1
|
Pimolbutr K, Lim WT, Leeson R, Hopper C, Kalavrezos N, Liew C, Schilling C, Sinha D, Jay A, Agrawal R, Porter S, Fedele S. Prognosis of oral epithelial dysplasia in individuals with and without oral lichen planus. Oral Dis 2024; 30:504-517. [PMID: 36648368 DOI: 10.1111/odi.14503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To investigate the role of oral lichen planus (OLP) on the long-term prognosis of oral epithelial dysplasia (OED). METHODS Retrospective single-centre cohort study using the 2007-2019 database of the Head and Neck Cancer and Oral Medicine units of University College London Hospital. The exposure of interest was the presence of OLP, and the prognostic outcomes included the development of new primary episodes of OED, progression to malignancy and mortality. Cox proportional hazard and Poisson regression models were performed. RESULTS A total of 299 patients, of whom 144 had OED arising on the background of OLP (OLP/OED) and 155 had OED without underlying OLP (non-OLP/OED), were included. A pre-existing diagnosis of OLP was significantly associated with a twofold increased risk of subsequent primary OED events (HR = 2.02, p = 0.04), which also developed faster (1.46 vs. 2.96 years, p = 0.04) and with more involvement of non-cancer-prone sites (p = 0.001) than in the non-OLP/OED group. There was no difference between groups in the progression to malignancy or mortality. CONCLUSIONS Oral lichen planus/OED patients are at higher risk of multiple episodes of primary OED, which can develop faster and at non-cancer-prone sites as compared to non-OLP/OED individuals. Further research is needed to clarify the effects of OLP upon progression to OSCC and mortality.
Collapse
Affiliation(s)
- Kununya Pimolbutr
- UCL Eastman Dental Institute, University College London, London, UK
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Woei Tatt Lim
- Oral and Maxillofacial Surgery Department, Sarawak General Hospital, Kuching, Malaysia
| | - Rachel Leeson
- UCL Eastman Dental Institute, University College London, London, UK
| | - Colin Hopper
- UCL Eastman Dental Institute, University College London, London, UK
| | - Nicholas Kalavrezos
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Colin Liew
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Clare Schilling
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Deepti Sinha
- Head and Neck Surgery Department, University College London Hospitals (UCLH), London, UK
| | - Amrita Jay
- Department of Cellular Pathology, University College London Hospitals (UCLH), London, UK
| | - Reshma Agrawal
- Department of Cellular Pathology, University College London Hospitals (UCLH), London, UK
| | - Stephen Porter
- UCL Eastman Dental Institute, University College London, London, UK
- NIHR UCLH Biomedical Research Centre, London, UK
| | - Stefano Fedele
- UCL Eastman Dental Institute, University College London, London, UK
- NIHR UCLH Biomedical Research Centre, London, UK
| |
Collapse
|
2
|
Hanroongsri J, Amornphimoltham P, Younis RH, Chaisuparat R. Expression of PD-L1 and p-RPS6 in epithelial dysplasia and squamous cell carcinoma of the oral cavity. FRONTIERS IN ORAL HEALTH 2024; 5:1337582. [PMID: 38370876 PMCID: PMC10869481 DOI: 10.3389/froh.2024.1337582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/02/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Oral squamous cell carcinoma (OSCC) is often preceded by oral epithelial dysplasia (OED). The role of ribosomal protein S6 (RPS6) and programmed cell death ligand-1 (PD-L1) in the progression of OED to OSCC remains unclear. This study aimed to investigate the expression of phosphorylated RPS6 (p-RPS6) and PD-L1 in OSCC and OED and to examine its relationship with clinicopathological features. Methods Fifty-two OSCC and 48 OED cases were recruited for immunohistochemical analysis of p-RPS6 and PD-L1 expression. The expression of markers was correlated with clinicopathological features of OSCC and OED. Results We found p-RPS6 expression in all cases of OSCC and OED, whereas PD-L1 was expressed in 42/48 (87%) OED and in 28/52 (53%) OSCC. The patients with mild OED presented higher expression level of PD-L1 and p-RPS6 significantly, when compared to moderate-differentiated OSCC patients (p < 0.05). Moreover, we found a significant positive correlation between PD-L1 and p-RPS6 expression in OED and OSCC patients (p < 0.01). The PD-L1 expression was significantly related to more than 2 cm tumor size in OSCC patients (p = 0.007). Discussion Our findings suggest the upregulation of PD-L1 may be related with activation of the mTOR pathway in the early events of tumor progression and the pathogenesis of OSCC.
Collapse
Affiliation(s)
- Jaruwat Hanroongsri
- Division of Oral Diagnostic Sciences, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | | | - Rania H. Younis
- Department of Oral Pathology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Risa Chaisuparat
- Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Avatar Biotechnologies for Oral Heath and Healthy Longevity, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
3
|
Sathasivam HP, Kist R, Sloan P, Thomson P, Nugent M, Alexander J, Haider S, Robinson M. Predicting the clinical outcome of oral potentially malignant disorders using transcriptomic-based molecular pathology. Br J Cancer 2021; 125:413-421. [PMID: 33972745 PMCID: PMC8329212 DOI: 10.1038/s41416-021-01411-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/06/2021] [Accepted: 04/16/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study was undertaken to develop and validate a gene expression signature that characterises oral potentially malignant disorders (OPMD) with a high risk of undergoing malignant transformation. METHODS Patients with oral epithelial dysplasia at one hospital were selected as the 'training set' (n = 56) whilst those at another hospital were selected for the 'test set' (n = 66). RNA was extracted from formalin-fixed paraffin-embedded (FFPE) diagnostic biopsies and analysed using the NanoString nCounter platform. A targeted panel of 42 genes selected on their association with oral carcinogenesis was used to develop a prognostic gene signature. Following data normalisation, uni- and multivariable analysis, as well as prognostic modelling, were employed to develop and validate the gene signature. RESULTS A prognostic classifier composed of 11 genes was developed using the training set. The multivariable prognostic model was used to predict patient risk scores in the test set. The prognostic gene signature was an independent predictor of malignant transformation when assessed in the test set, with the high-risk group showing worse prognosis [Hazard ratio = 12.65, p = 0.0003]. CONCLUSIONS This study demonstrates proof of principle that RNA extracted from FFPE diagnostic biopsies of OPMD, when analysed on the NanoString nCounter platform, can be used to generate a molecular classifier that stratifies the risk of malignant transformation with promising clinical utility.
Collapse
Affiliation(s)
- Hans Prakash Sathasivam
- grid.1006.70000 0001 0462 7212School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK ,Cancer Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Ralf Kist
- grid.1006.70000 0001 0462 7212School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Newcastle University Biosciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Philip Sloan
- grid.1006.70000 0001 0462 7212School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK ,grid.420004.20000 0004 0444 2244Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter Thomson
- grid.194645.b0000000121742757Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Michael Nugent
- grid.416726.00000 0004 0399 9059Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - John Alexander
- grid.18886.3f0000 0001 1271 4623The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Syed Haider
- grid.18886.3f0000 0001 1271 4623The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Max Robinson
- grid.1006.70000 0001 0462 7212School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK ,grid.420004.20000 0004 0444 2244Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
4
|
McCarthy C, Fedele S, Ottensmeier C, Shaw RJ. Early-Phase Interventional Trials in Oral Cancer Prevention. Cancers (Basel) 2021; 13:cancers13153845. [PMID: 34359746 PMCID: PMC8345124 DOI: 10.3390/cancers13153845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Oral cancer is a devastating disease with increasing incidence worldwide. Oral epithelial dysplasia (OED) is a potentially malignant disorder and patients with OED are at increased risk of developing oral cancer. Current strategies for management of OED include surgery or close observation and both fail to address the underlying pathogenesis of the disease. There is an urgent need for evidence-based medical treatments for OED to prevent oral cancer development in this cohort. Chemoprevention trials to date have not delivered therapeutic agents for routine clinical practice. Historically, there has been significant heterogeneity in the design of oral cancer chemoprevention trials, with most failing to selectively recruit patients with biopsy-proven OED, which limits the usefulness of the findings in the OED population. The present paper aims to review the current evidence and the methodology of early-phase trials in oral cancer chemoprevention. Novel strategies in oral cancer chemoprevention will also be discussed. Abstract The increasing breadth of molecular targets, promise of immune-targeted therapies and repurposed agents have heightened interest in cancer prevention. While, to date, testing of oral cancer chemoprevention strategies has failed to deliver therapeutic agents for routine clinical practice, there remains an urgent need for further clinical research to overcome this hurdle. Patients at the greatest risk of disease stand to benefit the most from inclusion in clinical trials; therefore, there is a need to carefully define this population using validated clinical and molecular markers. Safety, tolerability and the efficacy of interventions is assessed through carefully selected endpoints. These endpoints may include pharmacodynamic, clinical, histological and on-target molecular modifications as an individual or as a composite endpoint. Early-phase trials provide an area of opportunity to explore novel and repurposed agents in the setting of oral cancer chemoprevention, eventually leading to phase III trials with clinical endpoints such as transformation and clinical outcome; these studies are large, lengthy and expensive and should be reserved for the most promising of agents. This paper will explore current evidence in oral cancer chemoprevention, drug repurposing, selection of appropriate endpoints for early-phase trials and novel therapeutic angles in oral cancer chemoprevention.
Collapse
Affiliation(s)
- Caroline McCarthy
- Liverpool Head and Neck Centre, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 9TA, UK; (C.O.); (R.J.S.)
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool L3 9TA, UK
- Correspondence: ; Tel.: +44-7904-363-109
| | - Stefano Fedele
- Eastman Dental Institute, University College London, 21 University Street, London WC1E 6DE, UK;
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, Maple House Suite A 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Christian Ottensmeier
- Liverpool Head and Neck Centre, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 9TA, UK; (C.O.); (R.J.S.)
| | - Richard J. Shaw
- Liverpool Head and Neck Centre, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 9TA, UK; (C.O.); (R.J.S.)
| |
Collapse
|
5
|
Gilvetti C, Soneji C, Bisase B, Barrett AW. Recurrence and malignant transformation rates of high grade oral epithelial dysplasia over a 10 year follow up period and the influence of surgical intervention, size of excision biopsy and marginal clearance in a UK regional maxillofacial surgery unit. Oral Oncol 2021; 121:105462. [PMID: 34303087 DOI: 10.1016/j.oraloncology.2021.105462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the overall recurrence rate (RR) and malignant transformation rate (MTR) of high grade oral mucosal epithelial dysplasias (HGOED). MATERIALS & METHODS A clinicopathological review of records of patients diagnosed with a unifocal HGOED between 2004 and 2016 on incisional biopsy who then underwent excision. The mean duration of follow-up was 47.7 months (±29.9 SD). RESULTS Full demographic, historical and histopathological data were available for 120 patients. Six were lost to follow-up after excisional biopsy. Invasive squamous cell carcinoma (SCC) was present in 19 (18.3%) excisions. HGOED affected the lateral and ventral tongue in 58% of patients. Fourteen (11.7%) were not treated surgically but kept under surveillance. The overall RR was 34.7% (33 patients) and MTR 17.8% (17 patients). Four of the 14 (28.6%) patients who had not had the HGOED excised developed SCC, by contrast to the 13 of the 106 (12.3%) who had been treated. RR was significantly associated with positive excision margins (p = 0.007; OR = 3.6) and a clinical presentation of erythroplakia (p = 0.023; OR = 1.5). MTR was significantly associated with age (p = 0.034), clinical appearance (p = 0.030), site (p = 0.007), treatment received (p = 0.012) and positive excision margins (p = 0.007). The mean time for recurrence to develop was 62 months (±31.5 SD) (range 22-144 months), that for malignant transformation was 50 months (±32.5 SD) (range 8-97 months). CONCLUSION Patients with HGOED require follow-up for at least 10 years after treatment. Younger age, homogeneous clinical appearance, complete excision, a larger excision specimen and clear margins all improve prognosis.
Collapse
Affiliation(s)
- Ciro Gilvetti
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK.
| | - Chandni Soneji
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Brian Bisase
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Andrew William Barrett
- Department of Histopathology, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| |
Collapse
|
6
|
Karunagaran M, Murali P, Palaniappan V, Sivapathasundharam B. Expression and distribution pattern of podoplanin in oral submucous fibrosis with varying degrees of dysplasia – an immunohistochemical study. J Histotechnol 2019. [DOI: 10.1080/01478885.2019.1594543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Monika Karunagaran
- Department of Oral Pathology & Microbiology, Saveetha Dental College & Hospital, SIMATS University, Chennai, India
| | - Preethi Murali
- Department of Oral Pathology & Microbiology, Meenakshi Ammal Dental College & Hospital, MAHER University, Chennai, India
| | - V. Palaniappan
- Department of Pathology, Chengalpattu Medical College, Chennai, India
| | - B. Sivapathasundharam
- Professor & Head, Department of Oral Pathology & Microbiology, Meenakshi Ammal Dental College & Hospital, MAHER University, Chennai, India
| |
Collapse
|
7
|
Goertzen C, Mahdi H, Laliberte C, Meirson T, Eymael D, Gil-Henn H, Magalhaes M. Oral inflammation promotes oral squamous cell carcinoma invasion. Oncotarget 2018; 9:29047-29063. [PMID: 30018735 PMCID: PMC6044370 DOI: 10.18632/oncotarget.25540] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/07/2018] [Indexed: 12/24/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) represents 95% of oral malignancies and invasion, and metastasis underlies disease morbidity and mortality. We recently established a direct link between oral inflammation and cancer invasion by showing that neutrophils increase OSCC invasion through a tumor necrosis factor (TNFα)-dependent mechanism. The objective of this study was to characterize OSCC-associated inflammation and to determine the molecular mechanisms underlying inflammation-mediated OSCC invasion. Our results showed a significant increase in neutrophil infiltration, the neutrophil-to-lymphocyte ratio in the OSCC microenvironment and increased inflammatory markers, particularly TNFα in saliva. We performed next-generation sequencing of the TNFα-treated OSCC cells and showed marked overexpression of over 180 genes distributed among clusters related to neutrophil recruitment, invasion, and invadopodia. At the molecular level, TNFα treatment increased phosphoinositide 3-kinase (PI3K)-mediated invadopodia formation and matrix metalloproteinase (MMP)-dependent invasion. We show here that TNFα promotes a pro-inflammatory and pro-invasion phenotype leading to the recruitment and activation of inflammatory cells in a paracrine mechanism. Increased TNFα in the tumor microenvironment tips the balance towards invasion leading to decreased overall survival and disease-free survival. This represents a significant advancement of oral cancer research and will support new treatment approaches to control OSCC invasion and metastasis.
Collapse
Affiliation(s)
- Cameron Goertzen
- Cancer Invasion and Metastasis Laboratory, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Hayder Mahdi
- Cancer Invasion and Metastasis Laboratory, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Catherine Laliberte
- Cancer Invasion and Metastasis Laboratory, Faculty of Dentistry, University of Toronto, Toronto, Canada
- Oral Pathology and Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Tomer Meirson
- Cell Migration and Invasion Laboratory, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Denise Eymael
- Cancer Invasion and Metastasis Laboratory, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Hava Gil-Henn
- Cell Migration and Invasion Laboratory, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Marco Magalhaes
- Cancer Invasion and Metastasis Laboratory, Faculty of Dentistry, University of Toronto, Toronto, Canada
- Oral Pathology and Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, Toronto, Canada
| |
Collapse
|
8
|
Sieviläinen M, Passador-Santos F, Almahmoudi R, Christopher S, Siponen M, Toppila-Salmi S, Salo T, Al-Samadi A. Immune checkpoints indoleamine 2,3-dioxygenase 1 and programmed death-ligand 1 in oral mucosal dysplasia. J Oral Pathol Med 2018; 47:773-780. [DOI: 10.1111/jop.12737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Meri Sieviläinen
- Department of Oral and Maxillofacial Diseases; Clinicum; University of Helsinki; Helsinki Finland
| | | | - Rabeia Almahmoudi
- Department of Oral and Maxillofacial Diseases; Clinicum; University of Helsinki; Helsinki Finland
| | - Solomon Christopher
- Department of Mathematics and Statistics; University of Helsinki; Helsinki Finland
| | - Maria Siponen
- Department of Oral and Maxillofacial Diseases; Kuopio University Hospital; Kuopio Finland
- Institute of Dentistry; University of Eastern Finland; Kuopio Finland
| | - Sanna Toppila-Salmi
- Department of Allergy; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Tuula Salo
- Department of Oral and Maxillofacial Diseases; Clinicum; University of Helsinki; Helsinki Finland
- Medical Research Centre; Oulu University Hospital; Oulu Finland
- Department of Diagnostics and Oral Medicine; Research Group of Cancer Research and Translational Medicine; Medical Faculty; University of Oulu; Oulu Finland
| | - Ahmed Al-Samadi
- Department of Oral and Maxillofacial Diseases; Clinicum; University of Helsinki; Helsinki Finland
| |
Collapse
|
9
|
Hwang JT, Gu YR, Dickson BJ, Shen M, Ralhan R, Walfish PG, Mock D, Pritzker KP. RETRACTED: Straticyte demonstrates prognostic value over oral epithelial dysplasia grade for oral potentially malignant lesion assessment. Oral Oncol 2017; 72:1-6. [DOI: 10.1016/j.oraloncology.2017.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 12/29/2022]
|