Clinicopathological distinction of two categories of oral squamous cell carcinoma of the tongue: de novo vs. sequential types

Oral squamous cell carcinomas and oral potentially malignant disorders: A Latin American study

OBJECTIVE

To determine the frequency of oral squamous cell carcinoma (OSCC) associated or not with oral potentially malignant disorders (OPMD), and the epidemiological profile and traditional risk factors in Latin America.

METHODS

A retrospective observational study was conducted in 17 Latin American centres. There were included cases of OSCC, analysing age, gender, OSCC and their association with previous OPMD. Clinicopathological variables were retrieved. The condition of sequential-OSCC versus OSCC-de novo (OSCC-dn) was analysed concerning the aforementioned variables. Quantitative variables were analysed using Student's t-test, and qualitative variables with chi-square.

RESULTS

In total, 2705 OSCC were included with a mean age of 62.8 years old. 55.8% were men. 53.75% of the patients were smokers and 38% were common drinkers. The lateral tongue border was the most affected site (24.65%). There were regional variations in OPMD, being leukoplakia the most frequent. Of the overall 2705 OSCC cases, 81.4% corresponded to OSCC-dn, while s-OSCC were 18.6%. Regarding lip vermillion SCC, 35.7% corresponded to de novo lip SCC and 64.3% were associated with previous OPMD.

CONCLUSIONS

In Latin America, OSCC-dn seems to be more frequent with regional variations of some clinical and histopathological features. Further prospective studies are needed to analyse this phenomenon.

Differences among oral carcinomas arising de novo from those associated with oral potentially malignant disorders: a systematic review and meta-analysis

OBJECTIVE

To analyze the frequency of sequential oral squamous cell carcinomas (s-OSCC), preceded by oral potentially malignant disorders, and OSCC de novo (OSCC-dn) and explore differences in their clinicopathologic presentations.

STUDY DESIGN

A structured electronic search strategy identified studies that analyzed frequency, clinical, biological, demographic, biomarkers, and prognostic features of s-OSCC and OSCC-dn according to PRISMA guidelines in PubMed, Scopus, Cochrane Library, and Google Scholar, up to January 31, 2023. Inclusion criteria were original English, Spanish, Portuguese, French, Italian, and German cross-sectional, cohort, and case-control studies. The quality of studies was assessed using the Agency for Research and Health Quality tool and the Newcastle-Ottawa Scale tool.

RESULTS

The final selection included 40 studies. OSCC-dn and s-OSCC represent, respectively, 71% and 29% of cases of OSCC (P = .00), showing a higher percentage of T1 or of T1+T2 in s-OSCC (P < .0001). The association meta-analysis showed OSCC-dn with a significant association. The meta-analysis showed that s-OSCC was significantly associated with smaller tumor size, absence of distant metastases, relapses, male sex, and tumor sites different from tongue; and OSCC-dn was associated with more advanced tumor size, more regional and distant metastases, more advanced stages, and worse survival.

CONCLUSIONS

S-OSCC was less frequent than expected. OSCC-dn seems to have specific clinical, biological, and prognostic features. Future perspectives on oral cancer prevention should address novel approaches and alternatives to screening, such as urgent referral of OSCC-dn.

Intraoperative Assessment of Margin Accuracy in Early Oral Squamous Cell Carcinoma (cT1, T2, N0): Clinical Versus Frozen Section Analysis

Background The incidence of oral cavity cancer is increasing. During oral carcinoma surgery, to achieve a tumor-free margin, intraoperative margin assessment includes two primary methods, namely, clinical examination and frozen section analysis. With extensive preoperative imaging investigations and intraoperative clinical margin assessment, the need for further cost and resource-intensive frozen section analysis has recently come under question. This study aimed to assess whether frozen section analysis can be safely omitted in most cases of early oral squamous cell carcinoma surgeries for cost-effectiveness. Methodology A hospital-based, observational study including 30 admitted cases of early oral squamous cell carcinoma was conducted at the Department of General Surgery, Pradyumna Bal Memorial Hospital, Bhubaneswar. All consecutive confirmed cases of early oral squamous cell carcinoma of all age groups and both genders after considering the inclusion and exclusion criteria were involved in the study. A comparative assessment of the free margins after tumor excision was done by the surgeon followed by frozen section analysis. Results The mean age was 53.03 ± 13.72 years, with a male-to-female ratio of 6.5:1. Carcinoma of the lower alveolus with gingivobuccal sulcus was the most common presentation of the study (33.33%). In our study, clinically assessed margins had a sensitivity of 75.39%, a specificity of 94.43%, and an accuracy of 92.77%. Frozen section assessed margins had a sensitivity of 66.5%, a specificity of 96.94%, and an accuracy of 92.77%. Conclusions Based on the accuracy of clinically assessed and frozen section assessed margins, this study concluded that surgically resected/excised specimen by the surgeon plays a vital role in assessing the adequacy of resected/excised margins in early oral squamous cell carcinoma (cT1, T2, N0) cases, which can possibly replace the costly frozen section analysis.