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Estephan LE, Kumar G, Stewart M, Banoub R, Linnenbach A, Harshyne LA, Martinez-Outschoorn UE, Mahoney MG, Curry JM, Johnson J, South AP, Luginbuhl AJ. Altered extracellular matrix correlates with an immunosuppressive tumor microenvironment and disease progression in younger adults with oral cavity squamous cell carcinoma. Front Oncol 2024; 14:1412212. [PMID: 38957320 PMCID: PMC11217481 DOI: 10.3389/fonc.2024.1412212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024] Open
Abstract
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.
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Affiliation(s)
- Leonard E. Estephan
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Gaurav Kumar
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Matthew Stewart
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Raphael Banoub
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Alban Linnenbach
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
- Department of Pharmacology, Physiology and Cancer Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Larry A. Harshyne
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
- Department of Medical Oncology, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Ubaldo E. Martinez-Outschoorn
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
- Department of Medical Oncology, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - My G. Mahoney
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
- Department of Pharmacology, Physiology and Cancer Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Joseph M. Curry
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Jennifer Johnson
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
- Department of Medical Oncology, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Andrew P. South
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
- Department of Pharmacology, Physiology and Cancer Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Adam J. Luginbuhl
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
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Lakhera KK, Kumar V, Singhal PM, Patel P, Chatterjee A, Singh S, Babu A, Sharma RG. Epidemiological and Histopathological Analysis of Head and Neck Cancers in Northern India- A Retrospective Review. Indian J Otolaryngol Head Neck Surg 2024; 76:422-427. [PMID: 38440557 PMCID: PMC10908981 DOI: 10.1007/s12070-023-04176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/21/2023] [Indexed: 03/06/2024] Open
Abstract
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.
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Affiliation(s)
| | - Vimal Kumar
- Armed forces medical college, Pune, Maharashtra India
| | | | | | | | | | - Agil Babu
- SMS medical college, Jaipur, Rajasthan India
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Batistella EÂ, Gondak R, Rivero ERC, Warnakulasuriya S, Guerra E, Porporatti AL, De Luca Canto G. Comparison of tobacco and alcohol consumption in young and older patients with oral squamous cell carcinoma: a systematic review and meta-analysis. Clin Oral Investig 2022; 26:6855-6869. [PMID: 36131100 DOI: 10.1007/s00784-022-04719-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Elis Ângela Batistella
- Health Sciences Center, Federal University of Santa Catarina, Rector David Ferreira Lima Campus, Trindade, Florianopolis, SC, 88037150, Brazil.
| | - Rogério Gondak
- Department of Pathology, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Elena Riet Correa Rivero
- Department of Pathology, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Saman Warnakulasuriya
- Department of Oral Medicine and Experimental Oral Pathology, King's College Dental Institute, Bessemer Road, London, SE5 9RS, UK.,WHO Collaborating Centre for Oral Cancer and Precancer in the United Kingdom, Denmark Hill Campus, London, SE5 9RS, UK
| | - Eliete Guerra
- Laboratory of Oral Histopathology, Health Sciences Faculty, University of Brasilia (UnB), Brasilia, DF, Brazil
| | - André Luís Porporatti
- Laboratoire de Neurobiologie OroFaciale, Université de Paris, France and GHPS Assitance Publique Hopitaux de Paris, Paris, France
| | - Graziela De Luca Canto
- Brazilian Centre for Evidence-Based Research, Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianopolis, SC, Brazil
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Mohideen K, Krithika C, Jeddy N, Balakrishnan T, Bharathi R, Sankari SL. A Meta-analysis of Oral Squamous Cell Carcinoma in Young Adults with a Comparison to the Older Group Patients (2014-2019). Contemp Clin Dent 2021; 12:213-221. [PMID: 34759676 PMCID: PMC8525813 DOI: 10.4103/ccd.ccd_466_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/22/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Khadijah Mohideen
- Department of Oral Pathology and Microbiology, Dr. M.G.R. Educational and Research Institute, Chennai, Tamil Nadu, India
| | - C Krithika
- Department of Oral Medicine and Radiology, Dr. M.G.R. Educational and Research Institute, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Nadeem Jeddy
- Department of Oral Pathology and Microbiology, Dr. M.G.R. Educational and Research Institute, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Thayumanavan Balakrishnan
- Department of Oral Pathology and Microbiology, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
| | - R Bharathi
- Department of Oral Pathology and Microbiology, The Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
| | - S Leena Sankari
- Department of Oral Pathology and Microbiology, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
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6
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Chen S, Lin Z, Chen J, Yang A, Zhang Q, Xie C, Zhang X, Yang Z, Chen W, Song M. Older age is a risk factor associated with poor prognosis of patients with squamous cell carcinoma of the oral cavity. Eur Arch Otorhinolaryngol 2020; 277:2573-2580. [PMID: 32322960 PMCID: PMC7410825 DOI: 10.1007/s00405-020-05963-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/01/2020] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Shuwei Chen
- Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China
| | - Zhu Lin
- Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China
| | - Jingtao Chen
- Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China
| | - Ankui Yang
- Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China
| | - Quan Zhang
- Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China
| | - Chuanbo Xie
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,Cancer Prevention Center, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China
| | - Xing Zhang
- Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China
| | - Zhongyuan Yang
- Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China
| | - Wenkuan Chen
- Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China. .,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China. .,Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.
| | - Ming Song
- Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China. .,State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China. .,Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Dong Road, Guangzhou, 510060, Guangdong, China.
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