Secondary Squamous Cell Carcinoma of the Oral Cavity after Nasopharyngeal Carcinoma

Impact of prior cancer history on the prognosis of extranodal NK/T-cell lymphoma

Our goal was to assess the impact of prior cancer history on the prognosis of extranodal NK/T-cell lymphoma (ENKTCL). We searched the SEER database to retrospectively enroll patients with ENKTCL. The effects of cancer history on overall survival (OS) and disease-specific survival (DSS) were analyzed using the Cox model. A total of 691 patients were included, of whom 54 (7.8%) had prior histories of cancer. The most common solid malignancy was bone/soft tissue sarcoma. Most secondary ENKTCL cases occurred within 5-9 years following the first cancer diagnosis. Radiotherapy and chemotherapy had been administered to 45 and 40 patients, respectively, to treat their previous malignancies. Prior cancer history had little impact on DSS; however, the presence of prior solid cancer history, latency period of 10+ years, and prior administration of radiotherapy or chemotherapy significantly decreased OS. Prior cancer history had no effect on DSS, but survival compromised OS under specific circumstances.

Oral Squamous Cell Carcinoma and Concomitant Primary Tumors, What Do We Know? A Review of the Literature

Head and neck cancer is among the top ten cancers worldwide, with most lesions in the oral cavity. Oral squamous cell carcinoma (OSCC) accounts for more than 90% of all oral malignancies and is a significant public health concern. Patients with OSCC are at increased risk for developing concomitant tumors, especially in the oral cavity, due to widely genetically susceptible mucosa to carcinogenic factors. Based on fulfilling specific criteria, these concomitant tumors can be called second primary tumors (SPTs), which can be further categorized into metachronous and synchronous tumors. This research reviews the literature that investigated the concurrent OSCC with second or multiple primaries to improve understanding of the definition, classification guidelines, and its effect on cancer survival. It also highlights the current investigation methods, the variation of standard treatment approaches due to such a phenomenon, and preventive measures discussed in the literature.

Orocutaneous Fistula Formation in Free Flap Reconstruction for Oral Squamous Cell Carcinoma

Objective

The aim of this study is to identify the risk factors associated with orocutaneous fistula (OCF) formation after free flap reconstruction for oral squamous cell carcinoma (SCC).

Methods

Patients undergoing free flap reconstruction for oral SCC were retrospectively enrolled. The relationship between clinicopathologic variables and OCF formation was analyzed by univariate and multivariate analyses.

Results

A total of 87 OCFs occurred in 856 patients. Univariate analysis revealed cachexia, tumor at the tongue/floor of the mouth (TFOM), T4 stage, preoperative hemoglobin level, pull-through procedure, preoperative albumin level, and surgical site infection were associated with the formation of OCF. Multivariate analysis confirmed the independence of cachexia, TFOM, T4 stage, and surgical site infection in predicting OCF development. Conventional wound care could achieve successful fistula closure in 82.4% of the patients with a median time of 28 days.

Conclusions

OCF formation was common after free flap reconstruction. The presence of cachexia, TFOM tumor site, T4 stage, and surgical site infection significantly increased the risk of OCF formation. Although it required a long period, conventional wound care can obtain satisfactory outcomes in OCF management.

Secondary Oral Cancer after Systemic Treatment of Hematological Malignancies and Oral GVHD: A Systematic Review

(1) Purpose: In this article, the authors decided to systematically review the available literature to identify potential correlations regarding secondary oral carcinoma occurring after hematological systemic treatment and oral chronic graft-versus-host disease. (2) Methods: Medline (PubMed) and Scopus (Elsevier) databases were searched, including articles from the years 2002-2022. The 33 unique results were assessed by a PRISMA flowchart, and we rejected 24 papers and included 9 articles in the review. (3) Results: The majority of patients suffered from the oral form of chronic graft-versus-host disease before the diagnosis of oral malignancy. Two common cancer sites were the tongue and buccal mucosa. The exact percentage of secondary oral carcinoma after hematopoietic stem cell transplantation could not be estimated due to a lack of data. (4) Conclusions: Every physician taking part in the follow-up of patients after hematological treatment should be aware of the possibility of secondary neoplastic disease in the oral cavity, especially in patients with oral graft-versus-host disease. Proper follow-up protocols and monitoring are needed in this patient group as the cause of these cancers appears to be multifactorial.

Second primary oral squamous cell carcinoma after radiotherapy: a retrospective cohort study

Background

The purpose of the present study was to investigate the clinicopathological characteristics and prognostic factors of second primary oral squamous cell carcinoma after radiotherapy for head and neck cancer.

Methods

The clinicopathological characteristics of 48 second primary oral squamous cell carcinoma patients with a history of radiotherapy for head and neck cancer were retrospectively analyzed by Kaplan-Meier survival analysis and Cox proportional hazards model, including gender, age, alcohol consumption, smoking, clinical stage, margin status, regional lymph node status, tumor differentiation and treatment mode.

Results

The second primary oral squamous cell carcinoma mostly occurred on the tongue [18/48], buccal [12/48] and gingiva [10/48], and the 3- and 5-year overall survival (OS) was 60.3% and 39.4%, respectively. Margin status and extranodal extension were significantly associated with OS, while only margin status was found to be an independent prognostic factor of OS in the Cox proportional hazards model (P=0.003, HR =3.976, 95% CI: 1.596–9.904).

Conclusions

Oral squamous cell carcinoma patients underwent radiotherapy for head and neck cancer show poor survival outcomes. Margin status is an independent prognostic factor of second primary oral squamous cell carcinoma.

Survival Significance of Number of Positive Lymph Nodes in Oral Squamous Cell Carcinoma Stratified by p16

Objectives: To analyze the significance of the number of positive lymph nodes in oral squamous cell carcinoma (SCC) stratified by p16.

Methods: A total of 674 patients were retrospectively enrolled and divided into 4 groups based on their number of positive lymph nodes (0 vs. 1–2 vs. 3–4 vs. ≥5). The Kaplan-Meier method was used to calculate the disease-free survival (DFS) and disease-specific survival (DSS) rates. Cox model was used to evaluate the independent risk factor.

Results: p16 showed positivity in 85 patients with a rate of 12.6%. In patients with p16 negativity, the 5-year DFS rates were 52%, 39%, and 21% in patients with 0, 1–2, and 3–4 positive lymph nodes, respectively, in patients with ≥5 positive lymph nodes, all patients developed recurrence within 2 years after operation, the difference was significant; the 5-year DSS rates were 60, 38, and 18% in patients with 0, 1–2, and 3–4 positive lymph nodes, respectively, in patients with ≥5 positive lymph nodes, all patients died within 4-years after operation. The difference was significant. In p16 positivity patients, the 3-year DFS rates were 41% and 17% in patients with 0–2 and ≥3 positive lymph nodes, respectively, the difference was significant; the 3-year DSS rates were 84 and 46% in patients with 0–2 and ≥3 positive lymph nodes, the difference was significant.

Conclusions: The number of positive lymph nodes is significantly associated with the survival in oral SCC, its survival effect is not affected by p16 status.

Impact of submandibular gland preservation in neck management of early-stage buccal squamous cell carcinoma on locoregional control and disease-specific survival

Background

The feasibility of submandibular gland (SMG) preservation in oral squamous cell carcinoma (SCC) has occasionally been analyzed, but the differences in survival associated with the presence or absence of SMG preservation remain unknown. We aimed to prospectively evaluate the oncologic results of SMG preservation in cT1-2 N0 buccal SCC.

Methods

This was a prospective, non-randomized cohort study. Patients with surgically treated cT1-2 N0 buccal SCC were prospectively enrolled and divided into two groups based on the management of the SMG. Level 1b lymph nodes were categorized into six groups based on the positional relationship between the lymph node and the SMG. The main study endpoints were locoregional control (LRC) and disease-specific survival (DSS).

Results

A total of 31 of the 137 included patients underwent SMG-sparing neck dissection. Patients with SMG preservation were likely to be young persons. Superior metastasis occurred in 11 patients with a prevalence of 8.0%, followed by an anterior metastasis rate of 5.1%, and no metastases developed deeply or within the SMG. The 5-year LRC rates in the SMG-sparing and SMG-excision groups were 74 and 75%, respectively, and the difference was not significant (p = 0.970). The 5-year DSS rates in the SMG-sparing and SMG-excision groups were 74 and 69%, respectively, and the difference was not significant (p = 0.709).

Conclusions

SMG involvement was rare, and the superior group carried the highest risk for lymph node metastasis. SMG-sparing neck dissection is selectively suggested in cT1-2 N0 buccal SCC patients, and could avoid postoperative asymmetric appearance and dry mouth.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12885-020-07534-5.

Feasibility of Submandibular Gland Preservation in cT1-2N0 Squamous Cell Carcinoma in the Floor of the Mouth

Purpose: Our goal was to analyze the feasibility of submandibular gland (SMG) preservation in cT1-2N0 floor of the mouth (FOM) squamous cell carcinoma (SCC) patients. Methods: Patients with cT1-2N0 FOM SCC were retrospectively enrolled and divided into two groups according to the management of the SMG. Level 1b tissues were divided into six groups according to their location with respect to the SMG. The Kaplan-Meier method was used to calculate the locoregional control (LRC) and disease-specific survival (DSS) rates. A Cox model was used to determine the independent risk factors. Results: Twenty-nine patients underwent SMG-preserving neck dissection, and lymph node metastasis occurred in the superior group in 3 of the 37 dissections with a prevalence of 8.1% and in the anterior group in 2 of the 37 dissections with a prevalence of 5.4%. In patients without SMG preservation, lymph node metastasis occurred in the superior group in 7 of the 137 dissections with a prevalence of 5.1% and in the anterior group in 6 of the 137 dissections with a prevalence of 4.4%. The only pattern of SMG involvement was invasion by positive lymph nodes. The 5-year LRC rates for patients with SMG preservation and patients with SMG excision were 84 and 73%, respectively, and the difference was not significant (p = 0.239). The 5-year DSS rates for patients with SMG preservation and patients with SMG excision were 88 and 84%, respectively, and the difference was not significant (p = 0.524). Conclusions: In early-stage FOM SCC patients, SMG involvement is rare, the most common metastatic site in level 1b is the superior group, and SMG preservation does not decrease the LRC or DSS rates. Therefore, the findings suggest that there might be high feasibility of SMG-preserving neck dissection in cT1-2N0 FOM SCC.

Significance of PET-CT for Detecting Occult Lymph Node Metastasis and Affecting Prognosis in Early-Stage Tongue Squamous Cell Carcinoma

Objective: We aimed to clarify the significance of PET-CT for detecting occult lymph node metastasis and for affecting prognosis in early-stage tongue squamous cell carcinoma (SCC). Methods: Patients with surgically treated primary cT1-2N0 tongue SCC who agreed to undergo a preoperative PET-CT scan were prospectively enrolled. The primary study outcomes were occult neck lymph node metastasis and locoregional control (LRC). The Kaplan-Meier method was used to analyze the LRC rate, and then the factors that were significant in the Kaplan-Meier method were assessed in the Cox model to determine the independent factors. Results: A total of 135 patients were included, and the median maximum standardized uptake value (SUV max) of the primary tumor was 9.0. When analyzing the PET-CT results, 18 patients were recognized as having neck lymph node metastasis, and 12 patients were proven to have pathologic lymph nodes. A total of 117 patients did not have neck lymph node metastasis reported by PET-CT, and five patients were proven to have pathologic lymph nodes. The sensitivity and specificity of PET-CT for predicting occult metastasis were 70.6 and 94.9%, respectively. In patients with an SUV max ≤ 9.0, the 5-year LRC rate was 95%; in patients with an SUV max >9.0, the 5-year LRC rate was 85%, and the difference was significant. Further Cox model analyses confirmed the independence of the SUV max for predicting LRC. Conclusion: PET-CT has a high specificity for predicting occult lymph node metastasis, and an SUV max >9.0 is significantly associated with worse LRC in cT1-2N0 tongue SCC.

Lingual Lymph Node Metastasis in cT1-2N0 Tongue Squamous Cell Carcinoma: Is It an Indicator for Elective Neck Dissection

Objective: Accurate predictors for occult metastasis in cT1-2N0 tongue squamous cell carcinoma (SCC) remains scarce, the main goal in current study was to evaluate whether there is significant association between lingual lymph node (LLN) metastasis and occult lymph node metastasis as well as whether there is prognostic value of LLN metastasis in early stage tongue SCC.

Methods: Patients with surgically treated primary cT1-2N0 tongue SCC were prospectively enrolled from January 2010 to December 2018. LLNs were dissected independently for pathologic analysis. The main study endpoints were locoregional control survival (LRC) and disease-specific survival (DSS). The Chi-square test and multivariate regression analysis were used to assess the predictors for occult metastasis. The Kaplan-Meier approach and Cox model were used to analyze the potential prognostic factors.

Results: A total of 317 patients were enrolled for analysis. Eighty-eight patients had occult metastasis with a prevalence of 27.8%. LLNs presented in 89 patients, in which 43 patients had LLN metastasis. In the 43 patients with positive LLNs, 20 patients had occult metastasis, in 274 patients with negative LLNs or no LLNs, 68 patients had occult metastasis, the difference was significant (p = 0.012). Further multivariate regression analysis confirmed the independence of LLN metastasis in predicting the occult metastasis. In patients without LLNs, the 5-year LRC rate was 79%, in patients with negative LLNs, the 5-year LRC rate was 78%, in patients with positive LLNs, the 5-year LRC rate was 62%, the difference was significant (p = 0.024). In patients without LLNs, the 5-year DSS rate was 84%, in patients with negative LLNs, the 5-year DSS rate was 74%, in patients with positive LLNs, the 5-year DSS rate was 51%, the difference was significant (p < 0.001), further Cox model confirmed the independence of LLN metastasis in affecting the LRC and DSS.

Conclusions: LLN metastasis is significantly associated with occult neck lymph node metastasis, and decrease the LRC and DSS in early stage tongue SCC.

Significance of SUV Max for Predicting Occult Lymph Node Metastasis and Prognosis in Early-Stage Tongue Squamous Cell Carcinoma

Objective

Our goal was to clarify the significance of SUV max for predicting occult lymph node metastasis and prognosis in early-stage tongue squamous cell carcinoma (SCC).

Methods

cT1-2N0 tongue SCC patients who underwent a preoperative PET-CT examination were prospectively enrolled. The association between SUV max and occult lymph node metastasis was analyzed. The main study endpoint was locoregional control (LRC). The Cox model was used to determine the independent factors.

Results

A total of 120 patients were included for analysis, and the median SUV max was 9.7. In 60 patients with an SUV max ≤9.7, 5 patients had occult metastasis; in 60 patients with an SUV max >9.7, 13 patients had occult metastasis, and the difference was significant (p=0.041). In patients with an SUV max ≤9.7, the 5-year LRC rate was 93%; in patients with an SUV max >9.7, the 5-year LRC rate was 81%, and the difference was significant (p=0.045).

Conclusion

An SUV max >9.7 was a marker for occult lymph node metastasis and could decrease LRC in patients with cT1-2N0 tongue SCC.

Significance of depth of invasion determined by MRI in cT1N0 tongue squamous cell carcinoma

Depth of invasion (DOI) can be calculated preoperatively by MRI, and whether MRI-determined DOI can predict prognosis as well as whether it can be used as an indicator of neck dissection in cT1N0 tongue squamous cell carcinoma (SCC) remains unknown. The main goal of the current study was to answer these unknowns. A total of 151 patients with surgically treated cT1N0 tongue SCC were retrospectively enrolled, and MRI-determined DOI was measured based on T1-weighted layers with a 3.0T scan. The Chi-square test was used to evaluate the association between clinical pathologic variables and neck lymph node metastasis, and the factors that were significant in the Chi-square test were then analyzed in a multivariate logistic regression analysis model to determine the independent predictors. The main study endpoints were locoregional control (LRC) and disease-specific survival (DSS), and the Kaplan-Meier method (log-rank test) was used to calculate the LRC and DSS rates. The factors that were significant in univariate analysis were then analyzed in the Cox model to determine the independent prognostic factors. A value of p < 0.05 was considered significant, and all statistical analyses were performed with SPSS 20.0. Occult neck lymph node metastasis was noted in 26 (17.2%) patients, and the ROC curve indicated that the optimal cutoff value of MRI-determined DOI was 7.5 mm for predicting neck lymph node metastasis, with a sensitivity of 86.9%. The factors of lymphovascular invasion, MRI-determined DOI, pathologic DOI, and pathologic tumor grade were significantly associated with the presence of neck lymph node metastasis in univariate analysis, and further logistic regression analysis confirmed the independence of lymphovascular invasion, MRI-determined DOI, and pathologic DOI in predicting neck lymph node metastasis. The 5-year LRC and DSS rates were 84% and 90%, respectively. Cox model analysis suggested the MRI-determined DOI was an independent prognostic factor for both LRC and DSS. Therefore, elective neck dissection is suggested if MRI-determined DOI is greater than 7.5 mm in cT1N0 tongue SCC, and MRI-determined DOI ≥ 7.5 mm indicates additional risk for disease recurrence and cancer-related death.