Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as prognostic markers in oral cavity cancers

Background: Various studies have associated inflammation with carcinogenesis. But still, the role of inflammatory markers in oral cancer has not been evaluated extensively. Most of the existing studies have been done on patients of varied sites, and their sample size is also scarce. In this study, we have evaluated the impact of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) on various clinicopathological factors and survival. Methodology: This was a retrospective analysis of prospectively collected data of 400 patients with oral squamous cell cancer. The pretreatment neutrophil and lymphocyte and platelet counts were recorded, and NLR and PLR were calculated for all patients. The NLR and PLR tertiles were correlated with the incidence of various clinicopathological factors and overall survival. Results: The median follow-up of the cohort was 36 months. The mean survival of the cohort was 41.7 months. PLR was associated with higher incidence of adverse clinicopathological factors. There was a trend of decreased overall survival with increasing NLR tertile. It was found to be significant only for the group which received adjuvant chemoradiotherapy (P 0.01). Patients with higher PLR values have been found to have a lower overall survival (P 0.006). Conclusion: NLR and PLR can be used to predict survival and outcomes in patients oral cavity cancer. PLR is a good predictor for adverse clinicopathological factors and survival. NLR can predict survival only in the subset of patients who have received chemotherapy.

Incidence and impact of dysplasia at final resection margins in cancers of the oral cavity

BACKGROUND

The literature often cites margin status as being free, close or involved by tumor but there is very sparse evidence of the relevance of dysplasia at resection margin. Aims/Objectives: To compare the impact of dysplasia at final resection margin (D-FRM) and other margin statuses on overall survival (OS) and disease free survival (DFS).

METHODS

This is a retrospective review of 1700 treatment naïve oral squamous carcinoma patients who underwent surgery between January 2012 and December 2015. The study arm consisted of patients with dysplasia at final resection margin (D-FRM). Each of these patients were double propensity matched to obtain positive (P-FRM), close (C-FRM) and free final resection margins (F-FRM).

RESULTS

There was no hazard discrimination in survival among the D-FRM and C-FRM (vs F-FRM; p-0.597, HR-1.207 (0.621-2.346) and p-0.075, HR-1.594 (0.947-2.684), respectively). A decreasing survival trend was observed as the grade and number of D-FRM margins increased. Although not significant, the addition of adjuvant therapy for D-FRM showed a trend towards improved survival outcomes compared to C-FRM, especially with chemotherapy. Conclusion and relevance: The presence of D-FRM, irrespective of grade, had a similar impact on survival as C-FRM and underscores the possible need for treatment intensification.

Optimum surgical margins in squamous cell carcinoma of the oral tongue: Is the current definition adequate?

OBJECTIVES

To evaluate the impact of progressively increasing margin distances on locoregional recurrence-free survival (LFRS) and determine an optimum margin distance for tongue cancers.

METHODS

We retrospectively reviewed the records of patients with squamous carcinoma of oral tongue, surgically treated between January 2012 and December 2013. The patients were divided based on ROC derived optimal distance and differences in LRFS per millimeter: margin distances with no significant difference in LRFS starting from 0 mm onwards (Group-I), from upper limit of Group-I to ROC cut-off (Group-II), and all values above it (Group-III). Group-II and III were matched for clinicopathologic factors and type of adjuvant therapy received.

RESULTS

451 patients had a median LRFS of 29.4 months that included 32.1% of Stage I/II and 51.7% of Stage III/IV. Group-I consisted of 0--2.0 mm (2.0-2.1 mm (p-0.029)), Group-II form 2.1 to 7.5 (7.5-7.6 mm (p-0.042)) and Group-III were ≥ 7.6 mm. In the matched group, each millimeter increase in margin provided a 3.67 months survival advantage from 2.1 mm to 7.5 mm while a substantial advantage of 15 months was seen from 7.5 to 7.6 mm. No significant advantage was gained in LRFS when the margin was increased by a millimeter from the cut-off value (p-0.602). Among the patients that were not prescribed any adjuvant therapy, a significantly better LRFS was observed in Group III than Group II (HR-3.01, p-value = 0.002).

CONCLUSION

Based on these results, adequacy of surgical margins should be re-considered for oral tongue cancers.

Impact of age on elderly patients with oral cancer

INTRODUCTION

In this study we have tried to analyze the impact of age on various clinico-pathological parameters, treatment completion and subsequent survival in older patients.

MATERIALS AND METHODS

This is a retrospective analysis of 140 elderly (> 65 years) patients of oral cancer operated between January 2012 and December 2013. The patients were divided into two groups based upon their age that ≤ 70 years and > 70 years.Association of distribution of various clinico-pathological factors between different groups was assessed by using Chi-square test. Survival analysis was done using Kaplan Meir analysis. Univariate and multivariate analysis were performed.

RESULTS

The two groups had similar distribution of various clinico-pathological factors. Disease free survival for the group ≤ 70 and > 70 years was 37.6 months and 36.4 months (p < 0.594). 13.5% and 7.8% patients > 70 years and ≤ 70 years were either advised or received sub-optimal adjuvant therapy (p < 0.002).

CONCLUSION

There is no difference distribution of various clinico-pathological factors and survival in patients of oral cancer ≤ 70 and > 70 years of age. Age did not affect survival. Majority of patients could complete the adjuvant therapy advised. Still, significantly more number of patients > 70 years could not receive/complete appropriate adjuvant therapy. Thus treatment needs to be tailored keeping in mind the individual's performance status and the co-morbidities.

Outcomes of surgically treated oral cancer patients at a tertiary cancer center in India

BACKGROUND

Oral cancers are one of the most common cancers in India. Surgery is the main modality of treatment for oral cancer patients. It is important to understand the postoperative morbidity and mortality as it influences patient outcomes.

AIM

The aim of this study was to determine oral cancer patients' characteristics, treatment details, 30-day morbidity and mortality, and survival outcomes.

SETTINGS AND DESIGN

This was a retrospective analysis of prospectively collected data in a tertiary cancer center.

MATERIALS AND METHODS

This study included 850 surgically treated oral cancer cases between January and December 2012.

STATISTICAL ANALYSIS

We performed univariate survival analysis by log-rank test, and all significant (P < 0.05) variables underwent multivariate analysis using Cox regression.

RESULTS

The median age was 52 years and the male-to-female ratio was 3.4:1. Nearly one-third of the patients received some form of prior treatment. Buccal mucosa (BM) was the most common subsite (64.94%). BM cancers (81.1%) were more likely to present in advanced stage compared to tongue cancers (52%) (P = 0.000). The incidence of postoperative morbidity and mortality was 36.4% and 0.9%, respectively. Complications were higher in cT3-4 (P = 0.000), cN positive (P = 0.000), and those requiring microvascular reconstruction (P = 0.004). The 5-year overall survival of the entire study group was 70.4%. The survival of early and locally advanced stages was 75.1% and 68.4%, respectively. The factors influencing survival were age (>50 years), advanced cT stage, nodal metastasis, overall stage, and presence of orocutaneous fistula.

CONCLUSION

The morbidity, mortality, and long-term outcomes of surgically treated oral cancer patients at our center are comparable to those treated in the developed world. Aggressive management of postoperative complications is crucial for early recovery and timely initiation of adjuvant treatment.

Comparison of tumor volume, thickness, and T classification as predictors of outcomes in surgically treated squamous cell carcinoma of the oral tongue

BACKGROUND

As per TNM classification, superficial tumors with a favorable prognosis are fallaciously clubbed together with unfavorable, deeply infiltrating lesions in the same classification.

METHODS

This is a retrospective study of 588 patients with treatment-naive oral tongue cancers. Binary logistic regression was used to identify predictors of nodal metastasis and extracapsular spread (ECS) using tumor volume and thickness as separate models. The C-index was generated to quantify predictive accuracy of T classification, thickness, and tumor volume for survival.

RESULTS

Compared to T classification, tumor volume and thickness were better predictors of nodal metastasis and ECS. Predictive accuracy for disease-free survival (DFS) and overall survival (OS) given by C-index was equal and better for thickness (0.60 and 0.69) and tumor volume (0.61 and 0.69) as compared to T classification (0.59 and 0.64, respectively). For early-stage T1 to T2 oral tongue cancer, thickness is a better predictor of nodal metastasis as compared to tumor volume and T classification.

CONCLUSION

Concordance between the tumor thickness and volume proves that tumor thickness can be taken as a surrogate and reliable predictor of outcomes instead of calculating the tumor volume.