Combined quality of life and posttraumatic growth evaluation during follow-up care of patients suffering from oral squamous cell carcinoma

In-house virtual surgical planning and guided mandibular reconstruction is less precise, but more economical and time-efficient than commercial procedures

BACKGROUND

To compare an in-house and a commercially available surgical planning solution for mandibular reconstruction in terms of postoperative reconstruction accuracy and economic benefit.

METHODS

Twenty-nine consecutive patients with advanced oral squamous cell carcinoma (OSCC) requiring segmental mandibular reconstruction were enrolled. Fifteen patients underwent in-house surgical planning and 14 patients underwent a commercially available planning solution. A morphometric comparison of preoperative and postoperative computed tomography (CT) data sets and a cost-benefit comparison were performed.

RESULTS

Volumes of planned and reconstructed bone segments differed significantly for both in-house planning (p = 0.0431) and commercial planning (p < 0.0001). Significant differences in osteotomy angles were demonstrated for in-house planning (p = 0.0391). Commercial planning was superior to in-house planning for total mandibular deviation (p = 0.0217), intersegmental space volumes (p = 0.0035), and lengths (p = 0.0007). No significant difference was found between the two planning solutions in terms of intersegmental ossification and the incidence of wound healing disorders. In-house planning took less time than commercial planning (p < 0.0001). Component manufacturing costs (p < 0.0001) and total cumulative costs (p < 0.0001) were significantly lower for in-house planning.

CONCLUSIONS

In-house surgical planning is less accurate but has a cost advantage and could be performed in less time.

Sclerostin Alters Tumor Cell Characteristics of Oral Squamous Cell Carcinoma and May Be a Key Player in Local Bone Invasion

Localized jawbone invasion is a milestone in the progression of oral squamous cell carcinoma (OSCC). The factors that promote this process are not well understood. Sclerostin is known to be involved in bone metabolism and there are preliminary reports of its involvement in bone tumors and bone metastasis. To identify a possible involvement of sclerostin in the bone invasion process of OSCC, sclerostin expression was analyzed in vitro in two different human OSCC tumor cell lines by quantitative real-time polymerase chain reaction (qRT-PCR), and the effect of recombinant human (rh)-sclerostin treatment on tumor cell capabilities was evaluated using proliferation, migration, and invasion assays. Undifferentiated human mesenchymal stem cells (hMSCs) were osteogenically differentiated and co-cultured with OSCC tumor cells to demonstrate potential interactions and migration characteristics. Sclerostin expression was evaluated in clinical cases by immunohistochemistry at the OSCC-jawbone interface in a cohort of 15 patients. Sclerostin expression was detected in both OSCC tumor cell lines in vitro and was also detected at the OSCC-jawbone interface in clinical cases. Tumor cell proliferation rate, migration and invasion ability were increased by rh-sclerostin treatment. The migration rate of tumor cells co-cultured with osteogenically differentiated hMSCs was increased. The results presented are the first data suggesting a possible involvement of sclerostin in the bone invasion process of OSCC, which deserves further investigation and may be a potential approach for drug-based tumor therapy.

Postoperative facial appearance of patients with extensive oral squamous cell carcinoma can be adequately preserved with in‑house virtually planned mandibular reconstruction

The present study aimed to assess the concordance of preoperative and postoperative hard and soft tissues in patients with advanced oral squamous cell carcinoma (OSCC) following virtual surgical planning (VSP) mandibular reconstruction. In the present study, a cohort of 32 patients with OSCC underwent in-house VSP, followed by guided mandibular reconstruction utilizing vascularized free tissue grafts sourced from the fibula or scapula. A morphometric analysis was conducted comparing preoperative and postoperative three-dimensional virtual models to evaluate discrepancies and identify potential risk factors associated with poor reconstruction outcomes. The outcome variables were the differences in root mean square (RMS) and mean surface distance (MSD) resulting from the application of an iterative closest point algorithm to the virtual data. The validity of soft tissue comparison data is limited due to its susceptibility to various confounding variables. The present study conducted a comprehensive re-evaluation of these variables. High tumor stage, positive N status and the use of adjuvant therapy contributed to more noticeable differences in preoperative and postoperative facial soft tissue appearance. The accuracy of postoperative bone reconstruction results was higher in patients who underwent neomandibular formation using a fibular graft compared with those who received a scapular graft. Preoperative and postoperative soft tissue analyses were conducted for comparison. The MSD showed a deviation of 3.2 mm (± 2.0 mm SD; range 1.3-9.5 mm), whereas the RMS was 5.3 (± 2.9 SD; range 2.1-14). In conclusion, in-house VSP and guided mandibular reconstructions can yield clinically accurate results, preserving patient appearance and offering the advantage of rapid feasibility.

Combined Biomarker System Predicts Prognosis in Patients with Metastatic Oral Squamous Cell Carcinoma

BACKGROUND

Metastatic oral squamous cell carcinoma (OSCC) is associated with poor patient prognosis. Metastasis is a complex process involving various proteins, tumor cell alterations, including changes attributable to the epithelial-to-mesenchymal transition (EMT) process, and interactions with the tumor microenvironment (TME). In this study, we investigate a combined protein marker system consisting of connexin 43 (Cx43), EMMPRIN (CD147), E-cadherin, and vimentin, with a focus on their roles in the invasive metastatic progression of OSCC and their potential utility in predicting prognosis.

METHODS

We conducted an immunohistochemical analysis to assess the protein expression profiles of Cx43, EMMPRIN, E-cadherin, and vimentin using tissue samples obtained from 24 OSCC patients. The metastatic process was mapped through different regions of interest (ROIs), including adjacent healthy oral mucosa (OM), center of primary OSCC, invasive front (IF), and local cervical lymph node metastases (LNM). The primary clinical endpoints were disease-free survival (DFS) and overall survival (OS).

RESULTS

Substantial changes in the expression profiles of the different marker proteins were observed among the different ROIs, with all p-values < 0.05, signifying statistical significance. Multivariable Cox regression analysis results showed a significant effect of increased EMMPRIN expression toward the IF on DFS (p = 0.019) and OS (p = 0.023). Furthermore, the combined predictive analysis showed a significant predictive value of the marker system for DFS (p = 0.0017) and OS (p = 0.00044).

CONCLUSIONS

The combined marker system exhibited a significant ability to predict patient prognosis. An increase in EMMPRIN expression toward the IF showed the strongest effect and could be an interesting new antimetastatic therapy approach.

Mastication in health-related quality of life in patients treated for oral cancer: A systematic review

INTRODUCTION

Treatment for oral cancer can impair oral functions such as mastication, which may negatively affect quality of life (QoL). In this review, an overview is provided of masticatory ability in patients treated for oral cancer.

METHODS

The PubMed (MEDLINE), Embase and Cochrane databases were systematically searched for scientific literature on masticatory ability in relation to QoL in patients treated for oral cancer. Studies were included when oral cancer treatment was provided, and the University of Washington Quality of Life (UW-QoL) questionnaire was used. Risk of bias (MINORS) was independently assessed by two authors.

RESULTS

The PubMed (MEDLINE), Embase and Cochrane search yielded 575 unique records of which 111 were assessed full text, and 27 studies were included. The UW-QoL mastication scores ranged from 31.9 to 97.4. There was a wide variety in methodology, patient groups, tumour site, treatment and assessment moment, to such a degree that outcome scores are difficult to compare.

CONCLUSION

The wide variety in studies exploring health-related QoL in relation to mastication in oral cancer patients prevents the identification of possible relations between treatment, masticatory ability and QoL. Our findings underline the limitations in currently available literature and indicate the necessity for more comparable research.