA ACUST UNITED AC 2019; 10:e12436. [DOI: 10.1111/jicd.12436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 05/11/2019] [Accepted: 06/07/2019] [Indexed: 12/18/2022]
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14
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Kapali AS, George NA, Iype EM, Thomas S, Varghese BT, Balagopal PG, Sebastian P. Retrospective Outcome Analysis of Buccal Mucosal and Lower Alveolar Squamous Cell Carcinoma from a High-Volume Tertiary Cancer Centre. Indian J Surg Oncol 2019; 10:286-291. [PMID: 31168249 DOI: 10.1007/s13193-019-00896-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022] Open
Abstract
To evaluate treatment outcome and factors affecting locoregional control and distant metastasis in buccal mucosal and lower alveolar squamous cell carcinoma. A retrospective analysis of all diagnosed cases of buccal mucosal and lower alveolar squamous cell carcinoma in patients who underwent surgical treatment in 2011 was included from the data base. The patients were analysed for their habits, trismus, skin and bone involvement, neck nodes, type of surgery for primary and nodes, differentiation of tumour, pathological nodal status, recurrence site, and duration after completion of treatment and follow-up. A total of 114 patients were included in the study. The mean duration of follow-up was 23.8 months. On follow-up, 30 patients had recurrence (26.32%) either locoregional or distant metastasis. Age less than 45 years, nodal positivity, presence of perineural invasion, extracapsular spread, and degree of differentiation were found to be statistically significant by univariate analysis (p < 0.05). On multivariate analysis, node positivity and presence of perineural invasion emerged as independent predictors of recurrence. Cox regression analysis showed trismus, node positivity, and perineural invasion are significantly associated with recurrence. Aggressive multimodality treatment achieves good local control rates even in locally advanced disease, and the intent of treatment should be curative. Node positivity, presence of perineural invasion, and presence of trismus are found as independent predictors of recurrence. Clinically, presence of trismus is associated with poorer outcomes in view of higher stage.
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Affiliation(s)
- Aravind S Kapali
- 1Department of Surgical Oncology, M S Ramaiah Medical College and Teaching Hospitals, M S Ramaiah Nagar, MSRIT Post, Bengaluru, 560 054 India
| | - N A George
- 2Regional Cancer Centre, Trivandrum, 695 011 India.,3Head and Neck Service, Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, 695 011 India
| | - E M Iype
- 2Regional Cancer Centre, Trivandrum, 695 011 India.,3Head and Neck Service, Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, 695 011 India
| | - S Thomas
- 2Regional Cancer Centre, Trivandrum, 695 011 India.,3Head and Neck Service, Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, 695 011 India
| | - B T Varghese
- 2Regional Cancer Centre, Trivandrum, 695 011 India.,3Head and Neck Service, Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, 695 011 India
| | - P G Balagopal
- 2Regional Cancer Centre, Trivandrum, 695 011 India.,3Head and Neck Service, Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, 695 011 India
| | - P Sebastian
- 2Regional Cancer Centre, Trivandrum, 695 011 India.,3Head and Neck Service, Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, 695 011 India
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Porcheri C, Meisel CT, Mitsiadis T. Multifactorial Contribution of Notch Signaling in Head and Neck Squamous Cell Carcinoma. Int J Mol Sci 2019; 20:E1520. [PMID: 30917608 PMCID: PMC6471940 DOI: 10.3390/ijms20061520] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/20/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) defines a group of solid tumors originating from the mucosa of the upper aerodigestive tract, pharynx, larynx, mouth, and nasal cavity. It has a metastatic evolution and poor prognosis and is the sixth most common cancer in the world, with 600,000 new cases reported every year. HNSCC heterogeneity and complexity is reflected in a multistep progression, involving crosstalk between several molecular pathways. The Notch pathway is associated with major events supporting cancerogenic evolution: cell proliferation, self-renewal, angiogenesis, and preservation of a pro-oncogenic microenvironment. Additionally, Notch is pivotal in tumor development and plays a dual role acting as both oncogene and tumor suppressor. In this review, we summarize the role of the Notch pathway in HNSCC, with a special focus on its compelling role in major events of tumor initiation and growth.
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Affiliation(s)
- Cristina Porcheri
- University of Zurich, Institute of Oral Biology, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
| | - Christian Thomas Meisel
- University of Zurich, Institute of Oral Biology, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
| | - Thimios Mitsiadis
- University of Zurich, Institute of Oral Biology, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
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16
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Campbell BR, Sanders CB, Netterville JL, Sinard RJ, Rohde SL, Langerman A, Mannion K, Kim YJ, Murphy BA, Lewis JS, Warner JL, Smith DK, Lang Kuhs KA. Early onset oral tongue squamous cell carcinoma: Associated factors and patient outcomes. Head Neck 2019; 41:1952-1960. [PMID: 30633435 DOI: 10.1002/hed.25650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/15/2018] [Accepted: 12/21/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Incidence of oral tongue squamous cell carcinoma (OTC) is rising among those under age 50 years. The etiology is unknown. METHODS A total of 395 cases of OTC diagnosed and/or treated at Vanderbilt University Medical Center between 2000 and 2017 were identified. Of those, 113 (28.6%) were early onset (age < 50 years). Logistic regression was used to identify factors associated with early onset OTC. Cox proportional hazards models evaluated survival and recurrence. RESULTS Compared to typical onset patients, patients with early onset OTC were more likely to receive multimodality treatment (surgery and radiation; adjusted odds ratio [aOR], 2.7; 95% confidence interval [CI], 1.2-6.3) and report a history of snuff use (aOR, 5.4; 95% CI, 1.8-15.8) and were less likely to report a history of cigarette use (aOR, 0.5; 95% CI, 0.2-0.9). Early onset patients had better overall survival (adjusted hazard ratio, 0.6). CONCLUSIONS This is the largest study to evaluate factors associated with early onset OTC and the first to report an association with snuff.
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Affiliation(s)
| | | | - James L Netterville
- Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, Tennessee, USA
| | - Robert J Sinard
- Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, Tennessee, USA
| | - Sarah L Rohde
- Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, Tennessee, USA
| | - Alexander Langerman
- Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, Tennessee, USA
| | - Kyle Mannion
- Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, Tennessee, USA
| | - Young J Kim
- Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, Tennessee, USA
| | - Barbara A Murphy
- Vanderbilt University Medical Center, Department of Medicine, Division of Hematology and Oncology, Nashville, Tennessee, USA
| | - James S Lewis
- Vanderbilt University Medical Center, Department of Pathology, Microbiology, and Immunology, Nashville, Tennessee, USA
| | - Jeremy L Warner
- Vanderbilt University Medical Center, Department of Medicine, Division of Hematology and Oncology, Nashville, Tennessee, USA
| | - Derek K Smith
- Vanderbilt University Medical Center, Department of Biostatistics, Nashville, Tennessee, USA
| | - Krystle A Lang Kuhs
- Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, Tennessee, USA
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17
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Mohideen K, Krithika C, Jeddy N, Bharathi R, Thayumanavan B, Sankari SL. Meta-analysis on risk factors of squamous cell carcinoma of the tongue in young adults. J Oral Maxillofac Pathol 2019; 23:450-457. [PMID: 31942130 PMCID: PMC6948024 DOI: 10.4103/jomfp.jomfp_118_19] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Tongue squamous cell carcinoma (TSCC) generally affects the older age group exposed to tobacco for an extended period. However, recent research points out that there is an increased incidence of TSCC in the younger age group without any traditional risk factors making TSCC as a distinct biological entity in this group. This study aims to assess the prevalence and risk factors of tongue carcinoma in the younger group of patients. This article included studies that addressed the TSCC involving young patients and that which are PubMed indexed. Initially, 390 articles were considered; but after refined evaluation, 123 articles had their titles and abstracts matching to this present work. After the extraction of the case reports, review articles and the articles without the assessment of the parameter of harmful habits, we have included only 23 articles in the sample matching the title. The statistical analysis was formed by using chi-square tests using IBM SPSS ver. 20.0. The cohort of the younger population in these studies was mostly in the 35- to the 45-year age group. The majority of reports (64%) classified the patients below 40 years of age as a young group. Though male predominance is reported to be 55%, female patients are also more affected (40%) in the younger age group compared with, the more typical and usual group of head and neck carcinoma patients. TSCC in older adults predominantly reported in tobacco users (70%) whereas in young adults, TSCC was associated with a higher incidence in nonsmokers (53%); the causes of these cancers in young adults remain unclear. The identification of the potential risk factors aside from traditional factors is vital to control the incidence of TSCC in young patients.
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Affiliation(s)
- Khadijah Mohideen
- Department of Oral Pathology and Microbiology, Dr. M.G.R. Educational and Research Institute, Chennai, Tamil Nadu, India
| | - C Krithika
- Department of Oral Medicine and Radiology, Dr. M.G.R. Educational and Research Institute, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Nadeem Jeddy
- Department of Oral Pathology and Microbiology, Dr. M.G.R. Educational and Research Institute, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - R Bharathi
- Department of Oral Pathology and Microbiology, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - B Thayumanavan
- Department of Oral Pathology and Microbiology, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
| | - S Leena Sankari
- Department of Oral Pathology and Microbiology, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
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18
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Campbell BR, Netterville JL, Sinard RJ, Mannion K, Rohde SL, Langerman A, Kim YJ, Lewis JS, Lang Kuhs KA. Early onset oral tongue cancer in the United States: A literature review. Oral Oncol 2018; 87:1-7. [PMID: 30527223 PMCID: PMC7039330 DOI: 10.1016/j.oraloncology.2018.10.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/04/2018] [Accepted: 10/06/2018] [Indexed: 12/11/2022]
Abstract
The incidence of early onset oral tongue squamous cell carcinoma (OTC) has been increasing in the United States, and no clear etiology has been identified. Studies on this topic have generally been small and presented varied results. The goal of this review is to analyze and synthesize the literature regarding early onset OTC risk factors, outcomes, and molecular analyses within the US. To date, studies suggest that early onset OTC patients tend to have less heavy cigarette use than typical onset patients, but there may be an association between early onset OTC and smokeless tobacco (chewing tobacco and snuff) use. Early onset OTC is associated with similar or possibly improved survival compared to typical onset OTC. There has been no evidence to support a significant role for human papillomavirus in development of early onset OTC. Further research with larger cohorts of these patients is needed to better characterize this disease entity.
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Affiliation(s)
- Benjamin R Campbell
- Vanderbilt University School of Medicine, 1161 21st Ave S #D3300, Nashville, TN 37232, USA.
| | - James L Netterville
- Vanderbilt University Medical Center, Department of Otolaryngology, 1215 21st Ave S, Nashville, TN 37232, USA.
| | - Robert J Sinard
- Vanderbilt University Medical Center, Department of Otolaryngology, 1215 21st Ave S, Nashville, TN 37232, USA.
| | - Kyle Mannion
- Vanderbilt University Medical Center, Department of Otolaryngology, 1215 21st Ave S, Nashville, TN 37232, USA.
| | - Sarah L Rohde
- Vanderbilt University Medical Center, Department of Otolaryngology, 1215 21st Ave S, Nashville, TN 37232, USA.
| | - Alexander Langerman
- Vanderbilt University Medical Center, Department of Otolaryngology, 1215 21st Ave S, Nashville, TN 37232, USA.
| | - Young J Kim
- Vanderbilt University Medical Center, Department of Otolaryngology, 1215 21st Ave S, Nashville, TN 37232, USA.
| | - James S Lewis
- Vanderbilt University Medical Center, Department of Otolaryngology, 1215 21st Ave S, Nashville, TN 37232, USA; Vanderbilt University Medical Center, Department of Pathology, Microbiology, and Immunology, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Krystle A Lang Kuhs
- Vanderbilt University Medical Center, Department of Otolaryngology, 1215 21st Ave S, Nashville, TN 37232, USA; Vanderbilt University Medical Center, 2525 West End Ave, Suite 300, Nashville, TN, 37203, USA.
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19
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Treatment outcomes of squamous cell carcinoma of the oral cavity in young adults. Oral Oncol 2018; 87:43-48. [DOI: 10.1016/j.oraloncology.2018.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/10/2018] [Accepted: 10/14/2018] [Indexed: 11/19/2022]
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20
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Farquhar DR, Tanner AM, Masood MM, Patel SR, Hackman TG, Olshan AF, Mazul AL, Zevallos JP. Oral tongue carcinoma among young patients: An analysis of risk factors and survival. Oral Oncol 2018; 84:7-11. [PMID: 30115478 DOI: 10.1016/j.oraloncology.2018.06.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/14/2018] [Accepted: 06/16/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The incidence of oral tongue squamous cell carcinoma (OTSCC) in younger adults has rapidly increased over the past two decades. While tobacco and alcohol use may be less likely to cause these tumors, it remains controversial whether differences also exist in their prognosis. Our aim is to examine the risk factors for cancer among young (<45 years old) OTSCC patients at our institution, and to compare their recurrence and survival with older patients in a matched cohort. MATERIALS AND METHODS All OTSCC patients seen at our institution between 2000 and 2015 were reviewed. Patients under 45 who with sufficient treatment information were matched 1:1 on race, T-stage, and N-stage with patients 45 and older. Three-year recurrence and survival were determined in stratified and adjusted Cox regression models. RESULTS Of 397 OTSCC patients were seen at our institution, 117 (29%) were less than 45 years old. Younger patients were significantly more likely to be female, (50% vs. 39%; p = 0.04) and to abstain from tobacco (51% vs. 39%; p < 0.01). Young patients in the matched cohort were significantly more likely to have a recurrence (HR 3.9 95% CI 1.4-10.5). There was no difference in overall survival. CONCLUSION Younger OTSCC patients in a matched cohort were more likely to recur within 3 years, although there was no difference in overall mortality. Differences in risk factors and recurrence between older and younger patients suggest that some cancer among younger patients may be distinct from traditional OTSCC.
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Affiliation(s)
- Douglas R Farquhar
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States.
| | - April M Tanner
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Maheer M Masood
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Sagar R Patel
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Trevor G Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, MO, United States
| | - Jose P Zevallos
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, MO, United States
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21
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Qin SH, Li XM, Li WL. [Influencing factors on the quality of life and medical coping style of patients with oral cancer]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2018; 36:271-276. [PMID: 29984927 PMCID: PMC7030301 DOI: 10.7518/hxkq.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/15/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the influencing factors on the postoperative quality of life and to analyze the coping styles of patients with oral cancer. METHODS A total of 131 oral cancer cases confirmed through diagnostic criteria were investigated to analyze the influencing factors on the quality of life (QOL) and the relationship between coping style and QOL of these patients by using the fourth edition of the University of Washington Quality of Life Questionnaire (UWQOL) and medical coping modes questionnaires (MCMQ), respectively. RESULTS Among the 131 questionnaires collected, only 126 were valid with a recovery rate of 96.18% (126/131). Single factor analysis showed that age, marital status, educational level, other systemic diseases, personal income level, tooth loss, operation times, adjuvant radiotherapy, cancer staging, cervical lymph node dissection, recurrence, and jaw resection yielded different UWQOL scale scores (P<0.05). Multiple regression analysis showed that the loss of teeth, cancer staging, recurrence, and jaw resection yielded statistically significant differences in the total score of UWQOL (P<0.05). Among the coping styles, the average scores of "confrontation", "avoidance", and "yielding" were 17.54±4.97, 17.79±2.19, and 12.97±5.70, respectively. Compared with the norm, the difference was statistically significant (P<0.05). Correlation analysis showed that "confrontation" and "avoidance" were positively correlated, whereas "yielding" was negatively correlated to QOL (P<0.05). CONCLUSIONS Age, marital status, educational level, other systemic diseases, personal income level, tooth loss, operation times, adjuvant radiotherapy, cancer staging, cervical lymph node dissection, recurrence, and jaw resection have different effects on the quality of QOL. Tooth loss, cancer staging, recurrence, and jaw resection are the main causative factors affecting the patients' perceived QOL. Personalized treatment and nursing care should be strengthened to improve the coping style and quality of life of patients.
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Affiliation(s)
- Shuai-Hua Qin
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xin-Ming Li
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Wen-Lu Li
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Appah EO, Ballard BR, Izban MG, Jolin C, Lammers PE, Parrish Jr DD, Marshall DR. A rapidly growing human papillomavirus-positive oral tongue squamous cell carcinoma in a 21-year old female: A case report. Oncol Lett 2018; 15:7702-7706. [PMID: 29849799 PMCID: PMC5962839 DOI: 10.3892/ol.2018.8339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/01/2017] [Indexed: 11/06/2022] Open
Abstract
Oral tongue squamous cell carcinoma (OTSCC) has a median age at diagnosis of 62 years. The incidence of OTSCC in young adults has been increasing, and the reason is unclear. The present study describes a case, and molecular analysis, of OTSCC in a 21-year-old female. Clinical and pathological information were collected from medical records. Formalin-fixed paraffin-embedded biopsy tissue from the patient was reassessed using standard hematoxylin & eosin staining, and immunohistochemistry was used to assess the expression of cellular p16, MutL homolog (MLH)1, MLH2, MutS homolog 6 (MSH6) and PMS1 homolog 2 (PMS2). The human papilloma virus (HPV) genome was detected by PCR analysis of the extracted DNA. The young age of the patient with OTSCC was unusual. The original pathology report indicated koilocytotic atypia, a cellular abnormality associated with HPV. Although HPV-positive oral cancer tends to occur in 'younger' individuals, 21 years is unusual. The confirmation of biologically active HPV in the tumor was obtained via the observation of strong positive staining for cellular p16. The patient described a maternal family cluster of rare cancer types, thus the possibility that this rapidly growing cancer resulted from HPV infection combined with an underlying genetic mutation causing decreased DNA-mismatch repair was explored. However, MSH1, MSH2, MSH6 and PSM2, proteins that are associated with Lynch Syndrome, were expressed at normal levels. A rapidly growing OTSCC of a 21-year-old female was determined to be HPV-positive. The patient underwent combination chemotherapy and radiation and has experienced long-term survival without recurrence. The reason this tumor grew so quickly in such a young individual remains unknown. These types of cases warrant additional genomic and proteomic studies to improve understanding of this phenomenon.
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Affiliation(s)
- Ebenezer O. Appah
- Department of Internal Medicine, Meharry Medical College, Nashville, TN 37208, USA
| | - Billy Ray Ballard
- Department of Pathology, Anatomy and Cell Biology, Meharry Medical College, Nashville, TN 37208, USA
| | - Michael G. Izban
- Department of Pathology, Anatomy and Cell Biology, Meharry Medical College, Nashville, TN 37208, USA
| | - Cassandra Jolin
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA
| | - Philip E. Lammers
- Department of Internal Medicine, Meharry Medical College, Nashville, TN 37208, USA
| | - Dwight D. Parrish Jr
- Department of Pathology, Anatomy and Cell Biology, Meharry Medical College, Nashville, TN 37208, USA
| | - Dana R. Marshall
- Department of Pathology, Anatomy and Cell Biology, Meharry Medical College, Nashville, TN 37208, USA,Correspondence to: Dr Dana R. Marshall, Department of Pathology, Anatomy and Cell Biology, Meharry Medical College, 1005 Dr. DB Todd Jr. Boulevard, Nashville, TN 37208, USA, E-mail:
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Hasegawa H, Kusumi Y, Asakawa T, Maeda M, Oinuma T, Furusaka T, Oshima T, Esumi M. Expression of von Hippel-Lindau tumor suppressor protein (pVHL) characteristic of tongue cancer and proliferative lesions in tongue epithelium. BMC Cancer 2017; 17:381. [PMID: 28549422 PMCID: PMC5446680 DOI: 10.1186/s12885-017-3364-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 05/17/2017] [Indexed: 12/15/2022] Open
Abstract
Background Patients with tongue cancer frequently show loss of heterozygosity (LOH) of the von Hippel–Lindau (VHL) tumor suppressor gene. However, expression of VHL protein (pVHL) in tongue cancer has rarely been investigated and remains largely unknown. We performed immunohistochemical staining of pVHL in tongue tissues and dysplasia, and examined the association with LOH and its clinical significance. Methods Immunohistochemical staining of pVHL in formalin-fixed, paraffin-embedded sections of cancerous and other tissues from 19 tongue cancer patients showed positivity for LOH of VHL in four samples, negativity in four samples, and was non-informative in 11 samples. The staining pattern of pVHL was also compared with those of cytokeratin (CK) 13 and CK17. Results In normal tongue tissues, pVHL staining was localized to the cytoplasm of cells in the basal layer and the area of the spinous layer adjacent to the basal layer of stratified squamous epithelium. Positive staining for pVHL was observed in the cytoplasm of cancer cells from all 19 tongue cancer patients. No differences as a result of the presence or absence of LOH were found. Notably, cytoplasm of poorly differentiated invasive cancer cells was less intensely stained than that of well and moderately differentiated invasive cancer cells. pVHL staining was also evident in epithelial dysplasia lesions with pVHL-positive cells expanding from the basal layer to the middle of the spinous layer. However, no CK13 staining was noted in regions of the epithelium, which were positive for pVHL. In contrast, regions with positive staining for CK17 closely coincided with those positive for pVHL. Conclusions Positive staining for pVHL was observed in cancerous areas but not in normal tissues. pVHL expression was also detected in lesions of epithelial dysplasia. These findings suggest that pVHL may be a useful marker for proliferative lesions. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3364-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hisashi Hasegawa
- Deparment of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yoshiaki Kusumi
- Department of Pathology, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takeshi Asakawa
- Deparment of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Miyoko Maeda
- Deparment of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Toshinori Oinuma
- Department of Pathology, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tohru Furusaka
- Deparment of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Takeshi Oshima
- Deparment of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Mariko Esumi
- Department of Pathology, Nihon University School of Medicine, 30-1 Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
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Vigneswaran N, Williams MD. Epidemiologic trends in head and neck cancer and aids in diagnosis. Oral Maxillofac Surg Clin North Am 2015; 26:123-41. [PMID: 24794262 DOI: 10.1016/j.coms.2014.01.001] [Citation(s) in RCA: 541] [Impact Index Per Article: 60.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Head and neck squamous cell carcinoma is the sixth most common cancer worldwide predominately associated with tobacco use. Changing cause and increased incidence in oropharyngeal carcinomas is associated with high-risk types of human papilloma virus and has an improved survival. Optical devices may augment visual oral examination; however, their lack of specificity still warrants tissue evaluation/biopsy. Histologic factors of oral carcinomas are critical for patient management and prognostic determination. Clinical biomarkers are still needed to improve early detection, predict malignant transformation, and optimize therapies.
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Affiliation(s)
- Nadarajah Vigneswaran
- Oral and Maxillofacial Pathology Biopsy Service, The University of Texas School of Dentistry at Houston, 1941 East Road BBSB, Room 5320, Houston, TX 77054, USA.
| | - Michelle D Williams
- Surgical Pathology Fellowship Program, Head & Neck Section, Department of Pathology, UT MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit #085, Houston, TX 77030, USA
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CD147 and Ki-67 overexpression confers poor prognosis in squamous cell carcinoma of oral tongue: a tissue microarray study. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119:553-65. [PMID: 25747176 DOI: 10.1016/j.oooo.2014.12.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Squamous cell carcinoma of the oral tongue (SCCOT) exhibits high risk for recurrence and regional metastasis even after surgical resection. We assessed the clinicopathologic and prognostic significance of a group of functionally related biomarkers. STUDY DESIGN We used a tissue microarray consisting of SCCOT from 32 patients for this study. These patients were treated at the University of Texas MD Anderson Cancer Center from 1995 to 2008. Biomarker expression levels were examined by immunohistochemistry and graded semiquantitatively to determine their prognostic significance. RESULTS CD147 and Tp63 expressions were significantly associated with a higher T stage and Ki-67 labeling index, as well as a shorter overall survival (OS) rate. Expression of Tp63 associated positively with poorly differentiated histology. There was significant association of Tp63 with the expression levels of CD147 and Glut-1. Glut-1 overexpression was marginally associated with a higher T stage. There was no prognostic significance of CD44 v6 expression in SCCOT. CONCLUSION SCCOT with CD147 overexpression in combination with high Ki-67 labeling index had poor OS. CD147 and Ki-67 overexpression is associated with aggressive disease with poor prognosis in SCCOT.
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26
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Ur Rahaman SM, Ahmed Mujib B. Histopathological correlation of oral squamous cell carcinoma among younger and older patients. J Oral Maxillofac Pathol 2014; 18:183-8. [PMID: 25328296 PMCID: PMC4196284 DOI: 10.4103/0973-029x.140734] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 07/30/2014] [Indexed: 11/30/2022] Open
Abstract
Background: Oral Squamous Cell Carcinoma (OSCC) is commonly noted in elder men, when occurring in younger individuals, its aggression and prognosis is questioned due to biased data in literature. Traditionally, various histopathological grading systems have been used for assessing aggression and prognosis of OSCC. However, multifactorial grading of Anneroth et al., is considered effective. Materials and Methods: In this retro-prospective study, files of 75 OSCC patients were retrieved from Oral Pathology Department; among this 50 patients were >40 years and 25 patients were ≤40 years of age. Archival formalin fixed paraffin embedded tissue blocks of these patients were used to prepare hematoxylin and eosin (H and E) stained sections for grading OSCC based on Broder's and Anneroth et al., criteria. Further, recurrence of OSCC among study subjects within 5 years of treatment was evaluated. Chi-square test was used to compare the disease in patients who were >40 years with ≤40 years. Results: Comparison according to Broder's classification didn’t show any relevant variation. Three of the six parameters and overall grading according to Anneroth et al., criteria showed statistically higher grades of OSCC in the younger age-group; however, there was no significant difference in 5-year recurrence rate. Interpretation and Conclusion: Results of the study are suggestive of aggressive OSCC among young patients when compared to older. Conversely, this aggression didn’t affect the recurrence in younger patients. Further studies on genetics, diet and demographics of patients below 40 years of age affected by OSCC will be of greater value.
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Affiliation(s)
- Syed Mukith Ur Rahaman
- Division of Oral Pathology and Oral Biology, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Br Ahmed Mujib
- Department of Oral Pathology and Microbiology, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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27
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Fonseca FP, Coletta RD, Azevedo MB, Prado Ribeiro AC, Pires Soubhia AM, Miyahara GI, Carlos R, Farthing P, Hunter KD, Speight PM, Vargas PA, Almeida OP, Lopes MA, Santos-Silva AR. Stromal myofibroblasts in squamous cell carcinoma of the tongue in young patients - a multicenter collaborative study. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:483-9. [PMID: 25240996 DOI: 10.1016/j.oooo.2014.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 07/11/2014] [Accepted: 07/21/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the presence of myofibroblasts, frequently associated with a more aggressive neoplastic behavior, in oral tongue squamous cell carcinoma (TSCC) of young patients and to compare with the distribution observed in older patients. STUDY DESIGN Tumor samples from 29 patients younger than 40 years old affected by TSCC were retrieved and investigated for the presence of stromal myofibroblasts by immunohistochemical reactions against α smooth muscle actin, and the results obtained were compared to TSCC cases affecting older patients. RESULTS No positive reaction could be found in the stromal areas devoid of neoplastic tissue, whereas myofibroblasts were present in 58.6% of the lesions in young patients and in 75.9% of the older ones. No significant difference was found when comparing the invasive front and the overall stroma of both groups, and no correlation could be obtained with stromal α smooth muscle actin expression, higher tumor grades or clinical stage (P > .05). CONCLUSION There was no significant difference between the presence of stromal myofibroblasts of TSCC affecting young and old individuals.
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Affiliation(s)
- Felipe Paiva Fonseca
- Department of Oral Diagnosis, University of Campinas (UNICAMP), Piracicaba Dental School, Piracicaba, Brazil
| | - Ricardo Della Coletta
- Department of Oral Diagnosis, University of Campinas (UNICAMP), Piracicaba Dental School, Piracicaba, Brazil
| | - Marina Barbosa Azevedo
- Department of Oral Diagnosis, University of Campinas (UNICAMP), Piracicaba Dental School, Piracicaba, Brazil
| | - Ana Carolina Prado Ribeiro
- Service of Dental Oncology, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Ana Maria Pires Soubhia
- Department of Pathology and Clinical Propedeutic, Univ Estadual Paulista (UNESP), Araçatuba Dental School, Araçatuba, Brazil
| | - Glauco Issamu Miyahara
- Department of Pathology and Clinical Propedeutic, Univ Estadual Paulista (UNESP), Araçatuba Dental School, Araçatuba, Brazil
| | - Roman Carlos
- Centro Clinico de Cabeza y Cuello, Guatemala City, Guatemala
| | - Paula Farthing
- Academic Unit of Oral and Maxillofacial Pathology, The University of Sheffield, School of Clinical Dentistry, Sheffield, UK
| | - Keith D Hunter
- Academic Unit of Oral and Maxillofacial Pathology, The University of Sheffield, School of Clinical Dentistry, Sheffield, UK
| | - Paul M Speight
- Academic Unit of Oral and Maxillofacial Pathology, The University of Sheffield, School of Clinical Dentistry, Sheffield, UK
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, University of Campinas (UNICAMP), Piracicaba Dental School, Piracicaba, Brazil
| | - Oslei Paes Almeida
- Department of Oral Diagnosis, University of Campinas (UNICAMP), Piracicaba Dental School, Piracicaba, Brazil
| | - Marcio Ajudarte Lopes
- Department of Oral Diagnosis, University of Campinas (UNICAMP), Piracicaba Dental School, Piracicaba, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, University of Campinas (UNICAMP), Piracicaba Dental School, Piracicaba, Brazil.
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Fang QG, Shi S, Liu FY, Sun CF. Tongue squamous cell carcinoma as a possible distinct entity in patients under 40 years old. Oncol Lett 2014; 7:2099-2102. [PMID: 24932296 PMCID: PMC4049723 DOI: 10.3892/ol.2014.2054] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/14/2014] [Indexed: 11/05/2022] Open
Abstract
Much controversy exists in the published literature regarding the clinical course and prognosis of tongue squamous cell carcinoma (SCC) in young patients. The aim of the current study was to evaluate the clinical results of tongue SCC in young patients. A total of 176 patients were included in this retrospective study. The patients were divided into two groups (young and old) according to an age cut-off of 40 years. The χ2 test and Kaplan-Meier method were used to analyze the variables. In total, 15 patients were <40 years old and placed into the young group, with five-year recurrence-free survival (RFS) and disease-specific survival (DSS) rates of 30 and 63%, respectively, compared with 47 and 62%, respectively, in the old group. No significant differences were identified between the RFS and DSS rates of the two groups, however, the young patients exhibited a different failure pattern. Overall, nine out of 10 recurrences in the young group occurred at a primary site compared with 18 out of 70 in the old group (P<0.001). Univariate analysis revealed that gender and differentiation were associated with recurrence and neck nodal involvement. In addition, poor differentiation was found to significantly decrease the DSS time. However, the prognosis of tongue SCC in the young patient group did not appear to differ from that of the old patient group. Furthermore, in the young patient group, local recurrence was the most common failure pattern and tumor differentiation was the most important prognostic factor.
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Affiliation(s)
- Qi-Gen Fang
- Department of Oral and Maxillofacial Surgery, China Medical University, Shenyang, Liaoning 110002, P.R. China
| | - Shuang Shi
- Department of Pediatric Dentistry, School of Stomatology, China Medical University, Shenyang, Liaoning 110002, P.R. China
| | - Fa-Yu Liu
- Department of Oral and Maxillofacial Surgery, China Medical University, Shenyang, Liaoning 110002, P.R. China
| | - Chang-Fu Sun
- Department of Oral and Maxillofacial Surgery, China Medical University, Shenyang, Liaoning 110002, P.R. China
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Oral tongue squamous cell carcinoma in young women: a matched comparison-do outcomes justify treatment intensity? ISRN OTOLARYNGOLOGY 2014; 2014:529395. [PMID: 24734200 PMCID: PMC3964833 DOI: 10.1155/2014/529395] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 02/03/2014] [Indexed: 11/23/2022]
Abstract
Background. The incidence of oral tongue squamous cell carcinoma (OTSCC) in young women is increasing with uncertain outcomes compared to traditional patients. Published outcomes data are at odds in this cohort of young women. Methods. Retrospective analysis comparing demographic, clinicopathologic, and outcomes data of women OTSCC patients younger than 45 years old matched 1 : 2 by stage with men both younger and older than 45 and women older than 45. Results. No disease-free or overall survival differences were found between cohorts. Young women were significantly more likely to receive radiation therapy, particularly in stage I disease, even when controlling for common pathologic indications. Conclusions. OTSCC in young women was not associated with worse outcomes compared to a matched cohort of other patients. Increased frequency of radiation treatment for this cohort may not be justified.
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Impact of young age on the prognosis for oral cancer: a population-based study in Taiwan. PLoS One 2013; 8:e75855. [PMID: 24086646 PMCID: PMC3784390 DOI: 10.1371/journal.pone.0075855] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 08/22/2013] [Indexed: 11/20/2022] Open
Abstract
Background Oral cancer leads to a considerable use of health care resources. Wide resection of the tumor and reconstruction with a pedicle flap/ free flap is widely used. This study was conducted to investigate if young age at the time of diagnosis of oral cancer requiring this treatment confers a worse prognosis. Methods A total of 2339 patients who underwent resections for oral cancer from 2004 to 2005 were identified from The Taiwan National Health Insurance Research Database. Survival analysis, Cox proportional regression model, propensity scores, and sensitivity test were used to evaluate the association between 5-year survival rates and age. Results In the Cox proportional regression model, the older age group (>65 years) had the worst survival rate (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.45-2.22; P<0.001). When analyzed using the propensity scores, the adjusted 5-year survival rates were also poorer for oral cancer patients with older age (>65 years), compared to those with younger age (<45 years) (P<0.001). In sensitivity test, the adjusted hazard ratio remained no statistically elevated in the younger age group (<45 years). Conclusions For those oral cancer patients who underwent wide excision and reconstruction, young age did not confer a worse prognosis using a Cox proportional regression model, propensity scores or sensitivity test. Young oral cancer patients may be treated using general guidelines and do not require more aggressive treatment.
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Lassig AAD, Lindgren BR, Fernandes P, Cooper S, Ardeshipour F, Schotzko C, Yueh B. The effect of young age on outcomes in head and neck cancer. Laryngoscope 2013; 123:1896-902. [PMID: 23729020 DOI: 10.1002/lary.23932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 11/13/2012] [Accepted: 11/13/2012] [Indexed: 01/14/2023]
Abstract
OBJECTIVES/HYPOTHESIS Many head and neck surgeons believe that young patients with head and neck cancer (HNCA) have poorer outcomes than older patients, whereas the evidence in the literature is mixed. We sought to review our HNCA population to evaluate for survival differences between young and older patients. STUDY DESIGN Matched pair retrospective cohort study. METHODS A matched pair retrospective cohort study was completed of mucosal HNCA patients at our academic center (2003-2008). Patients aged 45 or less when diagnosed were identified as cases and matched one-to-one to controls by site of tumor, stage of disease, and gender. Risk factors, disease and treatment variables, and survival outcomes were compared between groups. In addition, a subset survival analysis was completed with oropharyngeal cancer patients and nonoropharyngeal cancer patients. RESULTS There were 87 cases matched to 87 controls. Despite no difference in T and N stage between groups, cases more frequently underwent neck dissection. On Kaplan-Meier and multivariate analysis, overall survival was marginally better for all young patients, whereas disease-free survival was significantly better. Within the subgroup analysis, the statistically significant disease-free survival advantage was lost for young patients with oropharyngeal cancer but maintained for all other sites. CONCLUSIONS In this cohort, young HNCA patients had mildly improved overall survival but statistically greater disease-free survival. There was no statistically significant survival difference between young and older patients with oropharyngeal cancer, potentially secondary to a human papillomavirus effect.
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Affiliation(s)
- Amy Anne D Lassig
- Department of Otolaryngologyz-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Li R, Fakhry C, Koch WM, Gourin CG. The Effect of tumor subsite on short-term outcomes and costs of care after oral cancer surgery. Laryngoscope 2013; 123:1652-9. [PMID: 23686386 DOI: 10.1002/lary.23952] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if epidemiologic differences exist between patients with oral tongue carcinoma compared to tumors arising from other oral cavity subsites, and the relationship between primary site and in-hospital mortality, postoperative complications, length of stay, and costs in patients undergoing surgery for oral cavity cancer. STUDY DESIGN Retrospective cross-sectional study. METHODS The Nationwide Inpatient Sample was analyzed for patients who underwent an ablative procedure for a malignant oral cavity neoplasm in 2001 to 2008 using cross-tabulations and multivariate regression modeling. RESULTS Overall, there were 45,071 patients treated surgically for oral cavity cancer, with oral tongue cancer comprising 35% of all oral cavity tumors. Patients with oral tongue cancer were significantly more likely to be female (odds ratio [OR] = 1.4) and undergo neck dissection (OR = 1.4), and significantly less likely to be black (OR = 0.4), over 40 years of age (OR = 0.4), have Medicaid payer status (OR = 0.7), advanced comorbidity (OR = 0.7), receive care at a teaching hospital (OR = 0.5), and undergo pedicled or free flap reconstruction (OR = 0.6, P < .001). Oral tongue primary site was not associated with in-hospital mortality or surgical complications, but was significantly associated with a reduced incidence of medical complications (OR = 0.8, P = .005). After controlling for all other variables, oral tongue primary site disease was associated with a significantly reduced length of hospitalization and hospital-related costs. CONCLUSIONS Oral tongue cancer is associated with a distinct epidemiologic profile compared to other oral cavity cancer subsites, and is associated with lower postoperative morbidity, length of hospitalization, and hospital-related costs. Further investigation is warranted to determine if biologic factors underlie these observations.
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Affiliation(s)
- Ryan Li
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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van Monsjou HS, Lopez-Yurda MI, Hauptmann M, van den Brekel MWM, Balm AJM, Wreesmann VB. Oral and oropharyngeal squamous cell carcinoma in young patients: The Netherlands Cancer Institute experience. Head Neck 2012; 35:94-102. [DOI: 10.1002/hed.22935] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2011] [Indexed: 12/29/2022] Open
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Kaminagakura E, Vartanian JG, da Silva SD, dos Santos CR, Kowalski LP. Case-control study on prognostic factors in oral squamous cell carcinoma in young patients. Head Neck 2011; 32:1460-6. [PMID: 20175200 DOI: 10.1002/hed.21347] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Oral squamous cell carcinoma affects mainly patients between the fifth and sixth decades of life, being rare in the young (≤40 years old). METHODS Demographic, clinical, and pathologic features, and the long-term survival of 125 patients younger than 41 years of age were compared with 250 control patients older than 50 years old. Data were submitted to Kaplan-Meier and log-rank tests. RESULTS The percentage of nonsmokers was higher in the younger patients (p = .04). In the younger patients, tumors at advanced clinical stage (p < .01) and poorly differentiated tumors (p = .01) were associated with a higher risk of recurrence. The relapse rate was higher in the younger patients (p = .02); however, there was no significant difference on overall survival (p = .86). The younger patients diagnosed after the 1990s had less advanced clinical stage tumors, had an increase in the use of combination of surgery, radiotherapy, and chemotherapy, and their overall survival was improved. CONCLUSION This study emphasizes the importance of early diagnosis and aggressive treatment of oral squamous cell carcinoma.
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Affiliation(s)
- Estela Kaminagakura
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Hospital, São Paulo, Brazil
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Alburqueque R, López-López J, Marí-Roig A, Jané-Salas E, Chimenos-Küstner E, Santos JR. Relationship between squamous cell carcinoma of the anterior two thirds of the tongue and removable denture use: a pioneer study in a Portuguese population. Braz Dent J 2011; 22:410-4. [DOI: 10.1590/s0103-64402011000500011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 08/01/2011] [Indexed: 11/22/2022] Open
Abstract
The aim of the study was to determine whether there is any relationship between the presence of removable dentures and squamous cell carcinoma of the anterior two thirds of the tongue in a Portuguese population. A retrospective cross-sectional study was conducted on patients with a biopsy-proven diagnosis of squamous cell carcinoma of the tongue, who were seen and treated at the Department of Head and Neck Surgery of the Portuguese Institute of Oncology 'Francisco Gentil', Lisbon, Portugal, during a 3-year period. Several factors were examined: gender, use of removable dentures, age, location of the lesion, and alcohol and tobacco consumption. One hundred and six cases were selected from the initial 151 cases, with a male:female ratio of 3:1 and the lateral borders being the most commonly affected site. The prevalence in both genders was between the sixth and seventh decade of life. Men were more likely to consume alcohol and tobacco than women, and no relationship was observed between denture use and presence of carcinoma of the tongue. In light of the data obtained, it may be considered that female use of a denture plays an important role, but it cannot be identified as a remarkable etiologic factor.
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Affiliation(s)
| | | | | | | | | | - Jorge Rosa Santos
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Portugal
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Clinical outcome of squamous cell carcinoma of the tongue in young patients: a stage-matched comparative analysis. Clin Exp Otorhinolaryngol 2010; 3:161-5. [PMID: 20978546 PMCID: PMC2958509 DOI: 10.3342/ceo.2010.3.3.161] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 07/27/2010] [Indexed: 12/05/2022] Open
Abstract
Objectives The reported incidence of tongue cancer in young patients has recently increased. The aim of this study was to analyze the clinical characteristics of tongue cancer in a young group of patients, and to compare them with those of an older group of tongue cancer patients. Methods We retrospectively reviewed the records of 85 patients who were diagnosed with squamous cell carcinoma of the tongue. They were divided into two age groups: over 45 years of age and under 45 years. To compare the prognosis of similarly staged patients in the group, each age group was divided into the early (stage I, II) and advanced stage groups (stage III, IV), and then they were compared. The young group consisted of 23 patients and the older group had 62 patients. Results At the early stage, the clinical prognosis of the patients in both age groups was good, and no significant difference was observed. However, at the advanced stage, the overall and regional recurrence rates were significantly higher in the younger age group as compared to that in the old age group (P=0.007, P=0.001, respectively). The disease-specific survival rate of the patients in the young group was significantly lower than that in the old age group (P=0.025). Conclusion Tongue cancer in young subjects has significantly different clinical outcomes according to the stage. The clinical outcome of the advanced-stage tongue cancer in young subjects was poorer than that in the older subjects. Regional recurrence seemed to be the main cause of the poor prognosis.
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Al-Swiahb JN, Chen CH, Chuang HC, Fang FM, Tasi HT, Chien CY. Clinical, pathological and molecular determinants in squamous cell carcinoma of the oral cavity. Future Oncol 2010; 6:837-50. [PMID: 20465394 DOI: 10.2217/fon.10.35] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Squamous cell carcinoma of the oral cavity (OCSCC) is the most frequently observed form of head-and-neck cancer in Southeast Asia and is the sixth most common cancer worldwide. Most cases of this preventable disease are caused by alcohol consumption, smoking and betel nut chewing. The survival rates of patients with advanced OCSCC have not increased significantly in recent years. While treatments for OCSCC are similar worldwide, survival rates differ by geographical area. The various genetic profiles and individual genetic susceptibility for carcinogens may account for this discrepancy. In some respects, molecular alteration or accumulation affects tumor progression and the clinical outcomes among patients with OCSCC. Clarifying the tumor behavior of oral cancer, with regard to pathological features or molecular aspects, could help clinicians to judge, tailor and adopt more effective therapeutic strategies to treat oral cancer.
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Affiliation(s)
- Jamil N Al-Swiahb
- Department of Otolaryngology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Harris SL, Kimple RJ, Hayes DN, Couch ME, Rosenman JG. Never-smokers, never-drinkers: unique clinical subgroup of young patients with head and neck squamous cell cancers. Head Neck 2010; 32:499-503. [PMID: 19691028 DOI: 10.1002/hed.21220] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Young patients represent an increasing subgroup with head and neck cancer. METHODS Patients between 18 and 39 years of age with newly diagnosed and previously untreated squamous cell cancers were identified. RESULTS Seventy-eight patients met the selection criteria: 28 patients were never-smokers/never-drinkers (NSNDs), and 50 patients reported tobacco or alcohol abuse (smokers and/or drinkers [SD]). NSND patients were diagnosed at a younger median age (31.5 years vs 35.5 years, p = .007), were more likely to be female (75% vs 30%, p < .001) and white (89% vs 60%, p = .006), and were more likely to have tumors of the oral tongue (57% vs 24%, p = .003) and T1 disease (47% vs 20%, p = .01). There was no difference in 10-year relapse-free survival, but a suggestion of improved 10-year overall survival for NSND patients (71% vs 46%, p = .10). CONCLUSIONS Young patients with head and neck squamous cell carcinoma (HNSCC) appear to have unique clinical profiles based on history of alcohol and tobacco abuse.
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Affiliation(s)
- Stephen L Harris
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Abstract
BACKGROUND Failure to diagnose and delayed diagnosis of cancer can have a significant effect on patients' morbidity and mortality. Oral health care professionals should be alert for oral premalignant and malignant disease and head and neck involvement by malignant disease. These issues have patient care and medicolegal implications. CASE DESCRIPTION To provide guidance to practitioners, the authors present a series of cases of oral and head and neck cancer that resulted in legal action. They chose the medicolegal cases to highlight dental professionals' potential legal liability and provide guidance in patient care. CLINICAL IMPLICATIONS Clinicians need to obtain complete comprehensive histories, perform thorough head and neck and oral examinations and appreciate the importance of being vigilant for abnormalities that may lead to early detection of potentially malignant disease.
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Alsharif MJ, Jiang WA, He S, Zhao Y, Shan Z, Chen X. Gingival squamous cell carcinoma in young patients: report of a case and review of the literature. ACTA ACUST UNITED AC 2009; 107:696-700. [PMID: 19272815 DOI: 10.1016/j.tripleo.2008.12.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 12/02/2008] [Accepted: 12/18/2008] [Indexed: 12/15/2022]
Abstract
Squamous cell carcinoma is a malignant neoplasm of epithelium, most frequently occurring in intraoral tumors. In this article we describe a rarely reported, because the frequency of oral cancer in young people is extremely low, case of a 16-year-old Chinese girl with squamous cell carcinoma of anterior mandibular gingiva. The clinicopathologic features, etiology, clinical evaluation, management of squamous cell carcinoma of gingiva in young patients are discussed and the applicable literatures are reviewed.
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Affiliation(s)
- Mohd Jamal Alsharif
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Prognostic influence of gender in patients with oral tongue cancer. Otolaryngol Head Neck Surg 2008; 138:768-71. [PMID: 18503852 DOI: 10.1016/j.otohns.2008.02.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 02/25/2008] [Accepted: 02/10/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the independent role of gender in affecting prognosis in patients with anterior tongue cancer. DESIGN Patients recorded in the head and neck cancer registry of Milano-Bicocca School of Medicine between January 1981 and December 1998 were reviewed. Female patients with squamous cell carcinoma of the tongue were identified and matched to men for year of diagnosis, age, TNM classification, histologic grading, and treatment modalities. For each woman, two men were matched. RESULTS Seventy-one women and 142 men satisfied our selection criteria. The frequency of recurrences was similar in the two study groups. This event occurred in 33 (46%) women and in 78 (55%) men (Fisher exact test, P = 0.25). The survival analysis confirmed that the rate of recurrences did not differ (log-rank test, P = 0.31). The number of cancer-related deaths in women and men was 23 (32%) and 55 (39%), respectively (Fisher exact test, P = 0.45). The survival analysis confirmed that gender did not affect survival (log-rank test, P = 0.34). CONCLUSION In this study, gender does not influence prognosis in patients with oral tongue cancer.
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Squamous cell carcinoma of the oral tongue: a 25-year, single institution experience. The Journal of Laryngology & Otology 2008; 123:114-20. [DOI: 10.1017/s0022215108003186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAim:To report the characteristics, prognostic factors and treatment outcomes of 102 patients with squamous cell carcinoma of the oral tongue treated and followed up at a single institution over a 25-year period.Patients and methods:This retrospective study was carried out by auditing the medical records of 102 patients diagnosed with squamous cell carcinoma of the oral tongue and treated at our institution between 1982 and 2007. Patient follow up ranged from nine to 310 months (median 35 months). Fifty per cent of the patients were treated with surgery followed by a combination of chemotherapy and radiotherapy (43.1 per cent received concurrent chemoradiation and 6.9 per cent received sequential chemotherapy and radiotherapy), whereas 29.4 per cent received surgery followed by adjuvant radiotherapy alone. The remaining patients (20.6 per cent) did not undergo surgery and were treated with definitive radiotherapy with or without chemotherapy.Results:There were 48 men and 54 women. The age at presentation was 19–85 years (median 57 years). The peak incidence was observed between 60 and 70 years. Resection margins were clear in 75 per cent of patients and involved in 25 per cent. Stage I disease was found in 11.8 per cent of patients, stage II in 34.3 per cent, stage III in 22.5 per cent and stage IV in 31.4 per cent. The five-year disease-free survival and overall survival were 65.7 and 72.5 per cent, respectively. Thirty-five patients suffered recurrence after treatment, 74.0 per cent of them at the site of initial cervical nodal involvement. Univariate analysis for overall survival revealed the following as prognostic factors: treatment schedule (surgical vs non-surgical; p < 0.001); age (<60 years vs ≥60 years; p = 0.038); extent of cervical lymph node involvement (p = 0.015); primary tumour stage (p < 0.001); node stage (p = 0.034); and disease stage (p = 0.013). However, on multivariate analysis, only non-surgical treatment (p = 0.001) and advanced disease stage (p = 0.05) were found to have a negative influence on survival.Conclusions:Our limited data suggest that, in Iran, squamous cell carcinoma of the oral tongue tends to present at a locally advanced stage, with a high frequency of locoregional failure and a poor outcome. Combined modality therapy should be considered for the majority of patients with squamous cell carcinoma of the tongue.
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Asakawa T, Esumi M, Endo S, Kida A, Ikeda M. Tongue cancer patients have a high frequency of allelic loss at the von Hippel-Lindau gene and other loci on 3p. Cancer 2008; 112:527-34. [PMID: 18072267 DOI: 10.1002/cncr.23200] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although genetic abnormalities on 3p have been suggested to be linked to the development of squamous cell carcinoma of the head and neck, to the authors' knowledge no study to date has examined such genetic abnormalities in patients with squamous cell carcinoma of the tongue. In the current study, loss of heterozygosity (LOH) was evaluated at several loci within 3p, including the von Hippel-Lindau gene (VHL), in samples of tongue squamous cell carcinoma. In addition, the coding region of the intact VHL allele was screened for sequence mutations. METHODS DNA was extracted from tumor and nontumor tissues collected from 28 patients with tongue squamous cell carcinoma. LOH was investigated by analysis of single nucleotide polymorphisms within exon 3 of VHL and by microsatellite analysis within another 10 loci. Mutation analysis of the VHL gene was performed by polymerase chain reaction (PCR) amplification and sequencing of the coding region of the gene. RESULTS LOH within VHL was found at a high frequency (45.5%) within the tumor. However, mutations of the VHL gene were not detected in all tumor samples. LOH of other microsatellite markers on 3p was observed in 27.3% to 50% of tumor samples. Eleven (58%) of 19 samples that were informative at more than 2 loci exhibited LOH of at least 1 locus; 10 of these 11 cases exhibited LOH at multiple loci. CONCLUSIONS A wide range of deletions in 3p, including at the VHL gene, may play a role in the development of tongue cancer.
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Affiliation(s)
- Takeshi Asakawa
- Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Japan
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Lee CC, Ho HC, Chen HL, Hsiao SH, Hwang JH, Hung SK. Squamous cell carcinoma of the oral tongue in young patients: a matched-pair analysis. Acta Otolaryngol 2007; 127:1214-7. [PMID: 17851883 DOI: 10.1080/00016480701230910] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSIONS Young patients with squamous cell carcinoma (SCC) of the oral tongue developed fewer locoregional recurrences. The overall survival and disease-specific survival rates were better in the young patient population. OBJECTIVES To compare the survival rates of patients under 45 years of age and diagnosed with SCC of the oral tongue with those of patients older than 45 years. PATIENTS AND METHODS A retrospective review of 20 patients under 45 years of age with SCC of the oral tongue was performed. These patients were matched to an older population by sex and clinical stage. Overall survival, disease-free survival, disease-specific survival, and rates of local, regional and distant metastases were determined for both populations. RESULTS Stage and treatment modality were similar in the two age groups. There were significant differences in overall survival (p=0.013) and disease-specific survival (p=0.046) favoring young patients. Rates of locoregional recurrence and distant metastasis were higher in the older patients.
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Affiliation(s)
- Ching-Chih Lee
- Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, 2, Ming Shen Road, Dalin, Chiayi, 622, Taiwan.
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Squamous cell carcinoma of the oral cavity in young patients: a matched-pair analysis. Eur Arch Otorhinolaryngol 2007; 265 Suppl 1:S57-61. [PMID: 17957378 DOI: 10.1007/s00405-007-0496-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 10/08/2007] [Indexed: 11/27/2022]
Abstract
There is an increased incidence of oral squamous cell carcinoma (SCC) in young patients. However, the literature concerning prognosis for young patients with oral SCC is conflicting. The aim of this study was to compare the survival rates of patients under 45 years of age and diagnosed with SCC of the oral cavity with those of patients older than 45 years. A retrospective review of 28 patients under 45 years of age with SCC of the oral cavity was performed. We matched each of these patients by sex, tumor site, and overall stage with two patients older than 45 years. Overall survival, disease-free survival, disease-specific survival, rates of local, regional and distant metastasis were determined for both populations. Survival analysis was performed using Cox proportional hazard models. Stage and treatment modality were similar in the two groups. There were significant differences in overall survival (P=0.024) and disease-specific survival (P=0.03) favoring young patients. Locoregional recurrence and distant metastasis were higher in the older patients. Furthermore, matched survival analysis demonstrated a difference in overall survival rate [risk ratio (RR) 2.457; P=0.033] and disease-specific survival [RR 2.475; P=0.048]. Young patients with SCC of the oral cavity developed fewer locoregional recurrences and distant metastasis. The overall survival and disease-specific survival rates were better in the young patient population.
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Garavello W, Spreafico R, Gaini RM. Oral tongue cancer in young patients: A matched analysis. Oral Oncol 2007; 43:894-7. [PMID: 17307026 DOI: 10.1016/j.oraloncology.2006.10.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 10/26/2006] [Accepted: 10/27/2006] [Indexed: 11/29/2022]
Abstract
Previous studies on squamous cell carcinoma of the tongue have reported conflicting results with respect to age and prognosis. The aim of this study is to elucidate if any differences in outcome exist between patients younger and older than 40 years. A case-control study was performed. Patients recorded in the head and neck cancer registry of Milano-Bicocca School of Medicine between January 1981 and December 1998 were reviewed. Cases were patients with squamous cell carcinoma of the tongue aged 40 years or less. Controls were patients older than 40 who were matched to cases for diagnosis, sex and TNM classification. Two controls were matched for each case, thus forty-six cases and 92 controls were selected. The frequency of recurrences was found to be significantly higher in younger patients. The survival analysis further supports this conclusion (log-rank test, p=0.002). The number of cancer-related deaths in patients younger and older than 40 years were 23 (50%) and 31 (34%), respectively (p=0.10). A statistical significant difference emerged when the number of deaths was compared using survival curves (log-rank test, p=0.05). In conclusion, in patients with squamous cell carcinoma of the tongue, young age is an independent predictor of worse survival.
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Affiliation(s)
- Werner Garavello
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Milano-Bicocca, DNTB, Ospedale San Gerardo, 20052 Monza (MI), Italy.
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Liao CT, Wang HM, Hsieh LL, Chang JTC, Ng SH, Hsueh C, Lee LY, Lin CH, Chen IH, Kang CJ, Huang SF, Yen TC. Higher distant failure in young age tongue cancer patients. Oral Oncol 2006; 42:718-25. [PMID: 16529977 DOI: 10.1016/j.oraloncology.2005.11.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Revised: 11/21/2005] [Accepted: 11/22/2005] [Indexed: 11/21/2022]
Abstract
The objective of this study was to understand if the age of the patient at onset of tongue cancer was an adverse factor for patient survival and distant metastasis (DM). Data were collected from a retrospective database (January 1996-June 2003, n=296). Local control rates, neck control rates, DM rates, and survival curves were assessed by the Kaplan-Meier method. Prognostic variables were assessed by the log-rank test and Cox proportional hazards regression method. For the young group (<or=40 years, n=76), a significantly higher 5-year DM rate (p=0.014) was noted than the elderly group (>40 years, n=220). No significant differences were seen in 5-year local and neck controls, disease-free, disease-specific and overall survivals between these two groups. We concluded that being <or=40 years of age at the onset of disease is a significant adverse factor for DM in tongue cancer.
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Affiliation(s)
- Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital at Taipei, Linkou Medical Center, and Department of Public Health, Chang Gung University, Taiwan
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Sasaki T, Moles DR, Imai Y, Speight PM. Clinico-pathological features of squamous cell carcinoma of the oral cavity in patients <40 years of age. J Oral Pathol Med 2005; 34:129-33. [PMID: 15689225 DOI: 10.1111/j.1600-0714.2004.00291.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Considerable controversy exists in the literature regarding the clinical course of young patients with oral squamous cell carcinoma (SCC). The purpose of this study was to evaluate the clinico-pathological features of oral SCC among young people. METHODS From a cohort of 529 patients diagnosed with SCC, 35 (6.6%) were under the age of 40 years. This group was compared to a control group of 110 cases aged over 40 to determine if there were any differences in clinicopathological features between the two groups. RESULTS In the young group there were 20 males and 15 females. The site was most frequently the tongue (51.3%), followed by the floor of the mouth, the buccal mucosa, and the upper and lower alveolus and gingiva. The local and regional control rate was 64.8% which was similar to that of older patients in this series. CONCLUSIONS The prognosis of oral SCC in the young patients does not appear to be different from that of the older population. Univariate analysis showed that clinical stage and the mode of invasion were the most significant prognostic factors in both younger and older patients.
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Affiliation(s)
- T Sasaki
- Department of Oral and Maxillofacial Surgery, Dokkyo University School of Medicine, Mibu, Tochigi, Japan.
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Zwetyenga N, Gargiulo M, Demeaux H, Siberchicot F, Majoufre-Lefebvre C. [Epidermoid carcinoma of oral cavity in patients less than twenty]. ACTA ACUST UNITED AC 2004; 105:201-5. [PMID: 15510069 DOI: 10.1016/s0035-1768(04)72307-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze a review of literature of patients aged less than 20 years with epidermoid carcinoma of oral cavity. PATIENTS AND METHODS Two sources were used to identify cases. A Medline search was performed as well as a review of our Medlog files where two cases of oral epidermoid carcinoma were identified in patients aged less than 20 years. RESULTS Sixteen patients treated between 1981 and 2000 were included in this study. The mean age was 15.6 years and the sex ratio was 2.2 male/female. The mean time to diagnosis was 16.4 months. Tumors were staged III or IV in 71.4% of cases. The mean follow-up was 33.2 months. Rate of failure was 50% and one patient experienced local recurrence. At last follow-up, seven patients were alive with one patient living with cancer. All deaths resulted from the original cancer. DISCUSSION This study illustrates the rarity of epidermoid carcinoma of the oral cavity in patients aged less than 20 years. Owing to the fact that most tumors were classified III or IV, time to diagnosis is probably the most important prognosis factor. Histological examination of all lesions of the oral cavity is required, irrespective of the age of the patient.
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Affiliation(s)
- N Zwetyenga
- Service de Chirurgie Maxillo-Faciale, Centre Hospitalier Universitaire, Hôpital Pellegrin, 33076 Bordeaux-Cedex.
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Popovtzer A, Shpitzer T, Bahar G, Marshak G, Ulanovski D, Feinmesser R. Squamous Cell Carcinoma of the Oral Tongue in Young Patients. Laryngoscope 2004; 114:915-7. [PMID: 15126756 DOI: 10.1097/00005537-200405000-00025] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Cancer of the tongue is reported with increasing frequency in young people. The objective of this work was to study the biologic and clinical course of the disease in this group. The clinical course of the disease in this patient group remains controversial. STUDY DESIGN A retrospective 30-year review was made from data from a tertiary academic medical center. METHODS A chart review was performed for 48 patients with oral tongue cancer. The following variables were compared: age, sex, tobacco and alcohol use, treatment, and outcome. RESULTS Stage (T1,2-N0) and treatment modality were similar in the two age groups, as was disease-specific outcome. However, in the younger group, the clinical course followed two distinct patterns: extremely aggressive appearance with a 40% mortality rate within 2 years compared with 10.7% in the older group (P <.05) or indolent with freedom from disease for over 15 years. CONCLUSIONS Squamous cell carcinoma (SCC) of the oral tongue may be associated with a variable clinical course in younger patients. Although, in general, the disease-specific outcome is similar to that of the older patients, some of the patients have an exceptionally aggressive disease. An extensive therapeutic regimen should be used in all cases.
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Affiliation(s)
- Aron Popovtzer
- Department of Otorhinolaryngology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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