Enhancing oral squamous cell carcinoma detection: a novel approach using improved EfficientNet architecture

PROBLEM

Oral squamous cell carcinoma (OSCC) is the eighth most prevalent cancer globally, leading to the loss of structural integrity within the oral cavity layers and membranes. Despite its high prevalence, early diagnosis is crucial for effective treatment.

AIM

This study aimed to utilize recent advancements in deep learning for medical image classification to automate the early diagnosis of oral histopathology images, thereby facilitating prompt and accurate detection of oral cancer.

METHODS

A deep learning convolutional neural network (CNN) model categorizes benign and malignant oral biopsy histopathological images. By leveraging 17 pretrained DL-CNN models, a two-step statistical analysis identified the pretrained EfficientNetB0 model as the most superior. Further enhancement of EfficientNetB0 was achieved by incorporating a dual attention network (DAN) into the model architecture.

RESULTS

The improved EfficientNetB0 model demonstrated impressive performance metrics, including an accuracy of 91.1%, sensitivity of 92.2%, specificity of 91.0%, precision of 91.3%, false-positive rate (FPR) of 1.12%, F1 score of 92.3%, Matthews correlation coefficient (MCC) of 90.1%, kappa of 88.8%, and computational time of 66.41%. Notably, this model surpasses the performance of state-of-the-art approaches in the field.

CONCLUSION

Integrating deep learning techniques, specifically the enhanced EfficientNetB0 model with DAN, shows promising results for the automated early diagnosis of oral cancer through oral histopathology image analysis. This advancement has significant potential for improving the efficacy of oral cancer treatment strategies.

Fractionated irradiation induces radioresistant oral carcinoma cells with enhanced malignant phenotypes

OBJECTIVE

The fact that certain oral carcinoma patients experience radiotherapy failure implies that a more radioresistant and aggressive phenotype of surviving cancer cells potentially occurs during treatment. Our study aimed to establish radioresistant oral cancer cells through a fractionated irradiation protocol that mimics clinically relevant radiotherapy dosing strategies and to investigate all-round alterations in the malignant phenotype.

METHODS

Radioresistant oral carcinoma cells were generated by exposing Cal27 and Detroit 562 cells to 60 Gy radiation in 10 dose-escalating fractions and verified by cell immunofluorescence. Specific markers related to the epithelial-mesenchymal transition (EMT) process and the cancer stem cell (CSC) phenotype were assessed by Western blotting. Cell invasion and migration were evaluated using Matrigel-coated transwell and wound healing assays, respectively. Nontargeted metabolomics was used to mechanistically delineate the potential metabolic patterns linked to EMT and CSCs; the CSC phenotype was also examined by sphere formation assays and cell immunofluorescence.

RESULTS

Radioresistant oral carcinoma cell lines were successfully established and validated. These cells exhibited enhanced EMT and increase in both cell invasion and migration. These radioresistant cells further demonstrated a high metabolic profile, notably marked by lipid metabolism reprogramming and functional enrichment of ATP-binding cassette (ABC) transporters. Consistently, enhanced CSC phenotype in radioresistant cells was confirmed by elevated expression of stemness markers and increased sphere-forming capacity.

CONCLUSION

Radioresistant oral carcinoma cells subjected to fractionated radiation exhibit an augmented malignant phenotype. The metabolic characteristics linked to enhanced EMT and CSC phenotypes provide potential targets for improving radiotherapy in oral carcinoma.

Oral mucosa - an examination map for confocal laser endomicroscopy within the oral cavity: an experimental clinical study

OBJECTIVES

Confocal laser endomicroscopy (CLE) is an optical method that enables microscopic visualization of oral mucosa. Previous studies have shown that it is possible to differentiate between physiological and malignant oral mucosa. However, differences in mucosal architecture were not taken into account. The objective was to map the different oral mucosal morphologies and to establish a "CLE map" of physiological mucosa as baseline for further application of this powerful technology.

MATERIALS AND METHODS

The CLE database consisted of 27 patients. The following spots were examined: (1) upper lip (intraoral) (2) alveolar ridge (3) lateral tongue (4) floor of the mouth (5) hard palate (6) intercalary line. All sequences were examined by two CLE experts for morphological differences and video quality.

RESULTS

Analysis revealed clear differences in image quality and possibility of depicting tissue morphologies between the various localizations of oral mucosa: imaging of the alveolar ridge and hard palate showed visually most discriminative tissue morphology. Labial mucosa was also visualized well using CLE. Here, typical morphological features such as uniform cells with regular intercellular gaps and vessels could be clearly depicted. Image generation and evaluation was particularly difficult in the area of the buccal mucosa, the lateral tongue and the floor of the mouth.

CONCLUSION

A physiological "CLE map" for the entire oral cavity could be created for the first time.

CLINICAL RELEVANCE

This will make it possible to take into account the existing physiological morphological features when differentiating between normal mucosa and oral squamous cell carcinoma in future work.

A rare case of cavernous sinus thrombosis following oral squamous cell carcinoma - The etiology and management dilemma

Intracranial cavernous sinus metastases of oral squamous cell carcinoma (OSCC) are rare, with a reported incidence of 0.4 %. Due to their extremely infrequent presentation the etiology and management modalities of such complications are not clearly represented in the literature. Here we present a case of a 58-year-old male diagnosed with OSCC of Right Lower Alveolus with underlying bone invasion, cT4aN1M0, Stage IV. He underwent Right Hemi-mandibulectomy with Modified Neck Dissection, Pectoralis Major Myocutaneous Flap, and 60 Gy/30# adjuvant radiotherapy. Six months later, the patient was diagnosed with recurrence involving the right infratemporal fossa with associated right cavernous sinus thrombosis. Immunohistochemistry block review showed PDL1 - Positive. The patient was subjected to Cisplatin and Pembrolizumab immunotherapy. After receiving 35 cycles of Pembrolizumab over a period of 2 years the patient is doing well with no recurrence.

Molecular docking analysis of proflavin with the Wnt pathway targets for OSCC

Wnt signaling pathway plays a critical role in tumor progression and metastasis of various cancer types. Therefore, it is of interest to document the molecular docking analysis of proflavin with the Wnt pathway targets (GSK3β, β-catenin, and VIM) for oral squamous cell carcinoma (OSCC). These results suggest that targeting the wnt signaling downstream targets with proflavine might leads to the better outcome for therapeutic outcome for the inhibition of invasion and metastasis in oral squamous cell carcinoma.

Molecular docking analysis of cetuximab with NOTCH signalling pathway targets for oral cancer

Notch signaling is an evolutionarily ancient mechanism which intricated in cell-cell communication and it plays a crucial role in various developments in malignancies. Inactivating mutations of NOTCH targets are present in about 10 % of cases of squamous cell carcinoma of the skin, oral cavity, and esophagus that rendering it one of the most frequently mutated genes in oral squamous cell carcinoma. Therefore, it is of interest to document the molecular docking analysis of cetuximab with the NOTCH signaling targets such as NOTCH1, NICD, and HES1. These results suggest that targeting the NOTCH signaling with cetuximab might leads to the better outcome for suppression of invasion and metastasis in oral carcinoma.

Buccal mucosal application of dissolvable microneedle patch containing photosensitizer provides effective localized delivery and phototherapy against oral carcinoma

The effectiveness of phototherapy using photosensitizers is limited by the challenges in their delivery at the site of irradiation. Here, we demonstrate the localized application of a photosensitizer-loaded microneedle patch for effective photodynamic and photothermal therapy in oral carcinoma. Indocyanine green (ICG) was studied as a photosensitizer for its effect on oral carcinoma, FaDu cells. Different parameters including concentration, near-infrared (NIR) laser irradiation intensity and irradiation time were optimized while measuring temperature increase and reactive oxygen species (ROS) generation in FaDu cells. A dissolvable microneedle (DMN) patch made of sodium carboxymethyl cellulose and sodium alginate was fabricated by the micromolding technique. DMN showed sufficient mechanical strength for insertion in the excised porcine buccal mucosa. DMN dissolved within 30 s in phosphate buffer and 30 min in the excised buccal mucosa. Confocal microscopy studies revealed DMN penetration up to a depth of 300 µm within the buccal mucosa. ICG-DMN applied on the back of the rat was found to be localized at the application site before and after irradiation using an 808 nm NIR laser. ICG-DMN was applied on the FaDu xenografted tumor model in athymic nude mice. The localized temperature increase and ROS generation significantly (P<0.05) decreased the tumor volume after ICG-DMN application compared with the control group. In conclusion, DMN can be developed for the localized administration of photosensitizers for phototherapy in oral carcinoma.

Bilateral Morgagnian Cataract Post Neoadjuvant Chemotherapy for Oral Carcinoma- A Potentially Blinding Sequelae

Cataract is one of the most common causes of defective vision globally, and one if the rare potential complication arising out of chemotherapy. This report highlights a rare case of bilateral Morgagnian cataract following neoadjuvant chemotherapy given for an oral cavity malignancy. A 65-year-old female presented with bilateral reduced visual acuity secondary to Morgagnian cataract with normal fundus. The patient underwent a successful cataract surgery in right eye preventing the eye from developing devastating sequelae like phacomorphic glaucoma, lens subluxation, or aphakia post-cataract surgery. The oncosurgeon, oncologist, and ophthalmologist should have a close liaison to prevent, diagnose, and treat these rare sequelae which could be potentially blinding.

Patients with oral preneoplastic lesions and integration of dental pathology referrals

PURPOSE

Oral cancers lack standardized monitoring systems. Our institution has developed an active surveillance system which provides detailed monitoring and follow up of patients with oral preneoplastic lesions (OPL). We examined a historic cohort of patients with OPL seen by regional dental professionals and a current cohort of clinic patients. The major aim was to examine follow up practices for biopsy proven dysplasia to gauge appropriateness of an active monitoring system for oral carcinoma.

MATERIALS AND METHODS

Questionnaires regarding patients with OPL were sent to 285 dentists who had requested oral pathology services from our institution. The follow up practices of 141 dentists were evaluated for patients with OPL. We then examined our current clinic referral patterns for the number of dental referrals after the creation of an oral carcinoma active surveillance clinic.

RESULTS

There were 76.5% (108/141) of patients who received follow up after diagnosis of preneoplastic oral lesions with 14.1% who underwent repeat biopsy. There was a malignant transformation rate of 11.3% including transformation of 42.8% of severe dysplasias into carcinoma within 2 years. After establishment of a dental referral clinic, 21.8% of tumor visits in a six-week period were referred from the regional dental community.

CONCLUSIONS

A high rate of transformation of OPL to cancer in this cohort may support a role for joint dental and otolaryngology surveillance of dysplasia with longitudinal follow up.

Accuracy of liquid-based brush cytology and HPV detection for the diagnosis and management of patients with oropharyngeal and oral cancer

Objectives

This study aims to evaluate the usefulness of liquid-based brush cytology for malignancy diagnosis and HPV detection in patients with suspected oropharyngeal and oral carcinomas, as well as for the diagnosis of tumoral persistence after treatment.

Material and methods

Seventy-five patients with suspicion of squamous cell carcinoma of the oropharynx or oral cavity were included. Two different study groups were analyzed according to the date of the sample collection: (1) during the first endoscopy exploration and (2) in the first control endoscopy after treatment for squamous cell carcinoma. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy diagnosis as well as for HPV-DNA detection on brush cytologies were assessed.

Results

Before treatment, the brush cytology showed a sensitivity of 88%, specificity of 100%, and accuracy of 88%. After treatment, it showed a sensitivity of 71%, specificity of 77%, and accuracy of 75%. HPV-DNA detection in cytology samples showed a sensitivity of 85%, specificity of 100%, and accuracy of 91% before treatment and an accuracy of 100% after treatment.

Conclusions

Liquid-based brush cytology showed good accuracy for diagnosis of oropharyngeal and oral squamous cell carcinoma before treatment, but its value decreases after treatment. Nevertheless, it is useful for HPV-DNA detection, as well as to monitor the patients after treatment.

Clinical relevance

Brush cytology samples are reliable for the detection of HPV-DNA before and after treatment and may be a useful method to incorporate in the HPV testing guidelines.

Oral cancer in non-smoker non-drinker patients. Could comparative pet oncology help to understand risk factors and pathogenesis?

During the last decades there has been a progressive increase in proportion of incidence of oral cancer not related to a known etiologic factor, such as the so-called "oral cancer in young", a relevant tumor in non-smoker non-drinker (NSND) patients. The topic is matter of long standing debate, and adequate study models to analyze this entity are lacking. Spontaneous oral cancer in companion animals such as dogs and cats, presents more clinical and biological similarities with the human oral cancer than any other animal model. In our review we analyze how the study of spontaneous oral cancer in common pets can prospectively prove to be of double usefulness in unraveling the question about the origin of oral cancer in NSND patients, allowing both the analysis of environmental and behavioral risk factors, and the study of how carcinogenic viruses, chronic inflammation, and changes in immunity can influence pre-tumoral and tumoral microenvironment.

The upregulation of oncogenic miRNAs in swabbed samples obtained from oral premalignant and malignant lesions

OBJECTIVES

Oncogenic miRNAs upregulated in OSCC play a range of versatile roles in oral carcinogenesis. Oral potentially malignant disorders (OPMDs) are the antecedent lesions to oral squamous carcinoma (OSCC) and they require a definitive diagnosis and early intervention. This study hypothesizes the presence of aberrant oncogenic miRNA expression in swabbed oral lesions.

MATERIALS AND METHODS

The expression of miR-21, miR-31, miR-134, miR-146a, and miR-211 in swabbed samples from 36 dysplastic or hyperplastic OPMDs and 10 OSCCs, relative to respective normal mucosa within the same patient, is analyzed with qRT-PCR to develop a diagnosis.

RESULTS

Upregulation of all tested miRNAs in OPMD and OSCC samples comparing to controls is found to have occurred. Receiver operating characteristics curve analysis shows that miR-31 gives the best diagnostic accuracy of 0.91 when differentiating OPMD/OSCC from controls. An analysis of miR-134 and miR-211 expression allows the discrimination of the dysplastic state associated with OPMD, while the use of expression of the combined miRNAs further improves the analytical performances when identifying the dysplastic state. The concordant upregulation of miR-21, miR-31, and miR-146a is found to occur during an early stage of OSCC carcinogenesis.

CONCLUSION

This study demonstrates the upregulation of multiple oncogenic miRNAs in swabbed OPMD and OSCC samples. miRNA expression in swabbed collectives enables the differentiation between normal mucosa and OPMD/OSCC, independent of their histopathological severity.

CLINICAL RELEVANCE

This conventional and convenient sampling tool, when coupled with an assessment of miR-31 expression, would seem to be an adjuvant approach to the diagnosis of OPMD and OSCC.

A PRISMA-compliant meta-analysis on association between X-ray repair cross complementing (XRCC1, XRCC2, and XRCC3) polymorphisms and oral cancer susceptibility

BACKGROUND

Oral Cancer (OC) is one of the leading causes of death and the disease mainly occurs over 50 years of age. Herein, a meta-analysis aimed to assess the association between X-ray repair cross complementing (XRCC) polymorphisms and OC risk.

METHODS

Four databases were searched extensively until June 5, 2020. Subgroup analysis, meta-regression, and funnel plots, as well as the quality assessment were estimated.

RESULTS

Fifteen studies were entered to the analysis. With regards to allele, homozygote, heterozygote, recessive, and dominant models, the pooled ORs for XRCC1 rs1799782 polymorphism were 1.51 (P = 0.01), 1.45 (P = 0.11), 1.45 (P = 0.0003), 1.44 (P = 0.0002), and 1.29 (P = 0.26); for XRCC1 rs1799782 polymorphism were 1.65 (P = 0.11), 1.50 (P = 0.33), 1.06 (P = 0.83), 1.57 (P = 0.12), and 1.32 (P = 0.45); for XRCC1 rs25489 polymorphism were 0.01 (P = 0.19), 1.44 (P = 0.48), 1.21 (P = 0.72), 1.17 (P = 0.19), and 1.38 (P = 0.54); for XRCC2 rs2040639 polymorphism were 0.68 (P = 0.0002), 0.63 (P = 0.02), 0.95 (P = 0.92), 0.79 (P = 0.49), and 0.61 (P = 0.005); and for XRCC3 rs861539 polymorphism were 1.24 (P = 0.20), 1.28 (P = 0.48), 0.99 (P = 0.95), 1.15 (P = 0.46), and 1.52 (P = 0.15), respectively.

CONCLUSIONS

The T allele and CT genotype of XRCC1 rs1799782 polymorphism had an elevated risk, whereas the G allele and GG genotype of XRCC2 rs2040639 polymorphism had a protective role in OC.

The prospective evaluation and risk factors of dysphagia after surgery in patients with oral cancer

Background

This prospective study investigated the change of swallowing ability using the Swallowing Ability Scale System (SASS) and swallowing-related quality of life (QOL) by Performance Status Scale for Head and Neck Cancer patients (PSS-H&N). This study also investigated the risk factors for postoperative dysphagia in patients who received reconstructive surgery for oral cancer.

Subjects and Methods

This study included 64 patients (33 men and 31 women) who underwent radical surgery with neck dissection and reconstructive surgery for oral cancers between July 2014 and February 2018. We evaluated risk factors for poor swallowing ability after treatment, including demographic factors, preoperative factors and perioperative factors, with univariate and multivariate analyses. The change of swallowing ability by the SASS and swallowing-related QOL by PSS-H&N were evaluated prospectively prior to the initiation of surgery within 1 week and at 1 and 3 months after treatment.

Results

Advanced T stage (T3, 4) (odds ratio (OR) = 79.71), bilateral neck dissection (OR = 20.66) and the resection of unilateral or bilateral suprahyoid muscles (OR = 17.00) were associated with poor swallowing ability after treatment. The scores for time for food intake and Eating in Public were associated with decrease of QOL in the poor group.

Conclusions

We propose that clinicians consider the risk factors identified in this study and pay close attention to the management of oral cancer patients with reconstructive surgery.

Graphical abstract

NF-κB subunit RELA suppression of mucosa-associated lymphoid tissue lymphoma translocation protein 1 expression in oral carcinoma cells

Loss of mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1) expression closely associates with increased aggressive behaviors of oral carcinoma cells. It emphasizes that a mechanism to suppress the expression is an important subject for understanding carcinoma progression pathway. However, nothing is known at present. This study conducted on transcriptional regulation of the gene down-regulation. Reporter assays showed the presence of the silencer region between +402 and +501 region of MALT1 gene in oral carcinoma cells. It encoded a binding site of nuclear factor-κB subunit, RELA. RELA binding to the site was confirmed by the chromatin immunoprecipitation analyses, and deletion and mutations of the site significantly decreased the RELA binding. Short interfering RNAs for RELA up-regulated reporter gene and endogenous MALT1 protein expressions, and deletion and mutations of RELA binding site increased reporter gene expression. These results demonstrated RELA-binding to the site suppresses MALT1 expression that may facilitate oral carcinoma progression.

Diffusion tensor imaging of oral carcinoma: Clinical evaluation and comparison with histopathological findings

PURPOSE

This study aims to assess the usefulness of diffusion tensor imaging (DTI) as a noninvasive method for the evaluation of histological grade and lymph node metastasis in patients with oral carcinoma (OC).

MATERIALS AND METHODS

Thirty-six consecutive patients with histologically confirmed OC underwent examination by 3-T MRI. DTI was performed using a single-shot echo-planar imaging sequence with b values of 0 and 1000 s/mm² and motion-probing gradients in 12 noncollinear directions. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) maps were compared with histopathological findings. The DTI parameters were correlated with the histological grade of the OCs based on the World Health Organization grading criteria and the presence or absence of lymph node metastasis.

RESULTS

The FA values (0.275 ± 0.058) of OC were significantly lower than those of normal tongue, muscle, and parotid glands (P < 0.001 for all), and the MD, AD, and RD values (1.220 ± 0.149, 1.434 ± 0.172, and 1.019 ± 0.165 × 10^-3 mm²/s, respectively) were significantly higher than their respective normal values (P < 0.001 for all). Significant inverse correlations with histological grades were shown for FA, MD, AD, and RD values in OC patients (r = -0.862, r = -0.797, r = -0.747, and r = -0.844, respectively; P < 0.001 for all). In addition, there was a significant difference in the FA values of metastatic and nonmetastatic lymph nodes (0.186 vs. 0.276), MD (0.923 vs. 1.242 × 10^-3 mm²/s), AD (1.246 vs. 1.621 × 10^-3 mm²/s), and RD (0.792 vs. 1.100 × 10^-3 mm²/s; P < 0.001 for all).

CONCLUSIONS

DTI may be clinically useful for the noninvasive evaluation of histological grade and lymph node metastasis in OC patients.

Radiation Esophagitis in a Patient with Oral Carcinoma and Bone Metastasis

Radiation esophagitis requiring endoscopic evaluation occurs quite rarely, affecting <1% of patients undergoing radiation treatment. Acute radiation esophagitis develops within 3 weeks of radiation therapy. We describe herein a case of radiation esophagitis in a patient with oral carcinoma with multiple general bone metastases. Cisplatin, fluorouracil, and cetuximab were given for 3 cycles. Radiation therapy (30 Gy) to the thoracic vertebrae and lumbar vertebrae was prescribed to prevent worsening of bone metastases and relieve pain. Neutropenia was also observed due to chemotherapy. After the end of radiation therapy, the patient experienced chest pain, heartburn, and dysphagia. Upper gastrointestinal endoscopy revealed severe radiation esophagitis of endoscopic Fukui Acute Radiation Esophagitis grade 4. Oral food was discontinued and an intravenous proton-pump inhibitor was administered. After 3 weeks, upper gastrointestinal endoscopy showed improvement of radiation esophagitis, with scars. The symptoms of chest pain, heartburn, and dysphagia had also disappeared. This is the first case to be reported of acute radiation esophagitis in a patient with oral carcinoma with bone metastasis who experienced dramatic improvement of endoscopic findings. Neutropenia appears to be associated with more severe acute radiation esophagitis.

Lymph node ratio as a prognostic marker of oral tongue squamous cell carcinoma: a cohort study

INTRODUCTION

Lymph node metastasis is a poor prognostic indicator and is well established in tongue squamous cell carcinoma. Based on the current staging system, accurate risk stratification is difficult. There is thus a need to evaluate an alternate method for predicting recurrence and survival. The objective of the study was to evaluate lymph node ratio as a prognostic marker as compared with N-staging for tongue squamous cell carcinoma.

MATERIALS AND METHODS

We conducted a retrospective cohort study with 56 patients with a lymph node ratio greater than 0.012 (exposed) and 74 patients with a lymph node ratio less than 0.012 (unexposed). Overall five-year survival and disease-free survival were assessed. The Cox proportional hazard model was used to analyse lymph node ratio as a predictor of outcome, together with other covariates.

RESULTS

A total of 130 patients were included in the study. Patients with lymph node ratio greater than 0.012 had a poor overall five-year (mean survival time 52.1 months vs 38.1 months) and disease-free survival (mean survival time 53.6 months vs 39.2 months). The hazard of death among patients with a lymph node ratio greater than 0.012 was 3.24 times higher than the hazard of death among patients with a lymph node ratio less than 0.012 (95% confidence interval 1.82-5.77).

DISCUSSION

Lymph node ratio is a superior prognostic marker compared with the currently used American Joint Committee on Cancer N-staging. Our findings also suggest that the margin status (involved) of the primary tumour resection adversely affects prognosis.

Lymph node yield and lymph node ratio in oral cavity and oropharyngeal carcinoma: Preliminary results from a prospective, multicenter, international cohort

OBJECTIVES

Recently, Lymph Node Yield (LNY) and Lymph Node Ratio (LNR) have emerged as prognostic indicators in head and neck cancer. However, there is a lack of data regarding the LNY and LNR values in the specific neck levels dissected and regarding the factors that influence these values.

MATERIALS AND METHODS

Preliminary results of the NCT03534778 trial are reported. LNY and LNR values were estimated for 100 patients with oral or oropharynx carcinoma, from November 1, 2018 to September 30, 2019.

RESULTS

Overall, the mean number of lymph nodes retrieved was 34.4 (95% confidence interval [CI] 31.6-37.3). LNY means and CI per single neck level were as follows: level I 5.5 lymph nodes harvested (95% CI 3.5-7.5), level II 15.4 (95% CI 10.6-20.2), level III 8.0 (95% CI 4.6-11.3), level IV 6.3 (95% CI 3.4-9.15), level V 6.3 (95% CI 3.6-9.0). cN+ patients had a higher number of lymph nodes retrieved, odds ratio (OR) 1.2 (95% CI 1.05-1.36). Smokers had less lymph nodes harvested, OR 0.78 (95% CI, 0.71-0.87). Mean LNR was 0.063 (95% CI 0.047-0.078). A multiple regression analysis showed that anatomic site, pN, smoking status and LNY statistically significantly predicted the LNR (p < 0.05) CONCLUSIONS: The LNY and LNR values are influenced by various demographic and pathological characteristics of the patient, such as the number of dissected levels, primary site, cN positivity, and smoking status.

Factors Affecting Postoperative Complications After Reconstructive Surgery in Oral Carcinoma Patients: A Prospective Study of 100 Patients

Postoperative complications may result in significant functional morbidity, poor cosmetic results, prolonged hospitalization, preclusion of optimal treatment for the cancer, or even be pose threat to life. We prospectively assessed postoperative complications in 100 patients who underwent surgical resection with free or pedicled flap reconstruction as a primary modality of treatment in patients with carcinoma of the oral cavity. One hundred consecutive patients who underwent reconstructive surgery for oral cancer were prospectively analyzed for age, gender, comorbidities, tumor stage, nodal stage, primary sub-site of tumour, reconstructive procedure (free or pedicled), duration of surgery, blood transfusions during surgery, preoperative weight and body mass index, patient generated subjective global assessment status and tracheostomy to determine their effect on postoperative complications as determined on the CD scale. The sample comprised 100 patients with a mean age of 52.12 years (range 24-80 years) and 74% men (M:F ratio 3:1). A total of 40 patients developed surgical complications (including two deaths) while medical complications were seen in 10 patients (including one death). Tracheostomy (52 vs. 7%, p = 0.002) and age (54 vs. 49 years, p = 0.031) were associated with higher complication rate. Higher age and tracheostomy is associated with higher complications in postoperative period.

Health-related quality of life: a retrospective study on local vs. microvascular reconstruction in patients with oral cancer

BACKGROUND

New medicinal and surgical oncological treatment strategies not only improve overall survival rates but continually increase the importance of Health-Related Quality of Life (HRQOL). The purpose of this retrospective cross-sectional study was to analyze HRQOL of patients with oral squamous cell carcinoma after ablative surgery and to evaluate predictive factors for HRQOL outcome.

METHODS

The study included 88 patients with histologically confirmed oral squamous cell carcinoma of whom 42 had undergone local reconstruction (LR) and 46 microvascular reconstruction (MVR). During follow-up, all patients completed the University of Washington Quality of Life Questionnaire (UW-QOL) containing 12 targeted questions about the head and neck. Descriptive analyses were made for the tumor site, the T-stage, and adjuvant therapies. HRQOL was compared between the LR and the MVR group with parametric tests. Further analyses were impact of the tumor site, the T-status, and the time from surgery to survey on HRQOL. Statistics also included multivariate correlations and different interaction effects.

RESULTS

HRQOL in the LR group was 'very good' with 84.3 ± 13.7 and 'good' in the MVR group with 73.3 ± 16.5 points. The physical domains swallowing (p = 0.00), chewing (p = 0.00), speech (p = 0.01), taste (p = 0.01), and pain (p = 0.04) were significantly worse in the MVR group. An increase in the T-status had a significant negative effect on swallowing (p = 0.01), chewing (p = 0.01), speech (p = 0.03), recreation (p = 0.05), and shoulder (p = 0.01) in both groups. Regarding the tumor site and subsequent loss of HRQOL, patients with squamous cell carcinoma on the floor of the mouth had significantly worse results in the categories pain (p = 0.002), speech (p = 0.002), swallowing (p = 0.03), activity (p = 0.02), and recreation (p = 0.01) than patients with tumors in the buccal mucosa. Speech (p = 0.03) and pain (p = 0.01) had improved 1 year after surgery.

CONCLUSION

Patients with flap reconstruction because of oral squamous cell carcinoma showed very good overall HRQOL. Outcomes for microvascular reconstruction were good, even in the case of larger defects. The T-status is a predictor for HRQOL. Swallowing, chewing, speaking, taste, and pain were the most important issues in our cohort. Implementing HRQOL questionnaires for the assessment of quality of life could further increase the treatment quality of patients with oral cancer.

Is There Any Role of Arsenic Toxicity in HPV Related Oral Squamous Cell Carcinoma?

Arsenic is a potent human carcinogen affecting the rate of cancer deaths worldwide. In India, West Bengal is the worst affected state by arsenic. To our best knowledge, this is the first study relating arsenic toxicity with oral carcinoma, along with HPV infection, the latter being well established in western countries. To find out a possible correlation between arsenic toxicity and oral carcinoma in the population of West Bengal, in or without any association with human papilloma virus infection. Ethical clearance of this study was obtained from the institutional committee. One hundred and four malignant and 103 premalignant cases were selected for this study along with 200 healthy age and sex-matched individuals selected as control (100 each for malignant and premalignant) (2013-2017). On proper consent, their buccal swab and hair samples were assessed for the presence of HPV DNA by DNA extraction, followed by PCR and arsenic estimation by flow injection hydride generation atomic absorption spectrometry respectively. A very highly significant correlation has been observed between arsenic toxicity, HPV infection and the occurrence of oral carcinoma (p value = 2.18e-06; p value = 0.00100 respectively). A correlation has also been observed between these two factors simultaneously, contributing to this malignancy (phi coefficient = 0.2194839). A statistically significant correlation observed between this metal toxicity and viral infection in the occurrence of oral carcinoma in this population indicates a possible symbiotic role between these two factors in this malignancy.

Establishing of mouse oral carcinoma cell lines derived from transgenic mice and their use as syngeneic tumorigenesis models

Background

The survival of OSCC patient needs to be further improved. miR-211 is oncogenic in OSCC and its upregulation is associated with tumor progression and poor patient survival. K14-EGFP-miR-211 transgenic mice also exhibit augmented potential for OSCC induction.

Methods

Four murine OSCC cell lines, designated MOC-L1 to MOC-L4, are established from tongue tumors induced by 4-nitroquinoline 1-oxide using the K14-EGFP-miR-211 transgenic mouse model. The genetic disruption, in vitro oncogenicity, and the eligibilities of tumorigenesis and metastasis of the cell lines are analyzed.

Results

All cell lines show green fluorescence and express a range of epithelial markers. The MOC-L1, MOC-L2 and MOC-L3 cells carry missense mutations in the DNA binding domain of the p53 gene. MOC-L1 exhibits a high level of epithelial-mesenchymal transition and has the aggressive characteristics associated with this. MOC-L1 and MOC-L2 are clonogenic in vitro as well as being tumorigenic when implanted into the dermis or tongue of syngeneic recipients. Nonetheless, only MOC-L1 exhibits immense potential for local regional and distal metastasis. Since the expression of miR-196b in MOC-L1 xenografts is drastically decreased on cisplatin treatment, it would seem that targeting of miR-196b might facilitate tumor abrogation.

Conclusions

As cell lines established in this study originated from the C57BL/6 mouse, the strain most suitable for transgenic engineering, exploring the interplay of these OSCC cells with other genetically modified cells in immune-competent mice would provide important insights into OSCC pathogenesis.

Electronic supplementary material

The online version of this article (10.1186/s12885-019-5486-7) contains supplementary material, which is available to authorized users.

Suicide Gene Therapy for Oral Squamous Cell Carcinoma

Suicide gene therapy has been tested for the treatment of a variety of cancers, including oral cancer. Among the various suicide gene therapy approaches that have been reported, the Herpes Simplex Virus thymidine kinase (HSV-tk)/ganciclovir (GCV) system is one of the most extensively studied systems, holding great promise in cancer therapy. In this chapter, we describe methods to use the HSV-tk/GCV system to achieve antitumor activity, both in cultured oral cancer cells and in orthotopic and subcutaneous murine models of oral squamous cell carcinoma, using ligand-associated lipoplexes for enhancing therapeutic delivery.

Low dietary n-6/n-3 polyunsaturated fatty acid ratio prevents induced oral carcinoma in a hamster pouch model

Dietary fatty acid patterns have been linked to the prevalence of certain cancers, however in oral carcinoma is limited. Thus, we investigated the chemopreventive effects of various dietary n-6 and n-3 fatty acids in a 9,10-dimethyl-1,2-benz[a]-anthracene (DMBA)- and betel quid extract (BQE) -induced hamster oral cancer model. Thirty 6-week-old adult male hamsters were housed and divided into normal, low, and high dietary n-6 and n-3 fatty acid groups under DMBA + BQE treatment for 16 weeks. The right buccal pouch of all hamsters were evaluated by tumor number, volume, burden and selected inflammatory parameters. The results indicate that the low dietary n-6/n-3 fatty acid group exhibited a significantly lower tumor number, volume, and burden than those of the other groups. Furthermore, this group had significantly lower nuclear factor-κB, proliferating cell nuclear antigen, and cyclin D1 expression in the right buccal pouch tissue. In conclusion, the lower dietary n-6/n-3 fatty acid ratio exerted chemopreventive effects in the DMBA- and BQE-induced hamster oral cancer model.

Cyclin D1 overexpression associated with activation of STAT3 in oral carcinoma patients from South India

Background

Our previous study showed that overexpression of cyclin D1 protein is associated with poor prognosis in oral squamous cell carcinoma (OSCC) patients. Regarding the alteration in the transactivating pathway regulating cyclin D1 expression is still unclear in OSCC from our population.

Objectives

The major objective of this study is to understand the alteration associated with the transactivation pathway regulating the cyclin D1 overexpression in OSCC patients from our population.

Materials and Methods

Alteration in the transactivation pathway regulating cyclin D1 expression was evaluated in tumor sample from OSCC patients. The findings were further validated using in vitro knockdown model in OSCC cell line.

Results

Results from the patients' samples showed that the Phospho-STAT3 has a significant association with cyclin D1 overexpression in OSCC tumor samples. Further knockdown in vitro studies using SCC66 showed a significant correlation between STAT3 and cyclin D1 in OSCC.

Conclusion

The results from this study showed that in our population the cyclin D1 overexpression is associated with hyperactivation of STAT3 pathway. Our previous result has shown that the cyclin D1 protein overexpression is associated with poor prognosis in OSCC patients. Hence, STAT3 pathway will be better target for the patients with increased cyclin D1 in OSCC patients from our population.

Oral Cancer Treatment: Still an Indication for Elective Neck Dissection?

INTRODUCTION

Oral squamous cell carcinoma has a high incidence and, although elective neck dissection is recommended, the removed nodes frequently present without metastasis. This surgical approach causes disabilities and increases possible surgical complications.

OBJECTIVE

To evaluate the possibility of a watchful waiting approach in oral cancer.

METHODS

We compared 78 patients with clinical and pathological node metastases and their counterparts with pathological node metastases but without evident clinical neck disease. Therefore, we provided a theoretical comparison between the patients who had an elective neck dissection and those who waited until a clinically positive node was evident.

RESULTS

The prognostic factor rates were similar between the groups. Their regional recurrence and mortality rates had no statistical differences.

CONCLUSION

A watchful waiting policy could be applied to selected oral cancer patients who can undergo a very close follow-up. This option would be more cost-effective and less harmful than elective neck dissection.

[A novel prognostic index for oral cancer in Fujian province]

Objective: To explore the survival factors and construct a prognostic index (PI) for oral squamous cell carcinoma (OSCC). Methods: From January 2004 to June 2016, a total of 634 patients with pathologically confirmed OSCC were recruited in a hospital of Fujian. The clinical and follow-up data of all the patients with pathologically confirmed OSCC were collected to identify the factors influencing the prognosis of OSCC. All the patients were randomly divided into two groups: modeling group (modeling dataset, n=318) and validation group (validation dataset, n=316). Randomization was carried out by using computer-generated random numbers. In the modeling dataset, survival rates were calculated using Kaplan-Meier method and compared using the log-rank test. Cox regression model was used to estimate the hazard ratio (HRs) and 95% confidence intervals (CIs) of prognosis factors. An PI for OSCC patients prognostic prediction model was developed based on β value of each significant variable obtained from the multivariate Cox regression model. Using the tertile analysis, patients were divided into high-risk group, moderate-risk group, and low-risk group according to the PI, the Akaike information criterion (AIC) and Harrell's c-statistic (C index) were used to evaluated the model's predictability. Results: Results from the multivariate Cox regression model indicated that aged ≥55 years (HR=2.22, 95%CI: 1.45-3.39), poor oral hygiene (HR=2.12, 95%CI: 1.27-3.54), first diagnosis of lymph node metastasis (HR=5.78, 95%CI: 3.60-9.27), TNM stage Ⅲ-Ⅳ (stage Ⅰ as reference) (HR=2.43, 95%CI: 1.10-5.37) and poor differentiation (well differentiation as reference) (HR=2.53, 95%CI: 1.60-4.01) were the risk factors influencing the prognosis of OSCC. The PI model had a high predictability in modeling group and validation group (AIC and C index were 1 205.80, 0.700 2 and 1 150.47, 0.737 3). Conclusion: Age, poor oral hygiene, first diagnosis of lymph node metastasis, TNM stage and histological grade were factors associated with the prognosis of OSCC, and the PI model has a certain significance in the clinical treatment of OSCC.

Micronuclei in Exfoliated Oral Epithelial Cells in Tobacco Users and Controls with Various Oral Lesions: A Study from Gujarat, India

To assess and compare cytogenic damage in the form of micronuclei in various oral lesions according to duration and frequency of tobacco use. The present cross sectional study was carried out from October 2015 to October 2016. We included total 420 cases with 60 cases in each of the following subgroups, no tobacco habit with no obvious oral lesion (control) and tobacco habit with no obvious oral lesion, oral sub mucous fibrosis, leukoplakia, melanoplakia, erythroplakia, oral squamous cell carcinoma. Oral mucosal cells were collected from both sides of cheek; slides were prepared and examined for cells with micronuclei. The mean micronuclei index distribution in control group, potentially malignant group, and malignancy group was 1.14, 2.63, and 4.88 respectively and was statistically significant. The mean micronuclei index in control group, smoking tobacco and smokeless tobacco group was 1.14, 2.64, and 2.76 and was statistically significant. The mean micronuclei index was significantly higher in those using tobacco, for longer duration and with frequent tobacco use. The mean micronuclei index can be used as a potential screening tool of genotoxic damage and biomarker for epithelial carcinogenesis. The method has practical utility for warning tobacco users that higher than range has a danger of malignant event and therefore this in future can be used as reinforcement to advice of avoiding tobacco before malignancy develops.

Efficacy of Multimodal Therapy in the Survival Outcomes of Advanced-Stage (Stage III-Stage IV) Oral Carcinoma Patients: An Institutional Experience in Asian Indian Population

Aim

Primary ablative surgery followed by post-op radiotherapy (S-RT) remains the mainstay of treatment for stage III-stage IV oral carcinoma. A retrospective analysis of survival rates of advanced-stage OSCC patients treated with multimodal therapies (S-RT or combined chemoradiation) was performed to analyse the outcome for patient survival and whether addition of adjuvant chemotherapy (S-CRT) improves survival.

Materials and Methods

Demographic, pathological, treatment and follow-up data of 128 patients were included in the study. Sixty-nine patients received S-RT, while 55 patients were opted for S-CRT. Overall survival, disease-specific survival and disease-free survival were estimated with Kaplan-Meier analysis and compared between groups with Cox regression analysis.

Results

Survival was significantly influenced by the type of modality and regional spread of disease. S-CRT group had improved overall, disease-specific, disease-free and metastasis-free survival compared to S-RT group. A survival advantage of 10% was achieved in S-CRT group compared to S-RT group even in patients with extracapsular spread and perineural invasion.

Conclusion

Addition of adjuvant chemotherapy to S-RT improves survival outcomes in advanced OSCC, especially in patients with regional spread of disease.

The role of epithelial-mesenchymal transition in squamous cell carcinoma of the oral cavity

Epithelial-mesenchymal transition (EMT) has emerged as a possible mechanism of cancer metastasizing, but strong evidence for EMT involvement in human cancer is lacking. Our aim was to compare oral spindle cell carcinoma (SpCC) as an example of EMT with oral conventional squamous cell carcinoma (SCC) with and without nodal metastases to test the hypothesis that EMT contributes to metastasizing in oral SCC. Thirty cases of oral SCC with and without nodal metastasis and 15 cases of SpCC were included. Epithelial (cytokeratin, E-cadherin), mesenchymal (vimentin, N-cadherin), and stem cell markers (ALDH-1, CD44, Nanog, Sox-2) and transcription repressors (Snail, Slug, Twist) were analyzed immunohistochemically. We also analyzed the expression of microRNAs miR-141, miR-200 family, miR-205, and miR-429. SpCC exhibited loss of epithelial markers and expression of mesenchymal markers or coexpression of both up-regulation of transcription repressors and down-regulation of the investigated microRNAs. SCC showed only occasional focal expression of mesenchymal markers at the invasive front. No other differences were observed between SCC with and without nodal metastases except for a higher expression of ALDH-1 in SCC with metastases. Our results suggest that SpCC is an example of true EMT but do not support the hypothesis that EMT is involved in metastasizing of conventional SCC. Regarding oral SCC progression and metastasizing, we have been facing a shift from the initial enthusiasm for the EMT concept towards a more critical approach with "EMT-like" and "partial EMT" concepts. The real question, though, is, is there no EMT at all?

Assessment of Lipid Peroxidation and Antioxidant Status in Vanillic Acid Treated 7,12-Dimethylbenz[a]anthracene Induced Hamster Buccal Pouch Carcinogenesis

INTRODUCTION

Vanillic acid, a naturally occurring bioactive substance, possesses diverse pharmacological potential including free radical scavenging and anticancer properties. Excessive generation of Reactive Oxygen Species (ROS) and insufficient antioxidant potential has been involved in numerous pathological disorders, including cancer.

AIM

To explore the anti-lipid peroxidative and antioxidant efficacy of vanillic acid in Dimethylbenz[a]Anthracene (DMBA) induced oral carcinogenesis.

MATERIALS AND METHODS

Topical application of DMBA for 14 weeks in the buccal pouch of hamsters resulted in well developed oral squamous cell carcinoma. Vanillic acid at a dosage of 200 mg/kg body weight was orally administrated to the hamsters for 14 weeks. The status of lipid peroxidation and antioxidants were measured in the plasma and buccal mucosa of hamsters using specific colorimetric methods.

RESULTS

Altered levels of lipid peroxidation by-products {Thiobarbituric Acid Reactive Substances (TBARS)} and disturbances in antioxidants status {Superoxide Dismutase (SOD), Catalase (CAT), Glutathione Peroxidase (GPx), vitamin E, vitamin C and reduced Glutathione (GSH)} were observed in the plasma and buccal mucosa tissues of hamsters treated with DMBA alone. Vanillic acid (200 mg/kg bw p.o) significantly restored the above mentioned plasma and buccal mucosa biochemical variables to near normal range in DMBA treated hamsters.

CONCLUSION

Present findings thus confirm the anti-lipid peroxidative and antioxidant efficacy of vanillic acid in DMBA induced hamster buccal pouch carcinogenesis.

Diagnostic Biomarkers in Oral Verrucous Carcinoma: A Systematic Review

Oral verrucous carcinoma (OVC), a low-grade variant of oral squamous cell carcinoma (OSCC), is most frequently seen in the oral cavity. No clear etiology has been found for this lesion, but human papilloma virus, chewing betel nuts, and ultraviolet radiation are suggested as probable causes. Differential diagnosis of OVC is challenging for oral pathologists. The aim of this study was to review the molecular-based approaches for differential diagnosis of OVC. An electronic search was conducted in Medline and Scopus from January 2004 to July 2015 limited to English language publications. Published papers on verrucous carcinoma (VC) were found according to the inclusion and exclusion criteria and analyzed qualitatively. Data extraction were performed according to PRISMA statement. A total of 423 articles were reviewed; out of which, 26 articles completely fulfilled the inclusion criteria. Most of the included studies investigated proliferative and apoptotic biomarkers such as p53 and Ki67. No definite conclusion was drawn for cytoskeletal biomarkers due to variability of factors and lack of significant expression. However, it seems that cytokeratin10 (CK 10) can be useful for differentiation of OVC and benign squamous lesions. Among cell surface and extracellular matrix biomarkers tissue biomarkers, matrix metalloproteinase (MMP)-2, -9, CD31 and CD68 seem to be useful for differentiation of OVC and OSCC and glucose transporter-1 (GLUT-1) can help in differentiation of OVC from oral epithelial dysplasia. Differences among OVC, OSCC and normal epithelium in expression profiles of the investigated biomarkers help in their differential diagnosis; although, clinicohistopathological similarities among verrucous hyperplasia, noninvasive OVC and invasive well-differentiated OSCC make the diagnosis difficult. Further studies are required to better differentiate these oral lesions.

EMODIN EFFICACY ON THE AKT, MAPK, ERK AND DNMT EXPRESSION PATTERN DURING DMBA-INDUCED ORAL CARCINOMA IN GOLDEN SYRIAN HAMSTERS

Background:

The present study has evaluated the Emodin efficacy on the Akt, MAPK, ERK and DNMT expression pattern during 7,12-dimethylbenz[a]anthracene (DMBA)-induced oral carcinoma in golden Syrian hamsters, in order to explore its antitumor potential.

Materials and methods:

Oral tumors were developed in the buccal pouches of golden Syrian hamsters using the carcinogen, DMBA.

Results:

While the incidence of tumor formation was 100% in hamsters treated with DMBA alone, the tumor formation was not noticed in DMBA+ Emodin treated hamsters. Also, Emodin reduced the severity of precancerous pathological lesions such as dysplasia, in the hamsters treated with DMBA. Emodin administration corrected the abnormalities in the expression pattern of Akt, MAPK, ERK and DNMT in the buccal mucosa of hamsters treated with DMBA.

Conclusions:

The present study thus suggests that the tumor preventive potential of Emodin is partly related to its modulating effect on the Akt, MAPK, ERK and DNMT expression pattern, as these molecular markers have a pivotal role in the process of cell proliferation, inflammation, invasion, and apoptosis.

Genome-scale methylation assessment did not identify prognostic biomarkers in oral tongue carcinomas

Background

DNA methylation profiling of heterogeneous head and neck squamous cell carcinoma (HNSCC) cohorts has been reported to predict patient outcome. We investigated if a prognostic DNA methylation profile could be found in tumour tissue from a single uniform subsite, the oral tongue. The methylation status of 109 comprehensively annotated oral tongue squamous cell carcinoma (OTSCC) formalin-fixed paraffin-embedded (FFPE) samples from a single institution were examined with the Illumina HumanMethylation450K (HM450K) array. Data pre-processing, quality control and analysis were performed using R packages. Probes mapping to SNPs, sex chromosomes and unreliable probes were accounted for prior to downstream analyses. The relationship between methylation and patient survival was examined using both agnostic approaches and feature selection. The cohort was enlarged by incorporation of 331 The Cancer Genome Atlas (TCGA) HNSCC samples, which included 91 TCGA OTSCC samples with HM450K and survival data available.

Results

Given the use of FFPE-derived DNA, we defined different cohorts for separate analyses. Overall, similar results were found between cohorts. With an unsupervised approach, no distinct hypermethylated group of samples was identified and nor was a prognostic methylation profile identified. The use of multiple downstream feature selection approaches, including a linear models for microarray data (LIMMA), centroid feature selection (CFS), and recursive feature elimination (RFE) support vector machines, similarly failed to identify a significant methylation signature informative for patient prognosis or any clinicopathological data available. Furthermore, we were unable to confirm the prognostic methylation profiles or specific prognostic loci reported within the literature for HNSCC.

Conclusions

With genome-scale assessment of DNA methylation using HM450K in one of the largest OTSCC cohorts to date, we were unable to identify a hypermethylated group of tumours or a prognostic methylation signature. This suggests that either DNA methylation in isolation is not likely to be of prognostic value or larger cohorts are required to identify such a biomarker for OTSCC.

Electronic supplementary material

The online version of this article (doi:10.1186/s13148-016-0235-0) contains supplementary material, which is available to authorized users.

Changes in the management and survival rates of patients with oral cancer: a 30-year single-institution study

Objectives

The aim of the present study was to evaluate changes in the management and 5-year survival rates of patients with oral cancer in our department over a 30-year period.

Materials and Methods

We investigated the patient distributions, treatment methods, method of neck dissection according to cancer stage, and 5-year survival rates for 700 oral cancer patients over the periods of 1982–1996 (256 patients), 1999–2006 (248 patients), and 2007–2011 (196 patients).

Results

Stage IV patients were the largest group in all of the time periods evaluated. Although surgery and radiotherapy were the most common methods in all periods (over 50%), the prevalence of patients who underwent concomitant chemoradiotherapy increased from 7.0% to 16.2%. The use of radical neck dissection decreased from 43.0% to 5.3%, while conservative surgical methods increased from 24.1% to 76.3%. Lastly, the overall 5-year survival rate increased from 31.6% to 63.5% during the study period.

Conclusion

Although the 5-year survival rate reached the same level as that of other developed countries during the course of our study, most patients continue to come to the hospital with stage IV disease. In order to increase the 5-year survival rate of oral carcinoma, it may be necessary to improve public education and social efforts relevant to early diagnosis.

Biopsy Diagnosis of Oral Carcinoma by the Combination of Morphological and Spectral Methods Based on Embedded Relay Lens Microscopic Hyperspectral Imaging System

Cytopathological examination through biopsy is very important for carcinoma detection. The embedded relay lens microscopic hyperspectral imaging system (ERL-MHIS) provides a morphological image of a biopsy sample and the spectrum of each pixel in the image simultaneously. Based on the ERL-MHIS, this work develops morphological and spectral methods to diagnose oral carcinoma biopsy. In morphological discrimination, the fractal dimension method is applied to differentiate between normal and abnormal tissues. In spectral identification, normal and cancerous cells are distinguished using five methods. However, the spectra of normal and cancerous cells vary with patient. The diagnostic performances of the five methods are thus not ideal. Hence, the proposed cocktail approach is used to determine the effectiveness of the spectral methods in correlating with the sampling conditions. And then we use a combination of effective spectral methods according to the sample conditions for diagnosing a sample. A total of 68 biopsies from 34 patients are analyzed using the ERL-MHIS. The results demonstrate a sensitivity of 90 ± 4.53 % and a specificity of 87.8 ± 5.21 %. Furthermore, in our survey, this system is the first time utilized to study oral carcinoma biopsies.

Analysis of Human Papilloma Virus 16/18 DNA and its Correlation with p16 Expression in Oral Cavity Squamous Cell Carcinoma in North-Eastern India: A Chromogenic in-situ Hybridization Based Study

BACKGROUND

The incidence of head and neck squamous cell carcinoma (HNSCC) is quite high in North Eastern India. Apart from the traditional risk factors like tobacco and alcohol consumption, human papilloma virus (HPV) is now considered an established causative agent. These HPV related tumour have a clinico-pathological profile that is quite divergent from conventional non-HPV related tumours. Association of HPV in oral cancers has not been explored in north-east India.

MATERIALS AND METHODS

Thirty-one patients with oral cavity squamous cell carcinoma (OSCC) on treatment from October 2010 to January 2013 were included in the study. Patients who received neo-adjuvant chemotherapy were excluded. HPV 16/18 DNA was evaluated using Chromogenic in-situ Hybridization (CISH). Presence of nuclear signals was taken as positive HPV expression. p16 was evaluated using immunohistochemistry and was considered positive if ≥ 80% of the tumour cells showed strong and diffuse nuclear/cytoplasmic immunostaining. The results were analysed using Fisher exact test and confidence interval was calculated where required.

RESULTS

The study group age ranged from 30 to 80 years (median age- 54.2 years). The most common site was gum, with well differentiated squamous cell carcinoma being the most common histology. HPV 16/18 DNA was positive in 29% (95% CI: 13.03% - 44.97%) cases and had a clear tendency towards statistical significance with non-smoker cases (p=0.05), lymph node metastasis (p=0.05) and a significant correlation with p16 overexpression (p=0.04). There was no significant correlation with other clinico-pathological parameters.

CONCLUSION

HPV 16/18 is associated with OSCC, commonly seen among non-smokers and may be related to nodal metastasis. So, HPV may be used as a prognostic factor in OSCC and p16 may be considered as a surrogate marker for HPV.

Metastasis to submandibular glands in oral cavity cancers: Can we preserve the gland safely?

OBJECTIVE

To analyze submandibular gland (SMG) involvement in cases of oral cavity cancers and decide whether to remove submandibular glands while performing neck dissections for oral cavity cancers to decrease the incidence of xerostomia, a common issue post-operatively.

METHODS

Retrospective analysis of 157 neck dissections out of 204 neck dissections performed for oral cavity carcinomas in the Department of Otolaryngology and Head and Neck Surgery from 2008 to 2013 was done. SMG was bilaterally removed in 6 dissections, hence a total of 163 glands were analyzed. Those involved by tumor in histopathology were further studied for the pattern of involvement.

RESULTS

3.68% (6/163) glands showed involvement by the tumor. 9.20% (15/163) showed chronic sialo-adenitic changes. Four of the six involved glands showed direct contiguous spread from primary lesion, one showed extra-capsular spread from level IB lymph nodes and evidence of both modes of spread was seen in one. Evidence of metastasis was not seen in any of the glands (0%). Literature review showed a metastasis rate of 0.096% (2/2074).

CONCLUSION

Metastatic involvement of submandibular gland is extremely rare. Submandibular gland preservation, in the absence of evidence of gross contiguous involvement, does not affect survival. Hence, SMG can be safely spared during neck dissections for oral cavity squamous cell cancers except in certain situations such as close proximity of the primary lesion to gland, presence of intra-capsular lymph nodes in radiology, gross intraoperative evidence of invasion of the SMG and in salvage surgeries performed in post-irradiated and recurrent cases.

Immunohistochemical Detection of p16(INK4a) in Leukoplakia and Oral Squamous Cell Carcinoma

INTRODUCTION

Over-expression of p16(INK4a) has been reported in tissues of oral squamous cell carcinoma (SCC) associated with Human Papillomaviruses (HPVs). Immunohistochemical (IHC) detection of p16(INK4a) is an easy technique than molecular detection of HPVs, hence we investigated the presence of this protein in the most common pre-malignant and malignant oral lesions i.e. leukoplakia and SCC respectively.

MATERIAL AND METHODS

We performed IHC detection of p16(INK4a) in sections of paraffin embedded formalin fixed tissues of leukoplakia with or without dysplasia (n= 21) and SCC lesions (n= 69) and correlated with various patterns of p16(INK4a) positivity with respect to histological diagnosis.

RESULTS

In the present study, 71% cases of oral SCC cases were positive for p16(INK4a), of which the most common pattern was diffuse nuclear and cytoplasmic staining. Among the cases with leukoplakia, 57.1% were positive for overexpression of p16(INK4a), wherein diffuse and sporadic pattern was observed among 23.8 percent each.

CONCLUSION

In the present study, significant number of oral SCC cases observed overexpressing p16(INK4a) . However HPV DNA detection based studies are needed to validate the utility of IHC detection of p16(INK4a) as a surrogate marker for HPV associated oral SCC.

PPARγ in head and neck cancer prevention

Head and neck cancer is a major source of morbidity and mortality worldwide. Intervention during the early phases of carcinogenesis represents a promising new strategy for curbing the devastating effects of this disease and its primary treatment modalities, surgery and radiation with or without concomitant chemotherapy. This review focuses on the peroxisome proliferator-activated receptor gamma (PPARγ) as a target for chemoprevention of oral cancer. Accumulating data suggest that ligands of PPARγ, which include the thiazolidinedione class of agents approved for the treatment of diabetes, inhibit cancer cell growth in vitro and in animal carcinogenesis models, providing the rationale for testing this approach in populations at risk for head and neck cancer.

Platysma myocutaneous flap - its current role in reconstructive surgery of oral soft tissue defects

Reconstruction of oral soft-tissue defects following resection of oral carcinomas can be achieved using various techniques including microsurgical tissue transfer. However, there seems to be a role for regional or local flaps. Small to medium-size defects can be functionally reconstructed with the platysma myocutaneous flap as an excellent choice particularly in medically compromised patients not being eligible for free tissue transfer. The present paper reviews the indication, surgical technique, and complications following reconstruction of defects of the oral cavity with the platysma myocutaneous flap.

Alteration of serum beta 2-microglobulin in oral carcinoma

Serum β(2)-microglubin (β(2)-m) levels were measured in oral carcinoma patients and compared with normal healthy controls. It was observed that there was a significant rise in serum β(2)-microglobulin in oral carcinoma patients. Progressively higher values were obtained as the cancer advanced clinically. Therefore the estimation of serum β(2)-microglobulin may be useful as one of a battery of tests in the assessment of oral carcinoma patients.

The need for early detection of neck nodal metastasis in squamous cell carcinoma of oral cavity

In the Indian subcontinent, the incidence of squamous cell carcinoma of the oral cavity has been constantly increasing despite the improvement in the awareness about squamous cell carcinoma. The patients generally report to us in the period in which the tumor would have undergone metastasis. This article highlights about the grading, staging, and decision-making regarding the surgical management of squamous cell carcinoma of the oral cavity. The article also stresses upon the early detection of the lesion by the practitioner for a definitive successful surgical treatment of the patient.

Immunophenotyping of HPV Types 16 and 18 among Sudanese Patients with Oral Lesions

OBJECTIVE

The aim of this study was to screen patients with oral lesions for the presence of Human Papilloma Virus (HPV) types 16 and 18.

METHODS

Sixty patients aged between 11-80 years with a mean age of 46 years were examined using immunohistological techniques. All samples were retrieved from RICK during the period from August 2009 to August 2010. Out of 60 patients, 50 had Oral Squamous Cell Carcinomas (OSCCs) and the remaining ten had benign oral lesions, included as internal control.

RESULTS

Of the 50 patients with OSCCs, 10 (20%) showed positive immunohistochemical results for HPV types 16 and 18 of which 50% were detected among males and 50% were demonstrated among females. The ten positive findings were Immunophenotyped as follows: five were positive with HPV type 16, four with type 18 and one was positive for HPV types 16 and18. All patients with benign oral lesions were negative for HPV immunohistochemistry.

CONCLUSION

The study suggests the role of HPV 16 and 18 in the etiology of oral cancers in different parts of Sudan. However, the use of molecular techniques such as PCR are needed to confirm the results of immunohistochemistry in the role of the HPV in developing of OSCC in Sudan.