Oral and oropharyngeal squamous cell carcinoma in young adults: A retrospective study in Granada University Hospital

Altered extracellular matrix correlates with an immunosuppressive tumor microenvironment and disease progression in younger adults with oral cavity squamous cell carcinoma

Introduction

Oral cavity squamous cell carcinoma (OSCC) occurs most frequently in patients >60 years old with a history of tobacco and alcohol use. Epidemiological studies describe increased incidence of OSCC in younger adults (<45 years). Despite its poor prognosis, knowledge of OSCC tumor microenvironment (TME) characteristics in younger adults is scarce and could help inform possible resistance to emerging treatment options.

Methods

Patients with OSCC were evaluated using TCGA-HNSC (n=121) and a stage and subsite-matched institutional cohort (n=8) to identify differential gene expression focusing on the extracellular matrix (ECM) and epithelial-mesenchymal transition (EMT) processes in younger (≤45 years) vs. older adults (≥60 years). NanoString nCounter analysis was performed using isolated total RNA from formalin-fixed paraffin-embedded (FFPE) tumor samples. Stained tumor slides from young and old OSCC patients were evaluated for CD8+ T-cell counts using immunohistochemistry.

Results

Younger OSCC patients demonstrated significantly increased expression of ECM remodeling and EMT process genes, as well as TME immunosuppression. Gene set enrichment analyses demonstrated increased ECM pathways and concurrent decreased immune pathways in young relative to old patients. Transcripts per million of genetic markers involved in ECM remodeling including LAMB3, VCAN, S100A9, COL5A1, and ITGB2 were significantly increased in tumors of younger vs. older patients (adjusted p-value < 0.10). Young patient TMEs demonstrated a 2.5-fold reduction in CD8+ T-cells as compared to older patients (p < 0.05).

Conclusion

Differential gene expression impacting ECM remodeling and TME immunosuppression may contribute to disease progression in younger adult OSCC and has implications on response to evolving treatment modalities, such as immune checkpoint inhibitor therapy.

Epidemiological and Histopathological Analysis of Head and Neck Cancers in Northern India- A Retrospective Review

INTRODUCTION

Head and neck malignancies are responsible for 30% of all cancers in India with a dramatic increase in numbers due to widespread tobacco consumption. This study aims to assess the epidemiological and histopathological spectrum of these tumors.

MATERIALS AND METHODS

A large retrospective review of 5469 biopsy-proven patients presenting between 2018 and 2022 with head and neck cancers was done. Tumors were analysed for distribution according to sites of presentations, gender, age and histopathological profiles.

RESULTS

With a male-to-female ratio of 4.2:1, men constituted 80.80% of the study population. Mean age of presentation in women was 53.5 years, whereas men presented at an earlier age of 47.2 years. Oral cavity was the commonest site involved (59.7% cases) followed by the oropharynx (23.8% cases). Buccal mucosa was the commonest subsite involved with 1112 cases followed by tongue lesions with 1088 cases. Larynx was responsible for 17.04% of cases. All subsites were more commonly affected in men with the highest Male: Female ratio of 8.29:1 seen in larynx. The lowest ratio of 1.02:1 was seen in lesions of the face and scalp. Squamous cell carcinoma (SCC) was the most common histopathological diagnosis encountered in 88.97% of cases followed by basal cell carcinoma which was seen in 2.10% lesions.

CONCLUSION

Oral cavity lesions constitute the bulk of head and neck cancer presentations in India. The disease is more prevalent in men overall and men present at a younger age in comparison to women. SCC is the most prominent histopathology encountered in our study.

Comparison of tobacco and alcohol consumption in young and older patients with oral squamous cell carcinoma: a systematic review and meta-analysis

OBJECTIVE

To compare the proportion of young (up to 45 years of age) and older (over 45 years of age) oral squamous cell carcinoma (OSCC) patients who report tobacco and alcohol consumption.

METHODS

Observational studies reporting tobacco and alcohol consumption among young and older OSCC patients were selected in a two-phase process. Search strategies were conducted on five main electronic databases and complemented by grey literature. The risk of bias was assessed using the Joanna Briggs Institute's Critical Appraisal Checklist for Studies Reporting Prevalence Data. Synthesis of results was calculated with the software R Statistics version 4.0.2 (The R Foundation).

RESULTS

From 6675 records identified, 38 studies met the eligibility criteria and were selected for qualitative synthesis and meta-analysis, encompassing 2439 young and 13,393 older patients. Tobacco smoking was reported by 39.5% (confidence interval (CI) = 31.7% to 47.9%, I² = 78%) of the young patients and 48.4% (CI = 37.8% to 59.2%, I² = 94%) of the older patients. Alcohol consumption was reported by 30.9% (CI = 22.7% to 40.5%, I² = 83%) of the young and 45.8% (CI = 35.6% to 56.5%, I² = 95%) of the older patients (P < 0.05).

CONCLUSION

The comparison in the proportion of individuals reporting tobacco and alcohol consumption demonstrated that these habits were more prevalent in the older group (48.4% and 45.8% respectively) than in the young group (39.5% and 30.9%, respectively).

CLINICAL RELEVANCE

As a significant proportion of patients with OSCC reported no habits, novel risk factors for OSCC need to be investigated in further research.

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.

Survival and prognostic factors in patients with oral squamous cell carcinoma

Background

This study aimed to evaluate sociodemographic and clinical factors influencing overall survival (OS) in patients with oral squamous cell carcinoma (OSCC).

Material and Methods

Medical charts of 547 patients with OSCC from a public hospital in northeastern Brazil seen between 1999 and 2013 were evaluated. Survival analysis was performed using the Kaplan-Meier method. The influence of age, sex, ethnicity, clinical stage, anatomical location, type of treatment, and comorbidities on the patients’ prognosis was evaluated. Cox proportional hazards regression model was used to identify independent prognostic factors.

Results

The 5-year OS was 39%. Multivariate analysis showed that age < 40 years (HR = 2.20; 95%CI: 1.02-4.72) and a single treatment modality (HR = 1.91; 95%CI: 1.37-2.67) were associated with a poor prognosis, while early clinical stage resulted in better outcomes (HR = 0.38; 95%CI: 0.25-0.58).

Conclusions

OSCC patients in advanced clinical stages, diagnosed at a younger age, and submitted to a single therapeutic modality have a poorer prognosis.

Key words:Head and neck cancer, oral cancer, oral squamous cell carcinoma, survival, prognosis.

Older age is a risk factor associated with poor prognosis of patients with squamous cell carcinoma of the oral cavity

Purpose

Whether or not young patients with squamous cell carcinoma of oral cavity (OC-SCC) have a difference in prognosis remains a controversy. This study aimed to analyze the clinical characteristics and difference of survival rates between adult patients less than 40 years of age and those 40 years of age and older.

Methods

A retrospective analysis was conducted using the database of patients diagnosed with OC-SCC between 1990 and 2013 in the Sun Yat-sen University Cancer Center, but patients older than 85 years, younger than 18 years, or died within 6 months of diagnosis were excluded. Patients were categorized into two groups: the young group (< 40 years of age) and the older group (≥ 40 years of age). Cox regression, survival and subgroups analyses were performed. The primary endpoints included the rates of 5-year overall survival (OS) and disease-specific survival (DSS).

Results

A total of 1902 OC-SCC patients were identified. The percentage of female in the young group was significantly higher than that in the older group (40.27% vs 31.03%, p < 0.001). This study failed to find the difference in TNM classification or tumor stage between the two groups (p > 0.05). The young group was more likely to receive adjuvant radiotherapy and/or chemotherapy (42.48% vs 26.91%, p < 0.001). The 5-year OS rate (71% vs. 57%, p < 0.001) and DSS rate (72% vs 58%, p < 0.001) in patients under 40 years were significantly higher than those for the older group.

Conclusion

Our findings suggested that OC-SCC in younger patients did not present at a more advanced stage. In addition, young age is an independent predictor for better survival.