Clinicopathological analysis of oral squamous cell carcinoma among the younger age group in coastal Karnataka, India: A retrospective study

A Retrospective Analysis of the Clinicopathological Profile of Oral Squamous Cell Carcinoma in Tobacco and Non-tobacco Users: Highlighting the Significance of Chronic Mechanical Irritation

BACKGROUND AND AIM

Oral squamous cell carcinoma (OSCC) is among the leading top three cancers in India. However, recent literature has shown an increase in the rise of oral cancer in younger individuals without any history of tobacco-related habits. Chronic mucosal irritation (CMI) has been noted to have a substantial impact on the development and etiology of OSCC. With the shift in the trend, it is imperative to observe and monitor alterations associated with its etiological factors. The study aims to evaluate the prevalence and clinical characteristics of OSCC patients and the association of these parameters in cases with and without tobacco usage.

METHODOLOGY

A retrospective study spanning a period of 10 years was done on histopathologically diagnosed cases of OSCC. Various clinicopathological characteristics were collected from patient records, including demographic features, tobacco-related habits, including tobacco chewing and smoking, clinical presentation, anatomic sites, and histopathological grading based on the inclusion and exclusion criteria. The data were tabulated to Microsoft Excel (Microsoft Corporation, Redmond, WA), and descriptive statistics analysis and chi-square test of significance were applied to the data using IBM SPSS Statistics (version 29.0.2; IBM Corp., Armonk, NY). The study correlated the epidemiologic behavior of OSCC with age, gender, site, and tobacco-related habits.

RESULTS

This study included a sample size of 204 (72 females & 132 males). Tobacco-related habit-associated cases were 98 (48.5%) and without tobacco habits were 61 cases (29.6%). Etiology associated with CMI emerged to be a significant tooth-related factor. Out of 72 females, 32 (44.4%) of the females were without habit. OSCC caused by trauma from CMI was analyzed in 40 cases (19.6%) and 22 (55%) were females. The majority of lesions (76 (37.4%) cases) presented on the lateral border of the tongue. Among the OSCC patients with a history of chronic mechanical irritation, 37 (48.7%) cases were observed to be specifically on the lateral border of the tongue.

CONCLUSION

These 10-year data will generate awareness about the disease pattern occurring within a community and provide an overview of the prerequisite of considering CMI as an etiological factor for the development of OSCC without the association of tobacco-related habits.

Expression of CD4+ and CD8+ Tumor-Infiltrating Lymphocytes in Oral Squamous Cell Carcinoma and Their Relationship With Clinicopathological Parameters: A Cross-Sectional Study

Background Oral squamous cell carcinoma (OSCC) is the most common malignant neoplasm of the oral cavity. The tumor microenvironment (TME) is a dynamic ecosystem composed of components contributed by both the tumor and the host. The immune cells of TME, mainly CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs), suppress the proliferation of cancer cells and play a crucial role in the progression of OSCC. The present study aims to analyze the immunohistochemical expression of CD4+ and CD8+ TILs in OSCC and to compare and correlate them with clinicopathological parameters. Methodology A total of 75 formalin-fixed paraffin-embedded samples of cases diagnosed with primary OSCC were immunostained with CD4+ and CD8+ antibodies and their expression was compared with the clinicopathological parameters. Results There was a significant positive correlation between CD4+ and CD8+ expression (r = 0.655, p = 0.001). Both CD4+ (r = -2.37, p = 0.041) and CD8+ (r = -0.348, p = 0.002) expressions negatively correlated with the TNM stage (r = -2.37, p = 0.041) of OSCC. CD8+ expression positively correlated with histopathological grade (r = 0.288, p = 0.012). Conclusions The study findings suggest that CD4+ cells are essential to maintain and sustain CD8+ TIL-mediated anti-tumor response. CD4+ and CD8+ TILs are key players in cell-mediated adaptive immunity and prevent tumor progression and metastasis. Strikingly, the higher grade of tumors despite heavy CD8+ infiltration may possibly be due to cancer immunoediting.

Identifying Biomarkers and Therapeutic Targets by Multiomic Analysis for HNSCC: Precision Medicine and Healthcare Management

Background: Head and neck squamous cell carcinoma (HNSCC) is one of the major types of cancer, with 900,000 cases and over 400,000 deaths annually. It constitutes 3-4% of all cancers in Europe and western countries. As early diagnosis is the key to treating the disease, reliable biomarkers play an important role in the precision medicine of HNSCC. Despite treatments, the survival rate of cancer patients remains unchanged, and this is mainly due to the failure to detect the disease early. Thus, the objective of this study is to identify reliable biomarkers for head and neck cancers for better healthcare management. Methods: In this study, all available, curated human genes were screened for their expression against HNSCC TCGA patient samples using genomic and proteomic data by various bioinformatic approaches and datamining. Docking studies were performed using AutoDock or online virtual screening tools for identifying potential ligands. Results: Sixty genes were short-listed, and most of them show a consistently higher expression in head and neck patient samples at both the mRNA and the protein level. Irrespective of human papillomavirus (HPV) status, all of them show a higher expression in cancer samples. The higher expression of 30 genes shows adverse effects on patient survival. Out of the 60 genes, 12 genes have crystal structures and druggable potential. We show that genes such as GTF2H4, HAUS7, MSN, and MNDA could be targets of Pembrolizumab and Nivolumab, which are approved monoclonal antibodies for HNSCC. Conclusion: Sixty genes are identified as potential biomarkers for head and neck cancers based on their consistent and statistically significantly higher expression in patient samples. Four proteins have been identified as potential drug targets based on their crystal structure. However, the utility of these candidate genes has to be further tested using patient samples.

What if amoxicillin/clavulanic acid reduces the cisplatin anticancer impact on oral cancer treatment?

Antibiotics-chemotherapeutics combination have become on the table for many cancer treatments. For this reason, we thought that further progress and development of studies to support chemotherapeutic approaches with the use of antibiotics may be beneficial in the clinical field. Cell lines (SCC-15, HTB-41, and MRC-5) were treated with 5-100 μM/ml concentrations of cisplatin (cisp) and amoxicillin/clavulanic acid (amx/cla) with combination (amx/cla-cisp) and alone in three different incubation periods. The all-cells viability was examined with WST-1 and apoptotic activity of the drugs were investigated via cell death ELISA assay kit. The cytotoxic impact of the 100 μM amx/cla-cisp combination was found to be reduced by up to 21.8%, which was significant given that the cytotoxic effect of only cisplatin therapy was 86.1%. Because our findings demonstrated that solo amx/cla therapy have almost no impact on proliferation or death, we focused on the amx/cla-cisp combination effect. It was found that the amx/cla-cisp combination has reduced the apoptotic fragment when comparing with the solely cisp-treated cells. Due to amx/cla-cisp combination on both cells but significantly on SCC-15 recovered the sole cisplatin effect, we believe that there might be a second thought when prescribing antibiotics while treating cancer patients. Not only the antibiotic's type but also the cancer type might interact to lessen the chemotherapeutic agent's impact which is clinically a dilemma to focus on.

Comparison of Clinico-Demographic and Histological Parameters Between Young and Old Patients With Oral Squamous Cell Carcinoma

INTRODUCTION

Among the epithelial malignancies of the head and neck region, oral squamous cell carcinoma (OSCC) arising from the oral mucosa is the commonest type. OSCC is common in the older population; however, recent epidemiological data indicate an increase in the incidence in the younger age group. The present study was designed to compare the clinicopathological characteristics of OSCC between young and old South Indian patients.

METHODS

All the histopathologically confirmed cases of OSCC were retrieved from the department archives. Patients aged more than 40 years were considered Group I, and patients aged less than or equal to 40 were considered Group II. Age, gender, laterality, site, degree of keratinization, nuclear pleomorphism, pattern of invasion, lymphoplasmacytic infiltration, grade, tumor budding (TB), and tumor stroma ratio (TSR) were assessed.

RESULTS

Among 510 patients reported with OSCC, 442 were aged above 40 years, and 68 were aged 40 years or younger. Nuclear pleomorphism, TB, and stroma-rich ratio were statistically higher in younger OSCC patients (p=0.00).

CONCLUSION

The results of our study support the fact that OSCC in younger individuals is more aggressive. Targeting TB and tumor stroma could provide new strategies for the management of OSCC.

Clinicopathologic features and risk factors associated with oral squamous cell carcinoma (OSCC): A comprehensive descriptive study analyzing the burden of OSCC in a tertiary-level hospital in North Kerala, India

BACKGROUND

Oral cancer is one of the most common types of cancer worldwide, and India shows a high incidence of oral squamous cell carcinoma (OSCC) cases. Kerala accounts for a sizeable number of these cases, most of which can be attributed to the deleterious habits prevalent in a vast majority of the population. A comprehensive descriptive-prospective study was done in our institution over 18 months to identify the possible risk factors, to describe the clinical and sociodemographic variables of OSCC, and to understand the burden of this dreaded disease in the North Kerala population.

MATERIALS AND METHODS

Data collection was done using a structured pro forma. The data were tabulated and organized; uni- and bivariate analysis were performed along with cross-tabulations for various parameters and relevant variables. A total of 243 histopathologically confirmed cases of OSCC during 18 months comprised the sample in this study.

RESULTS

Among the 243 cases, 220 patients had deleterious habits. Betel chewing was the most predominant habit. Buccal mucosa was the commonly affected site. Twenty-three patients had no history of any habits. Majority of the patients presented in stage 3 and 4 of the disease. Moderately differentiated squamous cell carcinoma was the major histologic type.

CONCLUSION

The majority of the patients had clinical lesions corresponding to the habit usage, showing a low awareness of tobacco cessation and intervention programs and a high burden of OSCC in the North Kerala population.

Comparative evaluation of oral mucositis in oral cancer patients undergoing 3-dimensional conformal radiation therapy and intensity modulated radiation therapy with or without chemotherapy

Context

Oral cancer is a significant cause of death across the world. A combined multimodal approach integrating surgery and radiation therapy (RT) with or without chemotherapy (CT) is commonly employed in advanced oral cancer to prevent recurrences and locoregional spread. Oral mucositis is a common acute toxicity reported in patients undergoing RT and CT. The delivery of optimal cancer therapy protocols is compromised due to morbidity caused by oral mucositis.

Aims

To compare the severity of oral mucositis in oral cancer patients undergoing 3-Dimensional Conformal Radiation Therapy (3DCRT) and Intensity Modulated Radiation Therapy (IMRT) with or without concomitant CT.

Settings and Design

This was a prospective, unicentric and longitudinal study conducted in a cancer centre.

Methods and Material

One hundred four patients with locally advanced oral cancer were enrolled in this study. Fifty-two patients were treated with IMRT and 52 patients with 3DCRT to a dose of >60 Gy, along with concurrent cisplatin weekly CT. Mucositis was recorded before the start, in the end, 1 month, and 3 months post-chemoradiotherapy treatment.

Statistical Analysis Used

Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software (v. 21.0, Chicago. 2012). Descriptive and frequency statistics were performed for different parameters assessed in 3DCRT and IMRT group.

Results

Grade 3 mucositis was the most predominant grade observed in both groups at the end of treatment. Thirty-six patients (69.3%) versus 24 patients (46.1%) developed grade 3 mucositis in 3DCRT and IMRT group, respectively (P = 0.013). Healing was better with IMRT group when compared to 3DCRT group 1 month and 3 months post-RT. Mucositis was severe in patients undergoing concomitant CT.

Conclusions

IMRT reduced the incidence of severe mucositis and also improved the treatment-compliance compared to 3DCRT in locally advanced head neck cancer patients treated by chemoradiotherapy.

Serum autoantibody profiling of oral squamous cell carcinoma patients reveals NUBP2 as a potential diagnostic marker

Introduction

Oral Squamous Cell Carcinoma (OSCC), a common malignancy of the head and neck region, is frequently diagnosed at advanced stages, necessitating the development of efficient diagnostic methods. Profiling autoantibodies generated against tumor-associated antigens have lately demonstrated a promising role in diagnosis, predicting disease course, and response to therapeutics and relapse.

Methods

In the current study, we, for the first time, aimed to identify and evaluate the diagnostic value of autoantibodies in serum samples of patients with OSCC using autoantibody profiling by an immunome protein array. The utility of anti-NUBP2 antibody and tissue positivity in OSCC was further evaluated.

Results and discussion

We identified a total of 53 autoantibodies with significant differential levels between OSCC and control groups, including 25 that were increased in OSCC and 28 that were decreased. These included autoantibodies against Thymidine kinase 1 (TK1), nucleotide-binding protein 2 (NUBP2), and protein pyrroline-5-carboxylate reductase 1 (PYCR1), among others. Immunohistochemical validation indicated positive staining of NUBP2 in a large majority of cases (72%). Further, analysis of OSCC data available in TCGA revealed higher NUBP2 expression correlated with better disease-free patient survival. In conclusion, the differential serum autoantibodies identified in the current study, including those for NUBP2, could be used as potential biomarkers for early diagnosis or as screening biomarkers for OSCC pending investigation in a larger cohort.

Depth of Invasion, Lymphovascular Invasion, and Perineural Invasion as Predictors of Neck Node Metastasis in Early Oral Cavity Cancers

Aims

The present study examines the role of demographic and pathological features of primary tumours in predicting neck metastasis in early oral cavity cancers, which has been a matter of debate.

Methods

A single-centre, retrospective, institution review was conducted of all the patients presented to our centre from January 2014 to December 2021. Patient characteristics were compared between the two lymph node groups (lymph node positive and lymph node negative) and significant prognostic factors were determined.

Results

A total of 462 oral squamous cell carcinoma (OSCC) patients were included, 407 male and 55 female. Tobacco chewing (59.2%) was a major habit with buccal mucosa (49.5%) and tongue (44.8%) as primary sites. The majority of the patient's histology was of SCC (96.8%) with grade II (moderately differentiated, 74.5%). Univariate logistic regression analysis to predict lymph node metastasis showed pT size (< 0.001), LVI (< 0.001), and PNI (< 0.001) as significant tumor characteristics. On multivariate, pT size (OR-1.58, P - 0.0001) and LVI (OR-19.70, P - 0.0001) were reported to be statistically significant to predict lymph node metastasis.

Conclusion

Reporting and studying the clinico-pathological features of primary tumors can give vital information in predicting the neck node metastasis in OSCC patients.

Inverse correlation of CD3 & vascular endothelial growth factor in incisional oral squamous cell carcinoma biopsies predicts nodal metastasis & poor survival of patients

Background & objectives

Oral squamous cell carcinoma (OSCC) is widely prevalent in the Indian subcontinent mainly due to habit-associated aetiologies. Immune regulation and angiogenesis are the part of tumourigenesis that play a crucial role in metastasis and survival. However, the concurrent expression of vascular endothelial growth factor (VEGF) and CD3 (immune regulator receptor on T-lymphocyte) in the same OSCC tissue samples has not been reported in the Indian population. The present study evaluated the expression of CD3+ T-cells and VEGF in OSCC tissue samples and studied the clinicopathological correlation and survival analysis in an Indian population.

Methods

This was a retrospective study conducted on 30 formalin-fixed and paraffin embedded sections which were histologically diagnosed as OSCC cases comprising of 15 metastatic OSCC and 15 non-metastatic OSCC with available clinical data and survival status.

Results

Reduced expression of CD3+ T-cells and increased VEGF expression were observed in metastatic OSCC samples. The correlation of expression of CD3+ T-cells and VEGF with clinicopathological parameters showed a significant association between these markers with age, nodal status, site of the lesion and survival.

Interpretation & conclusions

Reduced expression of CD3+ T-cells in OSCC was found to be associated with a significantly poor survival. VEGF was found to be over expressed in metastatic OSCC as compared to that in non-metastatic OSCC. The study findings suggest that the evaluation of CD3 and VEGF in incisional OSCC biopsies can be considered for predicting the survival outcome and metastasis.

Expression of CD 20 B-Lymphocyte in oral epithelial dysplasia and oral squamous cell carcinoma: A comparative immunohistochemistry study

Background

As the progressive trends in the field of immunotherapy, it is very favourable to reconsider the role played by B lymphocytes in the tumor microenvironment. Both the protumorogenic and antitumorogenic responses have to be evaluated to formulate an effective immunotherapeutic protocol.

Aim and objective

The study was primarily conducted to assess the qualitative expression of B lymphocytes in pretumorogenic (oral epithelial dysplasia) and tumorogenic environment (oral squamous cell carcinoma). The differential immunohistochemical staining of CD 20 immune marker was assessed in about 60 cases that included 30 cases of oral epithelial dysplasia and 30 cases of oral squamous cell carcinoma.

Results

The study found significant correlation between CD 20 IHC immune expression and histopathological diagnosis along with significant correlation between the subject's age group and histopathological diagnosis.

Conclusion

Modulating the immune response in a precancerous state can be highly beneficial in implementing better immunotherapeutic strategies to treat or prevent malignancy at an early stage.

Oral mucosal lesions - A study of 369 cases

Background

Diagnosing and treating oral cavity lesions is a challenging task for most of the clinicians due to similar symptoms and clinical appearances. Frequently, histopathology and immunohistochemistry aid in making the diagnosis.

Objectives

The objectives were to describe the clinical features, and histopathological features and systemic association in patients with oral mucosal lesions (OML).

Materials and Methods

A cross-sectional descriptive study was undertaken at a tertiary care centre in patients with OML. A total of 369 cases with OML were included in the study.

Results

Males constituted 61.78% of the cases. History of habits such as tobacco, gutka chewing, smoking, and alcohol was given by 32.25%, 29.81%, 26.56%, and 11.38% of cases, respectively. Common symptoms were soreness, burning sensation, oral pain and ulcers. Both oral and cutaneous involvement was seen in 17.89% of cases. Oral lichen planus (oral LP) constituted largest group of patients (21.96%) wherein reticulate type was the most frequent type and buccal mucosa was the commonest site. Oral carcinomas constituted 20.33% of cases followed by infective etiology (11.92%), vesiculobullous group of diseases (10.30%), aphthous stomatitis (8.94%), premalignant lesions (7.05%) such as leukoplakia (3.80%) and submucous fibrosis (2.44%). Histopathology was done in 209 cases. Clinico-histopathological correlation was seen in oral LP (90.27%), oral pemphigus (82.35%), and malignancies (98.66%).

Conclusion

Oral LP formed the largest group of cases followed by Oral squamous cell carcinoma (SCC). Several rare conditions, such as Melkersson-Rosenthal syndrome and blue rubber bleb nevus syndrome were also a part of the study. Thorough clinical and histopathological examination in this diverse group of diseases clinches the diagnosis.

Oral Squamous Cell Carcinoma Frequency in Young Patients from Referral Centers Around the World

Oral squamous cell carcinoma (OSCC) commonly affects older patients; however, several studies have documented an increase in its incidence among younger patients. Therefore, it is important to investigate if this trend is also found in different geographic regions. The pathology files of diagnostic and therapeutic institutions from different parts of the globe were searched for OSCC cases diagnosed from 1998 to 2018. Data regarding the sex, age, and tumor location of all cases, as well as the histologic grade and history of exposure to risk habits of cases diagnosed as OSCC in young patients (≤ 40 years of age) were obtained. The Chi-square test was used to determine any increasing trend. A total of 10,727 OSCC cases were identified, of which 626 cases affected young patients (5.8%). Manipal institution (India) showed the highest number of young patients (13.2%). Males were the most affected in both age groups, with the tongue and floor of the mouth being the most affected subsites. OSCC in young individuals were usually graded as well or moderately differentiated. Only 0.9% of the cases occurred in young patients without a reported risk habit. There was no increasing trend in the institutions and the period investigated (p > 0.05), but a decreasing trend was observed in Hong Kong and the sample as a whole (p < 0.001). In conclusion there was no increase of OSCC in young patients in the institutions investigated and young white females not exposed to any known risk factor represented a rare group of patients affected by OSCC.

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

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.

Early-onset oral cancer as a clinical entity: aetiology and pathogenesis

Oral squamous cell carcinoma (OSCC) is one of the most important medical and socio-economic problems in many of the developed countries worldwide, due to the high mortality. The incidence of OSCC among individuals under 45 years of age is growing every year; however, the aetiological factors and pathogenetic mechanisms are poorly understood. This review summarizes the available information regarding clinicopathological features, extrinsic and intrinsic aetiological factors, and the molecular and immune landscape of early-onset OSCC. This cancer shows high recurrence rates and is not associated with the aetiological factors specific to adult-onset OSCC. Young adults with OSCC are not infected with human papillomavirus and rarely consume alcohol or tobacco, but more frequently use smokeless tobacco. Data from single studies indicate the hereditary nature of early-onset OSCC: the KIR2DL1⁺-HLA-C2⁺ genotype and MMP-1 2 G allele are frequently detected in young patients. Early-onset OSCC shows specific genetic, epigenetic, transcriptomic, and proteomic changes. The tumour microenvironment in early-onset OSCC is tolerogenic rather than immunogenic. All of the data suggest that OSCC in young patients is a separate clinical entity with a specific aetiology and pathogenesis. Further studies are needed to reveal the causes and molecular targets of early-onset OSCC for the development of preventive and therapeutic strategies.

To compare the levels of salivary Interleukin 6 between oral potentially malignant disorders and oral squamous cell carcinoma

To compare the levels of salivary Interleukin 6 between oral potentially malignant disorders and oral squamous cell carcinoma. After ethical clearance and informed consent, the saliva samples were collected from 20 patients of OPMD’S, 20 patients of OSCC and 10 controls. Salivary IL-6 levels were detected by enzyme linked Immunosorbent essay and appropriate statistical analysis was done. Significant differences in IL-6 concentration between OSCC, OPMD’S and controls were noted. Salivary IL-6 levels were higher in OSCC. The results of  present study concluded that the level of salivary IL-6 in OSCC is significantly higher than oral potentially malignant disorders like OSMF and oral epithelial dysplasia and controls. This biomarker can be utilized as a major asset for early detection of cancer and can open a new horizon for treatment plans of targeted therapy.

The prevalence of oral squamous cell carcinoma with oral submucous fibrosis

Objective

The objective of the study was to find out the prevalence of oral squamous cell carcinoma (OSCC) with oral submucous fibrosis (OSF) in patients with OSF.

Materials and Methods

Of 48,757 patients, we found 300 OSF subjects. Three hundred patients of OSF were checked for OSCC. Both OSF and OSCC with OSF (OSCCwOSF) were diagnosed histopathologically. The prevalence of OSCCwOSF was calculated. Descriptive analysis was done. Chi-square test and t-test were calculated for proportions and mean, respectively, to check any difference among OSF and OSCCwOSF groups. Age-specific relative risk was calculated in OSF and OSCCwOSF groups. Multiple logistic regression analysis was done among odd ratios of the different variable between OSF and OSCCwOSF groups.

Results

The prevalence of OSCCwOSF among OSF was 13.7% over a period of 1 year. The mean age of OSCCwOSF group was 43.95 ± 10.22 years in comparison to the OSF group that was 35.51 ± 11.26 years (P < 0.00). The mean habit duration was significantly less in the OSF group when compared to OSCCwOSFgroup for mishri (P = 0.002). Age-specific adjusted relative risk of OSCC in OSF patient increases from 0.33 (18-34 years) to 3.86 (≥65 years).

Conclusion

It could be concluded that a 13.7% prevalence rate of OSCCwOSF in OSF patients should alert the clinician. Clinicians should, therefore, anticipate OSSC in OSF patients. This awareness could lead to the early diagnosis and management of such OSCC.

A Meta-analysis of Oral Squamous Cell Carcinoma in Young Adults with a Comparison to the Older Group Patients (2014-2019)

Background:

The oral squamous cell carcinoma (OSCC) often affects elderly aged adults, who had long-term tobacco exposure. In the recent past decade, there is an increasing incidence of OSCC in younger individuals, who had less tobacco association.

Aim:

The aim of this study is to examine the risk factors and to assess and compare the clinicopathological features and prognosis of OSCC in young patients with the older group patients.

Materials and Methods:

We included studies that addressed the OSCC involving young patients during the period between 2014 and 2019. Initially, we found 679 articles; after refined evaluation, 92 works had their titles matching to the present work. After extraction of case reports, reviews, and studies with un-matched objectives or inadequate data, we have chosen only 24 presentations matching to the abstract. The statistical analysis performed by Chi-square tests using SPSS 20.0 version for windows.

Results:

Of the total OSCC, 10% of patients belonged to the younger age group, and 90% were the older aged group. Both the groups showed male gender predominance and tongue as the predominant site of involvement. The younger patients tend to have significantly reduced tobacco exposure. The highly reported tumors were advanced staged and moderately differentiated tumors in both groups. There was a statistically evident high recurrence reported in the younger group. The overall survival seems to be similar for both groups.

Conclusion:

The identification of the potential risk factors, along with unique molecular mechanisms, and biological behavior of the disease is mandatory to control the incidence of OSCC in young adults.

Guide flange Prosthesis for management of hemimandibulectomy

Guide flange is given to patients who have undergone surgical hemi/segmental/subtotal mandibulectomy due to various reasons (leading cause being squamous cell carcinoma), with resultant mandibular deviation. If procedures such as secondary osseous grafting are planned, the clinician has to wait for healing of the graft, lesion, or radiotherapeutic effects to abate. Only after the healing of the graft, a definitive prosthesis can be planned. During this time lag, prosthesis must be given to the patient to correct mandibular deviation on account of unilateral muscle pull. Furthermore, in certain cases, a definitive prosthesis has to be put on hold due to failure of bone grafting or when the patient is not willing for a second surgery. This report describes the fabrication of such a mandibular guide flange prosthesis.

Increased Expression of p-GSK3β Predicts Poor Survival in T -III/IV Stage OSCC Patients

BACKGROUND/AIM

Glycogen synthase kinase 3 beta (GSK3-β) acts either as a tumor suppressor or an oncogene in various human cancers. The present study aimed to investigate the expression and activity of p-GSK3-β (Ser9) in oral cancer patients.

MATERIALS AND METHODS

We investigated the levels of p-GSK3β in 152 oral cancer tissues by immunohistochemistry, and explored their prognostic impact.

RESULTS

To investigate the role of p-GSK3β (Ser9) in OSCC progression, we first analyzed the expression levels of protein p-GSK3β in normal and oral cancer tissues using immunohistochemical staining. p-GSK3β immunostaining was detected in 32 of 152 (21.1%) oral cancer specimens. High p-GSK3β expression was significantly associated with T (III/IV) stage. Kaplan-Meier survival analysis revealed that high levels of p-GSK3β were correlated with poor survival (p=0.001) in T stage (III/IV) OSCC patients. Multivariate analyses indicated that TN stage, AJCC tumor stage, tumor differentiation status and clinical therapy, but not p-GSK3β levels, were independent prognostic factors. Significant mortality risk was found in T stage (III/IV) oral cancer patients with high levels of p-GSK3β (p=0.0006).

CONCLUSION

GSK3β inactivation is a key event in oral cancer patients and targeting GSK3β might be valuable in treating oral cancer patients.

Molecular alterations in oral cancer between tobacco chewers and smokers using serum proteomics

BACKGROUND

Tobacco exposure (through smoking or chewing) is one of the predominant risk factors associated with the development of oral squamous cell carcinoma (OSCC). Despite the growing number of patients diagnosed with OSCC, there are few circulating biomarkers for identifying individuals at a higher risk of developing the disease. Successful identification of candidate molecular markers for risk assessment could aid in the early detection of oral lesions and potentially be used for community screening of high-risk populations.

OBJECTIVE

Identification of differentially expressed proteins in the serum of oral cancer patients which can serve as biomarkers for the diagnosis of the onset of oral cancer among tobacco users.

METHODS

We employed a tandem mass tag (TMT)-based quantitative proteomics approach to study alterations in the serum proteomes of OSCC patients based on their tobacco exposure habits (chewing and smoking) compared to healthy individuals with no history of using any form of tobacco or any symptoms of the disease.

RESULTS

Mass spectrometry-based analysis resulted in the identification of distinct signatures in the serum of OSCC patients who either chewed or smoked tobacco. Pathway analysis revealed opposing effects of dysregulated proteins enriched in the complement-coagulation signaling cascades with a high expression of the Serpin family of proteins observed in OSCC patients who chewed tobacco compared to healthy individuals whereas these proteins showed decreased levels in OSCC patients who smoked. ELISA-based validation further confirmed our findings revealing higher expression of SERPINA6 and SERPINF1 across serum of OSCC patients who chewed tobacco compared to healthy individuals.

CONCLUSIONS

This study serves as a benchmark for the identification of serum-based protein markers that may aid in the identification of high-risk patients who either chew tobacco or smoke tobacco.

Tumor-associated macrophages: Harbingers of aggressiveness in oral squamous cell carcinoma

BACKGROUND

The significance of the tumor microenvironment (TME) as a modulator of tumor behavior was acknowledged by Hanahan and Weinberg in 2011 as the emerging hallmarks and enabling characteristics of the hallmarks of cancer. Subsequently, the role of inflammation, in conferring aggressiveness to a tumor, was regarded as a fundamental process in the evolution of the TME. Tumor-associated macrophages (TAMs) are distinctly polarized inflammatory cells and key shapers of a protumorigenic microenvironment.

AIMS

The aim of the study was to evaluate the distribution of TAMs and the expression of CD-163 as a marker to evince tumor aggressiveness, in oral squamous cell carcinoma (OSCC).

SETTINGS AND DESIGN

A retrospective institutional study was approved by the institutional ethics committee, and random sampling was carried out. Cases fulfilling the inclusion criteria were subjected to S(site), T(tumor), N( node), M( metastasis), P(pathology) STNMP staging along with immunohistochemical evaluation of CD-163.

METHODS

Samples for this study included 58 archival cases of OSCC. Demographic details were recorded, and the STNMP stage ascertained, following which, each case was reevaluated histopathologically for the invasive front. Cases with sufficient stroma and demonstrating the invasive front were further subjected to immunohistochemical evaluation of CD-163 for TAMs. The density of CD-163-positive cells was assessed by three pathologists, independently, in a double-blinded evaluation using Image-J©.

STATISTICAL ANALYSIS

Descriptive data were evaluated and analyzed statistically using Spearman's/Pearson's correlation tests based on the distribution of data.

RESULTS

The density of TAMs was noted to be directly proportional to the STNMP stage. In addition, a strong positive, statistically significant correlation was noted between the density of TAMs and tumor size, nodal status and STNMP stage.

CONCLUSION

The crucial role of the tumor microenvironment must be considered when evaluating OSCC. TAMs prove to be a reliable marker for assessing tumor aggressiveness and could aid in improved prognostication of OSCC, while also being potential targets for therapy.

CD133 Role in Oral Carcinogenesis

Objective:

to investigate CD133 immunoexpression, cancer stem cells marker, in oral epithelial dysplasias (OEDs) and oral squamous cells carcinomas (OSCCs) and understandits possible involvement in the malignant transformation process of these lesions and to better elucidate their biological behavior.

Material and methods:

Tissue samples of 15 cases of OSCCs and 15 OEDs were subjected to CD133 antibody immunohistochemistry reactions. The analysis used quantitative parameters (number of immunostained cells regardless of immunostaining sublocations).

Results:

All samples of OSCCs and OEDs showed positive immunostaining, with no significant difference between these groups (p = 0.283). We did not observe statistical difference between the degree of dysplasia and the amount of CD133+ cells (p = 0.899). CD133 immunoexpression showed no association with the OEDs and OSCCs sites. It was observed that nuclear and cytoplasmic immunostaining was more evident with the progression of the malignant process.

Conclusion:

It is suggested that the CD133 cellular localization together with the histopathological criteria of OEDs classification can contribute to provide more concrete indications about the oral carcinogenesis process.

PEG-coated nanoparticles detachable in acidic microenvironments for the tumor-directed delivery of chemo- and gene therapies for head and neck cancer

Background: Head and neck cancer (HNC) is a major cause of morbidity and mortality and has a poor treatment outcome. Irinotecan, a topoisomerase-I inhibitor, induces cell death by decreasing the religation of double-strand DNA. However, epithelial-mesenchymal transition (EMT), therapy resistance, and systemic toxicity caused by available antineoplastic agents hinder the efficacy and safety of HNC treatment. Chemotherapy combined with gene therapy shows potential application in circumventing therapy resistance and EMT. miR-200 exerts a remarkable suppressing effect on EMT-associated genes. Herein, liposomes and solid lipid nanoparticles (SLNs) modified with a pH-sensitive, self-destructive polyethylene glycol (PEG) shell and different peptides were designed as irinotecan and miR-200 nanovectors to enhance tumor-specific accumulation. These peptides included one ligand targeting the angiogenic tumor neovasculature, one mitochondrion-directed apoptosis-inducing peptide, and one cell-penetrating peptide (CPP) with high potency and selectivity toward cancer cells. Methods: Physicochemical characterization, cytotoxicity analysis, cellular uptake, regulation mechanisms, and in vivo studies on miR-200- and irinotecan-incorporated nanoparticles were performed to identify the potential antitumor efficacy and biosafety issues involved in HNC treatment and to elucidate the underlying signaling pathways. Results: We found that the cleavable PEG layer responded to low extracellular pH, and that the CPP and targeting peptides were exposed to improve the uptake and release of miR-200 and irinotecan into HNC human tongue squamous carcinoma (SAS) cells. The apoptosis of SAS cells treated with the combinatorial therapy was significantly induced by regulating various pathways, such as the Wnt/β-catenin, MDR, and EMT pathways. The therapeutic efficacy and safety of the proposed co-treatment outperformed the commercially available Onivyde and other formulations used in a SAS tumor-bearing mouse model in this study. Conclusion: Chemotherapy and gene therapy co-treatment involving pH-sensitive and targeting peptide-modified nanoparticles may be an innovative strategy for HNC treatment.

Oral microbial profile in oral cancer patients before and after radiation therapy in a cancer care center - A prospective study

Background:

Head and neck cancer is the sixth most common cancer reported worldwide. In many cases, the level of aggressiveness of therapy adopted in cancer patients may cause the alteration in oral microbiota; the emergence of potential pathogens may cause opportunistic infections in already immune-compromised individuals leading to increases in morbidity and mortality. Hence, this study was conducted to assess the oral microbial profile in oral cancer patients before and after radiotherapy.

Materials and Methods:

A total of 145 oral swabs were collected before radiotherapy (n = 96), 3 months postradiotherapy (n = 25), 6 months postradiotherapy (n = 12) and controls (n = 12). The samples were inoculated into brain–heart infusion broth and later in different media for bacterial isolation. The isolates were subjected to phenotypic characterization by automatic identification system.

Results:

Among the 96 samples studied from the preradiotherapy patient samples, Streptococcus species (n = 28) were the predominant isolate, followed by Staphylococcus species (n = 16), Enterobacter species (n = 6) and Enterococcus species (n = 6). Of the 25 samples studied 3 months after radiotherapy, Klebsiella pneumoniae (n = 4) was isolated and 12 samples studied after 6 months of radiotherapy Candida species (n = 4) and Pediococcus species (n = 3) were isolated. Among the control group (n = 12) screened, Streptococcus acidominimus (n = 3) is the predominant bacteria isolated.

Conclusion:

High prevalence of Streptococcus sp. was found in patients of oral cancer before radiotherapy, while Candida albicans and Klebsiella species and Pediococcus species are the significant pathogens isolated in postradiotherapy cancer patients.

John MA. The promise of immunotherapy in the treatment of young adults with oral tongue cancer

Historically considered a disease of the older male resulting from cumulative tobacco and alcohol use, more recently we have witnessed a rise in the global incidence of oral tongue squamous cell carcinoma in younger adults, particularly those without any identifiable risk factor exposure. These patients appear to be at higher overall risk for locoregional treatment failure and often experience a more heterogeneous clinical course, with some afflicted with particularly aggressive, rapidly progressive disease. Recent research efforts have supported the idea that although this disease may be genomically similar in these groups, and molecular differences in the tumor immune microenvironment may account for biological differences between young and older patients, as well as patients with and without exposure to alcohol or tobacco. In this review, we seek to summarize current knowledge regarding pathogenesis of oral tongue carcinoma in the young adult patient and examine the potential role of the immune response in disease progression and as a target for novel immunotherapies.

Overexpression of JAG2 is related to poor outcomes in oral squamous cell carcinoma

OBJECTIVES

JAG2 is one of Notch ligands, which recently appear to exert various carcinogenesis. In the present study, we aimed to unveil the relation of JAG2 expression and clinicopathological features in oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS

We examined JAG2 expression in OSCC plus adjacent nontumorous epithelia in eight patients. Ninety-one OSCC tissue specimens were immunohistochemically stained with specific antibodies to JAG2. The immunoreactivities of JAG2 were correlated with clinicopathological factors, including the prognosis of patients. Chi-square test, Kaplan-Meier survival, and Cox proportional hazard analysis were used to determine the statistical value of JAG2 expression in OSCC.

RESULTS

JAG2 mRNA expression was much expressed in OSCC tissues compared with adjacent tissue specimens in five of eight patients. JAG2 immunoreactivity was found at invasion front in 31 of 91 OSCC. JAG2 immunoreactivity was significantly associated with age, less than 50 years old of patients (P = .048). Kaplan-Meier analysis demonstrated that the patients with JAG2 immunoreactvty have a short overall survival. With the Cox proportional hazard regression mode, the independent factors predictive of poor overall survival included JAG2 immunoreactivity (P < .05).

CONCLUSIONS

The present findings suggest that JAG2 overexpression, especially at the cancer invasion front, has potential prognostic value.

Assessing Knowledge, Attitude and Practices for Oral Squamous Cell Carcinoma among Health Care Professionals in Princess Nourah University, Riyadh, KSA

Background:

Oral Squamous Cell Carcinoma (OSCC) is a growing public health problem affecting 2.2 million of the world’s population per year and the rates are increasing annually. The disease is usually diagnosed in later stages, and carries high morbidity and mortality rates worldwide. Proper awareness among health care professionals (HCP) is the most significant factor for ensuring early diagnosis and treatment. They should have thorough knowledge to identify all suspicious lesions or otherwise to seek specialist opinion when unsure. The present study aimed to assess the knowledge, attitude, and practices (KAPs) of OSCC among dental and medical undergraduate students along with general practitioners and specialists of both disciplines.

Materials and Methods:

The present cross-sectional study was conducted at Princess Nourah Bint Abdulrahman University and its affiliated hospital. A total of 332 participants filled a close-ended online questionnaire. Responses to the questionnaire were analyzed using descriptive and analytical statistics.

Results:

Of the 450 health care professionals approached, 332 filled the questionnaire with a response rate of 73.77.%. It was observed that the mean knowledge index was higher among dental participants (10.96 ± 1.85). The attitude index was higher at medical side (6.89 ± 1.11), and the practice index was also higher among the dental participants (4.95 ± 0.91). Most of the health care professionals had knowledge regarding risk factors associated with OSCC. HCPs indicated their lack of training as the main barrier for conducting a comprehensive examination for OSCC. Interestingly, the vast majority of HCPs expressed their interest to have further educational and training sessions regarding this malignancy.

Conclusion:

The study puts forward, the need for intensive training and workshops for awareness and improvement of the abilities of the HCPs, (including dental and medical undergraduate students along with practitioners and specialists) to diagnose OSCC.

Prevalence of oral cancer and oral epithelial dysplasia among North Indian population: A retrospective institutional study

BACKGROUND

Despite our sincere and serious efforts, oral cancer (particularly oral squamous cell carcinoma [OSCC]) is the major cause of morbidity and mortality in the Indian population. Oral precancerous lesions show quite high malignant transformation rate. Epidemiological data of oral epithelial dysplasia (OED) and OSCC could help in early diagnosis and thus may improve the prognosis. The current study aims to retrospectively analyze the epidemiological profile of patients with different grades of OED and OSCCs.

MATERIALS AND METHODS

The current study is a retrospective analysis of OED and OSCC reported in 5 years in our institution from 2014 to 2018. Data for the analysis were attained from the case sheets from the patients diagnosed with OED and OSCC.

RESULTS

The mean prevalence of OED and OSCC was 5.71% and 9.85%, respectively. Among the dysplastic lesions, severe dysplasia was more common, while well-differentiated squamous cell carcinoma was more common among the carcinomatous lesions. The peak age prevalence of both the lesions was third to fifth decade. Males were more frequently affected than females, with buccal mucosa being the most common site.

CONCLUSION

The data attained from this study highlight the need for community-based screening and awareness programs for general population and thus obtain a healthier society.